A derrame cerebral is the Spanish term for a stroke, a medical emergency that happens when blood flow to part of the brain is suddenly cut off or when a blood vessel in the brain bursts. Without a steady supply of oxygen-rich blood, brain cells begin dying within minutes. Globally, nearly 12 million people have a stroke each year, and over 7 million die from one, making it the second leading cause of death worldwide.
The Two Main Types of Stroke
Not all strokes happen the same way. About 87% are ischemic strokes, caused by a blood clot that blocks an artery feeding the brain. The clot may form inside a narrowed brain artery or travel from somewhere else in the body, often the heart. This is the more common and generally more survivable type.
The remaining 13% are hemorrhagic strokes, which occur when a blood vessel in the brain ruptures and bleeds into surrounding tissue. Intracerebral hemorrhage (bleeding directly into the brain) accounts for roughly 10% of all strokes, while subarachnoid hemorrhage (bleeding into the space surrounding the brain) makes up about 3%. Hemorrhagic strokes carry a higher death rate, with many fatalities occurring in the first hours and days.
What Causes Each Type
Ischemic strokes typically stem from atherosclerosis, the gradual buildup of fatty deposits inside artery walls. Over time, these deposits narrow the artery or break off and form clots. Heart conditions like atrial fibrillation (an irregular heartbeat) can also allow blood to pool and clot inside the heart, with those clots eventually traveling to the brain.
High blood pressure is the leading cause of hemorrhagic stroke. Years of elevated pressure weaken artery walls until one gives way. Other causes include ruptured aneurysms (balloon-like bulges in blood vessels), abnormal tangles of blood vessels called arteriovenous malformations, and the use of blood-thinning medications. In older adults, a condition where a specific protein builds up in brain blood vessel walls is another common trigger for bleeding.
Recognizing the Symptoms
Stroke symptoms appear suddenly. The CDC recommends the F.A.S.T. test to identify them quickly:
- Face: Ask the person to smile. Does one side of the face droop?
- Arms: Ask them to raise both arms. Does one drift downward?
- Speech: Ask them to repeat a simple phrase. Is their speech slurred or strange?
- Time: If you see any of these signs, call emergency services immediately.
Other symptoms include sudden confusion, trouble seeing in one or both eyes, a severe headache with no known cause, and difficulty walking or maintaining balance. These signs can appear alone or in combination. With hemorrhagic stroke, the headache is often described as the worst the person has ever experienced.
Mini-Strokes: A Critical Warning
A transient ischemic attack (TIA), sometimes called a “mini-stroke” or “derrame leve,” produces the same symptoms as a full stroke but typically resolves within an hour. Symptoms can last up to 24 hours. A TIA does not cause permanent damage on its own, but it is a serious warning sign. About one-third of people who have a TIA will eventually suffer a full stroke. Treating the underlying cause after a TIA is one of the most effective ways to prevent a larger, more devastating event.
Why Every Minute Counts
Emergency treatment for ischemic stroke centers on restoring blood flow as fast as possible. The primary tool is a clot-dissolving medication given through an IV. For decades, this treatment had to be started within 3 hours of symptom onset. That window was later extended to 4.5 hours based on clinical trial results. More recently, advanced brain imaging that can identify salvageable tissue has pushed the effective window to 9 hours in some patients, and even up to 24 hours in carefully selected cases involving large clots.
For strokes caused by large clots blocking major brain arteries, doctors can also perform a mechanical thrombectomy, a procedure where a small device is threaded through a blood vessel to physically pull the clot out. This procedure is most effective within the first 6 hours but can be performed up to 24 hours after symptom onset when imaging shows brain tissue that can still be saved. The key point for anyone witnessing stroke symptoms: getting to a hospital immediately opens up far more treatment options.
How a Stroke Is Diagnosed
In the emergency room, a CT scan is almost always the first imaging test. It’s fast, widely available, and highly sensitive to bleeding in the brain, which is critical because treatment for ischemic and hemorrhagic strokes is completely different. You cannot give a clot-dissolving drug to someone whose brain is actively bleeding.
CT scans have a notable limitation, though. They are not very good at detecting ischemic strokes in the first several hours. MRI, particularly a technique called diffusion-weighted imaging, can spot blocked blood flow and dying tissue much sooner and with greater accuracy. MRI also allows doctors to identify patients who may still benefit from treatment outside the standard time windows. In practice, most emergency departments start with CT for speed and follow up with MRI when more detail is needed.
Recovery and Rehabilitation
The brain has a remarkable ability to reorganize itself after injury, a property called neuroplasticity. After a stroke, surviving neurons can form new connections, strengthen existing ones, and even reroute functions away from damaged areas. The brain can generate new neurons in certain regions, and nearby healthy tissue can gradually take over jobs that the damaged area once handled. This biological rewiring is the foundation of stroke rehabilitation.
Recovery typically involves a combination of physical therapy to rebuild movement and strength, occupational therapy to relearn daily tasks like dressing and eating, and speech therapy for those whose language or swallowing was affected. The most rapid improvement generally happens in the first three to six months, but meaningful gains can continue for a year or longer. The intensity and consistency of rehabilitation matters enormously. Repetitive, task-specific practice drives the brain to rewire more effectively.
Recovery varies widely from person to person. Some people regain nearly all their previous abilities, while others live with lasting disability. The size and location of the stroke, the person’s age, how quickly they received treatment, and how aggressively they pursue rehabilitation all play a role in the outcome.
Risk Factors You Can Control
High blood pressure is the single biggest risk factor for both types of stroke. Keeping it in a healthy range, whether through diet, exercise, or medication, dramatically lowers your risk. Beyond blood pressure, several other conditions increase stroke risk: high cholesterol (which contributes to artery-clogging plaque), diabetes, atrial fibrillation, and obesity. Having already experienced a stroke or TIA also raises the chance of another one.
Lifestyle choices make a measurable difference. A diet heavy in saturated fats, trans fats, and sodium promotes the very conditions that lead to stroke. Regular physical activity helps control weight, blood pressure, cholesterol, and blood sugar simultaneously. Smoking damages blood vessels directly and accelerates plaque buildup. Excessive alcohol raises blood pressure and triglyceride levels, hardening arteries over time. Each of these factors is modifiable, meaning the choices you make today directly influence your stroke risk tomorrow.