Ischemic Stroke

What is an ischemic stroke?

An ischemic stroke happens when something blocks blood flow from getting to your brain. It’s a life-threatening medical emergency.

Ischemic strokes can cause permanent brain damage and death. If enough brain cells die, you can lose the abilities or body functions those cells control. They’re the most common type of stroke — around 80% of all strokes.

If you think you or someone you’re with is having a stroke, immediately call 911 (or your local emergency services number). The sooner someone is diagnosed and treated, the more likely they’ll survive a stroke. Every second counts.

What are the symptoms of an ischemic stroke?

The ischemic stroke symptoms you experience will depend on which area of your brain it affects. Some of the most common symptoms include:

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

What are the warning signs of an ischemic stroke?

Ischemic strokes can cause lots of different symptoms. To recognize the warning signs 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 your face.
• Arms. Raise both arms. If you’re having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech. You might slur your 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 for you.

What causes ischemic strokes?

Ischemic strokes happen when something causes ischemia in your brain. Ischemia (pronounced “iss-KEY-me-uh”) is the medical term for cells not getting enough blood and dying. Blood clots are the most common cause.

Many health conditions can cause blood clots, such as:

• Atherosclerosis (hardened arteries)
• Clotting disorders
• Atrial fibrillation
• Heart defects (atrial septal defects or ventricular septal defects)
• Microvascular ischemic disease (which can block smaller blood vessels in your brain)

Types of ischemic strokes

There are two types of ischemic strokes:

• Thrombotic strokes. These happen when a blood clot forms in your brain. The medical name for this process is thrombosis.
• Embolic strokes. These happen when a clot called an embolism forms somewhere else in your body, travels to your brain and gets stuck in a blood vessel.

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 permanent stroke soon. A person who has a TIA needs emergency medical care as quickly as possible.

Ischemic stroke risk factors

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

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

Having certain health conditions can increase your risk, including:

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

How are ischemic strokes diagnosed?

A healthcare provider will diagnose an ischemic stroke with a neurological exam and some tests. Providers in the emergency room may diagnose it if emergency services transport you to the ER.

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

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

What are ischemic stroke treatments?

The most important part of treating an ischemic stroke is restoring blood flow to your brain. Healthcare providers will do this as fast as possible to reduce your risk of permanent brain damage and death.

The two most common treatments include:

• Thrombolytic therapy. These are medications that dissolve clots. Providers will usually only use them if it’s been fewer than four hours since you started having stroke symptoms because they can increase your risk of dangerous internal bleeding.
• Thrombectomy. This is surgery to remove a blood clot. Your surgeon will insert a small, thin tube (a catheter) into a blood vessel somewhere else in your body. Then, they’ll thread the catheter up to the clot in your brain. They’ll either vacuum the clot up in one piece or break it apart and suck up the pieces.

You may need other treatments, including:

• Blood thinners. Anticoagulant medications thin your blood to prevent it from clotting too easily. Your providers may put you on blood thinners after thrombolytic therapy.
• Oxygen therapy. Your brain doesn’t get enough oxygen during a stroke. Your providers may have you wear a nosepiece that gives you extra oxygen. This will make it easier to breathe and help your body restore oxygen to your brain.
• Blood sugar management. Your providers will monitor your blood glucose (blood sugar) levels to help your brain recover.
• Mild intentional hypothermia. Your providers might safely lower your body temperature. This can slow down brain damage during and after a stroke. But this is rare.

Stroke rehabilitation

Stroke rehab is an important part of treating an ischemic stroke. You’ll need stroke 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:

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

How can you prevent an ischemic stroke?

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

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

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

What is the ischemic stroke survival rate?

It’s hard for experts to estimate a survival rate that applies to everyone. Ischemic strokes can be fatal and 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 automatically easier, faster or better.

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:

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

Most people take a few months to recover after a stroke. The most recovery usually happens in the first three to six months after a stroke. But it’s possible that symptoms and after-effects can linger for a year or longer. A stroke can also cause permanent disabilities and other changes in how you can use your body.

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 do I take care of myself after an ischemic 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:

• Take your medications. This is especially true while you’re taking blood thinners. Reducing the risk of future blood clots is important, and taking your medicine as often as your provider suggests will help your body heal.
• 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.

Which foods or drinks should I avoid?

Your provider may suggest you add or remove some foods and drinks to your eating plan. They might suggest tweaks to your routine to help you manage health conditions you have and/or to lower your risk of future blood clots after an ischemic stroke.

Common foods you might need to avoid include:

• Foods that have a lot of salt (sodium)
• Foods high in sugar
• Highly processed foods (like deli meat)
• Fried foods
• Alcohol
• Caffeine

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 an ischemic stroke have an increased risk of other potentially serious complications, including:

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

• What caused the stroke?
• What’s the best way to reduce my risk of another stroke?
• Will I have any long-term effects?
• How long will I need stroke rehab?
• Which changes to my daily routine will I need to make?