Conditions & Treatments

Stroke

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted.

Stroke

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution.

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

According to the National Stroke Association (NSA), it is important to learn the 3 R's of stroke:

  • Reduce the risk.

  • Recognize the symptoms.

  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.

Stroke is the fourth leading cause of death, ranking behind diseases of the heart, lungs, and all forms of cancer. According to the NSA, strokes kill more than 137,000 Americans each year.

What are the different types of stroke?

Strokes can be classified into 2 main categories:

  • 87% are ischemic strokes. These strokes are caused by blockage of an artery.

  • 13% are hemorrhagic strokes. These strokes caused by bleeding.

What is an ischemic stroke?

Illustration of Ischemic Stroke
Click Image to Enlarge

An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. The area of tissue death is called an infarct. About 87% of strokes fall into this category. Ischemic strokes are further divided into 2 groups, including the following:

  • Thrombotic strokes. These strokes are caused by a blood clot that develops in the blood vessels inside the brain.

  • Embolic strokes. These strokes are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain via the bloodstream.

What is a thrombotic stroke?

Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high-cholesterol levels and atherosclerosis (a buildup of fat and lipids inside the walls of blood vessels).

Sometimes, symptoms of a thrombotic stroke can occur suddenly and often during sleep or in the early morning. At other times, it may occur gradually over a period of hours or even days. This is called a stroke-in-evolution.

Thrombotic strokes may be preceded by one or more "mini-strokes," called transient ischemic attacks, or TIAs. TIAs may last from a few minutes to a few days and are often a warning sign that a stroke may occur. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke.

Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. The word lacunar comes from the Latin word meaning "hole" or "cavity." Lacunar infarctions are often found in people who have diabetes or hypertension (high blood pressure).

What is an embolic stroke?

Embolic strokes are usually caused by an embolus (a blood clot that forms elsewhere in the body and travels through the bloodstream to the brain). Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs. About 15% of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively.

What is a hemorrhagic stroke?

Illustration of hemorrhagic stroke
Click Image to Enlarge

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 13% of strokes are caused by hemorrhage. Hemorrhagic strokes are divided into 2 main categories, including the following:

  • Intracerebral hemorrhage. This is bleeding from the blood vessels within the brain.

  • Subarachnoid hemorrhage. This is bleeding in the subarachnoid space (the space between the brain and the membranes that cover the brain).

What is an intracerebral hemorrhage?

Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly. There are usually no warning signs and bleeding can be severe enough to cause coma or death.

What is a subarachnoid hemorrhage?

Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges (the membrane that covers the brain) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM):

  • An aneurysm is a weakened, ballooned area on an artery wall and has a risk for rupturing. Aneurysms may be congenital (present at birth), or may develop later in life due to such factors as hypertension or atherosclerosis.

  • An AVM is a congenital disorder that consists of a disorderly tangled web of arteries and veins. AVM is sometimes part of a syndrome, or it may be genetically caused. 

What are the most common symptoms of stroke?

The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately.

Symptoms may be sudden and include:

  • Weakness or numbness of the face, arm, or leg, especially on one side of the body

  • Confusion or difficulty speaking or understanding

  • Problems with vision such as dimness or loss of vision in one or both eyes

  • Dizziness or problems with balance or coordination

  • Problems with movement or walking

  • Severe headaches with no other known cause

  • Loss of consciousness or seizure

All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away take action immediately. The symptoms of stroke may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What are some other symptoms of stroke?

Other, less common, symptoms of stroke may include the following:

  • Sudden nausea, vomiting, or fever not caused by a viral illness

  • Brief loss or change of consciousness such as fainting, confusion, seizures, or coma

  • Transient ischemic attack (TIA), or "mini-stroke"

    A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes or up to 24 hours. Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

The stroke rehabilitation program

Rehabilitation of the patient with a stroke begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.

The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.

The goal of stroke rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life physically, emotionally, and socially. Rehabilitation is designed to meet each person's specific needs; therefore, each program is different. Some general treatment components for stroke rehabilitation programs include the following:

  • Treating the basic disease and preventing complications

  • Treating the disability and improving function

  • Providing adaptive tools and altering the environment

  • Teaching the patient and family and helping them adapt to lifestyle changes

Stroke can cause several types of disabilities: paralysis or problems controlling movement such as walking or balance and/or swallowing; sensory (ability to feel touch, pain, temperature, or position) disturbances; difficulty using or understanding language; thinking and memory problems, and emotional disturbances. Stroke rehabilitation can help you recover from the effects of stroke, relearn skills, and new ways to perform tasks and depends on many variables, including the following:

  • Cause, location, and severity of stroke

  • Type and degree of any impairments and disabilities from the stroke

  • Overall health of the patient

  • Family support

Areas covered in stroke rehabilitation programs may include:

Patient need

Example

Self-care skills, including activities of daily living (ADLs)

Feeding, grooming, bathing, dressing, toileting, and sexual functioning

Mobility skills

Walking, transfers, and self-propelling a wheelchair

Communication skills

Speech, writing, and alternative methods of communication

Cognitive skills

Memory, concentration, judgment, problem solving, and organizational skills

Socialization skills

Interacting with others at home and within the community

Vocational training

Work-related skills

Pain management

Medications and alternative methods of managing pain

Psychological testing

Identifying problems and solutions with thinking, behavioral, and emotional issues

Family support

Assistance with adapting to lifestyle changes, financial concerns, and discharge planning

Education

Patient and family education and training about stroke, medical care, and adaptive techniques

The stroke rehabilitation team

The stroke rehabilitation team revolves around the patient and family and helps set short- and long-term treatment goals for recovery. Many skilled professionals are part of the neurology rehabilitation team, including any or all of the following:

  • Neurologist/neurosurgeon

  • Physiatrist

  • Critical care nurse

  • Internist

  • Other specialty doctors

  • Rehabilitation specialists

  • Physical therapist

  • Occupational therapist

  • Speech/language pathologist

  • Audiologist

  • Registered dietitian

  • Social worker

  • Psychologist/neuropsychologist/psychiatrist

  • Case manager

  • Orthotist

  • Recreation therapist

  • Vocational counselor

  • Chaplain

Types of stroke rehabilitation programs

There are a variety of stroke treatment programs, including the following:

  • Acute rehabilitation programs

  • Subacute rehabilitation programs

  • Long-term care rehabilitation programs

  • Home health rehabilitation programs

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Imaging

  • Vascular Imaging and Intervention
    Working as part of the Vascular Center, the interventional vascular specialists of the Vascular Imaging and Intervention Program at Massachusetts General Hospital Imaging perform minimally invasive, image-guided treatments for conditions including stroke and peripheral vascular disease. These same interventionalists also use minimally invasive techniques to treat non-vascular conditions including uterine fibroids and certain kinds of cancer. In addition, our specialty-trained radiologists use the latest imaging technologies to provide diagnostic exams for a full range of vascular conditions.
  • Neuroendovascular Program
    Working as part of the Vascular Center, the interventional specialists of the Neuroendovascular Program perform minimally invasive, image-guided treatments for conditions including stroke and cerebral aneurysm. These same interventionalists also use minimally invasive techniques to treat non-vascular conditions including herniated disc and vertebral fractures. In addition, our specialty-trained radiologists use the latest imaging technologies to provide diagnostic exams for a full range of neurological conditions.
  • Pediatric Imaging
    The Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.
MassGeneral Hospital for Children

  • Pediatric Feeding Program
    The Pediatric Feeding Program at MassGeneral Hospital for Children diagnoses and treats feeding and swallowing disorders, or dysphagia, in infants, toddlers, children and adolescents.
  • Psychology Assessment Center
    The pediatric neuropsychology specialists at Massachusetts General Hospital’s Psychology Assessment Center provide neuropsychological assessments to aid in the diagnosis and treatment of neurological, medical, genetic and developmental disorders.
Vascular Center

  • Stroke and Carotid Artery Disease Program
    The Stroke and Carotid Artery Disease Program at the Massachusetts General Hospital Fireman Vascular Center offers innovative diagnostic, medical, surgical and endovascular interventions to treat patients with carotid stenosis or stroke.
Department of Neurology

  • Stroke Service at Massachusetts General Hospital
    The Stroke Service at Massachusetts General Hospital provides diagnosis, prevention and treatment for patients with stroke and other cerebrovascular diseases.
  • Neuro-ophthalmology Service
    The Neuro-ophthalmology Service at Massachusetts General Hospital provides expert evaluation, diagnosis and treatment for patients who have vision problems with a neurologic basis.
  • Neurocritical Care and Emergency Neurology
    Patients with serious brain and nervous system conditions receive individualized, expert, compassionate care throughout their MGH Emergency Department and Neurosciences Intensive Care Unit stay.
  • General Pediatric Neurology
    General Pediatric Neurology physicians diagnose and treat all neurological disorders in children, infants and adolescents.
  • General Neurology Program
    Part of the Neurology Department at Massachusetts General Hospital, the General Neurology Program’s board-certified neurologists work with primary care physicians to diagnose and treat a wide variety of neurological conditions.
  • Cardio-Neurology Clinic
    The Massachusetts General Hospital Cardio-Neurology Clinic provides comprehensive neurological evaluation and care for patients with cerebrovascular disorders related to the heart, including patent foramen ovale (PFO).
  • Cognitive Behavioral Neurology Unit
    The Cognitive Behavioral Neurology Unit offers diagnosis and treatment to patients with disorders and diseases of the brain affecting language, memory, problem solving, emotional function and behavior.
Department of Neurosurgery

  • Neurosciences Intensive Care Unit
    Neurosciences Intensive Care Unit (Neuro ICU) patients receive intensive medical and nursing management for post-surgical and post-interventional conditions, as well as stroke, cerebral hemorrhage, seizure, and head and spinal cord injuries.
  • Open Vascular Neurosurgery Program
    The Open Vascular Neurosurgery Program at Massachusetts General Hospital specializes in Neuroendovascular problems of the brain and spinal cord, including brain aneurysms, arteriovenous malformations (AVMs) and carotid disease.
Obstetrics and Gynecology

  • Midlife Women's Health Center
    The Massachusetts General Hospital Midlife Women’s Health Center brings together experts from more than 15 specialties to improve, promote and advance health care for women at menopause and beyond through research, collaboration and education.
Speech, Language and Swallowing Disorders

  • Cognitive Rehabilitation Therapy
    This therapy approach is designed to help the individual develop skills and learn compensatory strategies to improve how he/she functions at home, school, and/or at work. This type of therapy addresses difficulties with attention, learning new information, memory, time management, planning, organization, and problem-solving. Tailored to meet the individual needs of the patient with cognitive and executive function deficits, our approach emphasizes the development of metacognitive and self-awareness skills.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

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Mind over matter

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MGH receives top honor for stroke patients’ quality of care

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It takes a team

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