Stroke is a common occurrence, and can be permanently disabling. Most people recover from a stroke well, but depending on how severe it is. The majority of strokes are minor. However, a minor stroke or a transient ischaemic attack (a stroke-like event lasting <24 hours) may be the harbinger of a more disabling attack. Therefore, full appropriate investigation of any stroke-like event is important to address risk factors and initiate necessary treatments.
Most disabling and large strokes are due to rhythm abnormalities of the heart, especially atrial fibrillation. Most small strokes (which can be equally disabling) have no identifiable cause (cryptogenic). Reduction of the risk of a further disabling stroke can be achieved through use of antiplatelet drugs (Aspirin, Clopidogrel, Dipyridamole), anti-coagulation (only where indicated such as in Atrial Fibrillation), ceasing smoking, treating high blood pressure, improving diabetes control, treating high cholesterol, and other rarer contributing factors (e.g. Fabry’s disease).
Not all strokes are clots or blockages (~70%) because some are bleeds. Different types of bleeds can occur and identifying the cause of bleeding (blood vessel malformations, hypertension, cerebral amyloid angiopathy) helps to guide specific treatments. Bleeding is also seen after a clot has occurred, but treatment is aimed at treating the cause of the clot.