Other Diseases
Stroke
​Stroke is a cerebrovascular accident (CVA) that happens when blood flow to a part of the brain is cut off or greatly hampered, depriving brain cells of necessary oxygen and other vital nutrients. As a result, brain cells begin to die within minutes.
A stroke is a medical emergency. Prompt treatment is crucial as early action can minimize brain damage and potential complications post stroke.
Stroke can be treated by greater control over most stroke risk factors such as hypertension, smoking and high blood cholesterol. Controlling those factors is probably the leading cause of reduced stroke cases. 
 
Symptoms:
Watch for the following early signs:
  • Trouble with walking: You may stumble or experience dizziness, loss of balance or loss of coordination (between the senses, movement, and speech).
  • Trouble with speaking: You may slur your words or lose the ability to find the right words to describe what is happening to you and with you (loss of speech, or loss of language - Aphasia). Try to repeat a simple sentence, if you cannot do that, it's likely that you have a stroke.
  • Paralysis or numbness of one side of your body: You may lose sensation or develop paralysis on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall and you already having one of the other symptoms, you may be having a stroke.
  • Trouble with seeing: You may suddenly have blurred vision or lose vision for a few moments, or may suffer double vision (Diplopia).
  • Headache: A sudden, severe headache, which may be accompanied by spasms in the neck, pain in the face and between the eyes, sudden vomiting or altered consciousness, may sometimes indicate you're having a stroke.
With most people, the first sign of a possible stroke is cerebral ischemia transient (TIA - Transient ischemic attack), a temporary disorder in the delivery of blood to one part of the brain.
Causes and risk factors of stroke:
A stroke occurs when the blood supply to your brain is interrupted or reduced, causing the most prevalent type - ischemic stroke.
The cause of the other type of stroke - hemorrhagic stroke- is an excess of blood in the skull.
 
Ischemic stroke:
About 80% of strokes are ischemic strokes. This type of stroke occurs when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow to the brain (Ischemia), which prevents supplying the brain with oxygen and other different nutrients. As a result, brain cells die within minutes. 
The most common ischemic strokes include:
  • Thrombotic stroke: This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. This process occurs in one of the head arteries, at the lower part of the neck, which supply the blood to the brain, as same as other arteries in the neck and brain. 
  • Embolic stroke: This type of stroke occurs when a blood clot or other particle forms inside a blood vessel away from the brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. In general this type happens as a result of disturbances in heart rhythm in one of the heart's upper chambers (Atrial fibrillation), leading to a defect in the supply of blood and formation of clots.
Hemorrhagic stroke:
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from some conditions that affect your blood vessels, such as uncontrolled high blood pressure (Abnormal cystic expansion- Aneurysm). A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (AMV -Arteriovenous malformation) present at birth.
 
There are two types of hemorrhagic stroke:
Intracerebral hemorrhage:
In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and also damaged. High blood pressure may cause an intracerebral hemorrhage. As time passes, the high blood pressure can make the brain's tiny blood vessels thinner and more to cracking and rupture.
 
Subarachnoid hemorrhage:
In this type of stroke, an artery on or near the surface of your brain bursts and spills into the space between your brain and your skull. Such bleeding is often accompanied by a sudden, severe headache.
A subarachnoid hemorrhage is commonly caused by swelling or widening in one of the arteries which may form and enlarge with time or may be congenital. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.
There are many factors that may increase the likelihood of having a stroke. Also, some of these factors may increase the possibility of heart attack (AMI – Acute myocardial infarction).
 
Risk factors:
  • Age: Being age 55 or older.
  • High blood pressure: If the systolic pressure readings at 140 millimeters of mercury (mm Hg), or more, or the diastolic pressure readings at 90 millimeters of mercury (mm Hg), or more.
  • High cholesterol: If cholesterol level at 200 milligrams per deciliter (mg / dL) or more.
  • Smoking.
  • Diabetes.
  • Obesity: If the BMI (Body Mass Index) is 30 or more.
  • Cardiovascular disease including heart failure, heart defects, heart infection or abnormal heart rhythm.
  • A previous stroke or transient ischemic attack, (TIA - Transient ischemic attack).
  • High levels of homocysteine (Homocysteine), a type of amino acid.
  • Taking contraceptive pills, or other hormonal treatment.
Other factors associated with a higher risk of stroke include: Alcohol and drug use. Although stroke rates are equal in men and women, women are more likely to die of strokes than are men. Black people are more likely to have a stroke than people of other ethnic origins.
 
Complications:
Potential complications of a stroke vary according to the affected part of the brain. Such complications include:
  • Paralysis or loss of muscle movement.
  • Difficulty talking or swallowing.
  • Memory loss or thinking difficulties.
  • Pain.
People who have had strokes may become more withdrawn and less social. They may lose the ability to take care of themselves, and need help to do their daily chores, such as personal hygiene and other tasks.
The same applies to the complications of stroke, as its treatment varies from a person to another.
 
Diagnosis:
If someone has had a stroke or transient ischemic attack (TIA), or believes that they are at risk of stroke, they must talk to a neurologist about performing nuclear scanning.
Before starting treatment, the treating doctor needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. The doctor also needs to rule out other possible causes such as brain tumour. The following are the most common nuclear scanning tests which are capable of determining the degree of your risk of stroke, and can also be used for diagnosis if you got a stroke: 
  • Clinical examination
  • Ultrasound of the Arteriacarotis
  • Arteriography
  • CT scan
  • MRI
  • Echocardiography
Treatment:
The ischemic stroke is the most common type of strokes and can be treated with a drug called t-PA, which dissolves clots impeding blood flow to the brain. To evaluate and treat the case, it is important to quickly get to a hospital. If the transient ischemic stroke or attack occurred, the most important things to remember are: 
  • Don't ignore signs of stroke even if they disappeared.
  • When the first symptoms appeared
  • If there is one or more of the symptoms of stroke that continued for more than few minutes, contact emergency services immediately. 
Tests conducted at the emergency section indicate whether symptoms are caused by a transient ischemic stroke/attack or another medical problem. Treatment of the stroke caused by a blocked-artery is different from treatment of the stroke caused by a ruptured blood vessel. At the hospital, your doctor may prescribe you Aspirin or any other blood thinner to prevent blood clots from forming. Also some blood thinners are called antiplatelet drugs. And when you take the blood thinners, you may be in need of periodic blood tests. Other drugs may also be given in the hospital, which may include drugs to treat arterial hypertension, high cholesterol, heart problems and diabetes.
Surgery or other treatment - your doctor may recommend a surgical procedure to open up a blocked artery, partially or completely.
 
The procedures include the following:
- Carotid artery surgery (CEA)
- Carotid artery stenting (CAS)
  • Hemorrhagic stroke
Surgery may be useful to treat hemorrhagic stroke or prevent the next stroke.
Important tips recommended by doctors before leaving the hospital:
  • Quit smoking, if you are a smoker.
  • Follow up a proper diet after discharge from the hospital.
  • Learn the devices you may need to help you moving.
  • Get to know stroke support group in your community and how to live with the disease.
  • Keep track of the medical appointments that you may need with a physical therapist or a speech-language therapist.
  • Make regular follow-up visits to your doctor and taking medication on time.
Prevention:
Prevention of stroke is easier than treatment. If you have had a stroke you can protect yourself from having another one.There are certain factors that increase the chances of having a stroke, and these factors are called stroke risk factors.
Risk factors differ from a person to another. Some risk factors are unchangeable such as age, sex and race; older persons are at higher risk than younger ones. Other risk factors are changeable. You can reduce the chances of having a stroke by controlling the following:
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking habits
  • Weight and physical activity
It is important to control the risk factors in coordination with your doctor.
Introducing healthy changes into your lifestyle can reduce your chances of having a stroke, Allah willing.
 
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Last Update 15 March 2018 11:01 AM
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