Doctor's Notes on What Is a Stroke?
The two main causes of strokes are ischemic or hemorrhagic problems with the brain's blood vessels. Ischemic strokes (the cause of about 80%-85% of strokes) are due to blood vessels that are blocked usually due to a clot. With a hemorrhagic stroke, the blood vessels in the brain actually burst or leak blood. That leakage allows blood to spill into the brain tissue, causing a buildup of pressure on brain tissue and other brain blood vessels. Hemorrhagic strokes usually are more serious than ischemic strokes; death usually occurs in 30%-50% of individuals with this stroke type. Both types of strokes produce similar symptoms that signal brain tissue injury and/or death due to lack of oxygen supplied by the blood, but their emergency treatments are different. Call 911 as a stroke cause needs to be identified quickly in an emergency center, usually by a CT of the brain.
What Are the Treatments for a Stroke?
Recognition of a stroke is the first step in treatment of this common medical emergency. Symptoms usually happen quickly and may include the following:
- Sudden numbness and/or weakness on one side of the body
- Person slurs speech or can't talk
- Double vision or blurry vision in one eye
- Sudden loss of balance; falling down
Call 911 immediately (transport patient to a hospital that has an on-call stroke team if possible). The next treatments need to be done in a hospital by medical caregivers. They will determine if the patient has had a stroke (ischemic or hemorrhagic) or a transient ischemic attack (TIA). An emergency CT brain scan is usually done almost immediately on arrival in the ER. The stroke team (neurologist, and others) will quickly assess what treatments should be done, depending on their findings. In general, treatments may include the following:
- Observation (TIA)
- Thrombolysis (ischemic strokes for those who qualify)
- Surgery (hemorrhagic): various types, for example, blood vessel clamps, evacuating a hematoma
Some hospitals have the doctors and equipment to treat (directly remove) clots in the brain. For some patients that survive a stroke, rehabilitation is often necessary.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.