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Stroke

A Stroke is an injury to the brain that can be life threatening with significant current symptoms or long term consequences. It may cause a decrease and/or loss of brain function caused by destruction of Brain Tissue.

It can occur as a result of lack of oxygen [Ischemia] or bleeding [Hemorrhage]. It is often seen in the elderly or those with increased risk factors but can be seen in any age, race, sex or prior history.

The classification of stroke causes approximately 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.

Incidence of strokes have been expanding and increasing dramatically over the past 3 decades.

Potential 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:

–  Symptoms can be seen very quickly.
–  Headache
–  Fatigue
–  Nausea
–  Vomiting
–  Weakness
–  Numbness
–  Confusion
–  Lethargic
–  Anger (often unexpected or out of character)
–  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

Most Common Risk Factors

–  Hypertension
–  Previous Stroke
–  Age
–  Smoking
–  Diabetes
–  High Cholesterol
–  other

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
–  It 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

Similar Treatment Options that Can be seen in Both Types of Strokes (Basic)

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