STROKE

A stroke, often referred to as a cerebrovascular accident (CVA), is a medical emergency that happens when there is an interruption in blood flow to a portion of the brain, depriving the brain tissue of oxygen and nutrition. This may cause the brain cells to die quickly, resulting in neurological dysfunction that might cause abrupt weakness, numbness, paralysis, trouble speaking, vision issues, or excruciating headaches.

Types

1. Ischemic stroke: Caused by a blockage or clot in a blood vessel supplying the brain. It accounts for the majority of strokes, approximately 87%.
2. Haemorrhagic stroke: Caused by bleeding into the brain due to a ruptured blood vessel. Although less common, it tends to be more severe and has a higher mortality rate compared to ischemic stroke.

Symptoms

It’s critical to identify stroke symptoms to receive medical attention quickly. The following are typical stroke symptoms:

• Sudden Weakness or Numbness: This condition usually affects one side of the body, the arm, leg, or face.
• Trouble Speaking or Understanding Speech: slurred speech, trouble putting thoughts into words, trouble following what people are saying.
• Perplexity: Abrupt perplexity or trouble comprehending basic ideas or directives.
• Visual Issues: Abrupt loss of vision in one or both eyes or double or blurred vision.
• Dizziness or Loss of Balance: This can include an unexpected loss of balance, dizziness, or trouble walking.
• Severe Headache: Described as the worst headache of one’s life, this type of headache occurs suddenly and has no apparent explanation.

To identify stroke symptoms, keep in mind the acronym FAST:

• Face Drooping: Request a smile from the individual. Does a person’s face sag on one side?
• Arm Weakness: Request that they raise both arms. Is one arm slipping down?
• Speech Difficulty: Request that the individual repeat a short sentence. Do they have weird or slurred speech?
• Time to Call Emergency Services: It’s time to dial emergency services right away if you notice any of these symptoms.

Risk Factors

There are risk factors that increase the likelihood of having a stroke. These factors can be categorized into two (modifiable and non-modifiable):

1. Modifiable Risk Factors:

• Hypertension: The greatest risk factor for stroke is elevated blood pressure. Over time, it causes damage to blood vessels, raising the possibility of a rupture or blockage.
• Smoking: Tobacco smoke contains compounds that increase the risk of stroke by causing blood vessel damage and promoting the formation of blood clots.
• Diabetes Mellitus: Atherosclerosis, or the hardening and constriction of arteries, is a condition that increases the risk of stroke and can harm blood vessels if left unchecked.
• High cholesterol: A higher chance of blockages and stroke is associated with high cholesterol levels, which also lead to the accumulation of plaque in arteries.
• Physical Inactivity: Not getting enough exercise regularly raises the risk of obesity, high blood pressure, and stroke.
• Obesity: Having a high body mass index raises the risk of diabetes, high blood pressure, and other stroke risk factors.
• Heavy Drinking: Drinking too much alcohol causes blood pressure to rise and increases the risk of atrial fibrillation, a heart rhythm abnormality that can result in stroke.
• Substance Abuse: Raising blood pressure and increasing the risk of stroke are two effects of certain drugs, including amphetamines and cocaine.

2. Non-Modifiable Risk Factors:

• Age: After the age of fifty-five, the chance of having a stroke doubles every ten years.
• Gender: Compared to premenopausal women, men are more likely to have a stroke. However, following menopause, the risk is comparable for both sexes.
• Family History: People who have a history of heart disease or stroke in their family are more vulnerable.
• Racial/Ethnic Background: Compared to Caucasians, some ethnic groups—African Americans, Hispanics, and Asian/Pacific Islanders—have a higher risk of stroke.

To lower the risk of stroke, it’s critical to address modifiable risk factors through dietary adjustments and medical supervision. The risk of stroke can be decreased by engaging in regular exercise, eating a balanced diet, staying at a healthy weight, giving up smoking, controlling diabetes and hypertension, and consuming less alcohol.

Causes 

There are various causes of stroke, and understanding them is important for prevention and treatment. Here are some common causes of stroke:

• Atherosclerosis: The accumulation of plaque in the arteries, which is made up of fat, cholesterol, and other materials. This condition can cause the blood vessels supplying the brain to constrict or become blocked.
• Hypertension, or excessive blood pressure: If left unchecked, hypertension can lead to ischemic stroke from blood vessel damage and an increased risk of blood clots, or haemorrhagic stroke from artery rupture.
• Cardioembolism: When blood clots or other debris form in the heart, they might become loose and migrate to the brain, resulting in an embolic stroke. These situations are commonly caused by atrial fibrillation, heart valve abnormalities, or recent heart attacks.
• Cerebral Small Vessel Disease: Ageing, diabetes, high blood pressure, and other disorders can damage the brain’s small blood vessels, which can increase the risk of stroke.
• Smoking: Smokers have an increased risk of stroke because tobacco smoke includes chemicals that harm blood vessels and encourage the formation of blood clots.
• Uncontrolled diabetes mellitus increases the risk of stroke by damaging blood arteries throughout the body.
• Obesity: Higher blood pressure, diabetes, and cholesterol are just a few of the risk factors for stroke that are linked to being overweight or obese.
• High Cholesterol: When plaque accumulates in the arteries, it can constrict them and raise the risk of stroke. High cholesterol is one sign of this accumulation.
• Lack of Physical Activity: Excessive weight, hypertension, and other stroke risk factors are linked to chronic inactivity.
• Abnormal Alcohol Use: Excessive alcohol use can cause blood clots to develop, elevate blood pressure, and increase the risk of additional strokes.
• Substance Abuse: Several drugs, including amphetamines and cocaine, can cause heart rhythm disturbances, raise blood pressure, and increase the risk of stroke.

Complications 

Stroke can result in several consequences that might affect a person’s quality of life in the long run and range from moderate to severe. Among the frequent stroke complications are:

• Physical Disabilities: Paresis or hemiplegia, or paralysis on one side of the body, can result from a stroke and impair movement and coordination. Walking, balancing, and completing daily activities may become challenging as a result.
• Speech and Language Impairments: One typical consequence of stroke is a language impairment called aphasia, which affects speaking, understanding, reading, and writing. There is also a possibility of dysarthria, which impairs speaking muscles.
• Cognitive Deficits: Memory loss, trouble focusing and paying attention, and impairments in executive function (such as organizing and problem-solving) are just a few of the cognitive deficiencies that can accompany a stroke.
• Trouble Swallowing: Following a stroke, dysphagia, or trouble swallowing, can arise. This can raise the risk of aspiration pneumonia and malnourishment.
• Emotional and Psychological Effects: Following a stroke, depression, anxiety, and emotional lability (rapid mood swings) are frequent and can have an impact on both the person with the stroke and those who care for them.
• Sensory Deficits: A stroke can result in sensory impairments in the afflicted limbs or body parts, such as tingling, numbness, or lack of sensation.
• Bladder and Bowel Dysfunction: Strokes can cause constipation or bowel incontinence in addition to urinary incontinence or retention.
• Pain: Affected limbs, such as the shoulder or neuropathic pain, may cause pain for certain people.
• Seizures: Following a stroke, individuals may experience seizures, particularly in the initial days or weeks.
• Secondary Stroke: People who have experienced one stroke are more likely to experience another, particularly if underlying risk factors are not sufficiently addressed.

Optimizing recovery and quality of life through medical and supportive interventions, combined with rehabilitation programs designed to target specific impairments, is a common approach to managing stroke consequences.

Preventive Measures

The risk of stroke can be significantly decreased by taking preventive action. The following are some essential tactics for preventing strokes:

• Control High Blood Pressure (Hypertension): Medication and lifestyle changes (such as eating a balanced diet, exercising frequently, and controlling weight) can greatly lower the risk of stroke when high blood pressure is regularly monitored.
• Manage Diabetes Mellitus: Reducing the chance of stroke can be achieved by controlling blood sugar levels with diet, exercise, medication, and routine monitoring.
• Keep Up a Healthy Diet: Limit added sugars, cholesterol, sodium, saturated and trans fats, and consume a diet high in fruits, vegetables, whole grains, lean proteins, and healthy fats. The diet known as DASH (Dietary Approaches to Stop Hypertension) is very helpful in lowering the risk of stroke.
• Frequent Physical Activity: Consistently perform at least 150 minutes of moderate-intensity aerobic activity (such as brisk walking, swimming, or cycling) and two or more days of muscle-strengthening exercises per week.
• Give Up Smoking: One of the most crucial actions towards preventing strokes is to give up smoking, as it raises one’s risk of stroke.
• Restrict Your Alcohol Intake: If you do drink, do it sparingly. Men and women should each have no more than two drinks per day, respectively.
• Keep a Healthy Weight: Use a combination of a balanced diet and frequent exercise to keep your body mass index (BMI) between the normal range of 18.5 and 24.9 kg/m².
• Control Cholesterol Levels: Maintain healthy cholesterol levels with regular exercise, a balanced diet, and, if required, the use of prescription drugs from your doctor.
• Manage Atrial Fibrillation (AFib): If you suffer from atrial fibrillation, collaborate with your physician to control the disease and lower your chance of stroke and blood clots.
• Control Stress: Prolonged stress raises blood pressure and other stroke risk factors. Engage in hobbies and enjoyable activities, mindfulness, meditation, deep breathing, and other stress-reduction strategies.
• Frequent Health Check-ups: Make an appointment with your doctor for routine check-ups to monitor and control stroke risk factors like blood pressure, cholesterol, and blood sugar levels.
• By implementing these preventative steps and choosing a healthy lifestyle, you can lower your risk of stroke and enhance your cardiovascular health in general.

When to see a doctor

It is imperative that you get medical assistance right away if you think you or someone else may be having a stroke. In the crucial period of stroke rehabilitation, prompt action can reduce brain damage and enhance results. Here are some recommendations about when to see a doctor if you think you may be having a stroke:

• Act F.A.S.T.: To identify stroke symptoms, use the abbreviation F.A.S.T.
• Face Drooping: Does one face droop or feel numb on one side?
• Arm Weakness: Is one arm numb or weak? Request that they lift both of their arms. Does one arm sag to the side?
• Speech Difficulty: Is speech slurred? Is the person difficult to comprehend or incapable of speaking? Request that they reiterate a short sentence.
• Time to Call Emergency Services: Make an instant call to emergency services if you see any of these symptoms.
• Act Now: In the treatment of stroke, time is crucial. Get emergency medical attention right away, even if your symptoms seem to be getting better or going away. Never wait to see whether your symptoms get worse.
• Don’t Try to Drive Yourself: If you or someone else is exhibiting signs of a stroke, avoid attempting to drive to the hospital. To get to the closest medical center, dial for an ambulance.
• Keep Track of Symptoms: If you’re with someone who might be experiencing a stroke, keep track of when the symptoms started. This data can assist medical professionals in choosing the best course of action.
• Don’t Wait It Out: It’s imperative to get medical attention, even if symptoms appear minor or transient. Transient ischemic attacks (TIAs), popularly referred to as “mini-strokes,” are a type of stroke that can occur before a more serious one.
• Keep in mind that your chances of recovering from a stroke and reducing long-term disability are better the sooner it is identified and treated.

References

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3. Feigin, V. L., et al. (2018). Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. New England Journal of Medicine, 379(25), 2429-2437.
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6. Mayo Clinic. (2021). Stroke – Diagnosis and treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119.
7. Mayo Clinic. (2021). Stroke – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113.
8. Ovbiagele, B., & Nguyen-Huynh, M. N. (2011). Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics, 8(3), 319-329.
9. Powers, W. J., et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418.