What is a stroke?
Stroke is one of the most common diseases in our society. It has serious consequences for patients, their families, and for society in general. Stroke takes the form of sudden paralysis, with or without impairment of speech and / or vision. A stroke may be caused by a sudden reduction in blood flow to certain areas of the brain as a result of blood vessel blockage. The consequence is an inadequate supply of oxygen and other nutrients. Brain cells whose blood supply is interrupted are likely to die after only a short period of time.
A stroke may also occur as the direct result of bleeding from ruptured vessels into the brain tissue. This happens in about 12% of all strokes.
How severe the damage will be depends on the location of the brain tissue which has been destroyed. In nature, the left half of the brain controls the right side of the body and speech. The right half of the brain is responsible for the left side of the body.
Symptoms of stroke
Not all cells of the tissue affected by stroke are destroyed immediately after the cerebral vessels become blocked. Their function can be preserved if treatment is started as early as possible. Moreover, if the risk factors which encourage circulatory disturbances can be corrected in time, stroke can very often be prevented.
Warning signs of stroke:
- Visual disturbances in one or both eyes, ranging from temporary blurred vision to short- term blindness.
- Numbness or weakness in several fingers, a hand, a whole arm or leg or one entire half of the body, or paralysis down one side of the body.
- Short-term speech impairment or abnormal comprehension difficulties.
- Sudden feeling of dizziness, blurred vision, nausea/vomiting, weakness in both legs or double vision.
- A seizure is a warning of temporary impairment of cerebral blood flow.
- Abnormal mental confusion lasting up to several hours without loss of consciousness.
Cause of stroke
Narrowing or blockage of the cerebral vessels or of the carotid arteries leading to the brain are the most frequent causes. These changes occur as a result of arteriosclerosis, a chronic, progressive disease of the arteries which leads to damage of the vessel walls. As a result, the space within the vessel is considerably reduced.
Risk factors
- High blood pressure
- High level of blood lipids
- Diabetes
- Smoking
- Obesity
- Gout
- Oral contraceptives
Prevention
Today, most risk factors can be treated. Appropriate screening by a medical specialist is recommended for every patient over the age of 40. Arteriosclerosis is avoidable if patients think of it early enough and then seize the initiative to prevent or control it.
The following steps should be taken to prevent Arteriosclerosis:
- Reduce body weight to ideal range.
- Stop smoking.
- Check blood pressure regularly. High blood pressure must be controlled under medical supervision.
- Keep to a sensible diet; avoid fatty foods.
- Exercise regularly, especially if you are in a sedentary occupation.
- Women taking the contraceptive pill should not smoke at all.
- Avoid long-term stress situations.
What to do after a stroke?
Stroke must be treated by a brain specialist, a
neurologist. From the symptoms and diagnostic tests the neurologist can establish the areas of the brain that have been damaged.
Investigative techniques
There are many diagnostic tests that can detect the presence of risk factors, and vascular changes can now be made painlessly and non-invasively:
- Venous blood sample for determination of laboratory values
- Electrocardiogram (ECG)
- Electroencephalogram (EEG)
- Carotid Duplex Scan
- Computed Tomography Scan (CT scan)
- Magnetic Resonance Imaging (MRI & MRA)
How is a stroke treated?
Once neurological symptoms have occurred, treatment strategies must be implemented immediately. The patient should be admitted to a specially equipped hospital. Stroke is an emergency, no matter how mild it may seem.
Methods of treatment are
- If warning symptoms occur, get medical help immediately. Rapid evaluation and treatment are essential to prevent further damage.
- For an acute stroke, whatever the cause, call immediately for emergency medical assistance. The patient may need to be treated with thrombolytic drugs within a few hours of the onset of stroke.
- For the completed stroke, investigation treatment may be followed by thrombolytic drugs, which dissolve the blood clot to improve tissue perfusion in order to minimize tissue destruction. Sometimes professionals can reach unaffected parts of the brain to assume control of a lost function.
Complications
- Complications occur mostly during the first week:
- Recurrence of Arteriosclerosis in a blood vessel
- Cerebral edema due to damaged brain tissue
- Bleeding from ruptured vessels, hydrocephalus due to vascular blockage
- Complications which may occur after the first week:
- Pneumonia
- Infection, such as urinary tract infection
- Cardiac problems
- Diabetic mellitus
- Electrolyte imbalance
- Pressure sores
Apart from the suitable treatment strategies already indicated, appropriate remedial physiotherapy is crucial and should be started early, to prevent permanent physical damage.
Disease prognosis
- For the patient with mild stroke / transient ischemic attacks, one in three stroke victims may have permanent physical damage in the near future, and 50% of these strokes may present physical damage during the first year after the stroke the stroke.
- The mortality rate of 15 -30% of paralysis patients is secondary to cerebral hemorrhage, massive brain infarction, infection and so on.
- After receiving appropriate care the patient should be followed up with medical supervision to prevent further damage.
Prevention
Prevention is the top priority in caring for the patient exposed to risk factors for stroke. Nowadays there are two types of substances which can prevent vascular occlusion:
- Antiplatelet drugs, such as aspirin, Ticlopidine and Clopidogrel.
- Anticoagulant drugs, such as Warfarin.
This treatment should be carried out under medical supervision, so that any side effects can be detected as early as possible.
Care for paralysis patient
Prevention of complications and minimizing further physical damage are of prime importance. Giving care to a stroke patient you may find:
- Weakness or paralysis of one side of the patient's body; the patient may demonstrate inadequate self- care and need assistance to reposition every two hours to prevent pressure sores.Physiotherapy should be continued, with occupational therapy also included for the patient who experiences facial drop and difficulty in swallowing.
- Joint and muscle contractions with inability to move may occur after paralysis. This condition also needs continuous physiotherapy.
- Sensory loss: some patients may not be sensitive to hot, cold or pain on one side of the body and may injure themselves without realizing it. The patient needs instruction concerning the affected limb.
- Emotional disturbance; some patients may experience confusion, memory loss, irrational thinking. It is very important for the family to understand and show concern and support, which will benefit the patient.
- Aphasia is a speech disorder characterized by partial or total loss of understanding or ability to use words. Speech therapy may help the patient recover some communication skills in 6-12 months.
Conclusion
Avoiding stroke, that is, preventing stroke from ever occurring, is possible by minimizing risk factors. Nowadays most risk factors can be treated, and systematic treatment of risk factors has resulted in a decrease in the incidence of stroke. An annual physical examination by a physician is highly recommended. Early diagnosis and treatment of stroke will greatly benefit the patient.
We hope the information in this page will be useful, while at the same time pointing out that a stroke patient should be admitted to a hospital as a matter of urgency. We also hope this will encourage you, your family and the physician to form a partnership and work together towards the goal: many years of good health for you and your loved ones.
You can read more articles about Stroke treatment at our
Neuroscience Center.