STROKE (CEREBROVASCULAR ACCIDENT)- THE TRUTH WITHIN!!

Know more about stroke!!!!!

A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts due to increased blood pressure or is blocked by a blood clot.

This cuts off the supply of oxygen and nutrients, causing brain tissues affected to die.

The most common symptom of a stroke is - sudden weakness or numbness of the face, arm or leg, most often on one side of the body.

The weakness must last for longer than 24 hours and is of sudden onset. There are two main types: 

Ischemic (85%): can be due to a clot forming in one of the blood vessels supplying the brain or due to  a clot which travels from another site (usually the heart) to block off one of the arteries in the brain. 

Hemorrhagic (15%): this is due to rupture of one of the arteries in the brain – usually due to an aneurysm (an out-pouching of an artery – causing a point of weakness).

A TIA (transient ischemic attack) has the same symptoms as a stroke, but the one sided weakness and loss of sensation lasts for less than 24 hours – i.e. the person recovers completely within that time.

It is usually caused by a small clot of blood which is later on destroyed by the body itself.

Other symptoms include:

o   Confusion with memory loss.

o   difficulty speaking or understanding speech;

o   difficulty seeing with one or both eyes;

o   difficulty walking, dizziness,

o   loss of balance or coordination;

o   severe headache with no known cause

o   fainting or unconsciousness.

The effects of a stroke depend on which part of the brain is injured and how severely it is affected.

A very severe stroke can cause sudden death due to the brain cell death.

Statistics

o   Stroke is the third most common cause of death in developed countries.

o   It is uncommon before the age of 40 and is more common in males.

o   The incidence in younger age groups – e.g. 40-60 is dropping with better control of  hypertension.

Men
Men are at greater risk of stroke than women up until the age of 55 years, after which both sexes have similar risks.

Stroke is a major cause of disability, loss of function and death in the elderly.

Women

Stroke is considered a disease more commonly affecting men, women are actually twice as likely to die from stroke than men.

·        In addition, females have additional risk factors for stroke such as oral contraceptives, that are not present in men.

Children

Stroke is not a common condition for the children. Only a small percent gets stroke.

·        Stroke in children is often secondary to some born with heart disease.

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·        Half of strokes in children are hemorrhagic and these may be associated with long term disabilities.

Risk Factors

The risk factors for ischemic stroke are similar to the risk factors for coronary artery disease:  

Unavoidable risk factors

·        Age greater than 60 (risk of stroke doubles every decade)

·        Male sex

·        Family history of stroke

·        Racial origin.

Avoidable risk factors

·        Hypertension

·        Diabetic

·        Smoking

·        Excess alcohol use

·        Obesity

·         Lack of exercise

Women

Prolonged use of the Oral Contraceptive Pills.

The risk factors for hemorrhagic stroke are

·        Hypertension

·        anticoagulant drugs

·        bleeding disorders

·         cerebral aneurysm

Symptoms

·        Stroke commonly presents with loss of sensation/ feeling and weakness of muscles on one side of the body (85% of ischemic stroke patients have one side loss of function and muscle power),

1.         change in vision
2.         walking difficulties
3.         ability to speak or understand 
4.         severe headache.

How is it Diagnosed

Clinical assessment by a medical doctor/ profession will lead to diagnosis.

CT scan is very important in the early stages as it shows the area that have been affected.

In addition, blood tests will be taken including: 

Full blood picture-  a high white cell count may indicate inflammation or infection;

·         Blood glucose: a low blood glucose (eg in a diabetic) may show similar signs to stroke;

·         Cholesterol studies – these are often performed to look for treatable high cholesterol.

Prognosis,

•      25% of people die in the first one month following an ischemic stroke, and up to 75% after a hemorrhagic stroke.
•      The patients that survive are at a high risk of further strokes – recurrent strokes occur are seen in 10% of survivors in the first year.
•       patients that have suffered a stroke are also at a very high risk for a heart attack due to coronary artery disease.
•      Patients that have survived the initial period after a stroke are usually left with disabilities.
•     Around 1/3 are independently mobile (move on their own),     1/3 have a severe disability requiring on-going institutional care,
•      There is usually some improvement in function after a stroke, although the patient may be left with a severe deficit.
• The improvement made in the first month can be used to indicate the likely improvement the patient will make in future.
• A TIA alone is also an important prognostic factor on its own.
• After a patient has one TIA – there is a 40% chance of them suffering a stroke in the next 5 years, and a 25% risk of death due to heart disease or stroke.

Treatment

The treatment of a patient with stroke is divided into-; immediate and long-term management.

Immediate treatment is different for ischemic and hemorrhagic strokes but general principles of management for both are listed:

·         Blood glucose monitoring

·         Blood pressure control

·         Cardiac monitor- ECG for ischemic changes or and other heart problems.

·         Intravenous fluids

·         Oxygen- If low oxygen recorded

·         Maintaining normal temperature.

Ischemic strokes

• The patient should be admitted into the Hospital with multidisciplinary staff for rehabilitation.
•   The patient’s swallowing ability should be tested (by a speech therapist).
•  Further management is then centered on rehabilitation (physiotherapists, Occupational Therapist and speech therapists are important here) for prevention of complications and further strokes.
• Prevention of further strokes is important and the patient’s risk factors should be addressed. Long term medical management focuses on reduction of cerebrovascular risk to reduce recurrent stroke.  Other management of stroke includes;
•  changing lifestyle factors (increase exercise, healthy diet and stop cigarette smoking )
•  reduced blood pressure,
•  lipid control and strict blood glucose control. Additional management will depend on individual patient factors and concurrent disease.