What is Stroke?

A stroke, also known as cerebrovascular accident, cerebrovascular insult or brain attack, occurs when there is interrupted or reduced blood supply to the brain. This prevents brain tissue from getting oxygen and nutrients, causing brain cells to die. Some signs and symptoms include:

• Sudden paralysis, numbness or weakness of one side of the body
• Sudden, severe headache
• Sudden nausea, including vomiting, dizziness or altered consciousness
• Vision problems or difficulty in seeing in one or both eyes
• Difficulty in communicating
• Difficulty in walking or a loss of coordination

There are three types of stroke:

• Ischemic stroke: The narrowing or blockage of blood vessels in the brain due to fatty deposits or blood clots or other debris, causing severely reduced blood flow
• Hemorrhagic stroke: The leakage or rupture of blood vessels in the brain due to trauma, uncontrolled high blood pressure, overtreatment with blood thinners, bulges or deposits at weak spots in the blood vessel walls, causing severely reduced blood flow
• Transient ischemic attack: A temporary decrease in blood supply to the brain due to narrowing or blockage of blood vessels in the brain, that does not cause permanent damage. It is a warning sign of a future stroke, which often happens within a year.

What should I do if I or someone around me is experiencing a stroke?

A. Immediate Response

A stroke is a medical emergency which requires prompt and immediate treatment. Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely. Think "FAST" and do the following:

• Face. When the person is asked to smile, observe if there is a droop on one only side.
• Arms. When the person is asked to raise both arms, observe if one arm drifts downward or if one arm unable to rise.
• Speech. When the person is asked to repeat a simple phrase, observe if their speech is slurred or strange.
• Time. If you observe any of these signs, call 995 for an ambulance or emergency medical help immediately. Do not wait to see if symptoms stop, as the potential for brain damage and disability increases with time while the stroke goes untreated

B. History and Clinical Examination

During a history and clinical examination, a medical professional is likely to ask about your medical history and about the time your symptoms started.

C. Blood tests

These can help determine and check your blood sugar levels, whether you have an infection, platelet counts, how fast your blood clots and cholesterol levels.

D. Radiological Examinations

• CT Scan

- A procedure that uses X-rays to generate three-dimensional images of the brain, to show any bleeding or damage

• Magnetic Resonance Imaging (MRI)

- A procedure that uses radiofrequency waves in a strong magnetic field to generate two- and three-dimensional images of the brain, to show any damage in tissue or cells

• Carotid ultrasound

- A procedure that uses high-frequency sound waves to generate pictures of the carotid arteries which supply the blood to your face, neck, and brain, to determine the presence of fatty deposits or narrowed or blocked arteries

• Echocardiogram

- A procedure that uses high-frequency sound waves to generate pictures of the heart, to show clots that may have traveled to your brain and caused a stroke

E. Cerebral angiogram

During a cerebral angiogram, a long and flexible tube is inserted into an artery in the arm or leg. A special dye is injected into the the blood vessels that lead to the brain via the tube, to show blockages or clots in the arteries in the neck and brain.

F. Electrocardiogram (ECG)

Electrodes are placed at certain spots on the body to record the electrical activity in the heart, measuring its rhythm and recording how fast it beats. It can determine whether you have any heart conditions that may have led to a stroke, such as a prior heart attack or atrial fibrillation.

How is stroke treated?

Treatments for Ischemic stroke and Transient ischemic attack

A. Medication

Clot-busting drugs known as thrombolytics can prove useful in to breaking up blood clots if you have an ischemic stroke. These drugs improve a patient's chances of recovering from a stroke and reduce their likelihood or requiring long-term care after the stroke event, making them more likely to recover fully or have less disability than patients who do not receive the drug. However, this medication will only be effective if taken within 3 hours of the first symptoms of stroke.

B. Angioplasty and Stent Placement

Angioplasty and Stent Placement is a procedure which opens a narrowed or blocked blood vessel. First, a catheter is inserted through a small incision to reach the blocked artery. Then, a small balloon attached on the tip of the catheter is then inflated inside the artery to open the clog, while a small wire mesh cylinder, known as a "stent", is also inserted to hold the artery open and reduce the risk of the artery closing again.

C. Atherectomy

Atherectomy is a procedure which removes plaque from the blood vessel. It involves the insertion of a catheter into the blocked artery, where the plaque is cut by a sharp blade, collected in the tip of the catheter and removed as the device is removed from the artery.

D. Thrombolysis

Thrombolysis is a procedure which removes blood clots from the blood vessel. It is performed by injecting a clot-dissolving drug into your artery at the point of the clot to break it up.

E. Mechanical Thrombectomy

A Mechanical Thrombectomy is the open surgical removal of a blood clot from a blood vessel, by using a balloon catheter which is inserted and inflated in the affected blood vessel in the head, and then pulled back to bring the clot with it. However, this surgical procedure is most effective if performed within 6 to 24 hours of the first symptoms of stroke.

F. Endarterectomy

An Endarterectomy is the open surgical removal of plaque from a blood vessel, by making a cut on the side of the affected artery and separating the plaque from the arterial wall.

Treatments for Hemorrhagic stroke

A. Medications

Unlike an ischemic stroke, blood clotting can prove useful in stopping or slowing the leakage or rupture of blood vessels in the brain during a hemorrhagic stroke. Hence, medication to counteract blood thinners, as well as medication to reduce blood pressure, lower the pressure in the brain, prevent seizures and prevent blood vessel constriction may be prescribed.

B. Coiling

During this procedure, a doctor inserts a long tube through a major artery in the body and guides the tube to the area of hemorrhage or weakened blood vessel. The tube is then used to install a coil-like device to repair the damage or prevent bleeding by blocking blood flow.

C. Clamping

If the bleeding is found to be due to a ruptured aneurysm, a small metal clamp may be put in place to stop the blood loss. Additionally, during imaging tests, the doctor may discover aneurysms that have yet to start bleeding or have already stopped bleeding. A clamp is then also placed at the base of the aneurysm, to cut off blood supply and prevent a possible broken blood vessel or new bleeding.

What are some supportive treatments for stroke?

After a stroke, the process of recovery and rehabilitation is different for everyone. While some people recover fully, others have long-term or lifelong disabilities. Additionally, depending on the patient and their condition, the process can take weeks, months, or even years.

In the early stages of recovery and rehabilitation, some signs and symptoms of stroke observed in the early stage may persist. However, therapy can done to help the patient regain their independence. For example:

• Mental Therapy can help to prevent mental health conditions following a stroke. For example, joining a patient support group can help patients adjust to life after a stroke.
• Physical therapy can help patients relearn movement and coordination skills that they may have lost because of the stroke that affected a part of their brain.
• Occupational therapy can help patients improve daily activities, such as eating, drinking, dressing, bathing, reading, and writing as the stroke may have resulted in a loss of muscle movement in some areas.
• Speech therapy can help patients whose speech has been affected by stroke, as they may find it difficult to talk clearly, swallow and eat after the stroke has affected the muscles in the mouth and throat areas.
• Support from family and friends can also help relieve fear and anxiety following a stroke.

Is there a possibility of recurrence after I have had a stroke previously?

If you have had a stroke, you are at high risk for another stroke. However, the following methods can lower the chance of you having a stroke recurrence:

A. Medication

Some medications, such as medications to lower cholesterol, lower high blood pressure, control blood sugar, prevent blood clots and relieve symptoms, may be prescribed by your doctor to prevent a second stroke or prevent a stroke from happening in the first place.

B. Lifestyle Changes

A sedentary and unhealthy lifestyle, as well as a habit of smoking, can cause problems with stroke and other atherosclerosis conditions such as heart disease. By making positive changes to your lifestyle choices, it may be possible to lower the risk of stroke effectively:

• Regular physical activity

- A doctor will often recommend a program of supervised exercise training, which may consist of simple walking regimens, leg exercises, and treadmill exercise programs three times a week, as they can result in decreased symptoms in just a few weeks.

• Diet changes and adjustments

- Many individuals with stroke have elevated cholesterol levels. A diet low in fat and cholesterol can help lower blood cholesterol levels. Additionally, plenty of fruit and vegetables should be consumed.

• Smoking cessation

- Tobacco smoke greatly increases the risk of stroke as it damages blood vessels.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.