Can strokes be prevented?

Can strokes be prevented?

Prevention is always the best treatment, especially when the illness can be life-threatening or life-altering. Ischemic strokes are most often caused by atherosclerosis, or hardening of the arteries, and carry the same risk factors as do heart attacks (myocardial infarction, coronary artery disease) and peripheral vascular disease. These include high blood pressure, high cholesterol, diabetes, and smoking. Stopping smoking and keeping the other three under lifelong control greatly minimizes the risk of ischemic stroke.

Patients who have had a transient ischemic attack (TIA) are often prescribed medications to decrease their risk of a subsequent stroke. These include medications to lower blood cholesterol levels and control blood pressure. In addition, antiplatelet medications may be prescribed to make platelets less likely to promote blood clot formation. These include aspirin, clopidogrel (Plavix), and dipyridamole/aspirin (Aggrenox).

Patients with a TIA are usually evaluated for carotid stenosis or narrowing of the carotid artery. Surgery to open critically narrowed arteries may decrease stroke risk.

Lifelong control of high blood pressure decreases the risk of hemorrhagic stroke.

Atrial fibrillation is the most common cause of embolic stroke. Ideally the heart rhythm can be converted to normal sinus rhythm but in those patients whose hearts are chronically in atrial fibrillation, anticoagulation or “blood thinning” minimizes the risk of blood clot formation in the heart and subsequent embolization and stroke. Which drug that is used to “thin” the blood depends upon the specific patient and their individual situation. Patients who are prescribed warfarin (Coumadin), dabigatran (Pradaxa), and rivaroxaban (Xarelto) decrease the chance of a stroke but are at risk for bleeding complications.

What is stroke rehabilitation?

What is stroke rehabilitation?

The purpose of rehabilitation is to return the stroke patient as close as possible to their life and level of function before the stroke. The success of that goal depends upon the underlying health of the patient and severity of the stroke.

Rehabilitation may take weeks and months and usually requires a team approach for success. Physical therapists, occupational therapists, and speech pathologists will coordinate care with the primary health care professional and physical medicine and rehabilitation specialists.

Some of the treatments are directed to prevent life-threatening complications. For example, speech pathologists may help with swallowing to prevent aspiration pneumonia. Physical therapists may concentrate on strength and balance to prevent falls. Occupational therapists may find ways to allow the patient to perform daily activities from personal hygiene to cooking in the kitchen.

Many patients with significant stroke deficits may require admission to a rehabilitation hospital and/or longer term nursing facility prior to returning home. Unfortunately, some patients will have had too severe a stroke to be offered that opportunity.

What is the treatment for stroke?

What is the treatment for stroke?


A stroke is a medical emergency and there is now ability to intervene and restore blood supply to the brain of some stroke patients if they present for medical care early enough.

As in many emergencies, the first consideration is the ABCs (Airway, Breathing, and Circulation) to make certain that the patient can breathe and has adequate blood pressure. In severe strokes, especially those that involve the brainstem, the brains ability to control breathing, blood pressure, and heart rate may be lost.

Patients will have intravenous lines established, oxygen administered, and appropriate blood tests and CT scans performed at the same time that the health care professional is performing an assessment to make the clinical diagnosis of stroke and deciding whether TPA is an option to treat the stroke.

If the diagnosis of ischemic stroke has been made, there is a window of time when thrombolytic therapy using tPA (tissue plasminogen activator) may be an option to dissolve the clot that is blocking an artery in the brain and restore blood supply. For many patients, that time window is 3 hours after the onset of symptoms. In a select group of patients, that time frame may be extended to 4 ½ hours. In that time, the patient or family needs to recognize the stroke symptoms, get the patient to a hospital (call 9-1-1), have the patient assessed by the health care professional, get blood test results, perform a CT scan to look for other causes of stroke (including hemorrhage or tumor), consult with a neurologist, and administer the tPA or call a neurosurgeon.

Hemorrhagic strokes are difficult to treat and a specialist (neurosurgeon) should be consulted immediately to help determine if any treatment options are available to the patient (possibly aneurysm clipping, hematoma evacuation, or other techniques). Treatment for hemorrhagic strokes, in contrast to ischemic strokes, does not use tPA or other thrombolytic agents as these will likely make the hemorrhagic stroke worse or cause death. Consequently, it is important to distinguish between a hemorrhagic stroke and an ischemic stroke before treatment begins.

Hospital emergency department doctors and nurses are trained to act quickly in caring for stroke patients. The most common delay that prevents tPA from being administered is due to patient delay in seeking medical attention. A CT of the head is done emergently to help distinguish an ischemic from a hemorrhagic stroke. This may also cause a delay in a few instances.

The decision to administer tPA in the appropriate patient (there are many reasons that the drug is not indicated even if the patient arrives in time) is one that is discussed with the patient and family, since there is risk of bleeding in the brain with the use of tPA. While there is great benefit, because the blood vessels are fragile, there is a 6% risk that an ischemic stroke can turn into a hemorrhagic stroke with bleeding into the brain. This risk is minimized the earlier the drug is given and if the appropriate patient is selected.

In certain types of strokes involving the vertebrobasilar system and posterior circulation, the time frame may be extended.

If tPA is given, the patient will be admitted to an intensive care bed for monitoring. As well, depending upon circumstances, the patient may be transferred to a stroke center.

In some patients, instead of intravenous tPA, an option may exist to perform an angiogram where dye is injected into the arteries of the brain, identify the area of blockage, and inject tPA directly into the clot. It is also possible to suck the clot out of the artery. These procedures require the skill of a specially trained neuroradiologist or neurosurgeon.

In those patients where tPA and other interventions are not possible or are not indicated, the patient is usually admitted to the hospital for observation, supportive care, and referral for rehabilitation.

How is a stroke diagnosed?

How is a stroke diagnosed?

Time is of the essence since the longer a stroke remains unrecognized and untreated, the longer brain cells are deprived of oxygen-rich blood and the greater number of brain cells that die.

It recommend that everybody be aware of FAST in recognizing stroke: Face Drooping, Arm Weakness, Speech Difficulty, Time to Call 9-1-1
First responders, EMTs and paramedics may use the Cincinnati Prehospital Stroke Scale to recognize a stroke and alert the emergency department to prepare for their arrival. This scale addresses the same three components as the FAST: speech, arm strength, and speech.

In the emergency department, nurses and doctors may use the National Institute of Health Stroke Scale to perform a more in depth and standardized neurologic examination.
The clinical diagnosis of stroke is usually made after the health care professional performs a history and physical examination. While speed is important in making the diagnosis, it is also important to learn about the circumstances that brought the patient to be seen. For example, the patient just started slurring words about an hour ago versus the patient has been slurring his words since last evening.

There is urgency to make the diagnosis and determine whether treatment with thrombolytic medications (clot-busting drugs) to “reverse” the stroke is a possibility. The time frame to intervene is narrow and may be as short as 3 to 4 ½ hours after onset of symptoms. For that reason, family members or bystanders may be needed to confirm information, especially if the patient is not fully awake or has a speech deficit.

History may include asking about what symptoms are present, when they began, and if they are improving, progressing, or remaining the same. Past medical history will look for stroke risk factors, medications, allergies, and any recent illnesses or surgeries.

Physical examination includes assessing vital signs and patient wakefulness. A neurologic examination is performed, usually using the standardized stroke scale. Heart, lungs, and abdomen are also assessed.

If an acute stroke is still a consideration, blood tests and CT of the head are indicated. However, the tests are not used to make the diagnosis, but are used to help plan treatment. Nonetheless, a CT is often used to differentiate an ischemic from a hemorrhagic stroke because the treatment plans are quite different.

The CT is used to look for bleeding or masses in the brain.

In certain circumstances, an MRI of the brain may be possibly indicated, but not all hospitals have this technology readily available.

Blood tests may include a complete blood count (CBC), especially to measure platelets, international normalized ratio (INR), prothrombin time (PT) and partial thromboplastin time (PTT), and tests to measure blood clotting capabilities, electrolytes, blood glucose, and kidney function. Other blood tests may be indicated based upon the patient's specific situation.

An EKG may be performed to check the heart's rate and rhythm.

Stroke Symptoms

Stroke Symptoms

Each year about 500,000 people in the United States suffer a first stroke, and a further 200,000 people have a recurrent stroke. Stroke is the third leading cause of death in the U.S., and also is a major cause of disability and loss of independence and quality of life. Up to 40% of strokes are fatal, but the risks of death from a stroke and the degree of disability can both be significantly reduced by prompt treatment.

Strokes result from impaired oxygen delivery to brain cells via the bloodstream. The oxygen-deprived brain cells die and result in various neurological impairments, depending on the area of the brain that is involved. A stroke is also referred to as a cerebrovascular accident or CVA. The blood supply to the brain can be interrupted both by a blockage in one of the arteries that supply blood to the brain, or a rupture of a blood vessel within the brain. Stroke caused by blockage of an artery is called ischemic stroke, while stroke caused by rupture of an artery is called a hemorrhagic stroke. Ischemic stroke is much more common than hemorrhagic stroke.

The risk factors for stroke include high blood pressure, diabetes, cigarette smoking , a family history of stroke, heart disease, prior history of stroke, alcohol abuse, and increasing age. Learning to recognize the signs and symptoms of a stroke is vital in order to ensure that the victim receives immediate medical attention. According to The U.S. National Institute of Neurological Disorders and Stroke, these are the five major signs of stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.

• Sudden confusion, trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Cerebral haemorrhage is a type of stroke

Cerebral haemorrhage is a type of stroke

A cerebral haemorrhage is a type of stroke caused by bleeding from a ruptured blood vessel in the brain. It is sometimes called a haemorrhagic stroke. Without prompt medical treatment, this can result in death. A person who survives is often left with permanent disabilities.

Causes include weakened blood vessel walls, head trauma or congenital conditions (conditions that are present at birth). A cerebral haemorrhage is a life-threatening emergency. Approximately one in 10 strokes is caused by cerebral haemorrhage. This type of stroke (haemorrhagic stroke) is usually much more severe than ischaemic stroke, although symptoms are similar.

The major risk factor for cerebral haemorrhage is long-standing high blood pressure (hypertension) that weakens the walls of blood vessels, which then may split under the pressure.

Treatment of cerebral haemorrhage

After admission to hospital, treatment depends on the location and severity of the haemorrhage, but may include:

• medications to lower blood pressure after onset of haemorrhage
• treatment for underlying causes, such as long-term use of antihypertensive medications
• certain surgical procedures.

Any suspected signs and symptoms of cerebral haemorrhage require urgent medical attention. Dial triple zero (000) to call an ambulance to take the person to the nearest hospital emergency department.

How stroke affects the brain

How stroke affects the brain

The brain can be considered as a four-part organ, which includes the right and left hemispheres, the cerebellum and the brain stem. A stroke has different effects, depending on which part of the brain is targeted during the attack.

Right hemisphere
Some of the major functions of the right hemisphere include perception and control of the left side of the body. A stroke which affects the right hemisphere can cause many changes, including:

• the inability to judge distances, which can lead to falls or loss of hand-to-eye coordination
• short-term memory loss
• neglecting or ignoring anything situated on the left of the body
• impulsive behaviour
• paralysis of the left side of the body (‘left hemiplegia’).

Left hemisphere
Some of the major functions of the left hemisphere include speech and control of the right side of the body. A stroke affecting the left hemisphere can cause many changes, including:

• paralysis of the right side of the body (‘right hemiplegia’)
• various problems with speech and communication
• short-term memory loss.

Cerebellum
Some of the major functions of the cerebellum include coordination and balance. A stroke affecting the cerebellum can cause many changes, including:

• dizziness
• nausea and vomiting
• loss of coordination
• a tendency to unbalance and fall
• slurred speech.

Brain stem
Some of the major functions of the brain stem include breathing, heart rate and blood pressure. A stroke that affects the brain stem can cause many changes, including:

• complete paralysis
• coma
• double vision
• swallowing difficulties
• death.

How can I prevent a stroke?

How can I prevent a stroke?

Measures that reduce the chances of stroke are the same as those for avoiding heart attack. Adopt habits that promote cardiovascular health and deter atherosclerosis, or narrowing of the arteries. The essentials of a healthy lifestyle include not smoking, eating foods that are low in fat, salt and cholesterol, exercising regularly, controlling weight, blood pressure and cholesterol levels and limiting alcohol consumption.

A few other tips to prevent stroke:

• Get adequate treatment of atrial fibrillation. This heart arrhythmia can cause stroke but the risk is reduced by taking medication to reduce the clotting tendency of the blood
• Get treated for sleep apnoea, if you have it
• Learn stress management techniques
• Exercise
• Control your diabetes, if you have it
• Limit alcohol consumption

If your risk of stroke is high because of severe atherosclerosis, high blood pressure, or a history of heart disease, TIAs or previous strokes then you should see a doctor regularly. When a clot causing a stroke is the indicated danger, your doctor may advise an aspirin a day to “thin” the blood and reduce the risk of formation of blood clots. If you have diabetes, keep it under control because poorly controlled diabetes increases your risk of stroke.

For people who have partial obstruction of a carotid artery, which is the artery in the neck that provides blood supply to the brain, then a surgical procedure called carotid endarterectomy may be an option to prevent a stroke or TIA. This procedure involves the removal of fat and plaque build-up from the lining of these arteries. Insertion of a carotid stent may also be recommended to widen the artery and so improve blood flow.

10 questions to ask your Doctor about stroke

10 questions to ask your Doctor about stroke

1. How soon can I expect to recover after my stroke?
2. How can I find specialists that can help me regain my skills and functions?
3. Is there a recommended diet that I should follow?
4. Is there an exercise programme that I should follow? Will physiotherapy be helpful?
5. Who can help me find equipment to make my life easier?
6. Would antidepressants help me during my recovery?
7. Am I at risk of having another stroke?
8. What can I do to minimise my risk? Should I be taking aspirin? Am I a good candidate for other medications to help prevent another stroke?
9. Are there any local stroke support groups that my family and I can contact?
10. Are there any clinical trials for which I may be a good candidate?

Mini-stroke - Treating a transient ischaemic attack

Mini-stroke - Treating a transient ischaemic attack

After having a transient ischaemic attack (TIA), you will need treatment to help prevent another TIA or full stroke from occurring in the future.

Without treatment, there is a one in 10 chance that you will have a full stroke within four weeks of having a TIA. A stroke is a serious health condition that can cause permanent disability and can, in some cases, be fatal.

Your treatment will depend on your individual circumstances, such as your age and medical history.The healthcare team can discuss treatment options with you, and tell you about possible benefits and risks.

To reduce the risk of further TIAs or stroke, you may be prescribed medication and be advised to make changes to your lifestyle.

Some people may also need surgery as part of their treatment programme.

Medication

Platelets are blood cells that help it to clot (thicken). If a blood vessel is damaged, platelets stick together to form a blood clot to prevent bleeding.

Anti-platelet medicines work by reducing the ability of the platelets to stick together and form clots. If you have had a TIA, it is likely you will need anti-platelet medication.

The most commonly prescribed anti-platelet medicines for preventing a TIA, plus two other types of medication, are described below.

Aspirin and dipyridamole

Aspirin is the most commonly prescribed anti-platelet medicine. It is often taken with another anti-platelet medicine called dipyridamole.

Aspirin and dipyridamole are often prescribed together because they are more effective at preventing TIAs and strokes when used in combination compared to when taken separately.

Following a TIA, you will usually be prescribed aspirin and dipyridamole for two years. After this time, you may be able to stop taking dipyridamole and take a low-dose aspirin instead.

Depending on what your GP thinks is the best treatment for you, you may need to take low-dose aspirin indefinitely. A daily low dose of aspirin is thought to reduce your risk of having a TIA by 25%. It can also reduce your risk of having a heart attack.

Side effects of aspirin may include:

• stomach irritation
• indigestion 
• nausea

Side effects of dipyridamole may include:

• headaches 
• dizziness
• nausea 
• diarrhoea 

Clopidogrel

Clopidogrel  is another anti-platelet medicine. It is usually only prescribed if you have:

• severe side effects from taking aspirin
• had a further TIA, despite taking aspirin
• arterial disease

Side effects of clopidogrel may include:

• diarrhoea 
• abdominal pain
• indigestion
• bruising 
• bleeding

Anti-coagulant medication

Anti-coagulant medicines work by reducing the level of certain chemicals in your blood needed to help the blood to clot.

You will usually only be prescribed an anti-coagulant medicine if the blood clot that caused your TIA originated in your heart. This is often due to a condition called atrial fibrillation, which causes your heart to beat irregularly

Warfarin

Warfarin is the anti-coagulant medicine used to help prevent further TIAs.

It is important that you receive the correct dose of warfarin. It must be enough to ensure your blood is 'thinner' (less able to clot), but it should not be so thin that it causes problems, such as internal bleeding.

Your condition will be carefully monitored while you are taking warfarin. You will need regular blood tests, known as international normalised ratio (INR) tests.

An INR test measures how long it takes your blood to clot. Your warfarin dosage may have to be adjusted after an INR test to ensure you are getting the right amount.

Bleeding is the most serious side effect of warfarin. Seek immediate medical attention if you notice any of the following symptoms while taking warfarin:

• passing blood in your urine or stools (faeces)
• passing black faeces
• severe bruising
• prolonged nosebleeds (lasting more than 10 minutes)
• blood in your vomit
• coughing up blood
• unusual headaches
• in women, heavy periods or increased bleeding during your period, or any other bleeding from your vagina

If you are unable to tolerate warfarin, you may be prescribed an oral anti-coagulant medicine, such as dabigatran.

Blood pressure medication

If you have high blood pressure (hypertension), you may have to take medication to control it. This is because high blood pressure significantly increases your risk of having a TIA or stroke.

There are lots of different types of medicine that can help control your blood pressure. Your GP will advise you about which one is the most suitable for you. To be effective, some people have to take a combination of two or three different blood pressure medicines.

Cholesterol medication

High cholesterol is another factor that may increase your risk of having a TIA. You can lower your cholesterol by making certain lifestyle changes, such as eating a healthy, balanced diet.

If your cholesterol level needs to be lowered with medication, you will usually be prescribed a type of medicine known as a statin. Statins help reduce the production of cholesterol in your liver.

Surgery

In some cases, you may need surgery after having a TIA or stroke. A procedure known as a carotid endarterectomy is commonly used.

Carotid endarterectomy
A carotid endarterectomy is a surgical procedure that involves removing part of the lining of the damaged carotid artery, plus any blockage that has built up in the artery.

The carotid arteries deliver blood to your brain. When fatty deposits build up inside the carotid arteries, they become hard and narrow, making it more difficult for blood to flow through them. This is known as atherosclerosis.

If you have atherosclerosis, you may need a carotid endarterectomy to help reduce your risk of having a further TIA or stroke.

However, carotid endarterectomies are not suitable for everyone with atherosclerosis. For example, if your arteries are almost completely blocked, the procedure is unlikely to work.

If your carotid arteries are only partially blocked, you may also be unsuitable for this type of surgery because your risk of having a stroke during the procedure may outweigh the potential benefits of surgery.

A carotid endarterectomy is most suitable for people who have a moderate to severe blockage in their arteries. In such cases, the procedure can reduce the risk of further TIAs and strokes by more than a half.

Mini-stroke - Causes of a transient ischaemic attack (TIA)

Mini-stroke - Causes of a transient ischaemic attack (TIA)

During a transient ischaemic attack (TIA), one of the small blood vessels that supply your brain with oxygen-rich blood becomes blocked.

Blood is supplied to your brain by two main blood vessels (carotid arteries) and two other blood vessels (vertebral arteries). These arteries branch off into a series of smaller blood vessels that supply blood to every part of your brain.

If a blood vessel becomes blocked, the blood flow to your brain will be disrupted. In transient ischaemic attack (TIAs), the disruption quickly passes and your brain's blood supply soon returns to normal. In a full stroke, blood flow to your brain is disrupted for much longer. Without a constant supply of blood, your brain cells will begin to die.

The blockage in your blood vessels is usually caused by a narrowing of the arteries, or as a result of a blood clot that has formed elsewhere in your body and travelled to your brain.

Atherosclerosis

Atherosclerosis is a condition that causes narrowing of the arteries. It occurs when fatty deposits, known as plaques, develop on the inner lining of your blood vessels.

This can cause your blood vessels to become thickened, hard and less elastic, making it more difficult for blood to flow through them.
.

Blood clots

A transient ischaemic attack (TIA) can also occur when a blood clot develops in a blood vessel and blocks the blood supply to your brain.

Blood clots can be caused by a number of different factors including:

• heart conditions   -  such as atrial fibrillation, which causes your heart to beat irregularly, or congestive heart muscle disease where your heart does not pump blood effectively 
• blood conditions - such as leukaemia (cancer of the blood cells), sickle cell anaemia (an inherited blood disorder), high levels of fat in your blood (hyperlipidaemia), abnormally thickened blood (polycythaemia), or overproduction of platelets in your blood (thrombocythaemia)

A TIA can sometimes occur when a blood clot from a blood vessel in another part of your body moves into one of the arteries that supply blood to your brain. This is known as an embolism.

Haemorrhage

In very rare cases, a TIA can be caused by a small amount of bleeding in the brain. This is known as a haemorrhage.

Risk factors

A number of factors can increase your chances of having a TIA. These risk factors can either be:

fixed - such as age and gender
changeable   -  by altering your lifestyle, you may be able to reduce your risk of having a TIA
Some of the fixed risk factors associated with TIA are outlined below.

Age
As you get older, your arteries begin to harden and narrow, increasing your risk of having a TIA.

TIAs most commonly occur in people over 60 years of age, although they can occur at any age, including in children and young adults.

Gender
Men have a higher risk of having a TIA compared with pre-menopausal women. The risk of having a TIA or stroke increases in post-menopausal women.

It is not fully understood why the risk of having a TIA increases following the menopause (when a woman's monthly periods stop). However, the female hormones, oestrogen and progesterone, are thought to play a role as they can affect elasticity of the blood vessels.

In menopausal women, oestrogen and progesterone levels fall, which may cause the blood vessels to become harder and less elastic.

Ethnicity
As people of South Asian, African and Caribbean origin have an increased risk of developing high blood pressure and diabetes, they are also more at risk of having a TIA.

Family history
If you have a family history of stroke or TIA, your risk of having a TIA is increased. However, the risk is relatively small and having family members who have had a TIA will not necessarily mean that you will have one.

High blood pressure
High blood pressure (hypertension) is the most significant risk factor associated with TIA. Having high blood pressure puts extra strain on your body's blood vessels, causing them to become narrowed or clogged.

Weight and diet
A diet high in saturated fat increases your risk of developing atherosclerosis. If there is too much salt in your diet, it is likely your blood pressure will be elevated which, like atherosclerosis, is a major risk factor for TIA.

Being overweight also puts your heart under strain and weakens your blood vessels.

Smoking
Smoking can double your risk of having a TIA or stroke. The harmful chemicals in cigarette smoke cause the lining in the arteries to thicken, which makes your blood more likely to clot.

Therefore, stopping smoking (if you smoke) is one of the main ways of preventing a TIA or stroke.

TIA symptoms

TIA symptoms

The key to spotting TIA symptoms and the action to be taken are the same as for a full stroke - FAST:

• Face. The face may have drooped on one side, inability to smile, drooped mouth or eye. Possible loss of vision.
• Arms. Inability to raise both arms, weakness or numbness. Dizziness or possible paralysis down one side.
• Speech. This may be slurred. Swallowing may be difficult.
• Time. Getting treatment quickly is vital. Dial 999 immediately if someone has these warning signs.

The parts of the body affected will depend on the part of the brain the TIA has attacked.
In extreme cases, the person may be unconscious.

TIA - Transient Ischaemic Attack

TIA - Transient Ischaemic Attack (mini-stroke)

A transient ischaemic attack (TIA) is a temporary blockage of blood flow in the brain that causes brief stroke symptoms.

This is sometimes called a mini-stroke and considered a warning sign of a future more serious stroke with the risk of death or brain damage.

A transient ischaemic attack (TIA) usually lasts a matter of minutes and the symptoms resolve within 24 hours. They may include weakness on one side of the body, dizziness, blurred vision, confusion and speech problems.

The NHS estimates there are more than 50,000 transient ischaemic attacks in England each year.

Although the term mini-stroke doesn't sound serious, it is a medical emergency, which is why nowadays people are moving away from using the term mini-stroke. Without getting treatment, a person has a one in 10 chance of having a full stroke within four weeks of the transient ischaemic attack (TIA).

Are strokes preventable?

Are strokes preventable?

Up to 50% of all strokes are preventable. Many risk factors can be controlled before they cause problems.

Controllable risk factors Include:

• High blood pressure
• Atrial fibrillation
• Uncontrolled diabetes
• High cholesterol
• Smoking
• Excessive alcohol intake
• Being overweight
• Existing carotid and/or coronary artery disease

Uncontrollable Risk Factors:

• Age (over 65)
• Race (Black people and people of South Asian origin are at increased risk)
• Family history of stroke

Your doctor can evaluate your risk of stroke and help you control your risk factors. Sometimes, people experience warning signs before a stroke occurs. These are called transient ischaemic attacks (also called TIA or "mini-stroke") and are short, brief episodes of the stroke symptoms listed above. Some people have no symptoms warning them prior to a stroke or symptoms are so mild they are not noticeable. Regular check-ups are important in identifying problems before they become serious. Report any symptoms or risk factors to your doctor.

Types of Strokes

Types of Strokes

Stroke symptoms may differ, depending upon the type of stroke, where it occurs in the brain, and how severe it is. A less severe stroke may be more difficult to recognize.

An ischemic stroke happens when a vessel supplying blood to the brain becomes blocked. It can happen for a variety of reasons. For example, fatty deposits in arteries (atherosclerosis) can cause blood clots to form. Sometimes a blood clot forms in the heart from an irregular heartbeat called atrial fibrillation. It then travels to a place where it blocks an artery supplying the brain.

A hemorrhagic stroke happens when a weakened blood vessel ruptures and bleeds into the brain. This can also happen for a variety of reasons.

A transient ischemic attack (TIA) is a "mini stroke" from a temporary blockage. Although a TIA doesn't cause permanent brain damage, it may cause stroke warning signs, which may last minutes or even hours. Think of this as a warning sign you shouldn't ignore.

Causes of Stroke

Causes of Stroke


A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die.

A stroke may be caused by a blocked artery (ischemic stroke) or a leaking or burst blood vessel (hemorrhagic stroke). Some people may experience a temporary disruption of blood flow through their brain (transient ischemic attack, or TIA).

Ischemic stroke

About 85 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms).

A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation) present at birth. Types of hemorrhagic stroke include:

Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and damaged.

High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause intracerebral hemorrhage.

Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache.

A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped outpouching on an artery (aneurysm) in the brain. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — also called a ministroke — is a brief period of symptoms similar to those you'd have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn't leave lasting symptoms because the blockage is temporary.

Seek emergency care even if your symptoms seem to clear up. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain, or a clot source in the heart, putting you at a greater risk of a full-blown stroke that could cause permanent damage later.

It's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of people whose symptoms appear to go away actually have had a stroke causing brain damage.

Stroke Prevention

Stroke Prevention

The good news is that 80 percent of all strokes are preventable. It starts with managing key risk factors, including high blood pressure, cigarette smoking, atrial fibrillation and physical inactivity. More than half of all strokes are caused by uncontrolled hypertension or high blood pressure, making it the most important risk factor to control.

Medical treatments may be used to control high blood pressure and/or manage atrial fibrillation among high-risk patients. Those medicines include:
Anticoagulants/Antiplatelets
Antiplatelet agents such as aspirin and anticoagulants, such as warfarin, interfere with the blood's ability to clot and can play an important role in preventing stroke.

Antihypertensives
Antihypertensives are medications that treat high blood pressure. Depending on the type of medication, they can lower blood pressure by opening the blood vessels, decreasing blood volume or decreasing the rate and/or force of heart contraction. Learn about the types of antihypertensives.
Additionally, when arteries show plaque buildup or blockage, medical procedures may be needed. Such as:

View a detailed illustration of carotid endarterectomy (opens in new window)Carotid Endarterectomy
Carotid endarterectomy, also called carotid artery surgery, is a procedure in which blood vessel blockage (fatty plaque) is surgically removed from the carotid artery.
View a detailed illustration of carotid endarterectomy (opens in new window).

Angioplasty/Stents
Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease and help open up the blocked blood vessel

Learn More Stroke Warning Signs and Symptoms

Learn More Stroke Warning Signs and Symptoms
Other Symptoms You Should Know

• Sudden numbness or weakness of the leg, arm or face
• Sudden confusion or trouble understanding 
• Sudden trouble seeing in one or both eyes 
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Don't wait to see if symptoms go away. Every minute counts.

The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, you'll need to be treated at a hospital within three hours after your first symptoms appeared.

Symptoms of Stroke

Symptoms of Stroke

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when your signs and symptoms begin, because the length of time they have been present may guide your treatment decisions:

• Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
• Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
• Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
• Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
• Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.