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Stroke Treatment: Symptoms, Classification, Diagnosis & Recovery

A stroke is a serious medical emergency. It's essential to seek medical help immediately. Getting prompt emergency assistance can minimize potential brain damage and complications associated with a stroke.

It is a loss of neurological function caused by a sudden interruption of continuous blood supply to the brain. Blood flow can be disrupted by a blockage, which causes ischemic stroke, or with bleeding in the brain, which causes hemorrhagic stroke, which is more fatal. Ischemic stroke accounts for the majority of strokes. Strokes frequently strike without warning, and the consequences may be catastrophic. Normal blood flow and oxygen to the brain must be restored as quickly as possible. The afflicted brain cells are either injured or die within minutes of being deprived of oxygen and essential nutrients. When brain cells die, they usually do not recover, causing severe damage that can lead to physical, cognitive, and mental problems.

Strokes can be classified into different types based on their underlying causes. The main classifications of stroke are:

  • Ischemic Stroke: It is caused by a blockage or clot that obstructs blood flow to the brain. This is the most common type, accounting for the majority of stroke cases.
  • Hemorrhagic Stroke: It occurs by bleeding within the brain when a blood vessel ruptures. This type is less common but often more severe.
  • Transient Ischemic Attack (TIA): Often referred to as a "mini-stroke," TIA is a temporary disruption of blood flow to the brain, resulting in temporary symptoms similar to those of a stroke. It doesn't cause permanent damage, but it is a warning sign that should be addressed promptly.
  • Cryptogenic Stroke: When the exact cause of the stroke is unclear despite thorough evaluation. It may be related to undetected heart issues or other sources.
  • Embolic Stroke: This type of stroke is caused by an embolus, which is a blood clot or debris that travels through the bloodstream and blocks a blood vessel in the brain.

The signs and symptoms of a stroke can vary depending on the type of stroke and the area of the brain affected. It's important to recognize the common signs of a stroke and seek emergency medical attention if any of these symptoms occur suddenly. The acronym "FAST" is often used as a mnemonic to remember the signs of a stroke:

Face Drooping: One side of the face may droop or feel numb. Ask the person to smile, and check if the smile is uneven.
Arm Weakness: One arm may be weak or difficult to move. Ask the person to raise both arms and observe if one arm drifts downward.
Speech Difficulty: Speech may be slurred or difficult to understand. Ask the person to repeat a simple sentence and check for any speech abnormalities.
Time to Call Emergency Services: If you observe any of these signs, it's crucial to call emergency services immediately. Time is of the essence in stroke treatment.

  • Additional signs and symptoms of a stroke may include:
  • Sudden severe headache with no known cause.
  • Trouble walking, dizziness, loss of balance, or coordination.
  • Confusion, difficulty understanding, or trouble speaking.

The diagnostic evaluation for a suspected stroke typically involves various tests and imaging studies to determine the type of stroke, its cause, and the extent of brain damage. Common diagnostic tests for stroke include:

  • Physical Examination: The doctor will conduct a thorough examination, assessing neurological functions, strength, coordination, and reflexes.
  • Blood Tests: Blood tests may be performed to check for conditions such as clotting disorders, diabetes, and infection, which can contribute to stroke.
  • Imaging Studies: Computed Tomography (CT) Scan and MRI are performed to provide detailed images of the brain, helping to detect ischemic or hemorrhagic strokes and evaluate the extent of the damage.
  • Magnetic Resonance Angiography (MRA) and CT Angiography (CTA): These studies visualize the blood vessels in the brain, helping to identify blockages or abnormalities.
  • Electrocardiogram (ECG or EKG): An ECG can detect irregular heart rhythms (arrhythmias) that may contribute to stroke risk. Carotid Ultrasound: This test uses sound waves to create images of the carotid arteries, checking for the presence of plaque or blood clots.

  1. Whether you are having an ischemic or hemorrhagic stroke will determine the course of emergency care. The brain's blood arteries constrict or become blocked during an ischemic stroke. Brain hemorrhage occurs during a hemorrhagic stroke.
  2. Ischemic Stroke: An ischemic stroke requires prompt blood flow restoration to the brain. The following can be used to treat it.
  • IV medication for emergencies: It is necessary to administer an IV medication that breaks up clots within 4.5 hours of the onset of symptoms. It is best to provide the medication as soon as possible. Receiving treatment quickly may lessen problems and increase your chances of survival.
  • For the treatment of ischemic stroke, intravenous injection of recombinant tissue plasminogen activator (TPA) is the gold standard. Alteplase (Activase) and tenecteplase (TNKase) are the two forms of TPA. Within the first three hours, a vein in the arm is typically used to administer a TPA injection. TPA may occasionally be administered up to 4.5 hours after stroke symptoms begin.
  • By clearing up the blood clot that was causing the stroke, this medication opens up blood flow again. People may recover from strokes more fully if the stroke's cause is promptly eliminated. Your healthcare provider evaluates your risks, including possible brain hemorrhage, to decide if TPA is right for you.
  • Endovascular Therapy for Ischemic Strokes: Healthcare professionals perform endovascular procedures directly within the blocked blood vessel. These interventions, including delivering medicines directly to the brain through a catheter, aim to restore blood flow promptly.
  • Medicines and Clot Removal: A catheter, inserted through an artery in the groin, TPA is delivered directly to the brain during endovascular therapy. Alternatively, a stent retriever attached to a catheter can directly remove large clots from blocked blood vessels. This approach is particularly beneficial for individuals with clots resistant to complete dissolution with TPA. The time window for these procedures has expanded, facilitated by advanced imaging techniques like perfusion tests with CT or MRI, aiding in identifying those who may benefit from endovascular therapy.
  1. Other Procedures: The other procedures used to treat Ischemic Stroke are:
  • Carotid Endarterectomy: This surgery involves removing plaque that blocks a carotid artery, potentially lowering the risk of ischemic stroke. It's important to note that there are risks associated with this procedure, especially for individuals with heart disease or other medical conditions.
  • Angioplasty and Stents: In this procedure, a catheter is threaded through an artery in the groin to reach the carotid arteries. A balloon is then inflated to widen the narrowed artery, and a stent may be inserted to provide support for the opened artery.

Hemorrhagic Stroke: Emergency treatment for a hemorrhagic stroke focuses on managing bleeding and alleviating brain pressure from excess fluid. Here's how it's typically approached:

  • Emergency Measures: If you're on blood-thinning medication, treatments may be given to counteract its effects, such as medicines or a blood product transfusion.
  • Surgery: For large bleeding areas, surgery may be necessary to remove blood and relieve brain pressure. Surgery can also address damage to blood vessels linked to hemorrhagic strokes. Procedures like surgical clipping involve placing a tiny clamp at the base of an aneurysm to prevent it from bursting. Coiling, done through a catheter, places tiny coils in the aneurysm to block blood flow and induce clotting.
  • Surgical removal may be considered for an arteriovenous malformation (AVM), a tangle of blood vessels. Smaller accessible AVMs may be removed to eliminate rupture risk and lower the chance of hemorrhagic stroke. Stereotactic radiosurgery, a non-invasive procedure, employs focused radiation beams to repair blood vessel malformations.

  • After receiving emergency treatment, you'll be closely observed for at least a day. Following this, the focus shifts to helping you recover and regain independence. The impact of the stroke varies based on the affected brain area and the extent of damage.
  • If the right side of your brain is affected, it may impact movement and sensation on the left side of your body. Conversely, damage to the left side of the brain can affect the right side of your body and may lead to speech and language disorders.
  • Rehabilitation becomes a key part of recovery. Your healthcare professional will recommend a suitable therapy program tailored to factors like your age, overall health, and the level of disability from the stroke. Lifestyle, interests, priorities, and available support from family or caregivers are also considered.
  • Rehabilitation may start during your hospital stay and continue in a rehabilitation unit, skilled nursing facility, or even at home after discharge. Stroke recovery varies for each person, and your treatment team may include a neurologist, physiatrist, rehabilitation nurse, dietitian, physical therapist, occupational therapist, recreational therapist, speech pathologist, social worker or case manager, and a psychologist or psychiatrist. The goal is to support your unique journey towards recover.

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