What is cerebral ischemia?

Cerebral ischemia is one of three types of stroke. This type of stroke is caused by a blockage in an artery that supplies blood to the brain. The blockage reduces the blood flow and oxygen to the brain, leading to damage or death of brain cells. If circulation isn’t restored quickly, brain damage can be permanent.

Approximately 87 percent of all strokes are cerebral ischemia. Another type of major stroke is hemorrhagic stroke, in which a blood vessel in the brain ruptures and causes bleeding. The bleeding compresses brain tissue, damaging or killing it.

The third type of stroke is transient ischemic attack (TIA), also known as a ministroke. This type of stroke is caused by a temporary blockage or decreased blood flow to the brain. Symptoms usually disappear on their own.

What are the symptoms?

Specific symptoms of a cerebral ischemia depend on what region of the brain is affected. Certain symptoms are common across most cerebral ischemia, including:

  • vision problems, including blindness in one eye or double vision
  • weakness or paralysis in your limbs, which may be on one or both sides, depending on the affected artery
  • dizziness and vertigo
  • confusion
  • loss of coordination
  • drooping of face on one side

Once symptoms start, it’s crucial to get treatment as quickly as possible. This makes it less likely that damage becomes permanent. If you think someone is having a stroke, evaluate them using FAST:

  • Face: Is one side of their face drooping and hard to move?
  • Arms: If they raise their arms, does one arm drift downward or do they have significant difficulty raising their arm?
  • Speech: Is their speech slurred or otherwise strange?
  • Time: If the answer to any of these questions is yes, call your local emergency services as soon as possible.

TIA — even though it’s a brief period of the above symptoms that usually resolves on its own — also requires a doctor. This can be a warning sign of a full-blown cerebral ischemia.

What causes cerebral ischemia?

Cerebral ischemia occurs when an artery that supplies blood to the brain is blocked by a blood clot or fatty buildup, called plaque. Clots usually start in the heart and travel through the circulatory system. A clot can break up on its own or become lodged in an artery. When it blocks a brain artery, the brain doesn’t get enough blood or oxygen and cells start to die.

Cerebral ischemia caused by a fatty buildup happens when plaque breaks off from an artery and travels to the brain. Plaque can also build up in the arteries supplying blood to the brain and narrow those arteries enough to cause cerebral ischemia.

Cerebral ischemia is a stroke caused by a blockage, from a blood clot or fatty deposit, in an artery that supplies blood to the brain. This blockage can be at the neck or in the skull. The lack of blood flow or oxygen kills brain tissue.

Global ischemia, which is a more severe type of cerebral ischemia, happens when the flow of oxygen to the brain is greatly reduced or completely stopped. This is usually caused by a heart attack, but can also be caused by other conditions or events, such as carbon monoxide poisoning.

What are the risk factors?

Circulatory conditions are the main risk factor for cerebral ischemia. That’s because they increase your risk for clots or fatty deposits. These conditions include:

Other risk factors include:

  • diabetes
  • smoking
  • being overweight, especially if you have a lot of abdominal fat
  • heavy alcohol misuse
  • use of certain drugs, such as cocaine or methamphetamines

Cerebral ischemia is also more common in people who have a family history of stroke or who’ve had past strokes. Men are more likely than women to have cerebral ischemia, while African-Americans have a higher risk than other races or ethnic groups. Risk also increases with age.

How is it diagnosed?

A doctor can usually use a physical exam and family history to diagnose cerebral ischemia. Based on your symptoms, they can also get an idea of where the blockage is located.

If you have symptoms such as confusion and slurred speech, your doctor might perform a blood sugar test. That’s because confusion and slurred speech are also symptoms of severe low blood sugar. Learn more about the effects of low blood sugar on the body.

A CT scan can also help distinguish cerebral ischemia from other issues that cause brain tissue death, such as a hemorrhage or a brain tumor.

Once your doctor has diagnosed cerebral ischemia, they’ll try to figure out when it started and what the root cause is. An MRI is the best way determine when the cerebral ischemia started. Tests for a root cause might include:

  • an electrocardiogram (ECG) to test for abnormal heart rhythms
  • echocardiography to check your heart for clots or abnormalities
  • an angiography to see which arteries are blocked and how severe the blockage is
  • blood tests for cholesterol and clotting problems

How is cerebral ischemia treated?

The first goal of treatment is to restore breathing, heart rate, and blood pressure to normal. If necessary, your doctor will then try to reduce pressure in the brain with medication.

The main treatment for cerebral ischemia is intravenous tissue plasminogen activator (TPA), which breaks up clots. TPA is most effective when it’s given within three hours of the start of a stroke. It cannot be given more than five hours after the start of the stroke. TPA can cause bleeding, so you can’t take it if you have a history of:

  • hemorrhagic stroke
  • bleeding in the brain
  • recent major surgery or head injury

It also can’t be used by anyone taking anticoagulants. If TPA doesn’t work, clots can be removed through surgery.

Long-term treatments include aspirin (Bayer) or an anticoagulant to prevent further clots. If cerebral ischemia is caused by a condition such as high blood pressure or atherosclerosis, you’ll need to receive treatment for those conditions. For example, your doctor may recommend a stent to open an artery narrowed by plaque, or statins to lower blood pressure.

After cerebral ischemia, you’ll have to stay in the hospital for observation for at least a few days. If the ischemia caused paralysis or severe weakness, you may also need rehab afterward to regain function.

Recovering from cerebral ischemia

Rehab is often necessary to regain motor skills and coordination. Occupational, physical, and speech therapy might also be useful to help regain other lost function. Younger people and people who start improving quickly are likely to recover most function. If any issues are still present after a year, they’ll likely be permanent.

Having one cerebral ischemia puts you at a higher risk for having another. Taking steps to reduce your risk, such as quitting smoking, are an important part of long-term recovery.

What’s the outlook?

Cerebral ischemia is a serious condition and requires prompt treatment. However, with the correct treatment, most people with cerebral ischemia can recover or maintain enough function to take care of their basic needs. Knowing the signs of cerebral ischemia can help save your life or the life of someone else.