A stroke is a focal or isolated injury to a portion of the brain caused by either a blockage of an artery in the brain or a hemorrhage in a specific area in the brain. Strokes can be caused by blood clots migrating from the heart or the major blood vessels coming off the heart or in the neck. Stroke can also be caused by a gradual collection of blockage of smaller blood vessels in the brain and can be caused by rupture of these blood vessels causing hemorrhage. Strokes result in focal damage to one area of the brain which then can produce symptoms such as weakness on one side of the body, sensory loss on one side of the body, speech difficulty, visual difficulty, or difficulty swallowing or talking.

Since there are multiple types of strokes, there are multiple causes of strokes. Blood clots occurring in the heart associated with heart irregularities or arrhythmias can produce strokes. Hypertension with its effect on the blood vessels either in the brain or coming from the heart to the brain can result in strokes. Strokes are more likely to occur in people with hypertension or with elevated cholesterol or with cardiac arrhythmias but can occur in people with none of these disorders. Strokes are more frequent in people over the age of 60 and tend to increase in frequency as age increases.

Warning signs for strokes include so-called transient ischemic attacks in which a person has a short-lived episode of weakness, sensory loss, visual difficulty, etc. These episodes often last anywhere from a minute or two up to 15 to 30 minutes. This type of symptom should lead to medical consultation so that further investigation (including physical examination to exclude cardiac arrythmias, hypertension, etc.), and further studies (such as echocardiogram and carotid Doppler studies looking for abnormalities in the heart or in the great vessels leading from the heart) can be performed.

Prevention of stroke is of great concern. The primary preventive mechanism for stroke is the early treatment of hypertension. This should begin as soon as hypertension is diagnosed at any age. Prevention of stroke by the use of antiplatelet medication such as aspirin or other similar drugs can sometimes be of benefit. Anticoagulation is also used at times in the form of Heparin or Coumadin though a definite relationship between diminishing the frequency of stroke and the use of blood thinners has not been established.

In an acute stroke, some people recommend the use of TPA. In follow-up studies over the course of a year, this medication has been reported to have a 12% benefit to people with strokes who receive it within three hours of the onset of their stroke. However, there is a 6% rate of intracerebral hemorrhage in patients who receive this medication. The effectiveness of this medication still remains controversial although it is recommended by many physicians.

Once a stroke has occurred, the primary treatment is of a rehabilitative nature once the patient’s medical condition is stable. This treatment is provided by a physical medicine and rehabilitation team and sometimes is done in a rehabilitation unit and at other times is done as an outpatient. Improvement from stroke can be expected to occur for anywhere from 6 to 12 weeks relative to weakness and other neurologic symptoms. The one exception to this is speech since speech difficulties related to stroke can improve for as long as two to five years.