is an ischemic stroke?
occur when blood flow to the brain is blocked or insufficient to support
cellular function. If blood flow is not
restored or improved cells in the brain will die. This is different from a hemorrhagic or
bleeding stroke in which blood leaks out of a burst blood vessel or vascular
are the causes of ischemic stroke?
can cause blood clots that can travel to the brain or local diseases of the
blood vessels in the brain can cause ischemic strokes. Examples are:
stenosis or narrowing of the arteries in the neck
fibrillation that can create small blood clots in the heart that can travel to
dissections or tearing of the layers of the artery wall
are the symptoms of an ischemic stroke?
ischemic stroke usually start suddenly and can affect one or both sides of the
body. They can be subtle or dramatic but
classically result in numbness and/or weakness of one side of the face and
body. Sometimes the symptoms include
problems speaking or understanding speech.
Occasionally the symptoms resolve rapidly, however we still recommend
being seen by a medical doctor if you have any symptoms that are worrisome for
a stroke, even if they go away on their own.
A list of typical symptoms:
weakness/numbness on one side of face, arm and leg
speaking or understanding speech
with balance and trouble walking
change in vision with difficulty seeing out of one or both eyes
are the risk factors for ischemic stroke?
Below is a list
of some of the things that can increase the likelihood that someone will have
an ischemic stroke:
Disease – particularly atrial fibrillation
Ischemic Attacks or repeated stroke symptoms that resolve on their own
Stenosis or narrowing of arteries in the neck
of heart valves
should I do if I feel like I am having an ischemic stroke?
If you think you
are having an ischemic stroke call 911!
Do not delay calling for help. It
is better to find out that you didn’t have a stroke then to miss the
opportunity for treatment. TIME IS
BRAIN! ACT FAST!
can be done if I have an ischemic stroke?
ischemic stroke are based largely on how long the symptoms have been
present. The less time that has passed
the better. Several treatments are currently
available for ischemic stroke:
is clot busting medicine that can sometimes be used to dissolve the
blockage. This medicine is given through
a normal IV can be administered at a large number of hospitals. Some patient’s cannot be given this medication
because of bleeding disorders, recent surgeries or because the symptoms have
been present too long.
retrieval is a relatively new treatment that is performed at select hospitals
that specialize in stroke treatment.
This procedure is performed by passing catheters into the brain using
x-ray guidance and actually suctioning out or grabbing and pulling out the
blockage. This technique has recently
shown improved patient outcomes in multiple studies and is becoming more widely
available. The image below demonstrates the dramatic results of these new techniques. The image on the left shows a blockage of the middle cerebral artery and the image on the right shows the results of clot retrieval with opening of the artery and restoration of blood flow.
surgery is performed in rare cases when patients have narrowing or blockage of
an artery that has resulted in symptoms or puts them at high risk for
stroke. These procedures create detours
around the areas of narrowing or blockage that allow for improved blood flow to
the brain. Select centers around the
country that specialize in stroke treatment perform these procedures. The following images show the preparations for a bypass (top image) and the results of a completed bypass (bottom image).
is a Stroke Center?
Because of the
success of newer stroke therapies like the clot retrieval mentioned above many
hospital systems are focusing on improving stroke care. In many cases this has involved the
certification of various hospitals as primary (PSC) or comprehensive stroke
centers (CSC). Simply speaking a primary
stroke center has the ability to give tPA (clot buster) but may not have clot
retrieval services available 24/7 while it is the responsibility of the
comprehensive centers to have such availability of clot retrieval (or
endovascular services). There is also
going to be a stronger presence of intensive care unit care at the CSC. There is some variability in the capability
of different CSCs based on the pathway to certification that was followed. It is important to understand the capabilities
and reputation of stroke centers in your area.