What is stroke?

A stroke occurs when a blood vessel to the brain bursts or is blocked by a blood clot. The blood supply to part of the brain is reduced. Without blood and the oxygen it supplies, the nerve cells in that part of the brain die within minutes. As a result, the part of the body controlled by those cells cannot work properly.

The effects of a stroke may range from mild to severe. They may get better, or they may last the rest of your life. A stroke can affect many things, including vision, speech, behavior, thought processes, and your ability to move.

Symptoms of a stroke happen suddenly. If you have symptoms of a stroke, even if they go away quickly, call 911 or other emergency services right away.

General symptoms of a stroke include:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.
• Fainting.
• A seizure.

BE FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help.

BE FAST stands for:

• Balance. Loss of balance or trouble walking.
• Eyes. Trouble seeing out of one or both eyes.
• Face. Weakness or drooping on one side of the face.
• Arm. Weakness or numbness in an arm or leg.
• Speech. Trouble speaking.
• Time to call 911.

Brain damage can begin within minutes. That's why it's so important to know the symptoms of stroke and to act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

Symptoms can vary depending on whether the stroke is caused by a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke). They also depend on where the stroke occurs in the brain, and how bad it is.

Treatment depends on the type of stroke. For an ischemic stroke, a clot-dissolving medicine or a procedure to remove the clot can restore blood flow to the brain. For a hemorrhagic stroke, medicine or a transfusion with parts of blood, such as plasma, can help stop the bleeding in the brain.

Each type of care center offers a different level of care. These centers may have shared or private rooms. Here are some examples.

An assisted living center or residential care center:

• Has a range of services. These may include meals, cleaning, and laundry. And they may offer help with personal needs like bathing, grooming, and dressing.
• Often includes oversight by a nurse. You may be able to get help with basic care, such as getting medicines.

A skilled nursing facility:

• Offers nursing care up to 24 hours a day.
• Provides meals and laundry.
• Provides help with dressing, bathing, using the toilet, and other daily tasks.
• Offers rehab therapy.

A long-term acute care hospital:

• Is for stroke patients who have special medical problems. This may include things like not being able to breathe on your own.

You can help prevent another stroke by managing health problems that raise your risk. These include atrial fibrillation, diabetes, and high blood pressure. Take your medicines exactly as prescribed. Have a heart-healthy lifestyle. This includes eating heart-healthy foods, limiting alcohol, being active, staying at a healthy weight, and not smoking.

The first test the doctor will do in the emergency room is a CT scan or MRI of the head. This can show if there is bleeding in the brain. The results help the doctor know if the stroke is ischemic or hemorrhagic.

The doctor will also do an exam to check the stroke symptoms.

Other tests may include:

• Electrocardiogram (ECG, EKG) to check for heart problems.
• Blood tests to help your doctor make choices about your treatment and to check for conditions that may cause symptoms like those of a stroke. Tests may include:
  • Complete blood count (CBC).
  • Blood sugar.
  • Electrolytes.
  • Liver and kidney function.
  • Prothrombin time and INR (a test that measures how long it takes your blood to clot).

Later, you may have other tests to check for problems with your arteries or heart.

One of the best things you can do to prevent another stroke is to take a medicine called a blood thinner. These medicines don't really thin your blood. They work by helping to prevent blood clots. Blood clots can cause a stroke if they block a blood vessel in the brain. So when you prevent blood clots, you help prevent a stroke.

Antiplatelets are a type of blood thinner. They help keep platelets from sticking together and forming blood clots. (A platelet is a type of blood cell.)

Examples of antiplatelets include:

• Aspirin.
• Aspirin combined with dipyridamole.
• Clopidogrel.

Another type of blood thinner, called an anticoagulant, may be used if you have a health problem that raises your risk of blood clots.

Examples of anticoagulants include:

• Direct oral anticoagulants.
• Warfarin.

Be sure to learn how to take your medicine safely. Blood thinners can cause serious bleeding problems.

To deal with your emotions:

• Be easy on yourself. Let go of mistakes.
• Give yourself credit for the progress you have made.
• Make time for things that you enjoy.
• Join a stroke support group. Your rehab team or local hospital can help you find one.

After a stroke, problems with your vision, speech, or ability to move can change your ability to drive safely. So you'll need your doctor's approval to drive again. This may be hard to accept. This may feel like a big loss of independence. But this approval is for the safety of yourself and others.

Talk with your doctor and your loved ones about driving. Also, check with your motor vehicle department about the rules for people who have had a stroke. You may need to take classes, be tested again, and have changes made to your car. Some stroke rehab centers give driver training classes.

If you can't drive because of problems from your stroke, and you do not have other options, check with your stroke rehab center and public transit agency. They can help you find local services. Senior groups and volunteer agencies may also offer transportation services.

Your chances of having a stroke depend on your risk factors. Some risks can be lowered with treatment and a healthy lifestyle. Others can't.

This list includes some of the risk factors for having a stroke. You and your doctor can discuss your risk and how to lower it.

Risk factors you can control with treatment

• Atrial fibrillation. This type of irregular heartbeat increases the risk of blood clots that could cause a stroke.
• Atherosclerosis. Also called hardening of the arteries, this happens when fatty deposits build up inside arteries. It can cause conditions such as carotid artery disease or coronary artery disease.
• Diabetes. Diabetes results in high blood sugar. Over time, high blood sugar can lead to hardening of the arteries.
• High blood pressure. Over time, this damages the walls of the arteries which can lead to hardening of the arteries.
• High cholesterol. This can lead to the buildup of fatty deposits in artery walls.
• Other health problems. There are many problems that raise the risk of blood clots that could cause a stroke. These include sickle cell disease and blood clotting problems.

Risk factors you can control with a heart-healthy lifestyle

• Smoking. Smoking, or even inhaling secondhand smoke, increases your risk of heart attack and stroke.
• Being overweight. This makes it more likely that you'll develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
• Drinking too much alcohol. This means more than 2 drinks a day for men and 1 drink a day for women.
• Not getting enough physical activity. If you aren't active, you have a higher risk of health conditions that make a stroke more likely.
• Not eating a heart-healthy diet. Heart-healthy eating includes vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. You limit things like sodium, alcohol, and sugar.

Risk factors you can't control

• Having had a previous stroke or TIA (transient ischemic attack).
• Having a family history of stroke. Your chances of having a stroke are higher if other people in your family have had one.
• Being older. The risk of stroke goes up as you age.
• Being African American, Alaskan Native, Native American, or South Asian American.
• Being female. Women have a higher risk of stroke than men.
• Having certain problems during pregnancy. These include gestational diabetes and preeclampsia.
• Being past menopause.

Here are some ways to help.

• Realize that after a stroke, the person may be prone to strong emotional reactions. Remember that these are a result of the stroke. Try not to become too upset by them.
• Don't avoid someone who's had a stroke. Contact and support is very important to their recovery.
• Join a local support group. These groups provide a place where issues can be discussed in a supportive environment and an opportunity to meet others dealing with the same issues. Ask your doctor or the stroke rehab team about support groups in your area.
• Take care of yourself too. If you are a caregiver, you must stay healthy enough to help.

You are an important part of their recovery after a stroke.

• Give the person support and encouragement to participate in the decisions about their rehabilitation (rehab) program.
• Visit and talk with the person often.
• Participate in educational programs, and attend some of the rehab sessions.
• Help the person practice the skills they're learning.
• Work with the program staff to match the activities to what the person needs to do after returning home.
• Find out what the person can do independently and where help is needed. Avoid doing things for the person that they can do without help.

What causes a stroke depends on the type of stroke.

There are two types of stroke: ischemic (say "iss-KEE-mick") strokes and hemorrhagic (say "heh-muh-RAW-jick") strokes. Ischemic strokes are the more common type.

Causes of ischemic stroke

An ischemic stroke is caused by a blood clot that blocks blood flow to the brain.

• A blood clot can form in an artery that supplies blood to the brain.
  • Blood clots usually form in arteries damaged by plaque buildup. This buildup process is called atherosclerosis.
• A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to the brain. For example, clots may form:
  • After a heart attack.
  • As a result of other problems that change the blood flow through the heart. These conditions include abnormal heart rhythms (especially atrial fibrillation), heart valve problems, patent foramen ovale, atrial septal defects, and heart failure.
  • During or after certain types of surgeries and medical procedures.

Low blood pressure may also cause an ischemic stroke, but this is less common. Low blood pressure results in reduced blood flow to the brain. It may be caused by narrowed or diseased arteries, a heart attack, a large loss of blood, or a severe infection.

Causes of hemorrhagic stroke

A hemorrhagic stroke is caused by bleeding in or around the brain.

• Bleeding inside the brain itself (intracerebral hemorrhage, or ICH) can be caused by many things. Examples include long-term high blood pressure and taking blood thinner medicine, such as anticoagulants.
• Bleeding in the space around the brain (subarachnoid hemorrhage, or SAH) can be caused by different things, including a ruptured aneurysm.

Other less common causes include head or neck injuries, certain diseases, and radiation treatment for cancer in the neck or brain.

Normally, the heart beats in a regular, steady rhythm. In atrial fibrillation, the two upper parts of the heart (the atria) quiver, or fibrillate, and the heart does not beat in a regular rhythm. Your heart rate also may be faster than normal.

An episode is not usually dangerous. But because the heartbeat isn't regular and steady, blood can collect, or pool, in the heart. And pooled blood is more likely to form clots. Clots can travel to the brain, block blood flow, and cause a stroke.

A stroke can cause sudden numbness or weakness of the face, arm, or leg, especially on one side of the body. Strokes can also cause sudden confusion, trouble speaking or understanding, or even trouble seeing in one or both eyes. Strokes can even cause death.

Atrial fibrillation increases your stroke risk. But not everyone with atrial fibrillation has the same stroke risk.

A stroke is damage to the brain that occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.