Stroke – Symptoms and Causes

Overview

A stroke happens when blood flow to the brain is disrupted, causing brain cells to begin dying within minutes. About 800,000 people in the United States experience strokes each year.

There are two main types of strokes. Ischemic strokes account for 85% of all cases and occur when an artery becomes blocked, cutting off blood supply to part of the brain.

Hemorrhagic strokes happen when a blood vessel leaks or bursts, allowing blood to spill into or around brain tissue.

Risk Factors

While strokes can affect anyone, certain factors increase risk:

• Age (55 and older)
• African-American heritage
• Male gender
• Family history of strokes or heart attacks

Lifestyle factors that raise stroke risk include:

• Excess weight
• Physical inactivity
• Heavy alcohol consumption
• Recreational drug use
• Smoking

Medical conditions that increase risk include:

• High blood pressure
• High cholesterol
• Poorly managed diabetes
• Obstructive sleep apnea
• Certain heart diseases

Warning Signs

Recognizing stroke symptoms quickly is crucial. Look for these sudden changes:

1. Trouble speaking or understanding others
2. Numbness or paralysis on one side of the face, arm, or leg
3. Vision problems in one or both eyes
4. Difficulty walking or loss of balance
5. Severe headache (in some types of stroke)

If you notice these symptoms, even if they come and go, call 911 immediately. Every minute counts in stroke treatment.

Diagnosis

When someone arrives at the hospital with suspected stroke, the medical team conducts a physical exam and several tests to determine the type of stroke and appropriate treatment.

Common diagnostic tools include:

Test	Purpose
CT scan	Creates detailed images of the brain
MRI scan	Provides pictures of brain structures and blood vessels
Carotid ultrasound	Uses sound waves to examine blood flow in neck arteries
Blood tests	Check for various factors related to stroke risk

Treatment Options

Treatment depends on the type of stroke:

For ischemic strokes, the goal is to restore blood flow quickly. Doctors may use:

• Intravenous clot-busting medications to dissolve blockages
• Endovascular procedures where a catheter is threaded into brain arteries to physically remove clots

For hemorrhagic strokes, treatment focuses on controlling bleeding and reducing brain pressure. Options include:

• Medications to lower blood pressure
• Drugs to prevent blood vessel spasms
• Medications that encourage clotting
• Anti-seizure medications
• Surgery to remove blood from the brain (in severe cases)

Recovery Process

Recovery from a stroke varies widely from person to person. A comprehensive care team often includes neurologists, physical medicine specialists, rehabilitation experts, and other healthcare professionals.

The primary goal is to help patients regain as much function as possible to support independent living. Stroke recovery isn’t just physical—it often takes an emotional toll as well.

Feelings of helplessness, frustration, and depression are common. Support from friends and family plays a crucial role in recovery. Patients should understand that recovery requires time and dedication, and celebrating small improvements is important.

Prevention Strategies

Many stroke risk factors can be managed with lifestyle changes and proper medical care. Effective prevention measures include:

• Regular blood pressure monitoring and management
• Controlling cholesterol levels
• Managing diabetes properly
• Maintaining a healthy weight
• Regular physical activity
• Limiting alcohol consumption
• Avoiding tobacco products
• Following a balanced diet rich in fruits, vegetables, and whole grains
• Taking medications as prescribed

With proper medical care and lifestyle modifications, many strokes can be prevented. The declining stroke death rate in the U.S. indicates that prevention efforts and better treatments are effectively combating this serious health issue.

Signs and Symptoms

Stroke symptoms appear suddenly and require quick action. Knowing these signs can help save lives.

Trouble with speech is a key warning sign. Someone having a stroke may slur words, seem confused when talking, or have trouble understanding what others are saying.

Face, arm, or leg weakness often happens during a stroke. This typically affects just one side of the body. If someone can’t keep both arms raised or has a drooping smile, these are concerning symptoms.

Vision issues can arise unexpectedly. A person might experience blurred vision, blackened vision, or double vision in one or both eyes.

A severe, sudden headache can signal a stroke. This pain may come with vomiting, dizziness, or changes in alertness.

Walking difficulties frequently accompany a stroke. The person might stumble, lose balance, or have poor coordination.

Get Medical Help Immediately

Call 911 right away if you notice any stroke symptoms, even if they come and go quickly. Remember the “FAST” test to identify strokes:

• Face: Ask the person to smile. Does one side droop?
• Arms: Have them raise both arms. Does one drift down?
• Speech: Ask them to repeat a simple sentence. Is their speech unclear or strange?
• Time: Call emergency services immediately if you notice these signs.

Don’t wait to see if symptoms improve on their own. Every minute counts during a stroke. Faster treatment means less brain damage and better recovery chances.

While waiting for emergency help to arrive, stay with the person and watch them closely. Note when symptoms first started, as this information helps medical teams provide the best treatment.

Important: Some stroke treatments work best when given within the first few hours after symptoms begin.

What Causes Strokes

When blood flow to the brain becomes blocked, an ischemic stroke occurs. This is the most common stroke type. The blockage typically happens in two ways:

Fatty deposits build up in blood vessels over time, narrowing the path for blood. This narrows brain arteries and reduces blood flow.

Blood clots or debris can travel from other parts of the body (especially the heart) and get stuck in brain blood vessels. When these vessels become clogged, brain cells quickly begin to die from a lack of oxygen.

Types of Brain Bleeding

A hemorrhagic stroke happens when a blood vessel in the brain breaks open or leaks. Several factors can cause this dangerous bleeding:

• Uncontrolled high blood pressure puts too much strain on vessel walls
• Blood thinner medications used in excess
• Aneurysms (weak, bulging spots in blood vessel walls)
• Head injuries from accidents or trauma
• Protein deposits in vessel walls (cerebral amyloid angiopathy)
• Previous ischemic strokes that progressed to bleeding

An arteriovenous malformation (AVM) is a rare tangle of abnormal blood vessels that can rupture and lead to bleeding in the brain. These irregular vessel formations have thin, fragile walls prone to breaking.

Mini-Stroke Warning Signs

A transient ischemic attack (TIA) works like a temporary stroke. Blood flow to part of the brain decreases for a short time—sometimes just five minutes. Unlike full strokes, TIAs don’t cause permanent damage, which is why some call them “mini-strokes.”

TIAs happen when:

• Blood clots briefly block brain arteries
• Fatty deposits temporarily reduce blood flow

Important warning: Always get emergency medical help for stroke-like symptoms, even if they go away quickly. You cannot tell the difference between a TIA and a full stroke based on symptoms alone.

Having a TIA serves as a serious warning sign. It shows you likely have narrowed or partially blocked arteries leading to your brain. This significantly increases your risk of having a full stroke in the future.

Risks That Raise Stroke Chances

Ways Your Lifestyle Can Increase Risk

Being overweight puts extra strain on your blood vessels, raising stroke risk. When you don’t exercise regularly, your body loses important protection against vessel damage.

Drinking too much alcohol, especially binge drinking, can raise blood pressure and make strokes more likely. Using drugs like cocaine or methamphetamine is particularly dangerous as they can cause sudden blood pressure spikes and damage blood vessels in the brain.

Health Conditions That Increase Danger

High blood pressure remains the strongest risk factor for stroke. Smoking and exposure to secondhand smoke damage blood vessels and make clots more likely to form.

Other medical conditions that raise risk include:

• High cholesterol – builds up in arteries.
• Diabetes – damages blood vessels over time.
• Sleep apnea – reduces oxygen and stresses the heart.
• Heart problems – including irregular heartbeat, heart failure, or defects.

Having a previous stroke or TIA greatly increases your chances of another one. Evidence suggests that COVID-19 infection may increase the risk of stroke.

Age plays a role too, with people over 55 facing higher risk. African American and Hispanic individuals tend to have more strokes than other groups.

Men have a higher overall risk, though women often have worse outcomes. Hormone treatments containing estrogen may increase the risk for some women.

Complications

Strokes can lead to various physical, cognitive, and emotional issues. The severity of these problems depends on which brain area was affected and how long it went without blood flow.

Physical Effects

• Paralysis or weakness on one side of the body
• Facial muscle problems
• Difficulty controlling arm or leg movements
• Pain or unusual sensations in affected body parts
• Numbness or tingling feelings

Communication Challenges

• Unclear speech due to mouth and throat muscle problems
• Difficulty swallowing food and drinks
• Problems understanding what others say
• Trouble reading written material
• Challenges with writing and expressing thoughts

Cognitive Changes

• Memory difficulties
• Problems with thinking clearly
• Difficulty making decisions
• Trouble understanding complex ideas
• Reduced reasoning abilities

Emotional and Behavioral Changes

• Less control over emotions
• Increased risk of depression
• Withdrawal from social activities
• Personality changes
• Mood swings

Many stroke survivors require help with daily activities like bathing, dressing, and eating. The recovery process varies greatly between individuals. Some people regain most functions, while others face long-term challenges that require ongoing support and therapy.

Ways to Stop a Stroke

Medicines That Help Prevent Strokes

Taking medicines can lower your chance of having a stroke. This is especially true if you’ve already had one or a TIA (mini-stroke). These medicines work in different ways to keep blood flowing smoothly through your brain.

Antiplatelet Drugs

Antiplatelet drugs make blood cells less sticky, so they don’t form clots as easily. Aspirin is the most common one. Your doctor will tell you how much to take, based on your needs.

If you’ve had a TIA or small stroke recently, your doctor might give you both aspirin and another antiplatelet drug like clopidogrel.

Taking both medicines together for a short time can better protect you from having another stroke. People who can’t take aspirin might use clopidogrel by itself. Another option is ticagrelor, which works in a similar way.

Blood Thinners

Blood thinners (anticoagulants) are strong medicines that prevent blood clots. These medicines include:

• Heparin: Works quickly and is usually given in the hospital for a short time.
• Warfarin: Works more slowly but lasts longer
  • Requires regular blood tests
  • Must be taken exactly as prescribed
  • Needs careful monitoring for side effects

Several newer blood thinners offer advantages over warfarin:

• Dabigatran
• Rivaroxaban
• Apixaban
• Edoxaban

These newer medicines:

• Works faster than warfarin
• Don’t usually need regular blood tests
• Have a lower risk of bleeding problems

Besides medicines, you can take many steps to prevent strokes. These healthy habits are especially important if you’ve already had a stroke or TIA.

• Control high blood pressure – This is one of the most powerful ways to reduce stroke risk. Your doctor may recommend lifestyle changes and medicines to keep your blood pressure at a healthy level.
• Lower cholesterol and fat in your diet – Eating less cholesterol and unhealthy fats helps keep your arteries clear. If diet changes aren’t enough, you might need medicines to lower your cholesterol.
• Quit smoking – Smoking increases stroke risk for both smokers and people exposed to secondhand smoke. Quitting makes a big difference in lowering your risk.
• Manage diabetes – Keep your blood sugar in a healthy range through diet, exercise and weight control. Your doctor may also prescribe diabetes medicines, if needed.
• Maintain a healthy weight – Being overweight makes other stroke risk factors worse, including high blood pressure, heart disease, and diabetes.
• Eat plenty of fruits and vegetables – Try to eat at least five servings daily. The Mediterranean diet, with its focus on olive oil, fruits, nuts, vegetables, and whole grains, can be helpful.
• Exercise regularly – Aim for at least 30 minutes of moderate activity on most days. This could include walking, jogging, swimming, or bicycling.
  • Health experts recommend getting 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise each week.
• Drink alcohol in moderation or not at all – Heavy drinking raises blood pressure and stroke risk. If you drink, limit it to about one drink per day. Ask your doctor what’s right for you.
• Treat sleep apnea – This condition causes breathing to stop during sleep. Your doctor might recommend a sleep study if you have symptoms. Treatment often involves using a device that keeps your airway open while you sleep.
• Avoid illegal drugs – Drugs like cocaine and methamphetamine significantly increase your stroke risk.