Stroke and cerebrovascular disorders

Ischemic stroke is the most common type of stroke, affecting 87% of stroke patients. Ischemic stroke occurs when a narrowing or complete or partial blockage of arteries reduces blood flow to the brain.

In cases of ischemic stroke, it is of the utmost importance to restore blood flow as quickly as possible through the use of clot-dissolving medication, stent placement or mechanical thrombectomy.

There are two types of hemorrhagic stroke: intracerebral hemorrhage (ICH) and subarachnoid hemorrhage. Both types of hemorrhagic stroke occur when a blood vessel in the brain bursts and releases blood into or around the brain.

The goal of treatment for this type of stroke is to stop this bleeding, relieve pressure on the brain and minimize its effects on brain tissue using surgical or pharmacological treatments.

A brain aneurysm occurs when there is a weak, bulging area in one of the brain’s arteries, or the muscular blood vessels that convey oxygen and nutrients to the brain. The exact causes of brain aneurysm are not entirely clear, but risk factors include family history, aging, high blood pressure, and smoking.

Treatment will depend on the location and size of the aneurysm as well as whether or not it has ruptured.

Cerebrovascular malformation is an abnormal blood vessel formation in the brain. These formations may be made up of arteries, veins or capillaries. While they are often asymptomatic, malformations can lead to altered or obstructed blood flow.

Depending on the type, location and severity of a malformation, treatments may include computer assisted surgery, microsurgical resection or targeted radiosurgery.

• Sudden weakness or numbness of the face and/or limbs, especially on one side of the body
• Sudden loss of balance or dizziness
• Sudden trouble speaking or slurred speech
• Sudden blurred vision in one or both eyes
• Sudden confusion or disorientation
• Sudden severe headache without a known cause

• Partial or total loss of consciousness
• Nausea or vomiting
• Sudden weakness or numbness of the face and/or limbs, especially on one side of the body 
• Sudden severe headache without a known cause

Brain aneurysms may not cause any symptoms and go unnoticed. Ruptured aneurysms may be accompanied by:

• Partial or total loss of consciousness
• Nausea or vomiting
• Sudden severe headache without a known cause
• Sensitivity to light
• Weakness or confusion
• Seizure

• Numbness or tingling
• Headaches
• Sudden loss of balance or dizziness
• Sudden trouble speaking or slurred speech
• Sudden blurred vision in one or both eyes

• Medication therapy: The use of a clot-busting medication called t-PA can often dissolve blockages if administered intravenously shortly after the stroke symptoms begin.
• Minimally invasive clot removal: Using minimally invasive endovascular techniques, our stroke specialists can remove clots using retrievable stents, balloons and aspiration systems, in addition to intra-arterial t-PA application.

• Medication therapy: Certain medications may be administered to help decrease blood flow.
• Robotic and/or minimally invasive surgery: When possible, our specialized neurosurgeons may perform operations using robotic and/or minimally invasive surgical techniques to repair damaged blood vessels and stop bleeding. When required to ensure best patient outcomes, open surgery may be performed instead.
• Tractography: Tractography is a 3D modeling technique that enables your care team to carefully monitor nerve tracts using data from diffusion magnetic resonance imaging (MRI). This allows for better evaluation of patient condition, before, during and after surgery.

• Aneurysm coiling: In aneurysm coiling, a small tube is inserted into the artery and used to place specially made metal coils into the aneurysm. The coils fill the aneurysm to prevent blood from flowing into the aneurysm and causing a rupture.
• Flow diversion: In some cases, aneurysms can be treated with a special stent that diverts blood flow away from the aneurysm.
• Microsurgical aneurysm clipping: This minimally invasive surgery uses a microscope to place a metal clip around the aneurysm, blocking blood flow and lowering the risk of rupture. This procedure is often more durable than coiling, but the appropriate treatment will be based on the size and location of the aneurysm.

• Microvascular neurosurgery: This minimally invasive, computer-assisted surgery will remove the vascular malformation to reduce the risk of rupture. Availability of this procedure is based on the size and location of the malformation as well as the age and health of the patient.
• Embolization and coiling: For arterial malformations associated with aneurysm, metal coils or surgical glue may be inserted into the affected area to prevent blood flow to the area.
• Radiosurgery: Radiosurgery, also called stereotactic radiotherapy, uses focused X-ray beams to specifically target and shrink the malformation. The goal of this procedure is to shrink and eventually close off the vessels.