What Is A Stroke - What Causes A Stroke - Medical News Today

5/25/2014 What is a stroke? What causes a stroke?
- Medical News Today

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Stroke
Neurology / Neuroscience
What is a stroke? What causes a stroke?
A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen.
A stroke can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds
the brain.
The patient may suddenly lose the ability to speak, there may be memory problems, or one side of
the body can become paralyzed.
1
This Medical News Today information article provides details on the two types of stroke, who are
at risk, what its causes are, its symptoms, how a stroke is treated, and how strokes can be
prevented.
The two main types of stroke
The two main types of stroke include ischemic stroke and hemorrhagic stroke.
2
Ischemic stroke
Ischemic stroke accounts for about 87% of all strokes and occurs when a blood clot, or thrombus
forms that blocks blood flow to part of the brain.
3
If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an
embolus. This wandering clot may be carried through the bloodstream to the brain where it can
cause ischemic stroke.
Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the
space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective
artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).
4
5/25/2014 What is a stroke? What causes a stroke? - Medical News Today
Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too
much pressure on the brain.
The outcome of a stroke depends on where the stroke occurs and how much of the brain is
affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Major
strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of
the body, difficulty speaking, incontinence, and bladder problems.
Fast facts on stroke
Here are some key points about stroke. More detail and supporting information is in the main
article.
A stroke is a condition in which the brain cells suddenly die because of a lack of
oxygen.
A stroke can be caused by an obstruction in the blood flow, or the rupture of an
artery that feeds the brain.
The patient may suddenly lose the ability to speak, there may be memory problems,
or one side of the body can become paralyzed.
There are two main types of stroke; ischemic and hemorrhagic.
Anyone can suffer from stroke. Although many risk factors are out of our control,
several can be kept in line through proper nutrition and medical care.
Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood
flow to the brain.
Hemorrhagic strokes can be caused by uncontrolled high blood pressure, a head
injury, or aneurysms.
Symptoms include loss of balance, speech problems, dizziness, paralysis, impaired
vision, sudden severe headache, confusion.
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still
damage brain tissue.
Stroke is treated by trying to restore blood flow to the brain using a blood clot-
busting drug called tissue plasminogen activator (tPA). In addition, surgical
procedures may be performed that can open up or widen arteries.
Who gets stroke?
Anyone can suffer from stroke. Although many risk factors are out of our control, several can be
kept in line through proper nutrition
A stroke is a condition in which the brain cells suddenly die
because of a lack of oxygen.
and medical care.
Risk factors for stroke include the
following:
Age - as you get older your risk
increases
5
Being male
5
A family history of stroke
5
High blood pressure
5
High cholesterol
5
Smoking cigarettes
5
Diabetes
5
Obesity and overweight
5
A previous stroke or transient ischemic attack (TIA)
5
High levels of homocysteine (an amino acid in blood)
5
Divorced men have a higher risk of stroke.
6
Heavy use of alcohol
Researchers from the University of Lille Nord de France, Lille, France, reported in the journal
Neurology that heavy regular drinkers have a considerably higher risk of stroke early in life
compared to others.
7
Depression
Middle-aged women with clinical depression have a higher risk of stroke, researchers from the
University of Queensland, Australia, reported in the journal Stroke.
8
The authors gathered data on 10,547 Australian females aged from 47 to 52 years. They found
that women with depression are more likely to have a stroke by a factor of 2.4, compared to
women without depression.
Even after taking into account known stroke risk factors, depressed middle-aged women were still
1.9 times more likely to have a stroke.
Caroline Jackson, Ph.D., said "When treating women, doctors need to recognize the serious nature
of poor mental health and what effects it can have in the long-term. Current guidelines for stroke
prevention tend to overlook the potential role of depression."
The researchers emphasized that although the risk was higher for women with depression, their
total risk of stroke was still low.
What causes stroke?
Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the
brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged
by atherosclerosis from a build-up of plaques.
9
Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat
that leads to blood clot formation and poor blood flow.
Hemorrhagic strokes can be caused by uncontrolled high blood pressure, a head injury, or
aneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes
small arteries inside the brain to burst.
10
This deprives brain cells of blood and dangerously
increases pressure on the brain.
Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an
artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures,
blood spills into the space between the surfaces of the brain and skull, and blood vessels in the
brain may spasm. Aneurysms are often caused or made worse by high blood pressure.
A study published in the American Journal of Human Genetics found a single gene defect can
lead to stroke and deadly diseases of the aorta and coronary arteries.
11
A less common form of hemorrhage stroke is when an arteriovenous malformation (AVM)
ruptures. AVM is an abnormal tangle of thin-walled blood vessels that is present at birth.
An article published in the BMJ Online reported that migraines increase stroke risk during
pregnancy.
12
What are the symptoms of stroke?
Within a few minutes of having a stroke brain cells begin to die and symptoms emerge. It is
important to recognize the symptoms, as prompt treatment is crucial to recovery.
Common symptoms include:
Trouble walking, loss of balance and coordination
13
Speech problems
13
Dizziness
13
Doctor assessing an MRI brain scan.
Numbness, weakness, or paralysis
13
Blurred, blackened, or double vision
13
Sudden severe headache
13
Confusion.
13
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage
brain tissue.
14
A transient ischemic attack (TIA) may be a sign of an impending stroke - TIA is a temporary
interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a
shorter period and do not leave noticeable permanent damage.
15
How is stroke diagnosed?
A stroke is a medical
emergency, and anyone
suspected of having one
should be taken to hospital
immediately so that tests
can be run and the correct
treatment can be provided
as quickly as possible.
Physicians have several
tools available to screen for
stroke risk and diagnose an
active stroke. These
include:
Physical assessment -
blood pressure tests
and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels
16
Ultrasound - a wand waved over the carotid arteries in the neck can provide a picture that
shows whether there is any narrowing or clotting
17
Arteriography - a catheter is inserted into the arteries to inject a dye that can be picked up
by X-rays
18
Computerized tomography (CT) scan - a scanning device that creates a 3D image that can
show aneurysms, bleeding, or abnormal vessels within the brain
19
Magnetic resonance imaging (MRI) - a magnetic field generates a 3D view of the brain to look
at tissue damaged by stroke
20
CT and MRI with angiography - scans that are aided by a dye that is injected into the blood
vessels in order to provide clearer and more detailed images
21
Echocardiography - an ultrasound that makes images of the heart to check for embolus
22
Eye-movement analyzer may diagnose stroke - researchers from Johns Hopkins University
School of Medicine in Baltimore created a device that can help diagnose stroke by expertly
analyzing eye movements. They reported their findings in the journal Stroke. The electronic
device is a small, portable, video-oculography machine. It detects eye movements that most
doctors find hard to notice.
23
How is stroke treated?
The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be
attempted using a blood clot-busting drug called tissue plasminogen activator (tPA). A doctor will
inject tPA into the patient's arm. If for some reason the patient can't receive the tPA then an anti-
platelet medicine will be used instead.
24
In addition, surgical procedures may be performed that can open up or widen arteries. These
include carotid endarterectomy (removal of plaque and widening of the carotid artery) and
angioplasty (a balloon that widens the carotid artery and is held open with a metallic mesh tube
called a stent).
24
Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat
this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous
malformation (AVM) removal.
24
Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it
from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding.
24
Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil
that fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM
removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more
accessible portions of the brain in order to eliminate the risk of rupture.
24
Most stroke patients will require rehabilitation after the event. A person's condition is generally
dependent on the area of the brain and the amount of tissue that was damaged. It is common for
the rehabilitation process to include speech therapy, occupational therapy, physical therapy, and
family education.
Investigators at Massachusetts General Hospital found that patients who had experienced strokes
as long as six months earlier were able to regain brain function through the help of a novel
robotic device that they squeezed with their hand.
25
Recent developments on stroke treatment from MNT news
University of Oxford researchers discovered how the brain protects itself from damage
caused by stroke. If researchers can identify the inbuilt biological mechanism that protects
the brain researchers will be a step closer to developing effective treatments for stroke.
26
Stem cell discovery: Astrocytes could repair stroke brain damage. A collaborative study
published in Nature Communications revealed that astrocytes may prove useful against
stroke and other brain disorders.
27
Most stroke patients have undiagnosed "attention" disorders
A study carried out by a team at Imperial College London found that many stroke patients have
undiagnosed attention problems. Examples include difficulties filtering out distraction, reduction
in alertness, and problems following instructions.
28
The researchers tested 100 stroke patients and 62 controls (people who had not had a stroke).
Five of the stroke patients had already been diagnosed with neglect - poor awareness and
attention in one side of the body.
All the 162 participants were given an ANT (attention network test), a computer-based test which
measures alertness, executive control and orientation. They also underwent an MRI brain scan.
The team found that more than half of the stroke patients had undiagnosed attention disorders.
Head investigator, Dr. Paul Bentley, said:
Dr. Bentley explained that MRI brain scans can help predict what type of attention problems
stroke patients might have. Those with the front of the brain affected tended to have problems
filtering out distraction, if the center of the brain was affected the patients were more likely to
have poorer alertness, while lesions in the back of the brain were linked to difficulties following
instructions.
How can stroke be prevented?
One way to prevent a stroke is to be aware of a transient ischemic attack (TIA) - or mini stroke -
if one occurs, the symptoms are similar to stroke. Knowing the symptoms of stroke can lead to
"We found that more than half of stroke patients have some form of attention problem,
and these may be missed by routine bedside examinations."
earlier treatment and better recovery.
Much of stroke prevention is based on living a healthy lifestyle, which include:
Identifying and controlling blood pressure
29
Not smoking
29
Lowering cholesterol, sodium, and fat intake
29
Drinking alcohol only in moderation
29
Treating diabetes properly
29
Managing stress
29
Being physically active.
29
Follow a healthy diet
If you eat plenty of tomatoes, your risk of developing stroke could be reduced significantly.
Tomatoes are rich in lycopene, a powerful antioxidant. In a study published in Neurology, October
2012, researchers found that people with high blood concentrations of lycopene had a 59% lower
risk of stroke compared to those with the lowest concentrations.
30
Mediterranean diet helps prevent a genetic risk of stroke - a mutation in the Transcription Factor
7-like 2 (TCF7L2) gene, which is linked to the development of type 2 diabetes, is also associated
with stroke risk, especially if the person is a homozygous carrier (carries two copies of the gene
variant).
31
Scientists from the CIBER Fisiopatologa de la Obesidad y Nutricin, Spain, and Tufts University,
USA, found that the Mediterranean diet may protect homozygous carriers of the gene variant.
The investigators explained in the journal Diabetes Care "Being on the Mediterranean diet
reduced the number of strokes in people with two copies of the variant. The food they ate
appeared to eliminate any increased stroke susceptibility, putting them on an even playing field
with people with one or no copies of the variant."
Recent developments on stroke prevention from MNT news
Vitamin B supplements may protect from stroke. A study carried out at Zhengzhou
University in China found that vitamin B supplements could reduce people's risk of having
a stroke. The research was published in the journal Neurology.
32
Walking for at least 210 minutes each week was found to reduce the risk of stroke in
women. Women who walk for more than 210 minutes per week are at a lower risk of stroke
References
compared to those who did not do much physical activity, researchers from the Murcia
Regional Health Authority, Spain, reported in the journal Stroke (January 2013 issue).
However, the same benefit was not found among men.
33
Cholesterol-lowering drugs can prevent stroke recurrence. According to research published
in the May 26, 2009, print issue of Neurology, people who take cholesterol-lowering drugs
called statins after a stroke may be less likely to have another stroke later.
34
More Information
Stroke: the risks, symptoms and increasing awareness
Written by Joseph Nordqvist
Copyright: Medical News Today
Not to be reproduced without the permission of Medical News Today.
1. "What Is Stroke?" National Stroke Association. Accessed 11 December 2013.
2. "Types of Stroke" The American Heart Association. Accessed 11 December 2013.
3. "Ischemic Strokes (Clots)" The American Heart Association. Accessed 11 December 2013.
4. "Hemorrhagic Strokes (Bleeds)" The American Heart Association. Accessed 11 December 2013.
5. "Stroke risk factors" National Stroke Foundation - Australia. Accessed 11 December 2013.
6. "Gender differences in the association between parental divorce during childhood and stroke in adulthood:
findings from a population-based survey" Esme Fuller-Thomson, Angela D. Dalton. International Journal of
Stroke. DOI: 10.1111/j.1747-4949.2012.00935.x. 11 DEC 2012. Accessed 11 December 2013. Abstract.
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9. "Ischemic Stroke" The Internet Stroke Center. Accessed 11 December 2013.
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11. "Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya
disease, along with thoracic aortic disease." Guo DC, Papke CL, Tran-Fadulu V, Regalado ES, Avidan N,
Johnson RJ, Kim DH, Pannu H, Willing MC, Sparks E, Pyeritz RE, Singh MN, Dalman RL, Grotta JC, Marian AJ,
Boerwinkle EA, Frazier LQ, LeMaire SA, Coselli JS, Estrera AL, Safi HJ, Veeraraghavan S, Muzny DM, Wheeler
DA, Willerson JT, Yu RK, Shete SS, Scherer SE, Raman CS, Buja LM, Milewicz DM. Am J Hum Genet. 2009
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2013.
19. "CT or CAT scan" Heart and Stroke Foundation. Accessed 11 December 2013.
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December 2013.
22. "Echocardiography" The Internet Stroke Center. Accessed 11 December 2013.
23. "Quantitative Video-Oculography to Help Diagnose Stroke in Acute Vertigo and Dizziness: Toward an ECG
for the Eyes". David E. Newman-Toker, Ali S. Saber Tehrani, Georgios Mantokoudis, John H. Pula, Cynthia I.
Guede, Kevin A. Kerber, Ari Blitz, Sarah H. Ying, Yu-Hsiang Hsieh, Richard E. Rothman, Daniel F. Hanley,
David S. Zee, and Jorge C. Kattah. Stroke. published online before print 5 March 2013;
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24. "How Is a Stroke Treated?" National Institutes of Health, Department of Health and Human Services.
25. "Functional MRI of Rehabilitation in Chronic Stroke Using a Novel MR-Compatible, Hand-induced, Robotic
Device." A Aria Tzika, Dionyssios Mintzopoulos, Azadeh Khanicheh, Bruce Rosen, Loukas Astrakas, and
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26. TSC1 (hamartin) confers neuroprotection against ischemia by inducing autophagy Michalis Papadakis et
al. Nature Medicine (Feb 2013) doi:10.1038/nm.3097. Abstract. Accessed 12 December 2013.
27. "hESC-derived Olig2
+
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Rao, David E. Pleasure, Ying Liu, Quanguang Zhang, and Wenbin Deng. Nature Communications.
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12 December 2013.
29. "Lifestyle Changes To Prevent Stroke" American Heart Association. Accessed 12 December 2013.
30. "Serum lycopene decreases the risk of stroke in men - A population-based follow-up study" Jouni Karppi,
PhD et al. Neurology. October 9, 2012, vol. 79 no. 15 1540-1547. doi: 10.1212/WNL.0b013e31826e26a6.
Abstract. Accessed 12 December 2013.
31. "Mediterranean Diet Reduces the Adverse Effect of the TCF7L2-rs7903146 Polymorphism on
Cardiovascular Risk Factors and Stroke Incidence". Dolores Corella, DPHARM, PHD et al. Diabetes Care.
doi: 10.2337/dc13-0955. August 13, 2013. Abstract.
Additional Information
Citations
doi: 10.2337/dc13-0955. August 13, 2013. Abstract.
32. "Episodic migraine and obesity and the influence of age, race, and sex" B. Lee Peterlin, DO, Andrea L.
Rosso, PhD, Michelle A. Williams, ScD, Jason R. Rosenberg, MD, Jennifer A. Haythornthwaite, PhD, Kathleen
R. Merikangas, PhD, Rebecca F. Gottesman, MD, PhD, Dale S. Bond, PhD, Jian-Ping He, MD and Alan B.
Zonderman, PhD. Neurology. doi: 10.1212/WNL.0b013e3182a824f7. August 27, 2013. Abstract. Accessed
12 December 2013.
33. "Physical Activity and Risk of Cerebrovascular Disease in the European Prospective Investigation Into
Cancer and Nutrition-Spain Study" Jos Mara Huerta, PhD; Mara-Dolores Chirlaque, MD; Mara-Jos
Tormo, PhD; Diana Gavrila, MD; Larraitz Arriola, MSc; Conchi Moreno-Iribas, MD; Pilar Amiano, PhD; Eva
Ardanaz, PhD; Aurelio Barricarte, PhD; Miren Dorronsoro, PhD; Nerea Egs, MD; Nerea Larraaga, MSc;
Esther Molina-Montes, PhD; Jos Ramn Quirs, PhD; Mara-Jos Snchez, PhD; Carlos A. Gonzlez, PhD;
Carmen Navarro, PhD. Stroke. doi: 10.1161/STROKEAHA.112.670612. December 6, 2012. Abstract.
34. "Statin therapy after first stroke reduces 10-year stroke recurrence and improves survival." Milionis HJ,
Giannopoulos S, Kosmidou M, Panoulas V, Manios E, Kyritsis AP, Elisaf MS, Vemmos K. Neurology. doi:
10.1212/WNL.0b013e3181a711cb. 2009 May 26. Abstract. Accessed 12 December 2013.
Visit our Stroke category page for the latest news on this subject.
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Nordqvist, Joseph. "What is a stroke? What causes a stroke?." Medical News Today. MediLexicon, Intl., 15 May.
2014. Web.
25 May. 2014. <http://www.medicalnewstoday.com/articles/7624>
APA
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http://www.medicalnewstoday.com/articles/7624.
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