Stroke

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A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.

Symptoms

  • Trouble with speaking and understanding.
  • Paralysis or numbness of the face, arm or leg.
  • Trouble with seeing in one or both eyes.
  • Headache.
  • Trouble with walking.

When to see a doctor

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear.

Think “FAST” and do the following:

  • Ask the person to smile. Does one side of the face droop?
  • Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to raise up?
  • Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
  • If you observe any of these signs, call for help immediately.

Causes

A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die.

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain (transient ischemic attack, or TIA).

Types of sroke

Ischemic stroke

About 85 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

  • Thrombotic stroke.
  • Embolic stroke.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension), overtreatment with anticoagulants and weak spots in your blood vessel walls (aneurysms).

A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation) present at birth. Types of hemorrhagic stroke include:

  • Intracerebral hemorrhage.
  • Subarachnoid hemorrhage.

Complications

A stroke can sometimes 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
  • Difficulty talking or swallowing
  • Memory loss or thinking difficulties
  • Emotional problems
  • Pain
  • Changes in behavior and self-care ability

Diagnosis

To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you’re having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including:

  • Physical examination
  • Blood tests
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Carotid ultrasound
  • Cerebral angiogram
  • Echocardiogram

Treatment

Emergency treatment for stroke depends on whether you’re having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke that involves bleeding into the brain.

Ischemic stroke

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

Emergency treatment with medications. Therapy with clot-busting drugs must start within 3 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:

  • Aspirin
  • Intravenous injection of tissue plasminogen activator (TPA)

Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible, depending on features of the blood clot:

  • Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but is still limited.
  • Mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot.

Other procedures.

  • Carotid endarterectomy.
  • Angioplasty and stents.

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.

Emergency measures. If you take warfarin or anti-platelet drugs such as clopidogrel to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners’ effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.

Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes.

  • Surgical clipping.
  • Coiling (endovascular embolization).
  • Surgical AVM removal.
  • Intracranial bypass.
  • Stereotactic radiosurgery.

Stroke Prevention

  • Balanced diet
  • regular physical
  • exercise weight reduction
  • avoid alcohol
  • avoid smoking
  • control of risk factors
  • treatment of co morbidities

 

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