Stroke, which can be described as a "problem with the brain's plumbing," can cause symptoms ranging from barely noticeable to completely disabling, even fatal. Every second from the onset of stroke to treatment can make a difference, often between life and death. That’s why Yale Medicine strives to provide patients with immediate, state-of-the-art interventions and the full support of a comprehensive medical team to help manage their recovery. 

The Yale Medicine Stroke Center brings together specialists from various departments and specialties, to create an individualized treatment plan for each patient. We have a dedicated catheter lab that allows patients with ischemic stroke to be quickly transferred for immediate treatment.

“Stroke is a problem with the brain’s plumbing,” says neurologist David Greer, MD, at Yale Medicine. “There are different types of strokes—one where you have blocked plumbing, and one where you have burst plumbing.” The two types of strokes are:

Ischemic: The most common type of stroke (accounting for 87 percent of all strokes) is an ischemic stroke. As a case of “blocked plumbing,” the stroke occurs when a blood clot occludes a blood vessel or artery, and the area of the brain that is deprived of blood by this blocked flow begins to die.

Hemorrhagic: Hemorrhagic strokes are cases of “burst plumbing.” A blood vessel inside the brain ruptures, causing blood to spill into the brain. Hemorrhagic strokes are more rare than ischemic strokes, but they also are more likely to be fatal.

While some strokes cause clear and immediate problems with movements or speech, they are usually not painful, so the sufferer may not even know that something has gone wrong. Often, a patient’s family is the first to notice symptoms such as:

• Droopiness of the face
• A loss of or change in ability to speak
• Weakness in an arm or leg
• Numbness in an extremity
• Vision problems such as loss of vision or double vision
• Coordination problems, including difficulty walking

The acronym FAST is sometimes used to remind patients and their families about the major signs of stroke and the need for immediate action. FAST stands for:

• Face: facial numbness or drooping
• Arm: arm numbness or weakness
• Speech: speech is impaired or slurred
• Time: time to call 9-1-1 quickly

When a patient enters the hospital with possible symptoms of a stroke, the first thing the doctor will do is take a full health history and conduct a standard neurological exam, during which a patient is asked to go through a few noninvasive tests to demonstrate neurologic function.

The next step is to see what is going on inside the brain through imaging, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI). By looking into the brain, doctors are able to establish where the stroke is situated, whether the problem is ischemic or hemorrhagic (in other words, whether it’s a problem of a clogged blood vessel or a burst blood vessel), and when the stroke started.

Anyone of any age or background can have a stroke. But there are some factors that increase the risk.

Age. The risk of having a stroke doubles every 10 years after age 55. But in rare cases, young people and even babies can have strokes.

Genetics. There is evidence that some strokes may be brought on by a combination of hereditary and lifestyle factors, including high blood pressure, diabetes or abnormally high cholesterol.

Lifestyle. Smoking, obesity, lack of exercise and drug use (particularly cocaine and amphetamines) have all been connected to a higher risk of stroke.

Sex. Women are statistically at greater risk of having a stroke and dying from a stroke. About 1 in 5 women will have a stroke in her lifetime and strokes kill twice as many women annually as breast cancer. Risk factors unique to women may include hormonal birth control use, which has been linked to a slightly higher risk of developing blood clots in all areas of the body, particularly for smokers and women over 35 years old. A history of preeclampsia (high blood pressure during pregnancy) is also a risk factor unique to women.

The treatment approaches for stroke will depend on what kind of stroke has occurred.

Hemorrhagic strokes. If a blood vessel has ruptured, a doctor will first attempt to bring down the patient’s blood pressure. (The higher the blood pressure, the worse the brain bleeding will be.) The doctor will first try to determine if the patient is on any blood thinners and may try to counteract the effects of the blood thinners through the use of reversal agents. If the patient’s brain is swollen, doctors may also use anti-swelling agents that keep the brain from absorbing water and decrease pressure in the brain.

Ischemic strokes. To repair a clogged blood vessel, doctors may administer tPA (tissue plasminogen activator), which is currently the only clot-busting medication approved by the Food and Drug Administration. This is given intravenously up to four and a half hours after an initial stroke.

Another option is microsurgery, in which a narrow tube called a catheter is inserted into the clogged vessel to physically clear the blockage and allow blood to flow freely. This method can be used up to 12 hours after a stroke.

Surviving a stroke is just the first part of a long journey to recovery. After a patient is stabilized, he or she will need to see her doctor again to assess his or her level of physical and mental functioning and develop a treatment plan to help bring him or her back to the best possible quality of life.

Each patient’s recovery journey is different, dependent on the severity of the stroke, the parts of the brain affected, and the patient’s approach to rehabilitation and ongoing therapy. At the Yale New Haven Stroke Center, our team of physicians, nurses and therapists collaborates to create a customized plan that takes into account the individual needs of the patient.

Physicians at the stroke center also are on call to video conference with physicians at nearby hospitals, who rely on Yale Medicine’s expertise to help their patients.

Yale Medicine’s dedicated catheter lab also allows patients who enter the hospital with an ischemic stroke to be quickly transferred for immediate catheter treatment.

And in order to help patients recover and return to their lives after a stroke, our doctors use a multidisciplinary approach to treatment, bringing together neurologists, neurosurgeons, occupational therapists, physical therapists, speech therapists, nurses, and nurse practitioners.