The two main types of stroke are ischemic and hemorrhagic strokes. An ischemic stroke involves a blockage in a blood vessel, while a hemorrhagic stroke results from bleeding in or around the brain.

A stroke occurs when there is a sudden disruption to the blood and oxygen supply to a part of the brain.

Most strokes are ischemic strokes. They occur when a blockage prevents adequate blood flow to the brain cells.

Around 10–20% of strokes are hemorrhagic strokes. About half of all hemorrhagic strokes are subarachnoid hemorrhages, when bleeding occurs around the brain. The other half are intracerebral brain hemorrhages, when bleeding occurs inside the brain.

A person may also experience a transient ischemic attack (TIA), or ministroke. These usually last only a few minutes, but can be a warning sign of a major stroke to follow.

This article looks at the different types of stroke. It will also explore what causes each type of stroke, the potential symptoms of each, and some treatment options.

What is FAST, and what are the symptoms of a stroke?

A man holding his chests as he is experiencing one of the types of strokesShare on Pinterest
A person may have a stroke when there is a sudden disruption to the blood and oxygen supply to the brain.

An ischemic stroke is the most common type of stroke. It occurs when a clot in a blood vessel interferes with adequate blood flow to the brain. This can happen when a person has atherosclerosis, for example.

A blood clot that travels from the heart or the carotid arteries to a blood vessel in the brain may also cause an ischemic stroke.

Symptoms

Symptoms of an ischemic stroke include:

Risk factors

Anyone can have an ischemic stroke, but certain groups have a higher risk. Some risk factors include:

Treatment

There is currently no cure for ischemic stroke. Instead, urgent treatment focuses on removing the clot and preventing further brain damage.

The first line of treatment ideally includes a tissue plasminogen activator (TPA) or alteplase. Administering this treatment through a vein in the arm can help quickly dissolve the blood clot and improve blood flow to the affected area of the brain.

In some situations, it may be necessary to surgically dissolve or remove the clot using a procedure called a thrombectomy. Thrombectomy works best within 6 hours of stroke symptoms appearing, but it may improve outcomes up to 24 hours after a stroke.

During the first few days after an ischemic stroke, doctors will provide care that aims to reduce the likelihood of permanent damage, such as:

  • fluid management
  • blood pressure management
  • glucose management
  • anti-inflammatory medication, in some cases

A person will receive this care whether or not they have TPA or a clot removal.

A doctor may also give blood thinners, such as heparin, if the time window for TPA or surgical intervention has passed or if it is not suitable for the individual.

What are the first-line medications for a stroke?

Recovery

To help a person regain functioning and cope with the stress of having a stroke, they may need a variety of supportive treatments. These may include:

A doctor may also recommend making certain lifestyle changes, such as reducing the fat in their diet or exercising more often, to reduce the risk of experiencing another stroke.

Learn more about ischemic strokes here.

A hemorrhagic stroke occurs when a blood vessel either ruptures or leaks, causing bleeding into the brain. The blood that accumulates from the bleed compresses the surrounding brain tissue.

Like other strokes, a hemorrhagic stroke can cause rapid tissue death.

Symptoms

The symptoms of a hemorrhagic stroke are similar to those of an ischemic stroke and include:

  • numbness
  • loss of function, especially on one side of the body
  • drooping on one side of the face
  • trouble speaking
  • loss of consciousness
  • confusion
  • severe headache
  • seizure

Risk factors

Two possible causes of hemorrhagic stroke are aneurysms and arteriovenous malformations (AVMs).

An aneurysm is an enlarged, ballooning blood vessel. This change in a blood vessel’s size and shape increases the risk of it rupturing and bleeding.

Many people with aneurysms do not have symptoms, and most aneurysms will appear after the age of 40.

An aneurysm can be congenital or hereditary, or it may result from risk factors such as:

An AVM, on the other hand, is a misshapen blood vessel. An AVM is usually present from birth.

The misshapen blood vessel may rupture or bleed, causing a hemorrhagic stroke.

Treatment

Sometimes, a health professional can surgically remove the blood and repair the blood vessel. However, it is often necessary to manage hemorrhagic strokes with fluid control and monitor for effects such as seizures.

To reduce the risk of brain damage, a doctor may also give medication to control blood pressure.

Learn more about hemorrhagic strokes here.

A transient ischemic attack (TIA), sometimes called a ministroke, is similar to an ischemic stroke because it temporarily blocks blood flow to the brain. Treatment aims to prevent a recurrence, as a person who experiences a TIA has a higher risk of a major stroke in the future.

Symptoms

TIAs may cause symptoms similar to those of an ischemic stroke, including:

  • confusion
  • trouble walking
  • drooping on one side of the face
  • tingling or numbness

However, the symptoms tend to be less severe and last just a few minutes. Unlike an ischemic stroke, a TIA resolves on its own, when the clot either moves or dissolves.

Risk factors

The risk factors for a TIA are the same as those for an ischemic stroke and include:

  • being older
  • smoking
  • getting little exercise
  • having cardiovascular disease
  • having A-fib

TIAs occur before about 15% of strokes. This means that many people who experience a TIA will experience an ischemic stroke in the future.

Prevention

A person who has a TIA should talk with a doctor about lifestyle changes, medications, and other treatment options that can reduce the risk of experiencing an ischemic stroke.

Learn more about TIAs here.

When a health professional cannot determine the cause of disrupted blood flow to the brain, they call it a “cryptogenic” stroke. A doctor may make this diagnosis if extensive tests have not shown any stroke risk factors.

The symptoms of a cryptogenic stroke are similar to those of other strokes. However, treatment can be challenging because there is no clear underlying risk or cause.

For this reason, a doctor may perform a wide variety of diagnostic tests. They may also recommend lifestyle changes to reduce the risk of experiencing another stroke.

Brain stem stroke

A brain stem stroke is not a specific type of stroke, but it is an ischemic or hemorrhagic stroke that occurs in the stem of the brain. It can cause complex symptoms and be difficult to diagnose.

Some symptoms of a brain stem stroke include:

  • dizziness
  • confusion
  • numbness
  • trouble walking

Most strokes cause symptoms on only one side of the body. Brain stem strokes, however, may cause symptoms on both sides of the body. In some cases, they may even lead to paralysis.

Treatment for a brain stem stroke will be the same as for other strokes. It aims to remove the clot or stop the bleeding, depending on the likely cause. A brain stem stroke can also affect breathing, so emergency respiratory support may also be necessary.

Learn more about brain stem strokes here.

Health professionals recommend using the acronym “FAST” to recognize and quickly intervene when someone is having a stroke. FAST stands for:

  • F: face drooping
  • A: arm weakness
  • S: speech difficulties
  • T: time to seek emergency medical attention

A stroke is a medical emergency. The person must begin treatment as soon as possible.