Strokes: Signs, Symptoms, Causes, & Treatment

A stroke (sometimes referred to as a “brain attack”) occurs when the blood supply to the brain is suddenly interrupted or reduced. As a result, parts of the brain can be starved of oxygen and become damaged. A stroke can happen at any age, but the risk almost doubles after the age of 55. Smoking cigarettes and having high blood pressure both increase the risk of having a stroke. It is not just adults who have strokes; children can also have a stroke although this is rare.

You may be worried about having a stroke yourself or you may have concerns about a loved one. Fortunately, there are things you can do to prevent a stroke. A stroke is a medical emergency that requires prompt treatment so it is important to be aware of its signs and symptoms. Getting medical assistance quickly can improve your chances of making a full recovery and reduce your risk of suffering long-term damage.

What Is a Stroke?

During a stroke, your brain’s blood supply is suddenly interrupted which can result in damage to parts of the brain. There are two ways in which the blood supply can be interrupted:

• Blockage: An artery leading to the brain gets blocked, either by a blood clot, other debris in the blood or through narrowing of the arteries by fatty plaques (as occurs in heart disease). A stroke caused by a blockage is called an ischemic stroke.
• Burst/rupture: One of the blood vessels leading to the brain suddenly bursts and then blood leaks out into the surrounding brain tissue where it can cause further damage. A stroke caused by a rupture is called a hemorrhagic stroke.

Because a stroke damages the brain, it can lead to problems with memory, speech, movement, and other functions. The most commonly reported after-effects of stroke are sudden weakness in a part of the body, loss of sensation, difficulty speaking, seeing, or walking. When the symptoms of stroke dissipate, this is called a transient ischemic attack (TIA) or a mini-stroke.

You may get a severe headache before the onset of stroke but in many cases, there are no warning signs. Learn about the warning signs of stroke below so you can evaluate whether you or a loved one is having a stroke which requires prompt medical attention.

What Causes a Stroke?

A stroke is caused by an event that affects the blood supply to the brain. This could be a blood clot, a narrowing, or a blockage in any of the arteries leading to the brain. It can also be caused by a ruptured artery which results in leaking of blood into the brain.

There are two main types of stroke:

• Ischemic stroke: This is the most common type of stroke, accounting for almost 80% of all strokes. Ischemic stroke happens when a blood clot or some other debris in the blood (embolus) causes a blockage in an artery that supplies blood to the brain.
• Hemorrhagic stroke: This is caused by the sudden rupture of an artery within or near the brain. Following the rupture, blood spills out into the surrounding brain tissue, damaging brain cells. This type of stroke can cause more widespread damage as brain cells beyond the leak are deprived of blood. Following the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing further brain cell damage. This type of stroke can sometimes be preceded by a severe headache, described as the “worst headache of your life”.

What Is a Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is sometimes referred to as a mini-stroke. The mechanism of injury in a TIA may be similar to stroke, but what differentiates this from a stroke is that the attack is short lived. This means that the effect of the TIA only lasts for a short time (often as little as five mins) and there is no long-term damage or after-effects.

However, having a TIA puts you at greater risk of getting a full-blown stroke in the future so always follow up with a doctor after a suspected TIA, even if your symptoms appear to have dissipated completely. In addition to ruling out a stroke, your doctor can also advise you on how to reduce the risks of getting another TIA or stroke.

Signs of Stroke in Women

Although stroke is more common in men, women are more likely to die from a stroke than men are. The more you know about the symptoms of strokes in women, the better prepared you will be to get help. There are a number of pre-stroke symptoms that are more common in women:

• Nausea or vomiting
• Seizures
• Hiccups
• Trouble breathing
• Pain
• Fainting or loss of consciousness
• General weakness

If you are a woman and unsure whether your symptoms indicate a stroke, call emergency services and get yourself examined. Prompt treatment can mean the difference between life and death.

Stroke Symptoms and Early Warning Signs

A stroke can creep up on you with no warning, although in many cases there are warning signs. Some early signs of a stroke are rapid-onset headache (although most headaches are not a sign of stroke), slurred speech, or sudden weakness in the muscles of your face, arms, or legs. Stroke signs and symptoms vary from person to person and depend on which side and area of the brain is involved and how severe the blockage or rupture.

The sudden onset of any of the following symptoms can also be an early warning of stroke:

• Numbness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking, or understanding speech
• Trouble seeing in one or both eyes
• Difficulty walking, dizziness, loss of balance, or coordination
• Severe headache with no known cause

How Is a Stroke Diagnosed?

When you seek medical attention for a stroke or suspected stroke, your medical team will need to promptly establish whether this is a stroke or another issue, what type of stroke you are having, and which areas of your brain were affected. There are several tests which your doctor may use in order to explore the cause of your symptoms:

• Information gathering: Your doctor will ask about your symptoms and any medications you take. They will also ask if you have suffered a head injury and about your family history of heart disease, TIA, and stroke.
• Physical examination: A doctor will do a detailed neurological exam to look for any deficits you may be experiencing. They will also complete an examination of the rest of your body, for instance checking your blood pressure, listening to your heart, or even checking for blood clots in the back of your eyes using an ophthalmoscope.
• Blood tests: Your doctor may order a complete blood count (CBC) to measure the overall health of your blood and diagnose infection, anemia, clotting, or other blood problems. You may also have a blood test to determine whether you suffered a heart attack.
• Computerized tomography (CT) scan: Your doctor may order a CT scan to create an image of your brain that can show hemorrhages, tumors, and other conditions.
• Magnetic resonance imaging (MRI): Your doctor may order an MRI test to get an even-more detailed view of your brain and see whether any areas have been damaged.
• Carotid ultrasound: This painless test used a scanner to show detailed images of the inside of the arteries in your neck and can reveal if there is any buildup of fatty deposits (plaques).
• Cerebral angiogram: This test allows your doctor to get a detailed view of arteries in your brain and neck by passing a catheter from a peripheral artery up to your brain and injecting dye.
• Echocardiogram: This common heart test uses sound waves to create detailed images of your heart. An echocardiogram can find the source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

Assessing the severity of your stroke

If you or a loved one has had a stroke, you may be told about the NIH Stroke Scale (also called NIHSS). This is a widely used tool designed to help doctors assess the impact of a stroke on the patient. Health professionals use the NIHSS score to determine the severity of a stroke and the course of treatment.

The scale incorporates 11 functions for which you are given a score between zero and four (zero is the least affected and four is the most). Your total NIHSS score is sometimes used by doctors as a rough predictor of your outcome.

The 11 functions of the NIH Stroke Scale are:

1. Level of consciousness: The tester will evaluate how alert and responsive you are by asking simple questions such as, “what is the current month?” or, “how old are you?”

2. Best gaze: The tester will evaluate whether you can use your eyes normally.

3. Visual: The tester will look at your visual field by testing whether you can see things not directly in front of you.

4. Facial palsy: The tester will look at your ability to move your facial muscles by asking you to show your teeth or raise your eyebrows.

5. Motor arm: The tester will test your ability to hold up your arms up for a certain amount of time.

6. Motor leg: This tester might ask you to hold up each leg in turn.

7. Limb ataxia: You may be asked to perform the finger-to-nose and the finger-to-finger test.

8. Sensory: The tester will test your sensory abilities by administering a pinprick.

9. Best language: The tester will try and determine whether your language abilities have been affected (if at all).

10. Dysarthria: The tester will assess whether you are slurring your speech (if at all).

11. Extinction and inattention: The tester will assess how your five senses are working.

Stroke Treatment Options

Your treatment will depend on the type of stroke you had:

Treatments for ischemic stroke

If you suffered an ischemic stroke, the first priority in your treatment will be to quickly restore blood flow to your brain. This can be done through the following interventions:

• Medication: Doctors will give you drugs that break up blood clots. The most common one is intravenous injection of tissue plasminogen activator (tPA). For best results, this medication should be given within four and a half hours of the stroke starting.
• Emergency endovascular procedures: Your doctor may carry out a procedure such as intra-arterial thrombolysis to unblock your blood vessels. He/she may also suggest removing the clot using a stent retriever procedure.
• Preventative treatments: Your doctor may suggest a carotid endarterectomy in which a surgeon removes plaques that block the carotid artery. He/she might also suggest angioplasty and stents–a type of procedure where the damaged artery is expanded with a balloon and kept open with a supportive stent.

Treatment for hemorrhagic stroke

If you have had a hemorrhagic stroke your treatment will be aimed at controlling your bleeding and reducing pressure in your brain. In some cases, surgery may be required. Here is a summary of the main treatments for hemorrhagic stroke:

• Emergency medical treatment: For those on blood thinners such as warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, your doctor may give you drugs to reverse those effects. Other drugs your doctor may prescribe could be aimed towards lowering your blood pressure, reducing pressure in your brain, preventing vasospasm, and/or preventing potential seizures.
• Surgical blood vessel repair: Your doctor may decide you need surgery to decompress the area of bleeding in the brain or repair blood vessel abnormalities associated with your hemorrhagic stroke. Surgical clipping involves placing a tiny clamp at the base of an aneurysm to stop blood flow to it. Coiling uses tiny, detachable coils to fill the aneurysm and cause the blood around it to clot.

Stroke Risk Factors

Many factors can increase your stroke risk.

Risk factors that you can’t prevent are:

• Age: Anyone over the age of 55 is at higher risk.
• Ethnicity: African Americans have a higher rate of stroke.
• Gender: Men are more likely to have a stroke than women.
• Medication: Increased estrogen due to hormone therapy, pregnancy, or birth control can also increase your risk of stroke.

There are certain lifestyle factors associated with stroke. If you make a concerted effort to change your lifestyle, many of these risks can be reduced or eliminated:

• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illicit drugs such as cocaine and methamphetamines
• Smoking

If you suffer from the following medical conditions, you are at an increased risk of getting a stroke in the future:

• Previous stroke or TIA
• High blood pressure
• High cholesterol
• Heart disease
• Diabetes
• Sickle cell anemia

Stroke Complications

A stroke can cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected.

Complications may include:

• Paralysis or loss of muscle movement: You may become paralyzed on one side of your body, or you may lose control of certain muscles, such as those on one side of your face or one arm. Hemiparesis or unilateral paresis is a weakness of one entire side of the body. Hemiplegia indicates complete paralysis of half of the body.
• Difficulty talking or swallowing: Strokes can affect the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia), or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing.
• Memory loss or thinking difficulties: You may experience some memory loss after a stroke or have difficulty thinking, making judgments, reasoning, and understanding concepts.
• Emotional problems: You may find it harder to control your emotions after a stroke, or you may become depressed.
• Sensory loss, pain or unusual sensations: You may feel pain, numbness, or other strange sensations in parts of your body affected by the stroke. This complication is known as central stroke pain or central pain syndrome. The condition generally develops several weeks after a stroke and may improve over time. You may also have become more sensitive to temperature changes, especially extreme cold, after your stroke.
• Changes in behavior and self-care ability: You may become more withdrawn, less social or more impulsive. You may need help with grooming and daily chores.

Stroke Recovery and Rehabilitation

Once you have been treated in the acute setting, your medical team can evaluate whether you have any long-term damage, in which case you may need rehabilitative treatment. Your rehabilitative care will focus on helping you recover as much function as possible and return to independent living. Rehabilitation may take place while you are still in the hospital, or you may be discharged and continue care as an outpatient.

Depending on your specific condition, your treatment team may include a:

• Doctor trained in brain conditions (neurologist)
• Rehabilitation doctor
• Nurse
• Dietitian
• Physical therapist
• Occupational therapist
• Recreational therapist
• Speech pathologist
• Social worker
• Case manager
• Psychologist or psychiatrist

What You Can Do at Home

If you have had a stroke, it is critical that you seek medical attention immediately by calling 911. In terms of prevention, while there are some uncontrollable risk factors for stroke, up to 50% of all strokes are preventable. Knowing your stroke risk factors, following your doctor’s recommendations, and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. Prevention is often the best cure.

General lifestyle recommendations to reduce stroke risk include:

• Control high blood pressure (hypertension)
• Lower cholesterol and saturated fat in your diet
• Quit smoking
• Control your diabetes
• Maintain a healthy weight
• Eat a diet rich in fruits and vegetables
• Exercise regularly
• Reduce or eliminate alcohol intake
• Treat obstructive sleep apnea (OSA)
• Avoid illegal drugs e.g. cocaine and methamphetamines

Preventive Stroke Medications

If you’ve had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke in the future. These include:

• Anti-platelet drugs: Anti-platelet drugs make cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin.
• Anticoagulants: These drugs, which include warfarin (Coumadin) and newer agents reduce blood clotting.

When to See a Doctor

The longer a stroke goes untreated, the greater the potential for long-term brain damage and disability. It is better to be safe than sorry so always seek immediate medical attention if you notice any of the signs or symptoms of a stroke – even if they seem to fluctuate or disappear.

If you suspect that someone is having a stroke, you could use the FAST stroke test to help you determine whether immediate action is required:

• F—Face: Look in the mirror and smile, or ask the person to smile. Does one side of the face droop?
• A—Arms: Raise both arms. Does one arm drift downward?
• S—Speech: Repeat a simple phrase, like “Hello, my name is ____.” Is the speech slurred or strange?
• T—Time: Act fast. Stroke is a medical emergency. If you or someone you know is having these signs, seek medical attention straight away.

If you have even the slightest suspicion that a stroke caused these symptoms, call emergency services immediately.

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