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Stroke

A stroke will happen when there is a reduction of blood supplies to the brain, preventing brain tissues from receiving needed oxygen and nutrients. When that happens, brain cells begin to die.

A stroke will happen when there is a reduction of blood supplies to the brain, preventing brain tissues from receiving needed oxygen and nutrients. When that happens, brain cells begin to die. A stroke is a disease that is considered a medical emergency. Immediate treatment is vital when a stroke occurs. When a stroke occurs, prompt treatment will also help reduce brain damage and complications and prevent the disability that may derive from a stroke.

Symptoms

If you or those close to you look as if having a stroke, it is essential to pay attention to these symptoms.

  • Difficulty speaking and trying to understand other people – The patient may experience confusion, have slurred speech, or have problems understanding speech.
  • Paralysis or numbness in the face, arm, or leg area – Sudden numbness or paralysis on the face, arm, or leg is one of the patient’s symptoms. In general, it often affects one side of the body. To test for signs of a stroke, try raising both your arms over your head at the same time; if one arm starts to fall, it could mean you are having a stroke. If the mouth droops on one side when the patient tries to smile, it is also a stroke symptom.
  • The problem seeing either in one or both eyes – The patient may experience sudden blurred or darkened vision in either eye. Double vision may also be one of the symptoms.
  • Headache – A sudden symptom of severe headache may occur, and it may come with other symptoms, including vomit, dizziness, or altered consciousness.
  • Difficulty when walking or losing balance – The patient may begin to stumble or lose balance and coordination.

When to see a doctor

The patient should seek immediate medical emergency if there are any strokes; even those symptoms come and go or eventually disappear. It is highly recommended to follow “FAST” and does as follows:

  • Face – Try to smile, does the mouth droop?
  • Arms – Try to raise both arms. Does one arm fall, or is one arm face difficulty to rise?
  • Speech – Try to repeat simple phrases. Do you find any signs of slurred speech?
  • Time – If any of these symptoms appear, seek immediate medical emergency as soon as possible.

Dial the local emergency number immediately. Do not wait to see if the symptoms will go away as the sooner the treatment comes; the less likely the brain damage and disability will occur.

Causes

Two main reasons can cause a stroke; the first one is an ischemic stroke or blocked arteries. The second one is a hemorrhagic stroke or when the blood vessel is leaking or breaking. Sometimes, a transient ischemic attack (TIA) will occur. This condition does not cause prolonged symptoms. The condition is temporary, and it is caused by a disruption of blood flow to the brain.

Ischemic stroke

Ischemic stroke is the most commonly occurring stroke. This type of stroke happens when the blood vessels in the brain become narrow or have been blocked. This will then lead to reduced blood flow.

Hemorrhagic stroke

Hemorrhagic stroke is the blood vessels leak or break in the brain. Many conditions could cause brain hemorrhages. These are the factors that could increase the risk of hemorrhagic stroke.

  • Uncontrollable high blood pressure conditions
  • Overtreatment of anticoagulants
  • Swelling at the weakened area in the blood vessel walls
  • Trauma; for example, from a road accident
  • Protein deposits in blood vessel walls
  • Hemorrhage caused by an ischemic stroke
  • Arteriovenous malformation

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) is a symptom similar to a stroke, but TIA occurs temporarily. Another name of TIA is also a ministroke, as it will not cause damage permanently. The cause of TIA is when blood that supplies to the brain parts begins to decrease temporarily. The period of transient ischemic attack could be as little as five minutes.

It is highly suggested for the patient to contact a medical emergency even if there is a possibility of a TIA because the symptoms have recovered. It is complicated to separate the condition of the stroke to a TIA based on just symptoms. If the patient had a TIA in the past, it would mean that their artery that led to the brain was partially blocked. TIA also increases the patient risk of a full-blown stroke in the future.

Risk factors – these factors can increase the chance of having a stroke.

Risk factors relating to lifestyle behaviors

  • Obesity
  • Sedentary behavior
  • Heavy alcoholic consumption
  • Use illegal drugs

Risk factors relating to medical conditions

  • High blood pressure
  • Smoker or secondhand smoker
  • High cholesterol
  • Diabetes
  • Obstructive sleep apnea condition
  • Cardiovascular disease; for example, heart failure, heart defects, heart infection, or atrial fibrillation
  • Personal history or family members had a history of stroke, heart attack, or TIA
  • COVID-19 infection

Other factors that could increase risks of stroke are as follow: 

  • Age — Senior people aged 55 or older tend to have a higher risk of developing stroke than younger people.
  • Race — Those with African American ethnicity will have a higher risk of stroke than other races.
  • Gender — Men tend to have a higher risk of developing stroke than women. On the other hand, women will tend to develop strokes when they are much older, and strokes are more likely to be fatal to women than men.
  • Use of hormones — Birth control pills or hormone therapies that include estrogen increases the risk of strokes.

Complications

A stroke can cause complications to the patient, which can be either temporary or permanent disabilities. The severity of the difficulties will depend on the period that the brain has reduced blood flow supply and depends on the affected areas.

  • Paralysis – The patient may become paralyzed on one side of your body or face muscle loss movement. It could occur on one side of the face or one arm.
  • Speaking or swallowing problems – Another complication of stroke is it will affect the mouth and throat muscles causing the patient to have problems talking, swallowing, or eating. The patient may also face other language problems such as speaking, trying to make sense of a speech, reading, or writing.
  • Loss of memory or cognitive problems – In general, those with stroke experience tend to experience some memory loss. Some other patients may experience issues with their rational thinking, making judgments and decisions, or understanding things.
  • Changes of emotions – The patient with stroke will find it challenging to manage their emotions, and they are more likely to develop depression.
  • Pain or numbness in the body – The patient will experience pain or numbness sensation in the body parts affected by stroke. For example, if having a stroke results in the loss of feeling in the left arm, the patient may begin to feel uncomfortable tingling in that side of the arm.
  • Behavior changes and self-neglect – A stroke could lead the patient to become withdrawn, and they may need assistance in grooming and performing routine activities.

Preventive measures for stroke

These measures may be able to help prevent recurrence stroke. Some of the recommendations are as follow:

  • Manage the blood pressure to be at a normal level
  • Reduce the diet that is high in cholesterol and saturated fat
  • Quit smoking
  • Manage diabetes
  • Maintain the weight at a healthy range
  • Consume more fruits and vegetables.
  • Exercise regularly
  • Limit alcohol beverage consumption
  • Get treatment for obstructive sleep apnea (OSA)
  • Avoid using illegal drugs

Medication treatment

The doctor may prescribe these medicines to help reduce the chance of recurrence stroke.

  • Antiplatelet drugs – Platelets are cells in the blood that form clots. These drugs help reduce the stickiness in these cells, so they will be less likely to turn into blood clots.
  • Anticoagulants – Anticoagulants help reduce blood clots.

Diagnosis

Once the patient arrives at the hospital, they will most likely receive a CT scan or other types of imaging tests as soon after they have arrived. The doctor will also cross out other possible conditions with similar symptoms, including brain tumors or reactions to drugs. These tests are some of the tests the patient will receive at the hospital:

  • A physical exam
  • Blood tests
  • CT scan
  • MRI
  • Carotid ultrasound
  • Cerebral angiogram
  • Echocardiogram

Treatment

The stroke treatment will depend on the types of stroke, whether it’s an ischemic stroke or hemorrhagic stroke.

Ischemic stroke

The treatment of ischemic stroke is to restore blood flow to the brain as quickly as possible. The processes are either through emergency IV medication or emergency endovascular procedures. Sometimes doctors will order perfusion imaging tests (through CT or MRI) to determine if the patient will benefit from receiving endovascular therapy.

Other treatment procedures

The doctor may recommend other procedures that may help decrease the risk of recurrent stroke or transient ischemic attack (TIA). The options vary depending on case by case. Options are Carotid endarterectomy and Angioplasty and stents.

Hemorrhagic stroke

The treatment of hemorrhagic stroke aims to control the bleeding in the brain. It also focuses on reducing the pressure caused by excess fluid. Possible treatments are as follow:

  • Emergency measures
  • Surgery
  • Surgical clipping
  • Endovascular embolization
  • Surgical AVM removal
  • Stereotactic radiosurgery

The recovery and rehabilitation program

After the patient receives emergency treatment, he or she will be closely monitored for another 24-hour. The after-treatment focuses on the recovery of the body’s function to return to their everyday lives. The stroke’s impact will depend on the affected brain part and the amount of damage to the brain tissue. If the brain’s right side is affected by the stroke, it will cause movement and sensation problems with the left side of the body. However, if the brain’s left side is affected by the stroke, it will cause movement and sensation problems with the right side of the body. The damages on the left side of the brain will result in disorders relating to speech and language. The doctor will recommend the appropriate rehabilitation therapy program based on the age, overall health conditions, and disability level caused by the stroke.

The rehabilitation program tends to begin after the patient leaves the hospital. Speech therapy will most likely be a part of stroke rehabilitation programs.

Preparing for the doctor appointment

Once the patient arrives at the hospital with a stroke, the first emergency care will reduce as much brain damage as possible. If the patient has not had a stroke but is concerned about the risk of developing one, it is recommended to discuss it with the doctor at the next appointment.

What to expect from the doctor

The emergency department team’s priority is to stabilize the symptoms and the patient’s overall health conditions. Next, the team will determine if it is a stroke, and the doctor will determine the cause of the stroke and find the most suitable treatment for the patient.

However, if the patient is consulting advice from the doctor during the scheduled appointment, the doctor will check the risk factors for stroke and heart disease. The doctor will recommend some measures to avoid these risk factors, such as quit smoking or avoid using illegal drugs.  The doctor will also suggest changes in lifestyle behaviors or prescribe medications to help manage high blood pressure, cholesterol, or other risk factors.




Dr Udom Suthiponpaisan
Neurologist
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