What Is Stroke? (Brain Attack)

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A stroke or brain attack is a condition in which the brain cells suddenly die leading to sudden focal neurological deficit in from of weakness of arm or leg, facial deviation, speech problem, giddiness with vomiting, or unconsciousness because of a lack of oxygen due to blockage of blood flow in certain area of brain or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.

 

Stroke is global health problem. It is the second commonest cause of death and fourth leading cause of disability worldwide. Approximately 20 million people each year suffer from stroke and 5 million of these do not survive. In India stroke is major leading cause of death and disability in young age population also.


The two main types of stroke include ischemic stroke and hemorrhagic stroke.

 

·         A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.

 


The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking,
incontinence, and bladder problems.

Who gets stroke?

Anyone can suffer from stroke. Although many risk factors for stroke are out of our control, several can be kept in line through proper nutrition and medical care. Risk factors for stroke include the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What causes stroke?

Ischemic strokes are ultimately caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots (thrombus clots) usually occur in areas of the arteries that have been damaged by atherosclerosis from a buildup of plaques. Embolus type blood clots are often caused by atrial fibrillation - an irregular pattern of heart beat that leads to blood clot formation and poor blood flow.

Hemorrhage strokes can be caused by uncontrolled high blood pressure, a head injury, or
aneurysms. High blood pressure is the most common cause of cerebral hemorrhage, as it causes small arteries inside the brain to burst. This deprives brain cells of blood and dangerously increases pressure on the brain.

Aneurysms - abnormal blood-filled pouches that balloon out from weak spots in the wall of an artery - are the most common cause of subarachnoid hemorrhage. If an aneurysm ruptures, blood spills into the space between the surfaces of the brain and skull, and blood vessels in the brain may spasm. Aneurysms are often caused or made worse by high blood pressure.

What are the symptoms of stroke?

Within a few minutes of having a stroke, brain cells begin to die and symptoms can become present. It is important to recognize symptoms, as prompt treatment is crucial to recovery. Common symptoms include:

Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.

A warning entity that a stroke is about to occur is called a transient ischemic attack (TIA) - a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter time period usually less than one hour and do not leave noticeable permanent damage. In TIA MRI brain with diffusion sequence will be normal unlike stroke in which MRI brain will show clot in brain.

 

WHO is using following simplified pneumonic to diagnose stroke (brain attack)

 

FAST-  

         

·         F-  Facial Weakness

·         A- Arm or Leg weakness

·         S- speech problem

·         T- Time (act fast to save your brain therefore it is called

 

                                  “TIME IS BRAIN”

 

 

 

 

Golden period to save permanent damage to brain is 6hrs in acute brain attack.

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If the pt comes within six hours then injection named TPA (recombinanttissue plasminogen activator) can be given intravenous or intraarterial catheter at site of blockage to dissolve the clot which leads to early and greater recovery in next 3 months time in 50-70 percent. There is small risk of haemorrhage (around 3-6 percent with this treatment. 95 percent of people develop stiffness and deformity in their limbs after brain attack known as post stroke spasticity. Usually pt develops after 1 month and then keeps on increasing then in a period of 3 months pt develops a full blown spasticity. The best possible treatment is

1-    Physiotherapy

2-    Pharmacotherapy and an inj. Named as BOTULINIUM TOXIN which is very effective relieving stiffness and deformities in these patients.

 

               

 

 

 

How is stroke diagnosed?

 

A stroke is a medical emergency, and anyone suspected of having a stroke with abve mentioned symptoms should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible.

Physicians have several tools available to screen for stroke risk and diagnose an active stroke. These include:

 

 

 

 

  

 

 

 

 

 

 

                        

White signals on left side are suggestive of blockage of blood flow in Lt side blood vessel (MCA) suggestive of acute brain attack (infarction)

·         CT and MRI with angiography - scans that are aided by a dye that is injected into            the blood vessels in order to provide clearer and more detailed images

 

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·         Echocardiography - an ultrasound that makes images of the heart to check for embolus

 

·         TCD (Transciunial Doppler) -  

 

                      

        

How is stroke treated?

The primary goal in treating ischemic stroke is to restore blood flow to the brain. This will be attempted using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen (TPA) activators TPA must be administered within 6 hours of the stroke. It has been seen that outcome is far better if patient receive TPA within 6 hours from onset of symptoms. This is known as thrombolysis. Thrombolysis can be done through intravenous route with in 4.5 hr and can done through intrarterial route in 4.5 to 6 hrs from onset of symptoms of stroke. The trhombolysis should be done at the earliest because each second is important in salvaging the damaged brain, therefore it is called “ TIME IS BRAIN.”In some case if there is contraindication for thrombolysis then antiplatelets (blood thinners) should be given at the earliest.

 

In addition, surgical procedures may be performed that can open up or widen arteries. These include carotid endarterectomy (removal of plaque and widening of the carotid artery) and angioplasty (a balloon that widens the cartoid artery and is held open with a metallic mesh tube called a stent).  In some case if there is deterioration in consciousness present then removal of scalp knwon as hemicraniectomy can be done.

Hemorrhagic stroke is treated differently than ischmic stroke. Surgical methods used to treat this stroke variant include aneurysm clipping, aneurysm embolisation, and arteriovenous malformation (AVM) removal. Aneurysm clipping consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of it's attached artery and keeps the aneurysm from bursting or re-bleeding. Aneurysm embolisation (coiling) uses a catheter inserted into the aneurysm to deposit a tiny coil that coil fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries. AVM removal is a surgical procedure to remove usually smaller AVMs or AMVs that are in more accessible portion of the brain in order to eliminate the risk of rupture.

Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include speech therapy, occupational therapy,
physical therapy, and family education.

How can stroke be prevented?

One way to prevent a stroke is to notice a transient ischemic attack (TIA) - or mini stroke - that provides symptoms similar to stroke. Knowing the symptoms of stroke can lead to earlier treatment and better recovery.

Much of stroke prevention is based on living a healthy lifestyle. This includes:

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