
Strokes occur in the brain when there is an issue with blood flow. This can be due to a blocked artery or bleeding in the brain. There are two main types of strokes: ischemic and hemorrhagic. Ischemic strokes are caused by blocked blood flow to the brain due to a blood clot or fatty deposits and cholesterol building up in the blood vessels. Hemorrhagic strokes are caused by bleeding in or around the brain due to a burst blood vessel.
Characteristics | Values |
---|---|
Type of stroke | Ischemic, Hemorrhagic |
Cause | Blocked blood flow, Burst blood vessel |
Location | Brain |
What You'll Learn
Blocked blood vessel
There are two types of blocked blood vessel strokes: ischemic and hemorrhagic. Ischemic strokes are the most common, making up about 80% of all strokes. They occur when a clot forms in the brain (thrombosis) or when a fragment of a clot formed elsewhere in the body breaks free and travels to the brain (embolism). In some cases, the location of the original clot is unknown. Ischemic strokes can also be caused by small vessel blockages (lacunar strokes), which can be the result of long-term, untreated high blood pressure, high cholesterol, or high blood sugar.
Hemorrhagic strokes, on the other hand, are caused by bleeding in or around the brain. This can happen when a blood vessel inside the brain tears or breaks open, causing bleeding that puts pressure on the surrounding brain tissue. This type of stroke can also occur when there is bleeding into the subarachnoid space, which is the space between the brain and its outer covering.
Plaque buildup in the arteries, known as atherosclerosis, is a common cause of ischemic strokes. Atherosclerosis is often referred to as hardening of the arteries and can lead to heart disease and stroke. It typically starts in childhood and progresses with age, affecting medium and large-sized arteries. Atherosclerosis can cause a stroke when plaque in a blood vessel breaks, forming blood clots that block blood flow to the brain.
It is important to recognize the signs of a stroke, as immediate medical attention is critical to prevent permanent damage or death. Some warning signs include a sudden loss of balance, loss of vision, muscle weakness or paralysis, and slurred speech or difficulty speaking.
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Ruptured blood vessel
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds, causing an accumulation of blood that compresses the surrounding brain tissue. This can happen inside the brain (intracerebral hemorrhage) or between the brain and the membranes that cover it (subarachnoid hemorrhage). This type of stroke accounts for about 13% of all stroke cases and can have serious, immediate, and life-threatening symptoms.
The risk factors for a hemorrhagic stroke include being older (over 65), having a family or personal history of stroke, uncontrolled diabetes, high cholesterol, high blood pressure, smoking, obesity, lack of exercise, and a poor diet. These factors can weaken blood vessels, making them more susceptible to rupturing.
When a hemorrhagic stroke occurs due to a ruptured blood vessel, immediate and severe symptoms may include a sudden, severe headache near the back of the head, described as the "worst headache of your life". Other symptoms can include losing consciousness, inability to move or feel, confusion, irritability, muscle pain in the neck and shoulders, sensitivity to light, and one eye pupil being larger than the other.
The treatment for a hemorrhagic stroke caused by a ruptured blood vessel involves locating the source of the bleed and surgically "clipping" it to stop the bleeding. Additionally, procedures such as draining the skull to decrease pressure in the brain and performing a minimally invasive "burr hole" removal of the intracerebral hemorrhage may be necessary. Medications are also administered to reduce blood pressure, pain, anxiety, headaches, and seizures.
The goal of treating a hemorrhagic stroke caused by a ruptured blood vessel is to prevent life-threatening complications, reduce disability, and help the patient regain as much normal functioning as possible through rehabilitation.
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Ischemic stroke
An ischemic stroke occurs when a blood vessel supplying blood to the brain is blocked. This accounts for about 87% of all strokes and can be caused by a piece of plaque or a blood clot. If the blockage occurs in the brain, it is called thrombosis, and if the blood clot travels to the brain from somewhere else in the body, it is called an embolism.
The main cause of ischemic stroke is atherosclerosis, or fatty deposits (plaques) that line the vessel walls. These fatty deposits can cause two types of obstruction: cerebral thrombosis and cerebral embolism. Cerebral thrombosis is a thrombus (blood clot) that develops at the site of fatty plaque within a blood vessel that supplies blood to the brain. Cerebral embolism is a blood clot that forms in the heart, large arteries in the upper chest or neck, or another location in the circulatory system. A main cause of embolism is an irregular heartbeat called atrial fibrillation, which can cause clots to form in the heart, dislodge, and travel to the brain.
The urgent treatment for ischemic stroke is clot removal, which can be done through medication and mechanical treatments. Medication treatment with Alteplase IV r-tPA, also known as tissue plasminogen activator or alteplase, is approved by the FDA to treat ischemic stroke. Alteplase is administered through an IV in the arm, dissolving the clot and improving blood flow to the affected area of the brain. Mechanical treatments involve a procedure called mechanical thrombectomy, where doctors use a wire-cage device called a stent retriever to remove the clot. This procedure is usually done within six hours of the onset of acute stroke symptoms but can be done up to 24 hours after symptoms begin if imaging tests show undamaged brain tissue.
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Hemorrhagic stroke
The leaked blood puts pressure on and kills the brain cells, causing brain swelling and damage. This is called intracranial hemorrhage, or bleeding within the skull, and it occurs in about 10% of stroke cases. There is also subarachnoid hemorrhage (SAH), which is bleeding between the brain and the membrane that surrounds it, and this occurs in about 3% of stroke cases.
The symptoms of a hemorrhagic stroke are varied and can include a sudden severe headache, vomiting, neck stiffness, increases in blood pressure, and the rapid development of neurological signs. Seizures, aphasia, and hemianopia can be seen in lobar hemorrhage, while coma occurs when the reticular activating system of the brainstem is involved.
As with other types of strokes, early diagnosis and treatment are critical to prevent severe morbidity and high mortality.
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Transient ischemic attack (TIA)
The symptoms of a TIA are similar to those of a stroke but do not last as long. They include:
- Numbness or weakness in the face, arm, or leg, especially on one side of the body
- Loss of vision in one or both eyes
- Difficulty walking or a loss of balance and coordination
- Confusion or difficulty talking or understanding speech
- A severe headache with no apparent cause
A TIA is a warning sign of a possible future stroke. Anyone can have a TIA, but the risk increases with age. If you experience any of the symptoms of a TIA, seek immediate medical attention. A comprehensive evaluation should be done within 24 hours of the onset of symptoms, and may include an assessment of vital signs and brain function, imaging of the blood vessels in the head and neck, and other tests such as a head CT, angiography, or MRI scan.
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Frequently asked questions
Strokes occur when there is an issue with blood flow to the brain.
The two main types of stroke are ischemic and hemorrhagic.
An ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a clot or a buildup of fatty deposits and cholesterol.
A hemorrhagic stroke occurs when a blood vessel in the brain bursts, causing bleeding into nearby tissues and increasing pressure and damage.