What are the Different Types of Stroke?
By Sidney Earley, NP
The month of May was stroke awareness month, but it is important all year long to understand stroke, a leading cause of death and serious, long-term disability. Stroke is an all-encompassing word for damage to the brain. Strokes are either ischemic, when a vessel supplying blood to the brain is obstructed, or hemorrhagic, the result of a weakened blood vessel that ruptures and bleeds into the surrounding brain.
The American Heart Association estimates that 87 percent of strokes are ischemic. The causes of ischemic stroke include plaque deposits in the vessels, irregular heartbeat, heart structure problems, and clotting disorders.
Plaque is substance that can build up in your vessels throughout your body. Plaque is made up of many components, with high cholesterol being the primary risk factor that contributes to plaque buildup. Plaque deposits narrow the vessels through which blood to passes, limiting the amount of blood necessary to supply the tissues. Plaque also can break off and block blood flow.
If you are diagnosed with high cholesterol, treatment is with a statin, a drug from the class HMG CoA reductase inhibitors. These medications work to help lower the cholesterol in the blood. Your medical provider also may place you on antiplatelet therapy; common medications include aspirin and Plavix. There are also tests that can be done to help identify if you have narrow vessels. However, these tests are not ordered routinely. If you are found to have a narrow vessel in your neck, for example, there are options to open the vessel including balloon angioplasty and the placement of a stent to keep the artery open. Imaging and treatment is determined by the patient’s care team.
Heart disease also can lead to stroke. Atrial fibrillation, the most common arrhythmia, increases the risk of stroke five times. Atrial fibrillation is an ineffective pumping of the top portion of the heart or the “atria.” When the atria can’t pump effectively, blood becomes stagnant and may result in blood clots that can travel to the brain, resulting in stroke. People with this type of heart rhythm usually are treated with a blood thinner to prevent from clot formation.
A stroke also can be the result of a patent foramen ovale (PFO), a hole in the heart that didn’t close the way it should after birth. PFOs allow blood clots to easily pass to the brain. Diagnosis is by echocardiogram, which creates an image of the heart using ultrasound. PFOs can be treated with aspirin, anticoagulants or catheter closure.
Hemorrhagic stroke, or bleeding in the brain, is the less common form of stroke. The two primary types are intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhages are most commonly caused by trauma, vascular malformation, and high blood pressure. Subarachnoid hemorrhage occurs in the area between the brain and its protective covering. Subarachnoid hemorrhages can either be traumatic, caused by an injury or accident, or nontraumatic, usually caused by the rupture of an aneurysm. Aneurysm rupture is responsible for subarachnoid hemorrhage in 80 percent of patients. An aneurysm is the outpouching of a vessel in the brain. A good analogy is a bulge in a tire on your car. Just as a tire may blow from the bulge, an aneurysm can burst and cause bleeding in your brain. Treatment options for aneurysms include embolization or blocking of the blood from entering the brain, which eliminate the risk of rupture.
For more information, or to take your free stroke risk assessment, go to https://www.centrahealth.com/neurology
* Neurointerventional radiology specializes in the diagnosis and treatment of vascular problems in the neck and brain, including narrow vessels, blood clots, and aneurysms via a catheter usually inserted in the wrist or groin.
Sidney Early is a Nurse Practitioner that works in Neurointerventional radiology at CMG-Neurology Center. Learn more from Sidney on our podcast – https://centrascripts.com/episode/lets-talk-about-stroke-month/