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Ischemic Stroke

(Cerebrovascular Accident; CVA; Cerebral Infarct)

Definition

A stroke happens when blood supply to the brain is stopped.

There are two main types of stroke: ischemic and hemorrhagic . An ischemic stroke is the most common type.

Medical care is needed right away. Cells in the brain die if they are without oxygen for more than a few minutes. This can be deadly.

Hemorrhagic vs. Ischemic Stroke

Causes

An ischemic stroke happens when blood flow is blocked. This may be caused by:

A clot from another part of the body that breaks off and becomes trapped in a blood vessel supplying the brain
A clot that forms in an artery that supplies blood to the brain
A tear in an artery supplying blood to the brain

Risk Factors

This problem is more common in older adults and people with a family history of stroke.

Problems that affect blood vessel health and blood flow can raise the risk of stroke. Some examples are:

History of transient ischemic attacks (TIA)
Lack of physical activity
Smoking
Alcohol use disorder
Obesity or metabolic syndrome
Type 2 diabetes or prediabetes
High blood pressure
High cholesterol
Heart diseases or injury such as previous heart attack, atrial fibrillation or enlarged heart
Diseases of blood vessels such as carotid artery stenosis or atherosclerosis

Daily habits can also play a role. Some examples are:

Smoking
A diet that is high in saturated fat, trans fat, cholesterol, and sodium
Physical inactivity
Drug abuse from cocaine , amphetamines, or heroin use

Symptoms

Symptoms occur suddenly. Some problems may be:

Muscle weakness
Hearing and vision problems
Sensory changes
Problems with balance
A feeling of spinning when a person is still
Problems breathing
Problems chewing, swallowing, and speaking

Diagnosis

A stroke needs to be diagnosed quickly. The doctor will ask you or a family member about your symptoms and health history. A physical exam will be done. The doctor will look for signs of nerve or brain problems.

Blood tests may be done to look for clotting problems.

Images may be taken of the brain. This can be done with:

CT scan
Angiogram —to look at the heart and its blood supply
CT angiogram
MRI scan
Magnetic resonance angiography (MRA)
Doppler ultrasound

Heart function will be checked. This can be done with:

Electrocardiogram (ECG) to look at the heart's electrical activity
Echocardiogram to look at the heart's muscle movements

Treatment

Emergency care will be needed. The heart and lungs may need support. A tube may also be placed to help with breathing. Other options are:

Medications

Medicine may be given to:

Dissolve clots and prevent new ones from forming
Thin blood

Surgery

Options to treat an ischemic stroke are:

Embolectomy—a tube is passed through blood to remove a clot or deliver medicine to break it up
Vertebrobasilar angioplasty and stenting —a major artery to the brain is widened and a mesh tube is left in place to help keep it open

Rehabilitation

Therapy may be needed to regain lost skills. Options are:

Physical therapy—to improve movement
Occupational therapy—to help with daily tasks and self care
Speech therapy—to improve swallowing and speech
Psychological therapy—to provide support after the stroke

Prevention

The risk of stroke can be lowered by:

Managing chronic health problems, such as high blood pressure and diabetes
Maintaining a healthy weight through diet and exercise
Eating a diet that is low in fat and cholesterol and rich in whole grains, fruits, and vegetables
Not smoking
Limiting alcohol

RESOURCES

American Heart Association
http://www.heart.org

National Stroke Association
http://www.stroke.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca

Heart and Stroke Foundation
http://www.heartandstroke.com

References

Effects of stroke. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/effects-of-stroke. Accessed January 13, 2021.

Ischemic strokes (clots). American Stroke Association website. Available at: American Stroke Association website. Available at: https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots#.Vk3ipE2FPIU. Accessed January 12, 2021.

Long-term management of stroke. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/long-term-management-of-stroke. Accessed January 12, 2021.

Medelson SA, Prabhakaran S. Pace of progress in stroke thrombolysis: are hospitals running to stand still? Circ Cardiovasc Qual Outcomes. 2017;10(1):e003438.

Neuroimaging for acute stroke. EBSCO DynaMed website. Available at: https://www.dynamed.com/evaluation/neuroimaging-for-acute-stroke. Accessed January 12, 2021.

Stroke (acute management). EBSCO DynaMed website. Available at: https://www.dynamed.com/management/stroke-acute-management-1. Accessed January 12, 2021.

1/18/2017 DynaMed Systematic Literature Surveillance https://www.dynamed.com/prevention/cardiovascular-disease-possible-risk-factors: Emdin CA, Odutayo A, Wet al. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118(4):511-519.

Revision Information

Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
Review Date: 12/2020
Update Date: 01/27/2021

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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