Stroke
The
Stroke
Association
UK
reports
that
a
stroke
occurs
every
3
minutes
and
27
seconds.
Statistics
also
indicate
that
Asians
are
twice
as
likely
to
have
a
stroke
compared
to
Caucasians.
In
the
USA
stroke
is
the
fifth
leading
cause
of
death
and
worldwide
is
the
second
leading
cause
of
death.
Recovery
from
a
stroke
differs
from
person
to
person
and
no
two
strokes
are
the
same.
Did
you
know
that
quicker
the
symptoms are recognised and treatment is initiated the better the recovery?
What is a Stroke?
When
blood
flow
to
an
area
of
the
brain
is
cut
off,
brain
cells
in
that
area
are
deprived
of
oxygen
and
die.
Depending
on
the
area
affected
various
permanent
disabilities
like
paralysis
of
a
limb,
loss
of
memory
or
inability
to
speak
can
occur.
If
the
area
affected
is
large,
the
person
will
have
severe
disability
affecting
many
parts
of the body. A massive stroke can also be fatal.
Symptoms of stroke
•
The face may be distorted and droop on one side. The person may not be able to smile.
•
Significant
weakness
of
one
arm.
When
asked
to
raise
both
arms
together,
one
arm
keeps
dropping
or
the
person
is
not able to raise that arm.
•
Speech may be altered or slurred.
Other less common symptoms may be:
Sudden severe headache that cannot be controlled by medication.
Sudden blurring of vision
Suddenly becoming violent or confused
Numbness of a limb or part of the face with weakness
Sudden dizziness or becoming unconscious
Any
one
of
the
signs
above
when
present
is
probably
a
stroke
and
the
person
will
need
emergency
medical
treatment.
Get
them
to
the
nearest
hospital
treating
strokes.
Make
sure
the
hospital
has
access
to
an
emergency
scanning
facility.
The sooner the diagnosis is confirmed and treatment begun the better the results.
A stroke is a medical emergency and needs immediate medical attention.
Types
of
Stroke:
There
are
two
types
of
stroke,
Ischaemic
and
Haemorrhagic.
Ischaemic
Stroke:
When
the
blood
vessel
supplying
an
area
of
the
brain
is
blocked
by
a
blood
clot
or
build-up
of
fatty
plaque
inside
the
vessel
wall,
the blood supply to the area is cut off and an “ischaemic stroke” results.
Haemorrhagic
Stroke:
When
a
vessel
supplying
an
area
of
brain
ruptures
leaking
blood
(burst
aneurysm),
the
area
is
deprived
of
oxygen
and
“haemorrhagic
stroke”
results.
Stroke
can
also
result
when
there
is
undue
pressure on an area of brain by a bulging blood vessel (aneurysm).
Investigation following Stroke
Although
the
majority
of
strokes
are
caused
by
a
clot
blocking
a
vessel
(ischaemic
stroke),
if
a
haemorrhagic
stroke
is
treated
as
you
would
an
ischaemic
stroke
the
result
would
be
catastrophic
as
more
blood
would
leak
in
to
the
area,
causing
more
damage
to
the
brain
cells.
According
to
the
American
Stroke
Association,
13%
of
strokes
are
haemorrhagic
strokes.
Therefore,
before
commencing treatment it is essential to investigate quickly and confirm the type of stroke.
Scan:
To
distinguish
between
ischaemic
and
haemorrhagic
stroke,
it
is
necessary
to
have
a
brain
scan.
The
scan
will
confirm the type of stroke.
Other
Tests:
General
examination
of
the
patient
will
include
checking
for
high
blood
pressure
and
for
irregular
heart
beats
(atrial
fibrillation).
An
irregular
heart
beat
can
produce
a
blood
clot
which
can
travel
to
the
brain
and
block
a
vessel.
Routine blood tests will also check for high cholesterol.
Treatment
The
aim
of
treatment
is
to
re-establish
normal
blood
supply
to
the
area
of
brain
affected.
I
n
ischaemic
stroke,
the
treatment
is
to
unblock
the
vessel
where
the
blood
flow
has
been
stopped.
In
haemorrhagic
stroke,
the
leak
from
a
blood
vessel
must
be
arrested.
Once
the
type
of
stroke
is
confirmed,
treatment
should
be
started
without
delay.
Effective
and
early
treatment
can
prevent
long-term
disability.
Treatment
is
usually
non-surgical
but
surgery
may
be
needed
in
some
cases.
Non-Surgical Treatment:
Alteplase,
also
known
as
tPA,
is
an
injection
that
is
given
to
dissolve
the
clot
(thrombolysis).
Fortunately
the
majority
of
strokes
are
caused
by
a
blood
clot.
However,
for
it
to
be
effective
it
must
be
given
within
4
to
5
hours
of a stroke. It is estimated that 1 in 7 patients benefit from this drug.
Other
Drugs:
Aspirin
and
Clopidogrel:
Both
d
rugs
can
prevent
further
clot
formation.
Aspirin
thins
the
blood.
Clopidogrel
acts
on
the
platelets
and
makes
them
less
sticky
thus
preventing
clot
formation.
Long
Term
Drugs:
To
prevent
further
clots
developing,
anticoagulants
like
heparin
and
warfarin
may
be
given
for
varied
lengths
of
time
depending
on
the
cause
for
the
clot
forming.
Anti-coagulants
are
particularly
useful
when
the
patient
has
an irregular heart rate (atrial fibrillation) or at risk of developing (or had) a blood clot in the leg (DVT).
Statins:
If
the
level
of
cholesterol
is
high
statins
that
lower
levels
may
be
prescribed.
High
cholesterol
levels
could
increase the build-up of fatty plaque inside a vessel wall.
Antihypertensives:
High
blood
pressure
can
cause
an
aneurysm
in
the
brain
to
leak
blood.
In
this
case
anti-hypertensive
medication will be prescribed.
Surgical
Treatment:
Surgery
could
be
undertaken
for
a
variety
of
reasons.
The
type
of
procedure
will
depend
on
the
cause and type of stroke.
Carotid
Endarterectomy:
If
an
artery
in
the
neck
(carotid
artery)
is
narrowed
by
a
build-up
of
fatty
plaque,
carotid
endarterectomy will be considered.
In
hemorrhagic
stroke,
the
types
of
surgery
done
will
include
clipping
of
an
aneurysm,
coil
embolization,
and
repair
of
arteriovenous malformation (AVM).
For more information about these procedures check the article
“Basic Facts About Stroke”
in
the “Medical Forum”
Conclusion:
Stroke
is
a
major
cause
of
disability
and
death.
As
every
stroke
is
different,
there
is
no
set
pattern
for
recovery. However, the sooner treatment is started, the better the recovery.
If
you
suspect
something
is
medically
not
right
with
someone
close
to
you, think
“FAST”.
It could be a stroke.
F
=
Facial
weakness,
A
=
Arm
weakness,
S
=
Speech
altered
and
T
=
Timing of treatment determines speed of recovery.
K. Badrinath, FRCS., MSc (Orth) (Lond)
References: NHS Choice, American Stroke Association, National Heart Lung and Blood Institute,
ALL RIGHTS RESERVED | © 2019 MADRAS RED FORT DOCTORS FOUNDATION
Fatty Plaque obstructing an artery
Blood clot obstructing an artery
Sudden Distortion of Face
Madras Red Fort Doctors Foundation
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