Medical Info

download The brain demands a constant supply of nutrient rich and oxygenated blood throughout life. The cerebral arteries accomplish the delivery of blood to all of the structures of the cerebrum. Thus, the cerebral arteries are absolutely imperative to survival. During our lifetimes, these cerebral arteries are prone to trauma, blockages and disease. Stroke pathophysiology is related trauma or blood clot formation in the brain. There are two different types of an acute stroke: an ischemic stroke and a hemorrhagic stroke. Ischemic strokes are far more common than hemorrhagic strokes as they make up roughly 85% of all acute strokes. An ischemic stroke results when a blood clot forms in one of the arteries of the brain. Ischemic strokes are very serious as permanent brain damage and death may result due to the blockage. The other type of acute stroke, a hemorrhagic stroke, results when a blood vessel ruptures and subsequent brain bleeding occurs. Hemorrhagic stroke etiology is related to aneurysms or arteriovenous malformations. They are less common and usually constitute roughly 15% of acute strokes. There are many risk factors associated with the development of an acute stroke. These can include hypertension, aging, genetics, abnormal cholesterol levels, heart complications, and alcohol consumption.

It is important to minimize these risk factors to avoid an acute stroke. Symptoms of strokes include the sudden onset of muscle weakness or numbness, cognitive decline, vision loss, loss of muscle coordination, and migraines. It is important to monitor for the sign and symptoms of an acute stroke, as treatment must begin immediately. The prognosis of strokes greatly improves when treatment is administered as fast as possible after the onset of stroke complications. Stroke diagnosis can also involved the use of numerous tests and procedures. These can involve cerebral computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasounds and cerebral angiograms. If the detection of brain bleeding or blood clot is confirmed, treatment is begun immediately to improve the prognosis of a stroke. Treatment of a stroke can involve lifestyle changes, medications and if needed, emergency surgery. Lifestyle changes commonly recommended are quitting smoking and exercising regularly, while medications used are anticoagulants and thrombolytics. Surgery is used as a last resort in the treatment of an acute stroke. This is due to the added risks and complications surgery may present. The most common surgical procedure is a carotid endarterectomy. This procedure involves the removal of plaque and restoration of blood flow through the carotid artery to the brain.

Ischemic Stroke

An ischemic stroke is the most common type of acute stroke. Ischemic strokes can be further subdivided into thrombotic and embolic strokes. Stroke etiology differs between the two. In a cerebral thrombotic stroke, a blood clot forms directly in one of the cerebral arteries and remains there. It blocks blood flow to the respectively area of the brain which the artery was supplying. In a cerebral embolic stroke, a blood clot forms elsewhere in the body, usually in the chest or neck regions. This blood clot then dislodges and travels via the circulatory system into the brain. The symptoms related to an embolic stroke depend on which area of the brain is affected by the clot and subsequent blockage. Prognosis of stroke after suffering from an ischemic event is more positive than a hemorrhagic event.

Hemorrhagic Stroke

Hemorrhagic strokes are less common than ischemic strokes. Hemorrhagic strokes are often extremely severe and life threatening. Stroke pathophysiology is caused by aneurysms and arteriovenous malformations. An aneurysm results when a weakened blood vessel eventually ruptures and blood begins to pool in the surrounding region. Arteriovenous malformations (AVM) can also trigger hemorrhagic strokes. Arteriovenous malformations are a group of abnormal blood vessels that are prone to rupture and bleeding. Stroke complications are severe in hemorrhagic strokes. Brain bleeding can cause severe pressure on the surrounding regions of brain tissue and cause permanent tissue death. Prognosis of a stroke involving brain bleeding is relatively poor, especially if immediate treatment is not sought to relive the bleeding and pressure.

Acute Stroke Risk Factors

Risk factors for the development of an acute stroke are associated with the increased likelihood of vessel hardening and narrowing. Both of these can trigger blood clot formation and rupture. Common risk factors include hypertension, diabetes, heart irregularities, smoking, aging, genetic history of clotting or rupture, alcohol consumption, obesity, lack of exercise, poor diet and abnormal cholesterol levels. These risk factors have the ability to compound and exponentially increase your risk for an acute stroke as well. It is important to mitigate the risk of developing an acute stroke. Speaking with your physician is imperative in minimizing the above risk factors.

Symptoms of Stroke

Symptoms of strokes can be very severe and life altering. In many cases, symptoms can be permanent as brain damage can result from an acute stroke. It is extremely important to be proactive in monitoring for the symptoms of strokes as immediate treatment can be life saving. Common symptoms associated with an acute stroke are facial paralysis, muscle weakness throughout the body, cognitive decline or confusion, vision difficulties, speech difficulties, trouble with motor movement, and migraines or headaches. Depending on where the blood clot or rupture occurs, patients can also suffer from a left-sided stroke or right-sided stroke. Patients suffering from damage in the right side of the brain, suffer from a life-sided stroke and vise versa. The left-sided stroke involves inability to speak, and language impairments, as while a right-handed stroke involves general cognitive decline and vision problems. These strokes are directly related to the left and right sides of the brain having distinct and different functions in everyday life.

Stroke Diagnosis

The quick and accurate diagnosis is imperative in prognosis of strokes. If treatment can begin immediately, the chances of a full recovery greatly improve. If stroke complications are present, several diagnostic tools and procedures are often used to confirm the presence of brain bleeding or clotting. This can include the use of blood tests, cerebral computed tomography (CT) scans, computed tomography arteriograms, magnetic resonance imaging (MRI), magnetic resonance arteriograms, carotid ultrasounds, carotid angiograms, electrocardiograms, and echocardiograms. These tests can provide information on how blood is flowing through the cerebral arteries, help detect brain bleeding and clotting, examine for pressure buildups and heart irregularities. It is important to discuss with your physician on what is the best diagnostic procedure for the detection of an acute stroke.

Stroke Treatment

2-27Stroke treatment must begin immediately following the detection of stroke complications and symptoms. The prognosis of an acute stroke greatly diminishes if treatment is not sought immediately. Treatment is also dependent on the size and severity of blood clot or blood vessel rupture. Treatment options include lifestyle changes, medications and, if needed, emergency surgeries to relieve the blood clot or cranial pressure build up.

Lifestyle Changes

The lifestyle changes commonly recommended are directly correlated with the risk factors associated with developing an acute stroke. These lifestyle changes aid in general health as well. Lifestyle changes can include dietary changes (avoidance of foods high in saturated and Tran’s fats, sugars), exercising regularly, and losing weight, quitting smoking and avoiding alcohol. All of these things can reduce the likelihood of blood vessel hardening and narrowing. It may also revere the development of atherosclerosis. It is important to seek advice from your doctor on how to best make lifestyle changes to decrease the risks associated with an acute stroke.

Medications

Medications are often vital in the treatment of an acute stroke. Common medications used are anticoagulants, antiplatelet and thrombolytics. Warfarin and Aspirin are the most common anticoagulant and antiplatelet respectively. They are used to help decrease the likelihood of blood clot formation in the future and also can limit the size of the present blood clot. Other medications used in the treatment process involve medications to control blood pressure and cholesterol. Managing blood pressure is vital in the avoidance of hemorrhagic strokes and thus, medications such as diuretics and ACE inhibitors are used. In terms of cholesterol, statins are commonly used to control low-density lipoprotein (LDL or bad cholesterol) levels to avoid atherosclerosis development. The most important medication for in the treatment of an acute stroke is thrombolytics. The most common thrombolytic medication is tissue plasminogen activator, or tPA. Tissue plasminogen activator works to dissolve the present clot entirely to restore blood flow to areas of the brain. Tissue plasminogen activator needs to be administered within 3-4 hours of stroke onset and thus, is the reason treatment must be sought immediately to improve prognosis of stroke. Patients on tPA must be monitored regularly as severe bleeding is a side effect of the medication.

Surgery

In terms of both ischemic and hemorrhagic strokes, emergency surgery may be used if deemed necessary. It is commonly used as last resort as due to the added complications and risk it poses. Carotid endarterectomy is a common procedure used to remove plaque build up from the carotid artery. This ensures adequate blood flow is flowing to the brain and the surrounding structures. Also, surgeons may perform a craniotomy. A craniotomy involves drilling into the skull to help ease cranial pressure and blood pooling.

It is important to discuss with your doctor what the best treatment procedure is for the recovery from an acute stroke.