Stroke: What It Is, Types, Symptoms, Causes, Risk Factors, Treatment & Prevention

Stroke is a medical emergency and the leading cause of disability in the United States. There are treatments to reduce the harm from stroke, but they can only be done if the stroke victim comes to the hospital right away. Unfortunately, more than half of Americans don’t know what a stroke is or what the symptoms are, and many people don’t arrive in time to get the best treatment.  

Here is a guide to learn more about stroke, including:

• What a stroke is

• The different types of strokes

• The stroke symptoms to be aware of

• What causes a stroke

• The stroke treatments currently available

• How to prevent a stroke

• What life is like after a stroke

A stroke is a permanent injury to the brain caused by the blockage or bursting of a blood vessel. Even though the injury is permanent, most patients improve after a stroke, and some go back to normal, but for some people, stroke can cause death.

When a blockage causes a stroke, healthcare professionals call it a cerebral infarct or an ischemic stroke. The word ischemic means an area of the brain does not get enough oxygen and starts to fail. In a brief time—sometimes just minutes—the injury becomes permanent, and that part of the brain is lost forever. 

We call it a transient ischemic attack, or TIA, if the blockage goes away very quickly, within minutes, and there is no permanent injury. With a TIA, people go back to normal, usually within an hour. The symptoms of ischemic stroke and TIA are the same. The only difference is in how long they last.

When the bursting of a blood vessel causes a stroke, healthcare professionals call it an intracerebral hemorrhage or a hemorrhagic stroke. When a blood vessel to the brain bursts, there is bleeding in the brain or on the surface of the brain. The bleeding causes two problems: loss of blood flow to the brain and pressure on the brain. Depending on how much bleeding there is, symptoms might be mild or very severe, even lethal. 

When bleeding is on the surface of the brain, usually from the bursting of an aneurysm, which is a bulge in a blood vessel on the surface of the brain, it’s called a subarachnoid hemorrhage.

Different parts of the brain control different activities. For example, the brain has language, vision and movement centers. The left side of the brain controls the right side of the body, and the right side of the brain controls the left. A stroke could cause one or more of the following symptoms:

• Weakness on one side of the body

• Numbness on one side of the body

• Loss of vision on one side

• Loss of balance or coordination

• Difficulty thinking of words

• Difficulty understanding speech

• Slurred speech

• Severe headache

Aside from sometimes causing a headache, acute strokes do not cause pain. Stroke symptoms are the same in men and women, but men and women may speak about their symptoms differently.

There is a difference between causes of stroke and risk factors for stroke. Causes of stroke are the way a stroke happened, such as a blockage in a blood vessel from a cholesterol plaque. A risk factor for stroke is something that increases the chance of that cause occurring, such as high cholesterol levels in the blood. 

The causes of ischemic and hemorrhagic strokes are different, but most of the risk factors are the same.

Common risk factors for stroke may include:

• High blood pressure

• Diabetes with high blood sugar

• High cholesterol

• An irregular heart rhythm called atrial fibrillation

Common causes of ischemic stroke and TIA may include:

• A clot traveling out of the heart to the brain

• Blockage due to atherosclerosis, which is buildup of a cholesterol plaque 

• Damage to small blood vessels deep in the brain from high blood pressure

Immediate treatment to reduce the severity of the stroke

If a patient arrives early enough, the stroke team may be able to reduce the severity of the stroke. For ischemic stroke, medication to dissolve a blood clot may be given within 4.5 hours. Pulling a large blood clot out with a catheter, a procedure called thrombectomy, may be possible within 24 hours. For hemorrhagic stroke, immediately treating blood pressure to reduce the growth of a hemorrhage or doing surgery to remove the hemorrhage might be appropriate.

Discovering the cause of the stroke to help prevent another stroke

Sometimes the cause of a stroke might require special treatment, such as giving a blood thinner to prevent clots from forming in the heart, or surgically removing a cholesterol blockage in the neck. Some causes of bleeding in the brain, such as an aneurysm, might be treated with a catheter or with surgery.

Treatment of stroke risk factors

Stroke risk factors need treatment to reduce the risk of future stroke. Some risk factors may already be known, but they may be treated better with a change in medication. Others may have been unknown and require new medication.

Rehabilitation to improve recovery

During a hospital stay for stroke, rehabilitation specialists, including rehabilitation doctors, physical therapists, occupational therapists or speech therapists, will examine a patient’s function and start a program of exercises and treatments for the problems caused by the stroke. Some patients will continue these treatments in a rehabilitation facility or when they go home.

Even without the help of a healthcare professional, people can reduce their risk of stroke by making healthy choices, such as:

• Quitting cigarettes, cocaine or methamphetamines

• Exercising moderately, such as walking half an hour per day, several days per week

• Eating a more plant-based diet, such as the Mediterranean Diet

• Taking medications as prescribed

Even people who completely recover from a stroke may have some difficulties after a stroke. Fatigue may last for several weeks after a stroke. Stroke may also cause depression, with either sadness or loss of interest in activities that used to seem fun.

Many people are left with symptoms after stroke, such as weakness or difficulty with language, which don’t completely go away with rehabilitation. Some people may have to stop working or change the way they care for others or do hobbies. Some people may need to rely on family or other caregivers to help get daily activities done, such as shopping, cleaning or cooking. Some may need to move to a nursing home.

As chief of vascular neurology at Montefiore Medical Center, I find that people often wonder, was what I had a severe stroke? In the end, a stroke is only as severe as the patient decides. Even after strokes that others might think were severe, many people find a way to live happy, fulfilling lives.

For more information on stroke, check out these additional resources:

Hemorrhagic Stroke: What It Is, Symptoms, Causes, Treatment & Recovery

Ischemic Stroke: What It Is, Symptoms, Causes, Treatment & Recovery

Transient Ischemic Attack (TIA): What It Is, Symptoms, Causes, Treatments & Recovery

Caregiving for Someone After a Stroke