Stroke

What is a stroke?

A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues. The good news is that strokes can be prevented and treated, and many fewer patients die of stroke now than in the past.

Stroke symptoms

Watch for the following signs and symptoms if you suspect a stroke:

• Trouble with understanding and speaking:One may experience confusion, slurred speech or have difficulty understanding speech.
• Paralysis or numbness in the face, arm or leg:The development of sudden numbness, weakness or paralysis in the face, arm or leg, often happening on one side of the body may be a sign of stroke. Another way of determining stroke is to raise both arms over one’s head at the same time. If one arm begins to fall, the patient may be having a stroke. Again one side of the mouth drooping when trying to smile may also be a symptom of an impending stroke.
• Trouble with walking:One may stumble or experience sudden dizziness, loss of balance or loss of coordination.
• Headache:Sudden, severe headaches, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate a stroke.
• Trouble with seeing in one or both eyes.One may experience blurred or blackened vision in one or both eyes, or may have double vision.

What are the first steps in dealing with stroke?

• Face: Ask the person to smile. Watch if one side of the face droops?
• Speech: Ask the person to repeat a simple phrase. Do you notice slurred or strangespeech?
• Arms: Ask the person to raise both arms above the head. Does any arm drift downward? Or is he unable to lift one up?
• Time: If you observe any of these signs, call on us for medical assistance or rush the person to any of our health facilities immediately. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.

Types and causes of stroke

Ischemic stroke

Ischemic strokes occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow (ischemia). About 80 percent of strokes are ischemic strokes.

The most common ischemic strokes include:

• Thrombotic stroke.This occurs when thrombus(a blood clot) forms in one of the arteries that supply blood to the brain. Among other artery conditions a clot may be caused by plaque(fatty deposits) that build up in arteries and cause reduced blood flow (atherosclerosis).
• Embolic stroke.This is when a blood clot or other debris forms away from the brain (commonly in the heart). This is then swept through the bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.

Hemorrhagic stroke

This happens when a blood vessel in the brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels.

These may include:

• Uncontrolled hypertension
• Weak spots in your blood vessel walls (aneurysms)
• Overtreatment with anticoagulants(blood thinners)

Types of hemorrhagic stroke include:

• Intracerebral hemorrhage.In an Intracerebral hemorrhage, a blood vessel inside the brain bursts and spills blood into the surrounding brain tissue. Brain cells beyond the leak are deprived of blood and are damaged.

High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an Intracerebral hemorrhage.

• Subarachnoid hemorrhage.In a subarachnoid hemorrhage, an artery on or near the surface of the brain bursts. Blood is spilled into the space between the surface of your brain and the skull. This bleeding is often characterized by a sudden, severe headache.

After the hemorrhage, the blood vessels in the brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.

Transient ischemic attack (TIA)

Sometimes known as a ministroke, is a temporary period of symptoms similar to those you'd have in a stroke. A temporary decrease in blood supply to part of the brain causes TIAs, which may last as short as five minutes.

Just like an ischemic stroke, this occurs when a clot or debris blocks blood flow to part of your nervous system However, there is no permanent tissue damage and no lasting symptoms.

It is prudent to seek emergency care even if the symptoms clears up. Having a TIA puts you at huge risk of having a full-blown stroke, which may cause permanent damage later. A TIA, would mean the likelihood of a partially blocked or narrowed artery leading to the brain or a clot source in the heart.

It's impossible to tell a stroke from a TIA based only on symptoms. Even when symptoms last for under an hour, there is still a risk of permanent tissue damage.

Risk factors for stroke

Many factors can increase the risk of stroke. Some factors can also increase the chances of a heart attack. Potentially treatable stroke risk factors include:

Lifestyle risk factors

• Being overweight or obese
• Use of narcotics
• Heavy or binge drinking
• Lack of physical activity

Medical risk factors

• Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg)
• Kidney diseases
• Gallstones and kidney stones
• Diabetes
• Obstructive sleep apnea
• High cholesterol
• Enlargment of prostate and BPH
• Cigarette / secondhand smoke
• Cardiovascular disease, e.g. heart failure, heart defects, abnormal heart rhythmor heart infection
• Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include:

• Age - People above age 55 have a higher risk of stroke than younger people.
• Race - African-Americans have a higher risk of stroke than do people of other races.
• Gender - Men generally have a higher risk of stroke than women. Even though women are more likely to die of strokes than men.
• Hormones - use of birth control pills or hormone therapies as well as increased estrogen levels from pregnancy and childbirth.

Complications

A stroke can cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected.

Complications may include:

• Paralysis or loss of muscle movement.One may suffer paralysis on one side of the body, or lose control of certain muscles. Physical therapy can help you return to activities affected by paralysis.
• Memory loss or thinking difficulties.Many people who have had strokes experience some level of memory loss. Others may have difficulty to think, make judgments, reason and understand concepts.
• Emotional problems.People who have had strokes may develop depression due to difficulty with controlling their emotions.
• Difficulty with talking or swallowing.A stroke might affect control of the muscles in the mouth and throat, this will create difficultieswith talking clearly, swallow or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing.
• Behavioral changes and self-care ability.People who have had strokes may become more withdrawn and less social or more impulsive.

How to prevent a stroke

You can take steps to help prevent stroke by living a healthy lifestyle.

This includes the following measures:

• Keep your kidney healthy and avoid UTI ( urinary tract infection)
• Quit smoking: If you smoke, quitting now will lower your risk for stroke.
• Consume alcohol in moderation: If you drink excessively, try to reduce your intake. Alcohol consumption can raise your blood pressure.
• Keep weight down: Keep your weight at a healthy level. Being obese or overweight increases your stroke risk. To help manage your weight:
• Eat a diet that’s full of fruits and vegetables.
• Eat foods low in cholesterol, trans fats, and saturated fats.
• Stay physically active. This will help you maintain a healthy weight and help reduce your blood pressure and cholesterol levels.
• Get checkups: Stay on top of your health. This means getting regular checkups and staying in communication with your doctor. Be sure to take the following steps to manage your health:
• Get your cholesterol and blood pressure checked.
• Talk to your doctor about modifying your lifestyle.
• Discuss your medication options with your doctor.
• Address any heart problems you may have.
• If you have diabetes, take steps to manage it.

Taking all these measures will help put you in better shape to prevent stroke.

Diagnosis

• Physical examination:our doctors' will ask to know what symptoms you are having. Our doctors' then will evaluate whether the symptoms are still present.

Our doctors' will then ask of the medications the patient is on and whether there are any head injuries,personal and family history of heart disease, transient ischemic attack and stroke. Our doctors' will then take blood pressure readings, use a stethoscope to listen to your heart, listen for a whooshing sound over the neck arteries, which may indicate atherosclerosis. Our doctors' may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.

• Blood tests:You may have blood tests, which will tell your care team how fast the blood clots.Managing your blood's clotting time and levels of sugar will be part of your stroke care whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection.
• Computerized tomography (CT) scan:A series of X-rays is used to create a detailed image of your brain. This scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater. There are different types of CT scans that our doctors' may use depending on your situation.
• Magnetic resonance imaging (MRI):Employs the use of powerful radio waves and magnets to create a detailed view of the brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages.
• Carotid ultrasound: Sound waves are used to create detailed images of the inside of the carotid arteries in your neck. This test reveals buildup of fatty deposits (plaques) and blood flow in the carotid arteries.
• Cerebral angiogram:A thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through the major arteries and into the carotid or vertebral artery. Then a dye is injected into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
• Echocardiogram:Sound waves are used to create detailed images of your heart. This will reveal the source of clots in the heart that may have traveled to your brain and caused the stroke.

Treatment

Emergency treatment for stroke will depend on whether it is an ischemic stroke blocking an artery or a hemorrhagic stroke that involves bleeding into the brain.

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to the brain.

Emergency treatment with medications. Therapy with clot-dissolving drugs must start within 4.5 hours if they are given intravenously and the sooner, the better. Quick treatment not only improves the chances of survival but may alsoreduce complications.

You may be given:

• Intravenous injection of tissue plasminogen activator (TPA).This injection is considered the gold standard treatment for ischemic stroke. Recombinant tissue plasminogen activator (TPA), also called alteplase, is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, TPA can be given up to 4.5 hours after stroke symptoms begin.

This drug restores the of flowblood by dissolving the blood clot that causedthe stroke.It may help people who have had strokes recover more fully. A doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate.

Emergency endovascular procedures. Sometimes doctors treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on features of the blood clot:

• Medications delivered directly to the brain.Doctors may perform intra-arterial thrombolysis – in which a long, thin catheter is inserted through an artery in the groin and thread it to the brain to deliver TPA directly into the area where the stroke is occurring.
• Removing the clot with a stent retriever.This procedure is particularly beneficial for people with large clots that can't be completely dissolved with TPA. Doctors may use a catheter to maneuver a device into the blocked blood vessel in the brain and trap and remove the clot.

Recent studies suggest that, depending on the location of the clot and other factors, endovascular therapy might be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after especially an ischemic stroke.

• Carotid endarterectomy. A surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, the surgeon makes an incision along the front of the neck, opens the carotid artery and removes plaque that blocks the carotid artery.

The surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce the risk of ischemic stroke. However, this procedure also involves risks, especially for people with heart disease or other medical conditions.

• Angioplasty and stents. Carotid arteries are accessed through an artery in your groin. Here, your surgeon can gently and safely navigate to the carotid arteries in the neck. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery.

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain. You might also need surgery to help reduce future risk.

Emergency measures. If a patient takes warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, he/she may be given drugs or transfusions of blood products to counteract the blood thinners' effects. Medication may also be given to lower pressure in the brain (intracranial pressure), lower the blood pressure, prevent vasospasm or prevent seizures.

Once the bleeding in the brain stops, treatment usually involves supportive medical care while the body absorbs the blood. Healing is similar to what happens while a bad bruise goes away.

• Coiling (endovascular embolization).A surgeon inserts a catheter into an artery in the groin and guides it to the brain using X-ray imaging. Tiny detachable coils are guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot and end the hemorrhage.
• Surgical AVM removal.Surgeons may remove a smaller AVM if it's located in an accessible area of the brain, to eliminate the risk of rupture and lower the risk of a hemorrhagic stroke. However, it's not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it's large or located deep within the brain.

Recovering from a stroke at Diamed

Concentrate on the rehabilitation and restoration of nerve tissue in the brain and peripheral nerve tissue (hands, legs, speech etc.) though combination of medical and physiotherapy courses with a special miostimulation art unique technologies by Dr. Marina.

Generally Stroke recovery focuses on the following areas:

Speech therapy

A stroke can cause speech and language impairment. A speech and language therapist will work with you to relearn how to speak. Or, if you find verbal communication difficult after a stroke, they’ll help you find new ways of communication.

Cognitive therapy

After a stroke, many survivors have changes to their thinking and reasoning skills. This can cause behavioral and mood changes. An occupational therapist can help you work to regain your former patterns of thinking and behavior and to control your emotional responses.

Relearning sensory skills

If the part of your brain that relays sensory signals is affected during the stroke, you may find that your senses are “dulled” or no longer working. That may mean that you don’t feel things well, such as temperature, pressure, or pain. A therapist can help you learn to adjust to this lack of sensation.

Physical therapy

Muscle tone and strength may be weakened by a stroke, and you may find you’re unable to move your body as well as you could before. A physical therapist will work with you to regain your strength and balance, and find ways to adjust to any limitations.