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A stroke, often referred to as a brain attack, occurs when blood flow to any part of the brain becomes interrupted or reduced. The brain cells in the affected area begin to die due to oxygen and glucose deprivation. Early diagnosis is key to prevent permanent brain damage or death, so stroke is a case of emergency. When brain cells die during a brain attack, abilities controlled by the affected part of the brain become lost.
The degree of affectedness is determined by the part of the brain where the stroke has occurred and the extent of damage to this part. Usually, a small stroke will result in minor problems while a large stroke will result in major problems for the affected person. Some individuals may totally recover from strokes, however, more than two-thirds who survive it will have some form of disability.
Strokes can be classified into 3 types according to the causes. They are ischemic stroke, hemorrhagic stroke and transient ischemic attacks, or TIA.
Ischemic stroke: majority of strokes are ischemic strokes, about 80%. This type of stroke occurs when there is an extremely decreased blood supply (ischemia) to the brain due to narrowed or clogged arteries. Ischemic stroke may occur in two forms namely thrombotic stroke and embolic stroke. Thrombotic stroke is that which happens when a blood clot (thrombus) forms in any of the arteries that supply the brain with blood. Fatty deposits or plaque that have accumulated over time are usually the cause of the clot formation. Embolic stroke occurs when blood clot (embolus) that is formed in other parts of the body, away from the brain, is carried to narrower arteries of the brain, and then clogs them.
Hemorrhagic stroke: this type of stroke is caused by leakage from or sudden rupturing of arteries in the brain. This leakage or rupturing of the arteries in the brain which causes brain hemorrhage may be due to many conditions that adversely affect the blood vessels. These conditions may include hypertension, use of blood thinners and weak spots in the walls of blood vessels, called aneurysms. Hemorrhagic stroke also has two types namely intracerebral hemorrhage and subarachnoid hemorrhage.
The intracerebral type is the more common of the two and it occurs when brain tissue becomes inundated with blood after the rupture of an artery in the brain. Subarachnoid hemorrhage occurs when an artery on or close to the brain surface ruptures and blood spills between the surface of the brain and the skull. The bleeding is usually signaled by an abrupt, intense headache.
Another but much less common cause of brain hemorrhage is the rupture of arteriovenous malformation, AVM. AVM is a delicate tangle of thin-walled blood vessels (arteries and veins) that are weaker than normal blood vessels and therefore, rupture more easily.
Transient ischemic attack (TIA): also referred to as a mini-stroke, and from the word ‘transient’, is a period of symptoms similar to those of stroke, only that the symptoms are temporary. There is a temporary reduction in blood supply to parts of the brain and symptoms may last as little as five minutes but not more than 24 hours before they disappear. TIA occurs due to temporary blockage of arteries by blood clot or other debris and as a result, there is only temporary tissue damage and no prolonged symptoms.
Stroke is the fifth leading cause of death in the U.S. Annually, about 800,000 people have stroke which brings the frequency to a stroke every 40 seconds. A person dies from stroke every four minutes and up to 80 percent of strokes are preventable. Also, stroke is the leading cause of disability seen in adults in the U.S. In the U.S, more females die from stroke than men in the ratio 60:40.
Risk factors that predispose one to developing stroke may depend on or be influenced by one’s lifestyle, medical conditions or just situations beyond human control. These risk factors include:
A stroke often manifests without any warning, however the following are the main symptoms that can be observed:
Quick tips on what to do if you feel someone has had a stroke are represented by the letters of the word in the acronym “FAST”
To get the best chance at a proper diagnosis and treatment, a person experiencing a stroke should be treated at a hospital within 3 hours of appearance of the symptoms. This is because the onset of strokes is rapid and so it will have happened before the person is able to see a doctor for an accurate diagnosis. Several diagnostic tests can be carried out by doctors to know the type of stroke that has occurred, because the type of stroke will determine the treatment. These diagnostic tests include:
The only possible way to confirm the type of stroke someone has had is by carrying out a brain scan on the person in a hospital.
The type of stroke will determine the form of treatment given, since strokes have differing causes. So ischemic type treatments are very different from the hemorrhagic type treatments plus the treatment method for one type may not suitable, and in fact, may be harmful for the other.
Ischemic stroke treatment
This treatment focuses on restoring sufficient blood supply to the brain, since these strokes are caused by arteries being clogged or narrowed. Treatment usually starts by administering drugs that dissolve clots and prevent formation of new ones.
Aspirin and tissue plasminogen activator (TPA) can be administered, but TPA as an injection through a vein in the arm. TPA is a very potent clot-buster but needs to be given within 4.5 hours of observing symptoms.
Emergency endovascular procedures may also be carried out by either delivering medications directly to the brain using a catheter inserted into an artery in the groin area, and threading it to the brain to deliver TPA directly into the part of the brain where the stroke is occurring or removing the clot with a stent retriever, a method used when the clot is too big to be totally dissolved by TPA.
Other procedures that can be done include carotid endarterectomy and angioplasty.
Hemorrhagic stroke treatment
Treatment here focuses on controlling bleeding and relieving the pressure on the brain, since this type of stroke is caused by a leaking or ruptured artery, spilling blood into the brain.
Treatment starts with administering medications that help relieve the brain of the pressure, lower overall blood pressure, prevent vasospasm and seizures.
Drugs that counter the effect of blood-thinning anticoagulants, such as warfarin or clopidogrel, are given to individuals taking them.
Blood vessels that led to or could lead to hemorrhagic stroke can be repaired with surgery by placing small clamps at the base of aneurysms.
Hemorrhagic stroke caused by AVMs can be prevented by removing them if they are not too big or deeply situated in the brain.
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