Stroke

When the blood supply to part of your brain is interrupted or severely reduced, a stroke occurs as the brain tissue is deprived of oxygen and nutrients. Within minutes, brain cells start to die.

It is a medical emergency and prompt treatment is extremely crucial. Early action can be taken to minimize brain damage and potential complications. The good new is that strokes can be treated and prevented. Up to 50% of all strokes are preventable. Many risk factors can be controlled before they cause any problems.

Different types of strokes

• Ischemic stroke: About 80% of all strokes are ischemic. It is similar to a heart attack. The only difference is that 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 it travels to the brain. It can also occur when too much fatty deposits and cholesterol clog up the brain’s blood vessels.
• Hemorrhagic stroke: This type of stroke occurs when blood vessel in the brain breaks or ruptures. Blood seeping into the brain tissue causes damage to brain cells. The most common causes of this type of stroke are high blood pressure and brain aneurysms.

Sometimes, a stroke may cause temporary or permanent disabilities. This depends on how long the brain lacks blood flow and which part was of the brain was affected. Complications may include:

• Paralysis or loss of muscle movement: One side of your body may become paralyzed or you may lose control of certain muscles such as those on one side of your face or one arm. Physical therapy may help you return to activities such as walking, eating and dressing.
• Difficulty talking or swallowing: Less control over the way the muscles in your mouth and throat move. This makes it difficult for you to talk clearly (dysarthria), swallow or eat (dysphagia). Difficulty with language (aphasia) including speaking or understanding speech, reading or writing may also occur. Therapy with a speech and language pathologist may help the condition.
• Memory loss or thinking difficulties: Many people who’ve had a stroke experience some memory loss while others may have difficulty thinking, making judgments, reasoning and understanding concepts.
• Emotional problems: Difficulty controlling their emotions or they may develop depression.
• Pain: Experiencing pain, numbness or other strange sensations in parts of the bodies affected by stroke. For instance, if stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in said arm. Some people may also become sensitive to temperature changes, especially extreme cold. This is known as central stroke pain or central pain syndrome and generally develops several weeks after a stroke. It may improve over time but because it is caused by a problem in your brain, there are few treatments.
• Changes in behavior and self-care ability: Become more withdrawn and less social or more impulsive. They may require assistance when grooming and completing daily chores.

The success of treating these complications will vary from person to person as with any brain injury.

SYMPTOMS OF STROKE

Being aware of the symptoms of a stroke is the first step in stroke prevention. If a stroke is not detected early, it can result in permanent brain damage or death.

The most common symptoms of a stroke include:

• Weakness or numbness on the face, arm or leg on one side of the body
• Loss of vision or dimming in one or both eyes
• Loss of speech, difficulty talking, or understanding what others are saying
• Sudden, severe headache
• Loss of balance or unstable walking (normally combined with another symptom)

Call you local emergency hotline immediately if you or someone you know is experiencing symptoms of a stroke. It is a medical emergency and immediate treatment can save your life or increase your chances of a full recovery.

TREATMENT OPTIONS AVAILABLE FOR STROKE

Emergency treatment will depend on whether you’re having an ischemic stroke (the most common kind) or a hemorrhagic stroke.

Ischemic stroke

Doctors must quickly restore blood flow to your brain to treat Ischemic stroke.

• • Emergency treatment with medications: Clot-busting drugs must start within 3 hours if they are injected into the vein (the sooner, the better). Quick treatment can increase your chances of survival and may also reduce complications. Drugs you may be given:
    • Aspirin: Immediate treatment administered in the emergency room to reduce the chances of having another stroke. Aspirin helps to prevent blood clots from forming.
    • Intravenous injection of tissue plasminogen activator (TPA): A recombinant tissue plasminogen activator (TPA), also called alteplase may benefit some people. It’s normally injected in a vein in the arm. This drug needs to be given within 4.5 hours after the symptoms start if it’s given in the vein. It restores blood flow by dissolving the blood clot causing your stroke and it may help people who have had strokes recover better. Certain risks such as potential bleeding in the brain may be considered to determine if this drug is appropriate for you.
  • Emergency procedures: Sometimes, doctors may perform procedures as soon as possible depending on features of the blood clot. These procedures are:
    • Medications delivered directly to the brain: A long, thin tube is inserted through an artery in your groin and is threaded to your brain to deliver TPA into the area where the stroke is occurring. The time frame for this treatment is slightly longer than for intravenous TPA but is still limited.
    • Mechanical clot removal: A catheter may be used to maneuver a tiny device into your brain to physically break up or grab and remove the clot. However, recent studies suggest that for most people who have suffered from a stroke might not benefit from this delivering medicine directly to the brain and breaking up the clot. Researchers are still working to determine who might benefit from this procedure.
  • Other procedures: A procedure to open up an artery that’s narrowed by fatty deposits (plaques) may be recommended to decrease your chances of having another stroke or transient ischemic attack. Sometimes, your doctor may recommend the following procedures to prevent a stroke. The 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) is removed. An incision along the front of your neck is made and the plaques that block the carotid artery is removed.Then, the artery is repaired with stitches or a patch made from a vein or artificial material (graft). This procedure may reduce the risks of developing an Ischemic stroke. However, this procedure involves risks, especially for those with heart disease or other medical conditions.
    • Angioplasty and stents: A surgeon gains access to your carotid arteries most often through an artery in your groin. They will gently and safely navigate to the carotid arteries in your neck. Then, a balloon is then used to expand the narrowed artery so that a stent can be inserted to support the opened artery.

Hemorrhagic stroke

Emergency treat for this type of stroke focuses on controlling the bleeding and reducing pressure in your brain. To help reduce future risk, surgery also may be performed.

• • • Emergency measures: If warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots are consumed, drugs or transfusions of blood products may be administered to counteract the blood thinners’ effects. Drugs to lower pressure in your brain, lower your blood pressure, prevent vasospasm or prevent seizures may also be given.
      Normally, treatment involves supportive medical care while your body absorbs the blood once the bleeding stops. Healing is somewhat similar to what happens while a bad bruise heals. 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: To repair blood vessel abnormalities associated with hemorrhagic strokes, surgery may be required. One of 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 is placed at the base of the aneurysm to stop blood flow to it. This keeps 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 your artery in your groin and is guided to your brain using X-ray imaging. Then, tiny detachable coils is guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm and blocks blood flow into the aneurysm and causes 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 that said, it isn’t always possible to remove an AVM if the removal would cause too large a reduction in brain function or if it’s large or located deep within your brain.
      • Intracranial bypass: Surgical bypass of intracranial blood vessels may be an option in some unique circumstances to treat poor blood flow to a region of the brain or complex vascular lesions such as aneurysm repair.
      • Stereotactic radiosurgery: This treatment uses multiple beams of highly focused radiation. It is an advanced minimally invasive treatment used to repair vascular malformations.
    • Rehabilitation: Strokes can affect a person both physically and emotionally; temporarily or permanently. After a stroke, successful recovery often involve specific rehabilitative activities such as:
      • Speech therapy: This helps with problems where producing or understanding speech becomes difficult. For example, practicing, relaxing and changing communication style using gestures or different tones help.
      • Physical therapy: To relearn movement and coordination. It’s important to get out and about even if it’s difficult at first
      • Occupational therapy: To improve their ability to carry out routine daily activities such as bathing, cooking, dressing, eating, reading and writing
      • Joining a support group: Common mental health problems such as depression that can occur after a stroke. Many people find it useful to share common experiences and exchange information
      • Support from friends and family: Practical support and comfort by letting friends and family know what can be done to help is important

DIAGNOSING STROKE

Your emergency team needs to evaluate the type of stroke and the areas of your brain affected by the stroke to determine the most appropriate treatment for your stroke. Ruling out other possible causes of your symptoms such as a brain tumor or a drug reaction must also be done. Several tests may be conducted to determine your risk of stroke. This includes:

• • Physical examination: You or a family member will be asked what symptoms you’ve been having, when they started and what you were doing when they started. These symptoms will be evaluated to see if they’re still present. What medications you take and whether you have experienced any head injuries is also important information you’ll doctor will want to know. Your personal and family history of heart disease, transient ischemic attack or stroke will also be enquired. Blood pressure will be checked and your doctor will listen to your heart to detect a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. An ophthalmoscope may 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 tests may be ordered. This can tell your care team how fast your blood is clotting, whether your blood sugar is abnormally high or low, if critical blood chemicals are out of balance or whether you may have an infection. Managing your blood’s clotting time and levels of sugar and other key chemicals will be part of your stroke care.
  • Computerized tomography (CT) scan: A series of X-rays 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): Powerful radio waves and magnets create a detailed view of your brain. It can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. A dye may be injected into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).
  • Carotid ultrasound: Sound waves create detailed images of the inside of the carotid arteries in the neck. This test shows buildup of fatty deposits and blood flow in your carotid arteries.
  • Cerebral angiogram: A a thin, flexible tube (catheter) is inserted through a small incision usually in your groin and is guided it through your major arteries into your carotid or vertebral artery. A dye is then injected into your blood vessels to make them visible under X-ray imaging. This gives a detailed view of arteries in your brain and neck.
  • Echocardiogram: Sound waves to create detailed images of your heart. It can find the source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. A transesophageal echocardiogram is where a flexible tube with a small device attached is inserted into your throat and down into the tube that connects the back of your mouth to your stomach. As your esophagus is directly behind your heart; it can create clear, detailed ultrasound images of your heart and any blood clots.