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Stroke: Symptoms, Prevention, Treatments & More

by Reed Rush

What is a stroke?

A stroke is a condition that occurs when blood flow to the brain is obstructed, which can also be referred to as a transient ischemic attack or cerebrovascular accident. This blockage prevents the brain from receiving essential oxygen and nutrients, resulting in the death of brain cells within a matter of minutes. Additionally, sudden internal brain bleeding can cause a stroke if it damages brain cells.

In the case of a stroke, immediate medical attention is necessary as it can potentially result in permanent brain damage, prolonged disability, or even fatality.

What is the prevalence of stroke?

Stroke is a common condition. According to the Centers for Disease Control (CDC), “Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.” (1) 


In addition, stroke is the 5th leading cause of death in the United States, claiming the lives of approximately 140,000 Americans each year (2, 3). It is also a primary cause of severe long-term disability (4).

Who does stroke affect?


Strokes can affect anyone, regardless of age, but some individuals are at a higher risk than others. Generally, strokes are more prevalent among older adults, with about two-thirds of cases occurring in individuals over the age of 65. 


It's important to note that certain medical conditions, such as hypertension, high cholesterol, Type 2 diabetes, or irregular heart rhythms like atrial fibrillation, can significantly increase the risk of stroke. Likewise, a previous stroke or heart attack history can put you at risk of a stroke. 

What are the different types of strokes?

There are three main types of stroke: transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke. It is essential to understand the difference between them. 


  • TIA is caused by a temporary blood clot that typically dissolves on its own. 

  • Ischemic stroke results from an artery blockage caused by a clot or plaque. This can lead to longer-lasting symptoms and complications that may even become permanent.

  • Hemorrhagic stroke is caused by a ruptured or leaking blood vessel that escapes into the brain.

What are the symptoms of stroke?


Immediate action is crucial in cases of stroke, as a lack of blood flow to the brain can seriously harm brain tissues, leading to symptoms that affect the body parts controlled by the damaged areas of the brain. Awareness of a stroke's signs is imperative for timely action and improving outcomes. Some symptoms to look out for include:


  • Slurred speech
  • Paralysis, often on one side of the body
  • Weakness or numbness in the face, arms, or legs
  • Loss of muscle control 
  • Confusion
  • Difficulty speaking or understanding the speech of others
  • Sudden partial or total loss of one or more senses, such as hearing, smell, taste, touch, and sight.
  • Severe headache
  • Loss of coordination
  • Vision issues, such as blurred or double vision
  • Clumsiness
  • Neck stiffness
  • Sudden changes in behavior, such as becoming angry or irritated
  • Dizziness or vertigo
  • Lack of balance
  • Nausea or vomiting
  • Memory loss
  • Fainting
  • Seizures
  • Coma

In a suspected stroke, seeking urgent medical assistance is imperative. Contact 911 or your local emergency services immediately to prevent potential brain damage, long-term disability, or death. Swift action is critical to minimizing the impact of a stroke.


What causes a stroke?

The cause of a stroke varies depending on the type of stroke.


Remember, the three types of stroke are as follows:


  • transient ischemic attack (TIA)
  • ischemic stroke
  • hemorrhagic stroke

Within these categories are several subtypes, including: 


  • embolic stroke
  • thrombotic stroke
  • intracerebral stroke
  • subarachnoid stroke

The specific type of stroke you experience will determine the treatment and recovery plan that will be implemented.

Ischemic stroke


Ischemic stroke occurs when the arteries that supply blood to the brain become blocked or narrow. This blockage can be caused by blood clots or reduced blood flow to the brain. It can also be caused by pieces of plaque breaking off and blocking a blood vessel. 


Two types of blockages can cause ischemic stroke: cerebral embolism and cerebral thrombosis (6). A cerebral embolism occurs when a blood clot formed in another part of the body, such as the heart or arteries in the upper chest and neck, moves through the bloodstream until it reaches an artery too narrow to let it pass. The clot gets stuck and stops blood flow, causing a stroke. 


On the other hand, cerebral thrombosis occurs when a blood clot develops at the fatty plaque within the blood vessel. The CDC states that 87% of all strokes are ischemic strokes (7).

Transient ischemic attack (TIA)

Have you heard of a transient ischemic attack? It's often referred to as a TIA or ministroke, which occurs when blood flow to the brain is temporarily blocked. The symptoms are similar to a full stroke. However, this happens when blockage moves and blood flow is restored.


While not a full stroke, it warns that an actual stroke may occur. Therefore, it's essential to pay attention to it. Seek the same treatment as you would for a major stroke and get emergency medical help.


According to the CDC, over one-third of people who experience a TIA and don't receive treatment have a major stroke within a year. Additionally, 10 to 15 percent of people who experience a TIA have a significant stroke within three months (8). Therefore, taking action and seeking medical attention is crucial to preventing further complications.

Hemorrhagic stroke

A hemorrhagic stroke is a severe medical condition that can occur when an artery in the brain ruptures or leaks, resulting in increased pressure inside the skull. This pressure can cause brain swelling and damage essential cells and tissues. 

There are two types of hemorrhagic stroke: intracerebral and subarachnoid. 

An intracerebral stroke is more common and occurs when blood fills the tissues surrounding the brain after an artery ruptures. 

A subarachnoid stroke is less frequent but still very serious, causing bleeding between the brain and surrounding tissues. 

Though hemorrhagic strokes are not as common as other types, they still make up 13% of all strokes, according to the American Heart Association (9).

What are some risk factors for stroke?

Several risk factors increase your risk of having a stroke. They fall into one of two categories: risk factors that you can control or risk factors that you cannot influence.

Controllable Risk Factors


 According to the American Stroke Association, stroke risk factors include the following:

Diet


Regularly eating a poor-quality diet is a significant stroke risk factor under your control. 


A poor-quality diet is high in:


  • Saturated fats
  • Cholesterol
  • Salt
  • Trans fats

Obesity


Obesity is a disease characterized by an excessive accumulation of body fat sufficient to present a health risk. A body mass index (BMI) of 30 is considered obese. However, being overweight (with a BMI over 25) is also unhealthy and can eventually lead to health problems. 


Obesity has reached epidemic proportions. According to the World Health Organization (WHO), “More than 1 billion people worldwide are obese – 650 million adults, 340 million adolescents, and 39 million children.” (10)


It is well documented that excessive body weight and obesity are associated with serious health problems such as high blood pressure, diabetes, heart disease, and stroke. 

Lack of Exercise


Numerous studies show that physical inactivity can increase your risk of many conditions, including stroke, overweight/obesity, heart disease, type 2 diabetes, high blood pressure (hypertension), and high cholesterol.


Regular physical activity can help reduce your risk of stroke by improving your cardiovascular fitness, blood pressure, and cholesterol. Exercise also helps maintain a healthy weight and reduce stress, which can help reduce the risk of stroke.

High Blood Cholesterol 

Cholesterol is a waxy substance naturally present in your blood and plays a vital role in building healthy cells. However, excessive levels of cholesterol can have harmful effects on your health.  

When cholesterol builds up in the blood vessels, it can form fatty deposits that obstruct blood flow, potentially leading to heart attacks or strokes. While genetics can contribute to high cholesterol levels, unhealthy lifestyle choices are often the main culprits. 

The CDC estimates that nearly 29 million Americans have high cholesterol levels that exceed 240 mg/dL (11), which is considered dangerous for health. 

The good news is that high cholesterol is preventable and treatable through healthy habits such as a balanced diet, regular exercise, and medications.

High Blood Pressure (Hypertension)

High blood pressure, also called hypertension, is a prevalent condition that affects an estimated 65 million people in the U.S.(12) With this condition, the pressure of the blood against the walls of your arteries is consistently too high, which can cause your heart to work harder than it should to pump blood.

High blood pressure is a significant risk factor for heart disease and stroke.

Tobacco Usage

Did you know that smoking can increase the risk of stroke? This is because smoking causes inflammation and damage to the blood vessels, resulting in plaque buildup in the arteries, making it more challenging for the heart to pump blood efficiently.

Smoking also constricts small arteries throughout the body, negatively affecting blood circulation. Furthermore, nicotine is known to elevate blood pressure.

Uncontrollable Risk Factors

Risk factors that you cannot control include:


  • Family history. Genetic health factors, like high blood pressure, can make strokes more likely in some families. 

  • Sex. While both women and men can have strokes, according to the CDC, women are more commonly affected than men in all age groups.

  • Age. Research shows that the risk of stroke increases with age. 

  • Race and ethnicity. Certain racial and ethnic groups, such as African Americans, Alaska Natives, and American Indians, are also more likely to experience stroke.

  • Medical History. Specific medical issues can make you more likely to experience stroke, such as diabetes, sickle cell disease, a previous stroke or TIA, coronary artery disease or other heart conditions, and blood clotting disorders.

What are the complications of stroke?

After experiencing a stroke, specific issues may arise from a direct brain injury or changes in your abilities. For instance, limited mobility can lead to the development of bedsores. It can also cause falls. In addition, clinical depression may manifest as a result of the stroke.

Some of the most common complications of stroke include:

Reduced mobility. Stroke-related motor disabilities are a common and frustrating feature of stroke, as they interfere with patients’ independence and participation in social activities. 

Pneumonia. Pneumonia is a lung infection that causes issues with breathing and is a complication of several conditions, including stroke. For instance, immobility resulting from a stroke can lead to pneumonia. Or, those with difficulty swallowing after a stroke may accidentally allow food to go down their windpipes, causing aspiration pneumonia.

Brain edema is a swelling of the brain and a severe stroke complication. It can cause brain damage and death if left untreated. 

Urinary tract infections (UTIs) or incontinence. UTIs are common complications after a stroke, affecting an estimated 29% to 58% of patients (13). An infection can occur due to having a Foley catheter placed to collect urine after a stroke when the patient cannot control their bladder function.

Bedsores. Reduced mobility and prolonged pressure on particular body parts are the two main causes of bedsores, also known as pressure ulcers.

Seizures. Seizures are sudden, abnormal electrical activity in the brain that causes convulsions. Those who have larger strokes are more likely to experience seizures.

Clinical depression. It is common for stroke victims to suffer from clinical depression. This mood disorder causes uncontrollable and unpleasant emotional and physical reactions to the physical and perhaps mental changes and losses they’ve endured. If they had problems with depression in the past, having a stroke might worsen it. Or, the depression they’re feeling following a stroke might be their first experience with this mood disorder. 

 Deep venous thrombosis (DVT). Blood clots known as "deep vein thrombosis" (DVT) can develop in the legs' veins due to immobility resulting from a stroke.

Healthcare providers often use various treatment methods to help patients recover from strokes, including physical therapy, medication, and psychotherapy. 

Also, depending on the stroke’s severity, patients may recover partial or total mobility with proper therapies.

How do I prevent a stroke?

Reducing the risk of stroke is possible through various measures. Although it cannot guarantee the prevention of a stroke, it can significantly reduce the likelihood of experiencing one.


Preventative measures include the following:

Lifestyle changes


Diet: Eat a healthy, whole-food diet that includes lots of nonstarchy vegetables, a moderate amount of lean protein, and some healthy fats. Reduce consumption of refined carbs, heavily processed foods, and sugary beverages. 


Exercise: Regular exercise will help control or modify many risk factors for stroke and cardiovascular disease. For example, exercise can help lower blood pressure and cholesterol levels, lessen the risk of developing type 2 diabetes, and reduce systemic inflammation. To prevent stroke, try to exercise at moderate intensity for at least 30 minutes a day, most days of the week. If you’ve been sedentary, you must gradually work up to the required intensity and time. 


Maintain a healthy weight: Losing weight (if you're overweight or obese) is crucial for cutting your risk of stroke. Eating a healthy diet and getting regular exercise will help you get there. 


Get enough sleep. Experts recommend getting at least 7 to 8 hours of uninterrupted sleep each night. 


Limit alcohol use. Prolonged alcohol abuse significantly increases the risk of stroke, primarily hemorrhagic stroke, characterized by bleeding in the brain. 


Stop smoking (if you smoke). Research shows that there are a few ways that cigarette smoking can increase the risk of stroke. First, it can damage blood vessels and the heart. Secondly, nicotine elevates blood pressure. Thirdly, the carbon monoxide you breathe in from tobacco smoke decreases the oxygen in your blood. Finally, even secondhand smoke can increase your risk of stroke.  


Manage diabetes. Diabetes is a significant risk factor for stroke, so if you have this disease, you must control your blood sugar levels.


Monitor your blood pressure. High blood pressure can result in arterial blockage as it exerts continuous pressure on the wall of the arteries, potentially leading to a stroke or heart attack. 


Take your prescribed medication. If you take blood pressure or cholesterol medications, you must take them on schedule as prescribed. 


Keep your regular doctor’s appointment. It's important to discuss with your physician the frequency of checkups for monitoring blood pressure, cholesterol levels, and any pre-existing medical conditions. Your doctor can also provide the necessary support and guidance to help you make lifestyle changes.


What are the treatments for stroke?


Receiving timely and accurate medical assessment and treatment is crucial for stroke recovery. In addition, the American Heart Association and American Stroke Association emphasize that every moment counts, as every passing second increases brain loss. 


If you suspect that you or someone else may be experiencing a stroke, it is essential to call 911 or local emergency services immediately. The course of treatment will vary based on the type of stroke.

Ischemic stroke and TIA


These types of strokes, both caused by brain blood clots, are treated using similar methods. 

Clot-dissolving drugs


In the event of a stroke, thrombolytic medications have the ability to dissolve blood clots in the brain's arteries, halting the stroke and minimizing any damage to the brain. 


A noteworthy example of this type of drug is tissue plasminogen activator (tPA), also known as Alteplase IV r-tPA, considered the optimal treatment for ischemic stroke (14). tPA functions by dissolving blood clots efficiently, resulting in a higher likelihood of stroke recovery and a lower chance of lasting disabilities.

Mechanical thrombectomy


In this medical procedure, a physician will insert a catheter into a major blood vessel within the head and utilize a device to extract the clot from the vessel. The efficacy of this surgery is highest when performed within 6 to 24 hours (15) after the onset of the stroke.

Stents


If a doctor discovers weakened artery walls, a procedure may be conducted to expand the constricted artery and reinforce its walls by inserting a stent.

Surgery


In cases where alternative treatments prove ineffective, surgical intervention can eliminate blood clots and plaque buildup in the arteries. The procedure can be performed using a catheter, but in scenarios where the blockage is significant, an artery may need to be surgically opened for removal.

Hemorrhagic stroke


Different treatment options are necessary for strokes that cause brain bleeding or leaks. For example, hemorrhagic stroke treatments can involve medication, coiling, clamping, or surgery.

Medication


In contrast to an ischemic stroke, hemorrhagic stroke treatment aims to prompt blood clotting. To that end, medications may be prescribed to counteract the effects of any blood thinners you take. 


Your healthcare providers may also prescribe drugs to:


  • Reduce the pressure in your brain
  • Lower your blood pressure
  • Stop the possibility of constricted blood vessels
  • Prevent seizures

Coiling


In this medical procedure, your physician will direct a long tube toward the site of the bleeding or damaged blood vessel. A coil-shaped device will then be implanted in the weakened area of the artery wall, effectively obstructing blood flow and minimizing bleeding.

Clamping


While conducting imaging tests, your doctor may detect an aneurysm that has not yet bled or stopped bleeding. To avoid further bleeding, a surgeon may insert a tiny clamp at the aneurysm's base, which cuts off the blood supply and prevents the risk of a ruptured blood vessel or fresh bleeding.

Surgery


If an aneurysm bursts, surgery may be necessary to clip it and prevent further bleeding. Similarly, a craniotomy may be required to alleviate the pressure on the brain if a large stroke has occurred. Your healthcare team will provide emergency treatment and guidance on preventative measures for future strokes.

Medications for stroke


There are numerous medications available to treat strokes, and the one your doctor prescribes will depend on the type of stroke you had. For example, certain medications aim to prevent a second stroke, while others strive to prevent a stroke from occurring in the first place. Depending on your health history and risks, your doctor may prescribe one or more of these medications to treat or prevent a stroke. The most commonly used stroke medications include:

Anticoagulants


Certain medications can decrease the clotting ability of your blood. For example, the anticoagulant most frequently prescribed is warfarin (Coumadin, Jantoven). 


These medications can also impede the growth of existing blood clots, which explains why doctors may suggest them to prevent a stroke or after an ischemic stroke or TIA.

Tissue plasminogen activator (tPA)


In the event of a stroke, emergency medication can be administered to dissolve the blood clot that caused it. This is the only medication currently available for this purpose, but it must be given within 3 to 4.5 hours after the stroke symptoms first appear. Then, the drug is injected into a blood vessel to expedite its effectiveness and mitigate the possibility of stroke-related complications.

Direct-acting oral anticoagulants (DOACs)


This new class of medication functions similarly to conventional anticoagulants by decreasing the clotting ability of your blood. However, they tend to have a quicker onset of action and require less frequent monitoring.


Additionally, if utilized for stroke prevention, DOACs could decrease the likelihood of experiencing a brain bleed.

Blood pressure medications


If left unmanaged, high blood pressure can lead to the formation of plaque in your arteries that can break off and cause a stroke by blocking the flow of blood. Therefore, taking blood pressure medication, eating a heart-healthy diet, exercising regularly, and making other lifestyle changes can prevent stroke.

Antiplatelet drugs


Antiplatelet medications can reduce blood clot risk by preventing the platelets from sticking together. Aspirin and clopidogrel (Plavix) are the most commonly used antiplatelet drugs.


These medications can help prevent ischemic strokes, especially in the case of secondary stroke prevention.


If you have never experienced a stroke, taking only aspirin as a preventive medication is advisable if you are at high risk of atherosclerotic cardiovascular disease (such as heart attack and stroke) and have a low risk of bleeding.

Stroke therapies


Even though stroke is a leading cause of long-term disability in the United States, this outcome is not inevitable. The American Stroke Association (16) has reported that 10 percent of stroke survivors recover almost completely, while another 25 percent regain most of their functionality, save for a few minor issues. 


Starting recovery and rehabilitation from a stroke as soon as possible, even during your hospital stay, is crucial. With the help of a healthcare team, your condition can be stabilized, and the effects of the stroke can be assessed. 


The team can also identify underlying factors and start therapy to help you regain some of your affected skills. Below are a few therapies used in stroke recovery:

Physical therapy


After experiencing a stroke, one may notice decreased muscle tone and strength, resulting in limited mobility. 


To address this concern, a physical therapist can aid recovery by devising exercises and techniques to build strength and improve balance. 


Depending on the individual's needs, rehabilitation can occur in an outpatient clinic, a skilled nursing home, or at home.

Speech therapy


Having a stroke can result in difficulties with speech and language. To address this, a speech and language therapist will assist you in relearning how to speak. 


Moreover, if verbal communication proves challenging following a stroke, they will provide guidance in discovering alternative forms of communication. 


They will also provide advice and support to help you adjust to any changes in your communication abilities and provide resources to help you cope with any changes in your life. Additionally, they will also help you develop strategies to help you communicate more effectively.

Cognitive therapy


Following a stroke, an individual may experience alterations in their cognitive and reasoning abilities, leading to changes in their mood and behavior.


Seeking assistance from an occupational therapist can aid in the process of restoring previous patterns of thinking and behavior while also providing guidance on managing emotional responses. 


For instance, an occupational therapist may help the individual develop strategies for problem-solving, such as breaking down tasks into smaller steps or using visual cues to help remember information.

Summary


If you suspect you may be experiencing stroke symptoms, it's crucial to seek emergency medical treatment as soon as possible.  


The administration of clot-dissolving medication is only possible during the first few hours after the onset of stroke symptoms. Prompt treatment is one of the most effective ways to lessen the risk of long-term complications and disability. 


Although it's not always possible to prevent a stroke entirely, adopting specific lifestyle changes can significantly reduce your risk. Additionally, medications can help minimize the risk of blood clots that may trigger a stroke. 


If your healthcare provider thinks you're at risk of developing a stroke, they'll collaborate with you to create a prevention plan tailored to your needs. This plan may include medical intervention and lifestyle adjustments. 


Regular physical activity, a healthy diet, quitting smoking, and reducing alcohol consumption are critical components of a prevention plan. Additionally, managing any underlying health conditions, such as high blood pressure and diabetes, can help reduce the risk of a stroke.


References

https://www.nhlbi.nih.gov/health/stroke


https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113


https://my.clevelandclinic.org/health/diseases/5601-stroke


https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke


https://www.healthline.com/health/stroke


1- https://www.cdc.gov/stroke/facts.htm


2- https://www.cdc.gov/dotw/stroke/index.html


3- https://www.cdc.gov/stroke/facts.htm#:~:text=Find%20facts%20and%20statistics%20about%20stroke%20in%20the,people%20in%20the%20United%20States%20have%20a%20stroke.


4- https://www.cdc.gov/stroke/facts.htm#:~:text=Find%20facts%20and%20statistics%20about%20stroke%20in%20the,people%20in%20the%20United%20States%20have%20a%20stroke.


5- https://www.cdc.gov/stroke/facts.htm


6- https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots


7- https://www.cdc.gov/stroke/about.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fstroke%2Ftypes_of_stroke.htm


8- https://www.cdc.gov/stroke/about.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fstroke%2Ftypes_of_stroke.htm


9- https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds


10- https://www.who.int/news/item/04-03-2022-world-obesity-day-2022-accelerating-action-to-stop-obesity


11- https://www.cdc.gov/cholesterol/facts.htm#:~:text=Nearly%2029%20million%20adult%20Americans%20have%20total%20cholesterol,don%E2%80%99t%20know%20that%20their%20cholesterol%20is%20too%20high.


12- 

https://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure#:~:text=One%20in%20every%20three%20adult%20Americans%20--%20about,have%20high%20blood%20pressure%2C%20also%20known%20as%20hypertension.


13- https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.109.576413


14- https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots/ischemic-stroke-treatment


15- https://www.heart.org/idc/groups/ahaecc-public/@wcm/@swa/documents/downloadable/ucm_493389.pdf


16- https://www.stroke.org/en/life-after-stroke/stroke-rehab/rehab-therapy-after-a-stroke
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