Stroke: Causes, Symptoms and Treatments

What Is a Stroke?

A stroke is a sudden interruption in the blood supply of the brain. An abrupt blockage of the arteries leads to the brain (ischemic stroke) or bleeding into brain tissue when a blood vessel ruptures (hemorrhagic stroke).

A stroke is a medical emergency. When a stroke occurs, an area of the brain becomes deprived of getting oxygen and nutrients from the blood. Brain cells and brain tissues can die in minutes resulting in brain damage, disability, and death.

A stroke can occur suddenly, just like a heart attack, and needs to be treated immediately.

In Australia, 50,000 people suffer a stroke each year.

Causes of Stroke

Ischemic stroke. A blood clot hinders blood flow to the brain. Blood clots can originate from artery plaque buildup or arise from the heart. 

Hemorrhagic stroke. Rupture of an artery in or around the brain can cause a stroke. When an artery bursts, blood will leak, causing the brain to swell.

TIA. Otherwise known as a transient ischaemic attack. Unlike a significant stroke, a TIA occurs when blood flow to the brain is blocked temporarily such that no permanent damage occurs to the brain. Nevertheless, when it does happen, it must be treated urgently and thoroughly investigated.

Major Risk Factors for Stroke

According to the Australian Institute of Health and Welfare, stroke is one of the country’s biggest killers and the leading cause of disability. Each year, about 50,000 Australians have strokes.

Some risk factors are uncontrollable.

• Gender. 52% of all strokes each year occur in men, and 53% of all deaths from stroke are in men.

• Age. Almost 60% of all strokes each year are in people under 70 years, while only 8% of all strokes are in people younger than 44 years.

• Family history. An inherited predisposition for hypertension or diabetes and genetic disorders, like sickle cell disease, can lead to stroke—the chances of stroke increase when genetic factors interact with combined with unhealthy lifestyle choices.

• COVID-19. Doctors have observed that the coronavirus can cause small clots to form and hinder blood flow, which causes ischemic stroke.

Other factors associated with stroke are related to an individual’s lifestyle. Everyone can lower their risk of having a stroke by controlling their habits and improving their lifestyle.

• High blood pressure. High blood pressure gradually alters your arteries throughout the body so that they can rupture or develop plaque quickly and increase the likelihood of a stroke.

• Cigarette smoking leads to cumulative damage to the cardiovascular system, accelerating plaque formation in combination with other factors such as high cholesterol and diabetes, leading to a higher risk of stroke.

• Diabetes. People who have diabetes are 1.5x likely to have a stroke.

• High blood cholesterol levels. Excessive cholesterol in the blood means fatty deposits are likely to build up in the arteries, making it harder for blood to flow.

• Heavy drinking. Alcohol contributes to several medical conditions that are risk factors for stroke, such as high blood pressure, diabetes, overweight, irregular heartbeat, and liver damage.

• Unhealthy diet. A diet high in fat (particularly saturated) and salt but low in fibre, fruit, and vegetables increase your risk of stroke.

• Lack of regular exercise. Exercise lowers blood pressure and improves blood vessels.

• Obesity is typically associated with an increased risk of hypertension, diabetes, and high cholesterol, exacerbating an increased risk of stroke.

Signs of Stroke

Every minute’s treatment delay can mean the death of millions of brain cells until blood flow is restored. Dial 000 immediately if you or someone around you feel signs of a stroke.

To check for signs of stroke, use the life-saving FAST test:

• Face. Has their mouth drooped? Ask the person to smile and check if their smile is uneven. If they stick out their tongue, is the tongue deviated to one side?

• Arms. Are they able to lift both arms? Or does one arm drift downward? Is there a sudden loss of coordination or weakness in one or both legs, arms, or hands? Is there a numbness on the arm or leg?

• Speech. Is their speech slurred or garbled? Do they understand you? Let the person repeat something you say. Are they able to say it quickly? Do they have trouble swallowing? Does their tongue feel thick?

• Time. When any of these signs are present, call 000 immediately. When it comes to stroke, time is critical.

  
  
  

How Is Stroke Diagnosed?

If you or someone you know is showing signs of a stroke, seek medical attention immediately. Even if the symptoms have subsided without treatment, this still needs to be discussed with the attending physician. 

Once the patient gets to the hospital, the emergency care team will identify what kind of stroke the person is having. This means the patient will undergo a CT scan and a series of other exams to determine the kind of stroke the patient suffered and rule out other possible causes of the symptoms.

Some of the tests might include the following:

• Physical examination. The doctor will check the patient’s heart, pulse, blood pressure, and lungs. 

• Neurological examination. This detailed exam primarily tests speech, movement, vision, balance, and sensation.

• Blood tests. While blood tests can’t diagnose a stroke alone, they can provide information about risk factors and other medical problems that may be critical.

• CT can identify the location of artery blockage and also indicate whether the blockage is causing a significant reduction in blood flow to the brain.

• MRI. This scan is used to confirm the presence of a stroke and possibly indicate the origin of the stroke. It may also provide clues if the symptoms have been caused by another condition.

• Carotid ultrasound. With the use of ultrasound waves, this test shows the build-up of fatty deposits and blood flow in the carotid arteries in your neck. The presence of significant amounts of plaque may require a procedure or carotid surgery.

• Cerebral angiogram. A diagnostic test that uses an X-ray, where a catheter is inserted in the patient’s groin or arm and guided through the major arteries into the carotid or vertebral artery. This test shows a detailed view of arteries in your brain and neck.

• Echocardiogram. Using ultrasound waves, this procedure detects the source of clots in the heart that may have traveled from your heart to the brain and caused the stroke.

• Cardiac rhythm monitoring. Atrial fibrillation is a common heart condition that can cause an irregular heartbeat. In many of our patients, this can only be found by wearing a cardiac monitoring device such as a Holter monitor or a HeartBug.

Treatment for Stroke

A stroke is always a medical emergency. The key to a good recovery is getting to the hospital and receiving treatment fast. 

If you or someone near you is experiencing symptoms of stroke, don’t drive yourself to the hospital or ask someone to take you there. Call 000 immediately. Alert them of a possible stroke, and tell them the time the symptoms started. Emergency treatment starts on the way to the hospital. 

At the hospital, emergency care is performed. The medical team will ask about the patient’s medical history and about the time the symptoms started. 

Within 4.5 hours of the first symptoms of an ischemic stroke, a thrombolytic drug, like the tissue plasminogen activator (tPA), is administered to break up blood clots.

Another form of treatment is called endovascular clot retrieval or intra-arterial thrombectomy. First, the doctor identifies the clot through a brain scan, usually CT. Once the patient is transferred to a procedural room and is often put to sleep with general anaesthesia. A catheter is inserted into an artery in the leg and guided to the blocked blood vessel in the brain. A wire stent retrieves the blood clot to get the blood flowing to the brain once again. It is often provided together with the thrombolytic drug. 

It’s critical that the medical team identifies the underlying causes of the stroke so it can be treated to prevent another stroke.

The Effects of Stroke

How a stroke affects a patient depends primarily on the location of the obstruction, how much brain tissue is affected, and which part of the brain was affected. Remember, one side of the brain controls the opposite side of the body. So a stroke that occurred on one side of the brain will result in a complication on the opposite side of the body.

• Paralysis. Many patients suffer from a loss of movement or power in any limb or down the left or right side of the body. This has enormous implications for the functioning and most but not all patients will require some form of rehabilitation.

• Sensation loss. A common problem where patients will be unable to feel touch or other sensory perception down in a part of the body.

• Imbalance. This is common with certain types of stroke disorders in the posterior (back) part of the brain.

• Vision loss. 1 in 3 stroke survivors experience vision loss. In general, patients who had a stroke that affects the vision centres on the right hemisphere will have vision loss to the left (in both eyes). Patients who had a stroke that affects the vision centres in the left hemisphere will have vision loss to the right (in both eyes).

• Communication problems. Stroke can affect communication in different ways: 

  • Aphasia. Affects how you speak, your ability to understand what is being said, and your reading or writing skills. 

  • Dysarthria. Weakens the muscles you use to speak (tongue, lips, mouth) so you have difficulty speaking clearly. Your voice may sound slurred, strained, quiet, or slow.

How to Prevent Stroke

Studies have shown that more than 80 percent of strokes can be prevented. So below are some tips you can start doing today to lower your risk of stroke, regardless of your age, gender, or family history.

• Monitor your blood pressure. Maintain a blood pressure of less than 120/80 if possible. If needed, you will be prescribed blood pressure medicines to maintain normal blood pressure. To achieve normal blood pressure, watch your salt intake (ideally about a half teaspoon), eat foods with polyunsaturated and monounsaturated, avoid foods high in saturated fats, eat fruits and vegetables, and add grains and low-fat dairy in your diet.

• Manage your weight. Obesity can increase your odds of having a stroke. If you are overweight, work with your physical trainer or doctor to create a personal weight loss plan.

• Exercise more. Take daily walks. Join a fitness program or commit to exercising at least 30 minutes a day at home.

• Drink moderately. Have no more than one glass of alcohol a day. Once you start drinking more than two drinks per day, your risk increases.

• Quit smoking. Smoking increases the risk of artery plaque build-up and blood clot formation. Speak with your doctor on the most appropriate way for you to stop smoking. You may be advised to use nicotine pills or patches, counseling, or medicine.

• Undiagnosed medical conditions. It is common for patients to have undiagnosed high blood pressure, diabetes, high cholesterol, and other disorders that increase their risk of stroke. Seeing your GP or family doctor to have these conditions screened for is an important part of maintaining good health as you get older.

Stroke Survival Rate

Here are some statistics from credible sources regarding stroke survival rate:

• Four in 10 stroke survivors will go on to experience recurrent stroke within a decade. (Stroke Foundation)

• According to Brain Foundation, of 100 stroke patients:

  • About 30 will die in the first year after their stroke, most (15–20) within the first 30 days

  • 85% with ischaemic stroke survive

  • 50% with hemorrhagic stroke survive

  • 35 remain permanently disabled at 1 year after a stroke, 10 of whom require care in a nursing home or other long term facility

  • 35 are not disabled to the point of affecting their independence in activities of daily living; 10 will have recovered completely and 25 will not be able to do everything they could previously, but will be able to care for themselves independently.

DISCLAIMER: The information provided is designed to support, not replace, the relationship that exists between a patient or site visitor and their existing healthcare professionals.