## Stroke Types There are two major types of stroke: hemorrhagic and ischemic. A hemorrhagic stroke refers to bleeding occurring in the brain or in the space surrounding the brain (subarachnoid hemorrhage). Although bleeding in other spaces surrounding the brain may occur (subdural, epidural), this is usually not considered a stroke. An ischemic stroke occurs when there is occlusion of a blood vessel, resulting in lack of blood supply to an area of the brain and death of brain tissue (infarction). These two types of stroke, hemorrhagic and ischemic, have different possible mechanisms. ## Risk Factors ### Non-Modifiable: Things You Can't Change - Previous Stroke or TIA - Age - Gender - Race - Family history ### Modifiable: Things You Can Change - High blood pressure **\#1 risk factor** - Smoking - Atrial fibrillation - Diabetes - Physical inactivity - Being overweight / have obesity - High cholesterol - Alcohol and drug abuse ## Stroke Prevention After a stroke occurs, the most effective way to prevent a recurrent stroke (secondary prevention) is to treat risk factors. Vascular risk factors include diverse diseases and conditions that have been associated with increased risk of stroke. There are risk factors that can be modified and others that are non-modifiable. Treatment focuses on influencing modifiable risk factors, including hypertension, diabetes, hyperlipidemia, [smoking](/programs/smoking-cessation), physical inactivity, obesity and carotid artery disease. When a patient has a stroke, the next step after acute treatment is provided is to attempt to identify the most likely cause of the stroke. Patients undergo different tests including imaging of the brain with computerized tomography (CT), and/or head magnetic resonance imaging (MRI) and of the blood vessels of the neck and head with angiography (CTA, MRA, and angiogram), transcranial doppler, and/or carotid ultrasound, and of the heart with TTE and/or TEE. In addition, several blood tests are obtained to evaluate blood sugar, lipid levels, and other conditions that may increase the risk of stroke. The type of tests recommended will vary for each patient, depending on the individual circumstances. Identification of the stroke type and mechanism will lead to specific therapies in most cases. Regardless of the type of stroke, assessment for the presence of modifiable vascular factors is done in every patient. If present, effective treatment of these risk factors will reduce the risk of recurrent stroke. However, effective treatment implies achieving therapeutic goals, which in turn depends on patient understanding of treatments, compliance with medications and recommendations, and close follow up with a vascular neurologist and primary care physician. The benefit of treating risk factors may vary, depending on the type of stroke. ### Physical Activity and Stroke Prevention A sedentary lifestyle is associated with an increased risk of stroke, and it does complicate recovery in patients who have suffered the stroke. Although the precise mechanisms underlying this association are uncertain, exercise improves control of other risk factors (high blood pressure, abnormal blood lipid levels, and diabetes). The American Heart Association recommends regular physical activity to eliminate some of the risk factors for stroke. Specifically, regular moderate physical activity (jogging, hiking, running, biking, brisk walking) can reduce high blood pressure, increase "good" cholesterol, and help to loose weight and lower the risk of diabetes. Guidelines by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health recommend moderate exercise for 30 minutes on most, and preferably all, days of the week. In the case of stroke prevention, the benefits are apparent even for light to moderate activities, such as walking and gardening, and the data support additional benefit from increasing the level and duration of such an activity. ## Stroke Warning Signs The following are common symptoms of stroke. If you are experiencing any of these symptoms, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately. - Sudden numbness or weakness of the face, arm or leg, especially on one side of the body - Sudden confusion, trouble speaking or understanding - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden, severe headache with no known cause If you suspect that a family member or loved one is suffering a stroke, it is important to act F.A.S.T. Ask the person to do the following: - **Face** - check for facial droop or an uneven smile - **Arm** - observe if one arm lags behind, or is not raised as high as the opposite arm. Also check to see if the person is unable to maintain both their arms at equal height. - **Speech** - Ask them to repeat a simple sentence, such as "today is a sunny day." Check if the person's speech is altered or slurred, or if they have difficulty understanding. - **Time** - Call 911 and get to the hospital immediately. It is possible that these symptoms occur transiently for several minutes or a few hours and may go away. This could be a transient ischemic attack (TIA) and is considered a mini stroke. Do not ignore any of the warning signs as they are considered high risk that another stroke may occur. Please call for medical help immediately. ### FAST Presentation .carousel-control.right,.carousel-control.left{background-image:none;color:#c53110;padding-top:25%} ![Think FAST to Recognize a Stroke](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide1.JPG) ![If you suspect someone is having a Stroke dial 911. At Boston Medical Center follow your departments emergence medical protocol: call a Code Stroke 4-7777 or proceed out 4-7777.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide-2.JPG) ![About 795,000 Americans each year suffer a new or recurrent stroke.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide3.JPG) ![Stroke is the 5th leading cause of death and the leading cause of serious long term disability costing the US $33 Billion dollars each year.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide4.JPG) ![37% of all Americans cannot accurately identify even one warning sign for stroke. Can you?](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide5.JPG) ![Why do you need to know how to identify a stroke? Recognizing a stroke can save a life.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide6.JPG) ![What is a stroke? Sometimes called a brain attack, stroke occurs when blood supply to the brain is blocked or a blood vessel in the brain bursts. In either case, parts of the brain can become damaged, or die. Two types of stroke: Blood clot (ischemic) most common!; Bleeding (hemorrhagic). A stroke can cause lasting brain damage, long-term disability, or even death. ](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide7.JPG) ![A TIA (trans ischemic attack) is also known as mini-stroke, or a warning stroke. A TIA can temporarily produce stroke like symptoms. This type of stroke is also an emergency and requires medical attention. A TIA presents an opportunity to make lifestyle changes to prevent stroke. ](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide8.JPG) ![Every single minute that the blood supply to the brain is blocked or there is bleeding in the brain causes further damage, causing long term disability affecting things like walking and talking. The longer the person waits to get medical help, the worse the outcome.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide9.JPG) ![You can recognize a stroke FAST! FAST is an easy way to remember the sudden signs of a stroke. When you spot even one sign, you’ll know quickly that you need to call the emergency response protocol for your area.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide10.JPG) ![FAST - Is it a stroke? Check these signs FAST! Face - does the face look uneven? Arm - or does one arm drift down? Speech - or does their speech sound strange? Time - then its time to call 911.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide11.JPG) ![Face: Ask the person to smile. Is the smile uneven? Does one side of the face droop?](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide12.JPG) ![Arm - Is one arm weak? Ask the person to raise both arms. Does one arm drift down? Even slightly?](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide13.JPG) ![Speech - Ask the person to repeat a simple sentence. Such as: The sky is blue in Boston. Are they having trouble speaking? Finding words, slurring words, Garbled speech - Is the person having difficulty understanding simple commands?](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide14.JPG) ![Time - If the person has any one of these signs, (even if the signs go away) then it is time to call for immediate medical help. Stroke is an emergency. Remember every single minute that passes reduces the persons chance for a good outcome.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide15.JPG) ![FAST is: Face, Arm, Speech, Time.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide16.JPG) ![REMEMBER: If you Suspect Someone is having a Stroke, At Boston Medical Center follow your departments emergency medical protocol Call a Code Stroke 4-7777, or Proceed out 4-7777; Outside of BMC, dial 911](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide17.JPG) ![Unsure? Call anyway! Don’t wait! False alarms are ok!](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide18.JPG) ![Summary - With a stroke, acting fast is very important! The FAST acronym is a quick way to recognize stroke symptoms. If you suspect a stroke (even if you are not sure) call for immediate help! At Boston Medical Center follow your departments emergency medical protocol: Call a Code Stroke 4-7777, or Proceed out 4-7777; Outside of BMC, dial 911.](https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/FAST/Think-FAST-Slide19.JPG) Previous [Next](#thinkFAST) ## Departments and Programs Who Treat This Condition department### [Neurology](/departments/neurology) A department providing specialized evaluation and treatment for a wide range of brain and nerve conditions, including stroke, Parkinson’s disease, epilepsy, headaches, memory loss… department### [Neurosurgery](/departments/neurosurgery) A department providing neurosurgical surgery and care, including evaluation and treatment for stroke, Parkinson’s disease, epilepsy, and other conditions affecting the brain and n… department### [Stroke and Cerebrovascular Center](/departments/neurology/stroke-and-cerebrovascular-center) A comprehensive stroke center within the Department of Neurology providing advanced stroke treatment for ischemic and hemorrhagic stroke with expert cerebrovascular care. department### [Interventional Neuroradiology](/departments/neurology/interventional-neuroradiology) A program within the Department of Neurology providing interventional neuroradiology care to diagnose and treat conditions such as aneurysms and stroke using minimally invasive, i… department### [Vascular Neurosurgery](/departments/neurosurgery/vascular-neurosurgery) A program within the Department of Neurosurgery providing cerebrovascular neurosurgery for conditions such as brain aneurysm, arteriovenous malformations, stroke, and vascular bra… department### [Cardiovascular Center](/departments/cardiovascular-center) A department providing cardiology care for heart and vascular conditions, including coronary artery disease, heart failure, arrhythmias, valve disorders, and vascular disease, wit… department### [Vascular Medicine Center](/departments/cardiovascular-center/vascular-medicine-center) A center providing vascular care, including diagnosis and treatment for conditions such as peripheral artery disease, aneurysms, and blood vessel disorders, with coordinated servi… department### [Physical and Occupational Therapy](/departments/physical-and-occupational-therapy) A department providing personalized PT/OT, physiotherapy, occupational therapy, and sports rehab to support recovery and mobility, helping patients regain function, build strength… department### [Occupational Therapy ](/departments/physical-and-occupational-therapy/occupational-therapy) A program within the Department of Physical and Occupational Therapy helping patients improve daily living skills, regain independence, and adapt to physical or cognitive challeng… department### [Physical Therapy](/departments/physical-and-occupational-therapy/physical-therapy) A program within the Department of Physical and Occupational Therapy providing physical therapy (physio) to help patients recover from injury, improve movement, and manage pain th…