Non-Communicable Diseases
Stroke

A stroke is defined as a cerebrovascular accident (CVA) that results from the blood flow to a part of the brain being stopped or severely disrupted, preventing brain tissue from receiving essential oxygen and other vital nutrients. As a result, brain cells die within a few minutes.

A stroke is deemed a medical emergency. Prompt treatment is extremely vital for its treatment. It can reduce damage to the brain and prevent potential complications after a stroke.

A stroke can be treated by raising the level of control over most of its risk factors, such as high blood pressure (hypertension), smoking, and high blood cholesterol. These factors are the most likely cause of a lower rate of strokes.
 
Symptoms: 
Pay attention to the following early signs:
  • Difficulty walking: A person with a stroke might stumble, feel dizzy, or lose balance and coordination between senses, movement, and speech.
  • Difficulty speaking: A person with a stroke may lose the ability to find the right words to describe what is happening to them; a loss of language (aphasia). Try to repeat a simple sentence. If you can't do that, then there is a great chance you are having a stroke.
  • Paralysis or numbness on one side of the body: A person with a stroke might lose sensation or feel paraplegic (paralysis on one side of the body). Try to raise both your arms over your head at the same time. If one of them begins to fall, and you have one of the other symptoms, it is possible that you are having a stroke.
  • Vision difficulties:  If a person has a stroke, they may experience sudden blurred vision. They could also lose vision for a few minutes or suffer from double vision (diplopia).
  • Headache: A headache that appears suddenly and without a warning, or an unusual headache that's accompanied by a cramping in the neck, face pain, pain between the eyes, sudden vomiting or changes in cognitive state may sometimes indicate a stroke.

For most people, the first sign of a stroke is transient ischemic attack (TIA), which is a temporary abnormality in the delivery of blood to one part of the brain.

Risk factors and causes of a stroke:
A stroke occurs if there is a problem or imbalance in the amount of blood flowing to the brain, causing a stroke of the most common type “ischemic stroke”. This type indicates the delivery of a small amount of blood to the brain.
The cause of the other type of strokes is hemorrhagicstroke. It includes an excess blood flow in the skull.

Ischemic stroke:
This type of stroke accounts for about 80% of all strokes. It occurs when the arteries of the brain become narrow or get blocked, causing a significant decrease in the amount of blood supplied to the brain (ischemia). This prevents supplying the brain with oxygen and other various nutrients, which leads to the death of brain cells within a few minutes.

Most common types of an ischemic stroke:
  • A thrombotic stroke: This stroke occurs when a thrombus (blood clot) is formed in one of the arteries responsible for supplying blood to the brain. Blood clotting usually occurs in areas that have been affected by atherosclerosis, a disease in which arteries become clogged due to the accumulation of fatty deposits (plaques). This process occurs in one of the arteries of the head (kuh - ROT - id) at the back of the neck. They are responsible for supplying blood to the brain, like other arteries in the area of the neck and brain.
  • Embolic stroke:  This type of stroke occurs when a clot or another particle forms in a blood vessel far from the brain, in the heart area. Usually, the blood stream pushes it until it settles in a narrow blood vessel in the brain area. This type of clots is called “embolus”.  This condition generally happens as a result of arrhythmia in one of the two upper chambers of the heart (atrial fibrillation), which leads to an imbalance in the blood supply and formation of clots.
  • Hemorrhagic stroke: This stroke occurs when a blood vessel in the brain begins to bleed or rupture. This bleeding may occur as a result of some medical conditions that affect the blood vessels, such as untreated high blood pressure (abnormal cystic expansion in one or more arteries - aneurysm). Another less common cause of hemorrhage is vascular rupture, which is an arteriovenous malformation (AMV - arteriovenous malformation) in which some blood vessels are thin-walled, which causes them to easily rupture. It is a congenital malformation.
 
There are two types of a hemorrhagic stroke:
Brain hemorrhage: In this type of stroke, a blood vessel inside the brain bursts and blood flows to the brain tissue around it, causing damage to brain cells. Likewise, the brain cells behind the leak do not get regular amounts of blood and they get damaged, too.

High blood pressure over time may cause a stroke of this type. Over time, high blood pressure can turn the small blood vessels inside the brain thinner and more likely to crack and tear.
 
Subarachnoid hemorrhage: In this type of stroke, bleeding begins in a large artery or on the surface of the brain. This causes the blood to flow into the space between the brain and the skull. This type of bleeding is often accompanied by a severe and sudden headache.
 
This stroke is often caused by a bulge or expansion of the wall of an artery, which could either form over time or be congenital (since birth). Once a hemorrhage begins, blood vessels in the brain may expand and narrow in an irregular manner (vasospasm). This could cause damage to cells due to further decline in the blood supply to other parts of the brain.

Several factors can increase the risk of a stroke. Furthermore, some of these factors may increase the risk of developing a heart attack (acute myocardial infarction - AMI - acute myocardial infarction).

The risk factors of a stroke include:
  • Age: Being over the age of 55.
  • High blood pressure (hypertension): The systolic pressure level being 140 mmHg or higher, or diastolic pressure level being 90 mmHg or higher. 
  • High cholesterol:  The blood cholesterol level being 200 mg/dL or higher.
  • Smoking
  • Diabetes
  • Obesity The BMI being 30 or more.
  • Cardiovascular diseases, including heart failure, a heart defect, heart inflammation or an irregular heartbeat.
  • A previous stroke or a transient ischemic attack.
  • Elevated levels of homocysteine, a type of amino acid. 
  • Using birth control pills or other forms of hormonal therapy.

Other factors can also increase the risk of a stroke. They include: Alcohol and drug use.
Even though stroke rates are equal among women and men, women are more likely than men to die from a stroke. People with darker skin are more likely to have a stroke than people of other ethnic groups.

Stroke complications: Possible complications of a stroke vary according to the part of the brain affected.
These complications include:
  • Paralysis or loss of ability to move muscles;
  • Difficulty speaking or swallowing; 
  • Memory loss or problems with comprehension;
  • Pain.

Stroke patients sometimes tend to become more introverted and less involved in social life. They may lose the ability to look after themselves, and could need a nursing care plan to help them perform daily tasks, such as taking care of personal hygiene and other aspects.

The same applies to stroke complications, as the success of its treatment varies from one person to another.

Diagnosis: 
If someone has had a TIA in the past, or thinks they are at risk of having a stroke, they must seek medical attention from a neurologist about having nuclear scaning.
Before treatment starts, the attending doctor must understand the type of stroke that occurred and which areas of the brain were affected or damaged by it. Additionally, before treatment starts, other possible causes, such as brain tumors, should be ruled out.

The following tests are the most common nuclear scanings which can determine the degree of a risk resulting from a stroke. They can also be a means of diagnosis if a person has had a stroke:
  • Clinical examination;
  • An ultrasound of the carotid artery (Arteria carotis);
  • An arteriography;
  • A computerized tomography scan (CT);
  • A magnetic resonance imaging (MRI);
  • An echocardiography.
Stroke treatment:
An ischemic stroke is the most common type of strokes. It can be treated with a drug called t-PA which dissolves clots that block blood flow to the brain. In order to assess and treat the condition, it is very important to get the patient to the hospital as quickly as possible. If a stroke or TIA occurs, the most important things to remember are:
  • Don't ignore signs of a stroke even if they disappear.
  • Look at time. When did the initial symptoms start appearing?
  • If one or more stroke symptoms seem to last for more than a few minutes, do not wait. Immediately call an ambulance. 

Tests performed in the emergency department determine whether the symptoms are caused by a stroke, TIA, or another medical problem. The treatment of a stroke caused by a blocked artery is different from the treatment of a stroke caused by a ruptured blood vessel. In the hospital, your doctor may prescribe aspirin or other blood thinners to prevent blood clots from forming. 

Some blood thinners are also called anti-platelet drugs, so when you are taking blood thinners you may need to have regular blood tests performed. You may also be given other medications in the hospital.  They may include drugs to treat high blood pressure, high cholesterol, heart problems and diabetes.

Surgery or other treatments: your doctor may recommend surgery to open up the blocked artery, whether it's partially or completely blocked.

These surgeries include: 
  • Carotid endarterectomy (CEA)
  • Carotid artery stenting (CAS)
  • A Hemorrhagic stroke

Surgery may be helpful in treating a hemorrhagic stroke or preventing the next stroke.

Your doctor will give you crucial tips before you leave the hospital. They include: 
  • Quitting smoking (if you're a smoker);
  • Following a proper diet;
  • Being aware of the tools you may need to help you move;
  • Becoming acquainted with stroke support groups in your community and learn how to live with the condition; 
  • Knowing the medical appointments you may need with a physical therapist or a speech therapist;
  • Continuing follow-up visits with your doctor and taking medications on time.

Prevention:
Strokes are easier to prevent than treat after they occur. If you have had a stroke, you can prevent it from recurring. Certain factors increase the chances of a stroke, and these factors are called stroke risk factors.
Risk factors differ from a person to another. Some risk factors cannot be changed, such as age, gender and ethnicity. For example, an older person is generally more likely to have a stroke than a young person. You can reduce the chances of a stroke by controlling other factors, such as:
  • High blood pressure (hypertension);
  • High cholesterol; 
  • Diabetes; 
  • Smoking habits;
  • Weight and physical activity. 
It is important to work on controlling risk factors in coordination with your doctor.
Making healthy lifestyle changes can reduce your chances of having a stroke.


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Last Update : 23 February 2021 04:07 AM
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