Stroke – Causes, Symptoms, Treatment, Prevention

When there is interruption of blood supply to the brain tissue it causes death of brain cells leading to Stroke. Brain tissue may get deprived of oxygen or food supply for few minutes causing serious complications. Stroke should be treated on emergency basis. It can be prevented by keeping the blood cholesterol and Blood Pressure under control. A stroke is also called as brain attack or cerebral vascular accident.

Stroke Types :

Two types of stroke namely ischemic stroke and hemorrhagic stroke are being recognized.

Ischemic stroke is caused when the blood vessels that supply to the brain are blocked for some reason. This can occur due to narrowing of arteries by deposition of fatty particles, hardening of arteries or formation of blood clot inside the blood vessel. Sometimes Blood Clots are formed in other places of the body and it moves towards the brain (embolism).

Hemorrhagic stroke occurs when there is leakage of blood from the blood vessel of the brain. It can be subarachnoid hemorrhage or intra-cerebral hemorrhage.

Stroke Symptoms :

Very often stroke occurs suddenly and hence the symptoms are felt suddenly. The person may feel discomfort and appear to be confused. Difficulty in talking (slurred speech), double vision or loss of vision, trouble in walking, loss of memory and concentration, poor judgment, loss of balance or co-ordination, sudden numbness in arms, legs and even face and in extreme cases loss of consciousness are some of the symptoms of stroke.

For some people, a seizure or severe Headache may occur followed by other symptoms. If the person shows any of the symptoms above, he should be moved to the hospital immediately. The more the delay in getting admitted, the more will be the damage done to the internal organs. For some individuals, there can be warning signs called transient ischaemic attack which are also called as mini stroke. The signs are almost the same for TIA but there is only temporary loss. TIA usually lasts for few minutes and there will not be any permanent loss.

Stroke Causes :

• The major cause for a stroke is sudden stoppage of blood supply to the brain. The blood supply will either be blocked or slowed down and hence the brain becomes deprived of oxygen and food. Sudden death of brain cells occur causing ischemic stroke or hemorrhagic stroke.
• Most of the strokes are ischemic type occurring due to the blockage of arteries that supply blood to the brain. It can be thrombotic (blood clot causing the block), embolic (blood clot that moves to the artery of the brain).
• Sudden high blood pressure or trauma can cause intracerebral hemorrhage or sometimes long-term intake of blood thinning medicines can also cause this problem.

Who Are At Risk ?

• Old age people, individuals with high blood pressure, Diabetes, people who are obese and physically inactive, people who smoke or drink excessively and individuals with heart infections or cardiovascular disease and people with high cholesterol are prone to develop stroke.
• Patients with irregular heart rhythm are likely to get stroke. A sleeping disorder called obstructive sleep apnea can also induce stroke formation.
• Often, men are more prone to get stroke than women for reasons unknown.
• You can reduce the risk of getting stroke by taking a balanced diet and practicing daily exercises.

Complications :

Stroke can cause permanent disabilities like paralysis, difficulty in talking, difficulty in thinking and concentrating are some of the complications of developing stroke. The intensity of brain damage determines whether the loss is temporary or permanent. For some people loss of muscle control over mouth can cause severe problem in swallowing or talking. They may also have great difficulty in controlling emotions and feel severe pain in some areas. In rare cases stroke can also cause changes in behavior by making the person withdrawn and depressed.

Diagnoses :

Once the person is admitted in the hospital, emergency team will work on him to find out the type of stroke that has developed. The doctor will collect the medical history of the patient from family members. He would physically examine the body checking his blood pressure and heartbeat.

Blood test is to be done for checking the blood clot formation, checking the blood sugar level and cholesterol level. Imaging tests like CT or MRI scanning is done for evaluating the intensity of damage the stroke has caused. For some cases carotid ultrasound and cerebral angiogram is to be done for getting complete picture of the arteries of the brain and neck region.

Stroke Treatment :

To begin with, the person will be put on IV fluids and oxygen supply to prevent further damage. Aspirin is given for preventing one more attack of ischemic stroke. If your doctor suspect blood clot is the root cause of the stroke, thrombolytics are given intravenously to burst the blood clot. The dosage of aspirin or heparin will be decided by your doctor depending on the health condition of the patient.

Emergency treatment is to be given for preventing more damage inside. Blood thinners like Warfarin, Plavix or Aggrenox are injected. Tissue plasminogen is given intravenously through the arm vein for causing bursting of clot. In some cases a catheter is inserted into the groin to be threaded to the brain through which TPA is sent for assisting bursting of clot.

In some cases, carotid endarterectomy is done for removing fat particles from the carotid arteries through surgery. Angioplasty or stent procedure is done for removing the block in the carotid artery. In case of hemorrhagic stroke, emergency treatment is to be given for arresting bleeding. Intracranial pressure is lowered to prevent seizures and control internal bleeding. Surgery is done in some cases for removing the blood that builds up pressure inside the brain.

Surgical clipping or endovascular embolization will be done depending on the case. Rehabilitation is to be done following the stroke with the support of family. Recovery can take weeks or even months depending on the intensity of damage and area of the brain that has been involved. Physiotherapy is given for improving co-ordination, balance and muscle control. Speech therapy is given for improving language and for retraining facial muscles. The patient with swallowing problems will be taught new methods of feeding. Occupational therapy can improve day-to-day skills gradually. For individuals with right side of brain damage, movement will be partially lost on the left side and vice-versa.

Coping :

Your lifestyle can change entirely when you have got a stroke. You need to cope with emotional issues apart from physical problems. There can be Depression, frustration and helplessness. It can cause behavior change and reduced sex drive. You can get help by joining a support group so that you will know you are not alone. Individuals recovering from stroke should get maximum support from family.

Stroke Prevention :

You cannot totally prevent developing a stroke but you can reduce the risk factors by following healthy life. Manage your weight and blood pressure. Reduce the intake of salt and alcohol. Take regular medications to control Hypertension. Stick on to healthy diet that does not contain saturated fat. Practice exercise or go for a long walk to control weight and diabetes. Avoid drinking and smoking habitually. Eat plenty of fruits and vegetables. Individuals who have already had a stroke should continue taking preventive medications like anti-platelet drugs and anticoagulants as per the instructions of the doctor.

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Heart Attack and Stroke : First Aid Treatment

Heart Attack and Stroke : First Aid Treatment






Heart attack has become a common term nowadays. Heart attack is one of the major causes of death worldwide. It is true that thousands of people die due to heart attack each year. Unlike popularly believe, heart attack will not stop the functioning of heart but it only damages and weakens the heart muscle. Most of the cases die within few minutes if prompt medical care is not given.

Heart :

Your heart is about the size of your fist and includes 4 chambers of which two are auricles and two are ventricles. Various valves are connected with these chambers for helping to and fro movement of oxygenated blood.

• Impure blood is received by the heart and pumped into the lungs wherein it gets transformed to oxygenated blood. This type of pure blood is sent to every organ of the body through ventricle. If your heart functions well, you can be sure that sufficient oxygen supply is given to the entire body.


• When the heart stops its function of pumping blood suddenly, the cells in the body gets deprived of oxygen. This makes them unable to perform its functions normally and cell death occurs within minutes. This in turn causes death. Death occurs almost instantly when the blood and oxygen supply is cut off to the brain.

Why Does The Heart Stop ?

The pumping activity of the heart is done in specific rhythm and the electrical impulses are generated there making the heart to contract and relax. As long as there is electrical activity in the heart, it can function well. Due to some factors, this rhythm gets interrupted causing irregular heartbeat. This in turn leads to sudden cardiac arrest. Many times, this kind of irregular heartbeat is made normal by the heart which is capable of generating nerve impulses. However the heart may stop functioning when there is severe and persistent irregular heartbeat.

Sudden enlargement of heart, congenital Heart disease, narrowing of artery of the heart due to Plague deposits, and severe disturbances in the transmission of electrical impulses are the leading cause of heart attack.

How Long You Can Survive After The Heart Stops Working ?

Oxygenated blood supply is abruptly stopped when the heart stops working. A person can remain alive for 5-7 minutes after the heart has stopped its beat. Brain cells die fast without oxygen. Immediate restoration of heart’s function can help in the survival of the person. Death will occur within 10 minutes (maximum) after the heart’s function has stopped. In many cases, even if the person is put on artificial lung machine like ventilator, death can occur due to brain tissue damage. Now the person is declared “brain dead”.

Heart Attack First Aid Treatment :

• CPR :

Cardio-pulmonary resuscitation, simply known as CPR is the only method that can increase the chances of survival of the person with heart attack. CPR can be done by any person until the affected person is taken to the nearest medical care unit. CPR can save plenty of life even when the heart has stopped working.

Basics Of CPR :

Chest compression, airway and breathing are the fundamental sequence of CPR. The chest area is to be compressed with force using both your hands. CPR should be done continuously after calling the medical help.

• Choose a flat floor for laying the unconscious person.


• Now place your fist of one hand on the chest area.


• Next other hand should cover the first one.


• Keep the elbows in straight position


• Now use maximum force to push down the chest area. You can place the entire body weight on your hands to push it down. This is known as chest compression.


• The rate of compression should be around 100-120 per minute. This should be fast and continuous.

Breathing and Airways :

• After performing 30 such compression you can go for airway and breathing.


• Lift the chin gently by moving the head backwards so that airway is opened freely.


• Now place your mouth on the person’s mouth and blow the air with force. This is what is called as rescue breath.


• If the person is still breathing the chances of survival is high.


• Rescue breath is given for one second and check whether the chest has started moving. If not, try for a second breath by repeating the same step.


• You can be free when the person’s chest rises and starts working.


• If not, continue giving chest compression again for 30 times or until the emergency ambulance arrives.

How Far CPR Is Effective ?

By compressing the chest with force, you are pumping the blood out of heart artificially. This is the work done by the heart. Indirectly you are helping the heart to revoke its function of pumping oxygenated blood to other organs. The second step in CPR is to give rescue breath. You are blowing oxygen directly into the lungs thus giving artificial respiration. Hence by continued effort of chest compression (30 times) followed by rescue breath you are considerably increasing the chances of survival of affected person.

Prognosis :

• Outlook of the patient depends on two factors.


• Early the medical services arrive, higher the chances of survival.


• Early the CPR is started, higher the chances of survival.


• However, some patients die on the way to hospital due to death of brain tissue.

Right Hemisphere Stroke: Symptoms and Treatments

Right Hemisphere Stroke: Symptoms and Treatments

A stroke or cerebral (brain) infarct, as it is known medically–is when there is a blockage to blood flow to one or more areas of the brain. Depending on where the blockage occurs and the subsequent areas of the brain which are left without oxygen, the symptoms of the stroke will present according to the corresponding centers of the brain which are affected.If the right hand side (hemisphere) of the brain is affected, then the left side of the body is affected.

Could I Have Right Hemisphere Stroke?
1. Common Symptoms

• Changes in mental acuity, like memory loss, erratic mood changes, changes in behavior


• Difficulty in walking normally


• Leaning towards the left side or losing awareness of that side


• Difficulty in swallowing


• Language and speech may also become impaired


• Paralysis on one side of the body or perhaps even on both sides of the body


• Age older than 55 years


• History of smoking


• Pre-existing medical conditions like Diabetes, Hypertension and high levels of cholesterol in the blood


• Males or of African-American descent


• History of Obesity and lack physical activity


• Family history of right hemisphere stroke


• Having a lower than normal birth weight


• Underlying cardiac problems, like valve disease, abnormal heartbeat or Heart Attack


• Taking hormones like in birth control or hormone replacement therapy


• Recent pregnancy or birth within 6 weeks

2. Risk Factors
3. Diagnosis
If your medical practitioner suspects a stroke, he will order a few tests to make a positive diagnosis, like:

Ÿ MRI or CT scan: you will be required to ingest some contrast liquid to show the brain and related organs clearly in the images. This method will help to pinpoint the exact location of the stroke and also how extensive the damage is.

Ÿ Arteriography: x-rays are taken of the blood vessels to show any blockages.

Ÿ Ultrasound of the carotid arteries: this method is also able to show up any abnormalities of the carotid arteries on the image.

Seek Medical Attention When:

• You experience vision loss or double vision.


• Bleeding occurs from the nose or rectum.


• One of your limbs feels painful, hot to the touch, red or swollen.


• You experience a seizure.


• While coughing, you notice blood.


• You experience chest pains, dizziness or are unable to breathe normally.


• You lose your co-ordination or balance inexplicably.


• You experience a sudden and severe Headache.


• You become confused or you cannot comprehend speech or you have trouble talking.

Effects of Right Hemisphere Stroke
1. Left-Side Weakness
Patients will often show weakness on the left side of the body. This is because the motor control regions in the brain control the corresponding opposite sides of the body.

2. Paralysis
The level of muscle weakness experienced will depend upon the severity of the stroke. The paralysis can range from slight paralysis to complete paralysis. The paralysis will not only affect the limbs but also the rest of the body, like the face and trunk of the body.

3. Reduced Sensation
The changes in sensation can be experienced as tingling or numbness as well. The patient may also have difficulty "feeling" the position of their affected limb without taking a look.

4. Loss of Clarity with Speech
If the mouth and tongue are affected, the person may not be able to form words properly hence sounding like having slurred speech.

5. Impaired Visual Perception
The person may not be able to see things on the left of them; they may not be able to distinguish top from bottom and left from right. Judging distance may also be affected.

6. Deviations in Normal Behavior
Some experience Depression, lose the ability to change their tone of voice, act impulsively, etc. Patients that exhibit the latter symptom need supervision and monitoring because they are unable to realize that their behaviors are hazardous.

7. Other Effects
Short-term memory loss can occur. The person may not be able to recognize faMiliar people or things.Patients may also struggle to focus their attention on a task for some time.

How to Treat Right Hemisphere Stroke
Treatment will depend on the severity of the stroke and the different body functions that are affected.

1. Physical Therapy
Physical therapy will help you regain some movement and strength. The patient will learn new skills to assist in daily life, to compensate for loss of other skills.

2. Treating Underlying Conditions
Treating and keeping any underlying medical conditions under control. This would include treatment for the hypertension or high cholesterol.

3. Surgical Intervention
A draining tube will be placed in the brain to prevent a build-up of fluids in the brain.

4. Speech Language Therapy
This type of therapy will help the patient toprioritize information and pick out the most pertinent features. They will get taught conversational cues and how to interpret them.Patients will also have to relearn how to read non-verbal cues.People around the patient will also be taught how to communicate with their loved one who has experienced a right hemisphere stroke. They will have to keep communication clear and simple and to avoid sarcasm and figurative speech.

Nursing Diagnosis for Stroke

Nursing Diagnosis for Stroke

Stroke occurs when blood supply to the brain is disturbed, resulting in loss of proper functioning of the brain. It was also known as cerebrovascular accident or CVA in medical terminology. When the brain cells do not receive blood, they are not able to function properly. This can result in improper functioning of limbs, inability to speak, understand or even see, due to loss in vision. This can happen mostly to one side of the body.

Stroke is an emergency, which can cause permanent damage or even death. It is a leading cause of disability in adults and death as well. The risk factors for it include Hypertension, Diabetes, smoking, high cholesterol levels, etc. It is important to get diagnosed properly and for that reason we will look at what the nursing diagnosis for stroke is.

How Is Stroke Diagnosed?
Nursing diagnosis for stroke can vary and be done using different techniques. A CT Scan, without using any contrast, MRI scan, Arteriography and Ultrasound using Doppler can be performed. A neurological examination like the Nihss can also be done to diagnose a stroke. The results from imaging technique are used to make a clinical diagnosis of stroke. It helps in finding the sub-type and the cause. Blood tests are not routinely done to diagnose stroke, but they can be done to find the cause of stroke.

Nursing Diagnosis for Stroke

Stroke can make the person require constant care and medical attention as well. We will look at some different nursing diagnosis for stroke:

1. Ineffective Cerebral Tissue Perfusion:
This is caused due to Hydrocephalus; in this condition, there is disturbance in the flow, absorption and production of the cerebrospinal fluid in the brain. It can occur in very young babies or in very old people.

Symptoms

• Memory loss


• Change in level of consciousness


• Restlessness


• Change in vital signs


• Emotional, sensory, intellectual and language deficit

Nursing Intervention

• Check for decrease in cerebral perfusion and increased ICP.


• Compare neurological status with baseline frequently.


• Check Blood Pressure in both arms, heart rate, respiration, pupil for size, shape and reactivity to light.


• Give lot of bed rest, keep head in elevated position, supplement oxygen as required.


• Administer medications as required.

2.Impaired Physical Mobility
This happens when the neuromuscular system is involved, leading to weakness, paralysis either flaccid or spastic, Paresthesia and cognitive impairment.

Symptoms

• Inability to move around


• Lack of co-ordination


• Restricted range of motion


• Reduced strength in muscles and muscle control

Nursing Intervention

• Access the impairment regularly and classify on a 0-4 scale.


• Change position frequently and keep in prone position couple of times in day.


• Use slings or positional Aids if possible.


• Inspect skin for reddening, color, Edema, etc.


• Teach and help in performing exercise for affected side and use the unaffected part.

3. Impaired Verbal Communication
This occurs when there is impaired cerebral circulation, loss of control of facial or oral muscles, overall weakness and fatigue as well as neuromuscular impairment.

Symptoms

• Unable to speak


• Inability in finding names and words, identifying objects, understanding written or spoken language or writing properly

Nursing Intervention

• Assess the level of dysfunction, whether there is trouble to speak or in understanding and expressing.


• Give and ask to repeat simple instructions, listen and provide feedback.


• Make them write simple sentence, if they are unable, ask them to read.


• Speak slowly and clearly, give adequate time to respond.


• Speech therapist can be consulted and referred to.

4. Disturbed Sensory Perception
This is related to psychological Stress which can be triggered by anxiety, changed sensory reception, transmission and integration which can be caused due to neurological deficit or trauma.

Symptoms

• Disorientation to person, place and time


• Over emotional responses, reduced concentration, bizarre thinking, changes in taste and smell


• Unable to point out body parts, change in communication, altered motor coordination

Nursing Intervention

• Observe the patient for behavior like crying, agitation, hallucination, hostility, etc.


• Keep communicating with the patient, while speaking in calm and quiet voice.


• Check perceptions, visual deficits and reorient when possible and required.


• If they are inattentive to body parts, make them see and become aware.

5. Ineffective Coping
This is related to crisis like situations being vulnerable and any other cognitive perpetual changes.

Symptoms

• Not being able to effectively make use of defense mechanisms


• Inability to ask for help


• Disturbed communication


• Unable to meet expectations


• Difficulty in problem solving

Nursing Intervention

• Assess the level of change in perception, find the dysfunction, determine which factors are causing stress.


• Give psychological support, let the patient express feelings and emotions freely.


• Find out support system when dealing with previous problems.


• Check if patient is sleep deprived, unable to cope, feeling withdrawn or lethargic.

6. Self-Care Deficit
The nursing diagnosis for stroke includes this risk of self-care deficit. In this, the patient shows neuromuscular impairment, loss of muscle control, Depression and cognitive impairment.

Symptoms

Unable to perform every day activities like bringing food from plate to mouth, to dress up, toileting activities, washing body parts, etc.

Nursing Intervention

• Assess and check the level of deficit.


• Provide assistance only when required, if patient is able to do the task themselves.


• Do not rush, provide adequate time to complete tasks.


• Give self-help devices like extension hooks, drinking straw, shower chair etc.

7. Risk for Impaired Swallowing
This can be caused due to neuromuscular impairment.

Nursing Intervention

• Check and assess the level of paralysis – speech, usage of tongue, coughing episodes, ability to protect the airway.


• Keep a suction pump handy during feeding sessions.


• 30 minutes of rest should be provided before eating.


• Let the patient remain in upright position and ensure oral care is given.


• Place the food in the unaffected part of the mouth and the consistency of the food should be appropriate.


• The food should be at usual temperature and water should be chilled.

8. Knowledge Deficit
This is due to lack of exposure, cognitive limitations, unable to recall information, misinterpretation, etc.

Symptoms

• Asking for information or having misconceptions


• Unable to follow instructions correctly


• Developing complications which could be avoided

Nursing Intervention

• Include the patient and family in discussions and teach the right way for providing support and care.


• Check for signs and symptoms which indicate further follow up or decrease in functioning.


• Give written notes and ask to follow written communication, rather than memory.


• Find out risk factors which can cause harm to general well-being and inform important of balanced diet.

Bell's Palsy vs. Stroke

Bell's Palsy vs. Stroke

The nerve effects of Bell's palsy are peripheral, while in a stroke, the nerve effect is central. As you can see in the figure, motor innervation in the forehead comes from both cerebral cortex hemispheres. A stroke with symptoms of facial paralysis would show drooping only in the lower part of the face, as the forehead would still be receiving motor innervation from the brain hemisphere that is unaffected. In Bell’s palsy the forehead becomes paralyzed as well, as the peripheral lesions affect the innervation of both hemispheres.



Symptoms of Bell's Palsy
Facial paralysis is most commonly caused by Bell's palsy, which is also known as idiopathic facial paralysis. Bell’s palsy symptoms include:

• Acute onset of upper and lower facial paralysis


• A flattened forehead, and an incapacity to raise the eyebrow on the affected side


• When smiling, the face lateralizes to the unaffected side


• Hyperacusis


• Loss of taste


• Inability to close eyelids

These symptoms are brought on by swelling, injury, and facial nerve ischemia (CN VII). The exact reason is unidentified, but it may be linked to a viral infection.
Stroke and Its Symptoms
An acute ischemic stroke occurs when there is an obstruction in the artery that supplies oxygen to the brain. The onset is sudden and becomes severe in just seconds or minutes. The affected artery and location will determine the symptom pattern. A stroke in many locations in the brain or brainstem can cause facial paralysis.

• Sudden weakness or numbness on one side of the body, in the leg, arm, or face


• Sudden loss of sensation, balance, strength, speech, coordination, vision or comprehension


• Sudden visual dimness, particularly in just one eye


• Vomiting or nausea, difficulty swallowing, fever, hiccups


• Sudden Headache with no known cause, with a rapid loss of consciousness (which may indicate a bleeding stroke)


• Sudden inexplicable dizziness

Bell's Palsy vs. Stroke
Distinguishing Bell’s palsy vs stroke can be done with the following steps:
1. Discuss the Symptoms
Bell’s palsy and acute ischemic stroke both cause acute facial paralysis; however, maximum severity is reached much quicker in a stroke. The patient is usually unaware of the exact time of onset, but witnesses may be able to help with more information.
2. Check for the Pattern of Symptoms
Identifying the cause of peripheral facial weakness is key to distinguishing Bell’s palsy vs stroke. Bell’s palsy generally affects the facial nerves, but a brainstem stroke can affect other sensory and motor skills as well. Determine if the weakness is occurring because of a brainstem stroke. Here is what to look for:

• Arm or leg weakness and/or numbness: Check for signs of weakness/numbness by asking the patient to lift arms and legs. The weakness or numbness can occur on either side of the body.


• Slurred speech: Dysarthria can be a result of cranial neuropathy. Listen for slurred speech in conversation, or give your patient a few tongue twisting word combinations to repeat.


• Double vision: Diplopia is caused by a cranial neuropathy that causes a misalignment of the eyes. Check with your patient about their vision, and see if they can move their eyes in all directions.


• Facial numbness: It is rare that Bell’s palsy will affect the trigeminal nerve, the nerve that provides facial sensation. Facial numbness is symptomatic of a stroke.


• Trouble with swallowing: Dysphagia is also a sign of cranial neuropathy, as well as brainstem ischemia. Ask your patient if they’ve experienced difficulty swallowing or coughing while swallowing.


• Loss of coordination: Ataxia may occur if there is damage to the Cerebellum or brainstem. Check for incoordination in your patient’s limbs by having them walk, and use the finger-nose-finger test.


• Vertigo: Cerebellar strokes and brainstem strokes often cause vertigo, the sensation of dizzying motion when there is no motion. Your patient may complain of nausea or a room spinning sensation.

3. Neurological Exam
Determine whether the facial weakness or paralysis is caused by a central lesion or a peripheral lesion, or Bell’s palsy vs. stroke, from the following points:

• Mouth: The patient will not be able to lift his/her smile on one side if the facial weakness is severe. Mild weakness would be indicated by a symmetrical smile, but a flattened nasolabial fold. Both central and peripheral lesions can cause mouth weakness.


• Eyes: The space between their eyelids, or the palpebral fissure, can be examined to see if one eye is closed more than the other. Asymmetrical eye closure would be caused by facial weakness from a peripheral facial palsy.


• Forehead: If the patient raises his/her eyebrows and one side does not lift at all, or one side is less wrinkled than the other, and the face becomes asymmetrical, it is indicative of peripheral facial nerve palsy.

If your patient presents any of these symptoms along with their facial paralysis, it is likely to be a stroke. If your patient is only displaying patterns of peripherally induced weakness, then it is likely to be Bell’s palsy.

Stroke

Stroke






When there is interruption of blood supply to the brain tissue it causes death of brain cells leading to stroke. Brain tissue may get deprived of oxygen or food supply for few minutes causing serious complications. Stroke should be treated on emergency basis. It can be prevented by keeping the blood cholesterol and Blood Pressure under control. A stroke is also called as brain attack or cerebral vascular accident.

Types :

Two types of stroke namely ischemic stroke and hemorrhagic stroke are being recognized.

Ischemic stroke is caused when the blood vessels that supply to the brain are blocked for some reason. This can occur due to narrowing of arteries by deposition of fatty particles, hardening of arteries or formation of blood clot inside the blood vessel. Sometimes Blood Clots are formed in other places of the body and it moves towards the brain (embolism).

Hemorrhagic stroke occurs when there is leakage of blood from the blood vessel of the brain. It can be subarachnoid hemorrhage or intra-cerebral hemorrhage.

Symptoms :

Very often stroke occurs suddenly and hence the symptoms are felt suddenly. The person may feel discomfort and appear to be confused. Difficulty in talking (slurred speech), double vision or loss of vision, trouble in walking, loss of memory and concentration, poor judgment, loss of balance or co-ordination, sudden numbness in arms, legs and even face and in extreme cases loss of consciousness are some of the symptoms of stroke.

For some people, a seizure or severe Headache may occur followed by other symptoms. If the person shows any of the symptoms above, he should be moved to the hospital immediately. The more the delay in getting admitted, the more will be the damage done to the internal organs. For some individuals, there can be warning signs called transient ischaemic attack which are also called as mini stroke. The signs are almost the same for TIA but there is only temporary loss. TIA usually lasts for few minutes and there will not be any permanent loss.

Causes :

• The major cause for a stroke is sudden stoppage of blood supply to the brain. The blood supply will either be blocked or slowed down and hence the brain becomes deprived of oxygen and food. Sudden death of brain cells occur causing ischemic stroke or hemorrhagic stroke.

• Most of the strokes are ischemic type occurring due to the blockage of arteries that supply blood to the brain. It can be thrombotic (blood clot causing the block), embolic (blood clot that moves to the artery of the brain).

• Sudden high blood pressure or trauma can cause intracerebral hemorrhage or sometimes long-term intake of blood thinning medicines can also cause this problem.

Who are at risk?

• Old age people, individuals with high blood pressure, diabetes, people who are obese and physically inactive, people who smoke or drink excessively and individuals with heart infections or cardiovascular disease and people with high cholesterol are prone to develop stroke.

• Patients with irregular heart rhythm are likely to get stroke. A sleeping disorder called Obstructive Sleep Apnea can also induce stroke formation.

• Often, men are more prone to get stroke than women for reasons unknown.

• You can reduce the risk of getting stroke by taking a balanced diet and practicing daily exercises.

Complications :

Stroke can cause permanent disabilities like paralysis, difficulty in talking, difficulty in thinking and concentrating are some of the complications of developing stroke. The intensity of brain damage determines whether the loss is temporary or permanent. For some people loss of muscle control over mouth can cause severe problem in swallowing or talking. They may also have great difficulty in controlling emotions and feel severe pain in some areas. In rare cases stroke can also cause changes in behavior by making the person withdrawn and depressed.

Diagnoses :

Once the person is admitted in the hospital, emergency team will work on him to find out the type of stroke that has developed. The doctor will collect the medical history of the patient from family members. He would physically examine the body checking his blood pressure and heartbeat.

Blood test is to be done for checking the blood clot formation, checking the blood sugar level and cholesterol level. Imaging tests like CT or MRI scanning is done for evaluating the intensity of damage the stroke has caused. For some cases carotid ultrasound and cerebral angiogram is to be done for getting complete picture of the arteries of the brain and neck region.

Treatment :

To begin with, the person will be put on IV fluids and oxygen supply to prevent further damage. Aspirin is given for preventing one more attack of ischemic stroke. If your doctor suspect blood clot is the root cause of the stroke, thrombolytics are given intravenously to burst the blood clot. The dosage of aspirin or heparin will be decided by your doctor depending on the health condition of the patient.

Emergency treatment is to be given for preventing more damage inside. Blood thinners like Warfarin, Plavix or Aggrenox are injected. Tissue plasminogen is given intravenously through the arm vein for causing bursting of clot. In some cases a catheter is inserted into the groin to be threaded to the brain through which TPA is sent for assisting bursting of clot.

In some cases, carotid endarterectomy is done for removing fat particles from the carotid arteries through surgery. Angioplasty or stent procedure is done for removing the block in the carotid artery. In case of hemorrhagic stroke, emergency treatment is to be given for arresting bleeding. Intracranial pressure is lowered to prevent seizures and control internal bleeding. Surgery is done in some cases for removing the blood that builds up pressure inside the brain.

Surgical clipping or endovascular embolization will be done depending on the case. Rehabilitation is to be done following the stroke with the support of family. Recovery can take weeks or even months depending on the intensity of damage and area of the brain that has been involved. Physiotherapy is given for improving co-ordination, balance and muscle control. Speech therapy is given for improving language and for retraining facial muscles. The patient with swallowing problems will be taught new methods of feeding. Occupational therapy can improve day-to-day skills gradually. For individuals with right side of brain damage, movement will be partially lost on the left side and vice-versa.

Coping :

Your lifestyle can change entirely when you have got a stroke. You need to cope with emotional issues apart from physical problems. There can be Depression, frustration and helplessness. It can cause behavior change and reduced sex drive. You can get help by joining a support group so that you will know you are not alone. Individuals recovering from stroke should get maximum support from family.

Prevention :

You cannot totally prevent developing a stroke but you can reduce the risk factors by following healthy life. Manage your weight and blood pressure. Reduce the intake of salt and alcohol. Take regular medications to control Hypertension. Stick on to healthy diet that does not contain saturated fat. Practice exercise or go for a long walk to control weight and diabetes.

Avoid drinking and smoking habitually. Eat plenty of fruits and vegetables. Individuals who have already had a stroke should continue taking preventive medications like anti-platelet drugs and anticoagulants as per the instructions of the doctor.