INTRODUCTION

A stroke (sometimes called an acute cerebrovascular attack) is the rapidly developing

loss of brain function(s) due to disturbance in the blood supply to the brain. This can be
due to ischemia (lack of glucose & oxygen supply) caused by thrombosis or embolism or
due to a hemorrhage. As a result, the affected area of the brain is unable to function,
leading to inability to move one or more limbs on one side of the body, inability to
understand or formulate speech, or inability to see one side of the visual field.

A stroke is a medical emergency and can cause permanent neurological damage,

complications, and death. It is the leading cause of adult disability in the United States
and Europe. It is the number two cause of death worldwide and may soon become the
leading cause of death worldwide. Risk factors for stroke include advanced age,
hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA),
diabetes, high cholesterol, cigarette smoking and atrial fibrillation. High blood pressure is
the most important modifiable risk factor of stroke.

The traditional definition of stroke, devised by the World Health Organization in the
1970s, is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or
is interrupted by death within 24 hours". This definition was supposed to reflect the
reversibility of tissue damage and was devised for the purpose, with the time frame of 24
hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic
attack, which is a related syndrome of stroke symptoms that resolve completely within 24
hours. With the availability of treatments that, when given early, can reduce stroke
severity, many now prefer alternative concepts, such as brain attack and acute ischemic
cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome
respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.

A stroke is occasionally treated with thrombolysis ("clot buster"), but usually with
supportive care (speech and language therapy, physiotherapy and occupational therapy)
in a "stroke unit" and secondary prevention with antiplatelet drugs (aspirin and often
dipyridamole), blood pressure control, statins, and in selected patients with carotid
endarterectomy and anticoagulation.

Classification

Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemic
strokes are those that are due to interruption of the blood supply, while hemorrhagic
strokes are the ones which are due to rupture of a blood vessel or an abnormal vascular
structure. 80% of strokes are due to ischemia; the remainder are due to hemorrhage.
Some hemorrhages develop inside areas of ischemia ("hemorrhagic transformation"). It is
unknown how many hemorrhages actually start off as ischemic stroke.
MILD STROKE
The clinical features of a mild stroke may include an extremely diverse group of effects,
or symptoms. These include changes in sensation, changes to patterns of movement,
weakness or paralysis, emotional disturbances and changes to speech. All, or only some
of these mild stroke symptoms may be present in any particular case.

Sensation
The first thing to be affected may be the senses, particularly the sense of touch, and this
can have a dramatic impact on the capacity of the person for rehabilitation. For example,
a lack of sensation on the hemiplegic (paralysed) side can often make it difficult for the
person to comprehend what is required. A lack of perception combined with loss of
sensation can lead to a great risk of injury. For instance, the person may not be able to
feel heat, which means they need a much greater awareness of where their limbs are in
space if they are to avoid being scalded or burned.

Movement
The thing that will be most obvious to those around the person with mild stroke
symptoms will be the abnormal patterns of movement. This may be caused by abnormal
tone, sensory deficit, loss of balance or equilibrium and righting reactions. For example,
when bringing food from the plate to the mouth the arm may go into a flexion pattern.

Paralysis
Paralysis (or plegia) is the most easily recognisable symptom of stroke. The paralysis
may be just a weakness where the stroke has been a mild one. This weakness happens on
the side of the body opposite to the lesion in the brain. The face, neck and trunk muscles
can be involved as well as the arms and legs. The tone of the muscles alters following a
stroke and may be either reduced (hypotonicity) or increased (hypertonicity, or
spasticity).

Emotional effects
Many people suffer emotional disturbances after a stroke, even a mild one. They can
become emotionally labile, for example laughing or crying at inappropriate times. This
can be very distressing both for the person and their carers, family or relatives. The
lability tends to pass, but it can give way to depression, frustration and aggression. This is
particularly the case where the stroke has also caused communication disorders.

Speech
Speech and language disorders normally occur where the person has a lesion in the left
hemisphere. If the muscles involved in speech are weak (or paralyzed) speech can
become slurred, although there is no real loss of language. The language deficits are
known are 'dysphasia' and this can mean that the person either cannot express themselves
through speech (although they can still understand the spoken word), or they may lose the
capacity to comprehend the spoken word.