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This page will feature the latest informative articles with stroke News
What is Stroke?
| Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 3 cause of death in the United States, behind diseases of the heart and cancer. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. |
Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke).
If we consider an isolated blood vessel, blood flow to the brain tissue can be hampered in two ways:
- the vessel clogs within (ischemic stroke)
- the vessel ruptures, causing blood to leak into the brain (hemorrhagic stroke)
Ischemic
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Ischemic stroke accounts for about 85 percent of all cases. View a detailed animation of ischemic stroke.Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. These fatty deposits can cause two types of obstruction:
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Cerebral thrombosis refers to a thrombus (blood clot) that develops at the clogged part of the vessel.Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain’s blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain
Hemorrhagic
Hemorrhagic stroke accounts for about 15 percent of stroke cases. View a detailed illustration of hemorrhagic stroke.
It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral hemorrhage or subarachnoid hemorrhage.
Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).
An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain. Learn more about cerebral aneurysm.
An arteriovenous malformation (AVM) is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain. Learn more about AVM.
Also called TIAs, transient ischemic attacks are minor or warning strokes. In a TIA, conditions that can cause an ischemic stroke are present and the typical stroke warning signs develop. However, the obstruction (blood clot) occurs for a short time and tends to resolve itself through normal mechanisms.
Even though the symptoms disappear after a short time, TIAs are strong indicators of a possible major stroke. Steps should be taken immediately to prevent a stroke
Diagnosing Stroke
Tests
When someone has shown symptoms of a stroke or a TIA (transient ischemic attack), a doctor will gather information and make a diagnosis. He or she will review the events that have occurred and will:
- get a medical history
- do a physical and neurological examination
- have certain laboratory (blood) tests done
- get a CT or MRI scan of the patient
- study the results of other diagnostic tests that might be needed
What are the types of diagnostic tests?
What are some common imaging tests?
What is an electrical activity test?
What is a blood flow test?
What are the types of diagnostic tests?
Diagnostic tests examine how the brain looks, works and gets its blood supply. They can outline the injured brain area. Most of them are safe and painless.
Diagnostic tests fall into three categories.
- Imaging tests give a picture of the brain similar to X-rays.
- Electrical tests record the electrical impulses of the brain.
- Blood flow tests show any problem that may cause changes in blood flow to the brain.
What are some common imaging tests?
CT scan (computed tomography) or CAT scan is a key imaging test. It uses radiation to create a picture of the brain. It’s usually one of the first tests given to patients suspected of stroke. CT test results give valuable information about the cause of stroke and the location and extent of brain injury. View a detailed animation of CT scan.
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MRI (magnetic resonance imaging) uses a large magnetic field to produce an image of the brain. Like the CT scan, it shows the location and extent of brain injury. The image produced by MRI is sharper and more detailed than a CT scan so it’s often used to diagnose small, deep injuries.
What is an electrical activity test?
Two basic tests, EEG and Evoked Response, show the brain’s electrical activity.
- In an EEG (electroencephalogram), small metal discs (electrodes) are placed on a person’s scalp to pick up electrical impulses. These electrical signals are printed out as brain waves.
- An Evoked Response test measures how the brain handles different sensory information. Electrodes record electrical impulses related to hearing, body sensation or vision.
Several blood flow tests exist; most use ultrasound technology. A probe is placed over the suspect artery — especially arteries in the neck (carotid) or at the base of the skull (vertebral) — and the amount of blood flow is determined.
Examples of blood flow tests are B-mode imaging, Doppler testing and duplex scanning. These tests give detailed information about the condition of arteries.
Another blood flow test is a medical procedure called angiography (arteriography or arteriogram). This test is like a cardiac catheterization, only the catheter is placed in the arteries of the brain rather than in the arteries of the heart. In this test, a special dye is injected into the blood vessels and an X-ray is taken.
Angiography gives a picture of the blood flow through the vessels. This allows the size and location of blockages to be evaluated. This test can be especially valuable in diagnosing aneurysms and malformed blood vessels and providing information before surgery. View an illustration of carotid (neck) angiography.
Acute and Preventive Stroke Treatments
Because their mechanisms are different, the treatments for the types of stroke are different:
- Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain.
- In hemorrhagic stroke, doctors introduce an obstruction to prevent rupture and bleeding of aneurysms and arteriovenous malformations.
Ischemic Stroke
Acute Treatment
- Clot busters, e.g., tPA
The most promising treatment for ischemic stroke is the FDA-approved clot-busting drug tPA (tissue plasminogen activator), which must be administered within a three-hour window from the onset of symptoms to work best. Administering tPA or other clot-dissolving agents is complex and is done through an intravenous (IV) line in the arm by hospital personnel. If given promptly, tPA can significantly reduce the effects of stroke and reduce permanent disability. Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment.
Preventive Treatment
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- Anticoagulants/Antiplatelets
Antiplatelet agents such as aspirin and anticoagulants such as warfarin interfere with the blood’s ability to clot and can play an important role in preventing stroke. Read more about anticoagulants.
- Carotid Endarterectomy
Carotid endarterectomy is a procedure in which blood vessel blockage is surgically removed from the carotid artery. View a detailed illustration of carotid endarterectomy.
- Angioplasty/Stents
Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease and reduce fatty buildup clogging a vessel. View a detailed illustration of carotid stent.
Hemorrhagic Stroke (Subarachnoid hemorrhage or AVM)
- Surgical Intervention
For hemorrhagic stroke (specifically for a subarachnoid hemorrhage), surgical treatment is often recommended to either place a metal clip at the base, called the neck, of the aneurysm or to remove the abnormal vessels comprising an arteriovenous malformation (AVM). Learn more about AVM.
- Endovascular Procedures, e.g., “coils”
Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm, guided to the aneurysm or AVM where it deposits a mechanical agent, such as a coil, to prevent rupture. Learn more about aneurysms.
Sabin's Stroke of Genius 