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Ischemic Stroke

(Cerebrovascular Accident; CVA; Cerebral Infarct)

Definition

Stroke is a brain injury caused by an interruption in blood flow. Brain tissue that does not get oxygen and nutrients from blood can die within minutes. The damage to the brain can cause a sudden loss in bodily functions. The types of function that are affected will depend on the part of the brain that is damaged.

There are two blood flow problems that cause a stroke. Strokes may be ischemic or hemorrhagic.

  • An ischemic stroke is caused by a blocked blood vessel. It is the most common cause of stroke.
  • A hemorrhagic stroke is caused by a ruptured blood vessel.

Hemorrhagic vs. Ischemic Stroke

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Causes    TOP

This stroke occurs when something stops the flow of blood. It may be due to:

  • Atherosclerosis—a build-up of fatty substances along the inner lining of the artery that gradually decrease the area the blood can flow through
  • A blood clot that has traveled from other parts of the body, such as the neck or heart
  • Swelling (inflammation) of the blood vessels
  • A combination of above (example: blood clot gets trapped in blood vessel narrowed by swelling)

A blockage in a small blood vessel will affect a smaller area of the brain. A blockage in larger blood vessels can block the flow of blood to several smaller blood vessels. This will lead to more severe brain damage.

Risk Factors    TOP

Certain factors increase your risk of stroke but cannot be changed, such as:

  • Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk
  • Age: Older than 55 years of age
  • Family history of stroke

Other factors that may increase your risk can be changed, such as:

Certain medical conditions can increase your risk of stroke such as:

Risk factors specific to women include:

Symptoms    TOP

Symptoms occur suddenly. Exact symptoms will depend on what area of the brain is affected.

Call for emergency medical services right away if you notice any of the following sudden symptoms:

  • Weakness or numbness of face, arm, or leg, especially on one side of the body
  • Confusion
  • Trouble speaking or understanding
  • Trouble seeing in one or both eyes
  • Lightheadedness, trouble walking, loss of balance, or coordination
  • Severe headache with no known cause

Diagnosis    TOP

A physical exam will be done. The doctor will look for muscle weakness, visual and speech problems. If possible, the doctor will be ask about your symptoms and medical history.

Images of your brain may be taken with:

Blood tests may also be done. It will show if there is a bleeding problem.

Treatment    TOP

Brain tissue without blood flow dies quickly. Rapid treatment will open the blocked blood vessel. This will help to restore blood flow and decrease damage.

Treatment after immediate care will aim to:

  • Reduce the chance of later strokes
  • Improve function affected by the stroke
  • Overcome disabilities

Supportive care may also include:

Medications

Thrombolytics may be used. The care team will needs to deliver it within hours of the start of symptoms. This medicine can rapidly break up blood clots. It is often given by IV. It may also be delivered directly to the blood clot. It is not appropriate for everyone.

To help manage other health issues and decrease the risk of future strokes the doctor may recommend medication to:

Surgery

An embolectomy may be an option. A tube is passed through blood vessels to the clot. The tube can be used to remove a blood clot or deliver medicine. The medicine will break up the clot.

A stroke can cause severe swelling of the brain. This swelling can place pressure on the brain and cause more damage. A decompressive surgery, such as craniotomy, can relieve this pressure.

Other surgeries may be performed after a stroke to prevent another one. Options include:

Rehabilitation    TOP

If brain tissue was damaged, rehabilitation can be an important part of your recovery. Rehabilitation may include:

  • Physical therapy—to regain as much movement as possible
  • Occupational therapy—to assist in everyday tasks and self care
  • Speech therapy—to improve swallowing and speech challenges
  • Psychological therapy—to improve mood and decrease depression

Prevention    TOP

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:

  • Exercise regularly.
  • Eat more fruits, vegetables, and whole grains. Limit dietary salt and fat.
  • If you smoke, talk to your doctor about ways to quit.
  • Increase your consumption of fish.
  • Drink alcohol only in moderation: no more than 1-2 drinks per day.
  • Maintain a healthy weight.
  • Check blood pressure frequently. Follow your doctor's recommendations for keeping it in a safe range.
  • Take a low dose of aspirin if your doctor says it is safe.
  • Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
  • Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
  • Seek medical care if you have symptoms of a stroke, even if symptoms stop.
  • If you use drugs, talk to your doctor about rehabilitation programs.

RESOURCES:

American Heart Association
http://www.heart.org
National Stroke Association
http://www.stroke.org

CANADIAN RESOURCES:

Heart and Stroke Foundation
http://www.heartandstroke.com

References:

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Last reviewed November 2017 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 5/9/2018

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