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Stroke

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic; Carotid artery - stroke

A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."

If blood flow is cut off for longer than a few seconds, the brain cannot get nutrients and oxygen. Brain cells can die, causing lasting damage.

Images

Brain
Carotid stenosis, X-ray of the left artery
Carotid stenosis, X-ray of the right artery
Stroke
Brainstem function
Cerebellum - function
Circle of Willis
Left cerebral hemisphere - function
Right cerebral hemisphere - function
Endarterectomy
Plaque buildup in arteries
Carotid dissection

Presentation

Stroke - Series

Animation

StrokeStroke - secondary to cardiogenic embolismHypertension - overview

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Causes

There are two major types of stroke:

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

Ischemic strokes may also be caused by a sticky substance called plaque that can clog arteries.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open. This causes blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. These defects may include:

Hemorrhagic strokes may also occur when someone is taking blood thinners, such as warfarin (Coumadin). Very high blood pressure may cause blood vessels to burst, leading to hemorrhagic stroke.

An ischemic stroke can develop bleeding and become a hemorrhagic stroke.

High blood pressure is the main risk factor for strokes. Other major risk factors are:

Stroke risk is also higher in:

Symptoms

Symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.

Most of the time, symptoms develop suddenly and without warning. But symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur if the stroke is caused by bleeding in the brain. The headache:

Other symptoms depend on how severe the stroke is, and what part of the brain is affected. Symptoms may include:

Exams and Tests

The doctor will do a physical exam to:

You may have the following tests to help find the type, location, and cause of the stroke and rule out other problems:

Other tests include:

Treatment

A stroke is a medical emergency. Quick treatment is needed. Call 911 or your local emergency number right away or seek urgent medical care at the first signs of a stroke.

People who are having stroke symptoms need to get to a hospital as quickly as possible.

Other treatments given in the hospital depend on the cause of the stroke. These may include:

Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed.

The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes.

Recovery from your stroke will begin while you are still in the hospital or at a rehabilitation center. It will continue when you go home from the hospital or center. Be sure to follow up with your health care provider after you go home.

Support Groups

Support and resources are available from the American Stroke Association -- www.strokeassociation.org.

Outlook (Prognosis)

How well a person does after a stroke depends on:

Problems moving, thinking, and talking often improve in the weeks to months after a stroke.

Many people who have had a stroke will keep improving in the months or years after their stroke.

Over half of people who have a stroke are able to function and live at home. Others are not able to care for themselves.

If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, people often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition.

People who have a stroke from a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke from bleeding in the brain (hemorrhagic stroke).

The risk for a second stroke is highest during the weeks or months after the first stroke. The risk begins to decrease after this period.

When to Contact a Medical Professional

Stroke is a medical emergency that needs to be treated right away. The acronym F.A.S.T. is an easy way to remember signs of stroke and what to do if you think a stroke has occurred. The most important action to take is to call 911 right away for emergency assistance.

F.A.S.T. stands for:

Prevention

Reducing your stroke risk factors lessens your chance of having a stroke.

Related Information

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Carotid artery disease
Carotid artery surgery
Contracture deformity
Muscle cramps
Aspiration
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Magnetic resonance angiography
Metabolic syndrome
Obesity
Brain aneurysm repair
Dementia - what to ask your doctor
High blood pressure - what to ask your doctor
Angioplasty and stent placement - carotid artery - discharge
Carotid artery surgery - discharge
Headache - what to ask your doctor
Communicating with someone with aphasia
Dementia and driving
Dementia - behavior and sleep problems
Dementia - daily care
Dementia - keeping safe in the home
Communicating with someone with dysarthria
Eating extra calories when sick - adults
Preventing falls
Caring for muscle spasticity or spasms
Swallowing problems
Being active when you have heart disease
Butter, margarine, and cooking oils
Constipation - self-care
Brain aneurysm repair - discharge
Stroke - discharge

References

Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 65.

Crocco TJ, Meurer WJ. Stroke. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 91.

January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071-2104. PMID: 24682348 www.ncbi.nlm.nih.gov/pubmed/24682348.

Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-3035. PMID: 26123479www.ncbi.nlm.nih.gov/pubmed/26123479.

Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110. PMID: 29367334 www.ncbi.nlm.nih.gov/pubmed/29367334.

Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169. PMID: 27145936 www.ncbi.nlm.nih.gov/pubmed/27145936.

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Review Date: 4/30/2018  

Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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