What is a Stroke?

Stroke is the 5th leading cause of death in America.

Per the National Stroke Association, stroke is the fifth leading cause of death in America and a leading cause of adult disability. Yet, research shows that too few people know what a stroke is and how to recognize when stroke is happening.

A stroke happens when blood flow to an area of the brain is cut off. Brain cells are deprived of oxygen and begin to die. A stroke can cause you to permanently loose speech, movement and memory. When you receive treatment at Chippenham & Johnston-Willis Hospitals, you know you’re in good hands. Our hospitals are a Five-Star Recipient of Stroke two years in a row (2016-2017) as awarded by Healthgrades.

There are two types of stroke: hemorrhagic and ischemic.

Hemorrhagic strokes are the least common type of stroke. Only 15% of all strokes are hemorrhagic, but they are responsible for about 40% of all stroke deaths.

A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain. There are two types of hemorrhagic stroke:

Intracerebral Hemorrhage

An intracerebral hemorrhage is the most common hemorrhagic stroke, happening when a blood vessel inside the brain bursts and leaks blood into surrounding brain tissue. The bleeding causes brain cells to die and the affected part of the brain stops working correctly. High blood pressure and aging blood vessels are the most common causes of this type of stroke.

Sometimes intracerebral hemorrhagic stroke can be caused by an arteriovenous malformation (AVM). AVM is a genetic condition of abnormal connection between arteries and veins and most often occurs in the brain or spine. If AVM occurs in the brain, vessels can break and bleed into the brain. The cause of AVM is unclear but once diagnosed it can be treated successfully.

Subarachnoid Hemorrhage

A subarachnoid hemorrhage type of stroke involves bleeding in the area between the brain and the tissue covering the brain, known as the subarachnoid space. This type of stroke is most often caused by a burst aneurysm. Other causes can include arteriovenous malformation (AVM), bleeding disorders, head injuries, and blood thinners.

Ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot, causing blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke. Ischemic strokes account for about 87% of all strokes. An ischemic stroke can occur in two ways:

Embolic Stroke

In an embolic stroke, a blood clot or plaque fragment forms somewhere in the body (usually the heart) and travels to the brain. Once in the brain, the clot travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. About 15% of embolic strokes occur in people with atrial fibrillation (Afib). The medical word for this type of blood clot is embolus.

Thrombotic Stroke

A thrombotic stroke is caused by a blood clot that forms inside one of the arteries supplying blood to the brain. This type of stroke is usually seen in people with high cholesterol levels and atherosclerosis. The medical word for a clot that forms on a blood-vessel deposit is thrombus. Two types of blood clots can cause thrombotic stroke:

  • Large vessel thrombosis is the most common form of thrombotic stroke and it occurs in the brain’s larger arteries. In most cases it is caused by long-term atherosclerosis in combination with rapid blood clot formation. High cholesterol is a common risk factor for this type of stroke.

  • Small vessel disease happens when blood flow is blocked to a very small arterial vessel (small vessel disease or lacunar infarction). Little is known about the causes of this type of stroke, but it is closely linked to high blood pressure.


If you suspect a stroke, remember to act FAST to identify symptoms:

  • FACE: Ask the person to smile. Does one side of the face droop?
  • ARMS: Ask the person to raise both arms. Does one arm drift downward?
  • SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • TIME: If you observe any of these signs, call 911 immediately.

Learn More About Risk Factors for Stroke

Telemedicine and tPA Administration

Telemedicine increases the quality and convenience of healthcare services. It can help provide patients with better, faster, and more specialized care. Doctors can provide more convenient, real-time interactions with patients and improve communications with other medical staff.

At Chippenham Hospital, a Joint-Commission Certified Primary Stroke Center, our expert doctors use on-site examinations and telemedicine capabilities to quickly access a neurologist at Johnston-Willis Hospital who can also evaluate the patient through a camera and microphone.

With a stroke, time is brain.

In addition, the patient can see and interact with the neurologist and see scans and reports of their tests which can also be shared with a specialist. The neurologist can view head scans, prior reports, and records in order to make an informed decision about care.

The most important decision for acute ischemic stroke is tPA administration. tPA (tissue plasminogen activators) is a clot buster drug for blockages in the arteries in the brain; the sooner it is given, the more brain tissue is preserved. This is very important during a stroke because 2 million brain cells die every minute you're not treated.

This technology leads to faster administration of the clot buster drug which can lead to improved outcomes in as little at 6 months. It is more convenient for the patient as they can receive specialized care faster, no matter what time of the day or night. Our own specialized neurologists will utilize this technology and continue to care for the patient throughout their hospital stay.

Educational information on this page provided in partnership with the National Stroke Association.