• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

STROKE – CAUSES, SYMPTOMS, DIAGNOSIS, AND TREATMENT

Strokes or also known as brain attacks occur when the blood supply to the brain or a part of the brain is blocked or reduced, causing the brain tissue to be starved of blood, oxygen and essential nutrients leading them to die within minutes if attentive medical care is not received. However, even medical care does not guarantee survival from a stroke as it depends on the intensity of the case. A stroke can also be caused due to rupture or bleeding of the blood vessels, thereby preventing blood and oxygen to reach the brain tissues. A stroke is a critical medical emergency that needs immediate medical care or the situation to worsen to cause brain damage or death.

Causes of strokes

There are basically two types of strokes or two reasons for strokes:

Ischemic strokes: One of the most common types of strokes, which is caused due to narrowing or blocking of the blood vessels that are responsible for taking blood to the brain. This blockage or narrowing causes severely reduced or lack of blood flow to the brain, leading to a slow death of the brain tissue. The blood vessels become narrow or blocked due to the build-up of fatty substances, debris, or blood clots that travel through the bloodstream and accumulate in the blood vessels of the brain.

Transient Ischemic Attack (TIA): A stroke that is caused due to clotting or build-up of debris in the blood vessels reducing or blocking the blood supply to the brain. However, TIA’s are temporary and do not cause permanent damage.

Hemorrhagic strokes: A stroke caused due to leakage or rupture of a blood vessel in the brain is called a hemorrhagic stroke. Leaked or ruptured blood vessels cause the blood to seep into the brain tissue, damaging the brain cells.The leakage or rupture of the blood vessels can be due to multiple factors such as high blood pressure, blood thinners, aneurysms (weakening or thinning of the blood vessel walls), trauma, protein deposits, and ischemic stroke causing haemorrhage.

Moreover, several factors increase the risk of stroke in people. Some of the risk factors include:

Lifestyle

  • Obesity or excessive unhealthy weight
  • Sedentary lifestyle
  • Lack of physical activity
  • Excessive consumption of alcohol
  • Drug abuse
  • Smoking

Health conditions

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Extreme sleep apnea
  • Cardiovascular problems
  • Family history
  • Existing hear conditions
  • History of heart problems

Diet

  • Excessive salt
  • Trans fats
  • Saturated fats

Other conditions

  • Increasing age
  • Sex – men more likely than women to have strokes though women have a higher probability of dying from stroke as compared to men
  • Hormones

Symptoms of Stroke

It is important to know the symptoms of stroke to get medical help and reduce complications and increase chances of survival. Some general symptoms that indicate a stroke include:

  • Trouble in speaking or slurry speech
  • Trouble in comprehending speech
  • Confusion
  • Paralysis
  • Numbness or weakness in the face, arm or leg
  • Vision problems – blurred or blackened vision
  • Severe headache without a cause
  • Loss of consciousness
  • Lack of coordination
  • Dizziness and vomiting
  • Trouble in balancing and walking

That said, symptoms of a stroke in women may vary than the ones mentioned above and could additionally include:

  • Nausea
  • Hallucination
  • Fatigue
  • Breathlessness
  • Seizures
  • Lack of responsiveness
  • Extreme and sudden anxiety or agitation

If you experience any of these symptoms are with someone who is displaying these symptoms, immediate medical help must be called for to avoid complications such as:

  • Brain Damage
  • Long-term or permanent disability
  • Death

Diagnosis of Stroke

Based on the symptoms, one should get immediate medical help. The doctor will understand the symptoms and carefully and quickly conduct a few exams to identify the type of stroke and initiate treatment right away. Some methods of diagnosis will include:

  • Physical examination to assess symptoms
  • Blood tests
  • CT scan
  • MRI
  • Carotid ultrasound
  • Cerebral angiogram
  • Echocardiogram (EKG)

Treatment of Stroke

Proper diagnosis and attentive medical care can majorly help in reducing the impact of a stroke and also increase the survival rate. Some of the common treatment options for strokes are:

Ischemic Stroke and TIA

  • Antiplatelet and Anticoagulants: These drugs such as aspirin should be taken within 24 to 48 hours of the stroke symptoms.
  • Clot-breaking drugs: A type of drugs called thrombolytic is very effective in breaking up the blood clots and restoring blood supply.
  • Mechanical Thrombectomy: This is a type of surgery where a catheter is inserted into the blood vessel to pull out the clot, restoring blood flow. This surgery is most effective if performed within 6 to 24 hours of the stroke.
  • Stents: This is a procedure in which a stent is placed in the weakened or narrowed artery to keep it inflated and regulate blood flow by supporting the walls of the artery.
  • Surgery: The surgery is the last resort when either the other treatment options do not qualify or have failed or in case the clot size is too large. The surgery may involve a catheter to pull out a clot or can involve opening an artery to remove the blockage.

Hemorrhagic Stroke

Medicines: A hemorrhagic stroke can be treated via medications that promote blood clots. These could include medications that reduce the impact of blood thinners, reduce blood pressure, soothe pressure in the brain, prevent seizures, etc.

Coiling: In this method, a long, flexible tube is guided to the area of haemorrhage or compromised blood vessels, where a coil-like instrument is placed to block the blood flow to the affected area.

Clamping: In case an aneurysm is detected in the blood test – which has not begun bleeding or has stopped – the doctors might place a clamp at the aneurysm’s base to limit the blood supply and prevent bleeding.

Role of Surgery:

In Ischemic Stroke- If the infarcted brain is causing pressure in Brain stem than decompressive craniectomy is done to relieve the pressure. Timely intervention is very crucial.

In hemorrhagic stroke- First due to aneurysmal bleed- clipping of aneurysm to prevent re- bleed and along with removal of Haematoma if present.

Second due to Hypertensie bleed- Mostly in basal ganglia & cerebellum area of Brain. If size is big and causes effect on brain stems then removal of clot is required. If blood has gone in ventricles – External Ventricular drainage of blood is done with endoscopic technique.

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