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 obstucts 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
- 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
Is the pooling of blood anywhere within the skull
Causes:
- Tearing or rupture of blood vessel
- Brain Trauma [Head injury]
- Brain aneurysm
- 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
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 dependant 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.