Strokes: Everything you need to know


What causes a stroke, and how are they treated? ADO’s Medical Director Dr. Howard Zahalsky takes an in-depth look.


What causes a Stroke?

Strokes occur when the blood supply to the brain is interrupted or reduced, depriving it of oxygen and nutrients. Strokes are caused by blocked blood vessels and typically affects one side of the body. If you have a stroke on the right side of your body, then an artery on the left side of your brain was clogged, and vice versa.

There are two types of strokes. An embolic stroke is when a blockage formed elsewhere in the body travels to the brain. Thrombotic strokes occur when there has been cholesterol buildup inside a vessel, causing a blood clot.

The most common type of stroke is the blockage or clot in the middle cerebral artery. This type of stroke leaves one side of your body paralyzed. If it happens on the left side, it leaves you unable to speak.

The Arteries

The good news is, it’s almost impossible to have a stroke that knocks out your whole brain. This is because all the arteries meet in what is a circle called the Circle of Willis. Each of the three arteries that branch out of the Circle of Willis all bring blood to the center of the brain. Since there are three separate arteries, there is no way you can have a stroke that affects all three parts of the brain at one time. If one branch is blocked, then there are still two other functioning branches that are delivering blood to the center of the brain.

Basilar Artery Stroke

The basilar artery brings blood to the circle from the heart. It is responsible for pumping blood to the back of the brain. If you do get a stroke here, you aren’t going to feel any numbness. You will however, have severe change in your ability to balance.

Middle Cerebral Stroke

This is the most common place to have a stroke. If it is on the whole artery, the right side of your face to the right side of your leg could all be affected. It could also be on the smaller branches of the artery. If this is the case, it depends on where in the body the branch goes. The middle branches of the middle cerebral artery will end up affecting the foot, leg or hip. Branches that are outside the brain will end up affecting the face or the hands.

Sometimes you can have a stroke on the basal ganglia. A tiny stroke on the basal ganglia can be rerouted. Meaning that outcomes like paralysis on the right side of your body might only last a few days. A sign that it was a small stroke on the basal ganglia is if your muscles are affected, but your speech is still intact. Another way to identify this is getting a CT scan.


Vertigo can be caused when there is a stroke in the back of the brain. But don’t worry, not all vertigo is caused because of a stroke. If you started getting vertigo in your early twenties or thirties, and you still get it, then you are fine. That kind of vertigo is called BPPV or Benign Positional Vertigo. If you’ve never had vertigo your whole life under 75 years old, and all of a sudden your vertigo is so severe that you can’t walk, then it might be a sign of a stroke.


Blood Clots

Strokes are caused by blood clots in your arteries. But how and why do these clots form? Well, they form in your heart and are caused in two ways: atrial fibrillation or high blood pressure.

Atrial Fibrillation

Atrial fibrillation is an irregular heart rhythm. This is when one of the chambers of your heart doesn’t squeeze right. Blood flies everywhere creating pools in your heart, which in turn, result in blood clots. These clots cause little lines on your fingernails called splinter hemorrhages and in severe cases, it can cause embolic strokes. People with atrial fibrillation are prescribed strong blood thinner medication for their entire life in order to prevent strokes and blood clots.

High blood pressure

You can think of high blood pressure like a balloon. A balloon can only hold so much air till it bursts. Fortunately, your blood vessels won’t actually burst, but they will get damaged. Over time, the excess amounts of pressure causes a lot of scar tissue and scar build up. This then causes some stretching in the vessel and eventually blockages in the blood vessel appear which can lead to a thermotic stroke. Having high cholesterol makes you more likely to have plaque buildup. The plaques begin building up as the walls of the blood vessel are damaged due to the high blood pressure. The best way to prevent this kind of stroke is lower your blood pressure.


Have you ever had a feeling where your body is a bit numb? Then everyone tells you to just ‘sleep it off’ because it’s probably not serious? Sudden numbness is one of the symptoms of an oncoming stroke – so watch out. Other symptoms include:

  • Trouble speaking or understanding
  • Trouble seeing in one of both eyes
  • Trouble walking
  • Severe headaches

If you start showing signs of a stroke, it is best to get to the hospital right away. Strokes can be treated up to three hours after the symptoms start showing!


The best kind of treatment for strokes is prevention. That means taking the blood thinner medication or trying to lower your blood pressure. But there are still other methods to treat strokes.

CT Scans

Before getting treatment for a stroke, the first thing you have to do is get a CT scan. A CT scan will show you blackened areas that tell if you had a stroke or not. For example, the most common stroke will show a big black area on the left side of the brain. That means the person had a stroke that affected their language center and likely left the paralyzed on the right side of their body.



In terms of medication, the best treatment would be Aspirin, especially for small to medium strokes after the three hours window has passed. Aspirin helps by affecting the platelets that float around in our blood. Strokes are caused by excessive tightening of our arteries which are made worse by platelets. By taking Aspirin, the platelets are deactivated.

If you do get to the hospital within the three hour period with a stroke, you are normally given potent clot-busting medications. However, these medications are very strong and carry a 3-6% chance of killing you by causing bleeding in the brain. But most are willing to take the risk since the alternative is being half-paralyzed in a wheelchair the rest of their lives!

Stronger Blood Thinners

Stronger blood thinners may be required in certain individuals. This means putting them in Coumadin, a medication that has the same ingredient as rat poison! But don’t worry, with humans, doctors make sure to regularly monitor the blood levels to make sure it stays at an even level where there won’t be any clots or uncontrollable bleeding. However, Coumadin requires constant monitoring, and it is still hard to get the exact dosage correct. Other medications that work similarly, and without complications are Xarelto and Pradaxa.


At the end of the day: time is of the essence! If you think you are having a stroke, it is best to get to the hospital as soon as possible.

How can Activ Doctors Online help you?

Personal Health Records

All of your health records are with you! You will be able to track your cholesterol, blood pressure, the dosages of your medication, the medication you have taken, how thick or thin your blood is, and much more. With Activ Doctors, you can make sure there are no gaps in your care and keep track of your own risk factors.

Second Medical Opinion

We can put you in touch with the top medical experts around the world. You will be able to get evaluations of your charts with top neurologists and feel comfortable that you are getting the best medical help. In most cases, you will have your medical response within 48-hours.


If your doctor is part of ADO, you will be able to have video conferences with him to discuss and concerns. Now this is NOT for when you think you are having a stroke, but maybe to discuss possible ways to decrease your risk factors.

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