Stroke

Most (85%) of strokes are caused by a blocked blood vessel; the other (15%) are caused by a bleeding blood vessel. This article will focus on the most common blocked type.

Strokes are caused by a blood vessel in the brain becoming blocked. Whatever brain tissue was behind that blockage starts to become injured. If blood flow is returned quickly the injured tissue can recover; like all injured things if it doesn’t get better it dies; this dead tissue is the stroke. If the blood flow returns spontaneously quick enough that brain tissue does not die we call that a TIA (transient ischemic attack) or more commonly a “mini-stroke.” All strokes in essence start as a TIA; if the blood flood returns and the patient’s symptoms resolve to normal and there is no damage seen on brain imaging (like a head CT scan but or brain MRI) we’ll call it a TIA. If we see damage on the head imaging we call it a stroke. They are both treated the same way.

Where the stroke occurs determines what symptoms the patient has. If in the language center the patient may not be able to speak, if in the balance center they are unsteady, if in the section that control movements they can’t move a body part. For the most part each side of the brain controls half the body; so strokes affect only one side.

Brain cells begin to die at the start of a stroke; for this reason, the faster someone can be treated the more brain they save and better they’ll do. A stroke is a “brain attack” with the same urgency as a “heart attack.”

When patients come to the ER soon (currently < 3 hours) after the onset of stroke symptoms doctors can decide whether or not to give a super blood thinner (think blood clot Drain-O) to break up the clot and return blood flow to the affected brain. The potency of this blood thinner means there are many reasons it cannot be safely given. Every patient must be individually evaluated and a judgement call made by the doctors if the risk of harm is less than the benefit of improving the stroke symptoms.

After this immediate time strokes are treated with a combination of blood thinners, cholesterol medications and most importantly physical and occupational therapy. Even when a stroke damages the brain it has some ability to heal; this is how people recover from a stroke.