FAQs in Stroke provides answers to many of the questions related to blood coagulation process, its effects, types of stroke and their causes, parts of the brain affected and their symptoms, after effect of stroke,
laboratory and imaging tests employed in the diagnosis of stroke, treatment options available for different types of stroke, preventive measures for those at risk, after effects of stroke, prognosis and rehabilitation.
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A stroke is a more frequently used term for a brain attack. Stroke occurs when the blood supply to part of the brain is blocked or when a blood vessel in the brain bursts, resulting in brain damage.
A "mini-stroke" is a Transient Ischemic Attack (TIA). TIA results from the temporary interruption of blood flow to part of the brain causing temporary impairment of brain function that lasts for a few minutes. TIA is mostly ischemic; caused by the blood clot formed in the artery of the brain. Symptoms include temporary loss of vision and speech, dizziness, weakness or tingling in the limbs (arm or leg). A mini stroke does not cause brain damage but they are the warning signs of subsequent major stroke.
Pediatric stroke is stroke occurring in children. It usually occurs in children with congenital heart problems and sickle cell anemia.
Hemorrhage refers to profuse bleeding from a ruptured blood vessel. Hemorrhage can be either external or internal. Hemorrhage causes internal bleeding and accumulation of blood around the tissue. This increases the pressure on the tissue and damages it. Hemorrhage can occur due to external causes such as injury to the head or internal causes such as weak blood vessel walls, high cholesterol levels, high blood pressure, etc.
A blood clot is a clump of blood cells, clotting factors and other substances. A blood clot occurs in response to damages in blood vessels, involving platelets and clotting factors to form a mesh of needle like fibers to trap blood cells and plug the damaged portion. Thus formed blood clot can hinder the blood supply to the surrounding tissues causing stroke. Blood clots formed in one part of the body can detach and travel to other parts of the body and block the blood vessels resulting in stroke.
Stroke is a medical emergency caused by blood vessel disorders in the brain. It is one of the leading causes of disability and death in adults. Stroke is a medical emergency and the emergency services should be called if a person seems to be having a stroke, to get them to hospital as fast as possible. Immediate medical treatment lowers the risk of disability or even death due to a stroke.
Yes, there are two types of stroke - ischemic and hemorrhagic. An ischemic stroke occurs when the artery of the brain is blocked by blood clots or other blockages. Hemorrhagic stroke occurs when a blood vessel bursts in the brain, causing blood accumulation that compresses the surrounding brain tissue.
Ischemic stroke is the most common type of stroke and accounts for nearly 80% of all strokes. Ischemic stroke can be classified into thrombotic and embolic. Thrombotic stroke occurs when a blood clot formed within the brain blocks an artery. Embolic stroke is caused by the blood clots formed in other parts of the body that travel to the brain and restrict the blood supply to the brain.
Aneurysm is a localized bulging or swelling of blood vessels that occurs when blood accumulates in an artery or vein due to weak blood vessel walls. This bulging can cause the weakened blood vessels to rupture and result in hemorrhagic stroke.
Arteriovenous malformation (AVM) is a snarled tangle of abnormal blood vessels (arteries and veins). These weak and fragile blood vessels put extreme pressure on its wall and rupture causing stroke.
Haemorrhagic stroke is caused by bleeding from a ruptured blood vessel in or near the brain. The two types of hemorrhagic stroke are intracerebral and subarachnoid hemorrhage. Intracerbral hemorrhage occurs when the blood vessel within the brain burst because of high blood pressure. The accumulation of the blood in the brain increases the pressure within the skull and damages the brain tissue. Subarachnoid hemorrhage occurs when the blood vessel just outside the brain bursts and the blood accumulates in the subarachnoid space (the area between the brain and the skull).
The major signs of stroke appear all of a sudden. They include:� Numbness or weakness of the face, arm, or leg� Confusion or trouble speaking or understanding oths.� Trouble seeing in one or both es. � Dizziness or trouble while lking.� Loss of balance or coornation. � Severe headache with no known cause.
The symptoms of a mini stroke depend upon the part of the brain that is affected. The symptoms include temporary loss of vision or double vision; confusion or difficulty in speaking; loss of balance; dizziness; weakness or tingling in arms and legs especially on one-side of the body. A mini stroke does not cause brain damage but it is a warning to a major stroke.
A transient ischemic attack (TIA) is a warning sign that should not go unheeded. In fact often, TIA is referred to as �warning stroke mini-stroke as it produces stroke-like symptoms but with no lasting damage. Sometimes it is difficult to identify the TIA symptoms. Recognizing and treating TIAs reduces the risk of a major stroke. The usual TIA symptoms are the same as those of stroke, however the symptoms are temporary. The short duration of these symptoms and the lack of permanent brain injury is the main difference between TIA and stroke.
The symptoms of stroke in child are not very different from the symptoms presenting in adults. As with adults, the symptoms present all of a sudden and depend on the part of the brain that has been injured. However, a few of the commonly presenting symptoms include trouble with speech or trouble in understanding words, difficulty in movement or weakness of muscles, especially muscles of the face and limbs, usually on one side of the body, loss of vision or other vision problems. Some of the other subtle symptoms are difficulty in concentrating or numbness in a very small area of the body, like a finger or hand, headache and sleepiness. Some children have seizures, and in very rare cases, a large stroke can cause a coma or death.
Hemorrhagic stroke occurs when a diseased blood vessel in the brain ruptures and bleeds. Accumulation of these blood increases the pressure and damages the brain tissue. Hemorrhagic stroke is caused by uncontrolled high blood pressure or by weakened blood vessels including aneurysm or arteriovenous malformations (AVM).
Ischemic stroke is caused by the blockage in the blood vessels leading to the brain. Fatty deposits known as plaque can build up in the blood vessels and narrows the artery of the brain. High LDL cholesterol or �bad cholesterol� in the blood causes fatty deposition in the blood vessels. Normally, the white blood cells responsible for the body's defense digest the LDL cholesterol. Overtime the accumulation of these cholesterol, cells and debris deposit on the walls of the arteries to form plaque and narrows the arteries by the process called arthrosclerosis. Blood cells accumulate in this region and form blood clots in the arteries.
The factors that increase the risk of a stroke are: � Family history of stroke, heart attack or TI� Past history of stke� Age - 55 years of age or older increases the risk of roke� High blood pssure � High chesterol � Cigarette smoking or exposure to secondand smoke Diabetes � Bei overweight � Phical inactive � Cardiovascular diseases such as heart failure, a heart defect, heart infection, or abnoal heart rhythm � Use of birth control pills or hormone therapies th include estrogen � Hey or binge drinking � Certain races especially blacks are at a greater risk
People with diabetes are at an increased risk of stroke, about two-and-a-half times higher than others. Diabetes is a prominent risk factor of ischemia and is responsible for 7% of deaths in stroke patients. Atherosclerosis is the leading cause of cerebral ischemia in diabetics. Additional factors that increase the risk of stroke in diabetics include reduced cerebral blood flow and reduced red blood cell deformity and high blood viscosity.
High blood pressure is the major risk factor of stroke. It is known to cause artery damage causing arteries to burst or clog more easily. High blood pressure damages the arteries and can create weak places that rupture easily or thin spots that fill up with blood and balloon out from the artery wall called aneurysm. Weakened arteries in the brain are also the reason that persons suffering from high blood pressure are at a greater risk for stroke � both ischemic stroke as well as hemorrhagic stroke.
Stroke is closely related to the heart and its function. The heart supplies oxygen-rich blood to the brain. In children with a variety of congenital heart conditions such as abnormal valves, genetic disorders especially those related to blood clotting and renal diseases are other underlying causes for pediatric stroke. The most common condition that predisposes a child to stroke includes sickle cell disease (SCD). About 17-24% children with SCD, usually in the age group of 3-10 years suffer from stroke.
Stroke restricts the blood supply to certain parts of the brain and damage the brain. As a result of the damage, particular body functions controlled by that part of the brain get affected. The extent of damage caused by stroke varies from person to person. Damage due to stroke can sometimes cause temporary or permanent disabilities. It also depends on the extent of damage and the part of the brain that is affected. Complications of stroke include: � Paralysis: Paralysis or loss of muscle movement results from lack of blood flow to the brain. Stroke can cause paralysis on one side of the body, resulting in loss of control of certain muscles of the body, usually facial muscles� Difficulty in talking/swallowing: Due to a stroke, the person may have less control over the movement of muscles, especially muscles of the mouth and throat, making it difficult to talk, swallow or eat. Speech may also be affected due to aphasia, a condition wherein a person has difficulty expressing him/herse. � Loss of memory or trouble with understanding: Memory loss is common in stroke victims. Some may experience difficulty in making judgments, reasoning and also in understanding concts. � Pain: Some may experience pain, numbness or tingling sensations in the stroke affected parts of the body. They may become sensitive to temperature changes, especially extreme cold, a condition known as central stroke pain or central pain syndromeCPS). � Behavioral changes: Stroke can cause people to become withdrawn and less social, sometimes impulsive. They may lose the ability to care for themselves and may need a caretaker to help them with their grooming needs and dailchores.
The effects of a stroke primarily depend upon the location of the obstruction. However, because one side of the brain controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the opposite side of the body. For example, the stroke in the right hemisphere of the brain affects the left side of the body. Right hemisphere stroke causes: � Paralysis on the left side of the body� Vision proble. � Quick, inquisitive behavioral sle. � Memo loss.
If the stroke occurs in the left hemisphere of the brain, the right side of the body will be affected, causing: � Paralysis on the right side of the body� Speech/language problems called aphaa � Slow, cautious behavioral sle. � Memy loss
Cerebellum controls reflexes; muscle coordination and balance. The stroke in the cerebellum cause:� Abnormal reflexes of the head and tor� Coordination and balance problem (ataa)� Dizness� Nausea and miting
The brain stem located at the base of the brain controls �life support� functions such as heartbeat, blood pressure and breathing. It also controls the nerves involved in eye movement, speech, hearing, chewing and swallowing. The stroke in brain stem affes � Heart fution� Bathing� Balance and codination� Bodyemperatu� VisionMost cases brain stem stroke leads to coma d/or death.
The length of time to recover from a stroke depends on its severity. Mostly it is a lifelong process. About 50�70% of stroke survivors regain functional independence, however about 30% are permanently disabled. More than 20% require institutional care.
It is extremely important to diagnose a stroke before damage is irreparable. The faster the diagnosis, the better is the chance of initiating treatment which leads to better recovery. Stroke is primarily diagnosed by the symptoms that appear all of a sudden. The symptoms include numbness or weakness of the face or limbs, confusion or trouble speaking or understanding others, sudden blurring of vision or inability to see clearly. Spells of dizziness, inability to walk, loss of balance or coordination, and severe headache with no known cause. A past personal history as well as family history also helps in diagnosing stroke. Assessing risk factors such as age, diabetes, high blood pressure, high cholesterol, obesity and sedentary lifestyle combined with thorough physical examination and laboratory and radiological tests helps diagnose stroke.
The first test to diagnose stroke is a radiological or imaging test known as CT (Computed Tomography) scan of the brain. A CT scan involves a series of X-rays that can show if and where there is bleeding. This is vital in not only diagnosing but also differentiating between ischemic or hemorrhagic stroke. An MRI (Magnetic Resonance Imaging) is useful to determine the extent of damage done to the brain and therefore is useful to predict recovery. EEG (Electroencephalogram) is used to record electrical activity of the brain. Other tests recommended for ischemic stroke are ECG (Electrocardiogram) to check for heart problems.
Tests done to diagnose a stroke are mainly imaging tests. However, a few laboratory tests are also done to provide necessary information that will benefit treatment. Laboratory tests include CBC, blood sugar levels, blood lipid tests, electrolytes, liver and kidney function tests and coagulation tests. A CBC or complete blood count is a routine test which is used to determine the number of red blood cells, white blood cells, and platelets in blood. Coagulation tests include PT (Prothrombin Time), PTT (Partial Thromboplastin Time), and INR (International Normalized Ratio). These tests measure how rapidly blood clots can be formed. An abnormality could result in excessive bleeding or excessive clotting. The blood lipid tests include cholesterol level, total lipids level, HDL and LDL levels. Other tests such as blood sugar levels, electrolytes, liver and kidney function tests are useful in determining the risks associated with stroke.
The treatment depends upon the type of the stroke. An FDA-approved treatment for ischemic stroke is a drug called tPA (Tissue Plasminogen Activator), a clot-busting drug which dissolve the clots in the blood, thus reestablishing blood flow to brain tissue. Drug tPA is an intravenous drug administered within the first three hours after stroke symptoms surface. There are a few new drugs which are under trail that can reverse the brain damage if administered immediately after a stroke. Drugs such as aspirin warfarin and heparin are used commonly for emergency treatment and also used in preventive treatment. Catheters are used in emergency procedure to deliver TPA directly into the brain through an artery in the groin up to the brain. Catheter is also used to remove the clot.
If aneurysm or weak blood vessel wall is the cause of stroke, it can be surgically treated. Carotid endarterectomy or surgical removal of the plaque from the carotid artery, the main artery that supplies blood to the brain, can be performed to treat stroke. Other options include carotid angioplasty and stenting procedure, which are used to widen the plaque-coated artery especially the carotid arteries. The latest FDA approved technology is the Merci Retrieval System, which can successfully remove the blood clot up to 8 hours after the stroke.
Emergency treatment of hemorrhagic stroke is to control the bleeding and reduce the blood pressure. Surgical procedures such as aneurysm clipping (clip is placed to isolate the aneurysm from the circulation and prevent it from rupturing) and surgical removal of arteriovenous malformation (AVM) are recommended for hemorrhagic stroke. Drugs such as warfarin and antiplatelet drugs are used to prevent blood clots and the drugs that lower the blood pressure are also used to treat hemorrhagic stroke.
The higher the risk of stroke, the greater is the chance of developing a stroke. While some factors such as age, family history, race and gender cannot be controlled, other factors such as diet, healthy weight and lifestyle can be regulated to lower the risk. A healthy diet, healthy weight, regular exercises and physical activity can reduce the risk for stroke. It is advisable to avoid smoking and alcohol intake.
The best ways to prevent stroke is to:� Eat a healthy diet. It is advisable to follow a diet low in saturated fat, rich in fruits, vegetables, and whole grains� Exercise regularly. Exercise for about 30 minutes everyday and maintaining a healthy weight are advid.� Keep relaxed and reduce sess.� Other conditions like blood pressure, blood cholesterol, diabetes or heart diseases must be kept under control by proper medications and life style cnges. � Quitting smoking and reducing alcohol consumption also reduces the risk ostroke.
Stroke is known to cause long-term disability. Persons who survive a first stroke or mini stroke or TIA are prone to a stroke within one year. About 25% who suffer from an initial stroke die within a year, and this percentage is higher among people at or above the age of 65. Few people experience symptoms such as hemiparesis, inability to walk independently, impaired speech ability and depression after the stroke. Many remain dependent on help for their daily living activities and few sufferers are institutionalized for care.
A stroke is a "brain attack" and the brain controls feelings, thinking capacity and movement of a person. Recovery depends on the area of the brain affected and the extent of the damage caused. In the first six months after a stroke, the doctor will be able to determine what brain functions has been restored. However, with time functional abilities can be improved by involving in daily life activities. Even the most basic functions such as dressing, bathing or eating help increase independence and enhance recovery.
Yes, stroke does have an emotional bearing on those who are and have suffered from it. It not only affects the sufferer but also the family. The effect of stroke depends upon the area of brain affected. The changes can vary from unnoticeable to fatal. Probable emotional changes include fear, anxiety, guilt, anger, depression, mood swings, emotional lability, confusion, caitiousness, humiliation, memory loss, etc. Often there is a loss of self-esteem and deep rooted concerns about sexuality. Family members experience grief when there is a loss of body function and anxiety about the future.
Rehabilitation is similar to education and it helps in bringing back the body�s function close to normal. Stroke rehabilitation is a process wherein the sufferer is made to work with nurses and therapists to regain living skills. These skills will improve with practice. Often the techniques and strategies learned during a rehabilitation program becomes a model for living.
Rehabilitation is an ongoing process of life changing behavior. Rehabilitation programs teach techniques, strategies and therapeutic programs to compensate regular living skills. They are intended as life-long behavior modifications to advance or maintain function. Rehabilitation can take place in many settings including in a hospital as an inpatient, or on an outpatient basis at a clinic or hospital, or at home.
Since the brain controls the functions of thinking, movement, feeling and speaking and because stroke can cause changes in any or all of these functions, some people will have to meet many therapists. This is because some sufferers may experience more difficulty moving, standing, or walking while others may have more difficulty speaking or understanding. The stroke rehabilitation team will help determine what changes have occurred since the stroke and design a personalized plan which may involve many specialists.
Through education and therapy, and after learning how to walk, often adaptive devices such as braces compensate or overcome any specific deficits. Future safety and mobility may be impaired if the person moves without the prescribed braces.
Usually pediatric stroke occurs in children with an existing sickness such as SCD or abnormalities in the structure or function of the heart. Some congenital heart defects are simply not treatable or are inoperable after a certain age, but others can be treated. In recovering from pediatric stroke, physical, occupational and speech therapists should be consulted to improve the condition. The therapists also act as resources for further help such as identifying or sourcing appropriate assistive devices for mobility and assistive aids for eating and other basic activities of daily living. Stroke recovery is a long process that requires a lot of mental, physical and spiritual strength from the child and the parent/care giver.
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