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.
Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic; Carotid artery - stroke
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.
Stroke risk is also higher in:
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:
A stroke is a medical emergency. Quick treatment is needed. Call 911 or the 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 and resources are available from the American Stroke Association -- www.strokeassociation.org.
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 or the local emergency number right away for emergency assistance.
F.A.S.T. stands for:
Reducing your stroke risk factors lessens your chance of having a stroke.
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 pubmed.ncbi.nlm.nih.gov/24682348/.
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused updated of the 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. J AM Coll Cardiol. 2019 Jan 21. pii: S0735-1097(19)30209-8. PMID: 30703431 pubmed.ncbi.nlm.nih.gov/30703431/.
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 pubmed.ncbi.nlm.nih.gov/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: 26123479 pubmed.ncbi.nlm.nih.gov/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 pubmed.ncbi.nlm.nih.gov/29367334/.
Riegel B, Moser DK, Buck HG, et al; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; and Council on Quality of Care and Outcomes Research. Self-care for the prevention and management of cardiovascular disease and stroke: a scientific statement for healthcare professionals from the American Heart Association. J Am Heart Assoc. 2017;6(9). pii: e006997. PMID: 28860232 pubmed.ncbi.nlm.nih.gov/28860232/.
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535 pubmed.ncbi.nlm.nih.gov/29146535/.
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 pubmed.ncbi.nlm.nih.gov/27145936/.
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. Internal review and update on 04/15/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.