Stroke

• A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients.

• Brain cells begin to die within minutes, making it a medical emergency.

Stroke with a blocked or burst blood vessel

Types of Strokes

1. Ischemic Stroke:

• Caused by a blockage in an artery supplying blood to the brain.

• Thrombotic Stroke: Blood clot forms in an artery supplying the brain.

• Embolic Stroke: Blood clot or debris forms elsewhere in the body and travels to the brain.

2. Hemorrhagic Stroke:

• Caused by bleeding in the brain.

• Intracerebral Hemorrhage: Bleeding within the brain tissue.

• Subarachnoid Hemorrhage: Bleeding in the space between the brain and the surrounding membrane.

3. Transient Ischemic Attack (TIA):

• Often called a mini-stroke, it's a temporary period of symptoms similar to those of a stroke.

Causes

1. Ischemic Stroke: Atherosclerosis, heart disease, atrial fibrillation, high blood pressure, high cholesterol.

2. Hemorrhagic Stroke: Hypertension, aneurysms, arteriovenous malformations (AVMs), head injury, blood-thinning medications.

Symptoms

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.

• Sudden confusion, trouble speaking, or understanding speech.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.

• Sudden severe headache with no known cause.

Diagnosis

1. Physical Examination: Neurological examination to assess symptoms.

2. Imaging Tests:

   • CT Scan: Quickly identifies bleeding in the brain.

   • MRI: Provides detailed images of brain tissue and blood vessels.

   • Carotid Ultrasound: Shows narrowing or blockage in the carotid arteries.

3. Blood Tests: To determine clotting factors, blood sugar, and other relevant parameters.

4. Cerebral Angiography: Visualizes the brain's blood vessels.

Pathophysiology of Stroke

1. Ischemic Stroke: Blockage of a blood vessel supplying the brain, usually due to a blood clot, leading to tissue ischemia and infarction.

2. Hemorrhagic Stroke: Rupture of a blood vessel causing bleeding in or around the brain, leading to increased intracranial pressure and tissue damage.

3. Neuronal Injury: Lack of oxygen and nutrients results in neuronal death and brain damage.

Treatment

1. Ischemic Stroke:

• Clot-Busting Medications: Intravenous tissue plasminogen activator (tPA) within a few hours of symptom onset.

• Endovascular Procedures: Mechanical thrombectomy to remove the clot.

• Antiplatelet Agents: Aspirin or clopidogrel to prevent further clots.

• Anticoagulants: For patients with atrial fibrillation or other risk factors.

2. Hemorrhagic Stroke:

• Emergency Measures: Controlling bleeding, reducing intracranial pressure.

• Surgical Interventions: Repairing blood vessel anomalies or removing the blood clot.

• Medications: To control blood pressure, prevent seizures, and manage symptoms.

3. Rehabilitation:

• Physical Therapy: To improve motor skills and mobility.

• Occupational Therapy: To regain skills for daily activities.

• Speech Therapy: To improve communication and swallowing.

• Supportive Care: Psychological support and counseling for patients and families.