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Hemorrhagic Stroke

Last full review/revision November 2007 by Elias A. Giraldo, MD


Hemorrhagic strokes include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner and outer layers of the tissue covering the brain (subarachnoid hemorrhage). There are two main types of hemorrhagic strokes: intracerebral hemorrhage and subarachnoid hemorrhage. Other disorders that involve bleeding inside the skull include epidural hematomas (see Head Injuries: Epidural Hematomas) and subdural hematomas (see see Head Injuries: Subdural Hematomas), which are usually
caused by a head injury. These disorders cause different symptoms and are not considered strokes.

Burst and Breaks: Causes of Hemorrhagic Stroke

When blood vessels of the brain are weak, abnormal, or under unusual pressure, a hemorrhagic stroke can occur. In hemorrhagic strokes, bleeding may occur within the brain, as an intracerebral hemorrhage. Or bleeding may occur between the inner and middle layer of tissue covering the brain (in the subarachnoid space), as a subarachnoid hemorrhage.

Intracerebral Hemorrhage An intracerebral hemorrhage is bleeding within the brain.

Intracerebral hemorrhage usually results from chronic high blood pressure. The first symptom is often a severe headache. Diagnosis is based on symptoms and results of a physical examination and imaging tests. Treatment may include vitamin K, transfusions, and, rarely, surgery to remove the accumulated blood.

Intracerebral hemorrhage accounts for about 10% of all strokes but for a much higher percentage of deaths due to stroke. Among people older than 60, intracerebral hemorrhage is more common than subarachnoid hemorrhage. Causes Intracerebral hemorrhage most often results when chronic high blood pressure weakens a small artery, causing it to burst. Using cocaine or amphetamines can cause temporary but very high blood pressure and hemorrhage. In some older people, an abnormal protein called amyloid accumulates in arteries of the brain. This accumulation (called amyloid angiopathy) weakens the arteries and can cause hemorrhage. Less common causes include blood vessel abnormalities present at birth, injuries, tumors, inflammation of blood vessels (vasculitis), bleeding disorders, and use of anticoagulants in doses that are too high. Bleeding disorders and use of anticoagulants increase the risk of dying from an intracerebral hemorrhage. Symptoms An intracerebral hemorrhage begins abruptly. In about half of the people, it begins with a severe headache, often during activity. However, in older people, the headache may be mild or absent. Symptoms suggesting brain dysfunction develop and steadily worsen as the hemorrhage expands. Some symptoms, such as weakness, paralysis, loss of sensation, and numbness, often affect only one side of the body. People may be unable to speak or become confused. Vision may be impaired or lost. The eyes may point in different directions or become paralyzed. The pupils may become abnormally large or small. Nausea, vomiting, seizures, and loss of consciousness are common and may occur within seconds to minutes. Diagnosis Doctors can often diagnose intracerebral hemorrhages on the basis of symptoms and results of a physical examination. However, computed tomography (CT) or

magnetic resonance imaging (MRI) is also done. Both tests can help doctors distinguish a hemorrhagic stroke from an ischemic stroke. The tests can also show how much brain tissue has been damaged and whether pressure is increased in other areas of the brain. The blood sugar level is measured because a low blood sugar level can cause symptoms similar to those of stroke. Prognosis Intracerebral hemorrhage is more likely to be fatal than ischemic stroke. The hemorrhage is usually large and catastrophic, especially in people who have chronic high blood pressure. More than half of the people who have a large hemorrhage die within a few days. Those who survive usually recover consciousness and some brain function over time. However, most do not recover all lost brain function. Treatment Treatment of intracerebral hemorrhage differs from that of an ischemic stroke. Anticoagulants (such as heparin and warfarin ), thrombolytic drugs, and antiplatelet drugs (such as aspirin ) are not given because they make bleeding worse. If people who are taking an anticoagulant have a hemorrhagic stroke, they may need a treatment that helps blood clot such as

Vitamin K, usually given intravenously Transfusions of platelets Transfusions of blood that has had blood cells and platelets removed (fresh frozen plasma) Intravenous administration of a synthetic product similar to the proteins in blood that help blood to clot (clotting factors)

Surgery to remove the accumulated blood and relieve pressure within the skull, even if it may be life-saving, is rarely done because the operation itself can damage the brain. Also, removing the accumulated blood can trigger more bleeding, further damaging the brain and leading to severe disability. However, this operation may be effective for hemorrhage in the pituitary gland or in the cerebellum. In such cases, a good recovery is possible. Subarachnoid Hemorrhage A subarachnoid hemorrhage is bleeding into the space (subarachnoid space) between the inner layer (pia mater) and middle layer (arachnoid mater) of the tissue covering the brain (meninges).

The most common cause is rupture of a bulge (aneurysm) in an artery. Usually, rupture of an artery causes a sudden, severe headache, often followed by a brief loss of consciousness. Computed tomography, sometimes a spinal tap, and angiography are done to confirm the diagnosis. Drugs are used to relieve the headache and to control blood pressure, and surgery is done to stop the bleeding.

A subarachnoid hemorrhage is a life-threatening disorder that can rapidly result in serious, permanent disabilities. It is the only type of stroke more common among women than among men. Causes Subarachnoid hemorrhage usually results from head injuries. However, hemorrhage due to a head injury causes different symptoms and is not considered a stroke. Subarachnoid hemorrhage is considered a stroke only when it occurs spontaneously that is, when the hemorrhage does not result from external forces, such as an accident or a fall. A spontaneous hemorrhage usually results from the sudden rupture of an aneurysm in a cerebral artery. Aneurysms are bulges in a weakened area of an artery's wall. Aneurysms typically occur where an artery branches. Aneurysms may be present at birth (congenital), or they may develop later, after years of high blood pressure weaken the walls of arteries. Most subarachnoid hemorrhages result from congenital aneurysms.
Less commonly, subarachnoid hemorrhage results from rupture of an abnormal connection between arteries and veins (arteriovenous malformation) in or around the brain. An arteriovenous malformation may be present at birth, but it is usually identified only if symptoms develop. Rarely, a blood clot forms on an infected heart valve, travels (becoming an embolus) to an artery that supplies the brain, and causes the artery to become inflamed. The artery may then weaken and rupture.

Did You Know... Almost half of people with a subarachnoid hemorrhage die before reaching the hospital. Symptoms Before rupturing, an aneurysm usually causes no symptoms unless it presses on a nerve or leaks small amounts of blood, usually before a large rupture (which causes headache). Then it produces warning signs, such as the following:

Headache, which may be unusually sudden and severe (sometimes called a thunderclap headache) Facial or eye pain Double vision Loss of peripheral vision

The warning signs can occur minutes to weeks before the rupture. People should report any unusual headaches to a doctor immediately. A rupture usually causes a sudden, severe headache that peaks within seconds. It is often followed by a brief loss of consciousness. Almost half of affected people die before reaching a hospital. Some people remain in a coma or unconscious. Others wake up, feeling confused and sleepy. They may also feel restless. Within hours or even minutes, people may again become sleepy and confused. They may become unresponsive and difficult to arouse. Within 24 hours, blood and cerebrospinal fluid around the brain irritate the layers of tissue covering the brain (meninges), causing a stiff neck as well as continuing headaches, often with vomiting, dizziness, and low back pain. Frequent fluctuations in the heart rate and in the breathing rate often occur, sometimes accompanied by seizures. About 25% of people have symptoms that indicate damage to a specific part of the brain, such as the following:

Weakness or paralysis on one side of the body (most common) Loss of sensation on one side of the body Difficulty understanding and using language (aphasiasee Brain Dysfunction: Aphasia)

Severe impairments may develop and become permanent within minutes or hours. Fever is common during the first 5 to 10 days. A subarachnoid hemorrhage can lead to several other serious problems:

Hydrocephalus: Within 24 hours, the blood from a subarachnoid hemorrhage may clot. The clotted blood may prevent the fluid surrounding the brain (cerebrospinal fluid) from draining as it normally does. As a result, blood accumulates within the brain, increasing pressure within the skull. Hydrocephalus may contribute to symptoms such as headaches, sleepiness, confusion, nausea, and vomiting and may increase the risk of coma and death. Vasospasm: About 3 to 10 days after the hemorrhage, arteries in the brain may contract (spasm), limiting blood flow to the brain. Then, brain tissues may not get enough oxygen and may die, as in ischemic stroke. Vasospasm may cause symptoms similar to those of ischemic stroke, such as weakness or loss of sensation on one side of the body, difficulty using or

understanding language, vertigo, and impaired coordination. A second rupture: Sometimes a second rupture occurs, usually within a week.

Diagnosis If people have a sudden, severe headache that peaks within seconds or that is accompanied by any symptoms suggesting a stroke, they should go immediately to the hospital. Computed tomography (CT) is done to check for bleeding. A spinal tap (lumbar puncture) is done if CT is inconclusive or unavailable. It can detect any blood in the cerebrospinal fluid. A spinal tap is not done if doctors suspect that pressure within the skull is increased. Cerebral angiography (see Brain Dysfunction: Aphasia) is done as soon as possible to confirm the diagnosis and to identify the site of the aneurysm or arteriovenous malformation causing the bleeding. Magnetic resonance angiography or CT angiography may be used instead. Prognosis About 35% of people die when they have a subarachnoid hemorrhage due to an aneurysm because it results in extensive brain damage. Another 15% die within a few weeks because of bleeding from a second rupture. People who survive for 6 months but who do not have surgery for the aneurysm have a 3% chance of another rupture each year. The outlook is better when the cause is an arteriovenous malformation. Occasionally, the hemorrhage is caused by a small defect that is not detected by cerebral angiography because the defect has already sealed itself off. In such cases, the outlook is very good. Some people recover most or all mental and physical function after a subarachnoid hemorrhage. However, many people continue to have symptoms such as weakness, paralysis, or loss of sensation on one side of the body or aphasia. Treatment People who may have had a subarachnoid hemorrhage are hospitalized immediately. Bed rest with no exertion is essential. Analgesics such as opioids (but not aspirin or other nonsteroidal anti-inflammatory drugs, which can worsen the bleeding) are given to control the severe headaches. Stool softeners are given to prevent straining during bowel movements. Nimodipine, a calcium channel blocker, is usually given by mouth to prevent vasospasm and subsequent ischemic stroke. Doctors take measures (such as giving drugs and adjusting the amount of intravenous fluid given) to keep blood pressure at levels low enough to avoid further hemorrhage and high enough to maintain blood flow to the damaged parts of the brain. Occasionally, a piece of plastic tubing (shunt) may be placed in the brain to drain cerebrospinal fluid away from the brain. This procedure relieves pressure and prevents hydrocephalus.

For people who have an aneurysm, a surgical procedure is done to isolate, block off, or support the walls of the weak artery and thus reduce the risk of fatal bleeding later. These procedures are difficult, and regardless of which one is used, the risk of death is high, especially for people who are in a stupor or coma. The best time for surgery is controversial and must be decided based on the person's situation. Most neurosurgeons recommend operating within 24 hours of the start of symptoms, before hydrocephalus and vasospasm develop. If surgery cannot be done this quickly, the procedure may be delayed 10 days to reduce the risks of surgery, but then bleeding is more likely to recur because the waiting period is longer. A commonly used procedure, called neuroendovascular surgery, involves inserting coiled wires into the aneurysm. The coils are placed using a catheter that is inserted into an artery and threaded to the aneurysm. Thus, this procedure does not require that the skull be opened. By slowing blood flow through the aneurysm, the coils promote clot formation, which seals off the aneurysm and prevents it from rupturing. Neuroendovascular surgery can often be done at the same time as cerebral angiography, when the aneurysm is diagnosed. Less commonly, a metal clip is placed across the aneurysm. This procedure prevents blood from entering the aneurysm and eliminates the risk of rupture. The clip remains in place permanently. Most clips that were placed 15 to 20 years ago are affected by the magnetic forces and can be displaced during magnetic resonance imaging (MRI). People who have these clips should inform their doctor if MRI is being considered. Newer clips are not affected by the magnetic forces.

What Is a Stroke?
http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/printall-index.html A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing. A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death. If you think you or someone else is having a stroke, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.

The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke. An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-urisms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloonlike bulges in an artery that can stretch and burst.) Another condition thats similar to a stroke is a transient ischemic attack, also called a TIA or mini-stroke. A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isnt permanent (lasting). Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, its important for your doctor to find the cause so you can take steps to prevent a stroke. Both strokes and TIAs require emergency care.

Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke. If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke. Researchers continue to study the causes and risk factors for stroke. Theyre also finding new and better treatments and new ways to help the brain repair itself after a stroke.

Types of Stroke
Ischemic Stroke
An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. The two types of ischemic stroke are thrombotic (throm-BOT-ik) and embolic (em-BOL-ik). In a thrombotic stroke, a blood clot (thrombus) forms in an artery that supplies blood to the brain. In an embolic stroke, a blood clot or other substance (such as plaque, a fatty material) travels through the bloodstream to an artery in the brain. (A blood clot or piece of plaque that travels through the bloodstream is called an embolus.) With both types of ischemic stroke, the blood clot or plaque blocks the flow of oxygen-rich blood to a portion of the brain.

Ischemic Stroke

The illustration shows how an ischemic stroke can occur in the brain. If a blood clot breaks away from plaque buildup in a carotid (neck) artery, it can travel to and lodge in an artery in the brain. The clot can block blood flow to part of the brain, causing brain tissue death.

Hemorrhagic Stroke
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. The two types of hemorrhagic stroke are intracerebral (in-trah-SER-e-bral) and subarachnoid (sub-ah-RAK-noyd). In an intracerebral hemorrhage, a blood vessel inside the brain leaks blood or ruptures. In a subarachnoid hemorrhage, a blood vessel on the surface of the brain leaks blood or ruptures. When this happens, bleeding occurs between the inner and middle layers of the membranes that cover the brain. In both types of hemorrhagic stroke, the leaked blood causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage cells and tissues in the brain.

Hemorrhagic Stroke

The illustration shows how a hemorrhagic stroke can occur in the brain. An aneurysm in a cerebral artery breaks open, which causes bleeding in the brain. The pressure of the blood causes brain tissue death.

http://www.neurology.ufl.edu/stroke/patient_education.shtml Updated: Nov 17, 2011 at 08:51AM :: Contact: Webmaster Location: http://www.neurology.ufl.edu/stroke/patient_education.shtml Disclaimer and Permitted Use :: 2008 University of Florida

Stroke is the third-leading cause of death in the United States and the leading cause of serious, long-term disability. A stroke occurs when a blood vessel (artery) that supplies blood to the brain leaks, bursts or is blocked by a blood clot. Within an hour, the nerve cells in that area of the brain become damaged and may die. As a result, the part of the body controlled by the damaged area of the brain cannot work properly. The Shands at the University of Florida Stroke Program is dedicated to preventing, diagnosing and treating strokes, providing the latest technology and medications, and treating the stroke patient's entire needs. Care is coordinated from the first point of contact with the patient, whether through the emergency department, the Stroke Program's inpatient or outpatient services or the rehabilitation ward.

Stroke and TIA Symptoms

A person having symptoms of a stroke needs immediate emergency care, just as if he or she were having a heart attack. The sooner medical treatment begins, the fewer brain cells may be damaged. The effects of a stroke can range from mild to severe and may be temporary or permanent. A stroke can affect vision, speech, behavior, the ability to think and the ability to move parts of the body. Sometimes it can cause a coma or death. The effects of a stroke depend on the specific brain cells that are damaged, how much of the brain is affected and how fast blood flow is restored to the affected area. One or more mini-strokes (transient ischemic attacks or TIAs) may occur before a person has a stroke. Symptoms for both are similar. However, unlike stroke symptoms, TIA symptoms disappear within minutes (usually 10 to 20) up to 24 hours. A TIA is a warning signal that a stroke may soon occur, and the condition needs to be treated as an emergency. There are two major types of strokes. Ischemic stroke is caused by a blocked or narrowed artery. Hemorrhagic stroke is caused by sudden bleeding from an artery.

General symptoms of a stroke include sudden onset of:

Numbness, weakness or inability to move (paralysis) of the face, arm or leg, especially on one side of the body. Trouble seeing in one or both eyes, such as dimness, blurring, double vision or loss of vision. Confusion, or trouble speaking and/or difficulty understanding speech.

Trouble walking, dizziness or loss of balance or coordination. Severe headache with no known cause, especially sudden onset.

Symptoms of a stroke may vary, depending on the type of stroke, as well as the location and severity. If a stroke is caused by a large blood clot or bleeding, symptoms occur within seconds. When an artery that is already narrowed is blocked, stroke symptoms may develop gradually within minutes or rarely hours.

Causes and Risk Factors

Ischemic stroke occurs when blood flow through a blood vessel (artery) that supplies blood to the brain is blocked. Blockage may develop from a blood clot in an artery leading to the brain (thrombus) or one formed in another part of the body, often the heart (embolus). The clot travels with the blood until it blocks an artery in the brain. These blood clots usually are the result of irregular heart beat (atrial fibrillation), heart valve problems, infection of the heart muscle, hardening of the arteries, bloodclotting disorders, inflammation of the blood vessels or heart attack. A less common cause of ischemic stroke occurs when blood pressure becomes too low (hypotension), reducing blood flow to the brain. This usually occurs with narrowed or diseased arteries. Low blood pressure can result from a heart attack, large loss of blood or severe infection. Each of these conditions affects the flow of blood through the heart and blood vessels and increases the risk of stroke. Hemorrhagic stroke is caused by sudden bleeding from a blood vessel inside the brain (cerebral hemorrhage) or in the spaces around the brain (subarachnoid hemorrhage). Sudden bleeding may result from the bursting of a blood vessel that has stretched and thinned (aneurysm). The most common cause of bleeding inside the brain is high blood pressure. Uncommon causes of hemorrhagic stroke include inflamed blood vessels, which may develop from syphilis, tuberculosis, or other infections, blood-clotting disorders, head or neck injuries, and cerebral amyloid angiopathy (a condition in which a protein substance builds up and weakens the blood vessels in the brain, causing bleeding and a stroke). Over the past several decades, doctors have learned more and more about the factors that lead to strokes. The American Heart Association has identified several factors that increase your risk of stroke. The more risk factors you have, the greater your chances of having a stroke.

These risk factors fall into two categories: 1) factors you cannot change, and 2) factors that you can modify by changes in your lifestyle. Your personal healthcare provider can help you assess your risk for stroke and recommend ways to control your risk factors and reduce your risk of getting a stroke. Risk factors that you cannot modify:

Age. While strokes can happen to a person of any age, even children, the older you are, the more at risk of having a stroke you are. Gender. While more men than women have strokes, more women die from strokes when they occur. More than half of the total deaths from stroke occur in women. Using birth control pills and being pregnant are special concerns for women. Race. African Americans have a much higher risk of death from a stroke than caucasians do. In part, this is because blacks have higher rates of high blood pressure, diabetes and obesity. Family History. Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke, or suffers significant cardiovascular disease. Personal health and medical history. Someone who has had a stroke is at much higher risk of having another one. If you have had a heart attack, you are at higher risk of having a stroke, too.

Risk factors that you can modify:

High blood pressure. High blood pressure is defined in an adult as a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher for an extended time. It is the single most important risk factor for stroke. Diabetes mellitus. While diabetes is treatable, having it still increases a person's risk of stroke. People with diabetes often also have high blood pressure, high cholesterol and are overweight. This increases their risk even more. If you have diabetes, work closely with your doctor to manage it. Carotid or other arterial disease. The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by atherosclerosis may become blocked by a blood clot.

People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It is also caused by atherosclerosis.

Atrial fibrillation. This heart rhythm disorder raises the risk for stroke because the heart's upper chambers quiver instead of beating effectively. This allows blood to pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke may result. Other heart diseases. People with coronary heart disease or heart failure have more than twice the risk of stroke as those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease, prior heart attack, and some types of congenital heart defects also increase the risk of stroke. Transient ischemic attacks (TIAs). TIAs are "mini-strokes" that produce stroke-like symptoms that resolve within 24 hours. Recognizing and treating TIAs can reduce your risk of a major stroke. Call 911 to get medical help immediately if they occur! Certain blood disorders. A high red blood cell count thickens the blood and makes clots more likely. This increases the risk of stroke. Doctors may treat this problem by removing blood cells or prescribing "blood thinners." Another blood disorder, sickle cell anemia, mainly affects African Americans. In this condition, sickle-shaped red blood cells are less able to carry oxygen to the tissues and organs. They also tend to stick to the blood vessel walls, which in turn can block arteries in the brain and cause a stroke. High blood cholesterol. A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease and stroke. Recent studies show that high levels of LDL cholesterol (greater than 100 mg/dL) and triglycerides (blood fats) directly increase the risk of stroke in people with previous coronary heart disease, ischemic stroke or transient ischemic attack (TIA). Low levels of HDL cholesterol (less than 40 mg/dL) also may raise stroke risk.

Lifestyle changes that can reduce your risk of stroke:

Stop using tobacco. Cigarette smoking is the top lifestyle risk factor for stroke. Carbon monoxide present in tobacco smoke lowers the amount of oxygen in your blood. It also damages the walls of blood vessels, making clots more likely to form. Combining the use of some kinds of birth control pills with smoking greatly increases a woman's stroke risk. Maintain a proper weight and exercise regularly. Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. Consume alcohol in moderation, if at all. An average of more than one alcoholic drink a day for women or more than two drinks a day for men raises blood pressure and may lead to stroke.

Illegal drug abuse. Intravenous drug abuse carries a high risk of stroke. Cocaine, amphetamine, crystal methamphetamine, and other stimulant use has been linked to strokes and heart attacks. Some have been fatal even in first-time users.

Diagnosis of a stroke is based on the patient's medical history, physical exam, and diagnostic studies. A variety of diagnostic tests are available through the UF Stroke Program. If stroke is suspected, the doctor will order an MRI or computed tomography (CT) scan to determine whether the stroke was caused by a clot or from bleeding inside the brain. Additional tests may be done depending on the scan results. If disease or narrowing of one of the large arteries in the neck (carotid arteries) is suspected, the following additional tests may be done:

Ultrasound of the carotid artery. Magnetic resonance angiography (MRA) scan to evaluate the flow of blood through the blood vessels. Carotid arteriography (injecting radio-opaque material into the blood stream) to show specific arteries. If evidence shows that the stroke is caused by a clot that formed in the heart, the doctor may order a chest X-ray, ECG or EKG, echocardiograph or other heart imaging test. Other laboratory tests may be done to see if other conditions are present, check the person's overall health and see if the patient's blood clots too easily.

For more information about the various kinds of diagnostic tests that may be used to diagnose stroke, visit our Diagnostic Testing information page.

People who have symptoms of a stroke need to seek emergency medical care. Prompt medical attention may prevent life-threatening complications and more widespread brain damage and is critical to ensure the best recovery. If emergency treatment is sought within the first one to two hours after symptoms begin, some people with a stroke caused by a blood clot may be able to receive a medication to dissolve the clot, helping to increase the chance of a full recovery. Treatment may include medication or surgery and is based on the type of stroke and the seriousness of the symptoms. The goals of treatment are to prevent life-threatening complications that may occur soon after stroke symptoms develop, prevent future strokes, reduce disability, prevent long-term complications and help the patient get back as much normal functioning as possible through rehabilitation.