The University of Utah Stroke Center is a national, DNV-accredited leader in comprehensive stroke care. We are a dedicated team specializing in stroke treatment and available 24/7 for our patients. Our center offers an accredited specialty stroke rehabilitation program as well as providing care to rural and underserved areas via Telestroke (telemedicine).

If you recognize signs of a stroke, call 911 immediately.

Overview of Stroke

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot or piece of plaque blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution and requires close observation. 

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

According to the National Stroke Association, it is important to learn the 3 Rs of stroke:

  • Reduce the risk.

  • Recognize the symptoms.

  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.

Risk Factors for Stroke

Evaluating the risk for stroke is based on heredity, natural processes, and lifestyle. Many risk factors for stroke can be changed or managed, while others that relate to hereditary or natural processes cannot be changed.

Risk factors for stroke that can be changed, treated, or medically managed

Risk factors for stroke that cannot be changed

Other risk factors of stroke to consider

  • High blood pressure. The most important controllable risk factor for stroke (brain attack) is controlling high blood pressure (140/90 or higher). High blood pressure can damage blood vessels (called arteries) that supply blood to the brain. According to the CDC, reducing the systolic (or top number) blood pressure by 12 to 13 points can decrease the risk for a stroke by 37%.

  • Heart disease. Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors.

  • Diabetes mellitus. Diabetes is controllable, but having it increases the risk for stroke. People with diabetes have 2 to 4 times the risk of having a stroke than someone without diabetes. Blood pressure for people with diabetes should be 130/80 or less to reduce the risk of stroke. Talk with your health care provider on specific ways to manage your overall health and diabetes care.

  • Cigarette smoking. Apart from other risk factors, smoking almost doubles the risk for ischemic stroke (blockage of a blood vessel supplying blood to the brain). The use of oral contraceptives, especially when combined with cigarette smoking and migraine, greatly increases stroke risk.

  • History of transient ischemic attacks (TIAs). A person who has had one (or more) TIA is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.

  • High red blood cell count. A significant increase in the number of red blood cells thickens the blood and makes clots more likely, thus increasing the risk for stroke.

  • High blood cholesterol and lipids. High blood cholesterol and lipids increase the risk for stroke. High cholesterol levels can contribute to atherosclerosis (thickening or hardening of the arteries) caused by a buildup of plaque (deposits of fatty substances, cholesterol, calcium). Plaque buildup on the inside of the walls of arteries can decrease the amount of blood flow to the brain. A stroke occurs if the blood supply is cut off to the brain. Atherosclerosis is a slow, progressive disease that may start as early as childhood.

  • Lack of exercise, physical inactivity. Lack of exercise and physical inactivity increases the risk for stroke.

  • Obesity. Excess weight increases the risk for stroke.

  • Excessive alcohol use. More than 2 drinks per day raises blood pressure, and binge drinking can lead to stroke.

  • Drug abuse (certain kinds). Intravenous drug abuse carries a high risk of stroke from cerebral embolisms (blood clots). Use of cocaine and other stimulants have been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them, even among first-time cocaine users, have been fatal.

  • Abnormal heart rhythm. Various heart diseases have been shown to increase the risk of stroke. Atrial fibrillation (an irregular heartbeat) is the most powerful and treatable heart risk factor of stroke. About 15% of strokes occur in people with atrial fibrillation.

  • Cardiac structural abnormalities. Damaged heart valves can cause chronic heart damage, which can ultimately increase the risk of developing stroke. This is known as valvular heart disease. New evidence shows that heart structure abnormalities including patent foramen ovale and atrial septal defect may possibly increase risk for embolic stroke.

  • Age. For each decade of life after age 55, the chance of having a stroke more than doubles.

  • Race. African-Americans have a much higher risk of death and disability from a stroke than whites, in part because the African-American population has a greater incidence of high blood pressure.

  • Gender. Stroke occurs more frequently in men, but more women than men die from stroke.

  • History of prior stroke. The risk of stroke for someone who has already had 1 is many times that of a person who has not had a stroke.

  • Heredity or genetics. The chance of stroke is greater in people who have a family history of stroke.

  • Where a person lives. Strokes are more common among people living in the southeastern United States than in other areas. This may be due to regional differences in lifestyle, race, cigarette smoking, and diet.

  • Temperature, season, and climate. Stroke deaths occur more often during periods of extreme temperatures.

  • Socioeconomic factors. There is some evidence that strokes are more common among low-income people.

Treatment for Stroke

Medical treatment for stroke

Specific treatment for stroke will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Severity of the stroke

  • Location of the stroke

  • Cause of the stroke

  • Your tolerance for specific medications, procedures, or therapies

  • Type of stroke

  • Your opinion or preference

Although there is no cure for stroke once it has occurred, advanced medical and surgical treatments are now available, giving many stroke victims hope for optimal recovery and reducing the risk of another stroke.

Emergency treatments for stroke

Treatment is most effective when started immediately. Emergency treatment following a stroke may include the following:

  • Medications used to the dissolve blood clot(s) that cause an ischemic stroke. Medications that dissolve clots are called thrombolytics or fibrinolytics and are commonly known as "clot busters." These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within 3 hours of a stroke's onset, so get to the emergency department as quickly as possible.

  • Medications and therapy to reduce or control brain swelling. Special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a hemorrhagic stroke (a stroke caused by bleeding into the brain).

  • Medications that help protect the brain from damage and ischemia (lack of oxygen). Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.

  • Life support measures, including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications

Other medications used to treat or prevent a stroke

Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:

  • Medications to help prevent more blood clots from forming. Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation (clotting) of the blood. Medications of this type include, for example, heparin and warfarin and enoxaparin.

  • Medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together. Examples of this type of medication include aspirin, clopidogrel or dipyridamole.

  • Medications to treat existing medical conditions, such as diabetes, heart, or blood pressure problems.

    • These are numerous and your doctor(s) will develop a plan of care to include all your diseases. 

Types of surgery to treat or prevent a stroke

Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:

  • Carotid endarterectomy. Carotid endarterectomy is a surgical procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.

  • Carotid stenting. A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery. The femoral artery (in your groin area) is used as the site for passage of a special hollow tube to the area of blockage in the carotid artery. This procedure is often done in radiology labs, but may be performed in the cath lab.

  • Craniotomy. A craniotomy is a type of surgery in the brain itself to remove blood clots, relieve pressure, or repair bleeding in the brain.

  • Surgery to repair aneurysms and arteriovenous malformations (AVMs). An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring. The surgery may involve surgical clips placed on aneurysms to prevent them from rupturing (and thus causing life-threatening bleeding in the future) or tiny coils curled up inside the aneurysm. The coils are placed inside the aneurysm through a special catheter advanced mechanically through the arteries of the body from a puncture site, usually through the large artery located in the groin. An AVM may be treated not only surgically, but also through the use of new chemical substances commonly called glues, which clot off some of the blood vessels that are part of the AVM. Special energy waves known as gamma waves are part of a relatively new mode of radiosurgery, in which part of an AVM can be scarred (and thus prevented from bleeding in the future) by use of a tool known as a "gamma knife" or a "cyber knife." 

  • Patent foramen ovale (PFO) closure. The foramen ovale is an opening that occurs in the wall between the 2 upper chambers of a baby's heart before birth. It functions to provide oxygen-rich blood to the baby from the mother's placenta while in the womb. This opening normally closes soon after birth. If the flap does not close, blood flows from the right atrium directly to the left atrium (atriums are the top chambers of the heart). It then flows out to the central circulation of the body. If this blood contains any clots or air bubbles, they can pass into the brain circulation causing a stroke or transient ischemic attack (TIA). PFO closure procedure can be performed through a percutaneous (through the skin) approach. Signs and symptoms of a PFO may not occur until early or middle adulthood and may even go undetected. Currently, it is controversial as to whether a PFO ought to be closed, and current research studies are still trying to determine when and under what circumstances this should be done.

Constraint-Induced Therapy (CIT) for arm and hand paralysis after stroke

Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the nonaffected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.

  • CIT restraints are worn for up to 90% of the waking hours.

  • Restraints can be removed for activities, such as bathing.

  • Small steps are used to break down complex tasks, such as making a phone call.

  • Verbal and written feedback is used to help motivate and inform people undergoing CIT.

Safdar A. Ansari, M.D.

Dr. Safdar Ansari recently joined the Department of Neurology and Division of Neurocritical Care as an Assistant Professor. Prior to his move to Salt Lake City, Dr. Ansari completed his postgraduate medical training at the Baylor College of Medicine in Houston, Texas. He attended medical school at the Aga Khan ... Read More

Specialties:

Neuro Critical Care, Neurology, Stroke, Traumatic Brain Injury

Locations:

A location has not yet been added by this physician.

L. Dana DeWitt, M.D.

L. Dana DeWitt, MD is Medical Director for the Inpatient Neurology Service at University Hospital. She is also a member of the Brain Attack Team and interprets transcranial Doppler. She has had the honor of receiving awards as Best of Boston Magazine’s Top Docs for Women, Consumers’ Checkbook Top Docs, and Best ... Read More

Specialties:

General Neurology, Multiple Sclerosis, Neurology, Stroke, Transcranial Dopplers, White Matter Disease

Locations:

Clinical Neurosciences Center (801) 585-7575
Imaging and Neurosciences Center (801) 585-7575

John E. Greenlee, M.D.

John E. Greenlee, MD is Professor of Neurology and former Interim Department Chair. His areas of specialty are central nervous system infections, autoimmune disorders of the central nervous system, and stroke. Dr. Greenlee was one of the first individuals to recognize the role of the immune response in causing c... Read More

Specialties:

General Neurology, Infections of the Nervous System, Neurology, Neurovirology, Stroke

Locations:

Clinical Neurosciences Center (801) 585-7575

Holly K. Ledyard, M.D., M.S.

Dr. Holly Ledyard, Assistant Professor, recently joined the University of Utah Neurosciences Critical Care Unit. Prior to her arrival, Dr. Ledyard was a clinical instructor and an assistant professor of emergency medicine at the University of Cincinnati College of Medicine, while she also served as a faculty me... Read More

Specialties:

Emergency Medicine, Neuro Critical Care, Neuro Intensive Care, Neurology, Stroke, Traumatic Brain Injury

Locations:

A location has not yet been added by this physician.

Jennifer Juhl Majersik, M.D., M.S.

Dr. Majersik is an Associate Professor of Neurology at the University of Utah, School of Medicine. After receiving her B.S. in Physics from Harvey Mudd College (Claremont, CA), she served in the Air Force as a Scientific Analyst at Wright-Patterson Air Force Base National Air Intelligence Center. In 1997, she at... Read More

Specialties:

Hereditary Hemorrhagic Telangiectasia, Neurology, Stroke

Locations:

Clinical Neurosciences Center (801) 585-7575

David R. Renner, M.D.

In 2002, Dr. Renner joined the Department of Neurology faculty, where he currently holds a position as an Associate Professor of Neurology. Dr. Renner is the Director of the Adult Neurology Residency Program, the course director for medical school neurosciences (NEUROSCIENCE), and the course master for medical ... Read More

Specialties:

EMG, General Neurology, HIV/AIDS, Movement Disorders, Neurology, Neuromuscular Diseases, Stroke

Locations:

Clinical Neurosciences Center (801) 585-7575

Michael J. Wilder, M.D.

Michael Wilder, MD is an Assistant Professor in the departments of Radiology and Neurology. His practice focuses on the acute treatment of stroke and other disorders involving blood vessels of the head, neck, and spine using endovascular, minimally invasive, imaging-guided techniques. Dr. Wilder participates in ... Read More

Specialties:

Interventional Radiology, Neurology, Stroke

Locations:

Clinical Neurosciences Center (801) 585-1688

Jana Wold, M.D.

Dr. Wold is an Assistant Professor of Neurology at the University of Utah, School of Medicine. After receiving her B.S. in Biology from Westmont College (Santa Barbara, CA), she attended medical school at Loma Linda University where she fell in love with the grandiosity of the brain and fascinated by its clinica... Read More

Specialties:

Neurology, Stroke

Locations:

Clinical Neurosciences Center (801) 585-7575

University Campus/Research Park

Clinical Neurosciences Center 175 N. Medical Drive
Salt Lake City, UT 84132
Map
(801) 585-7575
Imaging & Neurosciences Center 729 Arapeen Drive
Salt Lake City, UT 84108
Map
(801) 585-7575
Moab Stroke Patient Makes Miraculous Recovery Thanks to TeleStroke

Moab Stroke Patient Makes Miraculous Recovery Thanks to TeleStroke

In the middle of a warm June night in 2010, Robert Russell awoke to a tingling sensation in his left arm. He thought perhaps his arm had gone to sleep, until he realized his left leg was also tingling. He tried to roll over, but discovered he wasn’t able to move. “I was worried,” says Robert, “I was ...

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