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Stroke

 


Stroke is a medical emergency and is the third leading cause of death after heart disease and cancer in developed nations. Extended hospitalization during recovery and severe nature of disability requiring long period of rehabilitation services, makes economic and emotional impact of stroke one of the most devastating in the life of a patient and his family.


What is Stroke?

Many people confuse stroke with heart attack. In fact stroke may be called “brain attack”; because in stroke, brain is affected, not the heart. It occurs when the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. When the tissue is cut off from its supply of oxygen for more than three to four minutes, brain cells begin to die. Physical signs and symptoms then appear.



Blood supply to brain may be compromised due to two reasons. In 80%cases, cause of one type of stroke — ischemic stroke — is due to obstruction or block of blood vessels supplying blood to the brain. In the rest 20% cases, cause of other main type of stroke — hemorrhagic stroke — is due to leakage of blood from blood vessels in the brain.


What are the signs and symptoms of stroke?

It is important to realize that stroke warning symptoms are the signs of an emergency. For every minute that brain cells are deprived of oxygen during a stroke, brain damage increases. Also, the chances for survival and recovery are much better when treatment begins within the first few hours of noticing stroke symptoms. For most people, a stroke gives no warning. Knowing the signs and symptoms of a stroke may make it possible for you or someone you know to get prompt treatment. Signs and symptoms include:

  • # Sudden numbness, weakness, or paralysis of your face, arm or leg — usually on one side of your body, dizziness, loss of balance, or loss of coordination.
  • # Sudden nausea, fever, vomiting and difficulty swallowing.
  • # Difficulty speaking or understanding words or simple sentences
  • # Sudden blurred vision or decreased vision in one or both eyes
  • # Sudden inability to move part of the body (paralysis)
  • # A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness
  • # Confusion, or problems with memory, spatial orientation or perception


How to help a stroke victim:
          

While you are waiting for an ambulance to arrive, the person with the stroke symptoms should lie down. If the person is breathing but unconscious, roll him or her onto his or her side and lift the chin to keep the airway open. Do not give him anything to eat or drink. If the person is conscious, try to reassure and comfort him or her. Loosen constricting clothing or jewelry. Check for breathing and pulse.


Damages a stroke can cause
:

The effects of a stroke depend on the extent and the location of damage in the brain. Damages that can result from a stroke are:

1. Movement problems:

  • # Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole side or just the arm or leg.
  • # Spasticity, stiffness in muscles, painful muscle spasms
  • # Problems with balance and/or coordination, trouble swallowing (dysphagia)
  • # Problems with bowel or bladder control
  • # Problems using language, including having difficulty understanding speech or writing (aphasia); and knowing the right words but having trouble saying them clearly (dysarthria)

2. Problems of sensation:

  • # Being unaware of or ignoring sensations on one side of the body (bodily neglect or inattention), pain, numbness or odd sensations

3. Mental and psychological problems:

  • # Problems with memory, thinking, attention or learning
  • # Difficulty controlling emotions (emotional lability), depression
  • # Difficulties with daily tasks
  • # Change in personality, confusion or poor judgment


Screening and diagnosis:

If you've had a previous stroke or think you're at risk of stroke, talk with your doctor about screening and diagnostic tests. The following are most often used as screening tools to determine your risk, and to diagnose stroke:

  • # Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes, etc.
  • # Ultrasonography of neck vessels (carotid) supplying blood to your brain. This procedure, delineate any narrowing or clotting in your carotid arteries.
  • # Arteriography. This is specialized X-ray procedure, which gives a view of arteries in your brain not normally seen in usual X-rays.
  • # Imaging procedures. Various radiological and imaging techniques like CT scanning, and MRI are used to evaluate extent of organ involvement and damage.


Treatment Modalities:

Getting prompt medical treatment for stroke is of utmost importance. Treatment itself depends on the type of stroke. In case of Ischemic stroke (when blood vessel is obstructed causing cessation of blood supply to brain), doctors must remove any obstruction and restore blood flow to your brain. In case of Hemorrhagic stroke (bleeding into brain), surgery may be used to treat or prevent another one.


Recovery and rehabilitation:

Although stroke-related disabilities can be permanent, many people lead active lives after a stroke. Many are able to resume everyday life and responsibilities.

  • # 10 percent of stroke survivors recover almost completely
  • # 25 percent recover with minor impairments
  • # 40 percent experience moderate to severe impairments requiring special care
  • # 10 percent require care in a nursing home or other long-term care facility
  • # 15 percent die shortly after the stroke

Rehabilitation actually starts in the hospital as soon as possible after the stroke. The goal of rehabilitation is to help you recover as much of your independence and functioning as possible. Much of rehabilitation involves relearning skills you may have lost, such as walking or communicating.

Successful rehabilitation depends on:

  • # Amount of damage to the brain
  • # Skill on the part of the rehabilitation team
  • # Cooperation of family and friends. Caring family/friends can be one of the most important factors in rehabilitation
  • # Timing of rehabilitation – the earlier it begins the more likely survivors are to regain lost abilities and skills

The rate and amount of recovery after stroke is highly individualized. Much depends on the extent of damage to your brain, and the intensity and duration of the therapy you receive. But your recovery also is likely to be influenced by your personality, life experiences and coping styles. Your own motivation to recover is a key factor in obtaining an optimal level of rehabilitation.


Risk Factors and their Prevention:

Many factors can increase your chances of having stroke. Knowing your risk factors and living healthfully are the best steps you can take to prevent a stroke. In general, a healthy lifestyle means that you:

  • # Do early risk factor screening. All people, beginning at age 20, undergo risk factor screening that includes recording blood pressure, body mass index, waist circumference and pulse at least every two years, cholesterol and glucose testing at least every five years, screening of heart problems like valve defect arrhythmia.
  • # Control high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. Exercising, managing stress, maintaining a healthy weight, and limiting sodium intake, are all ways to keep hypertension in check.
  • # Lower your cholesterol and saturated fat intake. Eating less cholesterol and fat, especially saturated fat, may reduce the plaques in your arteries. Your doctor may prescribe a cholesterol-lowering medication.
  • # Don't smoke. Quitting smoking reduces your risk of stroke.
  • # Control diabetes. You can manage diabetes with diet, exercise, weight control and medication. Strict control of your blood sugar may reduce chances of stroke.
  • # Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease and diabetes.
  • # Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress.
  • # Manage stress. Stress can cause a temporary spike in your blood pressure — a risk factor for brain hemorrhage — or long-lasting hypertension. It can also increase your blood's tendency to clot, which may elevate your risk of ischemic stroke.
  • # Drink alcohol in moderation, Heavy drinking increases chances of stroke.
  • # Don't use illicit drugs. Many street drugs, such as cocaine and crack cocaine, are established risk factors for a TIA or a stroke.
  • # Preventive medications. If you have increased risk of stroke, your doctor may recommend medications to reduce blood clotting, and help reduce your risk.
  • # Follow a healthy diet: A brain-healthy diet should include: Five or more daily servings of fruits and vegetables; Foods rich in soluble fiber, such as oatmeal and beans; Foods rich in calcium, omega-3 fatty acids, including cold-water fish. 
 

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