Stroke is also referred to as a cerebrovascular accident (CVA) or brain attack. It means that there is an insult or disturbance in the blood supply of the brain, which leads to neurological function loss. Stroke may cause permanent disability to one or two or all four extremities.
Complications with stroke are abnormalities found with vision, paralysis (inability to move the limb or complete flaccidity) or paraparesis that is, weakness of muscles in one or more extremities, difficulties in speech such as difficulties found in formulation and understanding, gait abnormalities, severe headache, confusion, sudden loss of balance, etc. Hemiplegia - paralysis of one side of the body is a major drawback of stroke. Post-stroke disability is the major complication of stroke.
Types of Stroke:
Hemorrhage (bleeding due to injury) and ischemia (lack of blood supply) are the major causes for the disturbance of blood supply in the brain.
- Ischemic stroke occurs mainly due to the blockage of any major artery which supplies brain. This blockage prevents blood flow to the brain, and it is responsible for major permanent damage to brain tissue, which in turn will lead to neurological insult. Ischemic stroke is a very common type affecting 80 % of individuals with stroke. Due to blockage, brain deprives for necessary oxygen and nutrients.
- Hemorrhagic stroke refers to bleeding from blood vessels of the brain inside or outside the skull. When blood vessels rupture it will cause extravasation of blood.
Signs and Symptoms of Stroke:
Signs and symptoms of stroke depend upon the area of the brain affected. The most common areas involved in developing stroke are anterior cerebral artery, middle cerebral artery, internal carotid artery, posterior cerebral artery (lacunar syndrome), vertebrobasilar artery, etc. In stroke, many focal deficits are present such as changes in the level of consciousness and abnormal motor, sensory, cognitive, perceptual, and language functions.
Risk Factors for Stroke:
Some of the major causes responsible for stroke are as follows:
- High blood pressure.
- High cholesterol.
- Positive family history.
- Diabetes mellitus.
- Cardiovascular diseases.
- Atrial fibrillation.
- Congestive heart failure.
- Peripheral vascular disease.
- Excess alcohol consumption.
- Lack of exercise.
- Tobacco smoking.
- Age of above 55 years.
- African and American races.
Warning Signs of Stroke:
Early warning signs given by the National Stroke Association are as follows:
1) Transient Ischemic Attack (TIA):
- Sometimes stroke occurs without any symptoms, but sometimes with some early signs which are referred to as transient ischemic attack. It is also known as mini strokes.
- It may last for a few seconds to a few minutes and not more than 24 hours. It may originate from emboli, reduced cerebral perfusion (less blood circulation in the brain), due to arrhythmias (abnormal cardiac rhythm), reduced cardiac output, hypotension, overdose of antihypertensive medication, etc.
- It does not cause any permanent damage. The damage is totally reversible. It may give you a warning that you should not take it easy.
- Approximately 20 % of patients with TIA will go on to have a major stroke within 90 days and 2 % will have a major stroke in 2 days.
- Every minute counts. Contact the emergency number provided by the government of any country for immediate treatment.
2) High Blood Pressure:
High blood pressure increases four to five times the risk of stroke. If blood pressure is above 160/95 mmHg, then it is a warning sign for stroke.
- The person may feel sudden confusion, difficulties in speaking, pronunciation and understanding the words. This type of speech is referred to as slurred speech.
- Difficulties found with vision in one or both eyes. The patient may find it difficult while walking and will feel dizzy. The patient cannot maintain balance properly. Coordination of movement also becomes difficult prior to a stroke.
- Severe headaches may appear suddenly, without any known cause. Sometimes the person may feel nausea, vomiting, and fever for some minutes or hours or several days. Fainting may appear just prior, a few seconds, before developing the stroke.
3) Weakness of Limb or Side of the Face:
- Patients found numbness over face and weakness over extremities like arms and legs. It may be confined to one side of the body.
- Furthermore, patients cannot move their limb voluntarily. Problem found with lifting any objects.
- Facial drooping is also a sign of stroke. The reason behind this is the incomplete cessation of the blood supply to a part of the brain. The blood tries to force its path through the blocked artery.
- If a person has these signs, immediately go to the hospital and check for embolus block (atherosclerotic plaque that blocks the artery). This may be life saving.
- Presence of arm drift confirms the diagnosis. Arm drift means when a patient raises both his hands simultaneously, one hand suddenly drops in a downward direction.
The above-stated signs may appear before a stroke. Person and his relatives are encouraged to call the emergency department, even if these symptoms go away quickly and are painless. When you find these symptoms, please note the time, as this information is very important for doctors.
During a stroke, time is everything. Stroke needs immediate emergency treatment to prevent permanent focal defects in the brain. Morbidity and mortality rates are high with stroke. If treatment is not given as early as possible, chances for disabilities are more.
How to Diagnose a Stroke?
- Computed tomography (CT) in early stage is used to differentiate the type of stroke. It may be atheroembolic stroke or hemorrhagic stroke.
- Magnetic resonance imaging (MRI) study is also useful to diagnose stroke.
Management After the Appearance of Warning Signs:
If a patient gets stroke due to atherothrombotic reason, then the person should take a clot-dissolving enzyme such as Tissue plasminogen activator [tPA] 50 - 100 mg once daily or Urokinase or Prourokinase. tPA should be administered within 3 hours of the onset of signs and symptoms of stroke. It must be used in atherothrombotic stroke. It is strongly contraindicated in hemorrhagic stroke because it may increase blood loss. Researchers have proved that a person who was treated with tissue plasminogen did not get any disability or minimum disability as compared to those who did not receive the treatment.
- Improvement in cerebral perfusion is established by proper circulation and oxygenation. It can be delivered by a mask or cannula.
- Electrolyte balance and restoring fluid is an integral part of management.
- Anticoagulant therapy is initiated with Heparin or Coumadin (5000 units SC q8-12 hour or 7500 units SC q12 hour) to improve circulation and to reduce the risk of developing embolus. Low dose 2 mg of Heparin once a day is used for this purpose.
- Antiplatelet therapy with Aspirin (50 to 325 mg orally once a day) is initiated as soon as possible. Low dose is used to prevent second attack. High dose with 5 mg may be used to treat atrial fibrillation.
- Ticlopidine (250 mg twice daily with food) or Clopidogrel bisulfate (75 mg orally once daily) is another agent used to prevent recurrent attacks.
The above-stated medications are used in emergency treatment. Right recognition, right decision, right treatment at right time may save an individual’s life!
If you would like to gather more information about the warning signs of stroke and its emergency management then consult a stroke specialist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist/stroke
Last reviewed at: 06.Dec.2018