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.
– 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
– Symptoms can be seen very quickly.
– 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]
Most Common Risk Factors
– 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.
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]
– Seen in 20% of strokes
– A tear or rupture of a blood vessel
– It is the pooling of blood anywhere within the skull
1.) Tearing or rupture of blood vessel
2.) Brain Trauma [Head injury]
3.) Brain aneurysm
4.) Certain medications
1.) Intra-axial hemorrhage [Blood inside the brain]
2.) Extra-axial hemorrhage [Blood inside skull but outside brain]
– Bleeding into brain itself
– Also called cerebral hemorrhage
– Can see bleeding into ventricles
– Very dangerous
– Very difficult to treat
– Bleeding that occurs within the skull but outside the brain
Overall exam for concern for strokes are essential
– 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
– 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.
– Thrombolytic (Fibrinolytic) Drugs:
. Tissue Plasminogen Activator (tPA)
– Blood thinners
– Hyper-osmotic agents
. 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.