Stroke (Brain Attack)

Stroke (Brain Attack)

Overview

A stroke occurs when the blood supply is reduced or cut off to a part of the brain. This reduces oxygen levels in the brain and can lead to death of the oxygen deprived brain cells. It only takes 3-4 minutes for a brain cell to die when deprived of oxygen, hence a stroke is a very serious event that requires immediate medical attention at the emergency room. There are primarily two types of strokes – Ischemic stroke and Haemorrhagic stroke Ischemic stroke is the most common type of stroke, in which a blood clot in the brain prevents oxygenated blood from reaching a part of the brain tissue. Haemorrhagic stroke occurs when a blood vessel ruptures, usually as a result of an aneurysm or an arteriovenous malformation. Transient Ischemic stroke is a brief disruption in blood supply to tissues in the brain. Normal blood flow resumes shortly and the symptoms resolve without treatment soon after. This is also called a “mini-stroke”.

Signs and symptoms

The signs and symptoms of a stroke include slurred speech, difficulty comprehending others, paralysis or numbness of the extremities, blurred vision, headache, dizziness, vomiting, and loss of motor co-ordination. A typical symptom of a stroke is an imbalanced drooping of the face to one side. The patient must be rushed to the hospital as soon as they experience as stroke, as immediate treatment can help reduce neurological deficits. The common acronym FAST ( Facial drooping, Arm weakness, Slurred speech and Time < 3 hours) can be remembered to suspect and shift a stroke patient to nearby stroke care centre.

Causes

There are two main causes of a stroke – a blocked artery (ischemic stroke and transient ischemic stroke) or a ruptured blood vessel (haemorrhagic stroke). The blocked artery in the brain is usually caused by fatty deposits and or blood clots that cause a disruption in blood supply. A blood vessel could also rupture and trigger a stroke. The rupture could be caused by an aneurysm, an arteriovenous malformation, uncontrolled high blood pressure, overtreatment with blood thinners or a traumatic brain injury.

Risk factors

There are a multitude of factors that could affect your risk of stroke. People older than 55 years are at a higher risk of experiencing a stroke. Men are more likely to experience a stroke than women, but women are more likely to die as a result of the stroke than men. Pre-existing conditions like diabetes, high blood pressure, hypertension and high cholesterol increase the patient’s risk of experiencing a stroke. Family history is also an important risk factor. There are also lifestyle conditions that cause strokes, such as being overweight, physical inactivity, alcoholism, smoking and use of drugs such as methamphetamine and cocaine.

Complications

A stroke can cause temporary or permanent impairment of brain function, depending on how long the stroke lasted and which part of the brain was affected. Complications may include paralysis, speech impairment, memory loss and pain. Patients who have experienced a stroke are also more likely to develop depression.

Diagnosis

Strokes happen very suddenly, and the patient needs to be treated within 3 hours of the event. The doctor will assess the patient’s condition by way of a physical exam, blood pressure evaluation, blood tests, a CT scan, an MRI scan, a carotid ultrasound exam, a cerebral angiogram and an echocardiogram (ECG). The detailed tests are required to identify the cause of the stroke and plan an appropriate course of treatment.

Treatment

Ischemic strokes are caused by blood clots or blockages in an artery in the brain. They are usually treated with anticoagulant and anti-platelet drugs, 24 to 48 hours after the stroke symptoms begin. Thrombolytic drugs may also be prescribed to dissolve the existing blood clots in the brain. These drugs work effectively when administered within 3-4.5 hours from the symptom onset. This quickly reduces the blockage and restores blood flow, minimising any permanent damage to brain function. In case drug therapies are ineffective at clearing the blockage in the artery in the brain, it is surgically removed. The procedure is known as a Mechanical Thrombectomy, during which a catheter is inserted into the brain artery and the clot is vacuum suctioned out. In case of haemorrhagic stroke due to aneurysms, the surgeon will perform a procedure in which the “neck” of the aneurysm is clipped, to separate it from the artery and cut off its blood supply. This prevents the aneurysm from rupturing.

Prevention

Stroke prevention strategies include controlling hypertension, cholesterol levels and diabetes. Patients who have already experienced one stroke are advised to quit the use of tobacco, alcohol and other drugs. They must also ensure adequate exercise and a heart healthy diet. The patient may also be prescribed anti-platelet drugs and anti-coagulants to keep clotting under control.

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