A Visual Guide to Understanding Stroke

What Is a Stroke?

A stroke is a medical emergency. It happens when a blood vessel in the brain bursts or, more commonly, when a blockage develops. Without treatment, cells in the brain quickly begin to die. This can cause serious disability or death. If a loved one is having stroke symptoms, call 911 right away.

Stroke Symptoms

Signs of a stroke may include sudden:

• Numbness or weakness of the body, especially on one side
• Vision changes in one or both eyes, or trouble swallowing
• Severe headache with an unknown cause
• Problems with dizziness, walking, or balance
• Confusion, difficulty speaking, or understanding others

Don’t wait to see if these symptoms pass. Call 911 right away.

Think FAST

The FAST test helps spot symptoms. It stands for:

Face. Ask for a smile. Does one side droop?

Arms. When raised, does one side drift down?

Speech. Can the person repeat a simple sentence? Does he have trouble or slur words?

Time. Get medical help right away. Some stroke meds must be given very soon after symptoms start.

Stroke: Time = Brain Damage

Every second counts when seeking treatment for a stroke. When deprived of oxygen, brain cells begin dying within minutes. There are clot-busting drugs that can curb brain damage, but they must be given within 3 hours of when symptoms start. Once brain tissue has died, the body parts controlled by that area won’t work right. This makes stroke a top cause of long-term disability.

Diagnosing a Stroke

When someone with stroke symptoms arrives in the ER, doctors will check on whether it’s a clot-based (ischemic) stroke or one caused by bleeding (a hemorrhagic stroke). The treatments differ by type. A CT scan can help doctors learn whether the symptoms are coming from a blocked blood vessel or a bleeding one. More tests may be needed to find where the blood clot or bleeding is within the brain.

Ischemic Stroke

This is the most common type of stroke. Nearly nine out of 10 strokes fall into this category. It happens when a blood clot blocks a blood vessel inside the brain. The clot may start in that spot or travel through the blood from elsewhere in the body.

Hemorrhagic Stroke

Hemorrhagic strokes are less common but more likely to be fatal. They happen when a weakened blood vessel in the brain bursts. The result is bleeding inside the brain that can be hard to stop.

'Mini-Stroke' (TIA)

A transient ischemic attack, often called a "mini-stroke," is more like a close call. Blood flow is temporarily hampered in part of the brain, causing stroke-like symptoms. When the blood flows again, the symptoms stop. But you can’t tell at the time if it’s a stroke or TIA, so call 911. And since a TIA is a warning sign, see your doctor if you think you've had one.

What Causes a Stroke

A common cause of stroke is atherosclerosis. Plaque made of fat, cholesterol, and other things builds up in the arteries, leaving less space for blood to flow. A blood clot may lodge in this narrowed space and cause an ischemic stroke. Atherosclerosis also makes it easier for a clot to form. Hemorrhagic strokes can happen if uncontrolled high blood pressure makes a weakened artery burst.

Risk Factors: Chronic Conditions

Your chance of having a stroke rises if you have:

• Atrial fibrillation
• High blood pressure
• High cholesterol
• Diabetes
• Obesity

Taking steps to control these conditions may reduce your risk.

Risk Factors: Behaviors

These habits can make you more likely to have a stroke:

• Smoking
• Not getting enough exercise
• Heavy drinking

Risk Factors: Diet

Eating too much fat and cholesterol can lead to arteries that are narrowed by plaque. Too much salt may contribute to high blood pressure. And too many calories can lead to obesity. A diet high in fruits, vegetables, whole grains, and fish may help lower your stroke risk.

Risk Factors You Can't Control

These include getting older and having a family history of strokes. Gender plays a role, too: Men are more likely to have a stroke, but women are more likely to die of one. Also, African Americans, Native Americans, and Alaska Natives are at greater risk compared to people of other ethnicities.

Stroke: Emergency Treatment

For an ischemic stroke, emergency treatment focuses on medicine to restore blood flow. A clot-busting medication is very good at dissolving clots and cutting the chance of long-term damage, if it’s given in time. Hemorrhagic strokes are harder to manage. Treatment usually involves attempting to control high blood pressure, bleeding, and brain swelling.

Stroke: Long-Term Damage

Whether a stroke causes long-term damage depends on how severe it is and how quickly treatment helps the brain. The type of damage depends on where in the brain the stroke happens. A stroke survivor may have one or more issues, such as numbness in the arms or legs and trouble with walking, vision, swallowing, talking, or understanding. These problems may be permanent, but many people regain some or even most of their abilities.

Stroke Rehab: Speech Therapy

Rehabilitation is key to the stroke recovery process. It helps people regain lost skills and learn to adapt to damage that can't be undone. The goal is to help restore as much independence as possible. For people who have trouble speaking, speech and language therapy is a must. A speech therapist can also help if someone has trouble swallowing.

Stroke Rehab: PT and OT

Muscle weakness, as well as balance problems, are very common after a stroke. This can affect walking and other daily activities. Physical therapy is an effective way to regain strength, balance, and coordination. For fine motor skills, such as using a knife and fork, writing, and buttoning a shirt, occupational therapy can help.

Stroke Rehab: Talk Therapy

It’s common for stroke survivors and their loved ones to feel a wide range of intense emotions, such as fear, anger, worry, and grief. A psychologist or mental health counselor can show you ways to manage these emotions. A therapist can also watch for signs of depression, which often happens in people who are recovering from a stroke.

Stroke Prevention: Lifestyle

People who have had a stroke or TIA can take steps to help prevent it from happening again:

• Quit smoking.
• Exercise and get to a healthier weight.
• Limit alcohol and salt.
• Eat a healthier diet with more veggies, fish, and whole grains.

Stroke Prevention: Medications

For people with a high risk of stroke, doctors often recommend medications to lower this risk. Anti-platelet medicines, including aspirin, keep platelets in the blood from sticking together and forming clots. Some people may need anti-clotting drugs, such as warfarin. And if you have high blood pressure or high cholesterol levels, your doctor will prescribe medication to lower them, in addition to lifestyle changes.

Stroke Prevention: Surgery

In some cases, a stroke results from a narrowed carotid artery -- the blood vessels on both sides of the neck that bring blood to the brain. People who have had a mild stroke or TIA due to this problem may benefit from surgery known as carotid endarterectomy. This procedure removes plaque from the lining of the carotid arteries and can prevent additional strokes. Your doctor will help you weigh the risks and benefits.

Stroke Prevention: Balloon and Stent

Doctors can treat a clogged carotid artery without major surgery in some cases. The procedure, called angioplasty, involves temporarily inserting a catheter into the artery and inflating a tiny balloon to widen the area that is narrowed by plaque. A metal tube, called a stent, can be inserted and left in place to keep the artery open.

Life After a Stroke

More than half of people who have a stroke regain the ability to take care of themselves. Those who get clot-busting drugs soon enough may recover completely. And those who have some disability can often learn ways to manage it through PT or OT. While the risk of a second stroke is higher at first, this risk drops off over time.