[Update] Stroke: Symptoms, Causes, Treatment, Types & More | stroke – Sonduongpaper

What is a stroke?

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.

Stroke symptoms

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.

What causes 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.

Risk factors for stroke

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.

Complications

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.

How to prevent a stroke

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.

Diagnosis of 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

Tests to diagnose stroke

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.

Stroke treatment

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 still 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.

Stroke medications

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:

• rosuvastatin (Crestor)
• simvastatin (Zocor)
• atorvastatin (Lipitor)

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.

Recovering from 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.

The takeaway

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.

Stroke occurs due to a decrease or blockage in the brain’s blood supply. A person experiencing a stroke needs immediate emergency treatment.

Stroke is the fifth leading cause of death in the United States. In fact, nearly 800,000 people have a stroke each year. That equates to around one person every 40 seconds.

There are three main types of stroke:

• Ischemic stroke: This is the most common type of stroke, making up 87% of all cases. A blood clot prevents blood and oxygen from reaching an area of the brain.
• Hemorrhagic stroke: This occurs when a blood vessel ruptures. These are usually the result of aneurysms or arteriovenous malformations (AVMs).
• Transient ischemic attack (TIA): This occurs when blood flow to a part of the brain is inadequate for a brief period of time. Normal blood flow resumes after a short amount of time, and the symptoms resolve without treatment. Some people call this a ministroke.

Stroke can be fatal. According to the American Heart Association (AHA), the age-adjusted mortality rate for 2017 was 37.6 in every 100,000 stroke diagnoses. Doctors have made a great deal of progress in managing strokes, meaning that this mortality rate is 13.6% lower than it was in 2007.

This article explains why strokes occur and how to treat them. It also explores the different types of stroke, as well as the steps a person can take to prevent them.

What is a stroke?

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Stroke requires immediate medical attention.

A stroke occurs when a blockage or bleed of the blood vessels either interrupts or reduces the supply of blood to the brain. When this happens, the brain does not receive enough oxygen or nutrients, and brain cells start to die.

Stroke is a cerebrovascular disease. This means that it affects the blood vessels that feed the brain oxygen. If the brain does not receive enough oxygen, damage may start to occur.

This is a medical emergency. Although many strokes are treatable, some can lead to disability or death.

Treatment

Because ischemic and hemorrhagic strokes have different causes and effects on the body, both require different treatments.

Rapid diagnosis is important for reducing brain damage and enabling the doctor to treat the stroke using a suitable method for the type.

The sections below cover the treatment options for ischemic stroke and hemorrhagic stroke, as well as some general rehabilitation tips for both types.

Ischemic stroke

Ischemic stroke occurs due to blocked or narrowed arteries. Treatment tends to focus on restoring an adequate flow of blood to the brain.

Treatment starts with taking drugs that break down clots and prevent others from forming. A doctor may administer blood thinners such as aspirin or an injection of tissue plasminogen activator (TPA).

TPA is very effective at dissolving clots. However, the injection needs to take place within 4.5 hours of the stroke symptoms starting.

Emergency procedures include administering TPA directly into an artery in the brain or using a catheter to physically remove the clot. Research is ongoing as to the benefits of these procedures.

There are other procedures that surgeons can perform to reduce the risk of strokes or TIAs. A carotid endarterectomy, for example, involves opening the carotid artery and removing plaque that could break and travel to the brain.

Another option is angioplasty. This involves a surgeon inflating a small balloon inside a narrowed artery using a catheter. Afterward, they will insert a mesh tube, or a stent, into the opening. This prevents the artery from narrowing again.

Hemorrhagic stroke

Blood leaking into the brain can cause a hemorrhagic stroke. Treatment focuses on controlling the bleeding and reducing the pressure on the brain.

Treatment often begins with taking drugs that reduce pressure in the brain and control overall blood pressure, as well as preventing seizures and any sudden constrictions of blood vessels.

If a person is taking blood-thinning anticoagulants or antiplatelet medication, such as warfarin or clopidogrel, they can receive medications to counter the effects of the blood thinners.

Surgeons can repair some of the problems with blood vessels that have led or could lead to hemorrhagic strokes.

When an aneurysm — or a bulge in a blood vessel that may burst — causes a hemorrhagic stroke, a surgeon can place small clamps at the base of the aneurysm or fill it with detachable coils to stop the blood flow and shrink the aneurysm.

If the hemorrhage occurs due to an AVM, a surgeon can remove it. AVMs are connections between arteries and veins that can be at risk of bleeding.

Rehabilitation

Stroke is a potentially life changing event that can have lasting physical and emotional effects.

Successful recovery from a stroke will often involve specific therapies and support systems, including:

• Speech therapy: This helps with problems producing or understanding speech. Practice, relaxation, and changing communication style can all make communicating easier.
• Physical therapy: This can help a person relearn movement and coordination. It is important to stay active, even though this may be difficult at first.
• Occupational therapy: This can help a person improve their ability to carry out daily activities, such as bathing, cooking, dressing, eating, reading, and writing.
• Support groups: Joining a support group can help a person cope with common mental health issues that can occur after a stroke, such as depression. Many find it useful to share common experiences and exchange information.
• Support from friends and family: Close friends and relatives should try to offer practical support and comfort after a stroke. Letting friends and family know what they can do to help is very important.

Rehabilitation is an important and ongoing part of stroke treatment. With the right assistance and the support of loved ones, regaining a normal quality of life is usually possible, depending on the severity of the stroke.

Prevention

The best way to prevent a stroke is to address the underlying causes. People can achieve this by making lifestyle changes such as:

• eating a healthful diet
• maintaining a moderate weight
• exercising regularly
• not smoking tobacco
• avoiding alcohol, or only drinking moderately

Eating a nutritious diet means including plenty of:

• fruits
• vegetables
• whole grains
• nuts
• seeds
• legumes

Be sure to limit the amount of red and processed meat in the diet, as well as cholesterol and saturated fats. Also, moderate salt intake to support healthy blood pressure levels.

Other measures a person can take to help reduce the risk of stroke include:

• controlling their blood pressure levels
• managing diabetes
• getting treatment for heart disease

As well as making these lifestyle changes, taking anticoagulant or antiplatelet medications can also reduce the risk of experiencing another stroke.

Undergoing cardiac artery, carotid artery, or brain aneurysm surgery can also lower the risk of additional strokes, as can some other surgical options still under investigation.

Causes and risk factors

Each type of stroke has a different set of potential causes. Generally, however, stroke is more likely to affect a person if they:

• have overweight or obesity
• are 55 years of age or older
• have a personal or family history of stroke
• have high blood pressure
• have diabetes
• have high cholesterol
• have heart disease, carotid artery disease, or another vascular disease
• are sedentary
• consume alcohol excessively
• smoke
• use illicit drugs

Some studies have found that males have a higher risk of death from stroke than females. However, one 2016 review of studies suggests that these differences do not take into account adjustments for race, age, the severity of the stroke, and other risk factors.

The review explains that the risk of stroke mortality often increases due to age and demographic, rather than the biological differences between males and females.

According to a 2016 analysis, African American people have a significantly higher risk of experiencing a first-time stroke. They are also around 60% more likely to experience another stroke within 2 years.

The following sections describe the specific causes of each type of stroke.

Ischemic stroke

This type of stroke occurs due to blockages or narrowing in the arteries that provide blood to the brain. This causes ischemia, or a severely reduced blood flow, which damages brain cells.

Blood clots often cause ischemic stroke. Clots can form in the brain arteries and other blood vessels in the body. The bloodstream carries these into narrower arteries in the brain.

Fatty plaque deposits within the arteries can also cause clots that result in ischemia.

Hemorrhagic stroke

Leaky or burst arteries in the brain can give rise to hemorrhagic strokes.

Leaked blood puts pressure on brain cells and damages them. It also reduces the blood supply that can reach the brain tissue after the hemorrhage.

Blood vessels can burst and spill blood into the brain or near the surface of the brain. This may also send blood into the space between the brain and the skull.

Having hypertension, experiencing physical trauma, taking blood-thinning medications, and having an aneurysm can all make a blood vessel leak or burst.

Intracerebral hemorrhage is the most common type of hemorrhagic stroke. This occurs when brain tissue floods with blood after an artery bursts.

Subarachnoid hemorrhage is another type of hemorrhagic stroke. These are less common. In a subarachnoid hemorrhage, bleeding occurs in the area between the brain and the thin tissues that cover it.

TIAs

TIAs only briefly interrupt the flow of blood to the brain. They are similar to ischemic strokes, in that they occur due to clots.

People should treat them as medical emergencies, even if the symptoms are temporary. They serve as warning signs for future strokes and indicate a partially blocked artery or clot source in the heart.

According to the Centers for Disease Control and Prevention (CDC), over a third of people who experience a TIA have a major stroke within a year if they do not receive any treatment. Around 10–15% of people will have a major stroke within 3 months of experiencing a TIA.

Symptoms

The symptoms of a stroke often appear without warning. Some of the main symptoms include:

• confusion, including difficulty speaking and understanding speech
• a headache, possibly with altered consciousness or vomiting
• numbness or an inability to move parts of the face, arm, or leg, particularly on one side of the body
• vision problems in one or both eyes
• difficulty walking, including dizziness and a lack of coordination

Stroke can lead to long-term health problems. Depending on the speed of the diagnosis and treatment, a person can experience temporary or permanent disabilities after a stroke.

Some people may also experience:

• bladder or bowel control problems
• depression
• paralysis or weakness on one or both sides of the body
• difficulty controlling or expressing their emotions

Symptoms vary and may range in severity.

Learning the acronym “FAST” is a good way to remember the symptoms of stroke. This can help a person seek prompt treatment. FAST stands for:

• Face drooping: If the person tries to smile, does one side of their face droop?
• Arm weakness: If the person tries to raise both their arms, does one arm drift downward?
• Speech difficulty: If the person tries to repeat a simple phrase, is their speech slurred or unusual?
• Time to act: If any of these symptoms are occurring, contact the emergency services immediately.

The outcome depends on how quickly someone receives treatment. Prompt care also means that they would be less likely to experience permanent brain damage or death.

Diagnosis

Stroke begins rapidly. For the best outcome, a person should receive treatment at a hospital within 3 hours of their symptoms first appearing.

There are several different diagnostic tests a doctor can use to determine the type of stroke. These include:

• Physical examination: A doctor will ask about the person’s symptoms and medical history. They will check muscle strength, reflexes, sensation, vision, and coordination. They may also check blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes.
• Blood tests: A doctor may perform blood tests to determine if there is a high risk of bleeding or blood clots, measuring levels of particular substances in the blood, including clotting factors, and checking whether or not an infection is present.
• CT scan: A series of X-rays can show hemorrhages, strokes, tumors, and other conditions within the brain.
• MRI scan: These use radio waves and magnets to create an image of the brain, which a doctor can use to detect damaged brain tissue.
• Carotid ultrasound: A doctor may carry out an ultrasound scan to check blood flow in the carotid arteries and to see if there is any narrowing or plaque present.
• Cerebral angiogram: A doctor may inject a dye into the brain’s blood vessels to make them visible under X-ray or MRI. This provides a detailed view of the blood vessels in the brain and neck.
• Echocardiogram: This creates a detailed image of the heart, which doctors can use to check for any sources of clots that could have traveled to the brain.

It is only possible to confirm the type of stroke using a brain scan in a hospital environment.