For many people, the warning signs of a stroke — like numbness in the arm, confusion, loss of balance or trouble speaking and seeing — are unmistakable. But often, the underlying cause of these life-threatening medical events can be harder to uncover.
“Strokes are complicated because there’s no pain associated with it,” said Dr. Rishi Gupta, director of stroke and neurocritical care with Wellstar Health System. “Many people think they can sleep it off and they’ll be better in the morning.”
“However, if you are experiencing the signs of a stroke, the faster you get to the emergency room, the more likely it is that we can reverse disability.”
While the telltale symptoms may be similar to one another, all strokes are not alike.
At Wellstar, we know each and every stroke is different. That’s why our neuro team provides tailored care along with fast, life-saving treatment for all types of strokes, even the most complex cases.
Fight back against strokes and learn the difference between the three main types: ischemic, hemorrhagic and transient ischemic attack.
Types of Stroke
Not All Are the Same
Published on May 06, 2021
Last updated 11:22 AM May 06, 2021
If you are experiencing the signs of a stroke, the faster you get to the emergency room, the more likely it is that we can reverse disability.
- Dr. Rishi Gupta
Wellstar Director of Stroke and Neurocritical Care
Ischemic stroke
An ischemic stroke occurs when a blood vessel to the brain is blocked or becomes narrowed. By far, these are the most common type and account for about 87% of all cases, according to the American Stroke Association.
Fatty deposits lining the artery walls can cause a blockage in two ways:
- Thrombotic – A clot that develops in an artery that supplies blood to the brain.
- Embolic – A clot that develops elsewhere and is transported by the blood to a narrow brain artery. This is often caused by an irregular heartbeat, such as atrial fibrillation, which can lead to pooling and clotting of blood in the heart.
Hemorrhagic stroke
A hemorrhagic stroke is caused when a blood vessel leaks or bursts, and then bleeds in the brain. These are less common and account for about 13% of all stroke cases, according to the American Stroke Association.
Weakened blood vessels, often due to hypertension or an aneurysm, are the cause of a hemorrhagic stroke.
Like ischemic strokes, hemorrhagic strokes can occur in two different ways:
- Intracerebral – A blood vessel that bursts and bleeds within the brain.
- Subarachnoid – A blood vessel that ruptures and bleeds in the outside space surrounding the brain.
Transient ischemic attack
A transient ischemic attack (TIA), often called a mini-stroke, occurs when blood flow is temporarily blocked from the brain.While these medical episodes may not cause lasting damage, TIAs need to be taken seriously. TIAs can signal that a full-blown stroke is on the way, so it’s critical to get expert medical care right away.
No matter the type of stroke, calling 911 is still the quickest way to save a life and prevent lasting brain damage.
Want to take action before a stroke happens? Learn ways to lower your risk and stay ahead of strokes.
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Newsroom
Wellstar West Georgia Medical Center Receives Primary Stroke Certification
Wellstar West Georgia Medical Center recently earned Primary Stroke Certification from The Joint Commission.
Offered in collaboration with the American Heart Association/American Stroke Association, achieving Primary Stroke Center (PSC) Certification means the hospital is making exceptional efforts to foster better outcomes. It’s a signal to the community that quality of care provided meets the unique and specialized needs of stroke patients.
Joint Commission-certified PSCs adhere to a set of standardized performance measures. Organizations collect monthly data for each measure in the set, and the data is then submitted quarterly to The Joint Commission.
“This important certification as a primary stroke center demonstrates our team’s commitment to a higher standard of clinical service,” says Coleman Foss, Wellstar West Georgia Medical Center President. “Stroke patients can be confident in the quality and safety of care, treatment and services delivered at West Georgia Medical Center.”
West Georgia Medical Center joins Wellstar's network of other stroke-certified hospitals, including Comprehensive Stroke Centers Wellstar Kennestone and Wellstar North Fulton, other Primary Stroke Centers Wellstar Cobb and Wellstar Spalding, and Remote Stroke Treatment Centers Wellstar Douglas and Wellstar Paulding.
Highlights
Reducing Your Risk of a Stroke
While strokes have become relatively common—more than 795,000 people in the United States have a stroke each year, according to the Centers for Disease Control and Prevention—many risk factors for stroke can be managed in partnership with your healthcare provider.
Managing your risk factors
Factors that can increase your risk of experiencing a stroke include:
High blood pressure
Hypertension, or elevated blood pressure, increases the risk of a stroke. Stay up to date on your annual physicals to know your blood pressure levels, and if you have hypertension, talk to your provider about managing it. “High blood pressure is the most modifiable risk factor, meaning it’s the one that is most treatable and has the most impact on one’s risk,” said Wellstar Neurologist Dr. Ashis Tayal. “It is vastly underdiagnosed and when it is treated, it’s often undertreated.”
High cholesterol
Elevated cholesterol can lead to plaque buildup in the blood vessel and clotting in the blood, which can cause a stroke if the clot travels and blocks blood flow to the brain. Your primary care provider can help you monitor your cholesterol with a blood test and manage levels with medications or lifestyle changes.
Diabetes
People with diabetes are at increased risk of experiencing a stroke. Talk to your provider about diabetes screenings. If you are diabetic, discuss managing the condition in partnership with your provider.
Smoking
“Cigarettes accelerate atherosclerosis, or clogging in the arteries, and cause inflammation in blood vessels that then increases people’s risk of stroke and heart attack,” Dr. Tayal said.
Atrial fibrillation
Atrial fibrillation, a heart arrhythmia, can cause clots that then travel to the brain, leading to a stroke, according to Dr. Tayal.
While many of these risk factors can be controlled through medication or lifestyle changes in partnership with a healthcare provider, other risk factors for stroke are out of a person’s control. People of any age can experience a stroke, but stroke risk increases with age.
The risk of having a first stroke is nearly twice as high for Black adults as for white adults, and Black adults and Pacific Islander adults have the highest rates of death from stroke, according to the CDC. Hypertension is more common in Black patients, Dr. Tayal noted. People in rural communities may also experience higher rates of stroke due to limited access to healthcare and nutritious foods, he added.
To help lower stroke rates in our communities, Wellstar Community Health will distribute around 100 blood pressure cuffs in 2023 and educate community members about stroke risk and blood pressure monitoring at Wellstar Mobile Markets. The blood pressure cuffs can be used to monitor blood pressure at home so patients can work with their providers to take action against hypertension.
Recognizing a stroke
Learn the warning signs of a stroke, and if you notice any of these in yourself or someone else, be fast and call 911 right away.
Balance
Look for a sudden loss of balance or coordination. This can also appear as a sudden, severe headache or dizziness.
Eyes
Blurred vision, double vision or loss of vision can be signs of a stroke. If you think someone else may be having a stroke, ask if they are having trouble seeing out of one or both eyes.
Face
One side of the face may be feeling numb or appear to be drooping. Ask the person to smile and see if it appears uneven.
Arms
Check for sudden arm weakness or numbness. See if the person can lift both arms without one drifting downward.
Speech
Watch out for slurred speech or difficulty speaking. Ask the person to repeat a simple sentence to find out if they are having trouble talking.
Time
The more treatment is delayed, the more the brain is damaged. Don’t wait to seek care. If you notice any of these symptoms, call 911 immediately.
Highlights
Stroke prevention and the future of stroke care
This article was originally published on
Atlanta Business Chronicle on May 19, 2023.
Stroke is the fifth leading cause of death in the United States. The Georgia Department of Public Health reports the state had the 12th highest stroke death rate in the country. Georgia is also part of the “stroke belt,” an area of the southeastern United States with stroke death rates 30% higher than the rest of the nation.
As the leading — but preventable — cause of disability, stroke can happen at any age.
Stroke is a medical emergency, meaning the blood flow to an area of the brain is cut off, depriving brain tissue of oxygen and nutrients. When this happens, brain cells start to die and abilities controlled by that area of the brain, such as speech or muscle control, are lost.
New drugs and new advanced treatments — such as the Tigertriever and Artemis — are helping reduce the death and disability impact of stroke, as well as comprehensive care programs and innovative hospital partnerships that expand stroke services into rural areas.
Physicians from Wellstar Health System and the CEO of a hospital in northeast Georgia joined Atlanta Business Chronicle to discuss stroke prevention and the future of stroke care.
Panelists & moderator
- Dr. Rishi Gupta, Endovascular Neurologist and Co-Medical Director of Neuro Care
- Dr. Ashis Tayal, Vascular Neurologist, Wellstar, Director of Neuro Care Network
- Van Loskoski, CEO, Stephens County Hospital
- David Rubinger, Market President & Publisher, Atlanta Business Chronicle; Moderator
What is stroke, screening and secondary prevention
David Rubinger: Dr. Tayal, set the stage for us about the definition of stroke.
Dr. Ashis Tayal: A stroke is a sudden injury of the brain due to blockage or rupture of an artery in the brain. Injuries to the brain and disability can vary significantly.
The most common, ischemic stroke injury, is due to obstruction of an artery that causes a loss of blood flow to a critical part of the brain which damages the brain rapidly.
The other type of stroke is hemorrhagic stroke, where there’s a rupture of an artery, bleeding into the brain, or the surfaces of the brain, and that is called an intracerebral hemorrhage or a subarachnoid hemorrhage.
Rubinger: I think Americans have become a little better educated as to who’s at risk for stroke, but why don’t you walk us through that. Who would be a potential stroke candidate?
Tayal: High blood pressure, or hypertension, is the most common risk factor for both ischemic and hemorrhagic strokes. High blood pressure is an extremely common but controllable condition. Almost 80% of people have hypertension as they’re getting older.
Other risk factors include diabetes associated with elevated blood sugars causing accelerated blockage of arteries and high cholesterol, which can be related to diet and genetics.
Atrial fibrillation, a common heart arrhythmia that occurs as people get older, also places people at risk for the most severe and disabling types of strokes. And plaque buildup in specific arteries of the neck and brain also leads to an increased risk of stroke.
Smoking is another risk factor. Many adults still smoke despite a lot of progress in stroke treatment, and smoking puts people at risk for different types of stroke.
Rubinger: What about atmospheric things like stress and other areas like that? How does that play into it? Or do those things manifest themselves because of the other underlying physical conditions?
Tayal: I don’t view stress, in and of itself, as a risk factor for stroke. I think that’s more related to people’s environments and their own personalities and how they respond to stress. I do think people who are under undue stress can have poor lifestyle habits, and those poor lifestyle habits, whether poor eating habits, smoking, weight gain or lack of exercise, can lead to conditions that increase the risk for stroke.
Rubinger: So how is the healthcare system doing treating strokes? Do you believe that what’s going on at the primary care provider’s office is helping or do we have a way to go?
Tayal: In the United States, preventive care has improved the treatment of risk factors that lead to stroke, but communities must maintain routine checkups as many of the risk factors are silent.
There are improved treatments for hypertension, more aggressive treatment for diabetes, and more efforts at smoking cessation. Just the fact that we treat hypertension better than we did a generation ago has had a great impact on lowering the prevalence of stroke.
That being said, some of the most exciting work on stroke has often been done in the area of acute treatment of stroke with clot-busting drugs, catheter-based treatments and medications to protect the brain during an acute injury.
Rubinger: Has pharmacology gotten better in terms of the hypertension medicines that are out there? Have anti-cholesterol medicines improved in recent years?
Tayal: In the past, healthcare providers were often undertreating people with hyperlipidemia — high cholesterol — and not fully appreciating the benefits of significant reductions in cholesterol levels. For example, we’ve learned that driving cholesterol down into much lower ranges under 55 mg/dL can benefit our patients who have vascular disease as a cause for their stroke.
In the fight against high cholesterol, newer medications that prevent the absorption of cholesterol are now available. Recent developments have led to the discovery of a new underutilized class of drugs called PCSK-9 inhibitors that are highly effective.