What is #Stroke
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STROKE

When the blood supply to the brain is interrupted, causing a part of the brain to die, it is called a stroke, or 'brain attack.' Stroke is similar to a heart attack, but it affects the blood vessels in the brain instead of the heart.

When the flow of blood to the brain is blocked by a clot, it's called an ischemic stroke. Another type of stroke, called a transient ischemic attack, is sometimes called a 'mini stroke' and is caused by a temporary clot.

A hemorrhagic stroke happens when a blood vessel in the brain bursts and bleeds, depriving an area of the brain of blood and causing damage inside the brain. Hemorrhagic stroke are classified in two ways, defined by the type of blood vessel causing the damage. The most common - an aneurysm - occurs when an artery or ordinary blood vessel within the brain balloons, weakens, and bursts. In rare cases, an abnormal, tangled mass of blood vessels will form in the brain. This is called an arteriovenous malformation (AVM). Sometimes, one of the vessels within the AVM will burst, causing bleeding and compression in the brain.

TYPES

The three main types of stroke are:

  • Ischemic stroke.
  • Hemorrhagic stroke.
  • Transient ischemic attack (a warning or 'mini-stroke')
  1. Ischemic Stroke

Most strokes are ischemic strokes. An ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked.

Blood clots are often the cause of the blockages that lead to ischemic strokes.

  1. Hemorrhagic Stroke

This type of stroke happens when an artery in the brain leaks blood or ruptures. The leaked blood puts too much pressure on brain cells, which damages them.

Sometimes, high blood pressure and balloon-like bulges in an artery (aneurysms) can stretch and burst. These are examples of conditions that can cause a hemorrhagic stroke.

There are two types of hemorrhagic strokes:

  • Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood.
  • Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it.
  1. Transient Ischemic Attack (TIA)

A TIA is sometimes called a mini-stroke. It is different from the major types of stroke because blood flow to the brain is blocked for only a short time (usually no more than 5 minutes).

It is important to know that:

A TIA is a warning sign of a future stroke.

A TIA is a medical emergency, just like a major stroke.

Strokes and TIAs require emergency care. Call emergency services immediately if one feels signs of a stroke or see symptoms in someone nearby.

There is no way to find out whether symptoms are from a TIA or from a major type of stroke. Just like ischemic strokes, blood clots often cause TIAs.

More than a third of people who have a TIA and don’t get treatment have a major stroke within 1 year. Recognizing and treating TIAs can lower the risk of a major stroke. If one has a TIA, the health care team can find the cause and take steps to prevent a major stroke.

CAUSES

Some conditions that makes one more likely to have a stroke like the following, can be treated.

  • High blood pressure. Hypertension, it's the biggest cause of strokes. If blood pressure is typically 140/90 or higher, the doctor will likely discuss treatments with the patient.
  • Anyone could have a stroke, even babies in the womb. Generally, the chances go up as one gets older. They double every decade after age 55.
  • Some medicines can raise the chances of stroke. For instance, blood-thinning drugs, which doctors suggest to prevent blood clots, can sometimes make a stroke more likely through bleeding. Studies have linked hormone therapy.
  • Tobacco. Smoking or chewing tobacco products raises the odds of a stroke. Nicotine raises blood pressure. Cigarette smoke causes a fatty buildup in the main neck artery. It also thickens blood and makes it more likely to clot. Even secondhand smoke raises risks.
  • Heart disease. This condition includes defective heart valves as well as atrial fibrillation, or irregular heartbeat, which causes a lot of strokes among the very elderly. A person can also have clogged arteries from fatty deposits.
  • People who have it often have high blood pressure and are more likely to be overweight. Both obesity and hypertension raise the chance of a stroke. Diabetes damages the blood vessels, which makes a stroke more likely. If one has a stroke when blood sugar levels are high, the injury to the brain is greater.
  • Gender. Women are slightly less likely to have a stroke than men of the same age. But women have strokes at a later age, which make them less likely to recover and more likely to die as a result.
  • Weight and exercise. The chances of a stroke may go up if a person is overweight. The odds can be lowered by working out every day. A daily brisk 30-minute walk, or muscle-strengthening exercises like pushups and working with weights will help a great deal.
  • Family. Strokes can run in families. Both patients and their relatives may share a tendency to get high blood pressure or diabetes. Some strokes can be brought on by a genetic disorder that blocks blood flow to the brain.
  • Strokes affect African-Americans and nonwhite Hispanic Americans much more often than any other group. Sickle cell disease, a genetic condition that can narrow arteries and interrupt blood flow, is also more common among these groups.

STROKE SYMPTOMS

If a person or someone close by may be having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins.

Signs and symptoms of stroke include:

  • Trouble speaking and understanding what others say. A person may experience confusion, slur the words or have difficulty understanding speech.
  • Paralysis or numbness of the face, arm or leg. The person may develop sudden numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. Try to raise both both arms over the head at the same time. If one arm begins to fall, the person may be having a stroke. Also, one side of the mouth may droop when attempting try to smile.
  • Problems with sight in one or both eyes. Suddenly, one may have blurred or blackened vision in one or both eyes, the person may also see double.
  • Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate a stroke.
  • Trouble walking. A person may stumble or lose their balance. They may also have sudden dizziness or a loss of coordination.
  • RISK FACTORS OF STROKES

Many factors can increase a person’s stroke risk. Potentially treatable stroke risk factors include:

  • Physical inactivity
  • High blood pressure
  • Heavy or binge drinking
  • Lifestyle risk factors
  • Being overweight or obese
  • Use of illegal drugs such as cocaine and methamphetamine
  • Medical risk factors
  • Cigarette smoking or secondhand smoke exposure
  • High cholesterol
  • Diabetes
  • Obstructive sleep apnea
  • Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation
  • Personal or family history of stroke, heart attack or transient ischemic attack
  • COVID-19 infection

Other factors associated with a higher risk of stroke include:

  • Race - African Americans have a higher risk of stroke than do people of other races.
  • Sex - Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men Age - People age 55 or older have a higher risk of stroke than do younger people.
  • Hormones - Use of birth control pills or hormone therapies that include estrogen increases risk.

COMPLICATIONS OF STROKES

Depending on how long the brain lacked blood flow and which part was affected, a stroke can cause temporary or permanent disabilities,

Complications may include:

Paralysis or loss of muscle movement. A person may become paralyzed on one side of the body, or lose control of certain muscles, such as those on one side of the face or one arm.

Difficulty talking or swallowing. A stroke might affect control of the muscles in a person’s mouth and throat, making it difficult for them to talk clearly, swallow or eat. The patient may also have difficulty with language, including speaking or understanding speech, reading, or writing.

Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments and understanding concepts.

Emotional problems. People who have had strokes usually have more difficulty controlling their emotions, or they may develop depression.

Pain. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes the loss of feeling in the left arm, an uncomfortable tingling sensation in that arm may develop.

Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores.

DIAGNOSIS OF STROKE

Things will move quickly once the patient gets to the hospital, as the emergency team tries to determine the type of stroke. That means will most likely have a CT scan or other imaging tests soon after arrival. The doctors will also need to rule out other possible causes of the symptoms (e.g. A brain tumor or a drug reaction).

Some of the tests may include:

  • A physical exam. The doctor will do a number of tests such as listening to the heart and checking the blood pressure, a neurological exam to see how the potential stroke is affecting the nervous system.
  • Magnetic resonance imaging (MRI). An MRI uses 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. If it becomes necessary, the doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).
  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into the bloodstream to view the blood vessels in the neck and brain in greater detail (i.e. computerized tomography angiography).
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of the heart. An echocardiogram can find a source of clots in the heart that may have traveled from the heart into the brain and caused the stroke.
  • Blood tests. One may have several blood tests, including tests to check how fast the blood clots, whether or not blood sugar is too high, and whether there is an infection.
  • Carotid ultrasound. Sound waves create detailed images of the inside of the carotid arteries in the neck. This test will show clearly the buildup of fatty deposits and blood flow in the carotid arteries.
  • Cerebral angiogram. This is an uncommonly used test, in which the doctor inserts a thin, flexible tube (catheter) through a small incision, usually in the groin, and guides it through the major arteries and into the carotid or vertebral artery. Then the doctor will inject a dye into the blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in the brain and neck.

STROKE TREATMENT

Time lost is brain lost Proper medical evaluation and prompt treatment are vital to recovering from a stroke. Call emergency services as soon as there is the realization that one may be having a stroke, or if a loved one is having a stroke.

The treatment for stroke will depend on the type of stroke:

  • Ischemic stroke and TIA

These stroke types are caused by a blood clot or other blockage in the brain. For that reason, they’re largely treated with similar techniques, which include:

Antiplatelet and anticoagulants

Over-the-counter aspirin is often a first line of defense against stroke damage. Anticoagulant and antiplatelet drugs should be taken within 24 to 48 hours after stroke symptoms begin.

Clot-breaking drugs

Thrombolytic drugs can break up blood clots in the brain’s arteries, which still stop the stroke and reduce damage to the brain.

One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the main benchmark in ischemic stroke treatment. The drug works by dissolving blood clots quickly, if delivered within the first 3 to 4.5 hours after symptoms of the stroke began. People who receive a tPA injection are more likely to recover from a stroke, and less likely to have any lasting disability as a result of the stroke.

  • Surgery

In the rare instances that other treatments don’t work, the doctor may perform surgery to remove a blood clot and plaques from the arteries. This may be done with a catheter, or if the clot is especially large, the doctor may open an artery to remove the blockage.

  • Mechanical thrombectomy

With this procedure, the doctor inserts a catheter into a large blood vessel inside the head. Then they will use a device to pull the clot out of the vessel. This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.

  • Stents

If the doctor is able to find where the artery walls have weakened, they may perform a procedure to inflate the narrowed artery and support the walls of the artery with a stent.

  • Hemorrhagic stroke

Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:

  • If the doctor sees that an aneurysm has burst, they may do surgery to clip the aneurysm and prevent additional bleeding. In the same way, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.
  • Unlike with an ischemic stroke, if one is having a hemorrhagic stroke, the treatment goal is to make the blood clot. Therefore, patients may be given medication to counteract any blood thinners they take. They may also be prescribed drugs that can reduce blood pressure, lower the pressure in the brain, prevent seizures, and prevent blood vessel constriction.
  • During this procedure, the doctor will guide a long tube to the area of hemorrhage or weakened blood vessel. They will then install a coil-like device in the area where the artery wall is weak. This blocks blood flow to the area, reducing bleeding.
  • During imaging tests, the doctor may discover an aneurysm that hasn’t started bleeding yet or has stopped. To prevent additional bleeding, the surgeon may place a tiny clamp at the base of the aneurysm. This would cut off blood supply and prevent a possible broken blood vessel or new bleeding.

In addition to emergency treatment, healthcare providers will advise on ways to prevent future strokes.

Stroke medications

Several medications are used to treat strokes. The type that is prescribed depends largely on the type of stroke. The goal of some medications is to prevent a second stroke, while others aim to prevent a stroke from happening in the first place.

The most common stroke medications include:

Tissue plasminogen activator (tPA). This emergency medication can be provided during a stroke to break up a blood clot causing the stroke. Currently, it’s the only medication available that can do this, however, it must be given within 3 to 4.5 hours after symptoms of a stroke begin. This drug is injected into a blood vessel so the medication can start to work as quickly as possible, which reduces the risk of complications from the stroke.

Anticoagulants. These are drugs that reduce the blood’s ability to clot. The most common anticoagulant is warfarin (Jantoven, Coumadin). These drugs can also prevent existing blood clots from growing larger, which is why they may be prescribed to prevent a stroke, or after an ischemic stroke or TIA has occurred.

Antiplatelet drugs. These medications prevent blood clots by making it more difficult for the blood’s platelets to stick together. The most common antiplatelet drugs include aspirin and clopidogrel (Plavix). They can be used to prevent ischemic strokes and are especially important in preventing secondary stroke. It is most advisable that aspirin should only be used as as a preventive medication for those who have a high risk of atherosclerotic cardiovascular disease (e.g., heart attack and stroke) and a low risk of bleeding.

Statins. Statins, which help lower high blood cholesterol levels, are among the most commonly prescribed medications. These drugs prevent the production of an enzyme that can turn cholesterol into plaque - the thick, sticky substance that can build up on the walls of arteries and cause strokes and heart attacks. Common statins include rosuvastatin (Crestor) and atorvastatin (Lipitor).

Blood pressure drugs. High blood pressure may cause pieces of plaque buildup in the arteries to break off. These pieces can block arteries, causing a stroke. As a result, controlling high blood pressure can help prevent a stroke.

The doctor may prescribe one or more of these drugs to treat or prevent a stroke, depending on the patient’s general health history and risks.

PREVENTION

  • Prevention is always the best treatment, especially when the illness can be life-threatening or life-altering. Ischemic strokes are most often caused by atherosclerosis, or the hardening of the arteries, and they carry the same risk factors as heart attacks and peripheral vascular disease. These include high blood pressure, high cholesterol, diabetes, and smoking. Quitting the habit of smoking and keeping the other three under lifelong control greatly minimizes the risk of ischemic stroke.
  • Patients who have had a transient ischemic attack (TIA) are often prescribed medications to decrease their risk of a subsequent stroke. These include medications to lower blood cholesterol levels and control blood pressure. In addition, antiplatelet medications may be prescribed to make platelets less likely to promote blood clot formation. Antiplatelet medications include aspirin, clopidogrel (Plavix), and dipyridamole/aspirin (Aggrenox).
  • Patients with a TIA are usually evaluated for carotid stenosis or narrowing of the carotid artery. Surgery to open critically narrowed carotid arteries (termed endarterectomy) may decrease stroke risk.
  • A lifelong control of high blood pressure decreases the risk of hemorrhagic stroke.

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