What is a stroke?
A stroke, sometimes referred to as a cerebrovascular accident (CVA) or brain attack, occurs when an area of the brain becomes damaged from lack of blood supply to the brain due to a blocked or ruptured blood vessel. This damage can cause lifelong disability or death. Stroke is the fifth leading cause of death in the United States.
The Penn Stroke Center provides advanced resources for emergency stroke treatment, neurocritical care, and neurorehabilitation.
The main signs of stroke include a drooping face, arm weakness, and difficulty speaking. During a stroke, brain damage can occur in minutes. If you or a loved one is experiencing stroke symptoms, call 911 immediately.
Types of stroke
There are several types of stroke. The most common is ischemic stroke, which accounts for about nine in 10 strokes. Hemorrhagic stroke is a less common but equally dangerous cerebrovascular accident.
Ischemic stroke occurs when a blood clot blocks an artery and prevents the blood flow to part of the brain. Without a continuous supply of blood, brain cells become damaged and die.
Blood clots can develop in the brain or travel to the brain from other locations in the body. The types of blood clots that cause ischemic stroke include:
- Cerebral thrombosis: This is a blood clot that forms in an artery in the brain. It is usually the result of the buildup of plaque inside the arteries (atherosclerosis). Over time, the plaque can completely block the artery.
- Cerebral embolism: This type of blood clot usually breaks off from plaque in the heart or large arteries in the chest and neck. The blood clot travels through the bloodstream to the brain. Eventually, the arteries become too narrow for the blood clot to pass and the clot gets stuck.
A hemorrhagic stroke occurs when a blood vessel in the brain bursts and blood leaks into the surrounding area. The pooling blood creates pressure and injures the brain tissue.
Types of hemorrhagic stroke include:
- Intracerebral hemorrhage: The rupture happens within the brain.
- Subarachnoid hemorrhage: The hemorrhage occurs in the space between the brain and the membrane that covers the brain.
- A transient ischemic attack (TIA), also known as a “mini-stroke,” is a temporary blockage. Though symptoms last less than five minutes, a TIA is a warning that you may have a major stroke in the future.
How do you know if someone is having a stroke?
Stroke is a life-threatening condition. Knowing the warning signs using the acronym, BEFAST, can help you recognize a possible cerebrovascular accident and take quick action:
- B — Balance: Sudden loss of balance, difficulty walking, or dizziness.
- E — Eyes: Sudden vision changes, including loss of vision in one or both eyes, double vision, or blurred vision.
- F — Face: Ask the person to smile. One side of their face may droop.
- A — Arms: Ask the person to raise both arms. One arm may drift downward.
- S — Speech: Have the person repeat a simple phrase. Listen for slurred or strange speech.
- T — Time: Call 911 right away and note the time when symptoms started. This information helps medical personnel guide treatment.
Stroke symptoms
The early signs of a stroke appear quickly and include sudden:
- Weakness or paralysis in the face, arm or leg, especially on one side of the body
- Difficulty speaking or understanding speech
- Loss of balance or lack of coordination
- Severe headache
- Trouble seeing in one or both eyes
Symptoms of a transient ischemic attack (TIA)
Signs of a TIA are like a stroke but they clear up after a few minutes. Because symptoms don’t last, many people ignore a TIA.
More than three in 10 people who have a TIA and do not receive treatment will have a major stroke within one year. That’s why it’s important to seek emergency medical care even if your symptoms go away.
What causes a stroke?
The causes of stroke include a range of conditions that affect your heart and blood vessels. Certain health conditions and other factors also increase your risk of a cerebrovascular accident.
The main causes of ischemic stroke are:
- Atherosclerosis, the buildup of fatty plaque inside your arteries. When atherosclerosis occurs in the carotid arteries (the main arteries in your neck) it is called carotid artery disease.
- Atrial fibrillation, an irregular heartbeat, which increases your risk of blood clots.
Hemorrhagic stroke occurs when there are defects in the blood vessels in your brain. These abnormalities make it more likely the artery will rupture and bleed, especially if you have high blood pressure.
The most common causes of hemorrhagic stroke are:
- Arteriovenous malformations, tangles of arteries and veins that usually form before birth
- Brain aneurysm, a weakened area in a blood vessel that expands like a balloon
- Cerebral amyloid angiopathy, a buildup of protein in the blood vessels of the brain that makes them fragile
Health conditions associated with stroke
High blood pressure is the main risk factor for stroke. The extra force inside your blood vessels can cause small tears, which turn into scar tissue when they heal. Plaque builds up on these scarred areas, leading to blockages and blood clots. High blood pressure can also cause weakened areas of your blood vessels to break open.
Other heath conditions that increase your chance of having a stroke include:
- Diabetes: People with diabetes have a higher risk of cardiovascular disease, including high blood pressure.
- High cholesterol: Cholesterol is a main component of plaque that deposits inside your arteries in atherosclerosis.
- Previous stroke or transient ischemic attack (TIA): Repeat stroke is very common.
- Sickle cell disease: In this inherited disease, red blood cells are abnormally shaped like a sickle. The cells can get stuck in a blood vessel and block blood flow. Sickle cell disease mainly affects people who are Black.
Factors that increase stroke risk
There are many factors that increase your risk of stroke:
- Age: Stroke is more common among older adults but can also occur in adolescents and younger adults. One in seven strokes occurs in people age 15 to 49.
- Cigarette smoking and smokeless tobacco use: Smoking damages your heart and blood vessels and increases blood pressure.
- Excess alcohol use: Alcohol increases blood pressure.
- Family history: The genes you inherit from your parents, such as in sickle cell disease, may increase the risk of stroke.
- Obesity: Carrying excess weight is linked to conditions that cause stroke, including high cholesterol, high blood pressure, and diabetes.
- Poor diet: A diet high in saturated fat, salt, and sugar increases your risk of stroke by increasing cholesterol and blood pressure and your risk for diabetes.
- Sex: Women are more likely than men to have a stroke and to die from stroke.
- Race and ethnicity: Stroke may be more common in people who are Black, Hispanic, American Indian, and Native Alaskan.
You cannot control some of these factors, such as age, race, or family history. But you can lower your stroke risk related to these factors by making healthy lifestyle choices.
Diagnosing a stroke
Your doctor will work quickly to evaluate your medical history, identify the time your symptoms started, perform a physical exam, and run blood and imaging tests. These assessments help determine the type and severity of stroke and the affected areas of your brain.
Stroke treatment at Penn Medicine
Stroke treatments vary by type and, for ischemic stroke, how much time has passed since your symptoms began. At the Penn Stroke Center, you receive personalized care from a multidisciplinary team of experts in neurology, emergency and critical care, vascular surgery and endovascular therapy, interventional radiology, and neurorehabilitation.
The goal of ischemic stroke treatment is to open up the blocked blood vessel. If you arrive at the hospital within about four hours of the start of symptoms, you may receive thrombolytic therapy, where clot-busting drugs are administered to help prevent damage to tissues and organs.
Endovascular thrombectomy is another option if medication is not effective or you arrive to the hospital too late. This is a minimally invasive catheter-based treatment. Your doctor inserts the catheter into an artery in your groin or wrist and advances the catheter to the blood clot in your brain. Techniques for removing the blood clot include:
- Opening the clogged area by inflating a balloon in the artery and installing a metal mesh tube called a stent to keep it open
- Suctioning out the clot through the catheter
- Trapping the clot in wire mesh and pulling it out
Typically, endovascular procedures are only effective within six hours of the start of symptoms. But Penn Medicine doctors are able to offer this procedure to some patients up to 24 hours after a stroke.
In some cases, people do not receive treatment within the 24-hour window. Generally, removal of the clot at this point is not effective, and patients receive supportive care to relieve symptoms. Penn researchers are investigating whether endovascular thrombectomy can help improve outcomes after 24 hours.
Rehabilitation helps you regain lost function from the damage to your brain. This might include problems with movement, touch, speech, memory, thinking, and emotions.
You will begin rehabilitation in the hospital and continue after you go home. Some people recover from a stroke completely, while others have permanent disabilities. The Penn neurorehabilitation team offers specialized, compassionate care throughout your recovery.
Treatment for hemorrhagic stroke includes strategies to stop the bleeding, including:
- Medications: You may receive medications to lower blood pressure, reduce inflammation in the brain, and prevent brain damage. If you take a blood thinner such as warfarin, your doctor will stop the medication.
- Endovascular procedures: Minimally invasive endovascular neurosurgery procedures can repair a damaged blood vessel without a need for surgery.
- Radiation treatment: This treatment uses advanced technology, such as Gamma Knife®, to remove or shrink arteriovenous malformations.
- Surgery: This may be the best option to reduce swelling or remove pooled blood. Aneurysm clipping is a type of surgery that can repair an aneurysm permanently.
If you have a transient ischemic attack, a neurologist will evaluate your condition and take steps to reduce your risk of a major stroke. This might include lifestyle changes, medications, and minimally invasive or surgical treatment. At Penn, you have access to every available option to help you manage your condition.
After stroke treatment, patients transfer to a neurocritical care unit. Here, you receive close monitoring to quickly identify and treat and problems that may arise. Penn Medicine has one of the largest neurocritical care units in the nation.
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