BRAIN STROKE: CAUSES, SYMPTOMS, AND TREATMENT
A brain stroke is the 5th leading cause of death in the U.S with one person dying every 4 minutes. For black people, it is the 3rd leading cause of death. Approximately 800,000 people have a stroke each year, about one every 40 seconds. Only heart disease, cancer, chronic respiratory diseases, and accidents are equally deadlier like a stroke. A stroke occurs due to problems with the blood supply to the brain; either the blood supply is blocked or a blood vessel within the brain ruptures, causing the brain tissues to die. A stroke is a medical emergency and treatment must be done as quickly as possible.
KINDS OF STROKE
There are 3 main kinds of strokes:-
1.Ischemic stroke 2.Hemorrhagic stroke 3.Transient-Ischemic Attacks(TIAs)
SOME FAST FACTS ABOUT STROKES
- During a stroke, the brain does not receive enough oxygen or nutrients, causing brain cells to die.
- Ischemic strokes are caused by a narrowing or blocking of arteries to the brain.
- Hemorrhagic strokes are caused by blood vessels in and around the brain bursting or leaking.
- Strokes need to be diagnosed and treated as quickly as possible in order to minimize brain damage.
- Remembering the F.A.S.T acronym can help with recognizing the onset of stroke (Face, Arms, Speed, Time).
- Treatment depends on the type of stroke. Ischemic strokes can be treated with surgery to repair or block blood vessel weaknesses.
- The most effective way to prevent strokes is by maintaining a healthy lifestyle.
WHAT IS A STROKE?
A stroke occurs when the supply of blood to the brain is either interrupted or reduced. When this happens, the brain does not get enough oxygen or nutrients which cause brain cells to die. There are 3 main kinds of stroke:-Ischemic, Hemorrhagic, Transient-Ischemic Attack (TIA). In the US, approximately 40% of stroke deaths are in males, with 60%in females. According to the American Heart Association (AHA) compared to white people, black people have nearly twice the risk of a first-ever stroke and a much higher death rate from stroke. In 2009, stroke was listed as the underlying cause of death in 128,842 persons in the US resulting in an age-adjusted rate of 38.9 deaths per 100,000 populations. The rate was almost twice as high among non-Hispanic blacks (73.6 per 100,000) and the rate of premature death from stroke was also higher among non-Hispanic blacks than their white counterparts (25.0 versus 10.2). Stroke affects people if they are overweight, aged 55 or above, have a personal or family history of stroke, do not exercise much, drink heavily, smoke, or use illicit drugs.
WHAT CAUSES STROKE?
The different forms of stroke have different specific causes:-
THROMBOTIC STROKE—The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. A part of the brain gets deprived of blood and oxygen because of the clotting of any blood vessel. As a result of the deprivation of blood and oxygen, the cells of that part of the brain die and the part of the body controlled by that part of the brain stops working. A cholesterol plaque in one of the brain’s blood vessels ruptures starting the clotting process. The reason for narrowed blood vessels in the brain is the same as for the heart. They are:-
- High blood pressure and hypertension
- High cholesterol
EMBOLIC STROKE—Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through the bloodstream and lodges in an artery in the brain. When the blood flow stops the brain cells do not receive the oxygen and glucose required to function and a stroke occurs. This type of stroke is referred to as an embolic stroke. A blood clot may form in the heart chamber as a result of an irregular heart rhythm like atrial fibrillation. These clots remain attached to the inner lining of the heart but sometimes they can break off and travel through the bloodstream, block a brain artery, and cause a stroke. An embolism, either a plaque or clot, may also originate in a large artery, like the carotid artery, a major artery in the neck that supplies blood to the brain and then travel downstream to clog a small artery in the brain.
CEREBRAL HEMORRHAGE—It occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes symptoms similar to a stroke by depriving blood and oxygen to parts of the brain in a variety of ways. Blood flow is lost to some cells. It can also cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increase pressure within the skull and cause more damage by squeezing the brain against the bony skull. It further decreases blood flow to brain tissue and it’s cells.
SUBARACHNOID HEMORRHAGE—In this kind, the blood accumulates in the space beneath the arachnoid membrane lining the brain. The blood starts from an abnormal blood vessel that leaks or ruptures. It is often from an aneurysm. These cause a sudden severe headache, nausea, vomiting, light intolerance, stiff neck. If not recognized and treated coma and brain death may occur.
VASCULITIS—Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed causing a decreased flow of blood to parts of the brain.
MIGRAINE HEADACHE—There is an increased occurrence of stroke in people with migraine headaches. Migraines also called vascular headaches include narrowing of the brain blood vessels.
ISCHEMIC STROKE—It is the most common form of stroke accounting for 85% of total strokes. This type of stroke is caused by blockages or narrowing of the arteries that provide blood to the brain, resulting in ISCHEMIA, severely reduced blood flow. These blockages are often caused by blood clots, which can form either in the arteries connecting to the brain or in other blood vessels before being swept through the bloodstream and into narrower arteries within the brain. Clots can be caused by fatty deposits within the arteries called Plaque.
HEMORRHAGIC STROKE—These strokes are caused by arteries in the brain either leaking blood or bursting open. The leaked blood puts pressure on brain cells and damages them. Blood vessels can burst or spill blood in the middle of the brain or near the surface of the brain sending blood into the space between the brain and the skull. The ruptures can be caused by conditions such as Hypertension, Trauma, Blood-thinning medications, Aneurysms (weaknesses in blood vessel walls). Intracerebral hemorrhage is the most common type of hemorrhagic stroke and occurs when brain tissue is flooded with blood after an artery in the brain bursts. Subarachnoid hemorrhage is the second type of hemorrhagic stroke and is less common. In this type of stroke, bleeding occurs in an artery in the subarachnoid space, the area between the brain and the thin tissues that cover it.
TRANSIENT-ISCHEMIC ATTACK (TIA)
TIAs are different from the above kinds because the flow of blood to the brain is only briefly interrupted. TIAs are similar to ischemic strokes in that they are often caused by blood or other clots. TIAs should be regarded as medical emergencies, even if the blockage of the artery and symptoms are temporary. They serve as warning signs for future strokes and indicate that there is a partially blocked artery or clot source in the heart. Over a third of people who experience a TIA go on to have a major stroke within a year if they have not received any treatment. Between 10-15 percent will have a major stroke within 3 months of a TIA.
SYMPTOMS OF A STROKE
Strokes occur quickly so symptoms often appear suddenly and without warning. The main symptom of a stroke are-1.Confusion—including trouble with speaking and understanding.
- Headache—With altered consciousness or vomiting.
- Numbness or inability to move parts of the face, arm or leg, particularly on one side of the body.
- Trouble seeing in one or both eyes.
- Trouble walking—including dizziness and lack of coordination.
Strokes can lead to long term problems. Depending on how quickly it is diagnosed and treated the patient can experience temporary or permanent disabilities in the aftermath of a stroke. In addition to these problems, patients may also experience the following:-Bladder or bowel control problems, pain in the hands and feet that gets worse with movement and temperature changes.paralysis or weakness on one or both sides of the body, trouble controlling or expressing emotions.
Symptoms may vary among patients and range in severity. The acronym F.A.S.T is a way to remember the signs of stroke and can help to identify the onset of stroke more quickly.
Face drooping—If the person tries to smile does one side of the face droop?
Arm weakness—If the person tries to raise both arms does one arm drift downwards?
Speech difficulty—If the person tries to repeat a simple phrase, is their speech slurred or strange?
Time to call 911-If any of these signs are observed contact emergency services. The faster a person with suspected stroke receives medical attention, the better their prognosis and the less likely they will have to experience lasting damage or death.
HOW IS A STROKE DIAGNOSED?
Strokes happen fast and will often occur before an individual can be seen by a doctor for a proper diagnosis. For getting the best diagnosis and treatment for a stroke patient they should be treated at a hospital within 3 hours of their symptoms first appearing. Ischemia and hemorrhage strokes require different kinds of treatment. It is only possible to be sure of what type of stroke someone has by giving them a brain scan in a hospital environment. There are different types of diagnostic tests that doctors use to know about the type of stroke that has occurred.
- Physical examination—A doctor here will ask about the patient’s symptoms and medical history. They may also check blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes all to check for indications of clotting.
- Blood tests—A doctor may perform blood tests to find out how quickly the patient’s blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection.
- CT-Scan-–A series of X-rays that can show hemorrhages, strokes, tumors, and other such conditions.
- MRI Scan—Radio waves and magnets create an image of the brain to detect damaged brain tissue.
- Carotid ultrasound—An ultrasound scan to check the blood flow in the carotid arteries to see if there is any plaque present.
- Cerebral Angiogram—Dyes are injected into the brain’s blood vessels to make them visible under X-ray to give a detailed view of the brain and neck blood vessels.
- Echocardiogram—A detailed image of the heart is created to check for any sources of clots that could have traveled to the brain to cause a stroke.
IS RECOVERY AFTER A STROKE POSSIBLE?
If prompt intervention is taken and the blood supply to brain tissue is increased then brain damage to stroke patients can be minimized. Patients who have suffered physical, mental and emotional imbalances because of stroke can benefit from rehabilitation by gaining increased functioning. Also, the best treatment for stroke is preventing and minimizing risk factors not only for stroke but for heart attack and peripheral vascular disease (PAD).
The purpose of rehabilitation is to return the stroke patient to normalcy and in the normal way of functioning as was before the stroke. This depends on the health of the patient and the intensity of the stroke that he or she has suffered. Rehabilitation takes weeks or months and is possible with a team approach for success. The teamwork of physical, occupational and speech therapists along with the care of the primary doctor is required for attaining the recovery goals of the patient. The speech pathologists help with swallowing to prevent aspiration pneumonia. Physical therapists help in strength and balance issues and occupational therapists help the patient to perform daily activities from personal hygiene to cooking and accomplishing small and easy jobs.
CAN STROKES BE PREVENTED?
Prevention is always better than cure. So if we are able to prevent any life-threatening, dangerous disease we should go for it. Ischemic strokes are mostly caused by atherosclerosis or hardening of the arteries and have the same risks as heart attack and peripheral vascular disease which are high blood pressure, high cholesterol, diabetes, and smoking. If we are able to control these health problems we can minimize the risk of stroke occurrences. Patients who have suffered from TIA strokes are given certain medications to decrease the risk of another stroke. These include medications to lower blood cholesterol levels to control blood pressure. Also, antiplatelet medications may be given to make platelets help in reducing blood clot formation. These include aspirin, clopidogrel. Patients with a TIA are also evaluated for carotid stenosis which is narrowing of the carotid artery. A Lifelong control of high blood pressure decreases the risk of hemorrhagic stroke. Atrial fibrillation is the most common cause of embolic stroke.
LIFE AFTER A STROKE
About two-thirds of people (over 700,000) people that have a stroke each year survive and need some level of rehabilitation. Some who get clot-busting drugs may recover completely but others may not. Many people recover from their disabilities because of stroke with therapy and rehabilitation methods. There remains a risk of a second stroke after the first but if people take precautionary measures and follow the guidelines for a stroke-free life they may reduce the occurrence of stroke in the near future.