Everything You Should Know About Stroke

A stroke is a serious medical emergency that occurs when there is a deficiency of blood flow to an area of the brain or bleeding in the brain. This causes brain damage, with effects that may include weakness of one side of the body, vision changes, speech problems, loss of consciousness, and more.

A stroke can cause disability or death. Prompt intervention can help improve the outcome after a stroke, so it’s important to recognize a stroke right away and get immediate medical attention.

What Are the Signs and Symptoms of a Stroke?

Early signs and symptoms of a stroke can include numbness, weakness, vision changes, and dizziness. Sometimes a person who is having a stroke might not be able to communicate, and other people who are around must call for emergency services. 

There are many different signs and symptoms of a stroke. This is because a stroke can affect any area of the brain and will cause symptoms that correspond to the location of the damage.

There are a few key features that you can keep in mind so you will know to call for help if you or someone else is experiencing the common signs of a stroke.

Unique Signs of a Stroke in Women

Women are more likely to have a stroke during their lifetime than men. One reason may be due to women’s longer life expectancy. Pregnancy, birth control pills, and postmenopausal hormone therapy are also factors that raise the risk.

The symptoms of stroke are usually the same for people of any sex, but women may be more likely to have subtle stroke signs.

Subtle signs of a stroke include:

• Fatigue
• Light-headedness
• Nausea

Types of Stroke

There are a few different types of strokes. They all have certain features in common, due to an interruption of blood supply to a specific region in the brain. However, the causes vary, and the symptom duration can range from very brief to permanent.

Ischemic Stroke

An ischemic stroke involves an obstruction or interruption of the blood supply in an artery or a small arterial branch that supplies blood to an area of the brain.

When brain cells that would normally be supplied by that artery become deficient in oxygen and nutrients, they undergo ischemic damage and death, leading to physical or cognitive problems that correspond to the impacted area of the brain.

Hemorrhagic Stroke

A hemorrhagic stroke occurs due to bleeding of an artery in the brain. When the artery bleeds, it will cause swelling, pressure, and ischemic damage. The region of the brain that normally gets its blood supply from the leaking blood vessel will not receive adequate blood supply and will experience ischemic damage.

Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is a reversible stroke that occurs when there’s a brief blood flow interruption to a region of the brain. The temporary ischemia causes symptoms that go away completely within 24 hours (usually within a few seconds or minutes). There isn't permanent ischemic damage because blood flow is spontaneously restored.

The risk factors for a TIA are the same as those for a stroke, and a TIA is often a warning sign that someone is at risk of having a stroke. Sometimes a TIA is called a ministroke, but a better term is an "almost" stroke.

Causes and Risk Factors of Stroke

Stroke risk factors can often be modified or medically managed to help reduce the likelihood of a stroke.

Lifestyle Factors

Several lifestyle habits can increase the risk of a stroke. Smoking is especially damaging to blood vessels, and can substantially increase the risk of a stroke. 

Other lifestyle risk factors include:

• Excessive alcohol use 
• Sedentary lifestyle with minimal physical activity 
• Extreme, chronic stress 
• Unhealthy diet

Medical History

Certain medical conditions increase the risk of a stroke, and they are more common with advancing age.

Atherosclerosis, which is a narrowing and hardening of the arteries throughout the body, is a major stroke risk factor. Atherosclerosis in the heart, carotid arteries, and blood vessels in the brain are especially likely to lead to an interruption of blood flow within the brain.

Risk factors that can lead to atherosclerosis include:

• High blood pressure 
• Untreated heart disease, including heart valve disease, heart failure, and irregular rhythm, such as atrial fibrillation
• Untreated diabetes
• High fat and cholesterol levels
• Having obesity

Other Factors

Other factors that can increase the risk of a stroke include:

• Advancing age
• Family history of stroke 
• Chronic inflammatory disease
• Severe infections 
• Vascular disease 
• Cancer 

How Are Strokes Diagnosed?

Strokes are diagnosed based on symptoms, along with the physical examination. Generally, the signs and symptoms of a stroke correspond to the affected area of the brain. It is usually necessary to obtain diagnostic testing. 

Diagnostic tests for stroke include:

• Brain imaging: A brain computed tomography (CT) scan can often identify the blood of a hemorrhagic stroke within the first hours of bleeding. Brain magnetic resonance imaging (MRI) can identify the early, subtle changes of an ischemic stroke.
• Angiogram: An angiogram is an imaging test that examines the blood vessels. Angiograms of the cerebral vessels can include computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA). These tests can identify structural irregularities or a blood clot in the blood vessels of the brain.
• Blood tests: A stroke is not diagnosed with a blood test, but blood tests can often identify stroke risk factors, such as high cholesterol or diabetes. 
• Electrocardiogram (EKG/ECG): An EKG is a fast, noninvasive test that examines heart rhythm. It can identify abnormalities associated with an irregular heart rhythm, heart attack, or heart failure.
• Echocardiogram: An echocardiogram, also referred to as an echo, is a noninvasive test that examines the structure and movement of the heart. It can detect heart problems that increase the risk of stroke.
• Carotid ultrasound: A carotid ultrasound is a noninvasive test that examines the arteries in the neck that lead to the brain. Narrowing or disease of these arteries can cause a stroke.

Treatment for a Stroke

Effective stroke care begins with a prompt assessment to determine the type of stroke, followed by rapid treatment. Medical stabilization is necessary for all types of strokes. This includes maintaining optimal blood pressure, blood sugar, and fluids.

Sometimes direct stroke intervention is necessary, which can include:

• Blood thinners given intravenously (IV) for an ischemic stroke
• Injection of blood thinners directly into a blood clot for certain types of ischemic strokes
• Thrombectomy, in which a thin tube (catheter) is threaded through blood vessels to a clot in the brain and the clot is mechanically removed
• Surgical intervention for removal of blood for a hemorrhagic stroke
• Craniotomy, which is the removal of a small area of the skull, to relieve severe edema (swelling)

Over the first few days following a stroke, close monitoring of neurological functioning, fluid and electrolyte concentration, blood pressure, and blood glucose is necessary. Sometimes brain damage from a stroke may cause a seizure, necessitating treatment with antiepileptic medication.  

After stabilization, recovery can begin. Assessment of risk factors is necessary as well.

Recovering From a Stroke

Recovery after a stroke is often gradual. Some people fully recover, but most people have some degree of impairment after a stroke. Immediate medical care and consistent therapy can improve long-term outcomes. It’s important to be patient throughout recovery because improvement doesn’t always follow a smooth and steady path.

Complications

Sometimes complications can be prevented by taking proactive measures. Choking or pneumonia, which may occur due to difficulty swallowing, is an especially concerning risk.

Weakness and sensory changes can increase the risk of bedsores and blood clots. Weakness and vision changes may lead to falling after a stroke.

Rehabilitation

Rehabilitation should be tailored to specific deficits that occur after a stroke:

• Many people need physical therapy to help with improving muscle control and strength.
• Speech and swallow therapy are crucial to avoid choking and aspiration pneumonia.
• Occupational therapy teaches a person how to maintain self-care and day-to-day tasks safely and with as much independence as possible.

How Long Does Recovery Take?

Sometimes stroke symptoms worsen within the first few days before stabilizing. Then, symptoms may gradually improve if medical care is started within the first few hours of a stroke.

Recovery is often slow over the next few weeks. For some people, recovery continues for up to a year after a stroke.

A person who is otherwise healthy and had a small stroke may have a faster recovery, with greater improvement than a person who had a large stroke, underlying health problems, or a history of strokes.

Tips for Caregivers

Taking care of someone after a stroke can be challenging. Stroke-related disability may mean that a person needs a lot of assistance with day-to-day tasks.

Furthermore, depending on the type of stroke, some people are unaware of their limitations, making it even more difficult to take care of your loved one. Getting guidance and instructions is crucial to know how to care for your loved one safely.

Taking care of a loved one recovering from a stroke can take time and energy and can be emotionally demanding. This makes it important to seek practical help from professionals trained in caregiving for people who have had a stroke.

Asking for help from friends and family can ease the burden. Support groups can also provide practical tips and emotional support.

How to Prevent a Stroke

Stroke prevention is a crucial part of health maintenance for everyone. Getting recommended screening tests can identify risk factors.

Treatment for risk factors is effective in lowering the chances of a first stroke or a recurrent stroke. Even if you have already had a stroke, it is never too late to start stroke prevention. A recurrent stroke can compound the level of stroke disability.

Prevention is focused on treating and controlling risk factors:

• Stop smoking if you are a smoker.
• Take medication to lower blood pressure if you have high blood pressure (hypertension).
• Maintain optimal blood sugar if you have diabetes.
• Manage high cholesterol and fat levels with diet, and medication as needed.
• Get treatment for heart disease, such as heart rhythm abnormalities, heart failure, or coronary artery disease.
• Get treatment for carotid artery disease.
• Maintain treatment for chronic inflammatory conditions.

Most stroke risk factors do not include any noticeable symptoms and can cause a stroke without any warning. Getting regular check-ups is the best way to identify stroke risk factors.  

Outlook for Stroke

There are many types of strokes, and a wide range in stroke severity. So the outlook is highly variable. After a stroke, you might need to make adjustments to your day to day life, such as using a walker, giving up driving, or avoiding foods that are choking hazards.

Identifying and managing risk factors can substantially lower the likelihood of having another stroke.

About 25% of strokes in the United States are recurrent strokes.

The risk of stroke recurrence after surviving a stroke is approximately 12% within five years, but the risk is higher after large strokes and hemorrhagic strokes than it is after small ischemic strokes.