Thursday, October 24, 2019

Stroke: Symptoms, Causes, Risk Factors, Types and Prevention

Stroke: Symptoms, Causes, Risk Factors, Types and Prevention
Stroke is the third leading cause of death and a main cause of long-term disability worldwide. Heart attack is the major cause of death and all forms of cancer are second

Strokes are always a medical emergency and every minute is important for starting treatment, but except for transient ischemic attacks, all other types of strokes are life-threatening events. Blood pressure control is an important factor for most of the significant reduction. Therefore, the incidence of stroke and the reduction of mortality remain one of the health goals 

Stroke Definition

A stroke is a common cause of critical neurological disease, also called a cerebrovascular accident or stroke, it is a sudden and often paralyzing disorder of blood circulation in the brain, an interruption in the blood flow that carries oxygen to the brain. sometimes called the brain. seizures: disruption of blood circulation can be the result of an explosion or an artery that has been closed due to the presence of a blood clot. Blood circulation in the area of ​​the brain served by that artery is interrupted at the point of disturbance and the brain tissue beyond it is damaged or dies

Therefore, the definition of stroke is that clinical and laboratory studies that include brain imaging are used to support diagnosis. Given the complex anatomy of the brain and its vascularization, the clinical manifestations of stroke are highly variable. Cerebral ischemia is caused by a reduction in blood flow that lasts for more than a few seconds

Stroke symptoms

The observed stroke symptoms depend on the part of the brain affected and the extent to which part of the brain tissue has been damaged by CVA
  • Severe, sudden headache (often described as "the worst headache I've ever had" in a hemorrhagic stroke)
  • Mental confusion
  • Dizziness
  • Loss of balance or coordination
  • Vision problems
  • Aphasia or difficulty speaking and communicating, including bubbling words
  • Hemiplegia, or weakness in the arm, face, and leg, or paralysis of one side of the body, this one-sided weakness is often first noticed on the person's face

Stroke victims often have facial drops or loose facial muscles on the affected side, as well as difficulty swallowing. The severity of these symptoms relied on the amount of brain tissue that has died and its location in the brain

Neurological symptoms obvious themselves in seconds given neurons lack glycogen, so the power outage is rapid. If the interruption of the flow lasts more than a few minutes, a heart attack or death of the brain tissue happens. When blood flow is quickly restored, brain tissue can fully recover and the patient's symptoms are only transient; this is called a transient ischemic attack (TIA). The definition of TIA needs that all neurological signs and symptoms resolve within 24 hours without evidence of stroke on brain imaging. Stroke occurred if neurological signs and symptoms last longer than 24 hours or if stroke has been demonstrated

A decrease in cerebral blood flow due to low systemic blood pressure (e.g. cardiac arrhythmia, myocardial infarction or hemorrhagic shock) generally causes syncope. A heart attack may develop in the border areas between the main distributions of the cerebral arteries, If the low cerebral blood flow persists longer

Stroke Causes and Risk Factors

• High blood pressure is a major cause of stroke, Hypertension is when blood pressure is typically 140/90 or higher. Therefore you should  consult a doctor, serious condition that requires immediate medical attention

Risk factors for hemorrhagic stroke are those that can weaken the arteries that supply blood to the brain. They include high blood pressure, which can cause during a period of inflammation of the arteries known as hereditary aneurysms and malformations that produce defective and weakened veins and arteries

• Diabetes has been designated as a constant factor for atherothrombotic stroke. For hemorrhagic stroke, the risk is reversed. Diabetics have higher mortality and stroke morbidity rates than age compared to non diabetics

• Heart disease and abnormalities, including coronary artery disease, congestive heart failure, left ventricular hypertrophy, valvular heart disease, atrial fibrillation and cardiac thrombosis, increase the risk of stroke. 

• Hyperlipidemia, Hyperlipidemia, or called  high cholesterol promotes atherosclerosis and is associated with an increased odds of stroke incidence

• Obesity, Your odds of a stroke may rise if you're overweight. Take a brisk 1 Hour walk every day

• Smoking increases your risk of a stroke. Especially, nicotine what makes your blood pressure rise. It also works to coagulate the blood. Substance abuse is also a major cause

• Medications, Some medicines can go up your risk of stroke. Sometimes doctors suggest to prevent blood clots that can may cause hemorrhagic strokes, and also hormone therapy that  used for menopause symptoms is related to a higher risk of strokes

Stroke risk factors can be classified in terms of non-modifiable risk factors and modifiable risk factors. Those that cannot be changed include age, gender, race and family history. These modifiable risk factors include hypertension as a result of this build-up, as the heart tries to pump blood through these narrow arteries

Clinical risk factors for stroke in non-rheumatic atrial fibrillation include age> 75 years, previous attack or transient ischemic stroke, history of hypertension, diabetes mellitus and congestive heart failure. Echocardiographic risk factors are depressed ventricular function and an enlarged left atrium

• Patients <60 years of age with structurally normal hearts and without hypertension have a low risk of thromboembolism and do not require specific therapy

• Warfarin should be used to maintain an INR of 2.0-3.0 (although 2.0-2.5 is preferable in the elderly)

• Studies showed no difference between paroxysmal and chronic atrial fibrillation in heart rate risk

Stroke Types

Stroke: Symptoms, Causes, Risk Factors, Types and Prevention
There has been significant recognition of stroke subtypes in classification, epidemiology and treatment. In the international classification of diseases, etiology and pathology divide stroke into nine main groups.Ischemic strokes represent about 80% of all strokes. The classification of ischemic strokes is based on the location and duration of the occlusion. In addition, non-specific categories of Acute but poorly defined and late effects of cerebrovascular disease are also used.About 20% of strokes are called hemorrhagic strokes, including subarachnoid and intracerebral hemorrhage and other unspecified intracranial hemorrhages

The additional classification is based on the etiology of stroke, i.e. occlusive disease and embolic origin. Occlusive disease of large vessels and disease of small vessels have differential causality and prognosis. Almost a third of the strokes are embolic and small thrombotic comprise 20% and a large container 31%. Hemorrhagic stroke accounts for the rest with 17%

Ischemic strokes

This causes brain injury and is generally caused by thrombosis of the cerebral vessels or by emboli from a proximal arterial source or from the heart. on the other hand, the constellation of cognitive sequelae that occurs is called hypoxycyschemic encephalopathy. Focal ischemia or heart attack

Hemorrhagic strokes

It is caused by bleeding directly into or around the brain; It produces neurological symptoms by producing a mass effect on neural structures, by the toxic effects of the blood itself or by increasing intracranial pressure. The most common type of stroke is classified as ischemic or occurs because the blood supply to a part of the brain has been stopped

Both ischemic and hemorrhagic strokes show similar symptoms, depending on the part of the brain that has no food and oxygen. The brain is divided into two, left and right  hemispheres. These hemispheres are responsible for the movement of the body on the opposite side of the body from the cerebral hemisphere

Stroke Prevention

Primary prevention includes changing the risk factors for lifestyle and behavior, such as not smoking; diet such as fish, fruit and vegetables, adequate exercise; limit alcohol; and adherent the recommendations of doctors for the detection, monitoring and treatment of blood pressure, cholesterol and diabetes (blood glucose) 

Secondary prevention requires the intervention of the healthcare professional, which includes the treatment of hypertension, the treatment of cholesterol, For example, statins, TIA treatment, platelet aggregation inhibitors, anticoagulants for atrial fibrillation and other cardiac sources, treatment with ACS and carotid endarterectomy

Surgical prevention through carotid endarterectomy has also been shown to be effective, but should be reserved for those with a high degree stenosis. The role of angioplasty in secondary or tertiary prevention of ischemic strokes still needs evidence. So prevention remains the key  to provide a decrease in disability and death

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