Stroke
Also called: Cerebrovascular accident, CVA, Brain attack, Ischaemic stroke, Haemorrhagic stroke
This can be a medical emergency. Call emergency services immediately for any sudden face drooping, arm weakness or speech difficulty — even if it goes away (TIA).
Blood supply to part of the brain is suddenly cut off by a clot (ischaemic, about 85%) or a burst blood vessel (haemorrhagic). Brain cells die within minutes, so fast treatment saves brain function — 'time is brain'.
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About 12 million strokes a year worldwide; the second leading cause of death and a leading cause of disability.
What happens in the body
In ischaemic stroke a clot from the heart (atrial fibrillation), a carotid plaque or small-vessel disease blocks an artery; a core of tissue dies while a surrounding 'penumbra' can still be rescued. In haemorrhagic stroke bleeding raises pressure and damages tissue directly.
Causes
- Clots from the heart, especially atrial fibrillation
- Atherosclerosis of carotid or brain arteries
- Small-vessel disease from hypertension and diabetes
- Bleeding from hypertensive vessels, aneurysms or malformations
- Arterial dissection in younger people
Risk factors
- High blood pressure (most important)
- Atrial fibrillation
- Smoking
- Diabetes
- High cholesterol
- Obesity and inactivity
- Excess alcohol
- Previous stroke or TIA
- Age
Symptoms
- BE FAST: Balance loss, Eyes (vision loss), Face drooping, Arm or leg weakness, Speech difficulty — Time to call emergency services
- Sudden numbness on one side
- Sudden confusion or trouble understanding
- Sudden severe headache (haemorrhage)
Diagnosis — tests and examinations
- Emergency CT scan to exclude bleeding
- CT angiography and perfusion to find a blocked artery
- MRI
- ECG and heart monitoring for atrial fibrillation
- Carotid ultrasound, echocardiography, blood tests
Treatment
Medicines and medical treatment
- Clot-busting drugs (alteplase or tenecteplase) within 4.5 hours of onset
- Aspirin after bleeding is excluded
- Stroke unit care (swallowing assessment, positioning, early mobilisation)
- Blood-pressure lowering and reversal of anticoagulants in haemorrhage
- Secondary prevention: antiplatelets or anticoagulants for AF, statins, blood-pressure control
Operations and procedures
- Mechanical thrombectomy for large-vessel blockage, up to 24 hours in selected patients
- Carotid endarterectomy or stenting for significant carotid narrowing
- Neurosurgery for some brain haemorrhages; aneurysm coiling or clipping
Self-care, home remedies and lifestyle
- Rehabilitation: physiotherapy, occupational and speech therapy
- Stop smoking, control blood pressure, healthy diet, exercise
- Take preventive medicines every day
Possible complications
- Paralysis and loss of function
- Speech and swallowing problems
- Aspiration pneumonia
- Depression
- Epilepsy
- Vascular dementia
- Recurrent stroke
Prevention
- Control blood pressure
- Anticoagulation for atrial fibrillation
- Not smoking, healthy weight, exercise, moderate alcohol
Outlook
Varies widely; many recover substantially with rapid treatment and rehabilitation, but about a third are left with lasting disability.
When to see a doctor
Call emergency services immediately for any sudden face drooping, arm weakness or speech difficulty — even if it goes away (TIA).
Sources and further reading
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