A cerebrovascular accident, or stroke as it is more commonly known, occurs when the blood supply to the brain is disrupted in one way or another. When these types of events occur, the brain cells are deprived of the oxygen and nutrients they need to function properly. This can lead to the cells becoming damaged or dying altogether.
What Causes a Stroke?
Strokes most commonly occur when some sort of blockage limits the amount of blood flow to the brain. The blockage is often in the form of a blood clot that develops in the artery which delivers blood to the brain. This is known as an ischaemic stroke, and is usually the result of years of fatty deposit buildups in the arteries over an extended period of time.
As those fatty deposits grow, the arteries narrow and prevent the required amount of blood from reaching the brain. When the clot develops in a major artery leading to the brain, you get what is referred to as a cerebral thrombosis.
Blood clots can move through the bloodstream, and may therefore develop elsewhere and move to the artery leading to the brain. These clots often develop in the heart or neck, and are known as a cerebral embolism.
Stroke symptoms that disappear within 24 hours are a sign if a mini-stroke, or transient ischaemic attack, and may be a warning of something more major to come.
Not quite as common is a stroke that is cause by a burst blood vessel around the brain. A sudden severe headache may be a sign of suffering from a haemorrhagic stroke. It is often a weakness in the wall of the artery that causes this type of stroke. The walls stretch like a balloon, and when they become too thin, they burst to deliver what is referred to as an aneurysm.
What Are the Symptoms of a Stroke?
Most people are unaware of the symptoms of a stroke, usually because they tend to strike fast. Being aware of the symptoms can make it possible for you to seek medical help sooner, which could in turn help improve your odds of recovery. If you are displaying any of the following symptoms, you should call emergency services immediately, as it may end up being a lifesaving decision.
The symptoms to look out for include:
- A feeling of numbness or weakness of the arm, leg, or face, usually down one side of the body.
- Lack of mobility or weakness on one side of the body.
- Impaired speech or difficulty understanding what people are saying.
- A sudden blurring or decreased vision in one or both eyes.
- Loss of balance or coordination brought on by dizziness.
- A sudden severe headache that feels like a blow to the head (most common with a haemorrhagic stroke).
- Slurred speech.
- Problems with swallowing.
What Are the Risk Factors of a Stroke?
The good news is that strokes are easily preventable, and there are a number of risk factors that can be addressed, which include:
- High blood pressure – perhaps the most important of all the risk factors, high blood pressure can lead to the artery walls becoming damaged. As many as 40% of all stroke patients have high blood pressure.
- High cholesterol – this can be controlled by maintaining a healthy diet.
- Diet – high blood pressure can be brought on by having a diet with a high salt content. Too many fatty foods can lead to a narrowing of the arteries. Watch what you eat, and add fruits and vegetables to your daily diet.
- Alcohol – too much alcohol will increase your blood pressure.
- Weight – being overweight can be a burden on the circulatory system.
- Not enough exercise – people who exercise on a regular basis stay thinner and tend to have a lower cholesterol level.
All of that said, there are some risk factors that you have no control over, including:
- Age.
- Atrial fibrillation – Older people may develop an irregular heartbeat that can increase the risk of blood clots in the heart. Those clots can then move from the heart to the brain.
- Diabetes.
- If you have suffered a heart attack or stroke in the past.
- A history of heart disease in your family.
How Can You Avoid Having a Stroke?
The first steps you should take are to quit smoking and cut back in the amount of alcohol you consume. Eat a healthy diet and try to commit to 3 days of exercise of about 20 minutes per day.
Patients that have already suffered a stroke will likely have been prescribed a single daily tablet that will help reduce the risk of another stroke. Aspirin has also been proven to be effective in reducing the risk of further strokes, but talk to your doctor first before you begin to take them.
How Is a Stroke Diagnosed?
Anyone suspected of having a stroke should be taken to the emergency room immediately. A quick check of the symptoms should be enough for the doctor to diagnose a stroke. The doctor will check the speech and limb movement of the patient first. This may then be followed up with an MRI or CT scan, as that will allow the doctor to get a look at the brain in order to find the cause of the stroke, as well as the damage done.
Diagnosing a Stroke
Here, an accurate and timely diagnosis is crucial. If a loved one is suspected of having a stroke, they should be immediately taken to the nearest A&E department. Getting to hospital quickly is key.
Once you’re at the hospital, the staff will give the patient a neurological exam. They’ll ask about their symptoms and medical history. Get ready to answer a lot questions! The nurses or doctors will also check for common signs of a stroke: is the face drooping? are the arms weak? is speech is difficult? They look for those typical stroke symptoms to help figure out if that’s what’s going on.
Medical Imaging
A lot of tests will now take place. This is an important part of the diagnosis. Medical imaging tests are used by doctors to confirm the diagnosis, locate the stroke in the brain, and determine the type and cause.
- CT scan: This is often the first test done as it is quick and readily available in emergency rooms. A CT scan uses x-rays to take cross-sectional images of the brain and can detect bleeding or damage in the brain.
- MRI: An MRI uses magnetic fields to create more detailed images of the brain and show precisely which area has been affected. It can find smaller and earlier strokes than CT scans.
- Carotid ultrasound: This looks at the major arteries in the neck that supply blood to the brain. It can detect fatty deposits or blood clots that may have caused a clot to break off and travel to the brain.
- Echocardiogram: Uses sound waves to create images of the heart. It determines if a blood clot in the heart caused a stroke.
- Cerebral angiogram: Involves injecting dye into the blood vessels of the neck/brain and taking x-ray images. It provides a detailed view of the arteries in the brain.
Blood Tests
Blood tests may be done to check complete blood count, electrolytes, blood sugar, and clotting time. They can determine if an infection, blood disorders, or other conditions contributed to a stroke.
Treatments for Stroke
The main goals of stroke treatment are to restore blood flow, stop ongoing brain damage, and prevent future strokes.
- Clot-busting drugs like tPA can break up blood clots if given within 3-4.5 hours of symptom onset. This can restore blood flow and improve recovery.
- Thrombectomy is a minimally invasive procedure to physically remove the blood clot blocking an artery in the brain. It has an extended treatment window up to 24 hours for some patients.
- Anticoagulants or “blood thinners” like heparin help prevent existing clots from growing larger and new ones from forming. They are used acutely after an ischemic stroke.
- Antiplatelet agents such as aspirin make blood platelets less sticky and less likely to form clots. These may be prescribed long-term.
- Surgery can repair aneurysms, malformed blood vessels, or other abnormalities that may have caused a hemorrhagic stroke.
- Rehabilitation services including physical, occupational, and speech therapy are key for maximizing recovery after a stroke.
How Is a Stroke Treated?
If a blood clot is found during the CT scan, you may have to stay in hospital for a few days, during which tie medication will be administered to dissolve the clot.Once the clot has been dissolved and the condition of the patient has improved, a physiotherapist will be called in to help with speech and mobility. The doctor will also need to identify the underlying cause of the stroke.
Your heart health may also be checked via electrocardiogram (ECG).
What Happens after a Stroke?
The severity of the stroke will determine just how severe the after-effects are. At worst, you may experience paralysis that could be either temporary or permanent. This is caused by damage to the muscular and nervous systems. Most stroke patients end up paralysed on one side for anywhere from 3-6 month. You can also expect to experience loss of speech and understanding, as well as fatigue. Balance and eyesight issues are common in stroke patients, and you may need help with dressing, eating, and bathing for as long as 6 months.
The area of the brain where the stroke occurred, as well as the extent of the damage, will have an effect on recovery. You can expect to see some real progress after 3 months, but in some cases, you could be look at around 2 years before full function is recovered.
Medications may be prescribed to prevent future strokes. Your doctor may prescribe a low daily dose of aspirin, or perhaps a drug called warfarin. Both are effective blood thinners that help prevent the formation of clots.
Photo by Anthony Cunningham for Zoom Health
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