Stroke occurs when normal blood flow to the brain is interrupted. Without the oxygen and nutrients that blood carries, brain cells die quickly. For this reason, people experiencing a stroke are at risk for permanent brain damage or death if not treated quickly.
Stroke is a medical emergency. The word FAST can help you remember signs of stroke that mean someone may be having a stroke. If you see
Other symptoms of stroke may include:
A few minutes can mean the difference between death, long-term disability, or recovery, when it comes to stroke treatment. Depending on the type and severity of stroke, consequences can be complex and far reaching.
The majority (8 out of 10) strokes are ischemic (iss-key-mick) strokes, caused by a partial or complete blockage in blood vessels of the brain. This can be from narrowing of blood vessels or a clot (also called a thrombus) or blockage of a vessel.
Hemorrhagic (hem-ore-raj-hic) strokes are less common (2 out of 10) and just as serious. Hemorrhagic strokes are caused by bleeding into the brain or membranes that surround it. Bleeding like this is usually from a burst blood vessel, and this also prevent oxygen and nutrients from reaching brain cells. When the stroke is bleeding into the area surrounding the brain, it is a subarachnoid hemorrhage.
Sometimes a stroke is very brief and affects a very small area of the brain with milder but similar symptoms as an ischemic stroke. This is called a transient ischemic attack or TIA. Anyone who thinks they might have had a TIA see a doctor, because having a TIA puts a person at risk of a stroke and a medical professional can provide guidance on reducing that risk.
The way to know for sure if someone is having a stroke, and what type of stroke, is to get pictures of the brain with CT or MRI.
More important than knowing for sure, is acting FAST—face droop, arm weakness, or speech slurred, means it is TIME to call 911 and get to a medical center that can treat stroke.
Stroke is a life-threatening emergency! Anyone with symptoms of stroke needs to be taken, as quickly and safely as possible, to a medical center that can treat stroke. There are four types of stroke care centers.
Ischemic strokes can be treated with a medicine thought of as a “clotbuster,” called alteplase or tPA. For some strokes, that is enough to relieve the problem. For other strokes, surgery with a small incision and a “clot retriever,” a tool guided up through the blood vessel to grab and remove the clot physically is the better treatment. The sooner the clot is removed, the better the recovery will be. For some people clot removal is effective if done even up to 24 hours after stroke onset. For others that is not soon enough.
Hemorrhagic strokes require different treatment techniques, depending on what caused bleeding, where it is, and how severe it is. Sometimes, relieving pressure in the brain by making a hole in the skull (which will heal eventually) plus critical care to keep a person stable is all that can be done. Other times, the bleeding can be stopped by clipping or closing the burst blood vessel. These procedures are also done with small incisions and tools that are guided up through the blood vessels to reach the damaged area.
The care a person receives after blood flow is returned or bleeding is stopped, is also important.
After leaving the hospital, a person who had a stroke may be able to go home. Some people may need extra help at home at continued therapy at home or in their community. Others may need to spend time in a rehabilitation facility to recover more function before going home.
The most important thing to do to live well after a stroke is to prevent a second stroke. When a person has had one, they are much more likely to have another, and second strokes are much more dangerous.
Stroke prevention includes:
A doctor may prescribe blood thinners, blood pressure medications, or statins (cholesterol-lowering medication) to help with the above prevention methods, and it is very important to take those medications exactly as prescribed.
Continued rehabilitation may be needed to help you regain skills with confidence or learn to use new tools. It is common to have challenges with navigating relationships after stroke but maintaining a healthy and active social life can be incredibly beneficial to recovery. It may look different than social life before stroke though. You may find a therapist helpful, or your doctor may prescribe an antidepressant to treat any depression.
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The past decade there has been a resurgence in understanding of the relationship of atrial fibrillation to stroke.
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Saif A. Bushnaq, MD; and Sunil A. Sheth, MD
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Stroke systems of care need to advance as stroke care has.
Digvijaya Navalkele, MD, MPH; and Sheryl Martin-Schild, MD, PhD
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Nabil Ali, MD; Laura M. Clark, PhD, ABPP; and Kendra Corning, PsyD, HSPP
Stroke outcomes can be optimized with an evidenced-based and systematic approach during all phases of recovery.
Oluwole O. Awosika, MD; Samir R. Belagaje, MD; Elisheva R. Coleman, MD; Brett M Kissela, MD, MS; Holly K. Pajor, DO; Bridget A. Rizik, MD; and Daniel Woo, MD
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Which is best: primary, comprehensive, or just thrombectomy-ready?
Nerses Sanossian, MD
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