- Ischemic Stroke (Most Common, ~87% of strokes):
- Occurs when the blood vessels supplying the brain become narrowed or blocked, leading to severely reduced blood flow (ischemia).
- Thrombotic Stroke: A blood clot (thrombus) forms in an artery that supplies blood to the brain. Often occurs in arteries damaged by atherosclerosis (fatty deposits).
- Embolic Stroke: A blood clot or other debris forms away from the brain, typically in the heart, and travels through the bloodstream to lodge in narrower brain arteries. A common cause is atrial fibrillation (an irregular heartbeat).
- Risk Factors for Ischemic Stroke: High blood pressure, high cholesterol, diabetes, obesity, smoking, heart disease (e.g., atrial fibrillation, heart failure), carotid artery disease, sickle cell anemia, sedentary lifestyle, excessive alcohol consumption.
- Hemorrhagic Stroke (Less Common, but often more severe):
- Occurs when a blood vessel in the brain leaks or ruptures. Blood spills into or around the brain, creating pressure and damaging brain cells.
- Intracerebral Hemorrhage: The most common type of hemorrhagic stroke, where a blood vessel bursts within the brain tissue. High blood pressure is a primary cause.
- Subarachnoid Hemorrhage: Bleeding occurs in the space between the brain and the membranes covering the brain (subarachnoid space). Often caused by a ruptured aneurysm (a balloon-like bulge in a blood vessel).
- Risk Factors for Hemorrhagic Stroke: High blood pressure, ruptured brain aneurysm, arteriovenous malformation (AVM - abnormal tangle of blood vessels), anticoagulant medications, trauma, smoking, drug abuse (e.g., cocaine).
- Transient Ischemic Attack (TIA - "Mini-stroke"):
- Caused by a temporary disruption of blood flow to part of the brain, spinal cord, or retina, causing stroke-like symptoms that last only a few minutes to an hour and cause no permanent damage.
- A TIA is a warning sign of a future stroke and requires immediate medical attention.
- F - Face Drooping: One side of the face droops or is numb. Ask the person to smile. Is the smile uneven?
- A - Arm Weakness: One arm is weak or numb. Ask the person to raise both arms. Does one arm drift downward?
- S - Speech Difficulty: Speech is slurred, or the person is unable to speak or is hard to understand. Ask the person to repeat a simple sentence. Is it correct?
- T - Time to call emergency services: If anyone shows any of these symptoms, even if the symptoms go away, call emergency services immediately.
- Other Sudden Symptoms May Include:
- Sudden numbness or weakness of the leg, arm, or face.
- Sudden confusion or trouble understanding speech.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance, or coordination.
- Sudden severe headache with no known cause.
- Physical Exam and Neurological Assessment: Doctors will check symptoms, reflexes, vision, speech, and strength.
- Blood Tests: To check blood clotting time, blood sugar levels, and other factors that could contribute to stroke or mimic its symptoms.
- Imaging Tests:
- CT Scan (Computed Tomography): Often the first imaging test. It can quickly show bleeding in the brain (distinguishing hemorrhagic from ischemic stroke) and can identify large ischemic strokes later.
- MRI (Magnetic Resonance Imaging): Provides more detailed images of brain tissue and can detect ischemic strokes earlier than CT.
- CT Angiography (CTA) or MR Angiography (MRA): Use dye and imaging to look at the blood vessels in the brain and neck to identify blockages or aneurysms.
- Carotid Ultrasound: Uses sound waves to check for narrowing or blockages in the carotid arteries (major arteries in the neck supplying the brain).
- Echocardiogram: To check for blood clots in the heart that could travel to the brain.
- For Ischemic Stroke (to restore blood flow):
- Emergency IV Medication (tPA - Tissue Plasminogen Activator): Administered within 3-4.5 hours of symptom onset for eligible patients. This "clot-busting" drug can dissolve the clot and restore blood flow.
- Endovascular Procedures (Mechanical Thrombectomy): For large vessel occlusions, a catheter is threaded through an artery, usually in the groin, to the brain to physically remove the clot. This can be done up to 6-24 hours after symptom onset in select cases.
- Medications: Antiplatelet drugs (e.g., aspirin, clopidogrel) or anticoagulants (e.g., warfarin, direct oral anticoagulants) to prevent future clots.
- For Hemorrhagic Stroke (to control bleeding and reduce pressure):
- Emergency Measures: Control bleeding, reduce pressure in the brain, manage blood pressure.
- Medications: To lower blood pressure, reduce brain swelling, or reverse the effects of blood thinners.
- Surgery:
- Surgical Clipping: A tiny clamp is placed at the base of a brain aneurysm to stop blood flow to it.
- Endovascular Coiling: Coils are threaded into an aneurysm to block blood flow.
- Craniotomy: To relieve pressure on the brain or remove a large blood clot.
- Post-Stroke Rehabilitation:
- Crucial for recovery and often begins in the hospital.
- Physical Therapy: To regain strength, balance, and coordination.
- Occupational Therapy: To improve ability to perform daily activities (dressing, eating).
- Speech and Language Therapy: For problems with speaking, understanding, reading, or swallowing.
- Cognitive Therapy: For issues with memory, problem-solving, and judgment.
- Psychological Counseling: To address depression, anxiety, or emotional changes.
- Prevention of Recurrence:
- Long-term management of risk factors: controlling blood pressure, diabetes, cholesterol; quitting smoking; maintaining a healthy weight; regular exercise; healthy diet.
- Medications to prevent future strokes (e.g., antiplatelets, anticoagulants).
- Surgical procedures (e.g., carotid endarterectomy or angioplasty and stenting) to clear blocked neck arteries.