Doc Fio

What is Stroke ?

 

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial.

Early action can minimize brain damage and potential complications.

The good news is that strokes can be prevented

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What are the symptoms?

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Watch for these signs and symptoms if you think you or someone else may be having a stroke.

Pay attention to when the signs and symptoms begin.

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The length of time they have been present can affect your treatment options:

•  Trouble with speaking and understanding. 

        You may experience confusion.

        You may slur your words or have difficulty understanding speech.

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• Paralysis or numbness of the face, arm or leg. 

       You may develop sudden numbness, weakness or paralysis in your face, arm or leg.

       This often happens just on one side of your body.

       Try to raise both your arms over your head at the same time.

 If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when   you try to smile.

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• Trouble with seeing in one or both eyes. 

       You may suddenly have blurred or blackened vision in one or both eyes, or you may see double

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• Headache. 

       A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered                         consciousness, may indicate you're having a stroke.

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• Trouble with walking. 

       You may stumble or experience sudden dizziness, loss of balance or loss of coordination.​

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Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think "FAST" and do the following:

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• Face. Ask the person to smile. Does one side of the face droop?

• Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?

• Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

• Time. If you observe any of these signs, call 911 immediately.

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What Causes Stroke?

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A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn't cause permanent damage.

About 80 percent of strokes are ischemic strokes.

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Ischemic strokes

Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

• Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.

• Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries.

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Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. These include:

• Uncontrolled high blood pressure (hypertension)

• Over treatment with anticoagulants (blood thinners)

• Weak spots in your blood vessel walls (aneurysms)

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Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — sometimes known as a mini stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system — but there is no permanent tissue damage and no lasting symptoms.

Seek emergency care even if your symptoms seem to clear up.

Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later.

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What are the Risk factors?

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Many factors can increase your stroke risk.

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Potentially treatable stroke risk factors include:

• Being overweight or obese

• Physical inactivity

• Heavy or binge drinking

• Use of illicit drugs such as cocaine and methamphetamines

• Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg)

• Cigarette smoking or exposure to secondhand smoke

• High cholesterol

• Diabetes

• Obstructive sleep apnea

• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm

• Personal or family history of stroke, heart attack or transient ischemic attack.

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Other factors associated with a higher risk of stroke include:

• Age —People age 55 or older have a higher risk of stroke than do younger people.

• Race — African-Americans have a higher risk of stroke than do people of other races.

• Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men.

• Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.

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What are the Prevention?

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Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. 

Many stroke prevention strategies are the same as strategies to prevent heart disease.

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In general, healthy lifestyle recommendations include:

• Controlling high blood pressure (hypertension). This is one of the most important things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke.

  In addition to recommending lifestyle changes, your doctor may prescribe medications to treat high blood pressure.

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• Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.

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• Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.

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• Controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication.

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• Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Losing as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.

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• Eating a diet rich in fruits and vegetables. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. Following the Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful.

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• Exercising regularly. Aerobic or "cardio" exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

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• Drinking alcohol in moderation, if at all. Alcohol can be both a risk factor and a protective measure for stroke. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol, such as one drink a day, may help prevent ischemic stroke and decrease your blood's clotting tendency. Alcohol may also interact with other drugs you're taking. Talk to your doctor about what's appropriate for you.

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• Treating obstructive sleep apnea (OSA). Your doctor may recommend an overnight oxygen assessment to screen for OSA — a sleep disorder in which the oxygen level intermittently drops during the night. Treatment for OSA includes oxygen at night or wearing a small device in your mouth to help you breathe.

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• Avoiding illegal drugs. Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can narrow the arteries.

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Preventive medications

If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke

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Diagnosis

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• Physical examination. 

  Besides taking a full medical history taking by interview, Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis.

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• Blood tests, Your doctor will test your blood clots, blood sugar and,  critical blood chemicals.

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• Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography (angiography).

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• Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).

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• Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.

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• Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.

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• Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

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Treatment

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Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke that involves bleeding into the brain.

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Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:

• Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin.

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Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on features of the blood clot:

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Several large and recent studies suggest that, depending on the location of the clot and other factors, endovascular therapy might be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke.

Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. 

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Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain.

You might also need surgery to help reduce future risk.

Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects.

You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.

Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.

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