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.
Clinical Commentary: Stroke Care Reshuffles During COVID-19 Pandemic
“Time Is Brain” still applies.
David Z. Rose, MD
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08.05.20The Rapid Arterial Occlusion Evaluation (RACE) Scale Validated in First Study for Stroke Triage
07.27.20Studies Show the Varying Risks of Stroke in Individuals with COVID-19
Neurologists need to have a palliative care skill set.
Jessica M. Baker, MD
Stroke Snapshot: Poststroke Communication
An illustrative case with tips for difficult honest empathetic preference-based conversations with surrogate decision-makers.
Neha M. Kramer, MD; Jessica Besbris, MD; and Rima M. Dafer, MD, MPH
07.14.20FDA Grants Clearance for Neurovascular Artificial Intelligence System
07.10.20Strokes Associated with COVID-19 May Be More Severe With Higher Mortality
07.06.20The Women Neurologist Group and the Alliance for Advancement of Neuroscience Advocate for Continued use of Telemedicine
06.30.20Chronic Stress of Discrimination Increases Hypertension Risk in African Americans
06.15.20FDA Grants a Patented Digital Therapeutic a Breakthrough Device Designation for Poststroke Walking Deficits
06.12.20Likelihood of Women Receiving Clot-Busting Treatment for Stroke More Than Doubles
Stroke Snapshot: Poststroke Mood Disorders
Poststroke mood disorders are common, disabling, underrecognized, and undertreated.
Alexis Dallara-Marsh, MD
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The role of telerehabilitation is evolving rapidly.
Claire Smyth, BSc; David Roberts, BSc; and Kenneth Monaghan, PhD
Chief Medical Editor's Page
COVID-19: A Tele- All Exposé
Stephen M. Gollomp, MD, and Paul G. Mathew, MD, DNBPAS, FAAN, FAHS
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F. Stephen Benesh, MD, and Shruti P. Agnihotri, MD
Shailee S. Shah, MD, and Andrew McKeon, MD