STROKE

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WHAT IS STROKE?
A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain.

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TYPES OF STROKE

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ISCHEMIC STROKE
This type of stroke may occur for three main reasons: 1. A blood clot (or thrombus) forms inside an artery in the brain, blocking the flow of blood. Referred to as thrombotic stroke, this is the most common type of ischemic stroke. Blood clots form most often in arteries damaged by atheroscelerosis, These deposits slow the blood flow and provide a surface that supports the formation of blood clots.
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2. A clot forms in the blood, but unlike thrombotic stroke, it originates somewhere other than the brain. This type of stroke is referred to as an embolic stroke and occurs when a piece of clot (an embolus) or plaque fragment breaks loose and is carried in the bloodstream to the brain. When it reaches a point where it can go no further, it plugs the vessel and cuts off the blood supply to the area of the brain that is supplied by that vessel.

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3. Blood flow decreases to the brain which can result from poor overall blood flow in the body due to heart damage or dysrhythmia. This less common type of ischemic stroke is called systemic hypoperfusion.

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SIGNS AND SYMPTOMS OF STROKE

Some common signs and symptoms following a stroke include: Sudden weakness, numbness, or paralysis of the face, arm, or legespecially affecting one side of the body (hemiplegia, hemiparesis) Loss of speech or difficulty talking or forming words, the inability to understand what others are saying (apraxia, aphasia, dysarthria) Temporary loss of memory; forgetfulness; amnesia Confusion Sudden blurring or loss of vision, particularly in only one eye Sudden severe headaches with no apparent cause Unexplained dizziness, loss of balance or coordination, unsteadiness, or sudden falls (especially if associated with any of the above symptoms)
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DIAGNOSIS
A CT Scan of brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards. Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain that may have caused the stroke. Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart. Carotid duplex (a type of ultrasound exam) can show if narrowing of the neck arteries (carotid stenosis) led to the stroke. An angiogram of head can reveal which blood vessel is blocked or bleeding, and help your doctor decide if the artery can be reopened using a thin tube.

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 Laboratory tests will include a complete blood count (CBC), bleeding time, and blood clotting tests (prothrombin time or partial thromboplastin time). They will also check your blood cholesterol and sugar Electrocardiogram (ECG) and heart rhythm monitoring can help determine if an irregular heartbeat caused the stroke. A spinal tap (cerebrospinal fluid exam) may also be done.

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RISKS
Transient Ischaemic attacks High Blood Pressure High Cholesterol Smoking Heart Disease Diabetes Smoking Excessive alcohol use High cholesterol level Obesity and failure to exercise 30 minutes daily three times per week Prolonged and extreme stress Substance abuse (cocaine, crack, heroin, speed, amphetamines, diet pills or ecstasy) Use of oral contraceptives (especially for women who smoke)
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TREATMENT
The initial treatment for stroke is supportive. The patient will be given fluids through an IV because s/he may often be dehydrated.

Oxygen may be given to be sure that your brain is getting the maximal amount.

If you have any difficulty breathing, this will be assessed and treated.

Unlike people with chest pain, people having a stroke are not given an aspirin immediately.

You are requested not to eat or drink until your ability to swallow is assessed.

Blood pressure control: It is important not to lower the blood pressure too much so that the brain will get enough blood.

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 Medications : Drugs for acute stroke: Currently, only 1 medicine is approved to treat new strokes. It is the clot-busting medication called tissue plasminogen activator (tPA). This medicine works with the body's own chemicals and helps dissolve the blockage in the blood vessel in the brain that may be causing the stroke.

At some hospitals, clot-busting drugs are given through a small catheter that, through an IV, is threaded up into the neck and into the artery where there is a blockage. This treatment can potentially be used up to 6 hours after onset of stroke symptoms.

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PHYSIOTHERAPY TREATMENT FOR STROKE

Improve balance and walking Increase ability to roll / move in bed / sit / stand Reduce muscle spasms, pain and stiffness Increase strength Retrain normal patterns of movement Increase affected arm and leg function Increase energy levels. Increase independence and quality of lifereduce the risk of falls
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PREVENTION OF STROKE
Regular medical check-ups Control blood pressure Stop smoking Improve dietavoid excess fat and sodium Limit alcohol intake Engage in appropriate exercise 30 minutes per day, three times per week Take medicines as directed Reduce and better manage stress Never use drugs such as cocaine, crack, heroin, ecstasy or speed Control diabetes
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