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A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.
Brain damage can begin within minutes. That's why it's so important to know the symptoms of stroke and to act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.
Symptoms of a stroke happen quickly. A stroke may cause:
If you have any of these symptoms, even if they go away quickly, call 911 or other emergency services right away.
FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help. FAST stands for:
There are two types of stroke:
You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better.
The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important, because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.
To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.
For an ischemic stroke, treatment focuses on restoring blood flow to the brain. You may be given a clot-dissolving medicine called tissue plasminogen activator (TPA). This medicine can improve recovery from a stroke, especially if given as soon as possible after the stroke happens. Doctors try to give this medicine within 4½ hours after symptoms start.footnote 1 Other medicines may be given to prevent blood clots and control symptoms. A procedure, called thrombectomy, may be done to remove the blood clot and restore blood flow.
For a hemorrhagic stroke, treatment focuses on stopping the bleeding in the brain. Doctors may give you medicine or a transfusion with parts of blood, such as plasma. They may do surgery to drain the blood or to reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.
After either kind of stroke and after your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure or atrial fibrillation. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).
The best way to get better after a stroke is to start stroke rehabilitation (rehab). The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke. So it is important to start rehab soon after a stroke and do a little every day.
After you have had a stroke, you are at risk for having another one. But you can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.
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An ischemic stroke is caused by a blood clot that blocks blood flow to the brain.
Low blood pressure may also cause an ischemic stroke, although this is less common. Low blood pressure results in reduced blood flow to the brain. It may be caused by narrowed or diseased arteries, a heart attack, a large loss of blood, or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as carotid artery stenting) that are used to treat narrowed carotid arteries may cause a blood clot to break loose, resulting in a stroke.
A hemorrhagic stroke is caused by bleeding in or around the brain.
Other less common causes include head or neck injuries, certain diseases, and radiation treatment for cancer in the neck or brain.
If you have symptoms of a stroke, call 911 or other emergency services right away. General symptoms of a stroke include:
Symptoms can vary depending on whether the stroke is caused by a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.
A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.
If several smaller strokes occur over time, you may have a more gradual change in walking, balance, thinking, or behavior. This is called multi-infarct dementia.
It isn't always easy for people to recognize symptoms of a small stroke. They may mistakenly think the symptoms can be attributed to aging. Or the symptoms may be confused with those of other conditions that cause similar symptoms.
When you have an ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced. With a hemorrhagic stroke, there is bleeding in the brain.
After about 4 minutes without blood and oxygen, brain cells become damaged and may die. The body tries to restore blood and oxygen to the cells by enlarging other blood vessels (arteries) near the area.
If blood supply isn't restored, permanent damage usually occurs. The body parts controlled by those damaged cells cannot function.
This loss of function may be mild or severe. It may be temporary or permanent. It depends on where and how much of the brain is damaged and how fast the blood supply can be returned to the affected cells. Life-threatening complications may also occur. This is why it's important to get treatment as soon as possible.
Recovery depends on the location and amount of brain damage caused by the stroke, the ability of other healthy areas of the brain to take over for the damaged areas, and rehabilitation. In general, the less damage there is to the brain tissue, the less disability results and the greater the chances of a successful recovery.
Stroke is the most common nervous-system–related cause of physical disability. Of people who survive a stroke, half will still have some disability 6 months after the stroke.
You have the greatest chance of regaining your abilities during the first few months after a stroke. Regaining some abilities, such as speech, comes slowly, if at all. About half of all people who have a stroke will have some long-term problems with talking, understanding, and decision-making. They also may have changes in behavior that affect their relationships with family and friends.
After a stroke, you (or a caregiver) may also notice:
Long-term complications of a stroke, such as depression and pneumonia, may develop right away or months to years after a stroke.
Some long-term problems may be prevented with proper home treatment and medical follow-up. For more information, see Home Treatment.
A risk factor is anything that makes you more likely to have a particular health problem. Risk factors for stroke that you can treat or change include:
Risk factors you cannot change include:
Call 911 or other emergency services immediately if you have signs of a stroke:
Call 911 if you have symptoms that seem like a stroke, even if they go away quickly.
Signs of a transient ischemic attack (TIA) are similar to signs of a stroke. But TIA symptoms usually disappear after 10 to 20 minutes, although they may last longer. There is no way to tell whether the symptoms are caused by a stroke or by TIA, so emergency medical care is needed for both conditions.
Call your doctor now if you:
If you've had symptoms of a TIA in the past but you haven't talked with your doctor about it, call your doctor now.
Call your doctor for an appointment if you:
The first test after a stroke is typically a CT scan, a series of X-rays that can show whether there is bleeding in the brain. This test will show whether the stroke is ischemic or hemorrhagic. You may also have an MRI.
Other initial tests recommended for ischemic stroke include:
If it seems that you may have a narrowing of a carotid artery, your doctor may want you to have a:
If your doctor believes that the stroke may have been caused by a problem with your heart, an echocardiogram or Holter monitoring or telemetry test may be done.
Guidelines recommend that risk factors for heart disease also be assessed after a stroke to prevent disability or death from a future heart problem. This is because many people who have had a stroke also have coronary artery disease.
Measures will be taken to stabilize your vital signs, including giving you medicines.
Treatment includes efforts to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure.
Your treatment will also focus on preventing another stroke. This may include:
You may also need to make lifestyle changes such as quitting smoking, eating heart-healthy foods, and being active. For more information, see Prevention.
If your carotid arteries are significantly blocked, you may need a procedure to reopen the narrowed arteries. For more information, see Surgery and Other Treatment.
Starting a rehab program as soon as possible after a stroke increases your chances of regaining some of the abilities you lost.
Your rehab will be based on the physical abilities that were lost, your general health before the stroke, and your ability to participate. Rehab begins with helping you resume activities of daily living, such as eating, bathing, and dressing. Rehab can also help you make changes in your lifestyle, at home, at work, and in relationships. The changes you make will depend on how the stroke affected you.
Rehab can help you to:
If you are someone whose loved one has had a stroke, you can play an important role in that person's recovery by providing support and encouragement.
It's not possible to predict how much ability you will regain. The more ability you retain immediately after a stroke, the more independent you are likely to be when you are discharged from the hospital. For more information, see the topic Stroke Rehabilitation.
Some people move to a care facility that can meet their needs. There are several kinds of long-term care. Each provides different levels of care, assistance, and services. The quality and costs of care and services at long-term care facilities vary widely, and options vary from one community to another. Your doctor or rehab team can help you find which type of long-term care would be best for you.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
You can help prevent a stroke if you control risk factors and treat other medical conditions that can lead to a stroke. You can help prevent a TIA or stroke by taking steps toward a heart-healthy lifestyle.
Your doctor can help you know your risk. These are some of the common risk factors for stroke:
Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.
The types of medicines that prevent clotting are:
Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.
Anticoagulants prevent blood clots from forming and keep existing blood clots from getting bigger.
You may need to take this type of medicine after a stroke if you have atrial fibrillation or another condition that makes you more likely to have another stroke. For more information, see the topic Atrial Fibrillation.
Antiplatelet medicines keep platelets in the blood from sticking together.
These medicines include:
Statins and other medicines, such as ezetimibe, lower cholesterol and your risk for another stroke.
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
Medicines used to treat depression and pain may also be prescribed after a stroke.
When surgery is being considered after a stroke, your age, prior overall health, and current condition are major factors in the decision.
If you have serious blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke.
Treatment for hemorrhagic stroke may include surgery to:
Carotid artery stenting (also called carotid angioplasty and stenting) is sometimes done as an alternative to surgery to prevent stroke.
In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a stent to keep the artery open.
Carotid artery stenting is not as common as carotid endarterectomy, a type of surgery.
Thrombectomy is a procedure to remove a blood clot from a blood vessel. It can be used for some people who have had a stroke that was caused by a blood clot.
Thrombectomy can remove the clot and help blood to flow normally again. This can help limit damage to the brain.
In this procedure, the doctor puts a thin, flexible tube (catheter) into a blood vessel in the groin. The doctor moves the catheter through the blood vessel into the brain. The catheter is used to remove the clot. This is done with a tiny tool that looks like a wire cage. It fits inside the catheter.
Powers WJ, et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12): e344–e418. DOI: 10.1161/STR.0000000000000211. Accessed July 20, 2021.
Current as of:
July 6, 2021
Author: Healthwise StaffMedical Review: E. Gregory Thompson MD - Internal MedicineMartin J. Gabica MD - Family MedicineKathleen Romito MD - Family MedicineAdam Husney MD - Family MedicineRichard D. Zorowitz MD - Physical Medicine and Rehabilitation
Current as of: July 6, 2021
Author: Healthwise Staff
Medical Review:E. Gregory Thompson MD - Internal Medicine & Martin J. Gabica MD - Family Medicine & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Richard D. Zorowitz MD - Physical Medicine and Rehabilitation
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