Stroke is very dangerous disease caused by clotting of artery or vein in brain or rupture of brain blood vessel. Time is crucial as it can save patent’s life.
Stroke is neurological pathophysiology that is very often misunderstood as cardiovascular disease. In this case the brain blood vessel is affected. Based on difference that happens in brain during stroke we divide it to ischemic or hemorrhagic stroke. Ischemic means obstruction of blood vessel (vein or artery) with embolus or thrombus.
Embolus means debris, e.g. fat particle or air bubble. Thrombus means blood clot. Most common cause of thrombus is atherosclerosis. Clot is being released and travels to brain after mechanical trauma, infection or biochemical harm.
Main symptoms of stroke are:
- Weakness or paralysis of part of the body: inability to move arm or leg; we can see drop of mouth corner
- Speech disability (aphasia): difficulty speaking, mumbling
- Blurred vision: visible dilatation of pupil in one eye; temporary blindness
- Headache
- Loss of coordination
- Nausea and vomiting
- Trouble walking
- Loss of consciousness
Ischemic stroke
Ischemic stroke happens when brain blood vessels is obstructed with embolus or thrombus, therefore certain part of the brain isn’t supplied with blood. Consequently, this area of brain is damaged and is dying.
In case of ischemic stroke oxygen and glucose is not being delivered to brain.
We can see various symptoms (manifestations) in brain due to which artery is being blocked.
Anterior artery- paresis (plegia) or loss of sensory in contralateral limb (opposite side of body in contrary to damaged blood vessel; if there is obstruction in blood vessel in left part of the brain then right side of body is disabled)
Middle cerebral artery- aphasia (not only problems with speech but also inability to understand written words and inability to repeat what the person hears), hemiapnosia (vision impairment, partial vision), partial loss of sensory in contralateral part of body
Posterior artery- memory loss, blindness, dyslexia, visual halucinations, ataxia (bad coordination), contralateral loss of sensory in parts of body
Treatment of ischemic stroke is based on anticoagulants and thrombolytic medications so the blood clot is being “melted” and blood flow is renewed. Another possibility is endarterectomy, manual removal of thrombus or embolus.
Diagnosis of ischemic stroke
Standardized neurological scale is being used to diagnose ischemic stroke. Consciousness, ability to verbally reply, response to instructions, view and eye movement, face and body motor skills, sensory to stimuli, ability to read and understand read text, ability to perceive space, objects and sounds on disabled side of body are being tested.
Transient ischemic attack- TIA
TIA is momentary state very similar to stroke. The difference is that TIA can last less than one hour and doesn’t cause permanent damage. Occlusion of blood vessel and short blood supply in some part of brain happens too, just as in case of real stroke.
We can’t differ stroke and TIA, so seeking of medical help is crucial. If you experience TIA you can get stroke too.
Hemorrhagic stroke
In hemorrhagic stroke blood vessel ruptures usually during head trauma. Blood under brain covers pressures to certain hemisphere, part of the brain, which causes loss of consciousness but blood can make pressure to other parts of brain as well. Neurological symptoms can occur hours after this type of stroke as hematoma (spilled blood from blood vessel) pushes on brain for a certain time.
Risk factors include hypertension conditions.
After hemorrhagic stroke neurosurgery is needed.
Brain bleeding
Brain bleeding is most often caused of hypertension when too high pressure in blood vessel causses rupture (we call it rupture of aneurysm, bulging vessel). There are also malformations of vessels (wall of vessel is too fragile and easily breaks) or brain tumors.
Hemorrhage can be result of abuse of psychotropic substances like cocaine and amphetamine. It manifests as headaches and loss of consciousness.
Subarachnoid hemorrhage
This type of stroke can be caused by rupture of artery aneurysm or head trauma. Brain disfunction is a result of too high intracranial pressure.
So what is the difference among ischemic stroke, brain bleeding and subarachnoid hemorrhage?
During ischemic stroke blood vessel is clogged, certain part of brain is not filled with blood and is dying.
During brain bleeding the pressure in blood vessel is too strong which causes its rupture and blood is flooding into brain, most often cause of death is bleeding into hemispheres.
During subarachnoid hemorrhage bulged vessel (most often in shape of “berry”) ruptures and blood is spilled under brain covers. Blood accumulates and makes pressure on brain.
Prognosis
Prognosis depends on the extent of brain damage.
Almost half of patients who experienced stroke and survived die in one year. 50% of patients who survived are invalids and 25% of these patients have permanent damage in their body.
Consequences of stroke
- difficulties grabbing things and holding them, incontinence (leak of urine), pain, restricted movement, problems swallowing (people after stroke swallow during inspiration (inhale) and there is too high chance of inspiration of food), problems with vision and weakness or lasting paralysis of limbs
- mental problems as a result of physical restrictions; depression, anxiety, changed behaviour
- problems with learning new things, attention and orientation problems, and loss of short term memory