A stroke occurs when a blood
vessel in the brain is
blocked or bursts. Without blood and the oxygen it carries, part of the brain
starts to die. The part of the body controlled by the damaged area of the brain
can't work properly.
Brain damage can begin within minutes. That's why it's so important to know the symptoms of stroke and to act fast. Quick treatment can
help limit damage to the brain and increase the chance of a full
Symptoms of a stroke happen
quickly. A stroke may cause:
If you have any of these symptoms, call 911 or other emergency services right away.
FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help. FAST stands for:
See your doctor if you have
symptoms that seem like a stroke, even if they go away quickly. You may have
transient ischemic attack (TIA), sometimes called a
mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early
treatment for a TIA can help prevent a stroke.
There are two types of
You need to see a doctor right away. If a stroke is diagnosed quickly-right after symptoms start-doctors may be able to use medicines that can help you recover better.
The first thing the doctor needs to find out
is what kind of stroke it is: ischemic or hemorrhagic. This is important,
because the medicine given to treat a stroke caused by a blood clot could be
deadly if used for a stroke caused by bleeding in the brain.
find out what kind of stroke it is, the doctor will do a type of X-ray called a
CT scan of the brain, which can show if there is
bleeding. The doctor may order other tests to find the location of the clot or
bleeding, check for the amount of brain damage, and check for other conditions
that can cause symptoms similar to a stroke.
For an ischemic stroke, treatment focuses on restoring blood flow to
the brain. You may be given a clot-dissolving medicine called
tissue plasminogen activator (TPA). This medicine can improve recovery from a stroke, especially if given as soon as possible after the
stroke happens. Doctors try to give this medicine within 3 hours after symptoms start. Some people may be helped if they are able to get this medicine within 4½ hours of their first symptoms.footnote 1 Other medicines may be
given to prevent blood clots and control symptoms. A procedure may be done to remove the blood clot and restore blood flow.
hemorrhagic stroke, treatment focuses on stopping the bleeding in the brain. Doctors may give you medicine or a transfusion with parts of blood, such as plasma. They may do
surgery to drain the blood or to reduce pressure on the brain.
Medicines may be used to control blood pressure, brain swelling, and other
After either kind of stroke and after your condition is stable, treatment shifts to
preventing other problems and future strokes. You may need to take a number of
medicines to control conditions that put you at risk for stroke, such as high
blood pressure or atrial fibrillation. Some people need to have a
surgery to remove
plaque buildup from the blood vessels that supply the
brain (carotid arteries).
The best way to get
better after a stroke is to start
stroke rehabilitation (rehab). The goal of stroke rehab is to help you
regain skills you lost or to make the most of your remaining abilities. Stroke
rehab can also help you take steps to prevent future strokes. You have the
greatest chance of regaining abilities during the first few months after a
stroke. So it is important to start rehab soon after a stroke and do a little
After you have had a
stroke, you are at risk for having another one. But you can make some important
lifestyle changes that can reduce your risk of stroke and improve your overall
Learning about stroke:
Living with stroke:
Health Tools help you make wise health decisions or take action to improve your health.
ischemic stroke is caused by a blood clot that blocks blood flow to the brain.
Low blood pressure may also cause an
ischemic stroke, although this is less common. Low blood pressure results in reduced
blood flow to the brain. It may be caused by narrowed or diseased
arteries, a heart attack, a large loss of blood, or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as
carotid artery stenting) that are used to treat narrowed carotid arteries may cause a blood
clot to break loose, resulting in a stroke.
hemorrhagic stroke is caused by bleeding in or around the
Other less common causes include head or neck injuries, certain diseases, and radiation treatment for cancer in the neck or brain.
If you have symptoms of a stroke,
call 911 or other emergency services right away. General symptoms of a
Symptoms can vary depending on whether the stroke is caused by
a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.
A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.
If several smaller strokes occur over time, you may
have a more gradual change in walking, balance, thinking, or behavior. This is called multi-infarct dementia.
It isn't always easy for people to recognize symptoms of a
small stroke. They may mistakenly think the symptoms can be attributed to
aging. Or the symptoms may be confused with those of other conditions that
cause similar symptoms.
When you have an
ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced.
hemorrhagic stroke, there is bleeding in the
After about 4 minutes without blood and oxygen,
brain cells become damaged and may die. The body tries to restore
blood and oxygen to the cells by enlarging other blood vessels (arteries) near
If blood supply isn't restored, permanent damage
usually occurs. The body parts
controlled by those damaged cells cannot function.
This loss of function may be mild or
severe. It may be temporary or permanent. It depends on where and how much of the
brain is damaged and how fast the blood supply can be returned to the affected
cells. Life-threatening complications may also occur. This is why it's important to get treatment as soon as possible.
depends on the location and amount of brain damage caused by the stroke, the
ability of other healthy areas of the brain to take over for the
damaged areas, and
rehabilitation. In general, the less damage there is
to the brain tissue, the less disability results and the greater the chances of
a successful recovery.
Stroke is the most common nervous-system-related cause of physical
disability. Of people who survive a stroke, half will
still have some disability 6 months after the stroke.
You have the greatest chance of regaining
your abilities during the first few months after a stroke. Regaining some
abilities, such as speech, comes slowly, if at all. About half of all people
who have a stroke will have some long-term problems with talking,
understanding, and decision-making. They also may have changes in behavior that
affect their relationships with family and friends.
After a stroke, you (or a caregiver)
may also notice:
complications of a stroke, such as
pneumonia, may develop right away or months to years
after a stroke.
Some long-term problems may be prevented with proper home
treatment and medical follow-up. For more information, see Home Treatment.
A risk factor is anything that makes you more likely to have a particular health problem. Risk factors for stroke that you can treat or change include:
Risk factors you cannot change
Call 911 or other emergency services now if you have signs of a stroke:
Signs of a transient ischemic attack (TIA) are similar to signs of a stroke. But TIA symptoms usually disappear after 10 to 20 minutes, although they may last longer. There is no way to tell whether the symptoms are caused by a stroke or by TIA, so emergency medical care is needed for both conditions.
Call your doctor right away if you:
Call your doctor for an appointment if you:
Doctors who can diagnose and treat stroke
If you need surgery or have other health problems, other
specialists may be consulted, such as a:
Some hospitals have a stroke team made up of many
different health professionals, such as a neurologist, a neuroradiologist, a physical therapist, an occupational
therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse,
and a social worker.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
The first test after a stroke is
CT scan, a
series of X-rays that can show whether there is bleeding in the brain. This
test will show whether the stroke is ischemic or hemorrhagic.
You may also have an MRI.
Other initial tests recommended for ischemic stroke include:
If it seems that you may have a narrowing of
carotid artery, your doctor may want you to have a:
If your doctor
believes that the stroke may have been caused by a problem with your heart, an
Holter monitoring or telemetry test may be done.
Guidelines recommend that risk factors for heart disease also be
assessed after a stroke to prevent disability or death from a future heart
problem. This is because many people who have had a stroke also have
coronary artery disease.
Measures will be taken to stabilize your vital signs,
including giving you medicines.
Treatment includes efforts
to control bleeding, reduce pressure in the brain, and stabilize vital signs,
especially blood pressure.
Your treatment will also focus on
stroke. This may include:
You may also need to make lifestyle changes such
as quitting smoking, eating heart-healthy foods, and being active. For more information, see Prevention.
carotid arteries are significantly blocked, you may
need a procedure to reopen the narrowed arteries. For more information, see Surgery and Other Treatment.
rehab program as soon as possible after a
stroke increases your chances of regaining some of the abilities you
rehab will be based on the physical abilities that were lost, your
general health before the stroke, and your ability to participate.
Rehab begins with helping you resume activities of daily living, such
as eating, bathing, and dressing. Rehab can also help you make changes in your lifestyle, at
home, at work, and in relationships. The changes you make will depend on how the stroke affected you.
Rehab can help you to:
If you are someone whose loved one has had a stroke, you can play an important role in that person's recovery by providing support and encouragement.
possible to predict how much ability you will regain. The
more ability you retain immediately after a stroke, the more independent you
are likely to be when you are discharged from the hospital. For more information, see the topic
Some people move to a care facility that can meet their needs. There are several kinds of long-term care. Each provides different levels of care, assistance, and services. The quality and costs of care and services at long-term care facilities vary
widely, and options vary from one community to another. Your doctor or rehab team can help you find which type of long-term care would be best for you.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see
A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see
You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
stroke. You can help prevent a TIA or stroke by taking steps toward a heart-healthy lifestyle.
Your doctor can help you know your risk. These are some of the common risk factors for stroke:
Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.
The types of medicines that prevent clotting are:
Cholesterol-lowering and blood-pressure-lowering medicines are also used to prevent TIAs and strokes.
Anticoagulants prevent blood clots from forming and keep existing blood clots from getting bigger.
You may need to take this type of medicine after a stroke if you have atrial fibrillation or another condition that makes you more likely to have another stroke. For more information, see the topic Atrial Fibrillation.
Antiplatelet medicines keep
platelets in the blood from sticking together.
These medicines include:
Statins lower cholesterol and your risk for another stroke.
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
Medicines used to treat depression and pain may also be
prescribed after a stroke.
When surgery is being considered after a
stroke, your age, prior overall health, and current
condition are major factors in the decision.
If you have serious blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke.
Treatment for hemorrhagic stroke may include surgery to:
Carotid artery stenting (also called carotid angioplasty and stenting) is sometimes done as an alternative to surgery to prevent stroke.
In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a stent to keep the artery open.
Carotid artery stenting is not as common as carotid endarterectomy, a type of surgery.
CitationsJauch EC, et al. (2013) Guidelines for the early management of patients with acute ischemic stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44(3): 870-947. DOI: 10.1161/STR.0b013e318284056a. Accessed April 2, 2016.Other Works ConsultedAbbott AL (2009). Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis. Stroke, 40(10): e573-e583.Adams RJ, et al. (2003). Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: A scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation, 108(10): 1278-1290. Also available online: http://circ.ahajournals.org/content/108/10/1278.full.Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11-23.Claude Hemphill J, et al. (2015). Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46(7): 2032-2060. DOI: 10.1161/STR.0000000000000069. Accessed June 23, 2015.Holloway RG, et al. (2014). Palliative and end-of-life care in stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(6): 1887-1916. DOI: 10.1161/STR.0000000000000015. Accessed May 28, 2014.International Carotid Stenting Study investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomized controlled trial. Lancet, 375(9719): 985-997.Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160-2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.Lansberg MG, et al. (2012). Antithrombotic and thrombolytic therapy for ischemic stroke. Antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e601S-e636S. Also available online: http://journal.publications.chestnet.org/article.aspx?articleid=1159534.Latchaw RE, et al. (2003). Guidelines and recommendations for perfusion imaging in cerebral ischemia: A scientific statement for healthcare professionals by the writing group on perfusion imaging, from the Council on Cardiovascular Radiology of the American Heart Association. Stroke, 34(4): 1084-1104. Also available online: http://stroke.ahajournals.org/content/34/4/1084.full.Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.Powers WJ, et al. (2015). 2015 AHA/ASA Focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke, published online June 29, 2015. DOI: 10.1161/STR.0000000000000074. Accessed August 22, 2015.Spence JD, et al. (2010). Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Archives of Neurology, 67(2): 180-186.Towfighi A, et al. (2016). Poststroke depression: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online December 8, 2016. DOI: 10.1161/STR.0000000000000113. Accessed April 5, 2017.U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.Wahlgren N, et al. (2008). Thrombolysis with alteplase 3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study. Lancet. Published online September 15, 2008 (doi:10.1016/S0140-6736(08)61339-2).Winstein CJ, et al. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online May 4, 2016. DOI: 10.1161/STR.0000000000000098. Accessed June 3, 2016.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineKathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerRichard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Current as ofJune 7, 2017
Current as of:
June 7, 2017
E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Adam Husney, MD - Family Medicine & Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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Last modified on: 8 September 2017