Stroke

Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability.

Cedars-Sinai's Stroke Program is certified as a Primary Stroke Center by The Joint Commission the foremost accrediting body in healthcare in the United States. The Cedars-Sinai Stroke Program is dedicated to preventing, diagnosing and treating strokes, offering expertise and leading-edge technology.
 

Symptoms

General symptoms of a stroke include sudden onset of:

  • Numbness, weakness or inability to move (paralysis) of the face, arm and/or leg, especially on one side of the body
  • Trouble seeing in one or both eyes, such as dimness, blurring, double vision or loss of vision
  • Confusion, trouble speaking or understanding
  • Trouble walking, dizziness or loss of balance or coordination
  • Severe headache with no known cause

Symptoms of a stroke may worsen gradually within minutes, hours or days. Often they unfold in a step-by-step fashion, such as mild weakness that changes suddenly to an inability to move an arm and leg on one side of the body.

  • If a stroke is caused by a large blood clot or bleeding, symptoms occur within seconds.
  • When an artery is already narrowed or blocked, stroke symptoms usually develop gradually within minutes to hours or, rarely, days.
  • If several small strokes occur over time, the person may have a change in thinking, behavior, balance or walking.

A person having symptoms of a stroke needs immediate emergency care, just as if he or she were having a heart attack. The sooner medical treatment begins, the greater the chance fewer brain cells may be damaged.

One or more mini-strokes, called transient ischemic attacks (TIAs), may occur before a person has a stroke. Symptoms for both are similar. However, unlike stroke symptoms, TIA symptoms disappear within minutes (usually 10 to 20) up to 24 hours. A TIA is a warning signal that a stroke may occur, and the condition needs to be treated as an emergency.

Causes

There are two main types of stroke:

  • Ischemic stroke occurs when blood flow through a blood vessel (artery) that supplies blood to the brain is blocked. Blockage may develop from a blood clot in an artery leading to the brain (thrombus) or one formed in another part of the body, usually the heart (embolus). The clot travels with the blood until it blocks an artery to the brain. These blood clots usually are the result of irregular heart beat, heart valve problems, infection of the heart muscle, hardening of the arteries, blood-clotting disorders, inflammation of the blood vessels or heart attack. A less common cause of ischemic stroke occurs when blood pressure becomes too low (hypotension), reducing blood flow to the brain. This usually occurs with narrowed or diseased arteries. Low blood pressure can result from a heart attack, a large loss of blood or a severe infection. Each of these conditions affects the flow of blood through the heart and blood vessels and increases the risk of stroke. Additionally, surgery to correct narrowed or blocked arteries in the neck may sometimes cause a stroke.
  • Hemorrhagic stroke is caused by sudden bleeding from a blood vessel inside the brain (cerebral hemorrhage) or in the spaces around the brain (subarachnoid hemorrhage). Sudden bleeding may result from the bursting of a blood vessel that has stretched and thinned (aneurysm). The most common cause of bleeding inside the brain is high blood pressure. Uncommon causes of hemorrhagic stroke include inflamed blood vessels, which may develop from syphilis or tuberculosis, blood-clotting disorders, head or neck injuries, radiation treatment for cancer or cerebral amyloid angiopathy. Amyloid angiopathy occurs when a protein substance builds up and weakens the blood vessels in the brain, causing bleeding and a stroke.

Diagnosis

Diagnosis of a stroke is based on the patient's medical history and a physical exam. A variety of diagnostic tests for stroke are available through the Cedars-Sinai Stroke Program. If stroke is suspected, the physician will order an MRI or computed tomography (CT) scan to find out whether the stroke was caused by a clot or from bleeding inside the brain. Additional tests may be done depending on the scan results. If disease or narrowing of one of the large arteries in the neck (carotid arteries) is suspected, the following tests may be done:

  • Ultrasound of the carotid artery
  • Magnetic resonance angiography (MRA) scan to show the flow of blood through the blood vessels
  • Carotid arteriography (injecting radioactive material into the bloodstream) to show specific arteries

If evidence shows that the stroke is caused by a clot that formed in the heart, the doctor may order a chest X-ray, echocardiograph (ECG or EKG) or other heart imaging test. Other laboratory tests may be done to see if other conditions are present, check overall health and see if the blood clots too easily.

Treatment

It is critical for people who have symptoms of a stroke to seek emergency medical care. Prompt medical attention may prevent life-threatening complications and more widespread brain damage. If emergency treatment is sought within the first one to two hours after symptoms begin, some people with a stroke caused by a blood clot may be able to receive a medication to dissolve the clot and increase the chance of recovery.

Treatment may include medication or surgery and is based on the type of stroke and the seriousness of the symptoms.

Cedars-Sinai is utilizing the latest surgical techniques for removing blood clots. For more information on surgical options for stroke, please visit the Cedars-Sinai Neurovascular Center.

For an appointment, a second opinion or more information, please call 1-800-CEDARS-1 (1-800-233-2771) or email us at neurologicaldisorders@cshs.org.