Brain strokes

1. Brain strokes
A brain stroke is a brain attack that occurs due to reduced or interrupted blood supply to a part
of brain. It can occur to anyone at any point of time. The decreased blood supply results in
deprivation of nutrients and oxygen in brain, resulting in death of brain cells.
Brain stroke is always an emergency condition that needs immediate care and treatment to
prevent brain damage. Earlier the treatment, more are the chances of survival and less damage
to body parts.
Risk factors of stroke
There are many factors that can increase the chances of a person to have a brain stroke,
including:
 Obesity or being overweight
 Sedentary lifestyle
 Excessive alcohol intake
 Smoking cigarette
 Drug addiction
 Uncontrolled high blood pressure
 Hypercholesterolemia
 Diabetes
 Cardiovascular disease like heart failure, infection or defects
 Use of birth control pills or hormone therapies
Causes of Stroke
There can be following causes of stroke resulting in corresponding types of stroke:
 A blocked artery causes ischemic stroke
 Leaking or bursting of a blood vessel causes hemorrhagicstroke
 Temporary disruption of blood flow to the brain causes transient ischemic attack, or TIA
Ischemic stroke: Most commonly occurring stroke, ischemic stroke accounts for almost 80% of
the stroke cases. A narrowed or blocked artery causes ischemic stroke resulting in severe
reduction of blood flow to a part of brain. The common ischemic strokes are:
 Thrombotic stroke: Formation of a blood clot due to deposition of fatty deposits (plaque)
in an artery in the brain causes reduced blood flow and hence thrombotic stroke.
 Embolic stroke: It occurs when a blood clot formed at any other place (not in brain)
sweeps through blood flow and gets stuck in the narrow brain arteries, result in decreased
blood flow and hence an embolic stroke.
Hemorrhagic stroke: Hemorrhagic stroke occurs due to leaking or rupturing of brain blood
vessels due to any of the following reasons:
 Uncontrolled high blood pressure (hypertension)
 Excessive use of anticoagulants (blood thinners) drugs

2.  Presence of weak spots in blood vessel walls (aneurysms)
 Rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous
malformation).
Hemorrhagic stroke types: The types of hemorrhagic stroke depend upon the location of
leaking or rupturing of brain blood vessels
 Intracerebral hemorrhage occurs due to bursting and spilling of a brain blood vessel
into the surrounding brain tissue that damages brain cells. This results in deprivation of
blood and consequent death of the brain cells beyond the leak.
 Subarachnoid hemorrhage occurs due to bursting of an artery on or near the surface of
the brain that results in spilling of blood into the space between the surface of brain and
skull.
A transient ischemic attack (TIA): Also referred as mini-stroke, TIA is temporary appearance of
stroke symptoms due to temporary decrease in blood supply to a part of brain due to blockage
by a clot or debris. But it should not be ignored as the person becomes high risk individual for
future stroke attacks.
Symptoms of Stroke
The symptoms of stroke depend upon the brain area affected. But in most cases, patient
complains of the following:
 Trouble while speaking (slurring) and understanding what the other person is saying
 Trouble while walking
 Excessive confusion
 Sudden paralysis, numbness or weakness of the arm, leg or face, mainly on the one side
of the body.
 Sudden blurred vision or blackened vision in one or both eyes
 A sudden and severe headache
 Vomiting
 Dizziness
 Altered consciousness
Emergency symptoms of stroke
Immediate medical attention is required if any person notices following symptoms in himself
or any known person (the easy way to remember them is to remember “FAST”):
 Face: Drooping of one side of the face on smiling
 Arms: Drifting downward or inability to raise one arm on raising both arms
 Speech: Slurred speck on saying simple phrases
 Time: In above situation, don’t wait and take the person to emergency department at
the earliest.
Diagnosis of stroke

3. Stroke is an emergency condition and immediate action is required to minimize brain damage
and increase the chances of survival of the patient. But for proper management of the stroke, it
is important to know the type of stroke as treatment modalities are different for different types
of stroke. So, first of all following are immediately done to find out the cause of stroke and its
type:
 Physical examination and thorough history taking from patient’s relatives
 Blood tests to evaluate blood sugar levels, cholesterol levels, blood clotting time etc.
 CT scan to find out any hemorrhage, tumor or blockage in the brain blood vessels
 MRI scan to find out if any brain tissue is damaged by an ischemic stroke and brain
hemorrhages.
 Carotid ultrasound to find out if there is any buildup of fatty deposits (plaques) in the
blood flow of the carotid arteries.
 An echocardiogram to find out if there can be a clot in the heart that may have traveled
to brain and caused stroke.
Treatment of brain stroke
The treatment of stroke specifically depends upon the type of stroke i.e. blocking of artery or
bleeding into the brain:
In ischemic stroke, medications are given to restore blood flow to the brain like intravenous
injection of tissue plasminogen activator (tPA). These medications dissolve the blood clot and
restore the blood supply to the brain. Ischemic strokes are sometimes treated by emergency
endovascular procedures that directly work inside the blocked blood vessel:
Intra-arterial thrombolysis: This involves insertion of a long and thin tube called catheter into
the brain through an artery in the groin to directly deliver tPA medication into the affected
area. This procedure has extended treatment window that intravenous tPA.
Clot removal with a stent retriever: If the clot is big and cannot be dissolved with medication, it
is removed by using a catheter.
Once the patient is given proper medication and is under controlled conditions, doctor may
advise following procedures to prevent the risk for future strokes:
 Carotid endarterectomy: In this procedure, the plaque from the carotid arteries are
removed through an incision along the front of the neck.
 Angioplasty and stents: In the angioplasty procedure, carotid arteries are accessed
through an artery in the groin. Now to expand the narrowed artery, a balloon is inflated,
and a stent is inserted to support the opened artery.
In Hemorrhagic stroke, emergency medications like warfarin or anti-platelet drugs such as
clopidogrel are given to prevent blood clots, along with other medications to lower blood
pressure in brain, or prevent vasospasmetc. Other than medications, following surgeries may
also be required to repair blood vessel abnormalities:

4.  Surgical clipping: In this procedure, a tiny clamp is placed at the aneurysm base to stop
blood flow, prevent bursting of aneurysm, or to prevent re-bleeding of recently
hemorrhaged aneurysm.
 Coiling (endovascular embolization): This involves insertion of a catheter into a groin
artery and guiding it to brain with the help of x-ray imaging. The aneurysm is filled with
small detachable coils to block blood flow into the aneurysm.
 Surgical AVM removal: This involves removal of the small AVM that is located into an
easily accessible area to reduce future risk of stroke.
 Stereotactic radiosurgery: Highly focused radiations are used to repair vascular
malformations.
Post-stroke care
Stroke can cause widespread and long-lasting problems that require constant care and support.
The rehabilitation program after stroke may include many or all the following supportive care
therapies:
 Psychological support: Depression and anxiety of survival and quality of life may disturb
the patient a lot. So psychological support is very important to boost the morale of the
patient and increase his faith in medicine.
 Physiotherapy: Physiotherapy is required to improve the muscle strength and overcome
any walking or movement disabilities.
 Occupational therapy: This is required to make patient learn the techniques to use
equipment that may help him in carrying out daily activities effectively and on his own.
 Speech and language therapist: Speech therapy can be very helpful to manage problems
related with swallowing and speech.
Many more organs of body are affected by stroke and depending upon the need patient is
taught various exercises, activities or techniques to improve the quality of life.