Stroke

Stroke or cerebrovascular accident is a severe and potentially lethal medical emergency that occurs when a part of the brain loses its blood supply for an extended period of time resulting in cell death. The blood supply to the brain is essential because it carries oxygen and other vital nutrition that keep the brain functioning.  Without a blood supply, the brain dies, and consequently, the body part controlled by that particular portion of the brain malfunctions.

There are two kinds of stroke: ischemic and hemorrhagic. Ischemic stroke happens when the blood supply to the brain is blocked because of either a plaque that narrows down a brain artery or a clot that occludes a brain artery. Hemorrhagic stroke, in contrast, happens when an artery ruptures (usually due to high blood pressure), leading to “spillage” of blood before it could reach the part of the brain that it is supposed to supply. By nature of etiology, hemorrhagic strokes usually occur instantaneously and progress quickly, whereas ischemic strokes develop gradually sometimes over a period of minutes to hours. In some instances, the blockage of the blood supply to the brain is not permanent, and the brain recovers its function without major damages. This is called a Transient Ischemic Attack (TIA). It is characterized by symptoms of stroke that last for only 24 hours or less.

Symptoms

The symptoms of stroke depend on the part of the brain that is damaged. The body part that is controlled by the damaged portion of the brain usually presents with symptoms of numbness and/or weakness. To facilitate early recognition of stroke, the F.A.S.T. algorithm was developed.

• Facial asymmetry: Ask the person to smile and observe if one side of the face is drooping.
• Arm weakness: Ask the person to raise both arms and observe he can keep both arms elevated without drifting downward.
• Slurred speech: Ask the person to repeat a simple phrase and observe if speech is clear or slurred.
• Time: If any of these signs are present, call an ambulance immediately. Take note of the time when the first symptoms are felt.
• Other symptoms of stroke include dizziness, changes in vision, severe headache, and confusion.

In general, the longer the brain is devoid of its blood supply, the more permanent the damages are and the lesser the chances for the brain to recover. Hence, it is crucial to recognize the symptoms of stroke immediately so that actions can be taken to re-establish the blood supply as soon as possible. You need to act “FAST” to give patients the best chance for recovery.

Diagnosis

In addition to a good history and physical examination, a CT scan or an MRI might be requested by a physician to get an image of the brain. Both of these tests involve putting the patient into a big donut-like or tunnel-like machine that creates serial images of the brain and detects bleeding or damage in the brain tissues.

Treatment

Time is the most important element in the treatment of stroke. The sooner the treatment is given, the better the chances of recovery. After recognition of stroke, it is important to identify if it is ischemic or hemorrhagic.

For ischemic stroke, medications that dissolve blood clots and prevent the formation of new clots are given. Aspirin is often given immediately upon arrival in the emergency room. Not only does aspirin help prevent blood clots, it is also given to lower the risk of another stroke. In other cases, the clot might have to be broken up or removed surgically.

For hemorrhagic stroke, the treatment is comprised of medications that lower blood pressure and the pressure inside the skull. If the bleeding is extensive, a surgical intervention might be needed to evacuate the blood that has accumulated inside the skull or clip a leaking blood vessel.

After an episode of stroke, some of the symptoms might resolve completely while others might remain permanent. Some parts of the body might recover while others might remain permanently weak or numb. For these stroke residuals, rehabilitation or therapy might be helpful in gradually regaining the function of these affected body parts. Physical or Occupational therapy might include helping an individual regain speech, arm function, ambulation, etc.

Prevention

Stroke can be prevented by controlling the factors that increase its likelihood of occurrence. These risk factors are:

• Hypertension: Compliance to antihypertensive medications and proper lifestyle changes can keep the blood pressure controlled and prevent the rupture of vessels.
• Heart disease: Certain heart problems can cause formation of clots that can lodge into the brain. This can be prevented by medications such as blood thinners. A regular visit to a cardiologist is also important.
• Hypercholesterolemia: High levels of cholesterol in the blood can encourage development of plaques and clots. This can be prevented by exercise, managing your diet and medications.
• Diabetes: Type 2 Diabetes is linked to other metabolic diseases like hypercholesterolemia and hypertension. Diabetes can be controlled by exercise, managing your diet and medications.
• Obesity: Obesity is linked to hypercholesterolemia and type 2 diabetes, which predisposes an individual to develop plaques or clots. This is can be controlled by managing your diet and exercise.
• Exercise regularly. If cleared by the doctor, try to work up to 30 minutes of activity almost every day of the week. The best type of exercise is aerobic exercise, which can include walking, jogging, swimming, or cycling.
• Quit Smoking: Among the long list of health problems that can come from smoking is an increased risk of stroke. Smoking can cause a narrowing of the blood vessels, which increases the risk for stroke. Quit smoking now, or do not smoke at all.
• Limit alcohol consumption:  Too much alcohol increases the risk of stroke. A general rule is no more than 1 drink for women and 2 drinks for men, daily.