Stroke: Know the Signs

What is a stroke?

When blood stops flowing to the brain because of a clot or rupture (hemorrhage), it’s called a stroke. This is extremely dangerous because blood carries essential oxygen and nutrients to the brain.

The brain controls every part of the human body, and without blood, brain cells begin to die off and the brain cannot function properly.

What are the 3 types of stroke?

• Ischemic stroke is when a blood vessel is completely blocked and blood can’t flow through. This is by far the most common type of stroke.
• Hemorrhagic stroke happens when a blood vessel in the brain bursts. The leaked blood puts too much pressure on surrounding brain tissue, and damages them.
• Transient ischemic attack (TIA), which is sometimes called a mini-stoke, is when there is a brief and temporary blockage of a blood vessel. Because this only disrupts blood flow for a short amount of time, the symptoms are short-lived as well.

All types of strokes cause sudden symptoms involving your nervous system, affecting balance, sensation, and control. When a stroke affects multiple areas of the brain or is very large, it can lead to death.

Most common stroke symptoms

Stroke symptoms happen fast and often involve signs like:

• Blurred or double vision
• Weakness or numbness in an extremity
• Slurred speech
• Seizures

Main symptoms

The main symptoms you experience—and the amount of permanent damage you may have—depends on where the blockage occurs. There are four main blood vessels of the brain where a stroke can originate.

• The middle cerebral artery brings blood to the middle and sides of the brain. It's a large area across many parts of your brain with many responsibilities. Usually, this type of stroke leads to numbness or weakness in the face, hands, and feet. There may be problems with spatial processing (ability to sense physical space) and controlling their movement. They may seem clumsy, bumping into things, and standing too close. It can cause trouble speaking and understanding words. 
• The anterior cerebral artery and its branches bring blood to the front of the brain, which controls movement in the legs and executive function (like memory, focus, emotions, etc), and to the areas responsible for language. People who suffer a stroke here can experience personality changes and problems with impulse control.
• The posterior cerebral artery brings blood to the back of the brain. It is in charge of how you see. This type of stroke mainly involves vision problems like blurred vision, and not being able to see out of one eye completely. Though there can also be cognitive problems such as confusion.
• The cerebellum is the control center for balance and coordinated movements. A stroke in the cerebellar arteries usually causes symptoms like difficulties walking, changes in how you speak, abnormal eye movements (jerky eye movements), nausea, and feeling off balance (vertigo).

A transient ischemic attack can affect any of these areas. Though the symptoms are not permanent and tend to get better without the need for therapy.

Next steps

If you notice any of the signs or symptoms of stroke or a TIA, call 911 immediately. Time is crucial. The longer you wait to get treatment, the more likely that the damage will be permanent.

At the hospital, a doctor will perform emergency imaging like a computed tomography (CT) scan or a magnetic resonance imaging (MRI) to find out what type you are having. This will determine treatment.

Stroke causes

Strokes happen when blood flow to the brain stops. This can happen if a clot travels from another part of the body to the brain and then blocks a blood vessel, if the blood vessels have plaque buildup that makes them too narrow, or if a blood vessel bursts. In any of these scenarios, brain cells cannot get the oxygen they need to survive. The brain cells begin to release acids and electrolytes, which causes them to die.

Stroke treatment

It’s critical to get treated as soon as possible to reduce damage to brain cells. Ischemic strokes that are caught quickly can be treated with a medication called tissue plasminogen activator (tPA). This helps break down clots and gets the blood flowing again.

Very large clots or hemorrhagic strokes require surgery to remove the clot or stop the bleeding. Hemorrhagic strokes cannot be treated with tPA.

Risk factors

There are many factors that can increase a person’s risk of stroke.

• Any health issue that affects how easily blood flows through your body increases your risk. This includes conditions such as high blood pressure, diabetes, and atherosclerosis (plaque buildup in blood vessels).
• Having had a previous stroke or a family history for stroke.
• Genetic diseases such as sickle cell disease or protein C deficiency (clotting disorder).
• Smoking—even if you’ve quit. It makes you more likely to develop peripheral artery disease or cardiovascular disease.
• Being 40 and older. More likely to have plaque buildup (atherosclerosis) and other health issues like diabetes.

Stroke in children

It’s not very common, but children can also have strokes. They’re usually ischemic. Call 911 immediately if you think your child is having a stroke. It can cause serious complications, including interfering with a child’s cognitive (brain) development if not treated.

Unlike an adult, a stroke in a child isn’t usually because of diseases like diabetes or peripheral artery disease. Instead, it’s typically related to conditions a child is born with like:

• Congenital heart defects
• Blood disorders
• Infection
• Lack of oxygen during birth

Hemorrhagic strokes in children are most often caused by a head injury that damages blood vessels, aneurysms (weakness in the walls of the artery), or areas in the brain where the vessels don’t connect properly.

Children can also experience transient ischemic attacks. If a child complains or you notice any of the stroke symptoms, call 911 or go to the ER. Diagnostic testing should be performed to treat it and evaluate for underlying causes.

Follow up

Make an appointment with your primary doctor and a neurologist after you are discharged from the hospital or ER. If you have other conditions like peripheral artery disease and atherosclerosis, you may also need to see a vascular surgeon (or neurosurgeon). You will likely need to see a physical therapist and probably do rehabilitation. This is an important part of treatment to maximize recovery from the damage the stroke caused.

If you suffered an ischemic stroke, your doctors may suggest a blood-thinning medication to prevent future clots.

Transient ischemic attacks are a sign that you may have a full stroke in the future. They often require monitoring and control of other diseases that increase your risk (hypertension, diabetes, etc.). Your doctor may prescribe a medication to better control symptoms such as a statin (drug that lowers cholesterol) to treat atherosclerosis.

Stroke prevention

You can help lessen your risk for a stroke by:

• Knowing your family history and sharing it with your doctor.
• Exercising regularly.
• Eating a balanced, healthy diet (especially if you are overweight).
• For managing high blood pressure, monitor it with a reliable blood pressure monitor.
• Quitting smoking.
• Getting appropriate screening and treatment for other conditions. Your doctor may run tests for heart disease, diabetes, atherosclerosis, and other conditions.