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Stroke occurs when the supply of blood to the brain is either interrupted or reduced. When this happens, the brain does not get enough oxygen or nutrients which causes brain cells to die.
Strokes occur due to problems with the blood supply to the brain; either the blood supply is blocked or a blood vessel within the brain ruptures.
There are three main kinds of stroke; ischemic, hemorrhagic and TIA. This article will focus on ischemic and hemorrhagic strokes, as there is a separate Knowledge Center article for TIAs, which goes into specific detail about them.
Approximately 40% of stroke deaths are in males, with 60% in females. According to the American Heart Association (AHA), in 2006, the stroke death rates per 100,00 population could be split into specific social groups at 41.7% for white males, 41.1% for white females, 67.7% for black males and 57.0% for black females.
Stroke is also more likely to affect people if they are overweight, aged 55 or older, have a personal or family history of stroke, do not exercise much, drink heavily or use illicit drugs.
The different forms of stroke have different specific causes.
Ischemic strokes are the most common form of stroke, with around 85% of strokes being of this type. They are caused by the arteries that connect to the brain becoming blocked or narrowed, resulting in ischemia - severely reduced blood flow.
These blockages are often caused by blood clots, which can form either in the arteries connecting to the brain, or further away before being swept through the bloodstream and into narrower arteries within the brain. Clots can be caused by fatty deposits within the arteries called plaque.
Hypertension can lead to blood vessel ruptures and hemorrhagic strokes.Hemorrhagic strokes4,6
Hemorrhagic strokes are caused by arteries in the brain either leaking blood or bursting open. The hemorrhaged blood puts pressure on brain cells and damages them. Blood vessels can burst or spill blood in the middle of the brain or near the surface of the brain, sending blood into the space between the brain and the skull.
The ruptures can be caused by conditions such as hypertension, trauma, blood-thinning medications and aneurysms (weaknesses in blood vessel walls).
Transient ischemic attack (TIA)
TIAs are different from the aforementioned kinds of stroke because the flow of blood to the brain is only disrupted temporarily for a short time. They are similar to ischemic strokes in that they are often caused by blood clots or other debris.
TIAs should be regarded as medical emergencies just like the other kinds of stroke, even if the blockage of the artery is temporary. They serve as warning signs for future strokes and indicate that there is a partially blocked artery or clot source in the heart.
According to the Centers for Disease Control and Prevention (CDC), over a third of people who experience a TIA go on to have a major stroke within a year if they have not received any treatment. Between 10-15% will have a major stroke within 3 months.
Strokes occur quickly, and as such their symptoms often appear suddenly without warning. The main symptoms are as follows:
Confusion, including trouble with speaking and understanding
Headache, possibly with altered consciousness or vomiting
Numbness of the face, arm or leg, particularly on one side of the body
Trouble with seeing, in one or both eyes
Trouble with walking, including dizziness and lack of co-ordination.
Strokes can lead to long-term problems. Depending on how quickly it is diagnosed and treated, the patient can experience temporary or permanent disabilities in the aftermath of a stroke. In addition to the problems listed above continuing, patients may also experience the following:
Bladder or bowel control problems
Pain in the hands and feet that gets worse with movement and temperature changes
Paralysis or weakness on one or both sides of the body
Trouble controlling or expressing emotions.
Tests and diagnosis
Strokes occur quickly, so that often a stroke diagnosis will have to be made before an individual can be seen by a doctor. The acronym FAST is a way to remember the signs of stroke, and can help toward identifying the onset of stroke in someone:
It is important that strokes are diagnosed as quickly as possible. The quicker that treatment can be administered, the less damage that will be done to the brain. In order for a stroke patient to get the best diagnosis and treatment possible, they will need to be treated at a hospital within 3 hours of their symptoms first appearing.
Both ischemic strokes and hemorrhagic strokes require different kinds of treatment. Unfortunately, it is only possible to be sure of what type of stroke someone has had by giving them a brain scan in a hospital environment.
There are several different types of diagnostic tests that doctors can use in order to pin down precisely what type of stroke has been experienced:
CT scan of brain
CT scans of the brain are one of the only ways to diagnose what type of stroke a person has had.
Physical examination: a doctor will ask about the patient's symptoms and medical history. They may check blood pressure, listen to the carotid arteries in the neck and examine the blood vessels at the back of the eyes, all to check for indications of clotting
Blood tests: a doctor may perform blood tests in order to find out how quickly the patient's blood clots, what the levels of chemicals within it are like and whether or not the patient has an infection
CT scan: a series of X-rays that can show hemorrhages, strokes, tumors and other conditions within the brain
MRI scan: radio waves and magnets create an image of the brain to detect damaged brain tissue
Carotid ultrasound: an ultrasound scan to check the blood flow of the carotid arteries and to see if there is any plaque present
Cerebral angiogram: dyes are injected into the brain's blood vessels to make them visible under X-ray, in order to give a detailed view of the brain and neck arteries
Echocardiogram: a detailed image of the heart is created to check for any sources of clots that could have traveled to the brain to cause a stroke.
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