What Is a Massive Stroke?

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Ask the experts

I just read that an actor in my favorite show as a kid died from a “massive stroke,” according to news reports. He was in his 50s, which is scary because it seems young for a stroke. What is a massive stroke?

Doctor’s Response

A stroke is a damaging loss of blood supply to the brain, typically from a clot or bleeding in the brain. A massive one can be fatal, as in the unfortunate case of the actor you mention. Not all strokes affect the brain equally, and stroke symptoms and signs depend upon the part of the brain affected.

For example, most people's speech center is located in the left half of the brain so a stroke affecting the left side of the brain would affect speech and comprehension. It also would be associated with weakness of the right side of the body. A right brain stroke would make the left side of the body weak. And depending on where in the brain the injury occurred, the weakness could be the face, arm, leg or a combination of the three.

The NIH Stroke Scale tries to score how severe a stroke might be. It also monitors whether the person's stroke is improving or worsening as times passes as the patient is re-examined.

There are 11 categories that are scored and include whether the patient is awake, can follow commands, can see, can move their face, arms and legs, has normal body sensations or feelings, has speech difficulties, or has coordination problems.

So, a massive, fatal stroke – as in the case of this actor – does so much damage the brain can't recover, and as a result, ceases to be able to run your basic bodily functions like breathing and heartbeat.

Stroke remains a major killer in the United States and worldwide. In the U.S., 20% of stroke patients will die within a year. However, with the ability to intervene with thrombolytic therapy to reverse the stroke and with more aggressive rehabilitation, the goal is to increase patient survival and function after recovery.

Specialized stroke centers, hospitals that have the doctors, equipment, and resources to intervene quickly and treat strokes aggressively, have shown to increase stroke survival and patient function and recovery. These hospitals are certified by The Joint Commission, the American Stroke Association, and the health departments of some states. It is to your advantage to know which hospitals in your area are designated stroke centers because they will have the specialists and equipment needed to minimize diagnosis to treatment times.

Stroke can either be caused by bleeding or clotting, most commonly. Here are descriptions of some common types of stroke:

Thrombotic stroke

The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops working. Typically, a cholesterol plaque in one of the brain's small blood vessels ruptures and starts the clotting process.

Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing blood vessels in the heart and heart attack (myocardial infarction). These risk factors include high blood pressure (hypertension), high cholesterol, diabetes, and smoking.

Embolic stroke

Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through the bloodstream, and lodges in an artery in the brain. When blood flow stops, brain cells do not receive the oxygen and glucose they require to function and a stroke occurs. This type of stroke is referred to as an embolic stroke. For example, a blood clot might originally form in the heart chamber as a result of an irregular heart rhythm, like atrial fibrillation. Usually, these clots remain attached to the inner lining of the heart, but occasionally they can break off, travel through the bloodstream (embolize), block a brain artery, and cause a stroke. An embolism, either plaque or clot, may also originate in a large artery (for example, the carotid artery, a major artery in the neck that supplies blood to the brain) and then travel downstream to clog a small artery within the brain.

Cerebral hemorrhage

A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes stroke symptoms by depriving blood and oxygen to parts of the brain in a variety of ways. Blood flow is lost to some cells. Additionally, blood is very irritating and can cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure within the skull and causes further damage by squeezing the brain against the bony skull. This further decreases blood flow to brain tissue and its cells.

For more information, read our full medical article on stroke.

CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW

REFERENCE:

Jameson, JL, et al. Harrison's Principles of Internal Medicine, 20th ed. (Vol.1 & Vol.2). McGraw-Hill Education 2018.

Health Solutions From Our Sponsors

Reviewed on 3/7/2019