Stroke

For other uses, see Stroke (disambiguation).

Stroke
Other namesCerebrovascular accident (CVA), cerebrovascular insult (CVI), cerebrovascular lesion (CVL), brain attack
CT scan of the brain showing a massive, prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.[1]
SpecialtyNeurology, stroke medicine
SymptomsInability to move or feel on one side of the body, problems understanding or speaking, dizziness, loss of vision to one side[2][3]
ComplicationsPersistent vegetative state[4]
CausesIschemic (blockage) and hemorrhagic (bleeding)[5]
Risk factorsAge,[6] high blood pressure, tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, end-stage kidney disease, atrial fibrillation[2][7][8]
Diagnostic methodBased on symptoms with medical imaging typically used to rule out bleeding[9][10]
Differential diagnosisLow blood sugar[9]
TreatmentBased on the type[2]
PrognosisAverage life expectancy 1 year[2]
Frequency42.4 million (2015)[11]
Deaths6.3 million (2015)[12]

Stroke is a medical condition in which poor blood flow to a part of the brain causes cell death.[5] There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.[5] Both cause parts of the brain to stop functioning properly.[5]

Signs and symptoms of stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side.[2][3] Signs and symptoms often appear soon after the stroke has occurred.[3] If symptoms last less than 24 hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke.[3] Hemorrhagic stroke may also be associated with a severe headache.[3] The symptoms of stroke can be permanent.[5] Long-term complications may include pneumonia and loss of bladder control.[3]

The biggest risk factor for stroke is high blood pressure.[7] Other risk factors include high blood cholesterol, tobacco smoking, obesity, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation.[2][7][8] Ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes.[13][14][15] Hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes.[13][16] Bleeding may occur due to a ruptured brain aneurysm.[13] Diagnosis is typically based on a physical exam and supported by medical imaging such as a CT scan or MRI scan.[9] A CT scan can rule out bleeding, but may not necessarily rule out ischemia, which early on typically does not show up on a CT scan.[10] Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and possible causes.[9] Low blood sugar may cause similar symptoms.[9]

Prevention includes decreasing risk factors, surgery to open up the arteries to the brain in those with problematic carotid narrowing, and anticoagulant medication in people with atrial fibrillation.[2] Aspirin or statins may be recommended by physicians for prevention.[2] Stroke is a medical emergency.[5] Ischemic strokes, if detected within three to four-and-a-half hours, may be treatable with medication that can break down the clot,[2] while hemorrhagic strokes sometimes benefit from surgery.[2] Treatment to attempt recovery of lost function is called stroke rehabilitation, and ideally takes place in a stroke unit; however, these are not available in much of the world.[2]

In 2023, 15 million people worldwide had a stroke.[17] In 2021, stroke was the third biggest cause of death, responsible for approximately 10% of total deaths.[18] In 2015, there were about 42.4 million people who had previously had stroke and were still alive.[11] Between 1990 and 2010 the annual incidence of stroke decreased by approximately 10% in the developed world, but increased by 10% in the developing world.[19] In 2015, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.3 million deaths (11% of the total).[12] About 3.0 million deaths resulted from ischemic stroke while 3.3 million deaths resulted from hemorrhagic stroke.[12] About half of people who have had stroke live less than one year.[2] Overall, two thirds of cases of stroke occurred in those over 65 years old.[19]

  1. ^ Gaillard F. "Ischaemic stroke". radiopaedia.org. Retrieved 3 June 2018.
  2. ^ a b c d e f g h i j k l Donnan GA, Fisher M, Macleod M, Davis SM (May 2008). "Stroke". Lancet. 371 (9624): 1612–23. doi:10.1016/S0140-6736(08)60694-7. PMID 18468545. S2CID 208787942.(subscription required)
  3. ^ a b c d e f "What Are the Signs and Symptoms of a Stroke?". www.nhlbi.nih.gov. March 26, 2014. Archived from the original on 27 February 2015. Retrieved 27 February 2015.
  4. ^ Martin G (2009). Palliative Care Nursing: Quality Care to the End of Life, Third Edition. Springer Publishing Company. p. 290. ISBN 978-0-8261-5792-8. Archived from the original on 2017-08-03.
  5. ^ a b c d e f "What Is a Stroke?". www.nhlbi.nih.gov/. March 26, 2014. Archived from the original on 18 February 2015. Retrieved 26 February 2015.
  6. ^ "Stroke - Causes". 24 October 2017.
  7. ^ a b c "Who Is at Risk for a Stroke?". www.nhlbi.nih.gov. March 26, 2014. Archived from the original on 27 February 2015. Retrieved 27 February 2015.
  8. ^ a b Hu A, Niu J, Winkelmayer WC (November 2018). "Oral Anticoagulation in Patients With End-Stage Kidney Disease on Dialysis and Atrial Fibrillation". Seminars in Nephrology. 38 (6): 618–628. doi:10.1016/j.semnephrol.2018.08.006. PMC 6233322. PMID 30413255.
  9. ^ a b c d e "How Is a Stroke Diagnosed?". www.nhlbi.nih.gov. March 26, 2014. Archived from the original on 27 February 2015. Retrieved 27 February 2015.
  10. ^ a b Yew KS, Cheng E (July 2009). "Acute stroke diagnosis". American Family Physician. 80 (1): 33–40. PMC 2722757. PMID 19621844.
  11. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  12. ^ a b c GBD 2015 Mortality and Causes of Death Collaborators (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  13. ^ a b c "Types of Stroke". www.nhlbi.nih.gov. March 26, 2014. Archived from the original on 19 March 2015. Retrieved 27 February 2015.
  14. ^ Roos KL (2012). Emergency Neurology. Springer Science & Business Media. p. 360. ISBN 978-0-387-88584-1. Archived from the original on 2017-01-08.
  15. ^ Wityk RJ, Llinas RH (2007). Stroke. ACP Press. p. 296. ISBN 978-1-930513-70-9. Archived from the original on 2017-01-08.
  16. ^ Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, et al. (December 2005). "Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies". Stroke. 36 (12): 2773–80. doi:10.1161/01.STR.0000190838.02954.e8. PMID 16282541.
  17. ^ "Stroke, cerebrovascular accident". World Health Organization. 2024. Retrieved 12 March 2024.
  18. ^ "The top 10 causes of death". www.who.int. Retrieved 2024-08-12.
  19. ^ a b Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. (January 2014). "Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010". Lancet. 383 (9913): 245–54. doi:10.1016/S0140-6736(13)61953-4. PMC 4181600. PMID 24449944.