A stroke may cause a decrease and/or loss of brain function caused by destruction of Brain Tissue.

Can occur as a result of lack of oxygen [Ischemia] or bleeding [Hemorrhage].

Often are seen in the elderly or those with increased risk factors.

Stroke causes 10% of the deaths worldwide.

Men are 1.25 times more likely to suffer a stroke than women.

95% of stokes occur in someone who is 45 years of age and older

60% of strokes occur when over 65

Although stroke can occur at any age

Incidence has been expanding and increasing dramatically over the past 3 decades.

Causes:

  • Thrombosis – clotting
  • Embolus – clotted blood or other foreign matter that obstructs in a blood vessel.
  • Tearing or rupture of blood vessel
  • Brain Trauma  [Head injury]
  • Brain aneurysm
  • Certain medications
  • Certain drugs
  • others

Symptoms:

  • Very quick symptoms may be seen
  • Headache
  • Fatigue
  • Nausea
  • Vomiting
  • Weakness
  • Numbness
  • Confusion
  • Lethargic
  • Anger
  • Loss or change in sensation
  • Loss of consciousness
  • Speech pattern changes
  • Loss of speech  [can be Complete]
  • Motor skills changes
  • Paralysis  [Typically on one side of the body]
  • Coma
  • Death

Risk Factors

Classification:

1.)  Ischemic Stroke
2.)  Hemorrhagic Stroke

Ischemic Stroke

  • Seen in 80% of strokes
  • Occurs when oxygen is lacking in a portion of the brain
  • Caused by a stoppage in blood flow to a certain area.

Causes:

1.)  Thrombotic [blood clot that has formed locally]
2.)  Embolic [blood clot or foreign matter from somewhere else in body]
3.)  Systemic Hypoperfusion [Decreased blood flow due to shock or other factor]
4.)  Cryptogenic [Unknown origin]

Hemorrhagic Stroke

  • Seen in 20% of strokes
  • A tear or rupture of a blood vessel
  • Is the pooling of blood anywhere within the skull

Causes:

1.)  Tearing or rupture of blood vessel
2.)  Brain Trauma [Head injury]
3.)  Brain aneurysm
4.)  Certain medications

Types

1.)  Intra-axial hemorrhage  [Blood inside the brain]
2.)  Extra-axial hemorrhage  [Blood inside skull but outside brain]

Intra-axial hemorrhage

  • Bleeding into brain itself
  • Also called cerebral hemorrhage
  • Can see bleeding into ventricles
  • Very dangerous
  • Very difficult to treat

Extra-axial hemorrhage

  • Bleeding that occurs within the skull but outside the brain

Three subtypes

1.)  Epidural hemorrhage
2.)  Subdural hemorrhage
3.)  Subarachnoid hemorrhage.

Overall exam for concern for strokes are essential

Diagnosis

  • Exam by a provider is essential if any concern
  • CT and MRI are useful and quite helpful for evaluation of the brain
  • Angiography can be used to find aneurysms

Treatment:

  • Evaluation in Emergency room is often necessary and essential
  • Stay at hospital (ICU department) is often necessary

Treatment is largely dependent on type of stroke. Ischemic stroke and Hemorrhagic stroke are treated differently in some specific areas.

Ischemic treatment

  • Thrombolytic (Fibrinolytic) Drugs:

.  Tissue Plasminogen Activator  (tPA)

  • Blood thinners

.  Heparin
.  Coumadin
.  Aspirin

Hemorrhagic treatment

  • Hyper-osmotic agents

.  Mannitol
.  Glycerol
.  Hypertonic saline solutions

Both

  • Hypertension treatment
  • Pain management as required
  • Surgical treatment
  • Monitoring and Management may depend on cause.
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