Ischemic Stroke
Ischemic stroke is an acute neurological emergency caused by blockage of a brain-supplying artery by a clot or atherosclerotic plaque, depriving brain tissue of oxygen and causing cell death. It accounts for about 85% of all strokes; time to treatment is critical.
Останнє оновлення: 2026-06-07
Definition
Ischemic stroke occurs when an artery supplying the brain is blocked, depriving brain cells of oxygen and glucose and causing them to die. It is also called cerebral infarction and accounts for about 85% of all strokes. Around the irreversibly damaged infarct core lies a region of reduced blood flow that is still salvageable (the penumbra); the main goal of treatment is to rescue this tissue.
Causes and Risk Factors
Ischemic stroke may arise from large-artery atherosclerosis, cardiac embolism (most often atrial fibrillation), small-vessel (lacunar) disease or less common causes. Key modifiable risk factors are hypertension (the most important), diabetes, high cholesterol, atrial fibrillation, smoking, obesity, physical inactivity and sleep apnea. Age, sex, family history and prior stroke/TIA are non-modifiable. Controlling risk factors can prevent a large proportion of strokes.
Symptoms
Symptoms usually begin suddenly and depend on the territory of the blocked artery. The public FAST mnemonic aids recognition: facial droop (Face), one-sided arm/leg weakness (Arm), speech difficulty (Speech) and calling emergency services without delay (Time). Additional features include one-sided numbness, sudden vision loss, double vision, dizziness, and impaired balance or gait. These signs require emergency evaluation.
Diagnosis
The first study is non-contrast brain computed tomography (CT) to exclude hemorrhage, which is mandatory before clot-dissolving therapy. Diffusion-weighted MRI (DWI) shows acute infarction early and sensitively. CT/MR angiography and, when needed, perfusion imaging identify the occluded vessel and guide mechanical treatment. After treatment, carotid Doppler, ECG, rhythm monitoring and echocardiography are used to investigate the cause.
Treatment
In the acute phase the goal is to reopen the blocked artery as early as possible. Eligible patients receive intravenous clot-dissolving therapy (thrombolysis) within the early time window. In large-vessel occlusion, mechanical thrombectomy (catheter-based clot removal) may benefit selected patients even in extended windows. Antiplatelet therapy is started early. For long-term prevention of recurrence, antiplatelet or (in atrial fibrillation) anticoagulant therapy, statins, blood-pressure and diabetes control, and lifestyle changes are used.
Prognosis and Rehabilitation
Outcomes are closely related to time to treatment, the location and size of the infarct, patient age and comorbidities. Early, effective treatment improves the chance of recovery. Rehabilitation (physiotherapy, occupational therapy, speech therapy) is important for functional gains, with most recovery occurring in the first months. Outcomes differ by patient and none is guaranteed.
Джерела
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1559-1572.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:3563-3572.
- Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke (AHA/ASA). 2019.
- Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke (HERMES meta-analysis). Lancet. 2016.
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