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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 |
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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
http://www.heart.org
National Stroke Association
http://www.stroke.org
http://www.stroke.org
CANADIAN RESOURCES
Health Canada
https://www.canada.ca
https://www.canada.ca
Heart and Stroke Foundation
http://www.heartandstroke.com
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