Stroke
What is a stroke?
A stroke is a serious illness signaled by a sudden loss of consciousness, sensation and voluntary motion. A stroke usually happens when a blood vessel in any part of your brain suddenly breaks or is obstructed by a clot, and when this happens, your brain is deprived of certain nutrients and primarily oxygen, this, in turn, causes some of your brain cells to die which are the primary causes of a stroke. A stroke can also go by the names apoplexy, cerebrovascular accident, and brain attack.
Ischemic Stroke vs. Hemorrhagic Stroke
There are two primary types of strokes, Ischemic, and Hemorrhagic. Ischemic Stroke usually happens when the arteries to your brain become blocked or narrowed, that may reduce the blood flow to your brain. A blockage is usually composed of fatty deposits known as plaque. This is the most common type of stroke and composes about 85% of most stroke cases.
Ischemic stroke in turn, usually has two types, depending on the source of the blood clot: Thrombotic Stroke usually occurs when the blood clot is found in the arteries that directly supply blood to the brain. Embolic Stroke, on the other hand, happens when the blood clot occurs far away from the brain, usually in your heart. The obstruction that forms in here will be gradually carried to the arteries near your brain.
Hemorrhagic Stroke is another major type of stroke and occurs when a blood vessel in your brain breaks or has a leak. Hemorrhagic stroke, like ischemic stroke, also has two sub-types, these are known as:
- Intracerebral Hemorrhage is what happens when a blood vessel ruptures and spills fluids into the neighboring tissues of your brain, therefore damaging brain cells in that area. Subarachnoid Hemorrhage is another type and is similar to intracerebral hemorrhage. Subarachnoid hemorrhage is also caused by the rupture of a blood vessel in your brain, but this time the rupture occurs near the surface of your skull. This type can be signaled by a sudden, very painful headache.
- Mini-strokes, or sometimes called as a Transient ischemic attack (TIA) are symptoms that may feel the same as those of a stroke. Mini-strokes usually last less than five minutes and are simply a temporary decrease in blood supply to your brain.
Causes of Stroke
As mentioned before, causes of stroke can be by a limited supply of blood to your brain, usually in the form of a blockage or a rupture in the blood vessels in the area. The cause of these blockages and ruptures may vary, such as :
- Plaque – Fatty deposits in your blood vessels
- Hypertension – (uncontrolled high blood pressure)
- Aneurysms – rupture of a small pouch-shaped part of your arteries due to weak spots in the walls of your blood vessels.
- Arteriovenous Malformation – A condition present at birth wherein there is an abnormal tangle of thin-walled blood vessels in your brain.
- Vasospasm – Erratic narrowing and widening of the blood vessels in your brain.
Risk Factors Most Commonly Associated with Stroke
There are a lot of factors that can increase the possibility of the causes of stroke. Risk factors for causes of stroke go hand in hand with any condition that has something to do directly with your blood vessels, such as a heart attack. So, any of these factors can also increase your likelihood of having the same causes of stroke:
- High Blood Pressure is one of the causes of stroke
- Tobacco smoking (even exposure to secondhand smoke)
- Heavy Drinking is one of the causes of stroke
- Drug use - methamphetamines and cocaine
- Diabetes is one of the common causes of stroke
- Cardiovascular diseases such as heart failure, infections, defects and heart arrhythmia
- High cholesterol
- Age - Old age can also put you at risk of stroke, specifically ages 55 and above.
- Genetics – having a history of stroke, and any other blood-related illnesses in your family tree such as- heart attack and TIA
- Obesity is one of the known causes of stroke
- Inactive lifestyle - Lifestyle devoid of any physical exercise
- Gender – Men are usually more at risk of stroke than women
- Race - among all other races, African-Americans are more than likely to have a stroke in their lifetime.
Complications That Can Develop From Stroke
A stroke more often than not will leave lasting permanent disabilities, sometimes these complications may only last temporarily. However, the complications largely vary in the area of your brain affected by the condition, and more importantly how long the brain has been left without blood flow.
- Pain – pain can be very common DURING a stroke, but can also persist even after the condition has subsided. Pain can come in certain degrees to the body parts affected by having the condition or can come in the form of numbness.
- Memory loss
- Paralysis – this is perhaps one of the most common complications involved with the condition, and will sometimes persist on only one side of your body.
- Impaired motor functions – most evident in the mouth and certain parts of the face
What are the signs of a stroke?
Stroke sometimes occurs very suddenly, and will immediately induce a person to faint or loss of consciousness. However, a stroke will have several warning signs that may signal that a person will soon experience a stroke. Some of these stroke symptoms vary in length but will most often signal an onset of stroke, usually a few hours or minutes before a person experiences it, so be on the lookout for these:
- Trouble walking – A person that is experiencing signs of a stroke or will soon experience it will have trouble walking. This signs of a stroke may cause the patient to experience a sudden dizziness, that will cause a loss of balance. Loss of coordination with your limbs may also be present that will result in the person stumbling and tripping while walking.
- The trouble with seeing - this signs of a stroke may be present in one or both eyes. When a person describes that he or she has difficulty seeing and has a blackened vision or double vision, then he/she is probably experiencing the onset of a stroke.
- The trouble with Speaking - At the onset of a stroke, speaking will be difficult for the person. There will be a general confusion that will leave the person in a state where he/she has a difficult time understanding and forming speeches.
- A Headache - perhaps one of the most common signs of a stroke, as the place that is most affected is the brain. A headache associated with stroke will be a sudden, very painful headache. A headache will go hand in hand with vomiting, nausea, and will cause an altered consciousness within the patient
- Paralysis - This is also one of the most common signs of a stroke, and will sometimes indicate how severe the condition will be. Paralysis can be in any part of your body, usually only on one side (left or right), depending on what side of the brain is affected. The body parts most affected by stroke will be in your arms, legs, and in the parts of your face. You will have difficulty moving one of these parts, in the case of your face: You may have difficulty in doing basic facial expressions such as smiling, as one side of your mouth will most likely droop downwards.
Diagnostic Procedures
What are the medical procedures used to diagnose stroke?
Experiencing any of the signs of a stroke stated above can truly be a cause for concern, and must immediately warrant a trip to the doctor as soon as possible. The doctor can take a look at your medical history as well as use a physical exam as the basis for diagnosing your condition. The doctor will most likely diagnose that you have a stroke simply by observing the signs of a stroke that will appear, but sometimes the doctor will subject you to different exams to diagnose your stroke, but most especially to locate its source. These are some of the diagnostic procedures used to confirm the signs of a stroke you are experiencing:
- Physical Exams - A physical exam is most commonly used to determine if what you are experiencing is likely a stroke based on the signs you have shown. Physical examinations that your doctor will subject you to will most likely be simple assessments of your motor coordination and mental state. The doctor will also check for numbness or paralysis in any of your body parts, most especially your face, arms, and legs.
- Medical History - your medical history can say a lot of things about you, but most especially, it is a solid basis for any medical conditions you might develop in the future. So it is fair to say that the doctor will take a look at your medical history if you are at risk of having a stroke. Common red flags in your medical history will most likely be: previous conditions that are related to strokes such as heart and blood conditions, the doctor will also look out for any history of stroke and signs of a stroke in any one of your family members.
- MRI - Magnetic Resonance Imaging can be used to diagnose if you have a stroke based on your signs of a stroke, and what type of stroke you are having to effectively determine what is its cause.
- Brain CT Scan - or Computed Tomography can go hand in hand with an MRI scan to effectively produce pictures that may assist the doctor in determining if you have a stroke and what is likely the cause.
- Heart Tests - heart tests such as EKG (Electrocardiogram), Echocardiography, and Blood tests can effectively diagnose if you have a stroke based on your signs of a stroke. Most heart tests are usually painless and only measure basic functions of the heart and detect any irregularities present.
- Carotid Ultrasound
- Carotid Angiography
- Computed Tomography Arteriogram and Magnetic Resonance Arteriogram
How is Stroke Treated? Most Common Stroke Treatment In Use
Most stroke treatments are emergency treatments, so as to effectively and quickly remedy the condition to avoid permanent damage to your brain. Stroke treatment will largely vary on what type of stroke you have, ischemic or hemorrhagic.
Ischemic Stroke Treatment
1. Emergency Remedies with Medications - these stroke treatment medications will only temporarily remedy the condition, and will effectively reduce complications and increase your chances of fast recovery, however they must be administered fast if results are to be expected. Medications that are given as stroke treatment are:
- Aspirin – for immediate stroke treatment involving the pain and prevent further blood clots from forming
- TPA - or tissue plasminogen activator that is introduced intravenously into your body. This stroke treatment medication will dissolve blood clots that are causing your stroke. Please consult with your doctor if TPA treatment is ideal for your condition as it can cause potential bleeding in the brain.
2. Emergency Medical Procedures – the doctor will sometimes use stroke treatment procedures that must be immediately performed such as:
- TPA delivered directly to the brain - Delivering TPA directly to the brain rather than through intravenous injection will allow the TPA to act much faster and dissolve the blood clots quickly.
- Clot Removal - sometimes the doctor will choose to directly remove or break up the clot that is blocking the blood flow to your brain. A catheter is used in this stroke treatment to maneuver a tiny device in your brain.
3. Carotid endarterectomy - This is a surgery wherein the doctor removes plaques (fatty deposits) from your arteries from the neck that lead directly to your brain. These are called carotid arteries, and the doctor will make an incision on your skin right above where they are located to remove the plaque from there.
4. Angioplasty - angioplasty is done by a surgeon to access your carotid arteries, this time in the groin as opposed to the neck.
Hemorrhagic stroke treatment
1. Emergency Measures – The medical procedures involved in hemorrhagic stroke treatment differ directly from those of Ischemic stroke treatments as they are more geared on controlling, isolating and preventing the bleeding occurring in your brain to reduce pressure in it.
- Emergency medication – Warfarin and clopidogrel are most often administered by doctors to prevent blood clots and prevent them from spreading, as they are antiplatelet drugs and will effectively thin out your blood. Medications will also be given later on to counteract the thinning of your blood, and some medications will be prescribed by your doctor to reduce the pressure forming in your brain which can be potentially dangerous.
2. Surgical Procedures - Hemorrhagic stroke treatment often involves surgery, and the surgery is done to repair the damage done by the rupturing of blood vessels in your brain. The doctor will recommend this type of treatment to you if a vascular malformation occurs that maybe the cause of your stroke.
- Stereotactic radiosurgery - this type of surgical procedure involves multiple, highly focused beams of radiation that is used to repair vascular malformation. This type of surgery is an advanced treatment that does little damage and is minimally invasive.
- Surgical clipping - this procedure is done by placing a tiny clamp at the base of your aneurysm, effectively stopping the blood from flowing to it. This will prevent further bursting of that aneurysm, as well as re-bleeding.
- AVM Removal - arteriovenous malformations or AVMs are removed in this procedure to eliminate the risk of further rupturing as well as lower the risk of hemorrhagic stroke from happening. Only the smaller AVMs are removed through this procedure, as further removal of AVMs will cause a significant decline in brain function the deeper located they are in the brain.
- Coiling - coiling or endovascular embolization is a procedure of inserting a catheter into an artery located in your groin. The catheter is guided into your brain through the use of X-ray imaging. The coiling (attachment of tiny detachable coils) is then done on the aneurysm to block blood flow that may cause the blood to clot.
Stroke Recovery and Aftercare
The aftercare that is done after stroke treatment is focused on helping you regain the motor functions and overcome any paralysis you might have incurred during the stroke. The aftercare aims to help you go back to your way of living by helping you regain your strength and allow you to live and perform tasks independently, aiming to help you return to your normal way of living as much as possible.
Patients may choose to engage in a rehabilitation program prescribed to them by their doctors, and will effectively cater to the patient’s preferred pace of learning, taking into consideration his/her health, age and degree of disability.
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