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Article Category: Highlights

Types of Stroke

Not All Are the Same

Published on May 06, 2021

Last updated 01:27 PM May 08, 2024

Image of a brain scan

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 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.

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 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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Rishi Gupta Stroke Care Neuro Care
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Cindy cutting vegetables in her home kitchen

PeopleCare

CindyCare

To say Cindy Mejia is “busy” is an understatement. 

She’s constantly crunching numbers as an accounting manager for a large research institute, trying out new recipes in her kitchen at her Roswell home, or trying to keep up with her little granddaughter (who just discovered how much fun it is to run).

But one Wednesday in September, Cindy woke up and reached for her computer, trying to get an early start to her workday. She felt a little groggy and couldn’t remember her password but didn’t immediately realize something was wrong.

Then she stood up. Her right arm and leg weren’t functioning, and that’s when Cindy knew what was happening—she was having a stroke.

“The first thing I thought was, ‘I need to get to Wellstar North Fulton right away,’” Cindy said. “I knew the hospital was nearby and has a good reputation.”

That decision ultimately saved her brain and life.

For Cindy, the critical care she needed was close to home, too—she lives four miles from Wellstar North Fulton Medical Center. There, her care team sprang into action, bringing her the treatment and peace of mind in a moment of crisis.

“From then on, I felt well taken care of,” Cindy said. “I was relieved, and I knew I was going to be OK.”

 

Cindy's close-to-home 'pit crew'

When a patient has a stroke, every second matters. Each minute that ticks by could be the difference between a permanent stroke and a return to routine. So at North Fulton, Cindy’s care team assembled quickly to save her brainpower.

“We’re like the pit crew on a NASCAR team,” said Dr. Ed Malcom, an emergency medicine physician at Wellstar North Fulton. “We have our emergency stroke care response down to a science. Everyone knows their role and works together to act quickly.”

Cindy was one of the first patients at Wellstar North Fulton to benefit from the hospital’s new addition to its stroke program. While the hospital has been a primary stroke center for years, the introduction of thrombectomies at the hospital gives patients a close-to-home, life-saving option for stroke care—saving them both time and brainpower.

A thrombectomy is a minimally invasive procedure used to unclog an artery, restoring blood flow to the brain and preventing further damage. It does not involve cutting of the brain but instead starts with the insertion of a catheter through the patient’s groin.

“Recently, we’ve developed our own capability right here in the North Fulton area to pull the clot out of the brain. That’s a giant leap forward,” Dr. Malcom explained. “It's good for the whole state because there's only a handful of hospitals that do that, and it's good for the residents that live in that North Fulton area to have a hospital so close. They don't have to take a helicopter ride somewhere to get that procedure done. It saves time.”

For Cindy, having that procedure just a few miles from her home, right when she needed it, helped save her brain function.

“If Cindy would have gone to a different hospital that didn't provide this care, then it would have been a long time before she was able to have blood flow restored to the brain,” Wellstar Neurosurgeon Dr. Benjamin Zussman said, explaining how critical each section was when it came to Cindy’s care. “The delay could have been 30 minutes or even an hour, and it's possible that she would have had permanent stroke, permanent damage to her brain instead of making the recovery she did.”

Offering thrombectomies at Wellstar North Fulton has brought long-needed stroke services to the area north of Atlanta, so patients like Cindy don’t have to travel into the city through busy traffic to get the treatment they need. 

Proximity to care is especially important for critical situations like strokes, said Dr. Rishi Gupta, director of stroke care at Wellstar.

“Any disease that is time-sensitive where patients need to get to the hospital quickly, get treated quickly—the geography is everything, particularly in bad weather when helicopters cannot fly,” he said, explaining how logistics can impact life-saving stroke care. “We need to be able to provide services in the communities the patients reside and the North Fulton program is uniquely positioned to do that.”

Signs of a stroke can include a loss of balance, dizziness, blurry vision or sudden vision loss, drooping in the face, arm or leg weakness, and difficulty speaking. Patients who experience any of those symptoms should call 911 and seek medical care right away. 

Cindy said she is glad she got to the hospital as soon as she could—“I am so thankful that I took quick action and that I had Wellstar so close.” At Wellstar North Fulton, she not only received the highest level of stroke care. Wellstar takes a multidisciplinary approach to stroke care, including specialists such as critical care specialists, neurologists, neurointerventionalists and physical therapists on the care team. 

“When you're feeling pretty healthy, you don't think a stroke can happen to you. It happens so quickly. You don't necessarily get a warning,” Cindy said, sharing the importance of listening to your body’s signals when it comes to health. “You can feel one way one day or one minute, and the next minute, it changes.”

Keep reading
Illustration of fruits and vegetables, people exercising, checklist on clipboard

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 team.

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 clinician 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 team 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 clinician about diabetes screenings. If you are diabetic, discuss managing the condition in partnership with your care team.

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 your care team, 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 75 blood pressure cuffs in 2025 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.

Learn more about stroke care at Wellstar.

Keep reading
Stephen, a Wellstar Kennestone Level I Trauma Center patient, pictured with his daughter, Hannah.

PeopleCare

StephenCare

Stephen Nowlin became unexpectedly paralyzed one day when preparing for a Fourth of July celebration with friends. A flight EMS team was called to transport him when the flight nurse on call, Hannah Carr, recognized the address of the accident—her childhood home. She flew her father to Wellstar Kennestone Regional Medical Center, a Level I Trauma Center, where he could have the fastest, most comprehensive trauma response—and a chance at full recovery.

When routine yard work went wrong

Preparing for his annual Fourth of July party, Stephen mowed his 13-acre property in Waco, Georgia. The routine chore took a terrifying turn when his mower flipped. Trapped underneath, he realized he was paralyzed. His friend soon discovered him lying there and called 911. 

Meanwhile, Stephen’s daughter, Hannah, was working that day as a flight nurse for a local air ambulance company. When the call came in about a 60-year-old man in a tractor accident, paralyzed, at her parents' address, she instantly knew who it was. Hannah and her air ambulance service partner were on their way. 

In good hands: first responders act fast

The local fire department and EMS arrived quickly, carefully removing the mower without moving Stephen. They transported him to a nearby landing zone where Hannah and her flight partner waited. As Stephen was loaded onto the helicopter, he told his daughter, “I just hope they can fix me.”

Hannah and her partner did a thorough, head-to-toe assessment for life-threatening injuries.

“I knew I was in good hands,” Stephen said. “She's going to take care of me better than anybody else would.”

On the flight to Wellstar Kennestone Regional Medical Center, a Level I Trauma Center, Hannah communicated with the hospital ahead of arrival. In emergency situations, it’s important the team is assembled and ready to perform care as fast as possible. Because of their collaboration, not a minute was wasted.

Keep reading
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