Stroke is also called a cerebrovascular accident or brain attack. It is a clinical syndrome caused due to the reduced blood supply to a part of the brain. Lack of oxygen and nutrients owing to impaired blood supply causes the death of the brain cells in the affected part. Stroke is a medical emergency and therefore it requires quick and prompt treatment to minimize brain damage and potential complications.
SIGNS AND SYMPTOMS
The signs and symptoms of stroke include:
- Sudden numbness or weakness of face, arm or leg, especially on one side of the body
- Trouble in walking, dizziness, loss of balance or coordination
- Severe headache with no known cause
- Trouble seeing through one or both the eyes
- Confusion, difficulty in speech
- Double vision or partial vision
To screen the stroke outside the hospital, FAST tool is used. According to this, any sudden changes such as; Face drooping, Arm weakness, Speech difficulty, suggests it is Time to call emergency services. In such condition immediate medical attention is required to save the patient’s life.
Stoke can occur in following ways:
- It is caused when an artery supplying blood to the brain is blocked by blood clot (thrombus or embolus).
- Thrombus stroke is caused when clot occurs in one of the arteries supplying blood to the brain.
- An embolic stroke occurs when a clot, which is formed at another site, finds its way to the brain arteries and blocks it.
- It is caused when the blood vessel supplying the brain, leaks or bursts. It can be intracerebral hemorrhage or subarachnoid hemorrhage.
- Intracerebral hemorrhage occurs when the blood vessel in the brain bursts within the brain causing damage to brain cells.
- Subarachnoid hemorrhage occurs when brain artery bursts and the blood is released into the space between the surface of brain and skull.
Transient ischemic attack
- This refers to a temporary disruption of blood flow to the brain.
- This refers to a condition where the blood vessels are inflamed and blood flow to the brain is decreased.
Lifestyle risk factors
- Drug abuse such as cocaine and methamphetamines
- Cigarette smoking or passive smoking
- Being overweight or obese
- Sedentary lifestyle
- Chronic alcoholism
Medical risk factors
- Cardiovascular diseases such as heart failure, heart defects, heart infection
- Obstructive sleep apnea (oxygen levels may drop intermittently while sleeping)
- High blood pressure
Other risk factors
- Age 55 years and older
- Family history
- Gender (men)
Depending upon the duration of brain injury and location of the brain affected, stroke may cause temporary or permanent disabilities.
Complications of stoke include:
- Paralysis of the muscles around the mouth and jaw which can cause difficulty in talking and swallowing
- Paralysis affecting one side of the body
- Pain in parts of the body affected by stroke
- Depression and emotional problems
- Inability to think and memory loss
The doctor performs the following tests to diagnose stroke.
Physical examination: The doctor may discuss with patient or patient’s attendant regarding the onset and duration of symptoms and then evaluates the patient’s current condition.
Blood tests: There are various blood tests performed to obtain significant information which is helpful in the management of stroke such as, blood clotting time, blood sugar level, imbalances in levels of critical chemicals and enzymes in the blood and presence of any infection.
Computerized tomography (CT) scan: In this procedure, the doctor injects a dye into the patient’s bloodstream to view the blood vessels in neck and brain (computerized tomography angiography). A CT scan uses X-rays to create a detailed image of the brain and to detect the presence of hemorrhage, or tumor.
Magnetic resonance imaging (MRI): In this test, the doctor injects a dye into the patient’s blood vessel to view the arteries and veins and highlight the blood flow (magnetic resonance angiography, or magnetic resonance venography). An MRI uses powerful radio waves and magnetic fields to obtain a detailed image of the brain which may help to detect ischemic stroke and brain hemorrhages.
Carotid ultrasound: This imaging testhelps to assess the blood flow and identify fatty deposits (plaques) in the carotid arteries.
Cerebral angiogram: In this test, thedoctor inserts a catheter in the blood vessels and injects a dye. This helps in assessing the blood flow through the arteries in the neck and brain.
Treating a patient with stroke is very crucial and is a medical emergency. Based on the type and severity of stroke, it can be treated with the following medicines or surgery:
- Aspirin is an anti-clotting drug which is given to the patient to prevent a second stroke.
- Injection of a recombinant tissue plasminogen activator (TPA), also called alteplase may be given as it dissolves the blood clot and restores blood flow.
- Hemorrhagic stroke may be treated with warfarin and clopidogrel to prevent blood clots.
Carotid endarterectomy: The surgeon may clear the plaques from the blood vessels in the neck and brain using this method.
Angioplasty and stents: The surgeon treats the blocked artery by inflating a balloon which expands the artery, followed by inserting the stent.
Surgical blood vessel repair: The doctor may recommend this procedure in case of hemorrhagic strokes to repair the blood vessel abnormalities. Surgical blood vessel repair is done in several ways such as surgical clipping, coiling (endovascular embolization), surgical AVM removal, intracranial by-pass and stereotactic radiosurgery.
Stroke recovery and rehabilitation
This therapy starts in the hospital before discharge. The doctor will consider the patient’s lifestyle, interests and priorities, and the availability of family members or other caregivers to plan therapy accordingly. This therapy helps the patient to recover from the effects of paralysis and patient will be able to walk in regular pattern and speed, coordinate the movements and regains muscle strength and control.
Stroke may be prevented by following ways:
- Avoiding junk foods that are oily, and high in cholesterol
- Taking medicines for hypertension regularly
- Avoiding smoking and chewing tobacco
- Leading stress free life
- Eating healthy diet
- Exercising daily