April 24, 2019

Ischemic and Hemorrhagic – Two Types of Strokes

By Brooks Stewart, MD

brain MRIStroke is brain damage resulting from a problem with the brain’s blood supply. Symptoms may be transient or short-lived (called TIA, or transient ischemic attack), or they may become permanent if irreversible damage occurs to brain tissue (called stroke, or cerebrovascular accident). Broadly speaking, there are two types of strokes.

Ischemic Stroke

Eighty percent of all strokes are ischemic. An ischemic stroke is caused by a lack of blood flow to brain tissue, typically from a blood clot in one of the blood vessels to the brain. For ischemic strokes, the particular blood vessel that is involved (and thus which portion of the brain is most affected) will determine the exact symptoms.

Hemorrhagic Stroke

A hemorrhagic stroke is the result of the spontaneous rupture of a blood vessel in the brain, causing bleeding, or hemorrhage, directly into the brain. Twenty percent of strokes are hemorrhagic. For hemorrhagic strokes, the particular region of brain where the bleeding has occurred (and what that region controls) will determine the symptoms.

Common Stroke Symptoms

  • Speech and language problems. This can be slurred speech or problems with the production or comprehension of language. Patients can be completely nonverbal or have nonsensical speech and may seem confused because of this.
  • Facial weakness or numbness. Symptoms may produce facial droop, facial asymmetry or drooling.
  • Extremity weakness or numbness affecting one side of the body. This can affect the arm, leg or both.
  • Visual disturbances. This could include blurry vision, double vision, sudden loss of vision or decreased peripheral vision to one side or the other.
  • Balance and coordination. Unsteadiness or problems walking may occur.
  • Dizziness and vomiting. Patients may have unsteadiness or vertigo, which is the sense of movement that is not truly occurring, often perceived as a spinning sensation. Frequently this is associated with nausea and vomiting.
  • Sudden loss of consciousness or confusion. Although there are a variety of non-stroke problems that can cause loss of consciousness and confusion, certain types of stroke can do this also.
  • Headache and seizure. Although not typical with ischemic stroke, headache is common with hemorrhagic stroke. Likewise, seizure is also more common with hemorrhagic stroke.

The signs and symptoms of stroke are generally similar among men, women and children. The one exception is that infants less than one year of age are more likely to present with seizure and decreased responsiveness compared to older children and adults.

Addressing acute stroke depends on quick recognition and seeking medical care as soon as possible. An easy way to remember the most common signs of stroke is with a simple mnemonic called “BE FAST.”

Treatment and Disabilities

Of course, the best way to treat stroke is to prevent stroke. Diabetes, high blood pressure, high cholesterol, obesity and use of tobacco products are all things that can be treated or modified, in turn reducing a person’s risk of stroke in the future. Routine follow up with a primary care provider is the best way to screen for and address these risk factors.

Available treatment strategies for stroke hinge on arriving to medical care as soon as possible. A transient ischemic attack can be a warning sign of impending stroke, so even with symptoms that come and go, patients should be evaluated as soon as possible. Particularly with ischemic stroke, there are treatment methods that have strict time limitations, so the sooner a patient can arrive to the hospital, the more likely we are to have options available for treatment. Although these treatments (which can include medications designed to dissolve blood clots, as well as mechanical techniques to remove blood clots) cannot completely reverse the effects of stroke, a higher percentage of treated versus non-treated patients will have a desirable neurologic outcome.

Disability from stroke can have long-lasting effects on a person’s daily living and quality of life. Although most stroke patients will improve with time, studies have shown that early intensive rehabilitation treatment is the best way to facilitate improvement. This type of treatment, which can include speech therapy, cognitive therapy, physical therapy and occupational therapy, is started as soon as possible, generally in the hospital setting.

After acute hospitalization, patients with milder deficits may be able to continue therapy at home, whereas patients with moderate to severe deficits may benefit from intensive inpatient rehabilitation, like what can be provided in a skilled nursing facility. In addition to determining the level of rehabilitation treatment needed, a patient’s care team will also concentrate on secondary prevention, which involves addressing a person’s risk factors to reduce the risk of future stroke events.

Brooks Stewart, MD, is an emergency department physician practicing at Mission Hospital McDowell.

To learn more about stroke services at Mission Health, visit missionhealth.org/stroke.