What Is a Major Stroke?

6 answers | Last updated: Nov 03, 2016
A fellow caregiver asked...

What do doctors mean by a "major stroke," and why do some strokes cause more damage, and more severe long-term problems, than others?

Expert Answers

Jeremy Payne, M.D., is the medical director of Banner Good Samaritan Stroke Center in Phoenix, Arizona.

The term major stroke is used to distinguish a full-blown stroke from a minor stroke, or transient ischemic attack (TIA). A TIA is essentially a temporary stroke that resolves on its own without causing permanent damage. When doctors say someone suffered a major stroke, they really just mean a stroke, which is loss of brain function resulting from a blood vessel problem that restricts blood flow to an area of the brain. Usually what happens is that plaque builds up in the arteries, then a piece of plaque dislodges and causes a blood clot to form, clogging a blood vessel.

The brain is very complex, and some areas are much more vulnerable to blood loss from blockages than others. This is one of the main reasons some strokes cause so much more damage than others. The brain requires lots of blood from moment to moment, because it can't store any energy. So when brain cells don't get blood, they start to die right away.

But in some cases, the brain manages to reroute the blood flow through what's essentially alternate plumbing. So then the area still gets blood and there's less damage. It's basically an issue of luck whether the blockage occurs in a place where there are alternate blood pathways or not.

One more difference is that some strokes, called hemorrhagic strokes, are caused by bleeding rather than a blockage, and these can be catastrophic.

How fast a stroke victim gets treatment is also a major factor in how much damage is done. You can lose as many as 32,000 neurons per second during a stroke, so time is really important. When the stroke occurs, there's what's called the clot epicenter, which is completely deprived of blood and typically dies in five or six minutes.

And then there's an area that's called the penumbra, or shadow, around the epicenter, and that area's basically on life support; it's not dead yet, and you may have several days before the neurons die. So with treatment, you can reverse the damage and regain functioning in this area.

That's why TPA, the clot-busting drug, can be so important. So can aspirin, which thins the blood. I tell my patients that the minute you experience symptoms that might be from a stroke, even if you're not sure or they're very mild, you need to get your butt into the hospital and get checked. We can do an MRI and see the damage and injury to the brain within minutes after it happens. How fast someone gets treatment is probably one of the biggest factors in how much damage is done and what the prognosis is for recovery.

Community Answers

Too bad answered...

My mom went to O'Conner's Hospital in San Jose with stroke symptoms and they sent her home telling her she was only dehydrated! They are supposedly a certified stroke center. What an obscene joke! She actually suffered a massive stroke, can't speak, doesn't know there's a right side, one side completely paralyzed.

A fellow caregiver answered...

Yeah, my husband had all the symptoms of the flu. Headache, vomiting. We treated with aspirin until his face started numbing and the double vision set in. We knew that there was more going on. Called his doctor and transported him to emergency.

The doctor on duty did all the tests, Mri, and heart tests, saying he had the flu and released him. The MRI showed negative. This was on a Saturday.

Monday still feeling bad, still having double vision and could not speak, I took him to the doctor's office. His doctor took one look at him and immedicately admitted him back into the hospital. There he had another MRI, and also a MRA. The clot was in the back neck arterary. Because of the location of the clot, it can only be treated with aspirin. Yes, he had a stroke. Why wasn't the MRA done the first time? DAH! It doesn't take six years of medical school to know something wasn't right.

This was in 2007, the residual of the stroke is numbness in his right hand, balance coordination and speech problems. My husband is still able to work however, the residual flares up, becomes frustrated. This is a man who built our home, hammer and nail. We count our blessings everyday.

Oc1dean answered...

There is no objective definition of stroke severity because it currently is based on observations of deficits. The way to solve this is to require a diagnosis of actual damage, this section of the brain is dead,etc. this section is in the penumbra or bleed drainage areas and might come back with lots of work. Then those dead or damaged areas are correlated with functions. Right now the PMR doctors just send the survivors to PT,OT and ST with simple orders of ET - evaluate and treat. This then means we have no way to compare cases and treatment protocols. Until this changes stroke survivor treatment has no basis in scientific proof.

Howard3 answered...

I can not answer your question, I had a major stroke caused by clot four and a half years ago when I was 56. Doctors have still not determined how the clot got to my brain or why I clot. I still consider myself lucky, I have very few deficits and most people apon first meeting me cannot tell that I have had a stroke. I do have some deficits, mostly with multi-tasking, and with short term memory. But, I can still play with my grandkids, hang out with my kids and their friends, so for that I am very grateful. I volunteer as a stroke mentor, trying to answer all of those unanswerable questions ( like this one) of new stroke survivors and their families.

Boubi answered...

When i had my haemorhaegig stroke 4 years ago and since i didnt realize what it was,i thought its something transient,the only symtoms i fell down could not move my right arm and leg .i climbed to bed and slept for 4 hours .When i woke i tried to stand again but could not ,only then i was driven to hospital . thanks god that with physio and medication i can walk but with a limb and can drive again .Sometimes i feel a bit dizzy or have numbness in my right arm but i think that having waited so long did make a difference,by the way i am diabetic since 33 years and am 55 regards from egypt