What is a stroke?
Stroke, which is also known as a
cerebrovascular accident or CVA, is when part of the brain loses its blood
supply and the part of the body that the blood-deprived brain cells control
stops working. This loss of blood supply can be ischemic because of lack of
blood flow, or haemorrhagic because of bleeding into the brain tissue. Because
stroke can lead to either permanent disability or even death, it is considered
to be a medical emergency. Though there are opportunities to treat ischemic strokes,
it needs to be started within the first few hours of having signs of a stroke. If
stroke is suspected, the patient, family, or bystanders should immediately call
9-1-1 and activate emergency medical services.
A transient ischemic attack (TIA or
mini-stroke) describes an ischemic stroke that is short-lived where the
symptoms resolve spontaneously. Though short-lived, it also requires emergency
assessment to minimize the risk of a getting a stroke in the future. If all
symptoms of stroke were to be resolved within 24 hours, it would be classified
as a TIA.
What is the NIH Stroke Scale?
All strokes affect the brain differently and
the symptoms and signs of the stroke depend on which part of the brain was
affected.
For example, for most people, if speech
and comprehension is affected, the stroke is most likely located in the left
half of the brain. Having a weaker or weakness with
the right side of the body is also associated with it.
A stroke on the right side of the brain
would affect the left side of the and depending on where in the brain the
injury occurred, the affected areas could be the face, arm, leg or a
combination of the three.
The NIH
Stroke Scale tries to score how severe a stroke
might be. It also monitors whether the person's stroke is improving or
worsening as times passes as the patient is re-examined.
There are 11 categories that are scored
and include whether the patient
·
is awake,
·
can follow
commands,
·
can see,
·
can move their
face, arms and legs,
·
has normal body
sensations or feelings,
·
has speech
difficulties, or
·
has coordination
problems.
What are the risk factors for stroke?
Overall, the most common risk factors for
stroke are:
·
high blood
pressure,
·
high cholesterol,
·
smoking,
·
diabetes, and
·
increasing age.
·
Heart conditions
like atrial fibrillation, patent foramen ovule, and heart valve
disease can also be the potential cause of
stroke.
If stroke where to occur to younger
individuals (less than 50 years old), less common risk factors include illicit
drugs, such as cocaine or amphetamines, ruptured aneurysms, and inherited (genetic) predispositions to
abnormal blood clotting.
What are the warning signs and symptoms of a stroke?
Before stroke occurs, there may not be
any warning signs, which is why high blood pressure (hypertension), one of the risk factors for stroke, is called the silent killer.
Some patients who experience transient
ischemic attack (TIA) believed or assumed that the stroke had solved itself.
The symptoms may be either mild or dramatic and can mimic a stroke with the
same symptoms such as weakness, numbness, facial droop, and speech
difficulties, but only lasting few minutes. This however, should not be ignored
as there is no guarantee that the symptoms of stroke would resolve on its own
and they may also offer an opportunity to look for potentially reversible or
controllable causes of stroke. For that reason, a TIA should be considered an
emergency and medical care should be accessed immediately.
Amaurosis fugax describes the temporary
loss of vision in one eye that occurs because of an embolus of blood clot or
debris to the artery that supplies the eye. While it only involves vision, this
situation should be considered a type of TIA.
What are
the signs and symptoms of a stroke?
Symptoms of stroke depend upon what are
of the brain has stopped working due to loss of its blood supply. Often, the
patient may present with multiple symptoms include ng the following:
·
Acute change in
level of consciousness or confusion
·
Acute onset of
weakness or paralysis of half or part of the body
·
Numbness of one
half or part of the body
·
Partial vision loss
·
Difficulty speaking
or understanding speech
·
Difficulty with
balance and vertigo
The symptoms of ischemic and haemorrhagic
stroke may be the same but patients with haemorrhagic stroke may also complain
more of headache and vomiting.
Ischemic stroke
This happens when an artery in the brain
is being blocked or obstructed, thus preventing oxygenated blood from being
delivered to the brain cells. The artery can be blocked in various ways, such
as the narrowing of the artery due to cholesterol build-up called plaque, and
if it were to rupture, a clot would be form and it prevents blood from passing
through to the brain cells.
A stroke caused by debris or a clot that travels
from the heart or another blood vessel is called an embolic stroke. An embolus
or embolism is a clot, a piece of fatty material or other object that travels
within the bloodstream that lodges in a blood vessel to cause an obstruction.
Blood clots that embolize usually
arise from the heart. Atrial fibrillation is one of the most common. It is where
the upper chambers of the heart, the atria, do not beat in an organized rhythm,
causing the atria to jiggle like a bowl of jelly. While blood still flows into
the hearts lower chambers, some of the blood along the inner walls of the atrium
can form small blood clots, which if broken off, may flow to the brain, where
it can block the flow of blood and cause a stroke.
Haemorrhagic stroke
When a blood vessel leaks and spills
blood into brain tissue, those brain cells stop working. The bleeding or
haemorrhage is often due to poorly-controlled high blood pressure that weakens the wall of an artery over time. Blood may also
leak from an aneurysm, a congenital weakness or ballooning of an artery wall or
from an AVM (arteriovenous
malformation), a congenital abnormality where an
artery and vein connect incorrectly. The bleeding can form a hematoma that directly damages brain cells and may also cause swelling
that puts further pressure on surrounding brain tissue.
What causes a stroke?
Risk factors for narrowed blood vessels
in the brain are the same as those that cause narrowing blood vessels in the
heart and heart attack (myocardial
infarction). These risk factors include:
·
high blood pressure (hypertension),
·
high cholesterol,
·
diabetes, and
·
smoking.
· Embolic stroke
Can strokes be prevented?
Prevention is always the best treatment,
especially when the illness can be life-threatening or life-altering. Ischemic
strokes are most often caused by atherosclerosis, or hardening of
the arteries, and carry the same risk factors
as heart
attacks (myocardial infarction, coronary
artery disease) and peripheral vascular disease. These include high blood pressure, high cholesterol, diabetes, and
smoking. Stopping smoking and keeping the other three under lifelong control
greatly minimizes the risk of ischemic stroke.
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