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What Is A Stroke?

A stroke is a general term used to describe an injury to the brain caused by either bleeding ("hemorrhagic") or a lack of oxygen ("ischemic"). While people have used this term for many different conditions, it usually implies some type of permanent injury to the brain. The term "infarct" (or infarction) can also be used to describe a stroke.

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Types Of Stroke

Ischemic stroke

is usually caused by atherosclerosis (hardening of the arteries), embolism (obstruction of blood vessels by blood clots from elsewhere in the body), or microangiopathy (small artery disease, the occlusion of small cerebral vessels)

Hemorrhagic stroke

is usually caused by high blood pressure, arteriovenous malformation, cerebral aneurysms, and trauma.

Watershed strokes

are usually the result of poor blood flow to the brain from occlusion of the arteries in the neck (from atherosclerosis) or periods of poor cardiac function, such as during a heart attack.

What Causes A Stroke?

The cells in the brain are very delicate and require a steady supply of oxygen, and even brief interruptions in the delivery of oxygen can result in injury to them.

There are three major categories of causes for strokes: -
  • First, the blood supply to the brain may be blocked - tiny clots (emboli or thrombi) may plug the vessels that bring blood to parts of the brain, or the vessels themselves may be narrowed, reducing the amount of blood to the brain (as is seen in Moyamoya Syndrome, for example).
  • Second, the blood may not have enough oxygen in it to begin with (as in cases when someone can't breathe for long periods of time or in the setting of carbon monoxide poisoning) or the blood may not be circulating fast enough to bring fresh oxygen to the brain (as might occur if the heart is not beating appropriately).
  • Lastly, the brain itself might be under pressure (as occurs in brain swelling after trauma or when there is bleeding around the brain) or there may be bleeding within the substance of the brain itself, which directly injures the brain tissue and also makes it harder for blood with oxygen to be delivered to it. In these cases of increased pressure, the blood with oxygen from the heart cannot enter the confines of the skull if the pressure is too high.

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What Are The Symptoms Of A Stroke?

The loss of function of parts of the brain injured by stroke can be observed by the effects on the patient. The symptoms (deficits) that the patient will have will depend on which part of the brain has been injured by the stroke.

Some parts of the brain can suffer strokes with little or no recognizable symptoms, even if injury can be seen on MRIs or CT scans (so-called 'silent' strokes). Other strokes, even very small ones, can cause devastating symptoms, such as paralysis, blindness or even death, if they occur in sensitive areas of the brain.

How Are Strokes Treated?

The treatment of a stroke has two parts: -
  • First, the underlying cause of the stroke (such as high brain pressure, narrowed blood vessels or an increased tendency of the blood to clot inappropriately) should be diagnosed and corrected, if possible.
  • Second, regardless of the cause of the stroke, the problems that result from the stroke (weakness, numbness, etc.) can sometimes be improved with therapy over time. Identifying which patients may benefit from specialized therapy might require evaluation by specific health care professionals, such as neurologists, rehabilitation medicine physicians, or physical, occupational or speech therapists.
  • At Children's Hospital Boston, the Department of Neurosurgery works with many other health care teams here in a multidisciplinary effort dedicated to the treatment of children with strokes.

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