A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues.

According to the Centers for Disease Control and Prevention (CDC), stroke is a leading cause of death in the United States. Every year, more than 795,000 U.S. people have a stroke.

Without oxygen, brain cells and tissue become damaged and begin to die within minutes.

There are three primary types of strokes:

  • Transient ischemic attack (TIA) involves a blood clot that typically reverses on its own.
  • Ischemic stroke involves a blockage caused by either a clot or plaque in the artery. The symptoms and complications of ischemic stroke can last longer than those of a TIA, or may become permanent.
  • Hemorrhagic stroke is caused by either a burst or leaking blood vessel that seeps into the brain.

The loss of blood flow to the brain damages tissues within the brain. Symptoms of a stroke show up in the body parts controlled by the damaged areas of the brain.

The sooner a person having a stroke gets care, the better their outcome is likely to be. For this reason, it’s helpful to know the signs of a stroke so you can act quickly. Stroke symptoms can include:

  • paralysis
  • numbness or weakness in the arm, face, and leg, especially on one side of the body
  • trouble speaking or understanding others
  • slurred speech
  • confusion, disorientation, or lack of responsiveness
  • sudden behavioral changes, especially increased agitation
  • vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
  • trouble walking
  • loss of balance or coordination
  • dizziness
  • severe, sudden headache with an unknown cause
  • seizures
  • nausea or vomiting

A stroke requires immediate medical attention. If you think you or someone else is having a stroke, call 911 or local emergency services right away. Prompt treatment is key to preventing the following outcomes:

  • brain damage
  • long-term disability
  • death

It’s better to be overly cautious when dealing with a stroke, so don’t be afraid to get emergency medical help if you think you recognize the signs of a stroke.

The cause of a stroke depends on the type of stroke. Strokes fall into three main categories:

  • transient ischemic attack (TIA)
  • ischemic stroke
  • hemorrhagic stroke
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Illustration by Bailey Mariner

These categories can be further broken down into other types of strokes, including:

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

The type of stroke you have affects your treatment and recovery process.

Ischemic stroke

During an ischemic stroke, the arteries supplying blood to the brain narrow or become blocked. Blood clots or severely reduced blow flow to the brain causes these blockages. Pieces of plaque breaking off and blocking a blood vessel can also cause them.

There are two types of blockages that can lead to ischemic stroke: a cerebral embolism and cerebral thrombosis.

A cerebral embolism (often referred to as embolic stroke) occurs when a blood clot forms in another part of the body — often the heart or arteries in the upper chest and neck — and moves through the bloodstream until it hits an artery too narrow to let it pass.

The clot gets stuck, and stops the flow of blood and causes a stroke.

Cerebral thrombosis (often referred to as thrombotic stoke) occurs when a blood clot develops at the fatty plaque within the blood vessel.

According to the CDC, 87 percent of strokes are ischemic strokes.

Transient ischemic attack (TIA)

A transient ischemic attack, often called a TIA or ministroke, occurs when blood flow to the brain is blocked temporarily.

Symptoms are similar to those of a full stroke. However, they’re typically temporary and disappear after a few minutes or hours, when the blockage moves and blood flow is restored.

A blood clot usually causes a TIA. While it’s not technically categorized as a full stroke, a TIA serves as a warning that an actual stroke may happen. Because of this, it’s best not to ignore it. Seek the same treatment you would for a major stroke and get emergency medical help.

According to the CDC, more than one-third of people who experience a TIA and don’t get treatment have a major stroke within a year. Up to 10 to 15 percent of people who experience a TIA have a major stroke within 3 months.

Hemorrhagic stroke

A hemorrhagic stroke happens when an artery in the brain breaks open or leaks blood. The blood from that artery creates excess pressure in the skull and swells the brain, damaging brain cells and tissues.

The two types of hemorrhagic strokes are intracerebral and subarachnoid:

  • An intracerebral hemorrhagic stroke is the most common type of hemorrhagic stroke. It happens when the tissues surrounding the brain fill with blood after an artery bursts.
  • A subarachnoid hemorrhagic stroke is less common. It causes bleeding in the area between the brain and the tissues that cover it.

According to the American Heart Association, about 13 percent of strokes are hemorrhagic.

Certain risk factors make you more susceptible to stroke. According to the National Heart, Lung, and Blood Institute, risk factors for stroke include:

Diet

An unbalanced diet can increase the risk of stroke. This type of diet is high in:

  • salt
  • saturated fats
  • trans fats
  • cholesterol

Inactivity

Inactivity, or lack of exercise, can also raise the risk of stroke.

Regular exercise has a number of health benefits. The CDC recommends that adults get at least 2.5 hours of aerobic exercise every week. This can mean simply a brisk walk a few times a week.

Heavy alcohol use

The risk of stroke also increases with heavy alcohol use.

If you drink, drink in moderation. This means no more than one drink a day for women, and no more than two drinks a day for men.

Heavy alcohol use can raise blood pressure levels. It can also raise triglyceride levels, which can cause atherosclerosis. This is plaque buildup in the arteries that narrows blood vessels.

Tobacco use

Using tobacco in any form also raises the risk of stroke, since it can damage the blood vessels and heart. Nicotine also raises blood pressure.

Personal background

There are some risk factors for stroke you can’t control, such as:

  • Family history. Stroke risk is higher in some families because of genetic health factors, such as high blood pressure.
  • Sex. According to the CDC, while both women and men can have strokes, they’re more common in women than in men in all age groups.
  • Age. The older you are, the more likely you are to have a stroke.
  • Race and ethnicity. African Americans, Alaska Natives, and American Indians are more likely to have a stroke than other racial groups.

Health history

Certain medical conditions are linked to stroke risk. These include:

  • a previous stroke or TIA
  • high blood pressure
  • high cholesterol
  • carrying too much excess weight
  • heart disorders, such as coronary artery disease
  • heart valve defects
  • enlarged heart chambers and irregular heartbeats
  • sickle cell disease
  • diabetes
  • blood clotting disorder
  • patent foramen ovale (PFO)

To find out about your specific risk factors for stroke, talk with your doctor.

The complications after stroke can vary. They may occur because of either a direct injury to the brain during the stroke, or because abilities have been permanently affected.

Some of these complications include:

  • seizures
  • loss of bladder and bowel control
  • cognitive impairment, including dementia
  • reduced mobility, range of motion, or ability to control certain muscle movements
  • depression
  • mood or emotional changes
  • shoulder pain
  • bed sores
  • sensory or sensation changes

These complications can be managed by methods such as:

  • medication
  • physical therapy
  • counseling

Certain complications may even be reserved.

Lifestyle changes can’t prevent all strokes. But many of these changes can make a radical difference when it comes to lowering your risk of stroke.

These changes include the following:

  • Quit smoking. If you smoke, quitting now will lower your risk of stroke. You can reach out to your doctor to create a quit plan.
  • Limit alcohol use. Heavy alcohol consumption can raise your blood pressure, which in turn raises the risk of stroke. If reducing your intake is difficult, reach out to your doctor for help.
  • Keep a moderate weight. Overweight and obesity increases the risk of stroke. To help manage your weight, eat a balanced diet and stay physically active more often than not. Both steps can also reduce blood pressure and cholesterol levels.
  • Get regular checkups. Talk with your doctor about how often to get a checkup for blood pressure, cholesterol, and any conditions you may have. They can also support you in making these lifestyle changes and offer guidance.

Taking all these measures will help put you in better shape to prevent stroke.

Your doctor will ask you or a family member about your symptoms and what you were doing when they arose. They’ll take your medical history to find out your stroke risk factors. They’ll also:

  • ask what medications you take
  • check your blood pressure
  • listen to your heart

You’ll also have a physical exam, during which your doctor will evaluate you for:

  • balance
  • coordination
  • weakness
  • numbness in your arms, face, or legs
  • signs of confusion
  • vision issues

Your doctor will then do certain tests to help confirm a stroke diagnosis. These tests can help them determine whether you had a stroke and, if so:

  • what may have caused it
  • what part of the brain is affected
  • whether you have bleeding in the brain

Your doctor may order various tests to further help them determine whether you’ve had a stroke, or to rule out another condition. These tests include:

Blood tests

Your doctor might draw blood for several blood tests. Blood tests can determine:

  • blood sugar levels
  • whether you have an infection
  • platelet counts
  • how fast your blood clots
  • cholesterol levels

MRI and CT scan

Your doctor may order may an MRI scan, CT scan, or both.

An MRI can help see whether any brain tissue or brain cells have been damaged.

A CT scan can provide a detailed and clear picture of your brain, which can show any bleeding or damage. It may also show other brain conditions that could be causing your symptoms.

EKG

An electrocardiogram (EKG) is a simple test that records the electrical activity in the heart, measuring its rhythm and recording how fast it beats.

An EKG can determine whether you have any heart conditions that may have led to a stroke, such as a prior heart attack or atrial fibrillation.

Cerebral angiogram

A cerebral angiogram offers a detailed look at the arteries in your neck and brain. The test can show blockages or clots that may have caused symptoms.

Carotid ultrasound

A carotid ultrasound, also called a carotid duplex scan, can show fatty deposits (plaque) in your carotid arteries, which supply the blood to your face, neck, and brain.

It can also show whether your carotid arteries have been narrowed or blocked.

Echocardiogram

An echocardiogram can find sources of clots in your heart. These clots may have traveled to your brain and caused a stroke.

Proper medical evaluation and prompt treatment are vital to recovering from a stroke. According to the American Heart Association and American Stroke Association, “Time lost is brain lost.”

Call 911 or local emergency services as soon as you realize you may be having a stroke, or if you suspect someone else is having a stroke.

Treatment for stroke depends on the type of stroke:

Ischemic stroke and TIA

Since a blood clot or blockage in the brain causes these stroke types, they’re largely treated with similar techniques. They can include:

Clot-breaking drugs

Thrombolytic drugs can break up blood clots in your brain’s arteries, which will stop the stroke and reduce damage to the brain.

One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the gold standard in ischemic stroke treatment.

This drug works by dissolving blood clots quickly.

People who receive a tPA injection are more likely to recover from a stroke and less likely to have any lasting disability as a result of the stroke.

Mechanical thrombectomy

During this procedure, a doctor inserts a catheter into a large blood vessel inside your head. They then use a device to pull the clot out of the vessel. This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.

Stents

If a doctor finds where artery walls have weakened, they may perform a procedure to inflate the narrowed artery and support the walls of the artery with a stent.

Surgery

In the rare instances that other treatments don’t work, surgery can remove a blood clot and plaques from your arteries.

This surgery may be done with a catheter. If the clot is especially large, a surgeon may open an artery to remove the blockage.

Hemorrhagic stroke

Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:

Medications

Unlike with an ischemic stroke, if you’re having a hemorrhagic stroke, the treatment goal is to make your blood clot. Therefore, you may be given medication to counteract any blood thinners you take.

You may also be prescribed drugs that can:

  • reduce blood pressure
  • lower the pressure in your brain
  • prevent seizures
  • prevent blood vessel constriction

Coiling

During this procedure, your doctor guides a long tube to the area of hemorrhage or weakened blood vessel. They then install a coil-like device in the area where the artery wall is weak. This blocks blood flow to the area, reducing bleeding.

Clamping

During imaging tests, your doctor may discover an aneurysm that hasn’t started bleeding yet or has stopped.

To prevent additional bleeding, a surgeon may place a tiny clamp at the base of the aneurysm. This cuts off blood supply and prevents a possible broken blood vessel or new bleeding.

Surgery

If your doctor sees that an aneurysm has burst, they may do surgery to clip the aneurysm and prevent additional bleeding. Likewise, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.

In addition to emergency treatment, your healthcare team will advise you on ways to prevent future strokes.

Several medications are used to treat strokes. The type your doctor prescribes depends largely on the type of stroke you had.

The goal of some medications is to prevent a second stroke, while others aim to prevent a stroke from happening in the first place.

Your doctor may prescribe one or more of these medications to treat or prevent a stroke, depending on factors such as your health history and your risks.

The most common stroke medications include:

Direct-acting oral anticoagulants (DOACs)

This newer drug class works in the same way as traditional anticoagulants (reducing your blood’s ability to clot), but they often work faster and require less monitoring.

If taken for stroke prevention, DOACs may also reduce the risk of brain bleed.

Tissue plasminogen activator (tPA)

This emergency medication can be given during a stroke to break up the blood clot causing the stroke. It’s the only medication currently available that can do this, but it must be given within 3 to 4.5 hours after symptoms of a stroke begin.

This drug is injected into a blood vessel so the medication can start to work as quickly as possible, which reduces the risk of complications from the stroke.

Anticoagulants

These drugs reduce your blood’s ability to clot. The most common anticoagulant is warfarin (Coumadin, Jantoven).

These drugs can also prevent existing blood clots from growing larger, which is why doctors may prescribe them to prevent a stroke, or after an ischemic stroke or TIA has occurred.

Antiplatelet drugs

These medications prevent blood clots by making it more difficult for the blood’s platelets to stick together. The most common antiplatelet drugs include aspirin and clopidogrel (Plavix).

The drugs can prevent ischemic strokes. They’re especially important in preventing secondary stroke.

If you’ve never had a stroke before, only use aspirin as a preventive medication if you have a high risk of atherosclerotic cardiovascular disease (e.g., heart attack and stroke) and a low risk of bleeding.

Statins

Statins help lower high blood cholesterol levels. They’re among the most commonly prescribed medications in the United States.

These drugs prevent the production of an enzyme that can turn cholesterol into plaque — the thick, sticky substance that can build up on the walls of arteries and cause strokes and heart attacks.

Common statins include:

Blood pressure drugs

High blood pressure can cause pieces of plaque buildup in your arteries to break off. These pieces can block arteries, causing a stroke.

As a result, managing high blood pressure with medication, lifestyle changes, or both can help prevent a stroke.

Stroke is a leading cause of long-term disability in the United States.

However, the American Stroke Association reports that 10 percent of stroke survivors make an almost complete recovery, while another 25 percent recover with only minor issues.

It’s important that recovery and rehabilitation from a stroke start as soon as possible. In fact, stroke recovery should begin in the hospital.

In a hospital, a care team can stabilize your condition and assess the effects of the stroke. They can identify underlying factors and begin therapy to help you regain some of your affected skills.

Stroke recovery typically focuses on four main areas:

Speech therapy

A stroke can cause speech and language impairment. A speech and language therapist will work with you to relearn how to speak.

Or, if you find verbal communication difficult after a stroke, they’ll help you find new ways of communication.

Cognitive therapy

After a stroke, many people may have changes to their thinking and reasoning skills. This can cause behavioral and mood changes.

An occupational therapist can help you work to regain your former patterns of thinking and behavior, and to manage your emotional responses.

Relearning sensory skills

If the part of your brain that relays sensory signals is affected during the stroke, you may find that your senses are “dulled” or no longer working.

That may mean that you don’t feel things well, such as temperature, pressure, or pain. An occupational therapist can help you learn to adjust to this lack of sensation.

Physical therapy

Muscle tone and strength may be weakened by a stroke, and you may find you’re unable to move your body as well as you could before.

A physical therapist will work with you to regain your strength and balance, and find ways to adjust to any limitations.

Rehabilitation may take place in a clinic, skilled nursing home, or your own home.

If you suspect you may be experiencing symptoms of a stroke, it’s vital that you seek emergency medical treatment as soon as possible.

Clot-busting medication can only be provided in the first hours after the signs of a stroke begin. Early treatment is one of the most effective ways to reduce your risk of long-term complications and disability.

While it’s not always possible to completely prevent a stroke, certain lifestyle changes can greatly reduce your risk. Medications can also help reduce the risk of blood clots, which can lead to stroke.

If your doctor believes you might be at risk for a stroke, they will work with you to find a prevention strategy that works for you, including medical intervention and lifestyle changes.