A blood vessel in your brain may rupture and bleed or a blood suppling vessel in your brain may get blocked by a blood cloth or cholesterol plaque. Two different scenarios lead to the same consequences – blood and oxygen cannot reach brain`s tissues anymore. Two different types of the same condition: ischemic stroke and hemorrhagic. Stroke symptoms are specific and everyone must learn them by heart, as this is an emergency condition! Stroke treatment must start as soon as possible, as every minute counts. It depends on the type of condition a person has and may include medications, minimally invasive procedures and surgery. More detailed information about this condition, its` symptoms as well as treatment options and diagnosis is presented below.
When blood supply to part of your brain is interrupted or severely reduced, a stroke (brain attack) occurs. This deprives the brain tissue of oxygen and nutrients. Brain cells begin to die within minutes. It is a medical emergency and prompt treatment is extremely crucial. Minimize brain damage and potential complications by taking action as early as possible. The good news is that strokes can be treated and prevented.
There are 2 types of stroke:
- Ischemic stroke: About 80% of all strokes are ischemic. It is similar to a heart attack but it occurs in the blood vessels of the brain. Clots can form in the brain’s blood vessels, in blood vessels leading to the brain or even in blood vessels elsewhere in the body and then make the way to the brain. These clots block the blood flow to the brain’s cells. This type of stroke also occurs when too much plaque clogs the brain’s blood vessels.
- Hemorrhagic stroke: When a blood vessel in the brain ruptures. Blood seep into the brain tissue and causes damage to brain cells. High blood pressure and brain aneurysms are the most common causes of hemorrhagic stroke.
Is it Possible to Prevent a Stroke?
Being aware of the signs of stroke is the first step in preventing stroke. Up to 50% of all strokes are preventable. Many risk factors can be controlled before they cause any problems.
Controllable Risk Factors for Stroke:
- High blood pressure
- Atrial fibrillation
- Uncontrolled diabetes
- High cholesterol
- Excessive alcohol intake
- Carotid or coronary artery disease
Uncontrollable Risk Factors for Stroke:
- Age (65 years old and above)
- Gender (Men have more strokes, but women have deadlier strokes)
- Race (African-Americans are at increased risk)
- Family history of stroke
If you think you or someone else may be having a stroke, watch for the following signs and symptoms. It’s also important to note when your signs and symptoms begin as the length of time they have been present may guide your treatment decisions:
- Trouble with speaking and understanding: Confusion may be experienced. You may slur your words or have trouble understanding speech.
- Paralysis or numbness of the face, arm or leg: Sudden numbness, weakness or paralysis may develop in your face, arm or leg. Especially on 1 side of your body. You may be having a stroke if you try to raise both your arms over your head at the same time and one arm begins to fall. 1 side of your mouth may droop when you try to smile.
- Trouble with seeing in one or both eyes: Sudden blurred or blackened vision in 1 or both eyes or you may see double.
- Headache: Sudden and severe headache that may be accompanied by vomiting, dizziness or altered consciousness. This may indicate that you’re having a stroke.
- Trouble walking: May stumble or feel sudden dizziness, loss of balance or loss of coordination.
STROKE TREATMENT OPTIONS
Emergency treatment depends on what type of stroke you’re having; an ischemic stroke blocking an artery ( the most common kind) or a hemorrhagic stroke (involves bleeding into the brain).
When treating an ischemic stroke, doctors must quickly restore blood flow to your brain.
Emergency treatment with medications
Treatment with medication must start within 3 hours if they are given into the vein – the sooner, the better. Fast treatment improves your chances of survival and also reduce complications. Medications include:
- Aspirin: Immediate treatment given in the emergency room to reduce the chances of having another stroke. It also prevents blood clots from forming.
- Intravenous injection of tissue plasminogen activator (TPA): An injection of a recombinant tissue plasminogen activator (TPA) also called alteplase can benefit some patients. It is usually administered through a vein in the arm. It needs to be given within 4.5 hours after the stroke symptoms begin if it’s given in the vein. It restores blood flow by dissolving the blood clot and it may help people who’ve had strokes recover better. To determine if TPA is appropriate for you, your doctor will consider certain risks such as potential bleeding in the brain.
Occasionally, doctors treat ischemic strokes with emergency procedures that must be conducted as soon as possible depending on features of the blood clot:
- Medications delivered directly to the brain (intra-arterial thrombolysis): A long, thin tube is inserted through an artery in your groin and is threaded to your brain to deliver TPA directly into the affected area. The time frame for this treatment is a bit longer than intravenous TPA but it is important to note that it’s still limited.
- Mechanical clot removal (mechanical thrombectomy): A catheter is used to maneuver a tiny device into your brain to break up or grab and remove the clot.
However, recent studies suggest that for most people, these methods may not be beneficial. Researchers are working to identify who might benefit from this procedure.
Your doctor may recommend a procedure to open an artery that’s narrowed by fatty deposits to decrease your risk of having another stroke or transient ischemic attack. The following procedures may be recommended to prevent a stroke. Treatment options will vary depending on your situation:
- Carotid endarterectomy: Plaques from arteries that run along each side of your neck to your brain (carotid arteries) are removed. An incision is made along the front of your neck to open your carotid artery and remove plaques that block the carotid artery.
The artery is repaired with stitches or a patch made from a vein or graft. Your risk of ischemic stroke may be reduced but a carotid endarterectomy also involves risks, particularly for people with heart disease or other medical conditions.
- Angioplasty and stents: Your carotid arteries is accessed most often through an artery in your groin. Your surgeon can gently and safely navigate to the carotid arteries in your neck this way. To expand the narrowed artery, a balloon is used so that a stent can be inserted to support the opened artery.
To treat a hemorrhagic stroke, emergency treatment focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be conducted to help reduce future risk.
Drugs like warfarin (Coumadin) or anti-platelet drugs like clopidogrel (Plavix) can be used to prevent blood clots. Drugs or transfusions of blood products may be given to counteract the blood thinners’ effects. Drugs may also be prescribed to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.
When the bleeding in your brain stops, treatment involves supportive medical care while your body absorbs the blood. Healing is similar to what happens when a bad bruise is healing.
Your doctor may perform surgery to remove the blood and relieve pressure on your brain if the area of bleeding is large.
Surgical blood vessel repair
Surgery can be used to repair blood vessel abnormalities associated with hemorrhagic strokes. These procedures may be recommended after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke:
- Surgical clipping: A tiny clamp at the base of the aneurysm is placed to stop blood flow to it. It can keep the aneurysm from bursting or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
- Coiling (endovascular embolization): A catheter is inserted into an artery in your groin and guides it to your brain using X-ray imaging. Tiny detachable coils is inserted into the aneurysm (aneurysm coiling). The coils block blood flow into the aneurysm and cause the blood to clot.
- Surgical AVM removal: A smaller AVM may be removed if it’s located in an accessible area of your brain to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. Having said that, it’s not always possible to remove an AVM if its removal would cause too large a reduction in brain function or if it’s large or located deep in your brain.
- Intracranial bypass: A surgical bypass of intracranial blood vessels may be used in unique circumstances could be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
- Stereotactic radiosurgery: Multiple beams of highly focused radiation is used in this procedure. This is an advanced minimally invasive treatment used to repair vascular malformations.
Strokes can affect a person both physically and emotionally, temporarily or permanently. Successful recovery after a stroke will often involve specific rehabilitative activities such as:
- Speech therapy: Help with problems producing or understanding speech. For example; practice, relaxation and changing communication style, using gestures or different tones may help.
- Physical therapy: Relearn movement and coordination. Important to get out and about, even if it seems difficult at first.
- Occupational therapy: Improve the ability to carry out routine daily activities like bathing, cooking, dressing, eating, reading and writing.
- Joining a support group: Support common mental health problems like depression that may occur after a stroke. Many patients find it helpful to share common experiences and exchanging information.
- Support from friends and family: To receive support and comfort. Confiding in friends and family is very important.
Your emergency team needs to evaluate the type of stroke you’re having and the affected areas of your brain to determine the best treatment course. It’s also essential to rule out other possible causes of your symptoms like a brain tumor or a drug reaction. Several tests may be used to determine your risk of stroke. They including:
- Physical examination: Questions about the symptoms that you’ve been having, when they started and what you were doing when they began will be asked. These symptoms will to evaluated to determine if they’re still present. What medications you’re taking and whether you have experienced any head injuries will also be useful information. Personal and family history of heart disease, transient ischemic attack or stroke will also be asked. Blood pressure will be checked and a stethoscope will be used to listen to your heart and to listen for a whooshing sound over your neck arteries that may indicate atherosclerosis. An ophthalmoscope may also be used to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
- Blood tests: Several blood test may be conducted to give better information to your care team on how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance or whether you have an infection. Your stroke care will involve managing your blood’s clotting time and levels of sugar and other key chemicals.
- Computerized tomography (CT) scan: X-rays images will be used to create a detailed image of your brain. It can show hemorrhage, tumor, stroke and other conditions. A dye may be injected into your bloodstream to view your blood vessels in your neck and brain in greater detail.
- Magnetic resonance imaging (MRI): Radio waves and magnets will be used to create a detailed view of your brain. Brain tissue damaged by an ischemic stroke and brain hemorrhages can be detected. A dye may be injected into a blood vessel to view the arteries and veins and highlight blood flow.
- Carotid ultrasound: Sound waves create detailed images of the inside of the carotid arteries in your neck. Buildup of fatty deposits and blood flow in your carotid arteries can also be detected.
- Cerebral angiogram: A thin, flexible tube (catheter) through a small incision, normally in your groin and is guided through your major arteries and into your carotid or vertebral artery. A dye is injected into your blood vessels to make them visible under X-ray imaging. This procedure provides a detailed view of arteries in your brain and neck.
- Echocardiogram: Sound waves are used to create detailed images of your heart. The source of clots in your heart that may have traveled from your heart to your brain and caused your stroke can be detected. A transesophageal echocardiogram may be ordered. A small device (transducer) is inserted into your throat and down into the oesophagus. As the esophagus is located directly behind the heart, a transesophageal echocardiogram can create clear and detailed ultrasound images of your heart and any blood clots.