Stroke

What is a stroke?

From: MedlinePlus, National Library of Medicine

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call the local emergency number (112 in India) right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

What are the types of stroke?

From: MedlinePlus, National Library of Medicine

There are two types of stroke:

• Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
• Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but having a TIA puts you at much higher risk of having a stroke.

Who is at risk for a stroke?

From: MedlinePlus, National Library of Medicine

Certain factors can raise your risk of a stroke. The major risk factors include:

There are also other factors that are linked to a higher risk of stroke, such as:

• High blood pressure. This is the primary risk factor for a stroke.
• Diabetes.
• Heart diseases. Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
• Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
• A personal or family history of stroke or TIA
• Age. Your risk of stroke increases as you get older.
• Race and ethnicity. People who are African American or Hispanic have a higher risk of stroke.
• Alcohol and illegal drug use
• Not getting enough physical activity
• High cholesterol
• Unhealthy diet
• Having obesity

What are the symptoms of a stroke?

From: MedlinePlus, National Library of Medicine

The symptoms of a stroke often happen quickly. They include:

The F.A.S.T. test can help you remember what to look for if you think someone is having a stroke. Think "FAST" and look for:

If you think that you or someone else is having a stroke, call the local emergency number (112 in India) right away. Every minute counts during a stroke.

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking, or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden difficulty walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
• Face drooping on one side when smiling.
• Arm weakness occurs when the arms are raised, and one arm drifts downward.
• Speech is slurred or strange.
• Time to call the local emergency number (112 in India).

How are strokes diagnosed?

From: MedlinePlus, National Library of Medicine

To make a diagnosis, your health care provider will:

• Ask about your symptoms and medical history
• Do a physical exam, including a check of: Your mental alertness Your coordination and balance Any numbness or weakness in your face, arms, and legs Any trouble speaking and seeing clearly
• Run some tests, which may include: Diagnostic imaging of the brain, such as a CT scan or MRI. Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.

What are the treatments for stroke?

From: MedlinePlus, National Library of Medicine

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

Acute treatments for ischemic stroke are usually medicines:

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

• Acute treatment, to try to stop a stroke while it is happening
• Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
• Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke
• You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
• If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
• If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery.
• If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
• If an aneurysm is the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. They also can help prevent the aneurysm from bursting again.
• If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through:
• Surgery Injecting a substance into the blood vessels of the AVM to block blood flow Radiation to shrink the blood vessels of the AVM

Can strokes be prevented?

From: MedlinePlus, National Library of Medicine

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

• Eating a heart-healthy diet
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking
• Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

Which doctor should you see?

The suggested department for discussing Stroke is Neurology, with a neurologist as the relevant type of clinician. Emergency department now if this condition is suspected or newly occurring.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Which nervous-system findings help explain the symptoms?
• Would an assessment of walking, communication or daily function be helpful?
• Are rehabilitation or other specialist services relevant?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

When to seek emergency help

If this acute condition is suspected or the person is acutely unwell, seek urgent emergency assessment rather than waiting for a routine specialist appointment. Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.