Ischemic Stroke

Ischemic Stroke
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An ischemic stroke is death of an area of brain tissue (cerebral infarction) resulting from an
inadequate supply of blood and oxygen to the brain due to blockage of an artery.

Ischemic stroke usually results when an artery to the brain is blocked, often by a blood
clot or a fatty deposit due to atherosclerosis.

Symptoms occur suddenly and may include muscle weakness, paralysis, lost or abnormal
sensation on one side of the body, difficulty speaking, confusion, problems with vision,
dizziness, and loss of balance and coordination.

Diagnosis is usually based on symptoms and results of a physical examination, imaging

tests, and blood tests.

Treatment may include drugs to break up blood clots or to make blood less likely to clot
and surgery, followed by rehabilitation.

About one third of people recover all or most of normal function after an ischemic stroke.

Causes
An ischemic stroke typically results from blockage of an artery that supplies the brain, most
commonly a branch of one of the internal carotid arteries.
Commonly, blockages are blood clots (thrombi) or pieces of fatty deposits (atheromas, or
plaques) due to atherosclerosis. Such blockages often occur in the following ways:

By forming in and blocking an artery: An atheroma in the wall of an artery may

accumulate more fatty material and become large enough to block the artery. Or a blood
clot can form and block the artery when an atheroma ruptures (see Atherosclerosis: How
Atherosclerosis Develops ). Clots tend to form on a ruptured atheroma because the
atheroma narrows the artery and slows blood flow through it, like a clogged pipe slows
the flow of water. Slow-moving blood is more likely to clot. A large clot can block
enough blood flowing through the narrowed artery that brain cells supplied by that artery
die.

By traveling to another artery: A blood clot in the heart, a piece of an atheroma, or a

blood clot in the wall of an artery can break off and travel through the bloodstream
(becoming an embolus). The embolus may then lodge in an artery that supplies the brain
and block blood flow there. (Embolism refers to blockage of arteries by materials that
travel through the bloodstream to another part of the body.) Such blockages are more
likely to occur where arteries are already narrowed by fatty deposits.

Several conditions besides rupture of an atheroma can trigger or promote the formation of blood

clots, increasing the risk of blockage by a blood clot, such as the following:

Heart-related problems: Blood clots may form in the heart or on a heart valve
(including artificial valves). Strokes due to such blood clots are most common among
people who have recently had heart surgery and people who have a heart valve disorder
or an abnormal heart rhythm (arrhythmia), especially a fast, irregular heart rhythm called
atrial fibrillation.

Blood disorders: Some disorders, such as an excess of red blood cells (polycythemia),
make blood thick, increasing the risk of blood clots. Some disorders, such as
antiphospholipid syndrome and a high homocysteine level in the blood
(hyperhomocysteinemia), make blood more likely to clot.

Oral contraceptives: Taking oral contraceptives, particularly those with a high estrogen
dose, increases the risk of blood clots.

Another common cause of ischemic strokes is a lacunar infarction. In lacunar infarction, one of
the small arteries deep in the brain becomes blocked by a mixture of fat and connective tissuea
blood clot is not the cause. This disorder is called lipohyalinosis and tends to occur in older
people with diabetes or poorly controlled high blood pressure. Lipohyalinosis is different from
atherosclerosis, but both disorders can cause blockage of arteries. Only a small part of the brain
is damaged in lacunar infarction.
Rarely, small pieces of fat from the marrow of a broken long bone, such as a leg bone, are
released into the bloodstream. These pieces can clump together and block an artery. The resulting
disorder, called fat embolism syndrome, may resemble a stroke.
An ischemic stroke can also result from any disorder that reduces the amount of blood or oxygen
supplied to the brain, such as severe blood loss or very low blood pressure. Occasionally, an
ischemic stroke occurs when blood flow to the brain is normal but the blood does not contain
enough oxygen. Disorders that reduce the oxygen content of blood include a severe deficiency of
red blood cells (anemia), suffocation, and carbon monoxide poisoning. Usually, brain damage in
such cases is widespread (diffuse), and coma results.
An ischemic stroke can occur if inflammation of blood vessels (vasculitis) or infection (such as
herpes simplex) narrows blood vessels that supply the brain. Migraine headaches or drugs such
as cocaine and amphetamines can cause spasm of the arteries, which can narrow the arteries
supplying the brain and cause a stroke.

Clogs and Clots: Causes of Ischemic Stroke

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