Acute Stroke

An acute stroke is a "brain attack" caused by an interruption in blood flow to the brain. It is a medical emergency that can lead to disability or death if not treated immediately. The sooner a stroke is treated, the better the chances of recovery. 

Common causes

There are two main types of acute stroke:

  • Ischemic stroke: This is the most common type and is caused by a blood clot blocking an artery in the brain, cutting off blood supply. This can happen if:

    • Fatty deposits (plaque) build up in an artery wall and eventually block it.

    • A blood clot breaks off from another part of the body, such as the heart, and travels to the brain.

  • Hemorrhagic stroke: This occurs when a blood vessel in or on the brain bursts and bleeds into the surrounding tissue, putting pressure on the brain cells. A hemorrhagic stroke can be caused by:

    • Uncontrolled high blood pressure.

    • A balloon-like bulge in an artery (aneurysm) that ruptures.

    • A tangle of poorly formed blood vessels that bursts (arteriovenous malformation or AVM). 

Signs and symptoms

The symptoms of a stroke often appear suddenly. A simple way to remember the most common signs is with the acronym F.A.S.T.. 

  • Face drooping: Does one side of the face droop or feel numb? Is the smile uneven?

  • Arm weakness: Is one arm weak or numb? When the person tries to raise both arms, does one drift downward?

  • Speech difficulty: Is their speech slurred? Can they repeat a simple sentence correctly?

  • Time to call 911: If you notice any of these signs, call for emergency medical help immediately. 

Other symptoms can include: 

  • Sudden confusion or trouble understanding speech.

  • Sudden trouble seeing in one or both eyes.

  • Sudden dizziness, trouble walking, or loss of balance or coordination.

  • A sudden, severe headache with no known cause. 

Diagnosis

To diagnose a stroke, doctors need to determine what kind it is so they can begin the right treatment. They will ask questions about the person's symptoms and medical history and perform a physical exam. The most critical tools are imaging tests that allow doctors to see what is happening in the brain. 

  • CT scan: This is often the first test given because it is quick and can show whether there is bleeding in the brain.

  • MRI scan: This test provides a more detailed picture of the brain and can detect damage to brain cells, helping to determine the extent of the stroke.

  • Other tests: Further tests may be needed to examine the blood vessels in the neck and head or check for heart problems that could be the cause. 

Treatment

Treatment for a stroke depends on the type and must begin as quickly as possible to minimize brain damage. 

For an ischemic stroke (caused by a clot)

  • Clot-busting medication (tPA): For eligible patients, this medication can be given through an IV to dissolve the clot and restore blood flow. It is most effective when administered within the first few hours of the start of symptoms.

  • Mechanical thrombectomy: A doctor threads a catheter through an artery to the blocked vessel in the brain and uses a special device to physically remove the clot. This is an option for certain patients, even up to 24 hours after symptoms began. 

For a hemorrhagic stroke (caused by bleeding)

  • Medication: The person may receive medications to manage blood pressure or counteract blood-thinning drugs that may have contributed to the bleeding.

  • Surgery: Depending on the cause, surgeons may need to perform a procedure to repair the burst blood vessel or place a clip or coil to stop the bleeding. 

What to expect after treatment

After the immediate crisis has passed, many stroke patients require rehabilitation to recover lost function. This can include physical, occupational, and speech therapy to regain strength, coordination, and communication skills. 


 

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