Types of Stroke

Not all strokes are the same — and the type of stroke significantly affects treatment, recovery, and the caregiver's role. Understanding which type of stroke your client experienced shapes everything from medication management to activity restrictions.

Section 01

Ischemic Stroke — The Most Common Type

Ischemic strokes account for approximately 87% of all strokes. They occur when a blood clot blocks an artery supplying the brain.

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Thrombotic stroke

A clot forms directly in a brain artery — usually at a site of atherosclerosis (fatty plaque buildup). This is the most common type and is strongly associated with cardiovascular risk factors like high blood pressure, diabetes, and high cholesterol.

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Embolic stroke

A clot forms elsewhere in the body (often in the heart, particularly in people with atrial fibrillation) and travels to the brain. These strokes can occur without the typical cardiovascular risk factors and may require different medications — typically blood thinners like warfarin or newer anticoagulants.

💡 Care implication: blood thinners

Many ischemic stroke survivors are prescribed antiplatelet medications (aspirin, clopidogrel) or anticoagulants (warfarin, apixaban). These medications reduce second stroke risk but also increase bleeding risk. Know your client's medications. Report any unusual bruising, blood in urine or stool, or uncontrolled bleeding to the supervising nurse immediately.

Section 02

Hemorrhagic Stroke — Bleeding in the Brain

Hemorrhagic strokes occur when a blood vessel ruptures and bleeds into or around the brain. They are less common (about 13% of strokes) but generally more severe.

Intracerebral hemorrhage: Bleeding directly into the brain tissue, most commonly caused by chronically high blood pressure weakening the vessel walls. Blood pressure control is the most critical ongoing management factor.
Subarachnoid hemorrhage: Bleeding into the space surrounding the brain, often caused by a ruptured aneurysm. Survivors often describe the worst headache of their life as the warning sign.
Care difference: Hemorrhagic stroke survivors typically do NOT receive blood thinners — the opposite of ischemic stroke management. Always know which type your client had before assuming anything about their medication regimen.

Section 03

TIA — Transient Ischemic Attack

⚠ TIA is a warning — not a safe outcome

A TIA (transient ischemic attack) is a brief blockage of blood flow to the brain that resolves within minutes to hours, leaving no permanent deficit. Symptoms are identical to stroke but temporary. A TIA is a medical emergency and a major warning sign: the risk of full stroke in the days following a TIA is as high as 10–15%. A client who had a TIA needs urgent medical evaluation and aggressive risk factor management — not reassurance that "it went away on its own."

Section 04

Why Knowing the Type Matters for Caregivers

Ischemic stroke care focus

Medication adherence (blood thinners/antiplatelets)
Report unusual bleeding to nurse
Cardiovascular risk factor management
Watch for signs of second stroke

Hemorrhagic stroke care focus

Blood pressure monitoring and management
Activity restrictions (often stricter early on)
No blood thinners — different medication profile
Watch for headache, neurological changes

Section 05

Recognizing a Second Stroke

🚨 Second stroke risk is highest in the first weeks

The risk of a second stroke is highest in the days and weeks following the first. Know the BEFAST signs (covered in Module 2) and apply them every visit. Any new or worsening neurological symptom in a stroke survivor — new weakness, slurred speech, confusion, vision change, sudden severe headache — is a 911 emergency until proven otherwise.