Stroke Overview
Stroke occurs when blood flow to the brain is interrupted. Without a blood supply to deliver oxygen and nutrients, brain cells in the area of the interruption begin to die.
It’s estimated that more than 700,000 strokes occur each year in the United States. After the age of 55, a person’s risk of having a stroke more than doubles each decade.
Stroke, which is the third leading cause of death in the United States, is also responsible for more serious, long-term disabilities than any other disease. Stroke damage in the brain ranges from mild to severe. Disabilities after a stroke may include paralysis and problems with thinking, speaking, and emotional control.
Ischemic stroke (the most common kind) is caused by a blood clot that blocks a blood vessel that supplies the brain. When blood flow to a portion of the brain is blocked only for a short time, it is called a transient ischemic attack (TIA), or mini-stroke. The damage to the brain cells from a TIA isn’t permanent, but having a TIA greatly increases a person’s risk of having a full-blown stroke. Hemorrhagic stroke (which is less common) happens when a blood vessel in the brain leaks or breaks open and bleeds into the brain.
Symptoms of stroke include sudden onset of one or more of the following listed in this stroke patient education guide:
- Numbness or weakness of the face, arm, or leg (especially on one side of the body)
- Confusion, trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Trouble walking, dizziness, loss of balance or coordination
- Severe headache with no known cause
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Doctors Who Treat Stroke
As your stroke is diagnosed, treated, and managed, you may encounter the following team of doctors and specialists listed below in this stroke patient education guide.
Emergency Medicine Physician - A doctor who specializes in caring for patients with acute illnesses or injuries that require immediate medical attention, typically in the emergency department of a hospital. A person having a stroke is typically rushed to the hospital and treated by an emergency medicine physician.
Neurologist - A doctor who specializes in disorders of the brain and nervous system. Neurologists diagnose and treat patients who have had a stroke and supervise their ongoing treatment.
Neurosurgeon - A doctor who specializes in surgical treatments of the brain or nervous system. If surgery is required to treat or prevent a stroke, a neurosurgeon would perform the surgery.
Internist or Family Physician - Doctors who provide general medical care for adults. Adults who have had a stroke may also receive follow-up care and monitoring by an internist or family physician.
How to Prepare for Your Stroke Doctor Visit
A stroke is a medical emergency that initially requires care in the emergency room. After emergency medical treatment and release from the hospital, you will have a follow-up appointment with a doctor.
Having made your follow-up appointment, there are certain actions you can take to maximize the benefit of your doctor visit after a stroke.
- If you are unable to write, ask a friend or family member to write down the following information for you.
- A list of how you have been feeling since the stroke, including any symptoms that seem
- related or unrelated to the stroke
- A list of all medications, vitamins, and supplements that you’re taking (Include the dosage
- you’re taking of each)
- Key personal information, including prior illnesses, diet and exercise habits, type of work
- that you do, and any major stresses or recent life changes
- A list of questions you have for the doctor so that you don’t forget to ask any of them
- If at all possible, bring a family member or close friend who can help you remember everything you and the doctor discuss.
- If you are going to a neurologist, obtain a copy of your medical records and bring them to the appointment or ask your regular doctor to forward a copy to the neurologist.
Written by Laurie LaRusso, MS, ELS
Questions to Ask Your Doctor About Stroke
From your initial diagnosis throughout your treatment and care, you will have questions about your condition. Listed below in this stroke patient education guide are a list of questions to discuss with your doctor so you can make informed decisions about your condition and your care.
Questions About My Diagnosis
- What caused my stroke?
- Will my symptoms get worse?
- Will I become completely disabled?
- Will I ever regain some or all of the physical function I lost?
- Will I ever regain some or all of the brain function I lost?
Questions About My Treatment
- Are there medications to help with my post-stroke symptoms? Are there side effects?
- Are there medications to help prevent another stroke? Are there side effects?
- Will physical therapy help me improve physical function?
- Is there therapy that will help me improve brain function?
- Are there alternative or complementary therapies that may help manage my symptoms?
Questions About My Lifestyle & Family
- Do I need to make any changes to my diet or daily routines?
- Will exercise help me recover from my stroke?
- Are there certain jobs or activities I can’t do because I’ve had a stroke?
- Is it safe to have sex after a stroke?
- Is there a support group in my area for stroke survivors and their families?
Written by Laurie LaRusso, MS, ELS
Common Tests or Labs to Diagnose Stroke
Because a stroke is a medical emergency (like a heart attack), it is often diagnosed in a hospital emergency room rather than a doctor’s office.
In addition to lab tests, the doctor will perform a physical exam and ask questions about your symptoms, medical history, and risk factors for stroke (such as smoking, high blood pressure, heart disease, and family history of stroke). The physical exam will include:
- Checking for problems with vision, movement, feeling, reflexes, understanding, and speaking
- Using a stethoscope to listen for sounds of abnormal blood flow in the carotid arteries of the neck
- Checking blood pressure
Below is a list of common tests and labs ordered to diagnose stroke, why you need them, and what they reveal about your condition.
| Test |
Why Test? |
What Happens? |
Normal Result |
| CT scan of the brain |
An imaging test done right after a suspected stroke to take clear, detailed pictures of the brain |
A patient lies on a table that slides inside a large machine. Dye may be injected by syringe into the veins to help make clearer images. |
This test will show if there is bleeding in the brain or damage to the brain cells from a stroke. |
| MRI scan of the brain |
An imaging test done right after a suspected stroke to take clear, detailed pictures of the brain |
A patient lies on a table that slides inside a large machine. Dye may be injected by syringe into the veins to help make clearer images. |
This test can show changes in brain tissue and damage to brain cells from a stroke. |
| Carotid ultrasound (Doppler ultrasound) |
An imaging test to take pictures of the insides of the carotid arteries, which supply blood to the brain |
A patient lies on a table, and gel is put on the neck where the carotid arteries are located. A hand-held device (called a transducer) is moved back and forth against different spots on the neck. |
This test will show whether plaque has narrowed or blocked the carotid arteries, which would reduce blood flow to the brain. |
| Carotid angiography |
An imaging test to take pictures of the carotid arteries to confirm problems with blood vessels in the brain |
A small tube is inserted into an artery (usually in the upper thigh) and moved up into one of the carotid arteries. Dye is injected into the carotid artery to help make the artery visible on x-ray pictures. |
This test will show how blood flows through vessels in the brain and if there are problems with blood flow, such as narrowed blood vessels or blood leaking out of a vessel. |
| Magnetic resonance angiography (MRA) or CT angiography |
Imaging tests that may be done to check for abnormal blood vessels in the brain |
A patient lies on a table that slides inside a large machine. Dye may be injected by syringe into the veins to help make clearer images. |
These tests show the large blood vessels in the brain and may give more information about the site of a blood clot and the flow of blood through the brain. |
| Electrocardiogram (ECG, EKG) |
A test that records the heart’s electrical activity |
Flat metal disks (called electrodes) connected to wires are attached to the chest with a sticky substance. |
This test shows how fast the heart is beating, its rhythm, and the strength and timing of electrical signals passing through the heart. It may be done to help detect heart problems that may have led to a stroke. |
| Echocardiogram (ECHO) |
An imaging test done to look at the structures of the heart |
A patient lies on a table, and gel is put on the chest. A hand-held device (called a transducer) is moved back and forth over areas of the chest. |
This test shows the size and shape of the heart and how well the heart’s chambers and valves are working. It may be done to help detect heart problems that may have led to a stroke. |
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| Blood tests(e.g. clotting time, complete blood count, blood sugar, and cholesterol levels) |
To measure various substances in the blood and how long it takes for the blood to clot |
Blood is drawn with a syringe, typically from the arm. |
Blood tests can help determine whether other disorders contributed to a stroke or are causing symptoms similar to a stroke. |
Common Medications and Treatments for Stroke
Stroke is a medical emergency that requires taking an ambulance to the hospital so that medical personnel can begin life-saving treatment on the way to the emergency room. After initial treatment for stroke in the emergency room, you will need to follow up with a doctor for treatment of stroke risk factors and any complications from the stroke. This may involve changes to diet and lifestyle, exercise, medications, and/or physical or occupational therapy for disabilities resulting from the stroke.
Emergency medical treatment for stroke depends on whether it’s an ischemic stroke or a hemorrhagic stroke. Treatment for ischemic stroke aims to clear the blockage in a blood vessel, whereas treatment for hemorrhagic stroke is aimed at stopping leakage of blood from blood vessels into the brain.
The tables below describe the common medications and surgical procedures used to treat stroke.
| Drug Category |
Type of stroke |
How it works |
| Tissue plasminogen activator (tPA) |
Ischemic |
- This medicine works by breaking up blood clots in the arteries of the brain.
- It is injected into a vein in the arm.
- This medicine must be given within 4 hours of the time stroke symptoms appear, if not sooner.
|
| Anti-platelet agents |
Ischemic |
- These medicines help stop platelets in the blood from clumping together to form blood clots.
|
| Anti-coagulant agents (blood thinners) |
Ischemic |
- These medicines work by keeping blood clots from getting larger and preventing new blood clots from forming.
|
| Anti-hypertensive agents |
Hemorrhagic |
- These medicines work by lowering a person’s blood pressure.
- They may be prescribed if high blood pressure is causing bleeding in the brain.
|
| Procedure |
Type of stroke |
How it works |
| Carotid endarterectomy |
Ischemic |
- This is a surgical procedure to clear a blockage in the carotid artery, the main supply of blood to the brain.
- The procedure involves making incisions in the neck and the carotid artery itself to remove fatty deposits that are blocking blood flow to the brain.
|
| Carotid artery angioplasty |
Ischemic |
- This is a less-invasive procedure to clear a blockage in the carotid artery, the main supply of blood to the brain.
- A tube called a catheter is inserted into an artery in the groin and threaded through the arteries to the blockage in the carotid artery.
- Another catheter with a very small balloon on the end is pushed into the blockage and inflated to open up the artery so blood flow can resume.
- A wire mesh tube called a stent may also be placed in the blocked area to keep the artery open.
|
| Aneurysm clipping |
Hemorrhagic |
- This surgery helps prevent further leakage of blood from an aneurysm by blocking off the aneurysm from the blood vessels in the brain.
- The procedure involves making an incision in the brain and placing a tiny clamp at the base of the aneurysm.
|
| Coil embolization |
Hemorrhagic |
- This surgery helps prevent further leakage of blood from an aneurysm.
- A tube called a catheter is inserted into an artery in the groin and threaded through the arteries up to the site of the aneurysm.
- A tiny coil is pushed through the tube and into the aneurysm causing a blood clot to form and block blood flow through the aneurysm.
|
| Arteriovenous malformation (AVM) repair |
Hemorrhagic |
- This surgery prevents further bleeding in the brain by repairing an AVM—a tangle of faulty blood vessels within the brain that can rupture.
- This procedure may involve surgery to remove the AVM, injection of a substance into the AVM to block blood flow, or radiation to shrink the AVM blood vessels.
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