What Is an Acute (or Sudden) Stroke?

An acute stroke starts suddenly and typically worsens rapidly. Most strokes are acute strokes. Sometimes, a stroke may be preceded by a transient ischemic attack (TIA), which is a temporary stroke that reverses before it causes any lasting effects.

Stroke symptoms can progress quickly but may wax and wane over the course of a few hours. It is not possible to predict how severe a stroke will become or how long it will take to reach its maximum effect.

The most common symptoms of an acute stroke include:

• Numbness or weakness on one side of the body
• Difficulty speaking or trouble understanding what others are saying
• Difficulty with vision or loss of vision
• Falling or difficulty walking
• A sudden, severe headache involving a stiff neck, facial pain, pain between the eyes, or vomiting
• Loss of balance or coordination
• Confusion

A (TIA) can serve as a warning of an impending stroke. A TIA is like a stroke, but the symptoms resolve without any permanent brain damage. If you have a TIA, this means that you probably have at least one stroke risk factor. Most people who experience a TIA will have a stroke within three to six months unless the risk factors are identified and medically treated.

An acute stroke is caused by interruption of blood flow to a region in the brain, and it can be either ischemic or hemorrhagic.

During an ischemic stroke, the blood supply to a region of the brain is cut off because a blood vessel has been blocked by a blood clot. Several conditions can predispose a person to an ischemic stroke. These conditions include heart disease, high cholesterol, and high blood pressure. Other causes of an ischemic stroke include the use of recreational drugs, blood clotting disorders, or trauma to the blood vessels in the neck.

A hemorrhagic stroke occurs when an artery in the brain bleeds. This can happen when an abnormally shaped artery, such as an arterial venous malformation (AVM) or an aneurysm, bursts. The blood that seeps into the brain when a blood vessel bleeds causes pressure to build up within the skull, compressing the brain and potentially causing permanent brain damage.

The most common risk factors for stroke include heart disease, high blood pressure, high cholesterol, smoking, and diabetes. Additional risk factors for stroke include the following:

• Prior stroke or heart attack
• A family history of stroke
• Obesity
• Cerebrovascular disease
• Carotid artery disease
• Lack of physical exercise or activity
• Use of birth control pills or other hormone therapies
• Pregnancy
• Heavy or binge drinking
• Recreational drug use

If you have these risk factors, you can substantially reduce your risk of having an acute stroke by getting these conditions under control with the help of your doctor.

If you experience symptoms of an acute stroke, you need to get urgent medical attention as soon as you notice your symptoms. After your medical team does a neurological examination, the following diagnostic tests may be conducted to determine the cause of stroke and to make a plan for treatment:

• Imaging examinations such as CT scan and MRI scan
• Blood tests and other medical tests

If you are with someone who is having unusual symptoms, it is important that you call for medical help. Do not try to diagnose the stroke on your own.

An acute ischemic stroke is potentially manageable with a number of medical treatments, including a powerful treatment called tissue plasminogen activator (t-PA). This treatment is effective if the stroke is rapidly diagnosed and evaluated and if the treatment can be given within a few hours of the onset of stroke symptoms.

A combination of blood vessel surgery and medication to control bleeding may be used in the treatment of an acute hemorrhagic stroke. Treatment may include procedures that involve clipping the ruptured aneurysm or an endovascular embolization in which a coil is placed into the aneurysm in order to diminish blood flow.

Rehabilitation and recovery after an acute stroke takes time, involving a combination of specially tailored post-stroke programs. Newer methods in stroke rehabilitation are currently being examined in research studies, and include electrical therapy and mirror therapy.