Stroke (cerebrovascular disease) occurs due to shortage of blood supply to the brain. It usually occurs as a result of blockage (or interruption) of the blood vessels leading to limited blood supply to the brain.
This condition affects the blood vessels that feeds the brain with oxygen-rich blood [b1]. This hinders the blood from getting enough food and the cells start to die. When this happens, disability or death may occur.
Stroke is a fatal disease and the fifth leading cause of death in the United States [b2]. In fact, over 800,000 cases are reported each year. However, health practitioners have made a huge effort in limiting the mortality rate of stroke.
The interesting news is that many fewer Americans die of stroke now than in the past. Effective treatments can also help prevent disability from stroke
Types Of Stroke
There are three (3) major types of stroke; Ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA).
1. Ischemic stroke; This is the most common type of stroke. It occurs when an excess fat droplets building up in the blood vessels or as a result of blood clots. When this happens, the blood vessels becomes narrowed, leading to blockage or limited blood flow.
2. Hemorrhagic stroke; This occurs when vessels in the brain ruptures or breaks leading to excessive flow of blood (hemorrhage). There are many conditions traced to the cause of brain hemorrhagic stroke [b3]. Some of which are;
a. Ischemic stroke leading to hemorrhage
b. High protein content in the blood vessels that leads to the tenderness of the blood vessels walls
c. Unchecked high blood pressure
d. Anticoagulant etc.
3. Transient ischemic attack (TIA) or ministroke; This is a condition whereby part of the brain gets limited or decrease supply of blood due to clots and other fragments. Unlike other types that cause permanent damage, TIA is temporary.
Causes Of Stroke
Below are some of the causes of stroke which include;
- Obesity (overweight)
- High blood pressure (hypertension)
- Family history of stroke
- High cholesterol
- Excessive alcohol intake
- Use of illicit drugs
- Age (mostly 55 and above)
- Race (mostly Africans, Americans and affected)
- Heart complications
- Unable to talk, eat or swallow; A stroke might have negative control of the muscles in the mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing.
- Paralysis or loss of muscle control. You may become paralyzed on one side of the body, or lose control of certain muscles, such as those on one side of the face or one arm.
- Unable to think, understand and memory loss; Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments and understanding concepts.
- Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores.
- Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
Symptoms Of Stroke
The sooner a person having a stroke gets care, the better their outcome is likely to be. For this reason, it’s helpful to know the signs of a stroke so you can act quickly. Stroke symptoms can include:
- numbness or weakness in the arm, face, and leg, especially on one side of the body
- trouble speaking or understanding others
- slurred speech
- confusion, disorientation, or lack of responsiveness
- sudden behavioral changes, especially increased agitation
- vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
- trouble walking
- loss of balance or coordination
- severe, sudden headache with an unknown cause
- nausea or vomiting
Some factors associated with a higher risk of stroke include:
- Age; People age 55 or older have a higher risk of stroke than do younger people.
- Race or ethnicity; African, Americans and Hispanics have a higher risk of stroke than do people of other races or ethnicities.
- Sex; Men have a higher risk of stroke than do women. Women are usually older when they have strokes, and they’re more likely to die of strokes than are men.
- Hormones; Use of birth control pills or hormone therapies that include estrogen increases risk.
Risk factors associated with stroke include;
- Being overweight or obese
- Physical inactivity
- Heavy or binge drinking
- Use of illegal drugs such as cocaine and methamphetamine
Diagnosis of stroke
To diagnose stroke, your doctor will need to carryout series of tests such as brain imaging, measuring the blood flow in the brain among others.
- MRI; This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body. An MRI uses magnetic fields to find small changes in brain tissue that help to find and diagnose stroke.
- MRA (magnetic resonance angiography). This test uses MRI technology to check blood flow through the arteries.
- Doppler sonography (carotid ultrasound). A test that uses sound waves to create pictures of the inside of your carotid arteries. This test can show if plaque has narrowed or blocked your carotid arteries.
- CTA (computed tomographic angiography). An X-ray image of the blood vessels. A CT angiogram uses CT technology to get images of blood vessels.
- CT scan of the brain. An imaging test that uses X-rays to take clear, detailed images of the brain. A brain CT scan can show bleeding in the brain or damage to brain cells caused by a stroke. It is used to find abnormalities and help find the location or type of stroke.
Because ischemic and hemorrhagic strokes have different causes and effects on the body, both require different treatments. However, there is no cure for stroke once it has occurred. Thanks to advanced medical and surgical treatments that help reduce the risk stroke.
- Ischemic stroke; in ischemic stroke, treatment starts with taking drugs that break down clots and prevent others from forming. A doctor may administer blood thinners such as aspirin or an injection of tissue plasminogen activator (TPA) which help to dissolve clots.Emergency procedures include administering TPA directly into an artery in the brain or using a catheter to physically remove the clot. Research is ongoing as to the benefits of these procedures.There are other procedures that surgeons can perform to reduce the risk of strokes or TIAs. A carotid endarterectomy, for example, involves opening the carotid artery and removing plaque that could break and travel to the brain. Another option is angioplasty. This involves a surgeon inflating a small balloon inside a narrowed artery using a catheter. Afterward, they will insert a mesh tube, or a stent, into the opening. This prevents the artery from narrowing again
- Hemorrhagic stroke; When an aneurysm (a bulge in a blood vessel that may burst) causes a hemorrhagic stroke, a surgeon can place small clamps at the base of the aneurysm or fill it with detachable coils to stop the blood flow and shrink the aneurysm. In hemorrhagic stroke, treatment often begins with taking drugs that reduce pressure in the brain and control overall blood pressure, as well as preventing seizures and any sudden constrictions of blood vessels. If a person is taking blood-thinning anticoagulants or antiplatelet medication, such as warfarin or clopidogrel, they can receive medications to counter the effects of the blood thinners. Surgeons can repair some of the problems with blood vessels that have led or could lead to hemorrhagic strokes. If the hemorrhage occurs due to an AVM, a surgeon can remove it. AVMs are connections between arteries and veins that can be at risk of bleeding. lead to hemorrhagic strokes.
Treatment is most effective when started right away. Emergency treatment after a stroke may include:
- Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the blood clots that cause an ischemic stroke. They can help reduce the damage to brain cells caused by the stroke. To be most effective, they must be given within 3 hours of a stroke occurring.
- Medicines and therapy to reduce or control brain swelling. Special types of IV (intravenous) fluids are often used to help reduce or control brain swelling. They are used especially after a hemorrhagic stroke.
- Neuroprotective medicines. These medicines help protect the brain from damage and lack of oxygen (ischemia).
- Life support measures. These treatments include using a machine to help you breathe (a ventilator), having IV fluids, getting proper nutrition, and controlling your blood pressure.
- Craniotomy. This is a type of brain surgery that is done to remove blood clots, relieve pressure, or repair bleeding in the brain.
Rehabilitation is an important and ongoing part of stroke treatment. With the right assistance and the support of loved ones, regaining a normal quality of life is usually possible, depending on the severity of the stroke.
Successful recovery from a stroke will often involve specific therapies and support systems, including:
- Speech therapy: This helps with problems producing or understanding speech. Practice, relaxation, and changing communication style can all make communicating easier.
- Physical therapy: This can help a person relearn movement and coordination. It is important to stay active, even though this may be difficult at first.
- Occupational therapy: This can help a person improve their ability to carry out daily activities, such as bathing, cooking, dressing, eating, reading, and writing.
- Support groups: Joining a support group can help a person cope with common mental health issues that can occur after a stroke, such as depression. Many find it useful to share common experiences and exchange information.
- Support from friends and family: Close friends and relatives should try to offer practical support and comfort after a stroke. Letting friends and family know what they can do to help is very important.
Stroke is a potentially life changing event that can have lasting physical and emotional effects.
Lifestyle changes does not prevent all strokes. But many of these changes can help lowering your risk of stroke.
These changes include the following:
- Quit smoking. If you smoke, quitting now will lower your risk of stroke. You can reach out to your doctor to create a quit plan.
- Limit alcohol use. Heavy alcohol consumption can raise your blood pressure, which in turn raises the risk of stroke. If reducing your intake is difficult, reach out to your doctor for help.
- Keep a moderate weight. Overweight and obesity increases the risk of stroke. To help manage your weight, eat a balanced diet and stay physically active more often than not. Both steps can also reduce blood pressure and cholesterol levels.
- Get regular checkups. Talk with your doctor about how often to get a checkup for blood pressure, cholesterol, and any conditions you may have. They can also support you in making these lifestyle changes and offer guidance.
Living with stroke
How a stroke affects you depends on where the stroke occurs in your brain. It also depends on how much your brain is damaged.
Many people who have a stroke are left with paralysis of one of their arms.
Other problems can include having trouble with:
- Doing simple math such as adding, subtracting, or balancing a checkbook
- Going to the bathroom
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