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STROKE

What is stroke?

A stroke is a neurological medical emergency occurs due to reduced or interrupted blood supply to your brain, or when a blood vessel in the brain ruptures and bleeds. It prevents the blood and oxygen to reach up to brain’s tissue.

A stroke is a cerebrovascular disease. When there is no enough supply of oxygen to the brain’s tissue the blood cells begin to die.

Stroke symptoms:

The symptoms may appear without any warning signs. The faster a person having stroke gets care, the better their result likely to be. Stroke symptoms include:

  • Paralysis
  • Confusion
  • Numbness or weakness in face, leg and arm, especially only one side
  • Trouble in speech
  • Loss of coordination or balance
  • Dizziness
  • Headache
  • Trouble speaking
  • Vision problems, such as blurred vision, double vision in one or both eyes.

A stroke needs an immediate medical attention. Instant treatment is the key to preventing the following results:

  • Death
  • Long-term disability
  • Brain damage

To remember the signs and symptoms of a stroke remember it as “FAST”:

  • Face: When the person smile. Does one side of the face drop?
  • Arms: Tell the person to raise both arms, does one arm drift?
  • Speech: If the person face difficulty in speech, or a slurred speech?
  • Time: If you get any of these symptoms, call immediate medical help.

Types of stroke:

The strokes are of three types:

Ischemic stroke

The ischemic stroke occurs when the arteries to that supply blood to the brain become narrow or blocked. The cause of these blockage is severely reduced blood flow (ischemia) or blood clots or because of the fatty deposits that builds on the blood vessels or clots.

Thrombotic and embolic strokes are the most common type of ischemic stroke. A thrombotic stroke happens when a blood clots forms in one of the arteries supplying blood to the brain. The clots go through the circulatory system and becomes lodged, which blocks the blood flow. An embolic stroke is the point at which a blood clot or debris structures in another part of the body and afterward goes to the brain.

Hemorrhagic stroke

This occurs when a blood vessel in your brain ruptures or leaks blood. The blood from that leaking artery can cause excess pressure in the skull and swelling to the brain. This can cause damaging to brain cells and tissue.

There are two types of hemorrhagic stroke that are intracerebral and subarachnoid. In intracerebral hemorrhagic stroke the brain tissue surrounding the brain fill with blood after an artery rupture. Intracerebral hemorrhagic strokes are the most common type of hemorrhagic stroke. In subarachnoid hemorrhagic stroke there is bleeding in the area between the brain and the tissue that cover it.

Transient ischemic attack (TIA)

It is also known as a mini stroke sometimes. Transient ischemic stroke (TIA) is a temporary stroke it doesn’t cause any permanent damage. Symptoms of TIA is similar to the other types of stroke but these are temporary and go after few minutes or hours. TIA occurs when the blood flow to the brain is blocked temporary. The usual cause for TIA is a blood clot. They serve as the warning signs for the future stroke.

Causes of stroke

The cause for every stroke is different. There are three main types of the stroke i.e. ischemic stroke, hemorrhagic stroke and transient ischemic stroke.

Cause of Ischemic stroke

The cause of an ischemic stroke is the blockage in an artery that supply blood to the brain. The blockage can be a blood clot or it may be occurred by atherosclerosis. In this condition a fatty substance (plaque) deposits on the walls of blood vessel. This plaque can lodge and break off an artery and blocks blood flow that cases an ischemic stroke. 

Cause of hemorrhagic stroke

The hemorrhagic stroke can cause by aneurysm (bulging of a blood vessel) or arteriovenous malformation (an abnormal connection between veins and arteries). These are the two possible cause of hemorrhagic stroke.  

Cause of TIA

The main cause for the TIA is the blockage in an artery that supply blood to the brain. Mainly, blockage by a blood clot, that stops the blood from reaching to the certain parts of the brain. A TIA not lasts more than a few hours. The blood flow is restored after the blockage moves.

Risk factors for stroke:

Diet

Diet plans an important role for you to being healthy. An unhealthy diet may increase your risk of having a stroke. The diet contains high risk of stroke include:

  • Salt
  • Cholesterol
  • Saturated fats
  • Trans fats

Lack of exercise

Lack of exercise or inactivity may lead a risk of having stroke. A 30 minutes of daily walk is very essential.  

Alcohol consumption

If you drink too much of alcohol them your risk of having stroke increases. 

Tobacco

Using tobacco can cause damage to your blood vessels and heart, and it also increase a risk of having stroke. The risk increases more with the smoke. 

Other risk factors include

  • Previous stroke or TIA
  • Sickle cell anemia.
  • Age: If you are older than 55 than the risk of having a stroke increase.
  • Obesity: Having overweight can also increase the risk of stroke.
  • Diabetes: People having diabetes have more risk of stroke.
  • Family history: The risk of stroke is higher in some families because of genetic health issues such as high blood pressure.
  • High cholesterol: If your cholesterol level is high then the risk of having stroke increases.
  • Hormones: Taking birth control pills can increase a risk of a stroke.
  • Race or ethnicity: African Americans have higher risk of stroke than people of other races.

Diagnosis of stroke:

First your health care provider asks about your symptoms. They also take your medical history to check if you have any stroke risk factors. They will also:

  • Check your blood pressure
  • Listen to your heart
  • And ask about the medications you are taking

Your health care provider takes a physical exam of yours; this includes:

  • Balance
  • Weakness
  • Coordination
  • Difficulty in vision
  • Numbness in your arms, legs and face
  • Coordination
  • Any confusion signs

 

Your health care provider will perform some diagnostic tests after your physical examination. There are several tests to diagnose a stroke, these tests may help your doctor to find:

  • If you had a stroke
  • What was the possible cause for the stroke?
  • Which part of the brain is damaged?
  • If you have any bleed in the brain

 

Tests to diagnose a stroke

You have to get a lot of teste to determine if you had a stroke. These tests include:

Blood tests:

There are several of blood tests may be performed, these tests help to determine

  • Your blood sugar level
  • Your previous infections
  • Your platelets level
  • How fast you blood clots

MRI and CT scan:

You may go through either or both an MRI (magnetic resonance imaging) scan and a CT (computed tomography) scan.

An MRI will give the detailed images of internal structures so it is very helpful to look for any tissue or cells damage in your brain. While a CT scan gives a detailed and clear image of your brain for any bleeding or damage in your brain. MRI and CT scan may also show other conditions that could be causing your symptoms. 

Electrocardiogram (ECG):

Your health care provider may advise you for an electrocardiogram (ECG) to see if the stroke is cause by any conditions related to heart. ECG is a simple test; it records the electrical activities in the heart by measuring the rhythm and records the record how fast the heart is beating. ECG can determine the heart conditions that may have led to stroke like atrial fibrillation or a prior heart attack.   

Echocardiogram:

An echocardiogram can determine the clots in your heart by using sound waves. This test will create detailed pictures of your heart by using sound waves. There clots might travel to your brain and caused a stroke.

Cerebral angiography

Your doctor will get you this test to see blockage or clots in your arteries of brain and neck. This test gives a look of arteries in your neck and brain. Learn more about angiography.

Carotid ultrasound

A carotid ultrasound or a carotid duplex scan, this test used to see plaque (fatty deposits) in the carotid arteries, the carotid arteries supply blood to the brain, face and neck. This test also shows if your arteries are blocked or narrowing. 

Stroke treatment:

Treatment of a stroke depends on the type of stroke you had whether ischemic stroke or hemorrhagic stroke.

TIA and Ischemic stroke treatment

Both TIA and ischemic strokes are cause by a blood clot or other blockage in the brain. So, because of that similar techniques used to treat both of them, which include:

Antiplatelet and anticoagulants

Over-the-counter headache medicine (aspirin) is regularly a first line of protection against stroke damage. Anticoagulant and antiplatelet medications should be taken under 24 to 48 hours after stroke symptoms start.

Clot-breaking drugs

Thrombolytic drugs/medications can break blood clots in the arteries of your brain, which stop the stroke and reduce damage to the brain.

One such medication, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is viewed as the highest quality level in ischemic stroke treatment. It works by dissolving blood clots rapidly, if delivered inside the initial 3 to 4.5 hours after symptoms of your stroke started. Individuals who get a tPA injection are more likely to recover from a stroke, and more averse to have any lasting disability as an outcome of the stroke.

Mechanical thrombectomy

During mechanical thrombectomy, the doctor will insert a catheter into a large blood vessel in your head. After that they will pull the clot out of the vessel by using a device. If this surgery performed within 6 to 24 hours after the stroke begin, then it will be most successful.

Stents

In the event that your doctor finds where wall of arteries has narrowed, they may perform a method to inflate the narrowed artery and provide a support to walls of the arteries using stents.

Surgery

In the uncommon cases in which other treatment doesn’t work, your doctor may perform surgery to remove a blood clot and plaques (fat deposit) from your arteries. This might be finished with a catheter, or if the clot is particularly large, your surgeon may open an artery to remove the blockage.

Hemorrhagic stroke treatment

The hemorrhagic stroke caused by leakage or bleeding in your artery. The treatment of hemorrhagic stroke focus on the controlling the bleeding and to reduce blood pressure in the brain that caused by access fluid. These treatments include:

Medications

Unlike with an ischemic stroke, in case you’re having a hemorrhagic stroke, the treatment objective is to make your blood clot. In this manner, you might be given drug to prevent any blood thinners you take.

Your doctor may prescribe you the drugs that can reduce blood pressure, lower the pressure in your brain, prevent seizures, and prevent blood vessel narrowing.

Coiling

During this procedure, your doctor uses a long-guided tube to the area of hemorrhage or weakened artery after that, they install a coil-like device in the area where the artery wall is narrow. This will reduce the bleeding.

Surgical clipping

Your doctor places a tiny clamp at the base of the aneurysm, to prevent the blood flow. This clamp cut off the blood supply and also prevents a possible broken blood vessel or another new bleeding.

Surgery

In the event that the area of bleeding is large, your doctor may perform a surgery to remove the blood and relieve pressure on your brain. Surgery may likewise be performed to fix blood vessels related with hemorrhagic strokes. Your doctor may suggest one of these methodology after a stroke or if an aneurysm, arteriovenous abnormality (AVM) or other type of blood vessel problem caused your hemorrhagic stroke.

Stroke recovery

After getting treating in emergency department you will be monitored for at least one day. It is important to start recovery and rehabilitation from a stroke as soon as possible. So, stroke recovery should be started in the hospital. There a health care team can stabilize your condition, assess the stroke effects, find underlying factors, and start therapy to help you to regain your affected skills.

Stroke recovery focuses on four main things:

Speech therapy

A stroke can cause speech and language weakness. A speech and language therapist will work with you to relearn how to talk. Or then again, in the event that you find verbal communication difficulty after a stroke, they’ll assist you with finding better ways of communication.

Cognitive therapy

After a stroke, numerous survivors have changes to their reasoning and thinking skills. This can cause social and state of mind changes. An occupational therapist can assist you with attempting to recapture your previous examples of thinking and behavior and to control your emotional reactions.

Relearning sensory skills

You may find that your senses are damaged and not working properly, this happens when strokes affects the sensory signals in your brain. In that case you may not feel senses such as temperature, pressure, or pain. A therapist can help you by teaching you how to deal with lack of sensation.

Physical therapy

You may find that you can’t move your body like before, because muscle tone and strength may be weakened by a stroke. A therapist will help you to regain your balance and strength.

Rehabilitation may be started after you leave the hospital. Rehabilitation may take place in rehabilitation centers, or a skilled nursing home, or at your own home.

The team that is responsible for the rehabilitation includes:

  • Neurologists (doctor specialist in brain conditions)
  • Physiatrist (Rehabilitation doctor)
  • Rehabilitation nurse
  • Dietitian
  • Physical therapist
  • Recreational therapist
  • Occupational therapist
  • Speech pathologist

How a stroke can be prevented?

  • Quit smoking
  • Low alcohol consumption
  • Keep weight down
  • Go for regular checkups

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