What is a stroke?

A stroke is sometimes called a "brain attack." A stroke can injure the brain like a heart attack can injure the heart. A stroke occurs when part of the brain doesn't get the blood it needs. There are two types of stroke:

Ischemic stroke (most common type) This type of stroke happens when blood is blocked from
getting to the brain. This often happens because the artery is clogged with fatty deposits (atherosclerosis) or a blood clot.

Hemorrhagic stroke This type of stroke happens when a blood vessel in the brain bursts, and
blood bleeds into the brain. This type of stroke can be caused by an aneurysm a thin or weak spot in an artery that balloons out and can burst. Both types of stroke can cause brain cells to die. This may cause a person to lose control of their speech, movement, and memory.
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What is a mini-stroke?
A mini-stroke, also called a transient ischemic attack or (TIA), happens when, for a short time, less blood than normal gets to the brain. You may have some signs of stroke or you may not notice any signs. A mini-stroke lasts from a few minutes up to a day. Many people do not even know they have had a stroke. A mini-stroke can be a sign of a full stroke to come. If you think you are having a ministroke, call 911.
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What are the signs of a stroke?

A stroke happens fast. Most people have two or more signs. The most common signs are:

Sudden numbness or weakness of face, arm, or leg (mainly on one side of the body) Sudden trouble seeing in one or both eyes

 Sudden trouble walking, dizziness, or loss of balance Sudden confusion or trouble talking or understanding speech Sudden bad headache with no known cause
Women may have unique symptoms:

Sudden face and arm or leg pain Sudden hiccups Sudden nausea (feeling sick to your stomach) Sudden tiredness Sudden chest pain Sudden shortness of breath (feeling like you cant get enough air) Sudden pounding or racing heartbeat

Treatment

It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot. Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin. Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital. TREATMENT IN THE HOSPITAL Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.

For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding. If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

Other treatments depend on the cause of the stroke:

Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used. Other medicine may be needed to control symptoms such as high blood pressure. In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up. If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels. Surgery on the carotid artery may be needed.

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How is stroke diagnosed?

The doctor will usually start by asking the patient what happened and when the symptoms began. Then the doctor will ask the patient some questions to see if she or he is thinking clearly. The doctor also will test the patient's reflexes to see if she or he may have had any physical damage. This helps the doctor find out which tests are needed.

The doctor may order one or more of the following tests:

Imaging tests that give a picture of the brain. These include CT (computed tomography)
scanning, sometimes called CAT scans and MRI (magnetic resonance imaging) scanning. CT scans are useful for finding out if a stroke is caused by a blockage or by bleeding in the brain.

Electrical tests, such as EEG (electroencephalogram) and an evoked response test to record the
electrical impulses and sensory processes of the brain.

Blood flow tests, such as Doppler ultrasound tests, to show any changes in the blood flow to
the brain.
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What are the effects of stroke?

It depends on the type of stroke, the area of the brain where the stroke occurs, and the extent of brain injury. A mild stroke can cause little or no brain damage. A major stroke can cause severe brain damage and even death. A stroke can occur in different parts of the brain. The brain is divided into four main parts: the right hemisphere (or half), the left hemisphere (or half), the cerebellum, and the brain stem.

A stroke in the right half of the brain can cause:

Problems judging distances The stroke survivor may misjudge distances and fall or be unable
to guide her hands to pick something up.

Impaired judgment and behavior The stroke survivor may try to do things that she should not
do, such as driving a car.

Short-term memory loss The stroke survivor may be able to remember events from 30 years
ago, but not what she ate for breakfast that morning. A stroke in the left half of the brain can cause:

Speech and language problems The stroke survivor may have trouble speaking or
understanding others.

 Slow and cautious behavior The stroke survivor may need a lot of help to complete tasks. Memory problems The stroke survivor may not remember what she did ten minutes ago or she
may have a hard time learning new things. A stroke in the cerebellum, or the part of the brain that controls balance and coordination, can cause:

Abnormal reflexes of the head and upper body Balance problems Dizziness, nausea (feeling sick to your stomach), and vomiting
Strokes in the brain stem are very harmful because the brain stem controls all our body's functions that we don't have to think about, such as eye movements, breathing, hearing, speech, and swallowing. Since impulses that start in the brain must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis, or not be able to move or feel on one or both sides of the body. In many cases, a stroke weakens the muscles, making it hard to walk, eat, or dress without help. Some symptoms may improve with time and rehabilitation or therapy.

What about rehabilitation?

Rehabilitation is a very important part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn, or redefine how you live. Stroke rehabilitation is designed to help you return to independent living. Rehabilitation does not reverse the effects of a stroke. Its goals are to build your strength, capability, and confidence so you can continue your daily activities despite the effects of your stroke. Rehabilitation services may include:

Physical therapy to restore movement, balance, and coordination Occupational therapy to relearn basic skills such as bathing and dressing Speech therapy to relearn how to talk

Treatment

It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin. Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital. TREATMENT IN THE HOSPITAL Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.

For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding. If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

Other treatments depend on the cause of the stroke:

Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used. Other medicine may be needed to control symptoms such as high blood pressure. In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up. If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels. Surgery on the carotid artery may be needed.

Vascular Experts Treat Blocked Carotid Arteries Without Surgery to Prevent Stroke

A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain nerve cells will start to die. Once the brain cells die from a lack of oxygen, the part of the body that section of the brain controls is affected through paralysis, language, motor skills, or vision.
Stroke Prevalence

Stroke is third leading cause of death in United States, behind high blood pressure and cancer Every 45 seconds someone in the United States has a stroke

Every three minutes someone dies from a stroke

There Are Two Types Of Stroke

Ischemic Stroke

Strokes caused by blood clots that block the artery are ischemic (is-KEM-ik) strokes. This is the most common type, accounting for 70-80 percent of all strokes.
Hemorrhagic Stroke

When a blood vessel ruptures, it causes a bleeding or hemorrhagic (hem-o-RAJ-ik) stroke. Once the brain cells die from a lack of oxygen, the part of the body controlled by that section of the brain is affected. Strokes can cause paralysis or language, motor skills or vision difficulties.
There Are Also "Mini-Strokes"

There are also "mini-strokes" known as TIA's (transient ischemic attacks). People who have one TIA are likely to have another one. TIAs cause brief stroke symptoms that go away after a few minutes or hours. People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have a full blown stroke if left untreated. TIAs should be taken as seriously as stroke.

Stroke Symptoms

The most common symptoms of stroke are:

Sudden numbness or weakness in the face, arm and/or leg, especially on one side of the body. Sudden confusion, trouble speaking or understanding speech. Sudden trouble seeing, including double vision, blurred vision or partial blindness, in one or both eyes. Trouble walking, dizziness, loss of balance or coordination. Sudden severe, headache with no known cause.

If you experience any of these symptoms, even if they go away quickly, seek immediate emergency help. Every minute counts. Although starved of oxygen, brain tissue does not die in the minutes following a stroke. If blocked blood vessels can be opened within three to six hours, the chances of recovery are greatly improved.

Risk Factors

Obesity, high blood pressure and high cholesterol all increase the risk of stroke. These risk factors can be greatly reduced with healthy lifestyles or medication. High blood pressure puts pressure on the arteries, making them more susceptible to rupture and more prone to clot formation, which can block the artery. High cholesterol can lead to blockage in the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off and travel to the brain, causing a stroke. Obesity can cause high blood pressure and high cholesterol. Untreated atrial fibrillation causes the hearts upper chamber to beat irregularly, which allows the blood pool and clot. If a clot breaks off and enters the blood stream to the brain, a stroke will occur. Sickle cell anemia makes red blood cells less able to carry blood to the bodys tissues and organs, as well as stick to the walls of the blood vessels. These cells can block arteries to the brain, causing a stroke. Family history Smoking

Prevention and Carotid Stenting

As vascular experts, interventional radiologists treat atherosclerosis, "hardening of the arteries," throughout the body. In some patients, atherosclerosis, specifically in the carotid artery in the neck, can lead to ischemic stroke. Plaque in the carotid artery may result in a stroke by either decreasing blood flow to the brain or by breaking loose and floating into a smaller vessel, depriving a portion of the brain of blood flow. In patients at high risk of having a stroke, the narrowed section of artery may be reopened by an interventional radiologist through angioplasty and reinforced with a stent, thereby preventing the stroke from occurring. Vascular stents are typically made of woven, lasercut or welded metal that permits the device to be compressed onto a catheter and delivered directly into the hardened artery. In addition to diagnosing and treating those at risk for stroke, interventional radiologists use their expertise in imaging, angioplasty and stenting to treat those having an acute stroke. Patients can also take action to prevent strokes by:

Stop smoking Controlling high blood pressure Lowering cholesterol levels Maintaining healthy weight Exercising Utilizing appropriate medications like aspirin, prescription drugs like anticoagulants Treating carotid artery disease Treating unruptured cerebral aneurysm or arteriovenous malformation

Assessing Patients at Risk for Carotid Artery Disease and Future Stroke

Physical examination. Your doctor may be able to assess your risk for stroke during a

routine physical examination. If your physician suspects that you may be at high risk, he or she will ask if you have experienced symptoms such as numbness or muscle weakness, speech or vision difficulties, or lightheadedness. By listening to the carotid artery through a stethoscope, the doctor may hear a rushing sound, called a bruit ("brew-ee") that suggests the artery may be obstructed. Physical exam is not always accurate, however, and further tests may be ordered.

Ultrasound. A technique called doppler ultrasound that creates pictures using sound waves can determine whether there is blockage in the arteries that carry blood to the brain. Some physicians recommend ultrasound screening for those who have been diagnosed with atherosclerosis or other risk factors for carotid artery disease. In the ultrasound image shown here, the colors red and blue indicate direction of flow. Magnetic Resonance Angiography (MRA). This is a non-invasive diagnostic technique that creates an image of the arteries in the brain. A magnetic resonance (MR) scanner uses harmless but powerful magnetic fields and radio waves to create detailed images of the body's tissues.

Diagnosis

There are a number of diagnostic exams that can be performed to determine if someone has had a stroke or is at risk for having one.
When a Stroke Is Suspected

Computed tomography (CT). The first diagnostic test performed in the emergency room is usually a CT scan. CT uses computers to generate detailed pictures of the brain, and can confirm the diagnosis of stroke and tell whether the stroke is caused by a hemorrhage in the brain.
A CT scan. The area affected by stroke is purple.

Patient having an angiogram

Magnetic resonance imaging (MRI) is a diagnostic test which may be performed to identify and further localize the site of the stroke and find the source. It may be able to quickly identify the area deprived of sufficient blood flow and guide further therapy. In the MR Image, the arrow points to the area affected by a stroke.

Angiography. An angiogram is an X-ray in which a contrast agent, or dye, is injected into a vein to highlight the blood vessels. With this exam, radiologists can pinpoint the exact location of blockage or bleeding in the brain. Angiography also is used to guide thin tubes called catheters to the site of the problem and administer treatments.

Treatment

Interventional radiologists are a critical part of the stroke team in hospitals and are actively involved in creating more stroke teams across the country. Stroke teams generally consist of emergency room physicians, neurologists, and interventional radiologists. For those having a stroke, it must first be determined which kind of a stroke the patient is having so the proper treatment can be given. The interventional radiologist interprets the

non-contrast CT (computed tomography) imaging to determine if acute stroke patients are candidates for clot-busting drugs. CT is quick, inexpensive, and readily available. If the stroke is determined to be ischemic (due to a blood clot), the interventional radiologist will assess what caused the clot, such as a clogged carotid or other artery, and can correct the underlying problem to prevent future strokes from occurring.
Treatment To Dissolve Blood Clots

If the stroke is due to a blood clot, a clot-busting drug, tPA (tissue plasminogen activator) can be given intravenously to break up or reduce the size of blood clots to the brain. This technique must be performed within three hours from the onset of symptoms. When therapy cannot be initiated within three hours or when treatment with tPA during the first three hours is not sufficient to dissolve the blood clot, interventional radiologists (IR) that specialize in neurological procedures can provide intra-arterial thrombolysis treatment.

Using x-ray guidance, an IR will insert a catheter through a nick in the skin at the groin and advance it through the femoral artery in the leg all they way to the tiny arteries in the brain where they place the clot-busting drug directly on the clot or to break up the clot mechanically. When given locally this way, the tPA can be administered up to six hours after the onset of stroke symptoms. In many cases, the ambulance drivers will take a stroke victim past the three-hour window directly to the interventional radiology suite for assessment for this direct thrombolytic therapy. Often a significantly disabled stroke patient who receives this treatment can return to normal life with minimal or no after effects from the stroke. The interventional radiologist will also assess what caused the clot, such as a clogged carotid or other artery, and can correct the underlying problem to prevent future strokes from occurring. Unfortunately, many hospitals in this country do not have stroke teams that can rapidly assess patients and provide treatment within the three-hour window. Interventional radiologists are actively involved in creating more stroke teams across the country. Stroke teams generally consist of emergency room physicians, neurologists and interventional radiologists.

Before tPa therapy

After tPa therapy

Treatment for Hemorrhagic Stroke

Interventional neuroradiologists can also treat ruptured aneurysms inside the brain causing hemorrhage into the subarachnoid space, which can cause stroke or death. During the embolization technique, an interventional neuroradiologists inserts a catheter through a nick in the skin of the groin and advances it to the site of the ruptured blood vessel. An embolizing agent (a substance that clots or closes off the bleeding blood vessel) is injected under X-ray guidance. Most commonly, tiny metal coils are used to embolize and block the abnormal blood vessel or aneurysm. The catheter is withdrawn and the coils remain to provide the occlusion. The same technique can be used to treat aneurysms and AVMs before they rupture. Surgery had been the primary treatment available until the platinum coil device was approved by the FDA in 1995.