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WHAT'S A STROKE?
It's Very Important That Everyone Should Know!
Compiled
and edited for
public service by Conrad David Brillantes (More...
)
This
could happen to you! Stroke could occur when a blood cloth travels to the brain,
interrupting the supply of blood and the oxygen it caries to the nerve cells
that could die or stunned parts of the body they control due to lost of
manipulation. Blood clot may rupture a vessel that supplies the blood to the
brain…bleeding may also cause a stroke. Call emergency when the following
happens: 1. Sudden weakness, numbness or tingling in the face, arm or leg,
transpires.
2. Sudden temporary loss of speech or trouble understanding speech. 3.
Sudden loss of vision, particularly in one eye, or double vision. 4. Sudden
severe and unusual headache. 5. Sudden loss of balance, especially with any of
the above signs. Please do not wait and gamble someone’s life, call 911
immediately.
THE
DEFINITION: A stroke is when the blood supply to any part of the brain is
interrupted, resulting in tissue death and loss of brain function.
Alternative
names
Cerebrovascular disease; CVA; Cerebrovascular accident
Causes,
incidence, and risk factors
The brain requires about 20% of the body’s total circulation of blood. The
blood enters the brain from two carotid arteries in the neck, which branch off
into multiple arteries that supply each specific area of the brain.
If
blood flow in any of these arteries is interrrupted for longer than a few
seconds, brain cells can die, causing permanent damage. The
resulting stroke-related symptoms depend on the area of the brain affected, the
extent of the damage, and the cause of the stroke.
Common symptoms include
changes in vision, speech, and comprehension; weakness; vertigo; loss of
sensation in a part of the body; or changes in the level of consciousness.
Stroke accounts for 1 out
of every 15 deaths in the United States. It is the 3rd leading cause of death in
most developed countries, and the leading cause of disability in adults. The
risk doubles with each decade after age 35. Stroke occurs in men more often than
women.
The risk of stroke is increased by smoking, hypertension, diabetes,
hyperlipidemia, and heart disease. Rarely, strokes may happen in women on birth
control pills -- the risk is increased if a woman also smokes and is older than
35. Women have a higher risk of stroke during pregnancy and the weeks
immediately after pregnancy. Other illnesses such as vasculitis, lupus, or high
blood viscosity may contribute to stroke.
The most common cause of stroke is atherosclerosis. (See stroke
secondary to atherosclerosis.) Atherosclerosis is a condition in which fatty
deposits and blood platelets collect on the wall of the arteries, forming
plaques. Over time, the plaques slowly begin to block the flow of blood. A
plaque may block the artery enough to cause a stroke, or it may trigger a blood
clot that causes a stroke.
The formation of a plaque
does not always lead to a stroke. The arteries are large enough that 75% of the
blood vessel can be blocked, and there will still be adequate blood flow to that
area of the brain. Furthermore, there are many small connections between the
arteries in the brain. If the blood flow is gradually blocked in one artery,
these small connections will increase in size and "by-pass" the
obstructed area. Even a totally blocked artery may not cause a stroke.
A stroke may be caused by a
blood clot
that forms in the brain (a thrombus)
or a blood clot, piece of plaque, or other material that travels to the brain
from another location (an embolism).
Bleeding (hemorrhage) within the brain can, on rare occassions, cause symptoms
that mimic stroke.
A stroke caused by a blood clot in the brain (a thrombus)
is most common in older people, and often there is underlying atherosclerosis or
diabetes.
This type of stroke may occur at any time, including at rest. The person may or
may not lose consciousness.
Strokes caused by embolism
(a blood
clot that travels to the brain) are most commonly caused by heart disorders.
An embolism may also originate in the aortic arch, especially where there is
atherosclerotic plaque. The blood clot travels through the bloodstream and
becomes stuck in a small artery in the brain. This stroke occurs suddenly with
immediate, maximum damage to the brain. Consciousness may or may not be lost.
Embolic strokes are NOT
associated with activity levels and can occur at any time. Arrhythmias
of the heart, such as atrial fibrillation, are often seen with with this type of
stroke and may be the cause of the clot. Other causes of embolic stroke include
endocarditis (an infection of the heart valves), or a mechanical heart valve
that may have a clot attached to it. A heart attack puts people at greater risk
for having an embolic stroke.
The probable outcome is worsened if blood vessels damaged by stroke rupture and bleed (hemorrhagic stroke).
Here's the latest news from BBC Medical report article published on June 24, 2006
HEART DRUG MAY HELP TREAT STROKE
US researchers discover plant extracts, which are used in heart failure, may have benefits in early treatment of stroke. A compound called neriifolin, which comes from the yellow oleander, was found to be significantly protective against neurons in the brain that otherwise would have died.
Stroke can cause paralysis
US researchers have discovered a group of plant extracts that may have benefits in early treatment of stroke. Cardiac glycosides, compounds which include heart drug digoxin, were found to protect rat brain tissue against the lack of blood which occurs in stroke. The study published in the National Academy of Sciences may help scientists develop new treatments. Many drugs thought to have protective effects after stroke have been tested but as yet none have been effective. The researchers from Duke University Medical Center in North Carolina screened a large number of small compounds for neuroprotective activity by testing them on slices of rat brain deprived of oxygen and glucose.
Using the test - which is
designed to mimic stroke in the brain - a compound called neriifolin which comes
from the yellow oleander was found to be significantly protective against
neurons in the brain that otherwise would have died. Neriifolin appeared to show
neuroprotective properties even if given several hours after the brain tissue
was starved of oxygen and glucose. Although they hadn't initially been
identified in the screening test, the researchers hypothesised that several
other compounds related to neriifolin would also protect brain tissue against
ischaemic injury. They tested digoxin and digitoxin - which come from the
foxglove and have both been used for several decades in the treatment of
congestive heart failure and arrhythmia - and ouabain in a mouse model. Although
not as potent as neriifolin, all of the plant extracts had a neuroprotective
effect.
Clinical trials
The researchers said as
cardiac glycosides are already in use, it could speed up the process towards
clinical trials. Dr Donald Lo, Director of the Center for Drug Discovery, at
Duke University, said: "It's always a helpful stroke of luck when you find
something that already has clinical usage because we know many things about
dosage and side-effects." He added that finding the activity of the
compounds in the rat model was the very first step. "The aim of this study
was to survey as many different drug targets as possible because the last 50 to
100 that have been tested have not fared well in clinical trials." He
added: "It was surprising because this is a class that is generally
toxic." A spokesperson for the Stroke Association said: "The
researchers are correct in identifying the failure of many compounds that have
shown the potential to protect neurons between the stage of animal model testing
and clinical trials, and it is welcome to have other compounds to investigate.
"The advantage of this group of compounds is that they have been in
clinical use for other conditions over many years, and we therefore know a great
deal about the possible doses and side effects. "The negative side is that
these drugs have effects on the heart that will certainly limit the doses that
could be given, and it has been the case with other neuroprotectant drugs in the
past that cardiac side effects have meant that insufficient amounts of drug to
protect the brain cold be given safely. "[This model] might be useful as a
means of identifying candidate drugs in the future. "However, the
difficulty usually arises not in identification of possible neuroprotectant
molecules but in their successful translation into clinical trials, and our
track record speaks for itself. "Over the past 15 years there have been
dozens of molecules that have gone as far as clinical trials involving tens of
thousands of patients after showing great promise in animal studies, yet we
still have no drug of this class that is effective."
See also
Stroke
secondary to carotid dissection (bleeding from the carotid arteries)
Stroke
secondary to carotid stenosis (narrowing of the carotid arteries)
Stroke
secondary to FMD (fibromuscular dysplasia)
Prevention
Stroke prevention involves controlling the risk factors. Treat hypertension,
diabetes,
heart
disease, and other associated disorders. Reduce or stop smoking.
A low-cholesterol, low-salt diet may be appropriate if the risk factors include atherosclerosis
or hypertension. Exercise more.
The treatment of TIA
can prevent some strokes.
Symptoms
Loss
of movement (paralysis)
of any body area
Tingling
or other sensation changes
Language difficulties (aphasia):
slurred, thick, difficult speech
inability to understand speech
may have difficulty with reading or writing
Inability to recognize or identify sensory stimuli
(agnosia) resulting in "neglect" of one side of the body
Vertigo
(abnormal sensation of movement)
Personality changes
Mood/emotion changes (such as depression
or apathy)
Urinary
incontinence (lack of control over bladder)
Lack of control over the bowels
Cognitive decline
easily distracted
impaired judgment
limited attention
Additional
symptoms that may be associated with this disease:
Breathing, absent temporarily
Note:
Specific changes in brain function (neurologic deficits) depend on the location
and amount of injury to the brain. The symptoms are typically on one side of the
body but may be isolated to specific functions, may involve one side of the body
and the opposite side of the face, or may involve the face only.
Signs and tests
In diagnosing a stroke, the way the symptoms develop is important. The symptoms
may be severe at the beginning of the stroke, or symptoms may progress or
fluctuate for the first day or two (stroke in evolution). Once there is no
further deterioration, the stroke is considered a complete stroke.
The exam will look for specific neurologic, motor, and sensory deficits, because
these often correspond closely to the location of the injury to the brain. An
examination may show changes in vision or visual
fields, abnormal reflexes or abnormal extent of "normal" reflexes,
abnormal eye movements, muscle
weakness, decreased
sensation, and other changes. A "bruit" (an abnormal sound heard
with the stethoscope) may be heard over the carotid arteries of the neck. There
may be signs of atrial
fibrillation.
Tests may determine the location and cause of the stroke and rule out other
disorders that can cause the symptoms:
A head
CT or MRI
of head may be used to rule out bleeding
(hemorrhage) or other lesions and define the location and extent of the
stroke
An ECG
(electrocardiogram)
may be used to determine underlying heart disorders
An echocardiogram
may be used if the cause is suspected to be cardiac embolus
A carotid
duplex (ultrasound)
may be used if the cause is suspected to be carotid
artery stenosis
A cerebral (head) arteriography may be used if a disorder involving
the blood vessels is suspected
This
disease may also alter the results of the following tests:
Cytometric study
BERA (brainstem evoked
response audiometry)
Treatment
A stroke is serious condition. Immediate treatment is required. The treatment
varies depending on the severity of symptoms. For virtually all strokes,
hospitalization is required, possibly including intensive care and life support.
There is no known cure for a stroke. The treatment involves rehabilitation
(based on the symptoms) and prevention of future strokes. Recovery may occur as
other areas of the brain take over functioning for the damaged areas. The goal
of treatment is to prevent the spread of the stroke and to maximize the patient’s
ability to function.
IMMEDIATE TREATMENT
Life support and coma
treatment are performed as needed.
A number of medications may be used. RTPA is a medicine that lyses the clot and
potentially restores blood flow to the affected area to prevent cell death and
permanent damage. However, there are strict criteria for who can receive RTPA --
most important is that the stroke victim be evaluated and treated by a
specialized stroke team within 3 hours of onset of symptoms. It is a
controversial medication because there is a risk of serious
bleeding.
In appropriate
circumstances, other anti-coagulants such as heparin and coumadin are used to
prevent recurrent strokes. Aspirin and other anti-platelet agents are used to
prevent strokes as well.
Analgesics
may be needed to control severe headache.
Anti-hypertensive medication may be needed to control high
blood pressure.
Nutrients and fluids may be neccesary, especially if the person has swallowing
difficulties. The nutrients and fluids may given through an intravenous
tube or a tube in the stomach (feeding tube or gastrostomy
tube). Swallowing difficulties may be temporary or permanent.
Surgery may be appropriate in some cases, including surgical removal of blood
clots from the brain.
Carotid
endarterectomy, removal of plaque from the carotid arteries, may help
prevent new strokes from occurring in some people.
LONG-TERM TREATMENT
The recovery time and need for long-term treatment vary. Depression
and other symptoms should be treated.
Speech therapy, occupational therapy, physical therapy, positioning, range of
motion exercises, and other therapies may prevent complications and promote
maximum recovery of function. People should stay active within their physical
limitations.
In some cases, urinary
catheterization or bladder/bowel control programs may be necessary to control incontinence.
The individual’s safety must be considered. Some people with stroke appear to
have no awareness of their surroundings on the affected side. Others show a
marked indifference or lack of judgment, which increases the need for safety
precautions. For these people, friends and family members should repeatedly
reinforce important cues, like name, age, date, time, and where they
live, to help reduce disorientation.
Communication may require pictures, demonstration, verbal cues, or other
strategies, depending on the type and extent of language deficit.
In-home care, boarding homes, adult day care, or convalescent homes may be
required to provide a safe environment, control aggressive or agitated
behavior, and meet physiological needs.
Behavior modification may be helpful for some people in controlling unacceptable
or dangerous behaviors. This consists of rewarding appropriate or positive
behaviors and ignoring inappropriate behaviors (within the bounds of safety).
Family counseling may help in coping with the changes required for home care.
Visiting nurses or aides, volunteer services, homemakers, adult protective
services, and other community resources may be helpful.
Legal advice may be appropriate. Advance directives, power
of attorney, and other legal actions may make it easier to make ethical
decisions regarding the care of the person with organic brain syndromes such as
stroke.
Prognosis
Stroke is the third leading cause of death in developed countries. The outlook
depends on the cause and extent of damage. Of those who survive a stroke, many
have long-term disabilities, but some recover most or all function.
Complications
Pressure sores
Permanent loss
of movement or sensation of a part of the body
Bone fractures
Joint contractures
Permanent loss of cognitive or other brain functions
Disruption of communication, decreased social interaction
Decreased ability to function or care for self
Decreased life span
Side effects of medications
Pain syndromes (reflex sympathetic dystrophy)
Calling your
health care provider
Go to the emergency room or call the local emergency number (such as 911) if you
have symptoms of a stroke. Stroke requires immediate treatment.
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