Neurocritical Care

NCC Q&A - Stroke

  1. What is a stroke?
    There are several different kind of strokes:
    1. Ischemic Stroke: this is caused by lack of blood flow to parts of the brain due to blockages of the arteries in the brain. A stroke is like a heart attack, but in the brain. Depending on what part of the brain is denied adequate blood flow, symptoms unique to that area of the brain will develop. Risk factors for ischemic stroke include diabetes, high blood pressure and smoking.
    2. Hemorrhagic Stroke: Caused by bleeding in the brain. The biggest risk factor for this type of stroke is high blood pressure. Bleeding in the brain can cause similar symptoms to strokes where there is a lack of blood flow.
  2. What are the symptoms of stroke?
    Stroke symptoms vary and depend on what area of the brain is affected. Ischemic and hemorrhagic stroke can present very similarly.  Some symptoms can include weakness on one side of the body, difficulty speaking, changes in vision, feeling off balance when walking, vertigo (sensation of room spinning), just to name a few.
  3. How is stroke diagnosed?
    When a patient presents with symptoms concerning for stroke, a CAT scan of the head is done to look for signs of stroke. Hemorrhagic stroke can easily be seen on CAT scan.   Early ischemic stroke (within 6 hours of symptoms onset) is not usually seen on CAT scan. However, treatment is based on symptoms, not on what is seen on CAT scan unless the scan shows that a stroke has been present for a long time.
  4. How is stroke treated?
    Treatment for stroke varies, depending on the type of stroke.
    1. Ischemic stroke: if patients are early enough in their stroke (3-4½ hours), sometimes a clot-busting medicine can be used to improve blood flow. Otherwise, treatment is focused on appropriate blood pressure control and minimizing risk factors for further stroke. For very large strokes, sometimes surgery is done to help control swelling of the injured brain.
    2. Hemorrhagic stroke: the initial treatment for hemorrhagic stroke is control of blood pressure as high pressures can worsen bleeding. Other interventions that are sometimes needed include surgery to evacuate the blood from the brain.
  5. Why do some patients with stroke need an intensive care unit for treatment?
    Some strokes affect either very large portions of the brain, or smaller areas of the brain that are responsible for vital functions. With some stroke, patients are very sleepy and sometimes are not awake enough to protect their airways. Some patients need breathing tubes and help from a ventilator. Other patients may require a special catheter to measure pressure within the brain or to help drain blood from the brain.  When patients have strokes they are at risk for swelling around the area of injured brain. Most swelling happens within 3-5 days after the initial stroke. This is the time period when patients need the most intense monitoring as the swelling can cause them to feel drowsy and have difficulty with normal functioning.
  6. What is the recovery period for a stroke?
    Recovery from a stroke varies on the severity of the stroke. Patients with small strokes with minimal deficits can have a very short recovery time. Larger strokes or those with very significant deficits require months for rehabilitation. Often, there is some degree of functional recovery over time. Some patient require placement of an artificial airway (tracheostomy) in the neck along with a feeding tube through the stomach for long term assistance with breathing and nutrition, respectively.