What is a Stroke?

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.

  Act FAST

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.

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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.

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 causing life-altering damage or even death. 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. Aneurysms can be treated several ways, one with neurosurgery which involves an invasive approach to clip the aneurysm and the other with neuro intervention involving minimally invasive approach to coil the aneurysm. Not all facilities can treat an aneurysm with minimally invasive neuro intervention, but we can. 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 parts of 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.

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.

With a stroke, time is brain.

At Johnston-Willis Hospital, our expert doctors not only save stroke victims every day, but provide telemedicine support to other hospitals in the HCA Virginia network. 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 is tPA administration in acute stroke patients. tPA 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. The specialized neurologists at Johnston-Willis Hospital are not only providing expert care for our patients, but doing so throughout our community.

Stroke Treatment Window is now 24 hours

We work closely with local EMS to deliver brain-saving care within the critical first three hours after symptoms appear. We can administer new clot-dissolving drugs, clot retrieval devices, coiling or stents which can be utilized with the expertise of our neuro interventionalists in our state of the art Neurointerventional surgery center.

Together, our fast actions and response give you the greatest chance of recovery that preserves the best possible quality of life. In fact, we were the first medical center in Virginia to use the ischemaView RAPID neuroimaging platform, which allows a neurovascular physician to quickly and more accurately evaluate patients who have had a major stroke and also identify those patients who would most likely benefit from this life-saving process. This technology allows our physicians to expand the stroke treatment window from 6 hours to 24 hours.


If you're coping with the aftermath of a stroke, you want to restore your capacity for active living as fully and quickly as possible. At Johnston-Willis, you can expect us to be with you all the way along your path to recovery. While you're still an acute care hospital patient, we begin your rehabilitation right in your room, helping you launch the process of reclaiming your abilities.

Comprehensive Rehabilitation Resources

Within our comprehensive healthcare network, you can also take advantage of additional rehabilitation services and treatments, including:

  • Inpatient Rehabilitation - Focused, intensive treatments and therapies for qualified candidates during a designated period of time at a live-in facility. Click to learn more about our Inpatient Rehabilitation program.
  • Outpatient Rehabilitation - Extensive range of multifaceted treatments and therapies (speech/language, swallowing, physical, occupational, aquatic, and more) delivered with one-on-one support and tailored to your situation
  • Advanced Therapies and Treatments - Variety of options (Bioness, LiveOn, VitalStim, SaeboFlex) to retrain the body's electrical impulses and nervous system and improve function and control in hands, arms, legs, throat and other areas
  • Driving Assessment and Education - One-on-one evaluation and training, approved by the Department of Motor Vehicles, and provided by registered occupational therapists; designed to help you regain skills and return to independence. Click to learn more about our Driving Assessment Program.

Awards and Distinctions

The Joint Commission has also awarded Johnston-Willis with a Gold Seal Certificate of Distinction for Stroke Rehabilitation. Chippenham & Johnston-Willis Hospitals are also a Five-Star Recipient of Stroke two years in row (2016–2017) as awarded by Healthgrades. Why settle for other providers or facilities with less experience when Johnston-Willis is just a phone call away?

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Learn More About Risk Factors for Stroke

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