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Stroke Treatment

What is a stroke?

A stroke is a “brain attack”.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.
How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.

When to see a doctor?
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. The main symptoms of stroke can be remembered with the word F.A.S.T.
Think “FAST” and do the following:
Face. Ask the person to smile. Does one side of the face droop?
Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?
Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
Time. If you observe any of these signs, call ER immediately.
Stroke is a medical emergency. If you see any of the signs of stroke call ER immediately.Don’t wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

Introduction Of Stroke Treatment

  • Ischaemic – where the blood supply is stopped because of a blood clot, accounting for 85% of all cases
  • Haemorrhagic – where a weakened blood vessel supplying the brain bursts. Brain hemorrhages can result from many conditions that affect your blood vessels. These include:
  • Uncontrolled high blood pressure (hypertension)
  • Overtreatment with anticoagulants (blood thinners)
  • Weak spots in your blood vessel walls (aneurysms)
  • A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). There's also a related condition known as a transient ischaemic attack (TIA), where the blood supply to the brain is temporarily interrupted.

    A transient ischemic attack (TIA) — sometimes known as a ministroke — is a temporary period of symptoms similar to those you'd have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes.
    Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system — but there is no permanent tissue damage and no lasting symptoms.
    Seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart.
    Incidence and Prevalence of stroke in India:
    Incidence of stroke - 105 to 152/100,000 persons per year
    Prevalence of stroke - 44.29 to 559/100,000 persons
    These values are higher than those of high-income countries.

    Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
    Lifestyle risk factors

  • Being overweight or obese
  • Physical inactivity
  • Heavy or binge drinking
  • Medical risk factors
  • Hypertension
  • Cigarette smoking or exposure to secondhand smoke
  • High cholesterol
  • Diabetes
  • Obstructive sleep apnea
  • Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm
  • Personal or family history of stroke, heart attack or transient ischemic attack.
  • Other factors associated with a higher risk of stroke include:
  • Age —People age 55 or older have a higher risk of stroke than do younger people.
  • Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men.
  • Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.Educational video link :

  • https://www.nhs.uk/conditions/stroke/

    Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures.
    Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role as well.
    Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

  • Controlling high blood pressure (hypertension). If you've had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke. Exercising, managing stress, maintaining a healthy weight and limiting the amount of sodium and alcohol you eat and drink can all help to keep high blood pressure in check. Regular intake of medicines to lower BP in hypertensives.
  • Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque in your arteriesApart from dietary change statins or other lipid lowering medicines.
  • Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke.
  • Controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication.
  • Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes.
  • Eating a diet rich in fruits and vegetables.
  • Exercising regularly. Aerobic or "cardio" exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.
  • Drinking alcohol in moderation, if at all. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes.
  • Treating obstructive sleep apnea (OSA). Screen for OSA — a sleep disorder in which the oxygen level intermittently drops during the night. Treatment for OSA includes oxygen at night or wearing a small device in your mouth to help you breathe.
  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Contast dye may be injected into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
  • Magnetic resonance imaging (MRI). An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography). MRI is better than CT in stroke evaluation.
  • Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. In this test, through a small incision a catheter is inserted usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Dye is injected into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.
  • Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it.
    Strokes are usually treated with medication. This includes medicines to prevent and dissolve blood clots, reduce blood pressure and reduce cholesterol levels.
    In some cases, procedures may be required to remove blood clots. Surgery may also be required to treat brain swelling and reduce the risk of further bleeding in cases of haemorrhagic strokes
    Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications.
    Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully.
    Emergency endovascular procedures. Sometimes to treat ischemic strokes (especially if large artery is occluded with clo) mechanical thrombectomy is needed. This procedure must be performed as soon as possible, depending on features of the blood clot:

  • Removing the clot with a stent retriever. In this procedure catheter is placed inside artery blocked through a small incision at groin. Blocked artery can be opened with the help of stent retrieves or suction catheters.This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA, though this procedure is often performed in combination with intravenous tPA. It is not open surgery and can be done in local anaesthesia also..!! Rarely sent placement may be required is artry is very narrow.
  • Up to 80 percent of strokes can be prevented. Identifying and addressing mechanism of stroke is important.
    How can I prevent a stroke or having another stroke? You can prevent a stroke by knowing and controlling your risk factors. There are a number of factors that increase your risk of stroke. Some of the risk factors for stroke you cannot do anything about. These include age, gender, family history of stroke and previous stroke or TIA . There are a number of risk factors you can do something about to reduce your chances of having a stroke:
    High blood pressure is one of the most important known risk factors for stroke.

  • High cholesterol.
  • Smoking.
  • Obesity or being overweight.
  • Poor diet and lack of exercise.
  • Diabetes (type 1 or type 2).
  • Alcohol intake.
  • Irregular pulse (atrial fibrillation or AF).
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