Stroke and the Brain – Causes, Signs and symptoms

stroke brain

Also called: Embolic Stroke, Ischemic Stroke, CVA, Cerebrovascular Accident, Brain Attack, Thrombotic Stroke, Hemorrhagic Stroke

Summary

A stroke is a potentially life-threatening event in which part of the brain is deprived of adequate oxygen. Also known as a cerebrovascular accident (CVA), a stroke can be very dangerous. Each year, approximately 700,000 strokes occur in the United States, of which 500,000 are new (first-time) strokes, according to the Centers for Disease Control and Prevention. More than 160,000 Americans die every year from strokes.

There are two types of strokes. An ischemic stroke occurs when the blood supply to the brain is interrupted, usually by a blood clot. The second kind of stroke is a hemorrhagic stroke, which occurs when there is bleeding into or around the brain. Almost 90 percent of all strokes are ischemic, while the remainder are hemorrhagic, according to the American Heart Association.

When blood flow to the brain stops, brain cells begin to die because they do not receive the oxygen and nutrients they need to survive. Survival and potential recovery from a stroke depend on quick access to medical care. In recent years, the mortality rate from strokes has fallen, thanks to advances in immediate stroke treatment.

Symptoms of a stroke can vary depending on the type of stroke that has occurred. However, the National Institute of Neurological Disorders and Stroke (NINDS) lists several major general signs of stroke. All of these symptoms appear suddenly:

  • Numbness or weakness of the face, arms or legs
  • Confusion
  • Trouble speaking or understanding language (aphasia)
  • Trouble seeing in one or both eyes (vision loss)
  • Difficulty walking
  • Dizziness
  • Loss of balance and coordination (ataxia)
  • Severe headache (without a known cause)

When a patient shows symptoms of a stroke, the physician will promptly evaluate the patient’s medical history and immediately perform brain imaging tests such as a computed axial tomography (CAT) scan. Prompt treatment focuses on re-establishing blood flow to the brain and stabilizing the patient. Medications, surgery and rehabilitation (e.g. physical therapy) may be part of the overall treatment process.

There are many different risk factors associated with strokes. These include advanced age, a family history of strokes, smoking, high blood pressure, obesity, and a history of transient ischemic attacks, sometimes called “mini-strokes.” Preventative measures do not fully protect an individual against having a stroke but can go far to reduce the risks of such an event. These may include smoking cessation, blood pressure control, regular exercise and a healthy diet.

About stroke

A stroke is a potentially life-threatening event that occurs when part of the brain is deprived of adequate oxygen. Also known as a cerebrovascular accident (CVA) or a “brain attack,” a stroke occurs when a blood vessel in the brain bursts or becomes clogged by a blood clot or other materials. Thie blockage of brain blood vessels prevents oxygen and nutrients from getting to nerve cells in the affected area of the brain. Without adequate oxygen these nerve cells typically die within minutes, and the area of the body that they control can cease to function. This damage can be permanent, especially if the patient is not immediately treated.

Each year, approximately 700,000 strokes occur in the United States, of which 500,000 are new (first-time) strokes, according to the Centers for Disease Control and Prevention. More than 160,000 Americans die every year from strokes. Strokes are the third leading cause of death in the United States, behind heart disease and cancer, according to the National Stroke Association. 

Immediate response to a stroke can help prevent damage, but a stroke left untreated for too long may result in irreversible nerve and tissue damage that can cause symptoms such as a permanent loss of speech or paralysis. It can even lead to death. Damage to the brain due to a stroke can result in disabilities throughout the body that may be mild to severe. Complications associated with strokes include:

  • Emotional problems. Some stroke patients have difficulty controlling their emotions and may express inappropriate emotions. Others may become depressed. People may cry easily or undergo sudden mood swings for no apparent reason. This is known as emotional lability.
  • Paralysis and weakness. Strokes may cause complete paralysis on one side of the body (hemiplegia) or weakness that appears on one side of the body (hemiparesis).
  • Problems with language involving speaking and understanding (aphasia) and problems with thinking. Stroke survivors may have trouble initiating and/or understanding speech. They may also struggle with cognitive skills such as attentiveness, awareness, judgment, learning, memory and thinking.
  • Sensation and perception changes. Patients who have had a stroke may experience numbness or other unusual sensations. Pain or numbness may be experienced in the hands and feet, and may worsen with movement or temperature changes, particularly at lower temperatures. Patients may also find that their perception of everyday objects has changed due to an impaired ability to see, touch, move or think.
  • Difficulties chewing and swallowing (dysphagia). A stroke may weaken muscles on one or both sides of the mouth, leading to difficulty with chewing and swallowing.

The diagnosis, treatment and prevention of strokes are complicated because there are two major distinct types of strokes – ischemic and hemorrhagic strokes – and they are distinctly different. An ischemic stroke involves a clot or blockage in an artery, while a hemorrhagic stroke involves bleeding inside or around the brain. Of the two forms of stroke, hemorrhagic stroke generally poses more immediate danger because increased pressure on the brain due to bleeding can cause death.

Yet, people who survive a stroke tend to recover more fully if the stroke was hemorrhagic rather than ischemic. This is because the damage in a hemorrhagic stroke is caused by pressure on the brain and may be reversible once the pressure is relieved. In contrast, the damage associated with an ischemic stroke is a result of blockage in an artery that results in death of the affected brain tissues. When this occurs recovery is more difficult.  

In recent years, there have been advances in the immediate care and treatment of strokes as physicians have become better at diagnosing what type of stroke has occurred and moving quickly to treat it. This has resulted in higher survival rates, and a corresponding higher rate of hospitalization from strokes as more people survive their strokes.

Types and differences of strokes

There are two major types of strokes:

  • Ischemic stroke. An ischemic stroke is due to restriction of blood flow to the brain. It usually involves a blood clot or blockage in an artery (blood vessel that carries blood away from the heart) in the brain. The majority – almost 90 percent – of all strokes that occur in the United States are ischemic strokes, according to the American Heart Association. There are two kinds of ischemic strokes:
    • Thrombotic strokes. Stroke due to blood vessel blockage that begins in the brain. A thrombotic stroke can occur when a blood clot (thrombus) forms in an artery in the brain, which can result from a hardening of the arteries (atherosclerosis). Most ischemic strokes are thrombotic.
    • Embolic strokes. Stroke due to blood vessel blockage (embolism) that travels through the bloodstream to the brain from another part of the body. Embolic strokes are frequently the result of blood pooling in the upper chambers of the heart (the atria) in people who have abnormal heart rhythms (arrhythmias), such as atrial fibrillation. In addition, blood clots may form in the area due to a weakened heart muscle, or may travel from a vein to the heart (e.g., due to a hole in the wall between the right and left atria [atrial septal defect]). The swelling of blood flow in the heart raises the risk of a blood clot forming and of it traveling into the carotid arteries (the arteries that carry blood from the heart to the brain).
  • Hemorrhagicstroke. A hemorrhagic stroke is caused by excessive bleeding (hemorrhaging) within or around the brain. In addition, this loss of blood supply from cells in the brain can prevent the cells from properly functioning. Blood that accumulates may pressure surrounding brain tissue, which can lead to further interference with brain activity. There are two kinds of hemorrhagic strokes:
    • Cerebral hemorrhage. Bleeding within the brain. This may occur when a defective artery within the brain bursts, which is often a complication of high blood pressure. Blood that leaks from a blood vessel in the brain can accumulate over a matter of minutes or hours. Other causes of cerebral hemorrhage include cerebral aneurysms (blood-filled pouches that balloon out from weak spots in an arterial wall), arteriovenous malformations and brain tumors. Cerebral hemorrhage is the most common type of hemorrhagic stroke, accounting for just under 10 percent of all strokes in the United States, according to the American Heart Association.
    • Subarachnoid hemorrhage. Bleeding around the brain. This occurs when a blood vessel on the brain’s surface ruptures and bleeds into the space between the brain and skull, but not into the brain itself. It may result from various conditions, including a ruptured cerebral aneurysm or a head injury.

In addition to ischemic and hemorrhagic strokes, some people may experience a transient ischemic attack (TIA). This is a brief, temporary interruption in blood flow to the brain and is often called a “mini-stroke.” TIAs often precede certain types of ischemic strokes (thrombotic strokes). The National Stroke Association estimates that 40 percent of people who have had a TIA will have a major stroke at some point in the future. Despite the danger associated with TIAs, many people do not seek treatment for TIAs.

Risk factors and causes of stroke

Strokes can have a variety of causes, depending on the type of stroke involved.

Ischemic strokes result from a restriction of blood flow to the brain. Blood clots are the most common cause of arterial blockage, but blood vessel blockage can also result from a narrowing of the arteries (stenosis), which often results from a buildup of material in the lining of an artery (atherosclerosis).

Hemorrhagic strokes result from bleeding within or around the brain. This may be caused by the bursting of an artery within the brain. This can occur when a weak spot on an artery wall expands (cerebral aneurysm) or when artery walls begin to lose elasticity, leaving them brittle, thin and prone to cracks.

Various risk factors are associated with strokes. They include:

  • History of transient ischemic attacks (TIA). These “mini-strokes” are caused by brief, temporary interruptions in blood flow to the brain. People who experience a TIA are 10 times more likely to have a stroke than their counterparts who do not experience a TIA. A stroke may sometimes occur as soon as two days after a TIA.
  • Advanced age. While strokes can strike at any age, nearly three-quarters of strokes occur in people older than 65, according to the Centers for Disease Control and Prevention (CDC). The risk of a stroke doubles with each decade over the age of 55. Young people are most likely to have strokes resulting from cocaine use, high blood pressure, a traumatic head injury, carotid artery dissection or other causes.
  • Gender. At younger ages, men are more likely to experience and die from a stroke, although overall more women are killed by stroke, perhaps because women tend to live longer. Among older people, the incidence of stroke is roughly equal.
  • High blood pressure (hypertension). Studies have shown that people with hypertension have a risk of stroke that is 4 to 6 times higher than it is for people without hypertension. Hypertension is considered an important risk factor for stroke because it usually presents no symptoms or warning signs. Studies have shown that patients with a systolic/diastolic blood pressure of less than 120/80 mmHg have about half the lifetime risk of stroke compared to people with high blood pressure.
  • Coronary artery disease (CAD) (narrowing of the arteries that supply blood to the heart). There is a strong correlation between CAD and ischemic stroke because both are caused by the same underlying process, atherosclerosis. Atherosclerosis occurs when arteries become obstructed by plaque deposits in the lining of an artery.
  • Atrial fibrillation. This heart rhythm disorder can cause the blood to clot. If these blood clots travel from the heart up into the brain, a stroke may occur. The disorder is associated with 15 percent of all strokes, according to the CDC.
  • Diabetes. People with diabetes have two to four times the risk of stroke compared to people who do not have the illness, according to the CDC. Having diabetes also appears to worsen the outcome of a stroke in many cases.
  • Smoking. Smoking doubles a person’s risk for ischemic stroke, according to the CDC. Smoking promotes atherosclerosis, in which plaque builds up on the walls of arteries. In addition, smoking increases the levels of certain blood clotting factors, such as fibrinogen. Nicotine also raises blood pressure, and the carbon monoxide in cigarette smoke (if inhaled) reduces the amount of oxygen that blood can carry to the brain.
  • Family history of stroke. The risk of stroke increases if a person’s parents, grandparents, sisters or brothers have had a stroke.
  • Low levels of HDL (“good”) cholesterol and high levels of LDL (“bad”) cholesterol. Poor levels of good and bad cholesterol can lead to atherosclerosis, which significantly raises the risk of stroke.
  • Obesity. A body mass index (BMI) of 30 or greater (indicating a person is obese) increases the risk of stroke. BMI is usually related to the amount of body fat.
  • Lack of exercise. Not maintaining a moderate level of physical activity can lead to obesity, which increases the risk of stroke.
  • carotid artery dissection. A tear in the inner lining of the carotid artery, creating a space through which blood could leak, causing a stroke.
  • Excessive use of alcohol. This can lead to an increase in blood pressure, which increases the risk of stroke.
  • Illegal drug use. Drugs associated with an increased risk of stroke include cocaine, heroin and amphetamines.
  • Head injury, neck injury. Physical trauma to these areas can damage blood vessels and increase the risk of stroke.
  • Birth control pills and hormone therapy have been linked to an increased risk of stroke. Taking birth control pills increases the risk of stroke, especially for women who smoke and are over the age of 35. Low-dose birth control pills appear to carry a lower risk for stroke. Data from large studies have also demonstrated that hormone replacement therapy, using either estrogen alone or estrogen plus synthetic progesterone, raises the risk of stroke among healthy postmenopausal women.
  • Prior stroke or heart attack.
  • Living in the southeastern United States. For several decades, the southeastern United States has had the highest stroke mortality rate in the nation, according to the CDC. The reason for this increased risk factor remains unknown.
  • Undergoing catheter-based procedures. People who have surgeries that involve placing certain types of catheters (small, flexible tubes) into the heart have a higher risk of blood clot formation.

Other possible contributors to the risk of stroke include:

  • Sleep apnea. A condition in which breathing involuntarily stops and starts during sleep. Interruptions in oxygen to the heart and brain can significantly increase a person’s risk of heart disease, high blood pressure and stroke.
  • Atrial flutter. A type of atrial tachycardia, which is an unusually fast heart rhythm that originates in the upper chambers of the heart (atria). Atrial flutter is characterized by a very rapid but regular electrical signal in the atria, which causes a very rapid heartbeat.
  • Depression. Although the exact mechanism is not clearly understood, studies continue to show an association between chronic depressive symptoms and increased risk of stroke.
  • Acute inflammation in the body. Studies have shown that people that test positive on a blood test for certain proteins that indicate acute infection have an increased risk of stroke. The test used is called a C-reactive protein test. A positive result may indicate the presence of certain inflammatory conditions or diseases (e.g., rheumatoid arthritis, lupus).

Although stroke affects all races and ethnicities, African Americans have the greatest risk of stroke. This includes a higher likelihood of stroke at an earlier age and greater risk of overall mortality.

Medical researchers do not completely understand why African Americans have an increased risk of stroke. Some studies have suggested that racism and poverty may play a role. In addition, African Americans are more likely to have medical risk factors (e.g., diabetes, high blood pressure, sickle cell anemia, smoking, obesity) known to be closely associated with stroke.

Signs and symptoms of stroke

Strokes injure the brain, which makes it less likely that patients will recognize what is happening to them as a stroke unfolds. In addition, bystanders also may not be aware of what is happening. For this reason, people of all ages are urged to learn about the signs and symptoms of a stroke.

Prompt diagnosis and treatment of a stroke by a medical professional is crucial to limiting the potential damage associated with strokes. Strokes that are left untreated for too long can result in a loss of consciousness and death. It is important that anyone experiencing stroke-like symptoms seek emergency medical care, regardless of the degree or duration of symptoms.

Symptoms can vary according to the type of stroke experienced. However, the National Institute of Neurological Disorders and Stroke (NINDS) lists several major general signs of strokes. All of these symptoms appear suddenly:

  • Numbness or weakness of the face, arms or legs
  • Confusion
  • Trouble speaking or understanding language (aphasia)
  • Trouble seeing in one or both eyes (vision loss)
  • Difficulty walking
  • Dizziness
  • Loss of balance and coordination (ataxia)
  • Severe headache (without a known cause)
  • Paralysis of part of the body

The onset of symptoms of ischemic strokes may vary, depending on the subtype of ischemic stroke experienced. For example, the symptoms of an embolic stroke tend to appear suddenly, whereas the symptoms of a thrombotic stroke develop more gradually. The symptoms of both subtypes may include:

  • Blindness in one eye or hearing problems in one ear
  • Confusion
  • Dizziness or loss of balance/coordination
  • Nausea and/or vomiting
  • Numbness or weakness on only one side of the body
  • Seizures
  • Severe (and blinding) headache similar to a migraine
  • Trouble speaking or understanding speech

Hemorrhagic strokes tend to produce symptoms that appear suddenly and then continue to worsen. Both subtypes (cerebral hemorrhage and subarachnoid hemorrhage) produce similar symptoms. These symptoms include:

  • Confusion
  • Nausea and/or vomiting
  • Pain upon looking at or into a light
  • Painful or stiff neck
  • Severe headache

Transient ischemic attacks (TIA), or so-called “mini-strokes,” occur when the blood flow to the brain is briefly and temporarily restricted. The symptoms of a TIA are similar to an ischemic stroke, but generally milder. Although TIAs were once considered relatively harmless, new studies have shown that TIAs can result in long-term brain damage. In some cases, strokes may occur with no obvious symptoms. These are referred to as silent strokes. It is estimated that about one-third of elderly people in the United States may have had a silent stroke, which often damages their cognitive abilities. People who experience silent strokes have twice the risk of developing dementia.

Diagnosis methods for stroke

When a patient has signs or symptoms of a stroke, a physician will promptly evaluate the patient’s medical history and obtain brain imaging tests such as a computed axial tomography (CAT) scan. The CAT scan can help the physician determine whether the patient is having a cerebral hemorrhage or an ischemic stroke caused by cerebral ischemia. This information determines the course of emergency treatment. The CAT scan may also help a physician locate the exact position of the brain damage.

Once the patient is stabilized, a complete evaluation of a patient who has had a stroke can take several days. Tests that may be performed during this time may include:

  • Physical examination, during which functioning of the carotid arteries (the arteries that carry blood from the heart to the brain) will be examined with a stethoscope. If a physician hears an abnormal sound (a carotid bruit), it may indicate atherosclerosis (hardening of the arteries) or carotid artery disease – conditions that increase the risk of stroke.

  • A carotid ultrasound is a painless technique that uses high-frequency sound waves to identify the presence of plaque in the carotid arteries.

  • Magnetic resonance angiography (MRA) is a diagnostic imaging test used to assess the degree of blockage in arteries in and around the brain. The MRA is a variation of the magnetic resonance imaging (MRI) scan, which is also very important in diagnosing a stroke. MRA is used specifically for the arteries. Magnetic resonance venography (MRV) is a related blood vessel study that is more specific for veins in and around the brain. Radionuclide tests (such as PET scan) may also be performed to image the brain to determine the extent of damage.
  • An electrocardiogram (EKG) may be performed to identify any cardiac problems that may have led to the stroke, such as a prior heart attack. Patients who have had a heart attack in the past are at increased risk of blood clots forming in the heart, which could trigger a stroke. Patients are also at increased risk of developing a stroke if arrhythmias (heart rhythm disorders) such as atrial fibrillation are present. Finally, because an ischemic stroke and a heart attack may have the same underlying cause (e.g., atherosclerosis), a physician may use an EKG to look for additional signs of heart disease.

  • Blood tests, including a complete blood count (CBC) and a lipid profile (cholesterol test) may also be performed. These tests may help identify whether a patient has certain risk factors associated with stroke, such as high cholesterol.

Some additional tests may be performed to assess overall brain function, as measured by electrical activity. These tests can reveal how much neurological damage was done as a result of the stroke. Among the most common of these tests are:

  • Electroencephalogram (EEG). During this painless test, small metal electrodes are attached to the scalp. The electrodes are connected by wires (leads) to an electroencephalograph machine that charts the electrical activity of the brain.

  • Evoked potential study. A test of the nervous system that can measure the brain’s response to sight, hearing and touch stimuli.

Treatment options for stroke

Emergency medical attention should be obtained (e.g., by calling 9-1-1) for anyone experiencing signs or symptoms of a stroke. Aspirin should not be used by people who may have suffered a stroke because aspirin can worsen symptoms of a hemorrhagic stroke (stroke due to bleeding in or around the brain). Patients who have experienced a stroke will most likely be taken to a nearby hospital.

Upon arriving at a hospital, medical staff will attempt to stabilize the patient using information obtained from an emergency computed axial tomography (CAT) scan of the patient.

The focus of immediate care for patients who have suffered a stroke is to re-establish blood flow to the brain. However, when blood flow is restored (reperfusion) to the affected area of the brain, there is the risk that additional damage may occur. Returning blood carries white blood cells that may create a blockage in small blood vessels and may release toxins harmful to brain cells. Nevertheless, brain cells deprived of oxygen can die within minutes, causing long–term disability or death. Thus, re-establishing blood flow is a critical first step in emergency treatment of a person who has had a stroke.

Additional treatment methods that may be used for people who have had a stroke include:

  • Aid breathing. Maintaining breathing in patients who may be losing consciousness may be done through the use of breathing equipment and/or supplemental oxygen.
  • Reduce fever. If fever is present, it may be reduced with medications.
  • Administer certain medications in cases of ischemic stroke (stroke due to restricted blood flow to the brain). If a patient has had an ischemic stroke, medications that dissolve blood clots (thrombolytic medications) may be given intravenously. The most common thrombolytic medication is known as tissue plasminogen activator (tPA), which has been approved for use in treating strokes since 1996. It is most effective if administered within three hours of the onset of symptoms. Aspirin may also be beneficial for patients who have had an ischemic stroke (but not hemorrhagic stroke).
  • Prevent nutritional deficiency, Special attention may need to be provided to meeting a patient’s nutritional needs (intravenously or through the mouth) and to preventing pneumonia, a common complication after a stroke.

In cases where the stroke was caused by a partial blockage of a carotid artery (artery that carries blood from the heart to the brain) in the neck, a surgery called carotid endarterectomy may be performed to remove the accumulated plaque in the artery. In other cases, a cerebral angioplasty may be performed. This involves the use of a balloon-tipped catheter to stretch blood vessels in the brain and improve blood flow.

People who survive a stroke often need to undergo physical therapy to deal with impaired movement or speech that can occur as the result of a stroke. The sooner this treatment is begun, the more likely it is that patients will regain significant functioning. People who have had a stroke may also experience depression, which may be related to the temporary or permanent loss of body functioning. If depression occurs, patients are urged to seek the help of a qualified counselor for support and treatment.

Prevention methods for stroke

Preventive measures do not fully protect an individual against having a stroke but may help. These measures may include:

  • Controlling high blood pressure (hypertension). Blood pressure abnormalities should be continually monitored and controlled because they are a chief contributor to strokes.

  • Quitting smoking. The risk of stroke begins to decrease a few years after a person quits smoking.

  • Getting treatment for heart rhythm abnormalities such as atrial fibrillation or atrial flutter. For example, anticoagulant medications may help prevent the risk of a blood clot forming and traveling to the brain, which can cause a stroke.

  • Getting treatment for sleep apnea.

  • Learning stress management techniques and seeking help for depression or drug abuse. Cocaine use, especially, has been linked to hemorrhagic strokes (strokes due to bleeding in or around the brain).

  • Reducing cholesterol levels, perhaps by taking cholesterol-reducing medications.

  • Increasing amount of daily exercise. The U.S. Surgeon General recommends that adults participate in moderate physical activity for at least 30 minutes on most days of the week.

  • Maintaining an ideal weight.

  • Limiting use of alcohol to about one glass of wine or beer per day.

  • Controlling diabetes.

  • Eating a heart-healthy diet. Findings from a number of studies illustrate how a heart-healthy diet can decrease stroke risk:

    • Women who ate fish more than five times a week were found to have a significantly lower risk of stroke than women who ate fish less than once a month. Fish is a good source of omega-3 fatty acids, a substance helpful in reducing cholesterol levels.

    • People in rural Japan with high levels of vitamin C in their blood from eating large amounts of fruits and vegetables were found to be significantly less likely to have a stroke than those with the low levels of vitamin C. It is important to note that there is no proof that taking vitamin C supplements will produce the same effect, because researchers do not know which substances in the fruits and vegetables produced the effect.

    • Women who ate large quantities of whole-grain foods were found to have a decreased risk of ischemic stroke (stroke due to restricted blood flow to the brain), compared to women who ate little or no whole-grain foods.

In addition, some people may be advised by their physician to take aspirin or other antiplatelet agents to help prevent the formation of blood clots.

Surgery may be recommended for high-risk patients to help prevent the risk of stroke. This includes patients who have already had a stroke or transient ischemic attack, or people with a greater than 80 percent blockage in the carotid arteries (arteries that carry blood from the heart to the brain).

In some cases, a physician may recommend carotid artery stenting, a procedure in which tiny mesh tubes are placed in arteries to crush arterial plaque and improve blood flow through the arteries. It also helps prevent pieces of plaque from breaking off and traveling through the bloodstream, helping to prevent strokes. The Food and Drug Administration approved carotid artery stents in September 2004 for use in certain patients.

Alternatively, a surgical procedure called a carotid endarterectomy may help prevent strokes in certain patients. A carotid endarterectomy involves the removal of fatty build-up from the carotid arteries. While the patient is under general anesthesia, the plaque from the artery is removed, along with the entire inner lining of the artery.

Early detection and repair of a cerebral aneurysm may also prevent a stroke. If a cerebral aneurysm has not yet ruptured, but produces signs or symptoms that lead patients to seek medical attention, a stroke may be avoided. Surgery may be necessary to repair the aneurysm, a procedure sometimes called “clipping.” It involves snipping off the aneurysm before it can rupture. Another technique for repairing cerebral aneurysms is the detachable coil technique. In this minimally invasive procedure, a small coil is implanted into the bulge in the arterial wall. The coil provokes an immune system response from the body, which produces a blood clot inside the aneurysm that strengthens arterial walls and reduces the risk of a rupture and possible stroke.

Ongoing research regarding stroke

Surgery, medications, hospital care and rehabilitation efforts are all considered accepted methods of treating a patient who has suffered a stroke. Scientists are also continuously exploring new methods of treating and preventing strokes. Research is ongoing in many different areas, including:

  • Antibiotics. Studies have found that plaque that causes a hardening of the arteries (atherosclerosis) may also harbor bacteria that can increase the risk of arterial rupture. Researchers are investigating whether antibiotics can affect these bacteria, potentially reducing the risk of stroke.
  • Mechanical thrombolysis (use of physical means to break up blood clots). Certain devices that use catheter-delivered tools to break up or remove blood clots are being explored for use in helping to prevent strokes. Currently, medications are the only method available to break up a blood clot in the brain and can take up to an hour to be effective. Devices being tested include lasers, sound waves, suction, spinning blades and snares.
  • Neuroprotective agents. Certain substances are being studied that may protect brain cells from injury and help prevent brain damage as a result of some types of stroke. The substances being explored operate in different ways. For example, some may increase blood flow to the area of brain experiencing a stroke. Others may prevent damage that can be caused when blood returns to the affected area of the brain after a stroke. Still other substances may limit the damage caused by dying brain cells.
  • Stem cell transplants. Stem cells are “beginner” cells that have the ability to develop into many different types of cells. The cells start out similar but become highly specialized, depending on where in the brain they develop. Researchers are investigating a variety of methods in which stem cell transplants could be used as a treatment for brain damage caused by stroke and other conditions.
  • Hypothermia (bodily response to low temperatures). When exposed to low temperatures, the body responds in a variety of ways, including lowering the demand for oxygen to the brain. Researchers are studying whether lowering a patient’s body temperature can decrease the amount of brain damage that can occur during a stroke.
  • Cholesterol-lowering drugs. Recent studies indicate that cholesterol-lowering drugs called statins may decrease a patient’s stroke risk.
  • Electrical brain stimulation. Researchers are examining the potential benefits of short-term electrical stimulation, via electrodes attached to the head, during rehabilitation after a stroke. This may stimulate the cortex and enhance post-stroke learning.

More investigation is needed to determine the safety and effectiveness of these potential treatments and preventive measures.

Questions for your doctor regarding stroke

Preparing questions in advance can help patients to have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions related to stroke:

  1. How likely am I to have a stroke? Why?
  2. What symptoms may indicate I am having a stroke?
  3. How will I know if I have a “silent stroke” (stroke without any obvious symptoms)?
  4. Are there any tests available to me that would indicate whether or not I have had a stroke? How do I prepare for these tests?
  5. What type of testing will you need to perform after I have had a stroke? What information will this tell you?
  6. What type of stroke did I have? What was the extent of brain damage? Was there any permanent damage?
  7. What treatment options are available to me?
  8. Do any of my current medications or medical conditions interfere with these treatments, or affect my risk of stroke?
  9. Do you recommend that I undergo any type of physical therapy, occupational therapy or speech therapy?
  10. How can I protect myself against future strokes?
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