(Cerebrovascular Accident; CVA; Cerebral Infarct)
Stroke is a brain injury caused by an interruption in blood flow. Brain tissue that does not get oxygen and nutrients from blood can die within minutes. The damage to the brain can cause a sudden loss in bodily functions. The types of function that are affected will depend on the part of the brain that is damaged.
There are two blood flow problems that cause a stroke. Strokes may be ischemic or hemorrhagic.
- An ischemic stroke is caused by a blocked blood vessel. It is the most common cause of stroke.
- A hemorrhagic stroke is caused by a ruptured blood vessel.
Hemorrhagic vs. Ischemic Stroke
An ischemic stroke occurs when something stops the flow of blood. It may be a buildup or swelling of the walls of the blood vessels and/or something in the blood that becomes stuck in the blood vessel. A blockage in a small blood vessel will affect a smaller area of the brain. A blockage in larger blood vessels can block the flow of blood to several smaller blood vessels, leading to more brain damage.
The blockage may be the result of one or more of the following:
- Atherosclerosis—a build-up of fatty substances along the inner lining of the artery that gradually decrease the area the blood can flow through
- A blood clot that has traveled from other parts of the body, such as the neck or heart
- Inflammation of the blood vessels
Certain factors increase your risk of stroke but can not be changed, such as:
- Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
- Age: Older than 55 years of age.
- Family history of stroke.
Other factors that may increase your risk can be changed, such as:
Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include:
- High blood pressure
- High cholesterol levels—specifically high-LDL cholesterol
- Low bone mineral density, especially in women
- Obesity and metabolic syndrome
- Sleep apnea
- High blood homocysteine level
- Type 2 diabetes or impaired glucose tolerance
- Atrial fibrillation
- Blood disorders such as sickle cell disease and polycythemia
- Vascular dementia
- Disease of heart valves, such as mitral stenosis
- Prior stroke or cardiovascular disease, such as heart attack
- Peripheral artery disease
- Transient ischemic attack (TIA)—a warning stroke with stroke-like symptoms that go away shortly after they appear
Conditions that increase your risk of blood clots such as:
- Certain autoimmune diseases
- Migraine with aura
- Having a blood vessel abnormality
Risk factors specific to women include:
Symptoms occur suddenly. Exact symptoms will depend on the part of the brain affected. Rapid treatment is important to decrease the amount of brain damage. Brain tissue without blood flow dies quickly.
Call for emergency medical services right away if you notice any of the following sudden symptoms:
- Weakness or numbness of face, arm, or leg, especially on one side of the body
- Trouble speaking or understanding
- Trouble seeing in one or both eyes
- Lightheadedness, trouble walking, loss of balance, or coordination
- Severe headache with no known cause
A physical exam will be done to look for muscle weakness, visual and speech problems, and movement difficulty. If possible, you will be asked about your symptoms and medical history.
Images may be taken of your bodily structures. This can be done with:
Blood tests can also help determine if there is a bleeding problem.
Immediate treatment is needed to open the blocked blood vessel. This should restore blood flow to the brain tissue and stop further damage.
Treatment after immediate care will aim to:
- Reduce the chance of later strokes
- Improve function affected by the stroke
- Overcome disabilities
Supportive care may also include:
- Oxygen therapy
- Precautions to prevent choking
Certain patients will receive a group of drugs called thrombolytics. These medications can rapidly dissolve blood clots. They are often given by IV, but can be delivered directly to the arteries where the blood clot is. These medications need to be given within hours after the start of symptoms to be effective. That is why it is important to get medical help right away if stroke symptoms develop.
Aspirin and other medications that decrease the risk of blood clot formation may be recommended after immediate care is done. These medications may prevent future strokes from occurring.
To help manage other health issues and decrease the risk of future strokes the doctor may recommend medication to:
- Decrease blood pressure
- Correct irregular heart rhythms
A surgery may be done to allow blood flow back into the affected area such as:
- Extracranial/intracranial bypass—Blood vessel from the scalp is used to reroute blood supply around the blocked artery.
- Embolectomy—A catheter is threaded through blood vessels to the clot. It can remove the clot or deliver clot-dissolving medication directly to the area
A stroke can cause swelling in the brain. A decompressive surgery, such as craniotomy, may be needed to relieve the pressure in the brain to prevent damage.
Other surgeries may be performed following a stroke to prevent a recurrence. These surgical options include:
If brain tissue was damaged, rehabilitation can be an important part of your recovery. Rehabilitation may include:
- Physical therapy—to regain as much movement as possible
- Occupational therapy—to assist in everyday tasks and self care
- Speech therapy—to improve swallowing and speech challenges
- Psychological therapy—to improve mood and decrease depression
Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:
- Exercise regularly.
- Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
- If you smoke, talk to your doctor about ways to quit.
- Increase your consumption of fish.
- Drink alcohol only in moderation: no more than 1-2 drinks per day.
- Maintain a healthy weight.
- Check blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
- Take a low dose of aspirin if your doctor says it is safe.
- Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
- Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
- Seek medical care if you have symptoms of a stroke, even if symptoms stop.
- If you use drugs, talk to your doctor about rehabilitation programs.
American Heart Association
National Stroke Association
Heart and Stroke Foundation
Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-276.
Ischemic strokes (clots). American Stroke Association website. Available at: American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp#.Vk3ipE2FPIU. Updated August 29, 2014. Accessed November 18, 2014.
Long term management of stroke. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T900125/Long-term-management-of-stroke. Updated February 16, 2016. Accessed September 14, 2016.
Stroke (acute management). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T143427/Stroke-acute-management. Updated December 28, 2015. Accessed September 14, 2016.
11/20/06 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355(16):1726-1729.
12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Farquhar C, Marjoribanks J, Lethaby A, Suckling J, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2008;CD004143.
10/9/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mitchell PH, Veith RC, Becker KJ, et al. Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke. 2009;40(9):3073-3078.
3/28/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary fiber intake and mortality in the NIH-AARP diet and health study. Arch Intern Med. 2011;171(12):1061-1068.
2/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bushnell C, McCollough LD, Awad IA, et al. Guideline for the prevention of stroke in women. Available at: http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48. Accessed November 18, 2014.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Myint PK, Cleark AB, Kwok CS, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-Norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014;45(2):373-382.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Imfeld P, Bodmer M,Schuerch M, Jick SS, Meier CR. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013;81(10):910-919.
8/11/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-895.
1/18/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD: Emdin CA, Odutayo A, Wong CX, Tran J, Hsiao AJ, Hunn BH. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118(4):511-519.
Last reviewed December 2014 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.