Stroke

What is a Stroke?

A stroke is a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. As oxygen-rich blood been interrupted, within few minutes, brain cells start to die. Also sudden bleeding in the brain can damages brain cells causing stroke.

A stroke is a serious medical emergency which requires emergency treatment. Early action can minimize brain damage and potential complications. But a stroke can cause serious conditions which as long lasting brain damage, long-term disability, or even death.

When brain cells due to stroke die or become damaged, the symptoms occur in those part of body which been controlled by those brain cells.

A stroke is also known as brain attack, cerebrovascular accident (CVA), hemorrhagic stroke, ischemic stroke.

Types of Stroke

Strokes can appear as hemorrhagic strokes, ischemic strokes or transient ischemic attacks

Hemorrhagic Stroke

If a weakened blood vessel in the brain rupture or leaks, then a hemorrhagic stroke occurs. A hemorrhage, or bleeding from the blood vessel, occurs suddenly with a force and this force of blood escaped from the blood vessel can also damage the surrounding tissue of the brain. Hemorrhagicstroke is one of the most sever kind. There are two types of hemorrhagic stroke. They are intracerebral hemorrhageand subarachnoidhemorrhage.In both types the leaked blood causes swelling of the brain which increased pressure in the skull.

Intracerebral Hemorrhage: In an intracerebral hemorrhage, a blood vessel inside the brain leaks blood or ruptures.

Subarachnoid Hemorrhage: In a subarachnoid hemorrhage, a blood vessel on the surface(between the inner and middle layers of the membranes that cover the brain) of the brain leaks blood or ruptures.

Ischemic Stroke

If a blood vessel in the brain develops a clot and cuts off the oxygen-rich blood supply to the brain, then an ischemic stroke occurs. Almost 90 percent of strokes are ischemic strokes.There are two types of ischemic stroke. They are thrombotic stroke and embolic stroke. In both types of ischemic stroke blood clot or plaque, blocks the flow of oxygen-rich blood to a portion of the brain.

Thrombotic Stroke: In a thrombotic stroke, a blood clot forms in a blood vessel in the brain.

Embolic Stroke: In an embolic stroke,a blood clot formsin another part of the body, such as the neck or lining of the heart, and travels to the brain. Blood clots often occur from a condition called “atherosclerosis”, it is a process of plaque buildup within the blood vessel walls.

Transient Ischemic Attack (TIA)

If the blood flow to a certain part of the brain is cut off for a short period of time then transient ischemic attack occurs. The cut off time period is usually not longer than 5 minutes. Although Transient ischemic attack is a painless episode but it is an important warning sign which suggest that stroke can occur. Hence Transient ischemic attack should be also treated as serious as a stroke. It is also known as a ministroke.TIA may occur only once in a person’s lifetime or more often.

Causesof a Stroke

Hemorrhagic Strokes: It occurs when a blood vessel in your brain leaks or ruptures. Hemorrhage is the medical term for bleeding.Many conditions can increase the risk of hemorrhagic stroke such as:

• Highblood pressure (hypertension) and
• Aneurysms: It is a weakspots and is balloon-like bulges in an artery that can stretch and burst
• Arteriovenous malformation (AVM): It is an abnormal tangle of thin-walled blood vessels, present at birth that can rupture within the brain

Ischemic Strokes: It occurs when the arteries to the brain are narrowed or blocked, causing severely reduced blood flow or complete blockage.  Many medical conditions can increase the risk of ischemic stroke such as:

• Atherosclerosis: A disease in which a fatty substance called plaque builds up on the inner walls of the arteries.
• Lesions caused by atherosclerosis
• Carotid artery disease: A disease when plaque builds up in the carotid arteries. The two main arteries on each side of the neck are called the carotid arteries.
• Heart conditions and blood disorders
• Atrialfibrillation

Transient Ischemic Attack (TIA): It has similar cause as ischemic strokes.

Symptoms of a Stroke

The signs and symptoms of stroke often develop very fast but in some cases they can develop over hours or in some cases it can develop over days. Different type of stroke and the affected area of the brain cause different type of symptoms. Some of the signs and symptoms may include:

• Sudden weakness
• Paralysis or numbness (face, arms, legs, especially on one side of the body)
• Confusion
• Trouble with speaking and understanding
• Trouble with seeing in one or both eyes
• Trouble with walking  or loss of balance or coordination,
• Unexplained falls
• Sudden and severe headache
• Loss of consciousness
• Trouble with breathing

Transient ischemic attack (TIA): It has same signs and symptoms as any other stroke. The only difference is in TIA the symptoms usually last few hours. In some case it may last up-to 24 hours.

Complications by a Stroke

Complications after a stroke depend upon the location and the degree of damage in the brain. Some complications might be developed after a stroke may include:

• Paralysis  which can further lead to muscle weakness and decrease muscle flexibility
• Numbness in part of body
• Difficulty swallowing which may cause risk of pneumonia
• Loss of bladder control
• Loss of bowel control or constipation
• Vision loss
• Memory loss, confusion or poor judgment
• Change in personality
• Emotionalproblems
• Difficult communicating

Who is at the risk of a Stroke?

In Azerbaijan the stroke deaths has reached 26.51% of total deathsranking Azerbaijan #2 in the world.
There are certain traits, medical conditions and habits commonly known as risk factors which can raise the risk. There are controllable and uncontrollable risk factors.

Risk Factors

Age: Simply getting older increase the risk of stroke.

Gender: Men are likely to have stroke at young age than women. But women are more likely to die from strokes and women those who take birth control pills also are at slightly higher risk of stroke.

Family history of stroke or TIA: If a family member had a history of having stroke or TIA it is likely to increase the risk of stroke.

Personal history of stroke or TIA: If you’ve had a stroke, you’re at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke.

High blood pressure: Hypertension is the main risk factor for stroke.

Diabetes: It can promote other risk factor such as hypertension which can lead to a stroke.

Heartdiseases: Many heart diseases such as coronary heart disease, cardiomyopathy, heart failure, atrial fibrillations can cause blood to clot which can lead to a stroke.

Brain aneurysms: It is a weakspots and is balloon-like bulges in an artery that can stretch and burst

Arteriovenous malformation (AVM): It is an abnormal tangle of thin-walled blood vessels, present at birth that can rupture within the brain.

Smoking: Smoking is one of the main causes to damage blood vessels and raise blood pressure. Also smoking reduces the amount of oxygen in the blood, which can lead to other conditions which can cause a stroke.

Alcohol abuse: Excessive alcohol intake can precipitate hemorrhagic stroke.

Illegal drug use: Illegal drugs like cocaine can increase the blood pressure and cause bleeding in the brain. Also intravenous drugs can increase the risk of infections in the heart valves which can lead to stroke.

Certain medical conditions: Certain medical conditions such as sickle cell anemia, vasculitis (inflammation of the blood vessels), and bleeding disorders can cause bleeding and lead to stroke.

Cholesterol level: High cholesterol may increase the risk of heart disease and atherosclerosis, which are both risk factors for stroke.

Obesity: A new study indicates that people with abdominal obesity are at higher risk of ischemic stroke. Also obese have an increased chance of enlargement of the left side of the heart, known as left ventricular hypertrophy. This is due to increased blood pressure and strain on the heart which.

Unhealthy diet: Unhealthy diet causes many health conditions such as high blood pressure which is the major risk factor to cause stroke.

Lack of physical activity

Stress and depression

Diagnosis of a Stroke

Stroke will be diagnosed based on signs and symptoms, personal and family medical history, a physical examination and test results.

Medical History

The doctor may ask series of question regarding the risk factor for stroke with family members. Also ask if the patience or any family member had stroke or TIA. Also ask when the signs and symptoms began.

Physical Examination

The doctor will check the mental alertness, the coordination and balance. Also will check for numbness and will try to see if there is any trouble with speaking. Further doctor may look for signs of coronary heart disease as it is a common cause, listen to the carotid arteries. If there is a whooshing sound called a bruit in the carotid arteries, then it suggest that there is a changed or reduced blood flow due to plaque buildup.

Tests and Procedures

Some of the tests and procedures will be prescribed.

Laboratory Test

• Blood test

Imaging Tests

• Brain computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Carotid ultrasound
• Echocardiography
• Electrocardiogram (ECG or EKG)

Invasive Testing

• Carotid angiography

Treatments of a Stroke

Treatment of strokes dependsupon the type whether it is ischemic or hemorrhagic. The treatment includes:

Ischemic Stroke and TIA

To treat an ischemic stroke and TIA, doctors must quickly restore blood flow to your brain. Treatment for an ischemic stroke may include medicines and medical procedures.

Medicines

• Tissue plasminogen activator(tPA): It is used to break up blood clots in the blood vessels of the brain.
• Aspirin, warfarin (Coumadin), heparin and clopidogrel (Plavix): These medicines can keep blood clots from getting larger and prevent new blood clots from forming

Medical Procedures

• Carotid endarterectomy
• Carotid artery angioplasty
• Intra-arterial thrombolysis
• Mechanicalembolus removal in cerebral ischemia (MERCI)

Hemorrhagic Stroke
To treat a hemorrhagic stroke it is very important to find the cause of bleeding in the brain and then control it. If it is due to hypertension then doctors may try to lower the blood pressure which can prevent further bleeding.  The treatment of hemorrhagic stroke may need surgery.

People having a hemorrhagic stroke cannot be given clot-busters such as aspirin and TPA because these drugs may worsen bleeding.

Medical Procedures

• Coiling (aneurysm embolization)
• Using radiation to shrink the blood vessels of the AVM
• Injecting a substance into the blood vessels of the AVM to block blood flow

Surgical Procedures

• Aneurysm clipping
• Surgical AVM removal

Treating Risk Factors

Doctor may recommend lifestyle changes to help control your risk factors which can cause further stroke or TIA. If lifestyle changes aren’t enough, then medicine is needed to control risk factors.

Lifestyle Changes

There are some lifestyle factors which promote stroke. Hence the first step is to change the habits which could help to reduce the risk, some of them are:

• By quitting smoking
• By following a healthy diet
• By maintaining a healthy weight
• By being physically active
• By reducing alcohol

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