What Is A Stroke ?
A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. When blood flow to the brain is impaired, oxygen and glucose cannot be delivered to the brain. Blood flow can be compromised by a variety of mechanisms.
Risk factors for stroke:
- Arterial Hypertension
- Cigarette smoking
- Diabetes mellitus
- High alcohol intake
- Positive family history
- Oral contraceptives
What Are The Features Of Stroke ?
The most common symptom is weakness or paralysis of one side of the body or the other. There may be partial or complete loss of voluntary movement of and/or sensation in a leg and/or arm. A stroke can result in speech problems and weakens muscles of the face, which can cause drooling. Numbness or tingling is very common. A stroke can cause difficulty inbreathing and even unconsciousness.
How Is A Stroke Diagnosed ?
A stroke is a medical emergency. Anyone suspected of having a stroke should be taken to a medical facility immediately for evaluation and treatment. Initially, the doctor takes a medical history from the patient if he/she is alert or others familiar with the patient if they are available, and performs a physical examination. If a person has been seeing a particular doctor, it would be ideal for that doctor to participate in the assessment. Previous knowledge of the patient can improve the accuracy of the evaluation. A neurologist, a doctor specializing in disorders of the nervous system and diseases of the brain, will often assist in the diagnosis and management of stroke patients.
Just because a person has slurred speech or weakness on one side of the body does not necessarily signal the occurrence of a stroke. There are many other possibilities that can be responsible for these symptoms.
Other conditions that can mimic a stroke include:
- Brain Tumors,
- A Brain Abscess (A Collection Of Pus In The Brain Caused By Bacteria Or A Fungus),
- Migraine Headache,
- Bleeding In The Brain Either Spontaneously Or From Trauma,
- Meningitis Or Encephalitis,
- An Overdose Of Certain Medications, Or
- An Imbalance Of Sodium, Calcium, Or Glucose In The Body Can Also Cause Changes In The Nervous System That Can Mimic A Stroke.
What Are Stroke Symptoms ?
When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage.
Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.
- Sudden confusion or trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
What Causes A Stroke ?
Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die. Typically, a clot forms in a small blood vessel within the brain that has been previously narrowed due to a variety of Risk Factors including:
- High blood pressure (hypertension),
- High cholesterol,
- Diabetes, and
A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) can cause a stroke by depriving blood and oxygen to parts of the brain. Blood is also very irritating to the brain and can cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure within the skull and causes further damage by squeezing the brain against the bony skull.
In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks or ruptures. Often this is from an aneurysm (an abnormal ballooning out of the wall of the vessel). Subarachnoid hemorrhages usually cause a sudden, severe headache and stiff neck. If not recognized and treated, major neurological consequences, such as coma, and brain death will occur.
Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed.
There appears to be a very slight increased occurrence of stroke in people with migraine headache. The mechanism for migraine or vascular headaches includes narrowing of the brain blood vessels. Some migraine headache episodes can even mimic stroke with loss of function of one side of the body or vision or speech problems. Usually, the symptoms resolve as the headache resolves.
What Is The Treatment Of A Stroke ?
Tissue Plasminogen Activator (TPA) There is opportunity to use alteplase (TPA) as a clot-buster drug to dissolve the blood clot that is causing the stroke. There is a narrow window of opportunity to use this drug. The earlier that it is given, the better the result and the less potential for the complication of bleeding into the brain.
Present American Heart Association guidelines recommend that if used, TPA must be given within three hours after the onset of symptoms. Normally, TPA is injected into a vein in he arm. The time frame for use can be extended to six hours if it is dripped directly into the blood vessel that is blocked. This is usually performed by an interventional radiologist, and not all hospitals have access to this technology.
For posterior circulation strokes that involve the vertebrobasilar system, the time frame for treatment with TPA may be extended even further to 18 hours.
When a patient is no longer acutely ill after a stroke, the healthcare staff focuses on maximizing the patient's functional abilities. This is most often done in an inpatient rehabilitation hospital or in a special area of a general hospital. Rehabilitation can also take place at a nursing facility.
The Rehabilitation process can include some or all of the following:
- Speech therapy to relearn talking and swallowing;
- Occupational therapy to regain dexterity in the arms and hands;
- Physical therapy to improve strength and walking; and
- Family education to orient them in caring for their loved one at home and the challenges they will face.
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