What is a Stroke?
A stroke, sometimes referred to as a cerebrovascular accident (CVA) or brain attack, occurs when an area of the brain becomes damaged from lack of blood supply to the brain due to a blocked or ruptured blood vessel. This damage can cause lifelong disability or death. Stroke is the fifth leading cause of death in the U.S.
The Penn Stroke Center provides advanced resources for emergency stroke treatment, neurocritical care and neurorehabilitation.
The main signs of stroke include a drooping face, arm weakness and difficulty speaking. During a stroke, brain damage can occur in minutes. If you or a loved one is experiencing stroke symptoms, call 911 immediately.
Types of Stroke
There are several types of stroke. The most common is ischemic stroke, which accounts for about nine in 10 strokes. Hemorrhagic stroke is a less common but equally dangerous cerebrovascular accident.
Ischemic Stroke
Ischemic stroke occurs when a blood clot blocks an artery and prevents the blood flow to part of the brain. Without a continuous supply of blood, brain cells become damaged and die.
Blood clots can develop in the brain or travel to the brain from other locations in the body. The types of blood clots that cause ischemic stroke include:
- Cerebral thrombosis: This is a blood clot that forms in an artery in the brain. It is usually the result of the buildup of plaque inside the arteries (atherosclerosis). Over time, the plaque can completely block the artery.
- Cerebral embolism: This type of blood clot usually breaks off from plaque in the heart or large arteries in the chest and neck. The blood clot travels through the bloodstream to the brain. Eventually, the arteries become too narrow for the blood clot to pass and the clot gets stuck.
Hemorrhagic Stroke
A hemorrhagic stroke occurs when a blood vessel in the brain bursts and blood leaks into the surrounding area. The pooling blood creates pressure and injures the brain tissue.
Types of hemorrhagic stroke include:
- Intracerebral hemorrhage: The rupture happens within the brain.
- Subarachnoid hemorrhage: The hemorrhage occurs in the space between the brain and the membrane that covers the brain.
Transient Ischemic Attack (TIA)
A transient ischemic attack (TIA), also known as a "mini-stroke," is a temporary blockage. Though symptoms last less than five minutes, a TIA is a warning that you may have a major stroke in the future.
How Do You Know if Someone Is Having a Stroke?
Stroke is a life-threatening condition. Knowing the warning signs using the acronym, FAST, can help you recognize a possible cerebrovascular accident and take quick action:
- F — Face: Ask the person to smile. One side of their face may droop.
- A — Arms: Ask the person to raise both arms. One arm may drift downward.
- S — Speech: Have the person repeat a simple phrase. Listen for slurred or strange speech.
- T — Time: Call 911 right away and note the time when symptoms started. This information helps medical personnel guide treatment.
Stroke Symptoms
They early signs of a stroke appear quickly and include sudden:
- Weakness or paralysis in the face, arm or leg, especially on one side of the body
- Difficulty speaking or understanding speech
- Loss of balance or lack of coordination
- Severe headache
- Trouble seeing in one or both eyes
Symptoms of a Transient Ischemic Attack (TIA)
Signs of a TIA are like a stroke but they clear up after a few minutes. Because symptoms don’t last, many people ignore a TIA.
More than three in 10 people who have a TIA and do not receive treatment will have a major stroke within one year. That’s why it’s important to seek emergency medical care even if your symptoms go away.
What Causes a Stroke?
The causes of stroke include a range of conditions that affect your heart and blood vessels. Certain health conditions and other factors also increase your risk of a cerebrovascular accident.
Causes of Ischemic Stroke
The main causes of ischemic stroke are:
Causes of Hemorrhagic Stroke
Hemorrhagic stroke occurs when there are defects in the blood vessels in your brain. These abnormalities make it more likely the artery will rupture and bleed, especially if you have high blood pressure.
The most common causes of hemorrhagic stroke are:
- Arteriovenous malformations, tangles of arteries and veins that usually form before birth
- Brain aneurysm, a weakened area in a blood vessel that expands like a balloon
- Cerebral amyloid angiopathy, a buildup of protein in the blood vessels of the brain that makes them fragile
Health Conditions Associated With Stroke
High blood pressure is the main risk factor for stroke. The extra force inside your blood vessels can cause small tears, which turn into scar tissue when they heal. Plaque builds up on these scarred areas, leading to blockages and blood clots. High blood pressure can also cause weakened areas of your blood vessels to break open.
Other heath conditions that increase your chance of having a stroke include:
- Diabetes: People with diabetes have a higher risk of cardiovascular disease, including high blood pressure.
- High cholesterol: Cholesterol is a main component of plaque that deposits inside your arteries in atherosclerosis.
- Previous stroke or transient ischemic attack (TIA): Repeat stroke is very common.
- Sickle cell disease: In this inherited disease, red blood cells are abnormally shaped like a sickle. The cells can get stuck in a blood vessel and block blood flow. Sickle cell disease mainly affects people who are Black.
Factors That Increase Stroke Risk
There are many factors that increase your risk of stroke:
- Age: Stroke is more common among older adults but can also occur in adolescents and younger adults. One in seven strokes are in people age 15 to 49.
- Cigarette smoking and smokeless tobacco use: Smoking damages your heart and blood vessels and increases blood pressure.
- Excess alcohol use: Alcohol increases blood pressure.
- Family history: The genes you inherit from your parents, such as in sickle cell disease, may increase the risk of stroke.
- Obesity: Carrying excess weight is linked to conditions that cause stroke, including high cholesterol, high blood pressure and diabetes.
- Poor diet: A diet high in saturated fat, salt and sugar increases your risk of stroke by increasing cholesterol and blood pressure and your risk for diabetes.
- Sex: Women are more likely than men to have a stroke and to die from stroke.
- Race and ethnicity: Stroke may be more common in people who are Black, Hispanic, American Indian and Native Alaskan.
You cannot control some of these factors, such as age, race or family history. But you can lower your stroke risk related to these factors by making healthy lifestyle choices.
Diagnosing a Stroke
Your doctor will work quickly to
- Evaluate your medical history
- Identify the time your symptoms started
- Order tests
- Perform a physical exam
This assessment helps your doctor determine the type and severity of stroke and the affected area location of your brain.
Tests your doctor may order to test for a cerebrovascular accident include:
- Blood tests to check the basic functions of your body and rule out other conditions.
- Cerebral angiography, a minimally invasive test that uses a thin tube (catheter) inserted into an artery in your groin or wrist. Your doctor threads the catheter to the arteries that carry blood to your head and releases a contrast dye. X-ray images show the dye as it moves through the blood vessels and shows abnormal areas.
- Electrocardiogram (EKG) to look for heart conditions that may have caused the stroke.
- Medical imaging tests, such as X-ray, CT scan, MRI or ultrasound, to look at the blood vessels in your head and neck. At Penn Medicine, doctors use advanced imaging techniques, such as CT and MR perfusion studies, to look at the extent of damage in the brain.
Stroke Treatment at Penn Medicine
Stroke treatments vary by type and, for ischemic stroke, how much time has passed since your symptoms began. At the Penn Stroke Center, you receive personalized care from a multidisciplinary team of experts in:
Ischemic Stroke Treatment
The goal of ischemic stroke treatment is to open up the blocked blood vessel. If you arrive at the hospital within about four hours of the start of symptoms you may receive a medication that dissolves blood clots.
Endovascular thrombectomy is another option if medication is not effective or you arrive to the hospital too late. This is a minimally invasive catheter-based treatment. Your doctor inserts the catheter into an artery in your groin or wrist and advances the catheter to the blood clot in your brain. Techniques for removing the blood clot include:
- Opening the clogged area by inflating a balloon in the artery and installing a metal mesh tube called a stent to keep it open
- Suctioning out the clot through the catheter
- Trapping the clot in wire mesh and pulling it out
Typically, endovascular procedures are only effective within six hours of the start of symptoms. But Penn Medicine doctors are able to offer this procedure to some patients up to 24 hours after a stroke.
In some cases, people do not receive treatment within the 24-hour window. Generally, removal of the clot at this point is not effective and patients receive supportive care to relieve symptoms. Penn researchers are investigating whether endovascular thrombectomy can help improve outcomes after 24 hours.
Hemorrhagic Stroke Treatment
Treatment for hemorrhagic stroke includes strategies to stop the bleeding, including:
- Medications: You may receive medications to lower blood pressure, reduce inflammation in the brain and prevent brain damage. If you take a blood thinner such as warfarin, your doctor will stop the medication.
- Endovascular procedures: Minimally invasive endovascular neurosurgery procedures can repair a damaged blood vessel without a need for surgery.
- Radiation treatment: This treatment uses advanced technology, such as Gamma Knife®, to remove or shrink arteriovenous malformations.
- Surgery: This may be the best option to reduce swelling or remove pooled blood. Aneurysm clipping is a type of surgery that can repair an aneurysm permanently.
Transient Ischemic Attack Treatment
If you have a transient ischemic attack, a neurologist will evaluate your condition and take steps to reduce your risk of a major stroke. This might include lifestyle changes, medications and minimally invasive or surgical treatment. At Penn, you have access to every available option to help you manage your condition.
Neurocritical Care
After stroke treatment, patients transfer to a neurocritical care unit. Here, you receive close monitoring to quickly identify and treat and problems that may arise. Penn Medicine has one of the largest neurocritical care units in the nation.
Rehabilitation Following a Stroke
Rehabilitation helps you regain lost function from the damage to your brain. This might include problems with movement, touch, speech, memory, thinking and emotions.
You will begin rehabilitation in the hospital and continue after you go home. Some people recover from a stroke completely, while others have permanent disabilities. The Penn neurorehabilitation team offers specialized, compassionate care throughout your recovery.
Request an Appointment
To make an appointment, please call 800-789-7366 or request a callback.