Stroke
What is Stroke?
Stroke is a condition when a part of the brain dies because it goes without blood for too long. There are two main types of stroke:
- • Ischemic stroke, which is caused by a blockage in a blood vessel in the brain.
- • Hemorrhagic stroke, which is caused by bleeding in the brain or surrounding area.
What are the risk factors?
There are a number of risk factors for stroke; some of these factors increase the risk of one type of stroke (hemorrhagic or ischemic), while others increase the risk of both types.
Ischemic stroke risk factors include the following:
- • Age older than 40 years
- • Heart disease
- • High blood pressure
- • Smoking
- • Diabetes
- • High blood cholesterol levels
- • Illegal drug use
- • Recent childbirth
- • Previous history of transient ischemic attack
- • Inactive lifestyle and lack of exercise
- • Obesity
- • Current or past history of blood clots
- • Family history of cardiac disease and/or stroke
Hemorrhagic stroke risk factors include the following:
- • High blood pressure
- • Smoking
- • Illegal drug use (especially cocaine and "crystal meth")
- • Use of warfarin or other blood thinning medicines
Risk factors can increase the risk of stroke, but strokes can happen in people who don’t know that they are at risk. In some cases, the stroke may be due to problems with the blood vessels in the brain or the blood itself.
What are the symptoms?
Signs and symptoms of stroke often develop suddenly and then may temporarily improve or slowly worsen, depending upon the type of stroke and area of the brain affected. In both ischemic and hemorrhagic stroke, one or more areas of the brain can be damaged. Depending upon the area affected, a person may lose the ability to move one side of the body, the ability to speak, or a number of other functions.
BE FAST to help remember stroke symptoms:
Each letter in the word stands for one of the things you should watch for:
- • Balance – Difficulty standing or walking
- • Eyes – Changes in vision
- • Face – Sudden weakness or droopiness of the face, or problems with vision
- • Arm – Sudden weakness or numbness of one or both arms
- • Speech – Difficulty speaking, slurred speech, or garbled speech
- • Time – Time is very important in stroke treatment. The sooner treatment begins, the better the chances are for recovery. If you notice any of the above signs, call for an ambulance right away.
What are the diagnostic tests?
- CT scan or MRI scan
- CT angiography or MR angiography
- ECG or/and Echocardiogram
What is the treatment?
The treatment of a stroke depends upon the type of stroke, the time that has passed since the first symptoms occurred, and the patient’s other medical problems.
1. Very Early treatments:
After an ischemic stroke, the goal of treatment is to restore blood flow to the affected area of the brain as quickly as possible, that is, within the first hours after the onset of stroke symptoms. The main very early treatments for ischemic stroke are:
- Thrombolytic therapy – This involves giving a medication by IV (through a vein). It works by breaking up the clot that is blocking blood flow to the brain.
- Mechanical thrombectomy – This is a procedure that involves a specialist placing a catheter in the blocked artery and removing the clot. This is done using a “stent retriever device” or suction to reopen the blocked artery.
2. Other Early Treatments:
Other medications sometimes used for the early treatment of ischemic stroke are antiplatelets and anticoagulants.
- Antiplatelets — Antiplatelet therapy is often used immediately for ischemic stroke if thrombolytic therapy cannot be given, or it may be given following thrombolytic therapy.
- Aspirin is the best-known antiplatelet medication. Clopidogrel, ticagrelor, cilostazol, and dipyridamole are other antiplatelets sometimes prescribed. Antiplatelet therapy helps prevent new clots from developing and is beneficial for the treatment of acute ischemic stroke.
- Anticoagulants— Anticoagulants, or anti-clotting medications, are often referred to as “blood thinners.” However, they don’t actually cause the blood to become thinner, only less likely to clot. Because of the risk of excessive bleeding, anticoagulation is seldom given for the treatment of acute ischemic stroke.
3. Long term prevention of ischemic stroke:
In the longer term, treatment is aimed at reducing the chances that a person will have another stroke. This is called “secondary prevention.”
- Blood pressure medications— Having high blood pressure (hypertension) increases a person’s risk of stroke, especially if they have already had one.
- Cholesterol-lowering medications— Treatment that lowers low-density lipoprotein (LDL) cholesterol (LDL-C) can reduce a person’s risk of having another ischemic stroke.
- Antiplatelet therapy— The antiplatelet medicines aspirin, clopidogrel, and the combination of aspirin plus extended-release dipyridamole and cilostazol are all acceptable options for preventing recurrent ischemic stroke for people whose stroke was not caused by embolism from the heart.
- Aspirin— Aspirin (even at relatively low doses) is effective for preventing ischemic stroke. It is used as first-line treatment after a noncardioembolic stroke, meaning a stroke in which the blood clot did not originate from the heart. Aspirin and may then be continued longer term or switched to a different antiplatelet medication. Aspirin has the advantage of being less expensive than the other antiplatelet medications.
Outcome after stroke:
The effects of a stroke can be temporary or permanent, and a person may lose function partially or completely. A number of problems can develop in people who have had a stroke. The medical team caring for the patient can give guidance to family members regarding the risk of long-term disability or death. However, the outcome can vary greatly from person to person, and it is not always possible to predict what will happen, especially in the first hours or days after a stroke.
What are the Stroke complications?
- Blood clots
- Difficulty eating and drinking, which increases the risk of pneumonia and malnutrition
- Urinary tract infection
- Bleeding in the digestive system
- Heart attack or heart failure
- Bed sores
- Falls
- Depression
What Lifestyle changes recommended after stroke?
- Quit smoking
- Avoid or cut back on alcohol
- Eat a healthy diet and exercise
- Maintain a healthy body weight
