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A brainstem stroke happens when blood supply to the base of the brain is stopped. This can affect many functions in the body, such as heart rate, breathing, and blood pressure.
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.
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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
A hemorrhagic stroke is caused by a burst blood vessel. Blood pools in the brain. This slows or stops the flow of blood and causes a buildup of pressure on the brain.
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
- 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
- Drug abuse from cocaine , amphetamines, or heroin use
Daily habits can also play a role. Some examples are:
Some symptoms 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
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:
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:
For an ischemic stroke, medicine may be given to:
- Dissolve clots and prevent new ones from forming
- Thin blood
For a hemorrhagic stroke, medicine may be given to:
- Work against any blood-thinning drugs a person has been taking
- Reduce how the brain reacts to bleeding
Options to treat an ischemic stroke are:
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
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
American Heart Association
National Stroke Association
Heart and Stroke Foundation of Canada
Hemorrhagic strokes (bleeds). American Stroke Association website. Available at: https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds. Accessed January 12, 2021.
Intracerebral hemorrhage. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/intracerebral-hemorrhage. Accessed January 12, 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.
Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/subarachnoid-hemorrhage. 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.
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 12/2020
- Update Date: 01/12/2021