A stroke, medically referred to as a cerebral vascular accident (CVA), is a life-threatening condition that occurs when blood flow to a part of the brain is interrupted or significantly reduced. Without adequate oxygen and nutrients, brain cells begin to die within minutes, leading to permanent brain damage, disability, or death if not treated promptly. According to the World Health Organization, stroke is the second leading cause of death globally and one of the leading causes of long-term disability.

Types of Stroke

There are two main types of strokes, each with distinct causes and treatment approaches:

Ischemic Stroke: This is the most common type, accounting for approximately 87% of all strokes. It occurs when a blood clot blocks or narrows a blood vessel in the brain, typically due to atherosclerosis (plaque buildup in arteries). As a result, brain tissue is deprived of oxygen and nutrients.

Hemorrhagic Stroke: Less common but more severe, hemorrhagic strokes happen when a blood vessel in the brain ruptures, leading to bleeding (hemorrhage) inside or around the brain. The buildup of blood creates pressure that damages surrounding brain tissue. Causes include high blood pressure, aneurysms, trauma, or blood-thinning medications.

A third category, known as a Transient Ischemic Attack (TIA) or "mini-stroke," involves a temporary blockage that resolves on its own within minutes to hours. Though symptoms disappear, TIAs are serious warning signs of a potential future stroke.

Recognizing Symptoms

Timely recognition and treatment are crucial for minimizing the effects of a stroke. The acronym BEFAST helps identify early signs:

  • Balance: Sudden loss of balance or coordination
  • Eyes: Blurred or double vision, sudden vision loss
  • Face: Facial drooping, usually on one side
  • Arm: Arm weakness or numbness, especially on one side
  • Speech: Slurred or garbled speech, difficulty speaking
  • Time: Call emergency services immediately

Additional symptoms may include sudden confusion, dizziness, headache, difficulty understanding speech, and numbness or weakness in the leg or face. Even if symptoms are mild or brief, they warrant urgent medical attention.

Main Causes

The root cause of a stroke depends on the type but generally stems from issues affecting blood flow or blood vessels.

Ischemic Stroke Causes:

  • Atherosclerosis: Plaque buildup narrows arteries
  • Blood clots: Often forming in the heart (especially with atrial fibrillation) and traveling to the brain
  • Carotid artery stenosis: Narrowing of arteries in the neck
  • Heart conditions: Heart failure or recent heart attack

Hemorrhagic Stroke Causes:

  • Uncontrolled high blood pressure (most common cause)
  • Ruptured aneurysms: Weak spots in blood vessels
  • Head injury or trauma
  • Overuse of blood thinners or anticoagulants

Risk of recurrence is high if these underlying conditions are not managed.

Risk Factors

Some stroke risk factors are non-modifiable, while others can be reduced through lifestyle changes.

Non-Modifiable Risk Factors:

  • Age (risk doubles each decade after 55)
  • Gender (men have slightly higher risk)
  • Family history or genetic predisposition
  • Race and ethnicity (African Americans and Hispanics are at higher risk)

Modifiable Risk Factors:

  • High blood pressure (leading risk factor)
  • Diabetes or elevated blood sugar levels
  • High cholesterol
  • Obesity and sedentary lifestyle
  • Smoking and heavy alcohol consumption
  • Unhealthy diet high in salt and trans fats
  • Stress and poor sleep

Managing these factors can significantly reduce your stroke risk.

Diagnosis and Tests

Prompt diagnosis of a stroke involves a mix of clinical evaluation and advanced imaging tests. Upon arrival at the emergency department, the following steps are typically taken:

  • Physical and neurological exams: Assess muscle strength, reflexes, and mental status
  • CT scan (computed tomography): Quickly detects bleeding or tissue damage
  • MRI (magnetic resonance imaging): Offers detailed images of brain structures and early infarcts
  • Carotid ultrasound: Assesses blood flow in neck arteries
  • Electrocardiogram (EKG/ECG): Checks for arrhythmias like atrial fibrillation
  • Blood tests: Evaluate clotting factors, sugar levels, and infection markers

These tests determine the stroke type and appropriate course of treatment.

Treatment Options

Treatment for a stroke must begin as soon as possible to minimize brain damage and improve outcomes.

For Ischemic Stroke:

  • tPA (tissue plasminogen activator): A clot-busting drug administered intravenously within 3–4.5 hours of symptom onset
  • Mechanical thrombectomy: A catheter-based procedure to physically remove the clot, typically within 6–24 hours of symptom onset
  • Antiplatelet or anticoagulant therapy: Long-term medications like aspirin or warfarin to prevent future clots

For Hemorrhagic Stroke:

  • Blood pressure control: Immediate reduction of high blood pressure
  • Surgical intervention:
    • Clipping or coiling of aneurysms
    • Decompression to relieve brain pressure
    • Draining excess fluid (ventriculostomy)
  • Medication adjustment: Stopping or reversing anticoagulants

Post-Stroke Care:

  • Hospitalization in a stroke unit
  • Monitoring for complications like brain swelling, pneumonia, or seizures
  • Physical and occupational therapy

Recovery and Rehabilitation

Recovery varies based on stroke severity, the brain region affected, and overall health. Common elements of stroke recovery include:

  • Physical therapy: Regaining strength, coordination, and movement
  • Occupational therapy: Relearning daily tasks like dressing and bathing
  • Speech-language therapy: For communication and swallowing issues
  • Mental health support: Managing anxiety, depression, or cognitive changes

Recovery can take weeks to years. Some people regain full function, while others may live with permanent disabilities.

Preventive Measures

Preventing a first or recurrent stroke involves managing chronic health conditions and adopting healthy habits:

  • Blood pressure control: Aim for readings below 120/80 mmHg
  • Blood sugar management: Especially in people with diabetes
  • Cholesterol reduction: Through diet, exercise, and statins
  • Quitting smoking: Significantly reduces stroke and heart attack risk
  • Limiting alcohol: No more than one drink daily for women, two for men
  • Healthy diet: Emphasize fruits, vegetables, whole grains, and lean proteins
  • Regular exercise: At least 150 minutes of moderate activity weekly
  • Treating atrial fibrillation: Using anticoagulants when prescribed

Annual check-ups can help detect risks early and adjust treatments.

Living With Stroke

Surviving a stroke is a significant life event, and ongoing care is vital. People living with the aftermath of a stroke may face:

  • Physical limitations: Difficulty walking, moving arms or legs
  • Cognitive challenges: Memory loss, trouble concentrating
  • Emotional effects: Depression, frustration, anxiety
  • Communication barriers: Trouble speaking or understanding speech

Support from caregivers, therapists, and community resources is essential. Joining stroke support groups and maintaining open communication with healthcare providers can improve quality of life.