Dr. Alireza Minagar Explains the Types of Stroke

Stroke is a major concern of Waco residents. It is a common neurological emergency affecting up to 795,000 Americans each year, particularly in the South where both heat and obesity are higher than average. Stroke is one of the leading causes of long-term disability in the United States and abroad. Up to 140,000 Americans may die each year as a result of stroke. Uncontrolled high blood pressure is a major risk factor for stroke. Other risk factors include diabetes mellitus, heart disease, high serum cholesterol, and smoking.

While strokes are extremely serious and can leave permanent damages, some patients are able to make a full recovery if they are treated promptly and aware of the early warning signs. Dr. Alireza Minagar, a board-certified neurologist, explains the different types of strokes and offers treatment options for each one when available.

Ischemic Stroke

The ischemic stroke is the most common, accounting for 87 percent of strokes in the United States. This type of stroke happens when a blood vessel which supplies blood to the brain becomes obstructed.

Fatty deposits in the blood vessels, such as those which cause atherosclerosis or hardening of the arteries, obstruct the passage of blood and deprive the brain of much-needed oxygen and nutrients.

The two types of vessel obstruction related to fatty deposits are cerebral thrombosis and cerebral embolism. In cerebral thrombosis, a clot forms behind the fatty deposit in the blood vessel. In cerebral embolism, the blood clot forms in a certain area of the blood vessel and then travels to the brain. Irregular heartbeat or atrial fibrillation is a major cause of cerebral embolism.

Hemorrhagic Stroke

Roughly, 13 percent of strokes are of the hemorrhagic variety. Also known as a brain bleed, the hemorrhagic stroke occurs when a blood vessel weakened by uncontrolled high blood pressure ruptures or other reasons, ruptures. These strokes are caused by arteriovenous malformations and aneurysms. They can also be caused by head trauma.

In a hemorrhagic stroke, the blood flowing into the brain causes a compression of the tissues, causing brain damage. There are two types of hemorrhagic stroke: the intracerebral hemorrhage, which happens within the brain, and the subarachnoid hemorrhage.

The intracerebral hemorrhage can be devastating. Pressure on the brain causes brain cells to die, as does the disruption of the blood flow to these cells. Treatment for an intracerebral hemorrhage focuses on making the bleeding stop, removing the blood clot, and bringing relief to the pressure inside the brain.

A subarachnoid hemorrhage occurs when blood from a ruptured vessel flows into the space between the brain and the skull. This part of the body is filled with cerebrospinal fluid. When blood enters this area, it puts pressure on the brain in a similar manner to the intracerebral hemorrhage. Subarachnoid hemorrhages frequently happen when a patient has a ruptured aneurysm.

Subarachnoid hemorrhages are among the deadliest types of stroke. One-third of patients may be able to recover and resume a normal life. One-third of patients survive but are disabled. One-third of patients will die.

Treatment for the subarachnoid hemorrhage follows the same protocol as the intracerebral hemorrhage. The blood flow must be stopped, the blockages removed, and the pressure on the brain tissues relieved.

Arteriovenous Malformation

In arteriovenous malformation or AVM, blood vessels inside the brain or on its covering are defective. These tangles of blood vessels divert blood from the arteries to the veins, causing a lack of blood flow to the brain. These are spontaneously occurring problems which are generally not caused by genetics.

Brain AVMs are not common, appearing in less than 1 percent of the population. Males are more likely to have this problem than females.

AVMs cause intracranial hemorrhages in 50 percent of patients. Generalized or focal seizures occur in 25 percent of all cases. Patients may present with head pain targeted in the area of the AVM, and they may have problems with vision, movement, and speech.

Treatment of AVMs varies by the type and location. If the AVM is located in an area that is difficult to access and there are no symptoms, the patient may be advised to avoid too much exercise and to avoid taking blood thinning medications.

Stereotactic radiosurgery may help doctors treat AVMs which are not easily accessible for conventional surgery. In this type of surgery, lasers or high energy sources are used to cause the AVM to clot. It is also possible to operate on an AVM using endovascular neurosurgery, where a catheter is inserted in the brain and blocks off the abnormal blood vessels.

Warning Signs

The acronym FAST helps people remember the signs of a stroke. Face drooping, a patient unable to keep their Arm extended when it is held out to the side, and slurred Speech are warning signs. The final letter, T, reminds people that Time is of the essence in treating a stroke.

Neurologists like Alireza Minagar aim to help patients overcome the effects of a stroke. With proper treatment, patients can survive and live fulfilling lives.