Stroke

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Stroke Is No Longer a Disease of Old Age

….. It was a day, just like any other day, when Armenouhi (a fictitious name of a patient), a 38-year-old housewife set down to have dinner with her husband and five year old child.  Suddenly, she felt the most excruciating severe headache she had ever experienced. She asked her husband for her high blood pressure pill. Her hand just didn’t feel right. After a few minutes, she tried to get up but had trouble bearing weight on her right lower limb, she turn ed to her spouse and tried to tell him what was happening, but the words couldn’t come out right.  Her husband went to cal 911 and upon his return found Armenouhi on the floor, unconscious…….

I.          INTRODUCTION

   A.  What is a stroke or “brain attack”? A stroke, or brain attack, is caused by the sudden loss of blood flow to the brain or bleeding inside the head. Each can cause brain cells to stop functioning or die. When nerve cells in the brain die, the function of body parts they control is harmed or lost. Depending on the part of the brain affected, people can lose speech, feeling, muscle strength, vision, or memory. Some people recover completely; others are seriously disabled or die.

B.  How common is it? Every year, about 700,000 people in the United States suffer a stroke. That’s about one person every 45 seconds. And one person dies from stroke every 3 minutes, or nearly 170,000 a year. This means stroke is the nation’s number three killer after heart disease and cancer. It is the major cause of adult disability. The cost of stroke in the US is between $30 and $40 billion per year.

   C.  What are the symptoms? Stroke symptoms may not be as dramatic or painful as a heart attack. but the results can be just as life-threatening. Stroke is an emergency. Get medical help immediately and know when the symptoms started. Common symptoms include:

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden difficulty seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

            D.  How is it diagnosed?

  • Neurological exam
  • Neuropsychological evaluation, to examine how well the brain is working when it performs certain functions, such as remembering, problem solving, processing information. It is also used to document areas of weaknesses and strengths.
  • Brain imaging tests (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to understand the type, location, and extent of the stroke
  • Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography)
  • Blood tests for bleeding or clotting disorders
  • EKG (electrocardiogram) or an ultrasound examination (echocardiogram) of the heart to identify cardiac sources of blood clots that could travel to the brain

II.  IS STROKE PREVENTABLE?

The good news is, about 50% of all strokes can be prevented through medical attention and simple lifestyle changes.

A   How can I personally prevent it?  Some risk factors, such as age (stroke risk factors doubles with each decade past age 55), sex (males have slightly higher stroke risk, than females), race (African-Americans have double the stroke risk of most other racial groups), and a history of stroke in the family, cannot be changed. However, many others can be controlled. Most controllable factors relate to the health of the heart and blood vessels. Doing these things can help you prevent a stroke:

  • Have regular medical check-ups
  • Control high blood pressure
  • Do not smoke– and stop if you do
  • Treat heart disease, especially an irregular heart beat called “atrial fibrillation”
  • Improve your diet: Avoid excess fat, salt, and alcohol
  • Exercise
  • Manage diabetes
  • Seek immediate medical attention for warning signs

B.  How can medicine prevent it?  Some people are at risk for stroke because of known health factors, such as high blood pressure, diabetes, and heart disease. Also, having had a stroke puts you at greater risk of another attack. Fortunately for people in these situations, there are medical treatments that can help prevent stroke:

1)  Antiplatelets and anticoagulants.  Doctors can prescribe antiplatelet medications (such as aspirin) and anticoagulants (such as warfarin) to reduce the blood’s ability to form clots.

2) Angioplasty and stents   To remove blockages, doctors may thread a balloon angioplasty through a major vessel in the leg or arm to reach the affected vessel. A steel screen called a “stent” is sometimes inserted in a vessel to expand its diameter and improve blood flow.

3)  Carotid endarterectomy   In this surgical procedure, a blockage is removed from the carotid artery in the neck.

III.        WHAT ARE SOME TREATMENT OPTIONS?

Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment could include:

  • t-PA (tissue plasminogen activator), a clot-busting drug that is injected within three hours of the start of a non-bleeding stroke
  • Drugs that thin the blood, including anticoagulants (warfarin) and antiplatelet medications (aspirin or ticlopidine); a combination of aspirin and sustained release dipyridamole
  • Surgery that opens the insides of narrowed neck blood vessels (carotid endarterectomy)

If bleeding causes the stroke, treatment could include:

  • Drugs that maintain normal blood clotting
  • Surgery to remove blood in the brain or decrease pressure on the brain
  • Surgery to fix the broken blood vessels
  • Blocking off bleeding vessels by inserting a coil
  • Drugs that prevent or reverse brain swelling
  • Inserting a tube into a hollow part of the brain to lower pressure
  1. IV.             WHAT ABOUT REHABILITATION?

After a stroke, a person may have some disability. The disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body; in right-handed individuals it is important for attention and visual-spatial skills. The left side of the brain controls the right side of the body; in right-handed individuals (and 50 percent of left-handed people) it controls language – speaking and understanding. Language disorders are also called “aphasias.”

Rehabilitation helps regain functions lost from damage due to stroke. During rehabilitation, most people will get better. However, many do not recover completely. Unlike skin cells, nerve cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable. People can learn new ways of functioning, using undamaged brain cells.

This rehabilitation period is often a challenge. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.

ARTICLES BY DR KALINIAN

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