How Can You Recognize the Different Types of Stroke?

Every 40 seconds, someone in the United States experiences a stroke.

In observance of National Stroke Awareness Month, Neurology specialist Ryan Moorhouse, D.O., a physician with Lee Physician Group Neurology, shares some information about the different types of strokes, their treatments, and rehabilitation.

What is a stroke?

A stroke occurs when a blood vessel bringing blood to the brain gets blocked or ruptures (bursts). When brain cells are deprived of oxygen-rich blood, they begin to die and lose their functions. Without oxygen, nerve cells can’t function.

Dr. Moorhouse explains: “The part of the brain affected by a stroke determines the secondary effects that occur. For example, if a stroke affects the part of the brain that regulates sensation, the person may experience an impaired sensation like numbness."

Dr. Moorhouse adds it’s important you note the time when the symptoms first appear. This information can assist healthcare providers in determining the best treatment for each person. Also, call an ambulance instead of driving yourself (if you’re seeing stroke symptoms in yourself) or the possible stroke victim to the hospital so medical personnel can begin life-saving treatment on the way to the emergency room.

READ: Act F.A.S.T. at Signs of a Stroke. Acting fast can save a life—maybe even yours.

Types of stroke

Ischemic stroke. Most strokes are ischemic strokes. An ischemic stroke occurs when blood clots or other particles block the blood vessels to the brain. According to the Centers for Disease Control and Prevention (CDC), fatty deposits called plaque can also cause blockages by building up in the blood vessels.

Hemorrhagic stroke. Hemorrhagic strokes, which are less common than ischemic strokes, happen when an artery in the brain leaks or bursts. Large arteries in the brain or small blood vessels deep within the brain may be affected. The rupture keeps the surrounding areas of the brain from getting needed oxygen.

High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

Transient ischemic attacks (TIAs).  Often called “warning strokes,” TIAs hint at a future stroke. These “wake-up calls” produce symptoms just like a major stroke, but they are shorter in duration. A TIA is a medical emergency, just like a major stroke. Here’s what the CDC advises about TIAs:

• Strokes and TIAs require emergency care. Call 9-1-1 immediately if you feel signs of a stroke or see symptoms in someone around you.
• There’s no way to know in the beginning whether symptoms are from a TIA or a major type of stroke. That’s why you need to call 9-1-1 right away.
• Like ischemic strokes, blood clots often cause TIAs.
• More than 33 percent of people who have a TIA and don’t get treatment have a major stroke within one year. As many as 10 percent to 15 percent of people will have a major stroke within three months of a TIA.
• Recognizing and treating TIAs can lower the risk of a major stroke. If you have a TIA, your heatlhcare team can find the cause and take steps to prevent a major stroke.

Treating ischemic stroke

If medical personnel can treat you within three hours of the first symptoms of an ischemic stroke, you’ll likely get “clot-busting” drugs called thrombolytics. These medications break up blood clots that keep oxygen from reaching your vital organs. Thrombolytics are the gold standard for improving a patient’s chances of recovering from a stroke.

Doctors may also treat ischemic stroke with other medicines, such as blood thinners.

Nonmedication treatments include an endovascular procedure called a mechanical thrombectomy. “In this procedure, a surgeon inserts a wire-caged device through a catheter inserted in the groin to the site of the blocked blood vessel in the brain,” Dr. Moorhouse explains. “The stent then opens and grabs the clot, allowing the doctor to remove the stent along with the trapped clot.”

Treating hemorrhagic stroke

Treatment for hemorrhagic stroke depends on the location and severity of the bleeding. Dr. Moorhouse says lowering blood pressure is often key because it reduces the amount of bleeding and makes it easier for the damaged blood vessel to seal.

Medicine, surgery, or other procedures to stop the bleeding and save brain tissue can include:

1. Endovascular procedure. A tiny, flexible tube called a catheter is passed into the femoral artery, a large blood vessel. The surgeon gently moves it all the way up to the blood vessels in the brain, where a coil or clip is placed to prevent further bleeding.
2. Surgical clipping. If a ruptured aneurysm has caused the bleeding, a metal clip may be placed to stop the blood loss.

READ: How Lee Health saved a patient from an unknown "time bomb,' or aneurysm

3. Arteriovenous malformation (AVM) surgery. AVMs are abnormal, snarled tangles of blood vessels that prevent normal oxygen delivery to vital brain tissue, which can result in symptoms of bleeding and rupture. If the AVM is in an accessible area of the brain, a surgeon may remove it to eliminate the risk of rupture.
4. Stereotactic radiosurgery. This minimally invasive technique uses highly focused radiation to repair vascular malformations.

Treat the underlying causes of your stroke: It’s important

Dr. Moorhouse says if you’ve already had a stroke, you’re at high risk for another one.

“One-in-four stroke survivors have another stroke within five years,” he says. “In fact, the risk of stroke within 90 days of a TIA may be as high as 17 percent, with the greatest risk during the first week.”

You and your doctor should discuss how to treat the underlying causes of stroke, Dr. Moorhouse advises. “These causes can include heart disease, high blood pressure, atrial fibrillation (fast, irregular heartbeat), high cholesterol, and diabetes,” he notes. “Your doctor may give you medications or urge you to modify your diet, exercise more, or adopt other healthy lifestyle habits.”

Recovering from stroke: stroke rehabilitation

Rehabilitation after a stroke begins in the hospital, often within a day or two after it. Rehab helps ease the transition from hospital to home and can help prevent another stroke.

“The recovery time after a stroke is different for everyone,” Dr. Moorhouse says. “It can take weeks, months, or even years. Some people recover fully, but others have long-term or lifelong disabilities.”

Participating in rehabilitative therapy helps you recover as quickly as possible. Typically, stroke patients require rehabilitation to regain their strength in the affected area of the body and motor skills, as well as relearn daily tasks, like eating and getting dressed. Some stroke patients also may need to relearn how to speak or swallow.

WATCH Health Matters: Stroke Recovery

Lee Health offers two certified Primary Stroke Centers and a Comprehensive Stroke Center where patients receive care from a specially trained staff nationally recognized by the American Heart Association/American Stroke Association:

• Cape Coral Hospital – Primary Stroke Center
• Lee Memorial Hospital – Primary Stroke Center
• Gulf Coast Medical Center – Comprehensive Stroke Center