Stroke Treatment: Symptoms and Diagnosis

Stroke Treatment: Symptoms and Diagnosis

About Stroke

In simple terms, as a heart attack is for the heart, a Stroke is the same for the brain. Brain stroke is also termed a CEREBRO VASCULAR ACCIDENT. It is the damage caused to the brain due to interruption of blood supply that leads to oxygen starvation and brain damage. The part of the brain affected and the functions it controls get compromised partially or completely. The effect of Stroke can be short-term or long-term, depending on the site of the attack and also how quickly the patient receives acute medical care.

The blood supply can get interrupted due to a block in the form of clot present in one of the arteries of the brain (ischemic stroke). This is the most frequent cause. The most common artery which gets affected due to ischemic stroke is the Middle Cerebral Artery. The less common cause can be leaking of blood into other parts of the brain due to bursting of the artery due to high blood pressure (hemorrhagic stroke). A transient ischemic attack (TIA) is a temporary period of symptoms similar to that of stroke. It lasts only for a few minutes and does not cause permanent damage. It is often termed as MINI-STROKE and should be considered as a warning for a major stroke later.

Stroke has been proven to be one of the primary reasons for death and disability leading to dependency on activities of daily living across the globe. Stroke survivors can experience wide range of disabilities including speech, mobility disorders and even their thinking and cognitive abilities gets affected.

Types of Stroke

1. Ischemic Stroke

  • This type of stroke occurs when an artery which supplies blood to the brain get clogged or damaged due to the presence of a clot and in turn impairs blood flow to that part of the brain.
  • This constitutes for almost 87% of the total occurrence of Stroke.

There are two types of Ischemic Stroke

Thrombotic Stroke

  • Clots that develop inside blood vessels of the brain cause Thrombotic Stroke.
  • Mainly occurs in older adults who have high cholesterol and/or diabetes.

Embolic Stroke

  • This type of stroke occurs when a blood clot located elsewhere in the body travels to the brain through the bloodstream. Often occurs in individuals with irregular heart rhythm.

2. Hemorrhagic Stroke

This type of Stroke occurs when a blood vessel that supplies the brain ruptures and bleeds inside the brain. Oxygen and nutrient supply to the brain tissues and cells gets compromised and internal pressure increases. This in turn creates swelling and irritation which leads to further brain damage.

There are two types of Hemorrhagic Stroke:

Intracerebral Hemorrhage

  • Usually caused by high blood pressure
  • Occurs suddenly or rapidly

Subarachnoid Hemorrhage

  • This type of hemorrhage occurs when bleeding occurs between the brain and the membranes that cover the brain.
  • It is usually due to Arteriovenous (Arteries and veins) Malformation in the brain. It can also be caused due to Trauma.
  • High blood pressure
  • Atrial fibrillation (irregular heart rhythm)
  • Tobacco use
  • Physical inactivity
  • Unhealthy diet
  • Harmful use of alcohol
  • High blood lipid levels
  • Obesity
  • Genetic disposition
  • Stress and depression

How to Spot a Stroke

How to Spot a Stroke - Infographics

Noticing these FASTER signs can help spot stroke and seek immediate medical care which prevents major damage and improves outcome.

F – Face

  • Drooping or numbness on one side

A – Arms weakness

  • One arm drifts down when lifting and is numb

S – Stability

  • Dizziness and difficulty in walking
  • Loss of coordination

T – Talking

  • Slurring of words
  • Sluggish speech

E – Eyes

  • Double vision
  • Difficulty in maintaining vision

R – React

  • Immediately call for emergency medical care

Diagnosis

In emergency medical care, the doctor will perform the following tests to determine the type, size, and intensity of the damage inside the brain.

1. Physical Examination

A complete external examination such as Blood pressure, heartbeat, and other neurological tests to evaluate the sensorimotor system would be conducted and documented.

2. Blood Tests

All major tests pertaining to the vital organs would be conducted to check the vitals.

3. Computerized Tomography Scan (CT Scan)

This scan uses a series of x-rays to reveal a detailed image of the brain. It detects the presence of bleed or clot in the brain.

4. Magnetic Resonance Imaging

A series of powerful radio waves and magnetic fields reveal the extent of tissue damage in the brain.

5. Carotid Ultrasound

In this imaging, sound waves create detailed imaging of the carotid arteries in the neck and detect the presence of plaques and deposits

6. Echocardiogram

ECG detects the source of clots in the heart that may have traveled from the heart to the brain through the bloodstream and caused a stroke.

Symptoms of Stroke

Symptoms of Stroke - Infographics

Immediate medical management post stroke

For Ischemic Stroke

  • Emergency IV Injections: Thrombolytic (clot-busting drugs) have to be administered within the first four hours of spotting the symptoms. The timely administration of this drug increases the chances of survival and reduces the intensity of disability.
  • Emergency endovascular procedures:
  • In a few cases, Thrombolytic drugs are administered directly into the brain through an artery in the groin all the way to the brain with the help of appropriate imaging.
  • In case of large clots, doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in the brain.

For Hemorrhagic Stroke

  • Emergency drugs reverse the effect of blood thinners, lower blood pressure, lower intracranial pressure, and relieve spasms in the blood vessels.
  • Surgery: In case the area of bleed is large, then surgical interventions like Clipping are performed for relieving the pressure on the brain. Surgeries are performed in case of an aneurysm, arteriovenous malformation (AVM), or other types of blood vessel problems.

How to Avoid Stroke

1. Healthy Eating

  • Limit salt intake
  • Choose healthy snacking habits
  • Eat plenty of fruits and vegetables
  • Avoid high cholesterol diets and include a more fibrous diet

2. Regular Physical Activity

  • Aerobic and anaerobic exercises should be a part of one’s daily routine.
  • It helps to maintain blood pressure, lower cholesterol levels and maintain a healthy weight.
  • A minimum of three hours of Physical activity per week is the ideal recommendation.

3. Quit Smoking

  • Nicotine increases the risk of developing stroke.

4. Limit Alcohol Intake

  • Too much alcohol can raise the risk of high blood pressure which in turn increases the risk of Stroke

5. Manage your health conditions such as heart disease, diabetes, high cholesterol, or high blood pressure. Take regular medications and have checkups. Work closely with your doctors on how to manage your health condition.

Complications Involved after Stroke

The most important thing after a stroke is to prevent another stroke. Each type has stroke has its own complications involved.

1. Complication After Ischemic Stroke.

  • Blood clots (Deep vein thrombosis or Pulmonary embolism)
  • Urinary tract infections, or UTI
  • Bowel and bladder problems
  • Risk of pneumonia
  • Muscle weakness
  • Bed sores
  • Mobility problems and falls

2. Complications Involved after a Hemorrhagic Stroke.

  • Blood clots (deep vein thrombosis or pulmonary embolism)
  • Brain swelling
  • Seizures
  • Memory loss
  • Vision and hearing problems
  • Muscle weakness
  • Bed sores
  • Depression
  • Risk of pneumonia

3. Complications Involved after Transient Ischemic Attack

  • Blood clots (deep vein thrombosis or pulmonary embolism)
  • Difficulty swallowing
  • Urinary tract infections, or UTI
  • Bed sores
  • Mobility problems and falls

4. Complications Involved after Brainstem (Part connecting the Brain with the Spinal cord) Stroke

  • Difficulty swallowing
  • Difficulty breathing
  • Loss of sensation
  • Vision problems
  • Motor control problems
  • Coma
  • Locked-in syndrome, when the entire body is paralyzed except for the eyes

Recovery after Stroke

1. One to Three Months post stroke

This is the period of spontaneous recovery

  • The goal of the Stroke rehab program during this period is to attain pre-stroke physical independent life as much as possible
  • Physical therapy and speech therapy play the most crucial role during this period.
  • Positioning and attaining back the correct synergy pattern (coordination pattern) between the muscle groups is of utmost importance during this period.
  • Physical therapy works with the aim to get sensory-motor coordination back.

2. Post Six Months of Stroke

Neural plasticity is the ability of the damaged brain cells to network with the undamaged cells to create collaterals for relearning skills lost post-stroke.

  • Though the brain is in a heightened state of Plasticity immediately post-stroke, recent research has proven that neural plasticity can be activated even after 6 months to even years after stroke.
  • Recovery may be slower than the immediate month post stroke but the brain’s capacity to re-learn and adapt to newer ways of functioning can be initiated even after six months.

At Medigence, we have treated patients after three years of attack post Stroke. With customized rehabilitation protocols we have successfully activated the muscles which had gone into non-use post Stroke and helped them achieve a completely independent life. This has proven that recovery is possible even after six months post-stroke and that 6-month deadline is a myth.

Rehabilitation Post Stroke

After acute care management at the hospital, Rehabilitation plays a significant role in improving and developing the skills left post-stroke to the maximum possible functional capacity. The amount of damage is determined by the type, site and the side of the brain involved. When the right side of the brain is affected, the physical impairments are seen on the left side and vise a versa. In the case of hemorrhagic stroke, the damage depends upon the extent of the spread of bleeding in the brain. Rehabilitation protocols majorly depend upon the above factors and are set according to the individual stroke survival.

Stroke Rehabilitation Service by MediGence

What is Stroke Rehabilitation:

Stroke rehabilitation is a combination of different therapies designed to relearn and regain the skills lost after a stroke. Depending on the type of stroke and the site of the attack in the brain, rehabilitation can help you with movement, speech, strength, and daily living skills.

What do we deliver in our Stroke Rehabilitation Services:

Our programs include:

  • Physical therapy: For restoring strength, functions mobility balance, and coordination
  • Speech therapy: For speech and swallowing difficulties
  • Cognitive and Behavioral Therapy: For better acceptance and a positive mindset
  • Occupational therapy: For adaptability and modifications according to the present condition for moving back to work.
  • Prosthetics and Orthotics consultation and delivery: For assistive devices for functional recovery.
  • Nutrition and diet management
  • Counseling sessions to the primary caregivers in the family.

Expected Outcome

We realize how important it is to get back to a quality independent life after a debilitating attack of Stroke.

We not only aim to deliver comprehensive customized rehab protocols but also ensure that the patient re-habituates toward community living in the best possible manner.

  • Physical and functional independency
  • Improvement in speech and audio
  • Improvement in swallowing functions in the early stages through De-glutology therapy
  • Improvement in cognitive health through Psychotherapy programs
  • Community living and adaptation

Three Phases of Delivery of Our Care Delivery

1. Acute injury phase: the immediate phase after the attack

  • Sensory integration
  • Cognitive restoration
  • Synergy balancing
  • Correct positioning
  • Establishing coordination between sensory and motor systems
  • De-glutology , speech and voice therapy
  • Counseling for mental well being

2. Repair Phase: 3-6 Months Post-Attack

  • Progressive coordination between sensory-motor systems
  • Correction of deformities caused due to non-use
  • Progressive strengthening exercises
  • Balance and coordination protocols
  • Assistive gait training
  • Speech and voice therapy
  • Counseling for mental well-being

3. Remodelling Phase: Post Six Months 

  • Progression towards independence as much as possible
  • Occupational therapy
  • Community adaptability programs

Living after Stroke

Stroke strikes. Suddenly out of the blue. Simple activities like getting out of the bed, brushing, toileting, dressing up, etc. all become complex sets of tasks. Dependency increases.

But is all this permanent? The answer is NO.

Rehabilitation aims to train the left-over skills after completing your evaluation post discharge from acute care. The training and re-training help the brain to re-learn the skills through the process of neural plasticity. Neural plasticity is the process of re-wiring of the nervous system by modifying itself functionally and structurally, to compensate for the loss that occurred due to the injury.

Our brain has cells beyond the size of a galaxy and the unmatched capacity of this networking helps us to recover from the catastrophic effects of stroke.

Be it any kind of stroke, RECOVERY IS POSSIBLE, to the maximum possible functional capacity left after the attack.

Along with the best rehabilitation, the most important thing required after Stroke is the WILL POWER to get better.

Always remember, Neuro Rehabilitation is a progressive journey, not a destination.

 

Refence Link:

Last modified on blank at Sep 01, 2022

Reviewed By :- Megha Saxena
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Vijita Jayan

With over 14 years of experience. Dr. Vijita Jayan is an extremely competent, skilled & revered Senior Neuro Physiotherapist. She holds an impeccable academic record and extensive experience in the field of neuro-rehabilitation. She is renowned for handling mobility-dependent cases. She is also an avid writer of several published articles & research papers. Being awarded several accolades in her career, she is considered one of the leading names In the field of Physical Medicine and Rehabilitation.

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