Stroke (Cerebral Vascular Accident)

 

What is Stroke?

A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. In the same way that a person suffering a loss of blood flow to the heart is said to be having a heart attack, a person with a loss of blood flow to the brain or sudden bleeding in the brain can be said to be having a "brain attack." Alternative NamesCerebrovascular disease; CVA; Cerebral infarction; Cerebral haemorrhage 

Types of stroke

 Most strokes occur when a blood clot blocks one of the arteries (blood vessels) that carries blood to the brain. This type of stroke is called an ischaemic stroke.

• Transient ischaemic attack (TIA) is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is restored quickly, and symptoms of the stroke disappear completely. A transient stroke needs prompt medical attention, as it is a warning of serious risk of a major stroke. 

• Cerebral thrombosis occurs when a blood clot (thrombus) forms in an artery (blood vessel) supplying blood to the brain. Furred-up blood vessels with fatty patches of atheroma (arteriosclerosis) may make a thrombosis more likely. The clot interrupts the blood supply and brain cells are starved of oxygen. 

• Cerebral embolism is a blood clot that forms somewhere in the body before traveling through the blood vessels and lodging in the brain. This causes the brain cells to become starved of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming emboli.

• Cerebral haemorrhage occurs when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, extra damage is done to the brain tissue by the blood that seeps into it.

How do you recognize Stroke?

 Symptoms of stroke appear suddenly. Watch for these symptoms and be prepared to act quickly for yourself or on behalf of someone you are with:

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

• Sudden confusion, trouble talking, or understanding speech. 

• Sudden trouble seeing in one or both eyes. 

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

• Sudden severe headache with no known cause.

If you suspect you or someone you know is experiencing any of these symptoms indicative of a stroke, do not wait. Call 082 911 emergency immediately. There are now effective therapies for stroke that must be administered at a hospital, but they lose their effectiveness if not given within the first 3 hours after stroke symptoms appear. Every minute counts!

Who is at risk for Stroke?

 Some people are at a higher risk for stroke than others. Unmodifiable risk factors include age, gender, race/ethnicity, and stroke family history. In contrast, other risk factors for stroke, like high blood pressure or cigarette smoking, can be changed or controlled by the person at risk. What are the risk factors?

• High blood pressure (hypertension) does not cause any symptoms, so everyone over the age of 40 should have an annual blood pressure check. Persistently high blood pressure greater than 140 over 90 leads to the diagnosis of the disease called hypertension. People with hypertension have a risk for stroke that is four to six times higher than the risk for those without hypertension. Have your blood pressure checked regularly.

• Smokers have double the risk of stroke as non-smokers.

• Irregular heart beat (atrial fibrillation) is fairly common in old age, and increases the risk of stroke by causing blood clots to form in the heart. Blood clots can be prevented from forming by taking warfarin, a medicine that makes the blood less likely to clot. Warfarin treatment requires careful monitoring with regular blood checks and is a very effective way to reduce the risk of stroke.

• Diabetes affects 1 in 20 older people, and can also increase the risk of having a stroke. Good control of diabetes is important and requires attention to diet, regular urine tests or blood tests, and probably some medication.

• Too much alcohol increases the risk of a stroke. The recommended 'safe' limits for alcohol consumption are 21 units each week for women and 28 units each week for men. One unit of alcohol is equivalent to a measure of spirits, or a glass of wine, or half a pint of beer. People who drink more than this run a higher risk of stroke, liver disease and dementia.

What Stroke Therapies are Available?
Physicians have a wide range of therapies to choose from when determining a stroke patient's best therapeutic plan. The type of stroke therapy a patient should receive depends upon the stage of disease. Generally there are three treatment stages for stroke: prevention, therapy immediately after stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes, or preventing the widespread formation of blood clots that can cause ischemic stroke in everyone, whether or not risk factors are present. 

Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving a blood clot causing the stroke or by stopping the bleeding of a hemorrhagic stroke. The purpose of post-stroke rehabilitation is to overcome disabilities that result from stroke damage. 
Therapies for stroke include medications, surgery, or rehabilitation.

Post-Stroke Rehabilitation

TypeGoal

Physical Therapy (Physiotherapists and biokineticist)Relearn walking, sitting, lying down, switching from one type of movement to another

Occupational Therapy (OT)
Relearn eating, drinking, dressing, bathing, cooking, reading, writing, bathing etc.

Speech Therapy
 Relearn language and communications skills, including swallowing.

Psychological/Psychiatric Therapy
 Alleviate some mental and emotional problems

 
What disabilities can result from a Stroke?

Paralysis:A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. The paralysis or weakness may affect only the face, an arm, or a leg or may affect one entire side of the body and face. A person who suffers a stroke in the left hemisphere of the brain will show right-sided paralysis or paresis. Conversely, a person with a stroke in the right hemisphere of the brain will show deficits on the left side of the body. Cognitive deficits:Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. In some cases of stroke, the patient suffers a "neglect" syndrome. The neglect means that a stroke patient has no knowledge of one side of his or her body, or one side of the visual field, or is unaware of the deficit. A stroke patient may be unaware of his or her surroundings, or may be unaware of the mental deficits that resulted from the stroke. Language deficits:Stroke victims often have problems understanding or forming speech. A deficit in understanding or forming speech is called aphasia. Aphasia usually occurs along with similar problems in reading or writing. In most people, language problems result from damage to the left hemisphere of the brain. Slurred speech due to weakness or in-coordination of the muscles involved in speaking is called dysarthria, and is not a problem with language. Because it can result from any weakness or in-coordination of the speech muscles, dysarthria can arise from damage to either side of the brain.

 

Emotional deficits:
A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions in certain situations. One common disability that occurs with many stroke patients is depression. Post-stroke depression may be more than a general sadness resulting from the stroke incident. It is a clinical behavioural problem that can hamper recovery and rehabilitation and may even lead to suicide. Post-stroke depression is treated as any depression is treated, with antidepressant medications and therapy. 

Pain:
Stroke patients may experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be due to many factors including damage to the sensory regions of the brain, stiff joints, or a disabled limb. An uncommon type of pain resulting from stroke is called central stroke pain or central pain syndrome (CPS). CPS results from damage to an area in the mid-brain called the thalamus. The pain is a mixture of sensations, including heat and cold, burning, tingling, numbness, and sharp stabbing and underlying aching pain. The pain is often worse in the extremities - the hands and feet - and is made worse by movement and temperature changes, especially cold temperatures. Unfortunately, since most pain medications provide little relief from these sensations, very few treatments or therapies exist to combat CPS.