Stroke

What is a stroke?

A stroke is a medical emergency that happens when something prevents your brain from getting enough blood flow. A blocked blood vessel or bleeding in your brain can cause strokes.

Healthcare providers sometimes refer to strokes as cerebrovascular accidents (CVAs) or brain attacks.

Strokes are the second leading cause of death worldwide and the fifth most common in the U.S.

If you think you or someone you’re with is having a stroke, immediately call 911 or your local emergency services number. Strokes are life-threatening and can be fatal. The sooner someone is diagnosed and treated, the more likely it is they’ll survive a stroke. Every second counts.

What are stroke symptoms?

A stroke can cause different symptoms depending on which area of your brain it affects. Some of the most common symptoms include:

• Aphasia (trouble speaking or a complete loss of speech)
• Blurry vision or double vision (diplopia)
• Confusion or agitation
• Coma
• Dizziness or vertigo
• Headaches (usually sudden and severe)
• Loss of muscle control on one side of your face
• Loss of coordination or clumsiness (ataxia)
• Memory loss (amnesia)
• Mood swings or sudden personality changes
• Nausea and vomiting
• Neck stiffness
• Passing out or fainting
• Seizures
• Slurred or garbled speaking (dysarthria)
• Sudden worsening or loss of your senses (including vision, hearing, smell, taste and touch)
• Weakness or paralysis on one side of your face and body

How long does a stroke last?

A stroke lasts as long as your brain isn’t getting the right amount of blood flow. Your brain cells die if they go too long without oxygen from fresh blood. If enough brain cells in an area die, the damage becomes permanent. This can cause permanent disabilities and other changes in how you can use your body.

Restoring your normal blood flow may prevent that permanent damage or reduce its severity. That’s why time is critical in treating a stroke.

Even after you receive treatment, it’s common for the effects to linger. Symptoms and after-effects can continue for a year or longer.

What are the warning signs of a stroke?

Strokes can cause lots of different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance. Watch for a sudden loss of balance.
• Eyes. Look out for sudden vision loss or changes in one or both eyes.
• Face. Smile. Look for a droop on one or both sides of the face.
• Arms. Raise both arms. If you or someone is having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech. You or someone might slur your or their speech or have trouble choosing the right words.
• Time. Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best.

What causes strokes?

There are two types of strokes.

Ischemic strokes usually happen because a blood clot blocks a blood vessel connected to your brain. Issues that can cause these kinds of clots include:

• Atherosclerosis (hardened arteries)
• Atrial fibrillation (especially when sleep apnea causes it)
• Clotting disorders
• Heart defects (including atrial septal defect and ventricular septal defect)
• Microvascular ischemic disease

Hemorrhagic strokes happen when a blood vessel in your brain breaks or tears (ruptures). Causes can include:

• Brain aneurysms
• Brain tumors
• High blood pressure (especially if it’s very high or you have it for a long time)
• Moyamoya disease (and any other condition that weakens blood vessels in your brain)

Transient ischemic attack

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

Stroke risk factors

Anybody can have a stroke, but some groups have a higher risk, including people who:

• Are older than 65
• Smoke or use other forms of tobacco or nicotine (like vaping)
• Use recreational or nonprescription drugs

Having certain health conditions can increase your stroke risk, including:

• Alcohol use disorder
• COVID-19
• Frequent migraine headaches
• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• Type 2 diabetes

How are strokes diagnosed?

A healthcare provider will diagnose a stroke using a combination of a neurological exam and tests. Providers in the emergency room may diagnose a stroke if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a stroke:

• Blood tests
• CT scan
• Electroencephalogram (EEG)
• Electrocardiogram (EKG)
• MRI

What are stroke treatments?

The treatments you’ll need will depend on a few factors, including:

• How much the stroke damaged your brain
• Which area of your brain is affected
• Which type you have

Your providers will restore normal blood flow to your brain as fast as possible to limit the risk of permanent brain damage.

If you experience an ischemic stroke, your providers will break up or remove the blood clot that caused it. You’ll need thrombolytic medications and/or surgery (usually a mechanical thrombectomy). Your providers may also give you medications to manage your blood pressure.

If you have a hemorrhagic stroke, your providers will control the bleeding that caused it. You’ll need medications to stop the bleeding in your brain and manage your blood pressure. You may need surgery to reduce the increased intracranial pressure around your brain.

Your healthcare providers or surgeon will tell you exactly which treatments are best for you, what to expect and how long it will take to recover.

Stroke rehabilitation

Stroke rehab is an important part of stroke treatment. You’ll need rehab to help you adjust to changes in your brain and body after a stroke. You may need to regain abilities you had before or adjust to new or different disabilities. You might need a combination of:

• Cognitive rehab to help improve your memory, concentration and other mental abilities
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements
• Physical therapy to strengthen your muscles, improve your balance and regain use of your arms and legs
• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow

What is the stroke survival rate?

It’s hard for experts to estimate a stroke survival rate that applies to everyone. Strokes can be fatal, and they can cause permanent disabilities. But there’s no one set recovery timeline or outlook that’s accurate for everyone.

Ischemic strokes usually have better outcomes than hemorrhagic strokes, but that doesn’t mean your recovery will be easier, faster or better if you have one type or the other.

Stroke recovery time

Everyone’s body responds differently to a stroke. What you can expect (the prognosis) after a stroke depends on a few factors, including:

• How quickly it was treated
• Which areas of your brain it affected
• Which type of stroke you had
• Your overall health

Most people take a few months to recover after a stroke. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How can you prevent a stroke?

Maintaining your overall health is the best way to reduce your stroke risk. Try to:

• Eat plenty of healthy foods and maintain a weight that’s healthy for you.
• Get regular physical activity.
• Manage your blood pressure, cholesterol and any health conditions you have.
• Quit smoking.

Visit a healthcare provider for a check-up every year (or as often as they suggest). Many of the health conditions and issues that can cause stroke develop and build up over time, and may not cause symptoms you can notice. Many people with high blood pressure never feel or sense anything wrong. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke later on.

How do I take care of myself after a stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. You’re not weak or a quitter for feeling sad or upset. Your emotional health can be just as important as how your physical body is doing. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.
• Take your medications. Taking your medicine as your provider directs will help your body heal.

When should I go to the ER?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of causing severe complications and being fatal. Don’t wait to call for help or go to the emergency room.

People who’ve had a stroke have an increased risk of other potentially serious complications, including:

• Deep vein thrombosis (DVT)
• Heart attack
• Pneumonia
• Pulmonary embolism
• Seizures

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my doctor?

You might want to ask your provider a few questions, including:

• Which type of stroke did I have?
• Will I have any long-term effects from the stroke?
• Which kinds of therapy and rehab will I need?
• What warning signs of another stroke should I watch out for?