Stroke – what to do?

My worst nightmare – Stroke

(Source of information : University of Rochester Medical Center Rochester )

First thing we must know is that stroke can happen to anyone at any time in any age. in case you think you or other around you are having a stroke call the emergency service (911) since time is now the key to save life, since we got 3 hours to get a medicine to dissolve the blood clots that cause an ischemic stroke

The bottom line is that although there is no cure for stroke once it has occurred, with today advanced medical and surgical treatments are able to reduce dramatically the damage done, and can help reduce your risk for another stroke. but keep in mind that treatment depend on time from the stroke, so most important thing is to call the emergency service as soon as possible

So, how do we know if someone is having a stroke? The simplest way to remember the Stroke main signs is by remembering FAST which stands for:

F – Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

A – Arm weakness.  One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.

S – Speech difficulty. You may see slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly when asked.

T – Time to call Emergency service. If someone shows any of these symptoms, call Emergency service right away. Call even if the symptom goes away. Make note of the time the symptoms first appeared.

What actually happen in a stroke?

A stroke is caused when blood flow to your brain is stopped or disrupted either by a major blood vessel in the brain is blocked. It may be blocked by a blood clot. Or it may be blocked by a buildup of fatty deposit and cholesterol. This buildup is called plaque (Ischemic stroke) or by a blood vessel in your brain bursts, spilling blood into nearby tissues. With a hemorrhagic stroke, pressure builds up in the nearby brain tissue. This causes even more damage and irritation (Hemorrhagic stroke).

Since during a stroke blood stopped to flow to the brain, brain cells die, so as result brain function is lost. You may not be able to do things that are controlled by that part of the brain.

I’m in my way to the hospital, what can i expect now?

Once we’ll get to the hospital, they’ll start with diagnosis in order to understand the problem and set the game plan. Usually from ER you’ll be taken to CT in order to get the current status and upon the result way of action will be decided.

during your stay in the hospital they will take complete health history and do a physical exam.  You will need tests for stroke such as brain imaging and measuring the blood flow in the brain. Tests may include:

  • CT (computed tomography) scan of the brain. An imaging test that uses X-rays to take clear, detailed images of the brain. A brain CT scan can show bleeding in the brain or damage to brain cells caused by a stroke. It is used to find abnormalities and help find the location or type of stroke.
  • MRI (magnetic resonance imaging). This test uses a combination of large magnets, radio frequencies, and a computer to make detailed images of organs and structures in the body. An MRI uses magnetic fields to find small changes in brain tissue that help to find and diagnose stroke.
  • CTA (computed tomographic angiography). An X-ray image of the blood vessels. A CT angiogram uses CT technology to get images of blood vessels.
  • MRA (magnetic resonance angiography). This test uses MRI technology to check blood flow through the arteries.
  • Doppler sonography (carotid ultrasound). A test that uses sound waves to create pictures of the inside of your carotid arteries. This test can show if plaque has narrowed or blocked your carotid arteries.

The following heart tests may also be used to help diagnose heart problems that may have led to a stroke:

  • Electrocardiogram (ECG). This test records your heart’s electrical activity. It shows any irregular heart rhythms that may have caused a stroke.
  • Echocardiography. This test uses sound waves to create a picture of your heart. This test shows the size and shape of your heart. It can check if the heart valves are working properly. It can also see if there are blood clots inside your heart.

The medical treatment may include below option, depending the CT finding:

  • Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the blood clots that cause an ischemic stroke. They can help reduce the damage to brain cells caused by the stroke. To be most effective, they must be given within 3 hours of a stroke occurring.
  • Medicines and therapy to reduce or control brain swelling. Special types of IV (intravenous) fluids are often used to help reduce or control brain swelling. They are used especially after a hemorrhagic stroke.
  • Neuroprotective medicines. These medicines help protect the brain from damage and lack of oxygen (ischemia).
  • Life support measures. These treatments include using a machine to help you breathe (a ventilator), having IV fluids, getting proper nutrition, and controlling your blood pressure.
  • Craniotomy. This is a type of brain surgery that is done to remove blood clots, relieve pressure, or repair bleeding in the brain.

Looking back, how could we have prevented the stroke?

Know your risk for stroke. Many stroke risk factors can be changed, treated, or medically modified. Some things you can do to control your risk factors are listed below.

Lifestyle changes

A healthy lifestyle can help reduce your risk for stroke. That includes the following:

  • Stop smoking, if you smoke.
  • Make healthy food choices. Be sure to get the recommended amounts of fruits, vegetables, and whole grains. Choose foods that are low in animal fat, trans fat, cholesterol, salt (sodium), and added sugars.
  • Stay at a healthy weight.
  • Be physically active.
  • Limit alcohol use.

Medicines

Take your medicines as instructed by your healthcare provider. The following medicines can help prevent stroke:

  • Blood-thinning medicines (anticoagulants) help prevent blood clots from forming. If you take a blood thinner, you may need regular blood tests.
  • Antiplatelets, such as aspirin, are prescribed for many stroke patients. They make blood clots less likely to form. Aspirin is available over the counter.
  • Blood-pressure medicines help lower high blood pressure. You may need to take more than one blood-pressure medicine.
  • Cholesterol-lowering drugs make plaque less likely to build up in your artery walls, which can reduce the risk for stroke.
  • Heart medicines can treat certain heart problems that increase your risk of stroke.
  • Diabetes medicines adjust blood sugar levels. This can prevent problems that lead to stroke.

Surgery

Several types of surgery may be done to help treat a stroke, or help to prevent one. These include:

  • Carotid endarterectomy. Carotid endarterectomy is surgery to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help stop a stroke from occurring
  • Carotid stenting. A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery.
  • Surgery to repair aneurysms and AVMs (arteriovenous malformations). An aneurysm is a weakened, ballooned area on an artery wall. It is at risk for bursting (rupturing) and bleeding into the brain. An AVM is a tangle of arteries and veins. It interferes with blood circulation and puts you at risk for bleeding.
  • PFO (patent foramen ovale) closure. The foramen ovale is an opening that occurs in the wall between the 2 upper chambers of the heart. This opening usually closes right after birth. If the flap does not close, any clots or air bubbles can pass into the brain circulation. This can cause a stroke or TIA (transient ischemic attack). However, experts are still debating whether the PFO should be closed.

Living with a stroke

How a stroke affects you depends on where the stroke occurs in your brain. It also depends on how much your brain is damaged.

Many people who have a stroke are left with paralysis of one of their arms.

Other problems can include having trouble with:

  • Thinking
  • Speaking
  • Walking
  • Swallowing, eating, or drinking
  • Doing simple math such as adding, subtracting, or balancing a checkbook
  • Dressing
  • Showering
  • Going to the bathroom

Some people may need long-term physical rehabilitation. They may not be able to live in their home without help.

Support services are available to help with physical and emotional needs after a stroke.

How can I know if I’m in risk for stroke?

If you’re in one of below groups, you’re in risk for stroke:

  • High blood pressure. Blood pressure of 140/90 or higher can damage blood vessels (arteries) that supply blood to the brain.
  • Heart disease.Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors.
  • People with diabetes are at greater risk for a stroke than someone without diabetes.
  • Smoking almost doubles your risk for an ischemic stroke.
  • Birth control pills (oral contraceptives)
  • History of TIAs (transient ischemic attacks). TIAs are often called mini-strokes. They have the same symptoms as stroke, but the symptoms don’t last. If you have had one or more TIAs, you are almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.
  • High red blood cell count. A significant increase in the number of red blood cells thickens the blood and makes clots more likely. This raises the risk for stroke.
  • High blood cholesterol and lipids. High cholesterol levels can contribute to thickening or hardening of the arteries (atherosclerosis) caused by a buildup of plaque. Plaque is deposits of fatty substances, cholesterol, and calcium. Plaque buildup on the inside of the artery walls can decrease the amount of blood flow to the brain. A stroke occurs if the blood supply is cut off to the brain.
  • Lack of exercise
  • Obesity
  • Excessive alcohol use. More than 2 drinks per day raises your blood pressure. Binge drinking can lead to stroke.
  • Illegal drugs. IV (intravenous) drug abuse carries a high risk of stroke from blood clots (cerebral embolism). Cocaine and other drugs have been closely linked to strokes, heart attacks, and many other cardiovascular problems.
  • Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke. Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.
  • Cardiac structural abnormalities. Damaged heart valves (valvular heart disease) can cause long-term (chronic) heart damage. Over time, this can raise your risk for stroke.

Risk factors for stroke that can’t be changed:

  • Older age. For each decade of life after age 55, your chance of having a stroke more than doubles.
  • African-Americans have a much higher risk for death and disability from a stroke than whites. This is partly because the African-American population has a greater incidence of high blood pressure.
  • Stroke occurs more often in men, but more women than men die from stroke.
  • History of prior stroke.You are at higher risk for having a second stroke after you have already had a stroke.
  • Heredity or genetics.The chance of stroke is greater in people with a family history of stroke.

Other risk factors include:

  • Where you live. Strokes are more common among people living in the southeastern U.S. than in other areas. This may be because of regional differences in lifestyle, race, smoking habits, and diet.
  • Temperature, season, and climate. Stroke deaths occur more often during extreme temperatures.
  • Social and economic factors. There is some evidence that strokes are more common among low-income people.

Source of information : University of Rochester Medical Center Rochester 

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