Last Updated June 13th, 2021
What is a stroke?
A stroke is a term used to describe the state where the brain doesn’t get enough blood. This usually happens due to an aneurysm (a rupture of a blood vessel) or a blockage in one of the blood vessels that supply blood to the brain. Without the blood supply, the brain cells are deprived of oxygen and they begin to die within minutes.
Stoke is categorized into three types
This type of stroke happens when the blood vessels (arteries) that supply blood to the brain become narrowed or blocked leading to ischemia (severely reduced blood flow). Ischemic stroke is also further divided into two types
An embolic stroke occurs when a plaque or a blood clot that is formed in some other part of the body travels to the brain. The obstruction then moves to the blood vessels of the brain where it eventually lodges, blocking the blood flow and leading to a stroke.
A thrombotic stroke happens when a blood clot occurs inside one of the arteries of the brain. People who have high cholesterol levels usually get a thrombotic stroke. There are two types of thrombotic strokes
- Large Vessel Thrombosis: This type of stroke happens when the brain’s larger blood vessels are blocked by a blood clot or plaque. It is usually caused due to long-term atherosclerosis (the build-up of plaque in and on your artery walls).
- Small Vessel Disease: This type of stroke happens when the brain’s small blood vessels are blocked by a blood clot or plaque. This is usually caused by uncontrolled high blood pressure.
A hemorrhagic stroke happens when a blood vessel that supplies blood to the brain ruptures. This can either be due to
- An aneurysm
- Weakened blood vessels
The resulting blood spill in the brain creates inflammation and pressure that damages cells and tissues in the brain. Hemorrhagic stroke is divided into two types
This is the more common type of hemorrhagic stroke and happens when an artery inside the brain bursts and leaks blood into the adjacent areas. This blood leak causes the brain cells to die and the affected part of the brain stops working. This is usually caused by aging blood vessels and high blood pressure. This type of stroke can also result due to a genetic condition called arteriovenous malformation (an abnormal connection between arteries and veins).
This type of stroke happens when the blood vessels in the subarachnoid space (the area between the brain and the tissue covering the brain) rupture and begin leaking blood. This type of stroke is usually caused when an aneurysm bursts.
Transient ischemic attacks
This happens when the blood supply to the brain is interrupted for a short period of time. TIA has the same symptoms as a stroke but they only last for a short period of time and cause no permanent damage. TIA is usually caused when a blood clot is temporarily lodged in the brain.
A transient ischemic attack is a warning that the person may have a full-blown stroke in the future. Studies have shown that 1 in 3 people who get a transient ischemic attack will eventually get a stoke, mostly within a year.
Signs and symptoms of a stroke
The signs and symptoms of stroke are varied, depending on the specific part of the brain that has been affected. However, the most common symptoms are
- Headache: People experience a sudden, severe headache which is usually accompanied by dizziness, nausea.
- Trouble walking: People may experience sudden dizziness, loss of coordination or balance.
- Difficult in speech: This is a common sign of a stroke. People have difficulty in speaking as the words might be slurred. Some people also have difficulty understanding other people speak.
- Paralysis: People may experience paralysis or sudden numbness or weakness in the face, leg or arm.
- Vision problems: People may experience vision problems in one eye or both the eyes. This may include blurriness, tunnel vision, blackened or double vision.
- Confusion: Some people also experience confusion.
You can use the FAST test to check for the signs of a stroke in yourself or someone else.
- Face: You can smile and see if a part of your face droops
- Arms: Lift both your arms and check whether one or both arms fall down automatically
- Speech: Speak a sentence to see whether your speech is slurring or not
- Time: If all the above signs are there note the time when they all started and call the ambulance immediately.
The sign and symptoms of a stroke are sometimes different in men and women.
Signs and symptoms in men
According to stats, men are more likely to have a stroke when they are young as compared to women. However, men are less likely to die from stroke. That being said, stroke is the fifth leading cause of death in men. Men usually experience these symptoms during a stroke
- Numbness on one side of the body
- The weakness of the face, arm or leg
- Sudden severe headache
- Loss of balance
- Vision problems in one or both eyes
- Slurred speech
- Stomach discomfort
Signs and symptoms in women
According to stats, women are at a higher risk of developing a stroke compared to men. Stroke ranks at number 4 in the list of causes of death in women. While some of the symptoms of a stroke are same in men and women, there are some symptoms that are more common in women. These are
- Trouble breathing
- Increased agitation
- Involuntary eye movements
- Muscle stiffness
- Difficulty in swallowing
The signs and symptoms of a stroke also differ depending on which part of the brain has been affected. Strokes can be categorized into two types depending on which part of the brain is affected. These are
Posterior circulations strokes
This type of stroke affects the back portion of the brain. The symptoms of posterior circulation strokes include
- Arm or leg weakness (usually in one side)
- Slurred speech
- Vision problems
Anterior circulation strokes: This type of stroke affects the front portion of the brain. The symptoms of anterior circulation strokes include
- Cognitive impairment
- Numbness or loss of sensation
Early signs of stroke
Studies have indicated that the warning signs of a stroke may begin 7-10 days in advance. One out of three stroke victims would have suffered transient ischemic attacks before the actual attack. TIA usually happens a week before the actual attack. Some of the symptoms of transient ischemic attacks include
- Numbness on one side of the body, usually hands and legs
- Dysphasia (difficulty in speaking)
- Vision problems
- Paresthesias (tingling)
- Abnormal taste on the tongue
- Loss of balance
- Syncope (fainting)
Stroke : Shocking facts and statistics
- 80% of all strokes are caused by the blockage of an artery that supplies blood to the brain.
- Native American Indians are at a higher risk of getting a stroke compared African-Americans, Caucasians, and Asians.
- 700,000 people suffer from stroke annually
- Stroke causes deaths every three to four minutes
- 50% of the population who get TIA are unaware of what they had
- Strokes are common in young people too. Approximately 852,000 people between the ages of 18-44 years get strokes in the United States.
- 80 percent of strokes can be prevented
Diagnosis of a stroke needs to be done quickly as it can cause permanent damage to the brain. Diagnosis usually involves determining the type of stroke and the areas of the brain that have been affected. This may involve many tests including
- Blood tests: Your blood may be tested for several things including sugar, the density of platelets, hormonal imbalances or infections.
- Computerized tomography (CT) scan: This test can help determine the cause of the stroke and the affected areas of the brain.
- Magnetic resonance imaging (MRI): MRI can identify brain damage caused by strokes. It can also detect aneurysms.
- Carotid ultrasound: This test checks the carotid arteries in the neck for any abnormalities like a plaque deposit. It can also determine the blood flow in the carotid arteries.
- Cerebral angiogram: This test helps the doctor get a detailed view of the arteries in the brain and neck and determine where the blockage or ruptures are.
- Physical examination: The doctor may check the patient’s blood pressure or look for any physical symptoms of a stroke. He/she may also use a stereoscope to identify and abnormalities in the heart.
Treatment for stroke depends on the type of stroke a person is having.
The treatment for this type of stroke involves restoring the blood flow to the brain. This can be done in the following ways.
Medications: Drugs that open the blockage are administered as quickly as possible. Alteplase in the form of intravenous injection is usually given patients who have had a stroke. Alteplase works by dissolving the blood clot that is responsible for the stroke.
Endovascular procedures: Ischemic strokes, which cannot be treated by medicines, are treated by endovascular procedures, which are performed directly on the blocked blood vessel. This may be done by sending medications directly to the blockage or by using stents to clear the blocked blood vessel.
The treatment for hemorrhagic stroke aims at reducing the pressure on the brain by controlling the bleeding.
Medications: If the patient is on blood thinners, he/she may be given drugs to counteract the blood thinners’ effects. Drugs to lower the pressure within the brain is also given. After the bleeding stops, the patient is given supportive care while the body absorbs the excess blood. If the bleeding is too much then the doctor may have to perform surgery to get the blood removed.
Surgery: Surgery is usually necessary to treat a hemorrhagic stroke as a ruptured artery cannot be treated with only medications. The following procedures are usually done
- Surgical clipping: If the stroke is caused by a ruptured aneurysm, this technique is used. It involves placing a tiny clamp at the base of the aneurysm to staunch the blood flow.
- Endovascular embolization (coiling): This procedure involves inserting a tiny catheter into an artery in the groin. This device is then guided to the brain at the site of the haemorrhage. Tiny coils are then put in the aneurysm. The coil fills up the aneurysm and blocks the blood flow.
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