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Stroke

You succumb to a stroke whenever the blood supply to an aspect of your brain is disrupted or reduced so that brain tissue is deprived of the nutrients and oxygen it must have to survive. Brain cells begin to die within minutes after being starved of oxygen. Strokes didn’t used to be a medical emergency but now they are because there can be intervention that can minimize damage to the brain and reduce complications. This newer treatment means that fewer people die of a stroke than fifteen years ago.

The main signs and symptoms of a stroke include the following. Pay attention to when you first developed these symptoms:

• Difficulty walking. This includes stumbling behavior as well as dizziness and a loss of coordination and balance.
• Difficulty speaking. This includes dysarthria, which is difficulty getting the words out and trouble speaking as well as inability to understand the spoken word.
• Paralysis of an arm and leg on the same side or just one extremity. It would be unusual to involve both legs or both arms. This is associated with numbness of the same extremities. One side of the mouth may droop with a stroke.
• Blurry or blackened vision in one or both eyes. You can also experience double vision.
• Having a sudden severe headache associated with nausea and vomiting, lowered level of consciousness, or vertigo.

You should seek medical attention right away if you have any of the signs and symptoms of a stroke, even if the symptoms seem to come and go. Call 911 because there is a finite period of time in which adequate treatment can be given. The longer you let a stroke go, the more chances there are for disability and brain damage. Get to the hospital for treatment within three hours of when the symptoms first appeared.

There are two main types of stroke. The most common kind is the result of a blocked artery and is called an ischemic stroke. The second kind happens when a blood vessel bleeds and is called a hemorrhagic stroke. There can be a temporary blockage of blood flow to the brain in a condition called a transient ischemic attack or TIA.

Eighty five percent of strokes are considered ischemic strokes and are caused by blockages or narrowing of the arteries to the brain. This can include an embolic stroke, in which a clot from somewhere else in the body travels to an artery leading to the brain and blocks the artery. A thrombotic stroke happens when there is a blood clot that forms in an artery leading to the brain.

A hemorrhagic stroke happens when a blood vessel within the brain ruptures or leaks blood into the brain. It is not a common type of stroke. It can be caused by very high blood pressure along with weakened areas in the brain such as aneurysms. Hemorrhagic strokes come in several types, including the following:

• Intracerebral hemorrhage. This is when a blood vessel within the brain bursts and spills blood into brain tissue. Brain cells past the leak suffer from a lack of oxygen and brain damage happens. It is due to high blood pressure, vascular malformations, trauma and using blood thinning medications.
• Subarachnoid hemorrhage. This happens when an artery near the surface of the brain spills blood into the space between the brain and the skull. The result is a severe headache and other symptoms. It is often caused by having an aneurysm rupture and by the secondary vasospasm around the aneurysm.

A transient ischemic attack or TIA is a mini-stroke that lasts just a few minutes or so. The symptoms are exactly like having a stroke but they don’t last more than five minutes. It happens when a blood clot or debris in the arterial system block flow of blood to the brain. The blockage doesn’t last long and there is no lasting damage. The problem is that many people go on to have a stroke after their TIA so you should seek medical attention so that the chances of having a completed stroke are less.

There are things that can increase your risk of having a stroke. They are similar to your risks of having a heart attack and include the following:

• Having metabolic syndrome
• Being obese or overweight
• Being physically inactive
• Being a heavy drinker of alcohol
• Using drugs like methamphetamines or cocaine
• Having a blood pressure of greater than 120/80
• Having diabetes
• Being exposed to secondhand smoke or smoking yourself
• Having a high cholesterol
• Suffering from obstructive sleep apnea
• Having heart disease such as heart failure, atrial fibrillation, valvular deformities or other heart defects
• Having a family or personal history of having a heart attack, a TIA or a previous stroke
• Being older than 55 years of age
• Being African American
• Being male. Women tend to have their strokes later in life but are more likely to die from their stroke.
• Taking birth control pills or other hormone therapies

Strokes can lead to permanent or sometimes temporary disabilities, depending on how long the brain has suffered a lack of oxygen and where the brain was injured. Complications include paralysis on one side of the body along with numbness of the same extremities. Physical therapy can improve some aspects of this disability. You can have problems understanding speech, speaking words, or swallowing. Your muscles of your throat and mouth are affected by strokes. Dysphagia is a difficulty in eating that can come out of having a stroke.

Memory and thought processes are affected by strokes. Judgment and reasoning can become impaired. There can be difficulty controlling one’s emotions and there can be depression. Chronic pain can happen after a stroke along with strange sensations felt in the body in the extremities affected by the stroke. Tingling is possible after a stroke. There can be changes in a person’s behavior and in his or her ability to care for themselves. They may neglect parts of their body.

Strokes must be treated within three hours of onset. The mainstay of treatment of stroke is prompt delivery of tissue plasminogen activator (TPA), which is a clot buster that breaks up the clot in ischemic strokes. There is considerably less brain damage when this medication is given. The individual is placed on blood thinners like warfarin after that.

Stroke Complications

A stroke happens when there is an interruption in blood flow to the brain. This usually happens when a blood clot travels to the brain causing a “brain attack”. It can also happen when bleeding in the brain kills off a segment of brain tissue. These two causes of a stroke are referred to as an ischischemicemic stroke (from a blood clot) and haemorrhagic stroke (from bleeding).

In an ischischemicemic stroke, the blood clot can form in a narrow part of the brain’s arteries. This kind of stroke is called a thrombotic stroke. On the other hand, an embolic stroke stems from a blood clot that comes from a distant artery. Plaques have a lot to do with ischaemic strokes. In haemorrhagic strokes, the bleeding can come from an aneurysm or from an arteriovenous malformation or AVM. High blood pressure has a lot to do with this kind of stroke.

The other major risk factors for stroke include:

• Diabetes
• Atrial fibrillation
• High cholesterol
• Family history of stroke
ischemic
• Advanced age, above 55
• Black race
• Heart disease
• Peripheral vascular disease
• Smokers
• High fat diet
• Birth control pill use

Symptoms of a stroke depend on where in the brain the stroke is involved. Some obvious symptoms include lack of speech or garbled speech, weakness of the arm and/or weakness of the leg, numbness of parts of the body, neglect of parts of the body and limited mentation. There can be coma or decreased alertness and changes in hearing or taste. Clumsiness can happen as can loss of memory. Balance and coordination are off centre and there can be a loss of bladder or bowel function. Personality can change and vision can be affected.

After a physical exam is suspicious for a stroke, a CT scan is often done to confirm the problem. CT scans work better on haemorrhagic strokes than they do for ischaemic strokes but, over time, ischaemic strokes are seen on CT scan as well. A carotid ultrasound can be done to see if there is narrowing of the carotid artery as is seen in ischaemic stroke. An echocardiogram can look for areas in which there are blood clots that can break off and head to the brain.

The treatment of a stroke is considered medically necessary as soon as possible because quick treatment can save a person’s life and livelihood. If the stroke is determined to be from a blood clot, a clot busting drug can be given within 4 hours of the onset of stroke symptoms to be effective in altering the symptoms of a stroke. Blood thinners like heparin, warfarin, and aspirin or Plavix can be used for long term management of stroke symptoms. Medications are given to control blood pressure. If more strokes can happen, surgeries or procedures are done to prevent these strokes from occurring. Often a feeding tube is placed so that nutrition is given and the right amount of nutrients is given. Patients with stroke receive physical and occupational therapy, speech therapy and therapy to improve swallowing.

Complications of stroke treatment include giving clot busting drugs too late or giving the wrong dose so that extra bleeding in the brain occurs. Failure to do testing to prevent further strokes, such as carotid ultrasounds or echocardiograms can result in more strokes occurring. This can all be prevented with the right testing around the time of the first stroke. The doctor needs to give the appropriate amount of blood pressure medication so that bleeding doesn’t persist in the first stroke or reoccur in subsequent strokes.

Complications of stroke include coma, worsened symptoms and deteriorating health due to lack of self care. Stroke patients often need full time nursing care for things like eating, motor skills, dressing, self care like combing one’s hair and brushing one’s teeth and communication.

Prevention of stroke symptoms includes the treatment of dysphagia or problems with swallowing reflex. Speech therapists can work with the patient and make recommendations on the thickness of foods so that the patient can take in foods. Sometimes a feeding tube is recommended. A feeding tube is recommended for as long as six months.