Our brains need a constant supply of healthy, oxygen-rich blood. If blood cannot flow freely into your brain or if there is bleeding inside your brain, you can experience a stroke.
Strokes are dangerous because cutting off blood to any part of the brain causes brain cells to die or become damaged. Without its cells, the brain cannot keep our bodies functioning properly. For example, if brain cells die in the area of your brain that controls speech, you may have difficulty speaking.
Stroke is a serious condition that always requires immediate, emergency care. The faster you receive treatment for a stroke, the more likely you are to recover from its effects.
Types of Stroke
There are 2 primary types of strokes:
This type of stroke occurs when a blood clot, or obstruction, in an artery prevents blood from flowing to the brain. This is the more common form of stroke; nearly 87 percent of all strokes are ischemic strokes.
The underlying condition for this type of obstruction is atherosclerosis - the development of fatty deposits lining the vessel walls.
This type of stroke occurs when a blood vessel inside the brain bursts or leaks. The blood can put pressure on the brain, which can damage brain cells. The 2 types of hemorrhagic strokes are intracerebral hemorrhage and subarachnoid hemorrhage.
Hemorrhagic stroke accounts for about 13 percent of stroke cases but tends to have a higher mortality rate than ischemic stroke.
Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).
Transient Ischemic Attack (TIA)
A mini-stroke, also called a transient ischemic attack (TIA), occurs when blood flow to the brain suddenly stops for a short time, causing stroke-like symptoms. These symptoms can last anywhere from a few minutes up to 2 hours.
Like any other stroke, a TIA requires immediate emergency care. Having a TIA puts you at greater risk of experiencing a full-blown stroke.
Time is of the essence in treating stroke. You should immediately call 911 if you have any of the warning signs of stroke:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
FAST is a diagnostic acronym to spot the symptoms of a stroke. If you think someone is having a stroke, you should:
F: FACE. Ask the person to smile. Check to see if one side of the face droops.
A: ARMS. Ask the person to raise both arms. See if one arm drifts downward.
S: SPEECH. Ask the person to repeat a simple sentence. Check to see if words are slurred and if the sentence is repeated correctly.
T: TIME. If a person shows any of these symptoms, time is essential. It is important to get to the hospital as quickly as possible. Call 911. Act FAST.
Stroke Risk Factors
On average, someone in the United States has a stroke every 40 seconds. While age is the major risk factor, people who have a stroke are likely to have more than 1 risk factor which may include:
- Heart and vascular diseases such as
- High blood pressure
- High cholesterol
- Coronary artery disease
- Peripheral artery disease
- Atrial fibrillation
- Carotid artery disease
- Obesity and metabolic syndrome
- Alcohol and drug abuse
- Prior stroke or TIA
- Prior heart attack
- Sleep apnea
Although some of these risk factors are beyond our control, others are influenced by lifestyle. High blood pressure (hypertension) contributes to about 70 percent of all strokes. Learn ways to reduce your risk of stroke.
You may also want to know your own stroke risk factors—visit the Ward A. Riley Ultrasound Center for more information on how our health care practitioners can assess that risk.
A diagnostic work-up for stroke includes physical and neurological examinations, patient's medical history, blood tests and imaging tests. Many of the same procedures, such as ultrasound testing, are used to diagnose a stroke and to evaluate the risk of future major stroke in patients who have had a transient ischemic attack (TIA).
The key to treating strokes effectively is to act quickly using the most advanced technologies and procedures. As a Comprehensive Stroke Center, Wake Forest Baptist uses a multidisciplinary approach to stroke treatment that combines the expertise of specialists in neurosurgery, interventional radiology, emergency medicine, neuro-intensive care and neurology.
For patients who have suffered a major stroke, the first step is to determine as quickly as possible whether the stroke is ischemic or hemorrhagic.
Ischemic Stroke Treatment
Ischemic strokes and TIAs occur when a blood clot forms in an artery that supplies blood to the brain. To treat, the clot needs to be removed or dissolved and new ones need to be prevented from developing.
We do this with special medications, including blood thinners and anti-coagulants, as well as with surgical procedures.
Ischemic Stroke Treatment: Medications
Tissue Plasminogen Activator (tPA) is a medication injected into the bloodstream that dissolves blood clots in the arteries that supply blood to the brain. It’s a lot like a liquid clog remover that unclogs stopped-up drain pipes. Only instead of plumbing pipes, it works on arteries.
TPA is effective for ischemic stroke patients who receive it within a few hours of their ischemic stroke and who do not have any additional bleeding.
There are 2 ways to administer tPA:
- Intravenous tPA – You receive tPA through an intravenous (IV) line that injects the medication into your bloodstream. It then travels to the site of the blood clot, locks onto the clot, and breaks it up or dissolves it. This method needs to be administered within 3 hours after the stroke.
- Intrarterial tPA – In this method a thin tube is threaded through an artery in your groin area directly to the blood clot. TPA is administered directly to the blood clot to break it up or dissolve it. This method is faster at attacking the blood clot than intravenous tPA, and so can still be effective up to 6 hours after a stroke.
Ischemic Stroke Treatment: Surgical Procedures
TPA may not work for all patients, especially for those who arrive too late for treatment with medication. At Wake Forest Baptist, our specialists are trained in using highly advanced surgical methods to remove blood clots. Using a combination of imaging technology and devices, our ischemic strokes team can surgically take out or break up blood clots in the arteries. These procedures include:
- Merci retrieval device – With this tiny corkscrew shaped device, the surgeon can go from the patient’s groin to the clot in the artery in the head. By engaging the clot in the corkscrew, the surgeon can pull it out and restore blood flow to the brain.
- Solitaire™ FR – Guided through the patient's groin up to the brain with very tiny tubes (catheters), the Solitaire device restores blood flow to the brain by mechanically removing stroke-inducing blood clots. Wake Forest Baptist was the first hospital in North Carolina to use the device.
- Penumbra aspiration device – Using the same route to the brain—from the groin to the artery in the head—this tiny catheter is placed in the clot blocking the artery and is suctioned out. This opens the artery up again.
- Intracranial angioplasty and stenting – This minimally invasive ischemic strokes procedure can open up narrowed or blocked arteries that supply blood to the brain. The procedure helps blood flow more freely. Using imaging technology, our team will insert a thin tube into the groin area and guide it to the targeted artery. In the angioplasty procedure, the team will insert a tiny balloon into the artery to slowly widen it. In some cases, the team will also insert a stent into the artery. A stent is a small mesh tube that helps prevent arteries from becoming blocked again.
- Extra-cranial-Intra-cranial (EC-IC) bypass – This is a surgical procedure that helps improve blood flow to the brain by connecting a healthy artery in the scalp to the area of the brain that needs a better supply of blood. Wake Forest Baptist is the only hospital in the area to offer this rare procedure.
Hemorrhagic Stroke Treatment
A hemorrhagic stroke occurs when a blood vessel inside the brain bursts or leaks. The first step in treating a hemorrhagic stroke is determining the source of the leak. Common sources of a hemorrhagic stroke include aneurysm and arteriovenous malformations (AVM). Once the source has been identified, our stroke experts will determine the appropriate treatment method.
Managing Brain Swelling With Decompressive Hemicraniectomy
In some cases, a stroke can cause the brain to swell and push up against the skull, causing an increase in pressure in the skull. This is called elevated intracranial pressure, and it can cause significant brain damage, or even death. The stroke team at Wake Forest Baptist is skilled at reducing brain swelling and intracranial pressure using a surgical procedure called decompressive hemicraniectomy.
During the procedure, surgeons remove a significant portion of the skull to allow the brain to swell as much as possible. The brain returns to normal size before the surgeons replace the removed piece of skull.
Most people who survive a stroke will have some type of disability. But many people are able to make significant improvements through rehabilitation. For the best chance of improvement and regaining abilities, it is important that rehabilitation starts as soon as possible after a stroke.
At the Comprehensive Stroke Center, throughout your treatment and recovery period you will have access to our stroke rehabilitation services. Our stroke rehabilitation team includes:
- Physical therapists
- Occupational therapists
- Speech therapists
- Recreation therapists
- Stroke rehabilitation nurses certified in rehabilitation nursing
- Clinical psychologists
- Social workers
- Case managers
- Assistive technology specialists
The J. Paul Sticht Center for Rehabilitation offers world-class post-stroke in-patient rehabilitation. For the past 15 years, our Center has continually earned accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF), an international review board. This designation certifies that our rehabilitation, brain injury and stroke rehab specialty programs are of the highest quality and are measurable and accountable.