CVA/Stroke, Brain Hemorrhage, Arteriovenous Malformation (AVM)

The two forms of cerebral vascular accident, or stroke, are ischemic (blockage of blood vessels that supply the brain) and hemorrhagic (bleeding into or around the brain).

Stroke symptoms can appear suddenly, often with more than one symptom at the same time:

  • Numbness or weakness on one side of the body 
  • Confusion or problems with speaking or understanding speech 
  • Problems with seeing in one or both eyes 
  • Problems with walking, or loss of coordination 
  • Dizziness or loss of balance 
  • Severe headache 

The appearance of multiple symptoms is a way to distinguish stroke from other causes of headache and dizziness.

Experiencing stroke is an emergency situation; call 911 immediately.

Ischemic stroke — About 85 percent of strokes are ischemic, and the two types of ischemic stroke are thrombotic stroke (when a blood clot forms in an artery that supplies blood to the brain) and embolic stroke (when a blood clot forms elsewhere and is then carried to and lodged in a brain artery).

Hemorrhagic stroke — The types of hemorrhagic stroke differ according to where in the brain they occur and the underlying cause. With respect to location, an intracerebral hemorrhage bleeds into the surrounding brain tissue and a subarachnoid hemorrhage bleeds into the space between the brain surface and skull.

The two main causes of hemorrhagic stroke are ruptured aneurysm (weakened blood vessel wall, resulting in ballooning of the wall) and arteriovenous malformation, or AVM (a generally congenital condition resulting in an abnormal connection between arteries and veins).

An intracerebral hemorrhage can be caused by high blood pressure, trauma, AVM or blood-thinning medications; a subarachnoid hemorrhage can be caused by the rupture of an aneurysm.

If You Think Someone Is Having a Stroke
When it comes to stroke, the best way to determine if someone is having one is to think FAST.

  • Face — Does the face look uneven? Ask the person to smile. 
  • Arms — Does one arm drift down? Ask the person to raise both arms. 
  • Speech — Does their speech sound strange? Ask the person to repeat a simple phrase. 
  • Time — If you observe any of these signs, it is time to call 911. 

These symptoms may indicate that a stroke has occurred — medical attention is needed immediately.

Diagnosing Stroke
Doctors at Houston Methodist will perform a physical examination and obtain a medical history, if possible. Blood tests will include those to determine blood-clotting time, levels of critical blood factors and blood sugar, and presence of infection. You may undergo imaging, such as computed tomography (CT), magnetic resonance imaging (MRI), carotid ultrasound or cerebral angiogram, to allow our doctors to get a better understanding of what type of stroke has occurred. We may also perform an echocardiogram to see if there are clots in your heart.

Treating Stroke
Emergency treatment will depend on whether you have an ischemic stroke blocking an artery or a hemorrhagic stroke bleeding into the brain.

In an ischemic stroke, our team will focus on restoring blood flow to the brain:

  • You may be given clot-busting drugs intravenously within three hours of your stroke.
      • Aspirin
      • Tissue plasminogen activator
Emergency treatment may include intracerebral injection of medicines or surgery to remove the blood clot. This may not be appropriate for all patients.

Our team may perform other procedures to reduce the chances of another stroke:

  • Carotid endarterectomy — Removes plaques from the arteries that run along each side of the neck to the brain. 
  • Angioplasty — A balloon is inserted through a blood vessel in the groin to expand the narrowed artery, and then a stent is inserted to support the opened artery . 

In a hemorrhagic stroke, our team will focus on controlling the bleeding and reducing the pressure in the brain:

  • If you take drugs to prevent blood clots (warfarin), you may receive drugs or blood product transfusions to counteract their effects. 
  • You may receive medications to decrease intracranial pressure in the brain, lower blood pressure, prevent vasospasm (spasm of blood vessels due to loss of blood) or prevent seizures. 

Once the bleeding stops, we provide supportive medical care while your body absorbs the blood.

Surgical treatment for a hemorrhagic stroke depends on the location, cause and extent of bleeding:

  • Surgical clipping can keep an aneurysm from rupturing, preventing a second round of bleeding. 
  • Coiling (or endovascular embolization) involves placement of tiny detachable coils into the aneurysm, which fills the aneurysm and blocks blood flow, causing the blood to clot. 

After emergency treatment, stroke care focuses on helping you regain strength, recover as much of your previous function as possible and return to independent living. We coordinate your physical therapy, whether it occurs on an outpatient basis, at home or in a short-term rehabilitation facility .

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