Stroke

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 6, 2016
StartDiseasesStroke

An estimated 800,000 Americans suffer a stroke each year which is roughly one person every four seconds globally. Caused by inadequate blood supply to the brain, stroke is the sudden death of brain cells. An individual suffering from stroke may lose control over their perception, movement, and speech.

Contents

Definition & Facts

A stroke is an interference with blood supply to some parts of the brain, damaging the brain cells thus making the brain cease proper functioning. The blood flow could either be blocked or a blood vessel within the brain bursts. In the latter case, bleeding creates pressure on and damages brain tissue.

Symptoms & Complaints

The symptoms occur suddenly but they vary depending on the affected area of the brain. The part of the brain that controls one side of the body is located on the opposite side of the brain. Therefore, lack of blood supply to the left side of the brain will result in signs and symptoms to the right side of the body.

Primary symptoms may include a severe headache, blindness or vision loss, confusion, memory loss, loss of balance and muscle coordination, dizziness, paralysis, slurred speech, incontinence, loss of consciousness and weakness or numbness on one side of the face, arm or leg. The extent of the loss of functioning is determined by the affected part of the brain and the success and speed of treatment undergone.

Permanent effects may include swallowing difficulties, difficulty in expressing or suppressing emotions, depression, odd sensations of pain that are worsened by slight temperature changes, and difficulty in forming speech (apraxia) or understanding speech (aphasia). A stroke may result in poor judgment, learning and thinking, and attention.

Causes

There are three major causes of stroke resulting in three different types of stroke.

  • Blood clots in arteries within the brain can lead to blockage of the artery or reduced blood flow to the brain. The clots can be caused by fatty deposits within the arteries called plaque. This type of stroke is called ischemic stroke and is the most common type of stroke—close to 85% of all stroke cases.
  • Arteries in the brain can leak blood or burst open leading to a hemorrhagic stroke. The leaked blood applies pressure on brain cells and damages them. The bursting of the arteries may be as a result of a condition such as hypertension, aneurysms (weak blood vessel walls), trauma, or blood-thinners.
  • At times, the blood flow is interrupted temporarily as a result of a clot source in the heart leading to a transient ischemic attack (TIA). This type of stroke is at times called a mini-stroke and is temporary, but is a warning sign for future severe strokes.

Risk factors linked to lifestyle include: psychological stress, binge drinking, cocaine use, methamphetamine use, and obesity.

Diagnosis & Tests

A stroke occurs quickly, and a stroke diagnosis has to be carried out before one sees a doctor. The following can help in identifying the beginning of stroke in someone:

  • Face drooping—when the person tries to smile, one side of the face droops.
  • Arm weakness—when the person tries to raise both arms, one arm drifts downwards.
  • Slurred speech —when the person tries to utter a simple phrase, their expression seems slurred or strange.

It is imperative to diagnose a stroke as quickly as possible. The earlier the treatment is administered, the less the damage that will be impacted on the brain. To be sure of the particular type of stroke someone has had, a brain scan has to be performed in a hospital environment. Other tests that a doctor can perform include:

  • Blood tests. The doctor may test the patient’s blood to see how quickly it clots, and if the patient has an infection.
  • MRI scan. This involves creating an image of the brain using radio waves and magnets to see damaged brain tissues.
  • Echocardiogram. This involves creating a detailed image of the heart checking for any sources of clots that may have traveled to the brain.

Treatment & Therapy

Prompt treatment increases the chances of survival, thereby increasing the expected degree of recovery. The type of stroke suffered determines the type of treatment given.

Anticoagulants such as heparin may be prescribed to prevent new blood clots from forming and stop blood clots from getting bigger. Antihypertensive medications may be prescribed to help lower high blood pressure. Additionally, other drugs can be given to help reduce swelling in the brain and dissolve the blood clot to re-establish a healthy blood flow. Surgery may also be required to repair burst or blocked arteries.

Following a stroke, it is important to have adequate nutrition and fluids intake especially if swallowing has been affected. This may involve inserting an intravenous drip into a vein in the arm or the insertion of a feeding tubing into the stomach through the nose. It is also important to prevent complications like bed sores and pneumonia that may occur as a result of immobility.

After some brain cells have been affected by a stroke, other brain cells can take up some functions of the damaged parts. This process requires one to re-learn various skills such as movement and speech, and the rehabilitation process may involve physiotherapy (for mobility), speech therapy, and occupational therapy (for basic functions such as eating and using the restroom).

Prevention & Prophylaxis

Reducing risk factors is the best way of preventing a stroke. This includes

If discovered in time, some conditions like narrowed arteries, heart valve disease or heart rhythm disorders may be corrected surgically to prevent a stroke from occurring.

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