Stroke refers
to a brain disease caused by either blockage of blood supply or rupture of a
blood vessel to a particular part of the brain. This results in reduction of
blood and oxygen supply to the affected part of brain resulting in loss of
function
A stroke
can be categorized into two types –
Hemorrhagic
Strokes: This type
of stroke occurs when a blood vessel bleeds and burst within the brain. This
accumulated blood compresses the nearby tissues of the brain. This could be due
to –
- A
blood vessel on the brain surface starts bleeding in between the area of
the skull and the brain.
- A
blood vessel bleeding or bursting inside the brain
Hemorrhagic
strokes has two main types –
- Subarachnoid
hemorrhage: In this, there is bleeding in between the area of the brain
and the thin tissues covering the brain.
- Intracerebral
hemorrhage: This is considered as the most common type of hemorrhagic
strokes. This occurs when an artery bursts inside the brain and resulting
in the flooding of the nearby blood tissues.
Ischemic
Stroke: This
occurs when something is causing blockage in an artery which is carrying blood
to the brain. The potential causes are –
- When
there is a blockage in the small blood vessels within the brain
- When
a blood clot develops in the main artery to the brain
- When
an air bubble, a blood clot or fat globule develops in a blood vessel
which is carried to the brain.
Causes
Some of the causes that can lead
to a stroke are as follows:
1. Ageing
2. High blood pressure
3. Diabetes
4. Cardiovascular diseases
5. High cholesterol
6. Obesity
7. Vitamin B12 deficiency
8. Excessive alcohol and drug abuse
Symptoms:
Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.
The five most common signs and symptoms of stroke are:
Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.
The five most common signs and symptoms of stroke are:
- Sudden numbness or weakness of the face, arm, or leg - like
weakness of half of the body called as hemiplegia.
- Sudden confusion or trouble speaking or understanding others
called aphasia in medical terms.
- Sudden trouble seeing in one or both eyes called as mono or
binocular vision disturbance. This could be due a stroke anywhere in the
visual pathway.
- Sudden dizziness, trouble walking, or loss of balance or
coordination, this is commonly due to posterior circulation strokes.
- Sudden severe headache with no known cause is due to hemorrhage or
sometimes infarction.
Diagnosis:
The diagnosis Is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.
The treatment
for both hemorrhagic and ischemic stroke is different.
The
purpose of treating ischemic stroke is to restore the flow of the blood in the
brain. Medications are given in the first four and a half hours of the stroke
for destroying the clots in the blood vessels. An injection of tissue
plasminogen (TPA) can also be given to a patient for improving the probability
of a full recovery.
The main
purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the
pressure on the brain. Instead of blood thinners, clotting drugs can be given.
After the area has been healed and the bleeding is controlled, the damaged and
leaky blood vessels are then repaired.
The first
stroke device approved by FDA is Merci retriever. The aim of this device is to
restore the flow of the blood in the neurovasculature by removing thrombus in
those patients who have ischemic stroke.
The
penumbra system (endovascular thromboaspiration) is the last FDA approved
device that has been primarily developed for removing a clot in the case of
acute ischemic stroke. In order to eliminate or reduce the clot burden, this
system uses dual approaches to clot extraction by using debulking and aspiration
of the thrombus. Clot retrieval is then used where a ring device holds the
thrombus by capturing it in clasps with a cylinder. This is then withdrawn at
the time of flow arrest. This new aspiration device (the penumbra system) has
an excellent safety profile and a high rate of ‘target vessel’ recanalization.
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