Stroke

What is Stroke?

A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.

Types

Ischemic stroke
Accounts for about three-quarters of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

Hemorrhagic stroke
Occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood or when a defective artery in the brain bursts and fills the surrounding tissue with blood.

Risk Factors:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Increasing age

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

Three commands, known as the Cincinnati Prehospital Stroke Scale (CPSS), may help to determine if the potential for stroke exists. Ask the patient to do the following:

• Smile
• Raise both arms
• Speak a simple sentence

Treatments:

• Carotid endarterectomy:
  In a carotid endarterectomy, a surgeon removes fatty deposits (plaques) from your carotid arteries that run along each side of your neck to your brain. In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery, and removes fatty deposits (plaques) that block the carotid artery. Your surgeon then repairs the artery with stitches or a patch made with a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke.
• Angioplasty and Stents:
  In an angioplasty, a surgeon inserts a catheter with a mesh tube (stent) and balloon on the tip into an artery in your groin and guides it to the blocked carotid artery in your neck. Your surgeon inflates the balloon in the narrowed artery and inserts a mesh tube (stent) into the opening to keep your artery from becoming narrowed after the procedure.
• Surgical Clip:
  A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
• Coiling (Endovascular Embolization):
  In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
• Surgical AVM (Arteriovenous Malformations) Removal:
  Surgeons may remove a smaller AVM (Arteriovenous Malformations) if it’s located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM (Arteriovenous Malformations) if it’s too large or if it’s located deep within your brain.
• Rehabilitation:
  Most stroke survivors receive treatment in a rehabilitation program. The doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. The doctor will take into consideration your lifestyle, interests and priorities, and availability of family members or other caregivers. Rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.