Stroke: Types, Symptoms & Emergency Treatment

A stroke, sometimes called a "brain attack," occurs when blood flow to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency that requires immediate treatment to minimize brain damage and potential complications.

Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. Approximately 795,000 people in the US have a stroke each year.

Ischemic stroke (~87% of all strokes):

• Caused by a blood clot that blocks an artery supplying the brain
• Thrombotic stroke: clot forms in a brain artery
• Embolic stroke: clot forms elsewhere (often the heart in AFib) and travels to the brain

Hemorrhagic stroke (~13% of all strokes):

• Caused by a blood vessel in the brain that leaks or ruptures
• Intracerebral hemorrhage: bleeding within the brain tissue
• Subarachnoid hemorrhage: bleeding in the space between the brain and surrounding membranes

Transient ischemic attack (TIA) -- "mini-stroke":

• Temporary blockage causing stroke-like symptoms that resolve within minutes to hours (by definition, within 24 hours)
• A serious warning sign: approximately 10-15% of TIA patients have a full stroke within 90 days

Stroke symptoms appear suddenly and may include:

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden severe headache with no known cause (especially in hemorrhagic stroke)
• Sudden difficulty walking, dizziness, or loss of balance and coordination

• CT scan: Performed immediately to distinguish ischemic from hemorrhagic stroke (critical for treatment decisions)
• MRI: More sensitive for detecting early ischemic changes
• CT angiography: Identifies the blocked blood vessel
• Blood tests: Blood glucose, coagulation studies, complete blood count
• ECG: To check for atrial fibrillation
• Echocardiogram: To evaluate for cardiac sources of embolism

Acute ischemic stroke treatment:

• Intravenous thrombolysis (IV tPA/alteplase): Dissolves the clot if given within 4.5 hours
• Mechanical thrombectomy: Catheter-based clot removal for large vessel occlusions, up to 24 hours in selected patients
• Supportive care: Blood pressure management, blood glucose control, prevention of complications

Acute hemorrhagic stroke treatment:

• Blood pressure control (rapid lowering)
• Reversal of anticoagulants if applicable
• Surgical intervention if needed (craniotomy, clipping, or coiling for aneurysms)

Secondary prevention (preventing another stroke):

• Antiplatelet therapy (aspirin, clopidogrel) for ischemic stroke
• Anticoagulation for AFib-related stroke
• Statin therapy
• Blood pressure control (target generally below 130/80)
• Lifestyle modifications (smoking cessation, exercise, healthy diet)
• Carotid endarterectomy or stenting for significant carotid artery stenosis

Rehabilitation:

• Physical therapy for motor recovery
• Speech-language therapy for communication and swallowing
• Occupational therapy for daily activities
• Psychological support for post-stroke depression

• Control high blood pressure (the single most important modifiable risk factor)
• Treat atrial fibrillation with appropriate anticoagulation
• Do not smoke
• Manage diabetes and cholesterol
• Exercise regularly and maintain a healthy weight
• Limit alcohol intake

Any stroke symptom requires emergency medical attention. Call 911 immediately. Also seek urgent evaluation after a TIA, as it is a warning of future stroke risk.