Stroke: Causes, Symptoms, and Treatment

Stroke occurs when blood flow to your brain is interrupted or when a blood vessel bursts and bleeds. This condition, also known as “paralysis” among the public, causes brain cells to be deprived of oxygen and become damaged, leading to loss of function in the affected area of the body. Stroke manifests with sudden-onset symptoms, and its most important feature is that the intervention time is of vital importance. The earlier treatment begins, the lower the risk of permanent damage.

Stroke is usually seen in individuals with risk factors such as high blood pressure, diabetes, high cholesterol, and heart diseases. Sudden-onset symptoms such as facial drooping, arm weakness, and speech difficulty are harbingers of an emergency. In this article, we will comprehensively discuss what stroke is, its types, causes, symptoms, who gets it, diagnosis and treatment methods, prevention ways, and most importantly, when you should see a doctor.

What is Stroke?

Stroke is the sudden interruption of blood flow to your brain or the formation of bleeding in the brain. Brain cells need oxygen and nutrients to survive, and these needs are met through blood. When blood flow is interrupted, brain cells begin to die within minutes.

Although your brain makes up 2% of your body, it uses 20% of the blood pumped by the heart. Thanks to this intense blood flow, brain cells continuously receive oxygen and glucose. When blood flow is interrupted, cells suffer irreversible damage within 3-4 minutes.

You may experience different function losses depending on the affected area of your brain. Strokes in the left brain hemisphere usually affect speech and language functions. Strokes in the right brain hemisphere can disrupt spatial perception and attention functions.

What are the Types of Stroke?

There are two main types of stroke, and each has different causes and treatments. Ischemic stroke, the most common type of stroke, occurs when a blood clot blocks a brain vessel. Hemorrhagic stroke, which is rarer and more dangerous, occurs when a vessel in the brain bursts and bleeds. The symptoms of these two types can be similar, so making the correct diagnosis is of vital importance.

Let’s get to know the main types of stroke more closely:

Ischemic Stroke (Occlusive Stroke):

Ischemic stroke is a type of stroke that develops when a vessel going to a part of the brain is blocked by a clot. It accounts for approximately 80-85% of all strokes. This blockage prevents adequate oxygen from reaching brain tissue. Ischemic stroke is divided into two types. In thrombotic ischemia, the clot forms inside the vessel. In embolic ischemia, the clot breaks off from another source and blocks the brain vessel. Heart diseases and plaques in neck vessels can lead to this condition.

Hemorrhagic Stroke (Bleeding Stroke):

Hemorrhagic stroke is a type of stroke that occurs when a brain vessel tears and blood leaks into the brain. It accounts for approximately 15-20% of all strokes. Bleeding can be directly into brain tissue (intracerebral) or leak between brain membranes (subarachnoid). The bleeding vessel causes damage by pressing on surrounding brain tissue and usually presents with sudden, severe symptoms.

Transient Ischemic Attack (TIA):

This is a short-lasting condition that does not cause permanent damage, also known as a “mini stroke.” It occurs due to temporary reduction in blood flow to the brain. Although it does not leave permanent damage, it is a serious warning for a major stroke that may develop in the future and should not be neglected.

Cryptogenic Stroke:

Cryptogenic stroke is a type of stroke whose cause cannot be fully determined. Despite all examinations, no clear underlying cause can be found. In these patients, hidden heart diseases, rhythm disorders, or temporary clot sources are often investigated. Strokes of unknown cause account for approximately one-quarter of all cases.

What Causes Stroke?

The most important cause of stroke is cardiovascular diseases. High blood pressure is the biggest risk factor and continuously damages vessel walls, preparing the ground for both clot formation and bleeding. Diabetes, high cholesterol, and heart rhythm disorders (atrial fibrillation) also significantly increase stroke risk. In addition to these diseases, smoking, obesity, and sedentary lifestyle are also major risk factors for stroke.

Let’s examine the main causes of stroke in more detail:

High Blood Pressure (Hypertension)

Uncontrolled high blood pressure is the most important cause for both ischemic and hemorrhagic stroke.

Heart Diseases

• Atrial Fibrillation (AFib): Irregular beating of the heart can cause clot formation in the heart. These clots can go to the brain and lead to ischemic stroke.
• Heart Failure and Valve Diseases: The heart’s inability to pump blood adequately also increases the risk of clot formation.

Atherosclerosis

Plaques forming in heart and neck vessels can rupture, causing blood clot formation, and this clot can block brain vessels.

Diabetes

High blood sugar levels damage vessel walls and increase stroke risk.

Smoking

Chemicals in cigarettes damage vessel walls and increase the blood’s tendency to clot.

High Cholesterol

High levels of “bad cholesterol” (LDL) in the blood accelerate atherosclerosis.

Obesity and Sedentary Life

These conditions trigger other stroke risk factors such as high blood pressure and diabetes.

What are the Symptoms of Stroke?

Stroke symptoms usually start suddenly, and their most important feature is that they appear abruptly. The most common symptoms are drooping on one side of the face, weakness or numbness in arm and/or leg, and speech difficulty. These symptoms can be seen alone or several together.

Let’s examine the most common symptoms of stroke in detail:

• Facial Drooping: When the patient smiles, one side of the face may droop downward or become numb.
• Arm Weakness: One arm may not be able to be lifted or may become weak.
• Speech Difficulty: Speech may become incomprehensible, there may be slurring, or difficulty finding words may be experienced.
• Vision Loss: Sudden onset vision loss in one or both eyes may occur.
• Loss of Balance: Dizziness, difficulty maintaining balance, or walking difficulty may be seen.
• Severe Headache: Usually seen in hemorrhagic stroke, a sudden and very severe headache of unknown cause may be felt.

Who Gets Stroke?

Stroke risk increases with age but can also be seen in young people. Individuals with chronic conditions such as high blood pressure, diabetes, and heart diseases, which are the biggest risk factors, are at the highest risk for stroke. Smokers, those with obesity problems, and those with a family history of stroke are also groups with a higher likelihood of developing stroke.

How is Stroke Diagnosed?

Stroke diagnosis begins with a rapid evaluation in the emergency room when symptoms are suspected. Your doctor checks stroke symptoms with physical examination and neurological tests. Brain imaging methods are used to determine the type of stroke and which part of the brain is affected. These tests help us understand the difference between ischemic and hemorrhagic stroke and help us create the correct treatment plan.

The main methods used in stroke diagnosis are:

• Physical and Neurological Examination: Your doctor evaluates facial movements, arm and leg strength, balance, and speech ability.
• Computed Tomography (CT): This imaging method is the most commonly used tool to quickly detect brain bleeding (hemorrhagic stroke).
• Magnetic Resonance (MR) Imaging: Shows the extent and location of brain damage in more detail and can detect ischemic stroke at an earlier stage.
• Neck Vessel Ultrasound (Carotid Doppler): This ultrasound test is used to see possible narrowings or plaques in the main vessels in the neck (carotid arteries).
• Echocardiogram (Heart Ultrasound): Performed to detect clot formation in the heart or other heart diseases.
• Blood Tests: Performed to evaluate factors such as clotting, blood sugar, and cholesterol levels.

How is Stroke Treated?

Stroke treatment is determined according to the type of stroke, the time elapsed since symptom onset, and the patient’s general health condition. Emergency and rapid intervention in stroke is critically important to minimize brain damage. The main goal of treatment is to restore blood flow as quickly as possible or stop bleeding.

The methods applied in stroke treatment are:

Ischemic Stroke Treatment:

• Thrombolytic Treatment (Clot-Dissolving Drug): Within the first 4.5 hours after symptom onset, medication (tPA) is given intravenously. This drug aims to restore blood flow by dissolving the clot.
• Mechanical Thrombectomy: Within the first 6-24 hours after symptom onset, large clots in brain vessels are removed using a special catheter with an angiography-like method. This method can be preferred when drug treatment is not effective.

Hemorrhagic Stroke Treatment:

• Blood Pressure Control: Lowering blood pressure is very important to stop bleeding and reduce pressure in the brain.
• Surgical Intervention: A surgical operation may be necessary to drain blood on the brain or repair the ruptured vessel.

Rehabilitation

A comprehensive rehabilitation program is implemented to minimize post-stroke damage and regain functions. This program includes areas such as physical therapy, speech therapy, and occupational therapy.

What are the Risks and Complications of Stroke?

Stroke is a serious condition that can lead to permanent disabilities and be life-threatening. The most common complications include paralysis, speech difficulty, and memory loss. Post-stroke depression, anxiety, and swallowing difficulty are also frequently encountered problems. The severity of these complications depends on the severity of the stroke and which part of the brain is affected.

The main complications that stroke can cause are:

• Permanent Paralysis and Weakness: This is the most obvious consequence of stroke. Permanent loss of strength may occur on one side of the body or in one limb.
• Speech and Language Problems: With the language center of the brain being affected, conditions such as difficulty finding words, speech difficulty (aphasia), or incomprehensible speech may be experienced.
• Swallowing Difficulty (Dysphagia): Difficulty eating and drinking may be seen due to weakening of swallowing muscles.
• Memory and Thinking Problems: Deterioration in concentration, memory, or decision-making ability may occur.
• Emotional Changes: Post-stroke depression, anxiety, sudden mood changes, or uncontrolled emotional reactions may appear.

What are the Ways to Prevent Stroke?

The most effective treatment for stroke is preventing the disease from occurring. To reduce your stroke risk, you should make lifestyle changes and manage your underlying chronic diseases. Healthy nutrition, regular exercise, quitting smoking, and limiting alcohol consumption significantly reduce stroke risk. Regularly checking your blood pressure, cholesterol, and blood sugar is also of vital importance.

What you can do to reduce stroke risk:

• Keep Blood Pressure Under Control: Have your blood pressure measured regularly and use the medications recommended by your doctor regularly.
• Manage Diabetes: Follow your doctor’s recommendations to keep your blood sugar level balanced.
• Lower Cholesterol: Keep your cholesterol level in the ideal range through healthy nutrition and medication use when necessary.
• Quit Smoking: Smoking is one of the biggest risk factors for stroke.
• Regular Exercise: Do at least 150 minutes of moderate-intensity aerobic exercise per week.
• Eat Healthily: Apply a diet rich in vegetables, fruits, whole grains, and healthy fats such as Mediterranean or DASH diet.
• Limit Alcohol Consumption: Excessive alcohol can raise blood pressure and increase stroke risk.

How Should Nutrition and Exercise Be?

Post-stroke nutrition plays a critical role in the recovery process. Foods rich in antioxidants support brain health. Omega-3 fatty acids accelerate neuron repair. Choose fish, walnuts, flaxseed.

Texture modification is required in patients with swallowing difficulty. Nectar-thick liquids and pureed foods may be safe. Speech therapist evaluation is important. Keep your head upright to reduce aspiration risk.

Sodium restriction is necessary for blood pressure control. Keep your daily salt intake below 1 teaspoon. Foods rich in potassium lower blood pressure. Choose bananas, oranges, spinach.

Exercise program is arranged according to your condition. Physical therapy improves muscle strength and coordination. Interval exercises reduce fatigue. Do it in a safe environment to maintain balance.

Walking training is the most important rehabilitation component. Use of parallel bars, walkers, canes is taught. Stair climbing and ramp use are practiced. Practice with household obstacles.

Strength training reduces spasticity. Stretching exercises maintain joint range of motion. Water exercises are both safe and effective. Aim for 30 minutes of activity per day.

When Should You See a Doctor?

If you experience any stroke symptoms, call 112 immediately. Even a single symptom in the FAST test is an emergency. Delay increases brain damage and reduces treatment chances. The thought “let’s wait, it will pass” is wrong.

If you experience sudden severe headache, emergency consultation is required. Especially pain “at a severity I’ve never experienced in my life” is a warning sign. Vomiting, neck stiffness, consciousness changes may accompany.

TIA should be evaluated even if symptoms are temporary. Even if symptoms resolve, stroke risk continues. Stroke risk is 10% within the first 48 hours. Emergency evaluation and treatment are required.

If new symptoms develop during rehabilitation, see a doctor. Recurrent dizziness, fall risk, new weakness are important findings. Drug side effects should also be evaluated.

Depression symptoms should not be neglected. Insomnia, loss of appetite, loss of motivation require treatment. Post-stroke depression negatively affects recovery. Psychological support is important.

Infection symptoms such as fever, cough, urinary complaints require emergency evaluation. Stroke patients are more susceptible to infections. Antibiotic treatment should be started early.

Conclusion

Although stroke is a serious medical condition, it can be successfully managed with early diagnosis and modern treatment methods. Learning the FAST test and recognizing symptoms is life-saving. The time factor is critically important and rapid intervention dramatically improves outcomes.

Controlling risk factors greatly reduces the risk of second stroke. Blood pressure, cholesterol, diabetes control, smoking cessation, regular exercise are effective prevention methods. Use your medication treatment regularly and do not neglect your doctor check-ups.

The rehabilitation process requires patience but promising results can be obtained. Thanks to brain plasticity, lost functions can be largely regained. Family support and motivation accelerate the recovery process. With today’s medicine, most stroke patients can live quality lives.

Reference: Stroke