Understanding The Causes Of Brain Strokes

how do people get a brain stroke

A stroke, or brain attack, occurs when there is an issue with blood flow to the brain. This can be due to blocked blood vessels or bleeding in the brain. Without blood or oxygen, brain cells start to die within minutes, and brain function is lost. This can cause problems with vital body functions such as controlling emotions, speaking, or moving. While a stroke can happen to anyone at any age, certain risk factors such as high blood pressure, heart disease, diabetes, smoking, and older age can increase the likelihood of experiencing a stroke.

Characteristics Values
Type of stroke Ischemic stroke, Hemorrhagic stroke
Ischemic stroke cause Blocked blood flow to the brain due to a blood clot or fatty deposit
Hemorrhagic stroke cause Bleeding in the brain due to a burst blood vessel
Risk factors High blood pressure, diabetes, high cholesterol, age, race, gender, family history, sickle cell disease, unhealthy lifestyle, oral contraceptives, pregnancy, history of TIAs

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Blocked blood flow to the brain (ischemic stroke)

Blocked blood flow to the brain, also known as an ischemic stroke, is the most common type of stroke, accounting for 80%-87% of all strokes. It occurs when there is a blockage that keeps blood from reaching all areas of the brain. This blockage is usually caused by a blood clot, but it can also be caused by atherosclerosis, a disease that causes the arteries to narrow over time.

Ischemic strokes usually happen in one of the following ways:

  • Formation of a clot in the brain (thrombosis).
  • A fragment of a clot that formed elsewhere in the body breaks free, travels through the blood vessels, and gets stuck in the brain (embolism).
  • Small vessel blockage (lacunar stroke), which can be caused by long-term, untreated high blood pressure, high cholesterol, or high blood sugar.
  • Unknown reasons (cryptogenic strokes).

The risk factors for ischemic strokes include:

  • Age: The chances of having a stroke increase with age and double every decade after age 55.
  • Gender: Men are more likely to experience a stroke than women, but women are more likely to die from strokes.
  • Race: African Americans are at a higher risk of stroke than Caucasians, and Hispanics are more likely to suffer a stroke at a younger age.
  • High blood pressure (hypertension): This is the biggest cause of strokes and can lead to both ischemic and hemorrhagic strokes.
  • Tobacco use: Smoking or chewing tobacco raises blood pressure and nicotine thickens the blood, making it more likely to clot.
  • Heart disease: This includes defective heart valves, atrial fibrillation, and clogged arteries from fatty deposits.
  • Diabetes: People with diabetes often have high blood pressure and are more likely to be overweight, both of which increase the chance of a stroke.
  • Weight and exercise: Being overweight increases the risk of stroke, while regular exercise can lower the odds.
  • Medications: Certain medications, such as blood-thinning drugs, can increase the risk of stroke.
  • Family history: Strokes can run in families, and genetic disorders can block blood flow to the brain.

It is important to recognize the warning signs of a stroke, which can be remembered using the acronym FAST:

  • Face: Ask the person to smile and look for a droop on one or both sides of the face, indicating muscle weakness or paralysis.
  • Arm: Ask the person to raise their arms; if they have one-sided weakness, one arm will sag or drop downward.
  • Speech: Strokes can cause slurred speech or difficulty choosing the right words.
  • Time: Time is critical; call emergency services immediately if you observe any of these signs.

Immediate medical attention is crucial for ischemic strokes, as every second counts in preventing permanent brain damage or death.

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Bleeding in the brain (hemorrhagic stroke)

A hemorrhagic stroke, also known as a brain hemorrhage, occurs when a weakened blood vessel in the brain leaks or ruptures, causing bleeding in the brain. This can happen inside the brain tissue or outside it, and it accounts for about 13% of all stroke cases.

When a hemorrhagic stroke occurs, blood from an artery suddenly starts bleeding into the brain. This can be due to a weakened blood vessel that bursts or leaks, a tangle of abnormal blood vessels called an arteriovenous malformation (AVM), or other factors such as high blood pressure, aneurysms, or blood disorders. The pooled blood collects and compresses the surrounding brain tissue, leading to a range of symptoms.

The two main types of hemorrhagic strokes are intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhage occurs when blood pools within the brain tissue, and it is usually caused by long-term untreated high blood pressure. Subarachnoid hemorrhage, on the other hand, occurs when bleeding happens between the brain and the membranes that cover it. This type of hemorrhage is often due to head trauma or a brain aneurysm.

The symptoms of a hemorrhagic stroke can vary depending on the location and severity of the bleeding. However, common symptoms include a sudden severe headache, sensitivity to light, seizures, weakness in the arms or legs, decreased alertness, changes in vision, tingling or numbness, difficulty speaking or understanding speech, and loss of consciousness. It is important to seek immediate medical attention if any of these symptoms occur, as prompt treatment can prevent permanent brain damage and reduce the risk of death.

The treatment for a hemorrhagic stroke depends on its location, cause, and severity. In some cases, medication may be prescribed to ease symptoms and prevent further bleeding. For more severe cases, emergency surgery may be required to stop the bleeding, relieve pressure on the brain, and remove the accumulated blood. Rehabilitation, including physical therapy, occupational therapy, and speech therapy, may also be necessary to help individuals regain their abilities and recover from the stroke.

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High blood pressure

The second way in which high blood pressure can cause a stroke is through bleeding in or around the brain, known as a hemorrhagic stroke. Hemorrhagic strokes are less common but tend to be more serious and deadly. High blood pressure weakens the arteries, making them more prone to bursting or leaking. Uncontrolled high blood pressure can lead to an aneurysm, a balloon-like bulge in a blood vessel, which can then rupture and cause a hemorrhagic stroke.

To reduce the risk of having a stroke, it is crucial to manage high blood pressure. This can be achieved through lifestyle changes, such as reducing salt, sugar, and saturated fat intake, maintaining a healthy weight, quitting smoking, limiting alcohol consumption, and exercising regularly. Additionally, lowering stress levels and seeking medical advice on medication can help lower blood pressure and reduce the chances of having a stroke.

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Diabetes

There are several mechanisms by which diabetes increases the risk of stroke, including:

  • Large artery atherosclerosis: Diabetes causes dyslipidemia, hyperglycemia, and insulin resistance, leading to the formation of atherogenic low-density lipoprotein (LDL) and advanced glycation end products, which contribute to the development of atherosclerotic lesions.
  • Cerebral small vessel disease: Hyperglycemia, obesity, insulin resistance, and hypertension, which are common in people with diabetes, can lead to cerebral microvascular dysfunction and increase the risk of lacunar and hemorrhagic strokes.
  • Cardiac embolism: Individuals with type 2 diabetes have an overall 35% higher risk of atrial fibrillation, a common cause of cardioembolic stroke.

Hyperglycemia during the acute phase of a stroke is associated with poorer outcomes, including increased mortality and worse cognitive performance after a stroke. However, intensive glucose control during the acute phase of a stroke has not been shown to improve clinical outcomes.

Post-stroke outcomes are generally worse in people with diabetes, with higher post-discharge mortality rates, longer hospital stays, and an increased risk of stroke recurrence compared to those without diabetes.

The management of diabetes and other vascular risk factors is crucial for reducing the risk of stroke and improving post-stroke outcomes. While intensive glucose control alone may not be sufficient, a multifactorial approach targeting glucose, blood pressure, and lipids, along with the use of certain medications, has been shown to reduce the risk of stroke and other cardiovascular events in people with diabetes.

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Smoking

Nicotine causes an increase in blood pressure and the development of a fatty buildup in the main neck artery. Smoking also makes the blood thicker and more likely to clot. In addition, carbon monoxide in the blood reduces the amount of oxygen available. All of these factors increase the likelihood of a blood clot forming and blocking blood flow to the brain, or a weakened blood vessel bursting and causing a bleed on the brain—both of which are ways that a stroke can occur.

The risk of stroke is dose-dependent, meaning the more you smoke, the more likely you are to have a stroke. Quitting smoking can significantly reduce your risk of stroke. Studies have shown that the risk of stroke in ex-smokers becomes similar to that of people who have never smoked after five to ten years.

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