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Stroke


What is Stroke?

A stroke is the sudden death of a portion of the brain cells due to a lack of oxygen. A stroke occurs when blood flow to the brain is damage resulting in abnormal function of brain. It causes by blockage or rupture of an artery to the brain.

Alternative Names

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident

Symptoms of Stroke

Stroke

The symptoms of a stroke depend on what part of the brain and how much of the brain tissue is affected.

  • Stroke symptoms usually come on suddenly-in minutes to an hour.
  • There is usually no pain associated with the symptoms.
  • The symptoms may come and go, go away totally, or get worse over the course of several hours.
  • If the symptoms go away completely in a short time (fewer than 24 hours), the episode is called a transient ischemic attack (TIA).
  • A third of all strokes occur during sleep, so people first notice the symptoms when they wake up.
  • These are the common symptoms of stroke:
    • Weakness in the arm or leg or both on the same side: This can range from total paralysis to a very mild weakness. Complete numbness or a pins-and-needles feeling may be present on one side of your body or part of one side of your body.
    • Weakness in the muscles of the face: Your face may droop or look lopsided. Speech may be slurred because you can't control the movement of your lips or tongue.
    • Difficulty speaking: You can't speak, speech may be very slurred, or when you speak, the words sound fine but do not make sense.
    • Coordination problems: You may seem uncoordinated and stumble or have difficulty walking or difficulty picking up objects.
    • Dizziness: You may feel drunk or dizzy or have difficulty swallowing.
    • Vision problems: You may develop difficulty with vision, such as double vision, loss of peripheral (side) vision, or blindness. (Blurred vision by itself is not usually a symptom of stroke.)
    • Sudden headache: A sudden, severe headache may strike like "a bolt out of the blue." Some people have called this the worst headache of their lives.
    • Loss of consciousness: You may become unconscious, stuporous, or hard to arouse and could die.

Causes, and risk factors of Stroke

There are several medical conditions that can cause stroke. The most common condition, called ischemic stroke is caused by a blood clot blocks the blood flow to the brain. While the other condition, called hemorrhagic stroke, is caused by a rupture of a blood vessel in the brain.

Stroke can affect people of all age, races and gender. However, the possibility of having a stroke increase if a person has a certain risk factors, or criteria that can cause a stroke.

The good news is up to 80 percent of strokes risk factors can be prevented or controlled, and the best way to prevent yourself and loved ones from a stroke is to understand the risk factors and better manage them.

The stroke risk factors are changable risk factors and unchangeble risk factors. Certain conditions are proven to increase the risk of stroke, if these conditions can be kept under control, the risk of stroke may decrease.

The stroke risk factors that can be controlled are:

  • High blood pressure (hypertension) is the second most important risk factor after age
  • Diabetes. About a quarter of people with diabetes die from a stroke. The presence of diabetes doubles the risk of stroke due to damage to the blood vessels that occurs in this disease.
  • Elevated bad blood cholesterol levels (HDL) can lead to coronary artery disease and myocardial infarction which damages the heart muscle (myocardium) which may increase the risk of a stroke
  • Coronary artery disease that can lead to a heart attack and a stroke
  • Other heart disease such as atrial fibrillation, endocarditis, heart valve disease, cardiomyopathy, patent foramen ovale
  • Smoking, including passive smoking
  • Physical inactivity
  • Obesity
  • Certain drugs such as oral contraceptives – especially in women who smoke or who have other bleeding disorders – and anticoagulants or corticosteroids. It seems that women in menopause that follow a hormone replacement treatment have a lower risk of stroke
  • Increased consumption of alcohol, because people who drink alcohol excessively, especially those with acute alcohol intoxication have a higher risk of stroke.
  • Cocaine usage or other illicit drugs.

uncontrollable risk factors:

  • Age. The risk of stroke increases with age, each ten years double the stroke risk after the age of 55. At least 66 percent of all people with stroke were aged 65 or more.
  • Race. Black and Hispanic Americans have a higher risk than people of other races. Compared with whites, young black Americans, both women and men have a risk of 2 to 3 times more likely to make a stroke and die from this cause.
  • Sex. Stroke is more common in men than in women up to 75 years, but after this age women are more affected. At all ages, more women than men will die from a stroke.
  • Family history. The risk of stroke is greater if a parent, brother or sister had a stroke or transient ischemic atack present in the past.

Treatment for Stroke

Early treatment can prevent or at least limit damage to the brain. Acting fast, treatment at the first symptoms of brain attack, can save your life and avoid damages.

Common stroke treatments are medications, hospital care, surgery and rehabilitation.

Treatment for Ischemic Stroke

Initial treatment for ischemic stroke involves removing the blockage and restoring blood flow. Tissue plasminogen activator (t-PA) is a medication that can break up blood clots and restore blood flow when administered within 3 hours of the event. This medication carries a risk for increased intracranial hemorrhage and is not used for hemorrhagic stroke. Mannitol, a diuretic, may be administered intravenously (through an IV) to reduce intracranial pressure during an ischemic stroke.

Antihypertensives such as labetalol (Normodyne®) and enalapril (Vasotec®) may be used alone or in combination with diuretics to treat high blood pressure. Side effects are usually mild and include dizziness, fatigue, and headache.

Antiplatelet agents such as aspirin, clopidogrel bisulfate, and aspirin with dipyridamole (Aggrenox®) may be prescribed to reduce the risk for recurrent stroke. Aspirin may also improve the outcome of a stroke when administered within 48 hours. Side effects include stomach pain, heartburn, nausea, and gastrointestinal bleeding. Aggrenox is taken orally, twice a day, and may also cause headache.

Clopidogrel bisulfate (Plavix®) is an antiplatelet medication that is taken orally, once a day, to help prevent the formation of blood clots. It is prescribed for patients with atherosclerosis who have had a recent stroke and is used to prevent recurrence. Patients with medical conditions that may cause internal bleeding (e.g., stomach ulcers) should not use clopidogrel.

Side effects include abdominal pain, rash, diarrhea, and headache. Serious side effects (e.g., gastrointestinal hemorrhage) are rare. Physicians and dentists should be informed that a patient is taking clopidogrel before any surgery is scheduled.

Anticonvulsants such as diazepam (Valium®) and lorazepam (Ativan®) may be prescribed for patients who experience recurrent seizures after a stroke. Side effects include drowsiness, fatigue, and weakness.

Complications of Stroke

Stroke is nothing but the starvation of the brain as it fails to get the required amount of oxygen for proper functioning. The changes of the person after the stroke attacks are well seen in many patients and these are often referred to as complications of stroke. The stroke complications are many and well diversified and they normally vary from one person to another. Also these variations are not uniform and the patients may have one, two or more symptoms of the disease. Normally these complications are well seen in many patients who have suffered from very severe attacks and not well pronounced in the other mild cases of stroke attacks. So we infer that the degree of torture provided by these complications differ depending on the severity of the stroke attacks. These complications may also vary depending on time as short term and long term effects.

Normally the doctors can predict the onset of these complications depending on the patient’s health. However if the treatment is slightly compromised then the patients will have a serious risk of suffering from the disease. Taking a look at some of the stroke complications we learn that paralysis may happen in some patients. This is one of the cruelest forms of complications and the patients find increasingly difficult to come out of it. The patients also have severe risk of falling prey to coma wherein the person lies alive but the brain does not function. This one is seen in many patients for whom treatment has been delayed as it results in brain starvation.

Also vision and speech therapy may be needed for the patients for easy and a complete cure from the complication. This is another well known complication of this disease. The extreme thing that can happen to the patients is that the patients may even go the state where they are alive yet without any movement. Some patients may also develop breathing problems which is considered to be very severe and life threatening. This difficulty is mainly seen in patients where the stroke occurs in the brain stem which is considered as very dangerous for the patients.

Prevention of Stroke

Primary prevention of stroke refers to the treatment of individuals with no previous history of stroke. Risk-reduction measures may include the use of antihypertensive medications; warfarin; platelet antiaggregants; 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins); smoking cessation; dietary intervention; weight loss; and exercise.

Secondary prevention refers to the treatment of individuals who have already had a stroke or transient ischemic attack (TIA). Measures may include the use of platelet antiaggregants, antihypertensives, statins, and lifestyle interventions.

Most primary and secondary stroke prevention recommendations focus on ischemic stroke, but some apply to hemorrhagic stroke, or to cerebral venous thrombosis.


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