Types of Stroke and Symptoms

Cerebrovascular disorders include a wide range of conditions that affect blood flow in your brain. These can cause a reduction in blood flow to the brain or bleeding in a specific area of the brain. This group of disorders includes brain aneurysms, brain bleed, carotid artery disease and transient ischemic attack (mini stroke.) Among the most common forms of cerebrovascular disease are stroke (ischemic and hemorrhagic) and carotid stenosis.

Ischemic strokes: These occur when something blocks the flow of blood to your brain. Common causes include clots that form in the brain or fragments of clots from elsewhere in the body. These account for 80 percent of all strokes.

Hemorrhagic strokes: These occur because of bleeding in or around your brain. A common cause is the tearing or bursting of a blood vessel inside your brain.

Symptoms can vary, based on what part of the brain is being affected by the blockage or bleeding. Symptoms include:

• Paralysis or weakness on one side of your body
• Difficulty speaking
• Slurred speech
• Losing muscle control on one side of your face
• Suddenly losing one or more of your five senses
• Blurred vision
• Sudden clumsiness
• Dizziness
• Nausea and vomiting
• Sudden personality change
• Confusion or agitation
• Seizures
• Memory loss
• Sudden and severe headache

Carotid stenosis: This slow-developing disease often has no symptoms during the early stages. Unfortunately, the condition often is found only after an ischemic stroke, in which pieces of accumulated plaque break loose and cut off blood flow to an area of the brain. In many instances this may be preceded by a transient ischemic attack (mini stroke), where the blockage lasts only a few minutes. Symptoms of carotid stenosis include:

• Paralysis or weakness on one side of your body
• Vision problems in one eye
• Losing muscle control on one side of your face
• Difficulty speaking
• Slurred speech
• Nausea and vomiting
• Sudden personality change
• Confusion or agitation
• Seizures
• Memory loss

It is important to note that some symptoms can point to the general location of the stenosis. A blockage on the left side, for example, may create vision, muscle and limb problems on the right side of your body and vice versa.

Diagnosis

Symptoms of cerebrovascular disorders can mimic many other conditions, making it critical that you work with the right team to accurately diagnose your condition and get you on the path to treatment.

You should quickly seek medical help if you or someone you know is exhibiting stroke symptoms. Stroke is the fifth-leading cause of death in the U.S. and the leading cause of disability worldwide. Getting help sooner will increase the chances of a more positive outcome.

Diagnosis starts with a neurological examination where you doctor will ask you to answer a series of questions and perform a few tasks. This will help determine if there is a problem with how your brain is working. From there, possible tests include:

• Magnetic resonance imaging (MRI): Powerful magnets and radio waves are used to create detailed images of your head and neck.
• Computed tomography (CT) scan: These scanners use multiple X-ray images compiled with the help of a computer to create highly detailed 3D images of your head and neck. A dye may be injected into your bloodstream to highlight blockages.
• Blood tests: These tests look for a range of contributing factors, including signs of infection, clotting ability, blood sugar, and kidney and liver function.
• Electrocardiogram (EKG): This test can be used to rule out heart problems.
• Electroencephalogram (EEG): The test can rule out seizures.
• Carotid ultrasound: Soundwaves are used to create detailed images of the carotid arteries in the neck. It can reveal the presence of fatty deposits, which can restrict blood flow.
• Cerebral angiography: A thin, flexible tube is inserted through the groin and guided through major arteries. A dye, injected into blood vessels, helps X-ray imaging provide a detailed view of the arteries in the neck and brain.

Treatment

The treatment approach will vary, based on your diagnosis and unique needs. For an ischemic stroke, for example, the priority is to restore blood flow. If this can be done soon enough, permanent damage may be avoided or reduced in severity. With hemorrhagic strokes, the emphasis generally is on reducing the bleeding and improving your blood’s clotting ability. With carotid stenosis, the goal is to remove the blockage before it causes additional problems.

Treatments often involve a combination of options, including medications and lifestyle changes to slow the accumulation of fatty deposits and to keep your blood pressure and cholesterol under control. If you have experienced a stroke, you will likely need rehabilitation to regain abilities or learn new ways to accomplish day-to-day tasks.

Among the nonsurgical treatment and rehabilitation options:

• Thrombolytic drugs: These drugs are designed to dissolve blood clots. They can be effective if administered within four and a half hours after stroke symptoms start.
• Mechanical thrombectomy: A tube-like catheter is inserted into a major blood vessel and guided to the site of a clot. The catheter has a tip on the end that removes the clot. The procedure can be effective within 24 hours of the start of symptoms.
• Blood pressure control: Hemorrhagic strokes are often caused by high blood pressure. So getting that pressure under control can be critical to limiting bleeding and making it easier for the damaged blood vessel to clot and seal.
• Clotting support: This is another treatment common for hemorrhagic strokes. Infusions of medications or blood factors that increase clotting ability can help control bleeding.
• Speech therapy: You may need help regaining language and speaking skills. This also includes the muscles you use to eat, drink and breathe.
• Physical therapy: Your therapist will help you strengthen or relearn the ability to use your hands, feet, arms and legs. This could include your ability to walk and maintain balance.
• Occupational therapy: These sessions will focus on the activities of daily life, including getting dressed, preparing a meal and using a computer.
• Cognitive therapy: Your therapist will work with you on memory issues and activities requiring focus and concentration.

In some instances, your team may recommend surgery.

Surgical options include: