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Stroke
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A stroke occurs when the blood supply to the brain gets interrupted due to various factors. It takes very little time to have the brain cells deprived of oxygen and so they begin to die. Stroke is a treatable condition that needs emergent medical care so as to reduce the effect of the stroke. Strokes are also preventable and treatment by your doctor can both prevent and treat a stroke risk.
The signs and symptoms of stroke include difficulty walking with weakness of one leg or the other. You can have difficulty speaking and understanding words and may be confused. Paralysis of the side of the face or of one side of the body is common. Sight in one eye can be impaired. There can be a severe headache indicating increased pressure in the eye.
A stroke can be of two types. It can be an ischemic stroke and is an ischemic stroke in 90 percent of cases. This is caused by a blockage or narrowing of a major or minor artery leading to the brain. The blood clot interrupts the flow of blood to the brain and can be a thrombotic stroke, with an in situ blockage or an embolic stroke, where a blood clot forms elsewhere and travels to a narrowed spot in the artery leading to the brain.
A hemorrhagic stroke is quite different and it results from a broken blood vessel and bleeding to the brain. It occurs as a result of an uncontrolled high blood pressure and of weak blood vessels in the brain. Aneurysms can cause a hemorrhagic stroke. It can result in an intracerebral hemorrhage deep within the brain or a subarachnoid hemorrhage on the surface of the brain. A transient ischemic attack is a mini-stroke resulting from a temporary blockage of an intracerebral artery that clears itself before permanent damage is done to the brain cells. Some mild changes in brain function can remain after a transient ischemic attack, in which cases it is called a "partially reversible ischemic neural deficit" or PRIND.
If you have high cholesterol, you can get a stroke or if you smoke or have diabetes. Overweight people have a higher risk of stroke and if you are inactive you can get a stroke. If you have heart problems, including valvular problems or rhythm problems, you are at risk of stroke. If you are on birth control pills or hormone therapies, you are at risk of stroke and if you are a binge alcohol drinker or use illicit drugs like cocaine or methamphetamines, you can get a stroke. Blacks have a higher incidence of stroke and die from stroke at a greater risk than those of other races.
Diagnosing a stroke relies on a physical examination showing partial paralysis and showing speech difficulties. The doctor will do a thorough medical and neurological exam to diagnose the fact of a stroke. Blood tests will be done to see if you are at risk for bleeding or if your blood sugar is normal. A CT scan is done to show areas of bleeding in the brain in a hemorrhagic stroke. An ischemic stroke may show up nothing at all in the early stages of a stroke but can at least guide the therapy because hemorrhagic strokes and ischemic strokes are treated much differently from another. An MRI can show the findings of damaged tissue as a result of ischemic stroke. Dye is often used to outline the blood vessels and bleeding within the brain. A carotid ultrasound can show blockages of the brain's blood vessels and can determine the degree of blockage of the various arteries involved. Arteriography can outline the blood vessels of the brain. An echocardiogram can be done to see if there are heart abnormalities showing up as risk factors for ischemic stroke.
The treatment of an ischemic stroke is different from the treatment of a hemorrhagic stroke. In an ischemic stroke, there is emergency treatment given as soon as the stroke is defined. Aspirin is given at the time the stroke is identified and blood thinners such as Plavix, heparin and Coumadin can be used, although they are less commonly used recently. Now, an intravenous injection of the clot buster TPA or tissue plasminogen activator is used to quickly break up the clot and preserve brain function. It can only be given within a 4-5 hour interval from the onset of the stroke and cannot be given in cases of a hemorrhagic stroke. It would serve to make a hemorrhagic stroke worse.
In less common cases, TPA is given directly to the brain with a catheter thread through an artery in the groin. Mechanical clot removal is also possible. Treatment to prevent further strokes includes the possibility of a procedure that opens up the carotid artery in a carotid endarterectomy or balloon angioplasty and stent placement.
In hemorrhagic strokes, lowering the blood pressure can lower the bleeding. Blood thinning medicine is stopped and reversed if possible. Surgical clipping of an aneurysm can be done to prevent an aneurysm from bleeding again.