Stroke

• A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients.
• Brain cells begin to die within minutes, making it a medical emergency.

Types of Strokes

1. Ischemic Stroke:

   • Caused by a blockage in an artery supplying blood to the brain.
     1. Thrombotic Stroke: Blood clot forms in an artery supplying the brain.
     2. Embolic Stroke: Blood clot or debris forms elsewhere in the body and travels to the brain.

2. Hemorrhagic Stroke:

   • Caused by bleeding in the brain.
     1. Intracerebral Hemorrhage: Bleeding within the brain tissue.
     2. Subarachnoid Hemorrhage: Bleeding in the space between the brain and the surrounding membrane.

3. Transient Ischemic Attack (TIA):

   • Often called a mini stroke, it’s a temporary period of symptoms similar to those of a stroke.

Causes

1. Ischemic Stroke: Atherosclerosis, heart disease, atrial fibrillation, high blood pressure, high cholesterol.
2. Hemorrhagic Stroke: Hypertension, aneurysms, arteriovenous malformations (AVMs), head injury, blood-thinning medications.

Symptoms

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Sudden confusion, difficulty speaking, or trouble understanding speech.
• Sudden difficulty seeing in one or both eyes.
• Sudden difficulty walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.

Diagnosis

1. Physical Examination: Neurological examination to assess symptoms.
2. Imaging Tests:
   • CT Scan: Quickly identifies bleeding in the brain.
   • MRI: Provides detailed images of brain tissue and blood vessels.
   • Carotid Ultrasound: Shows narrowing or blockage in the carotid arteries.
3. Blood Tests: To determine clotting factors, blood sugar, and other relevant parameters.
4. Cerebral Angiography: Visualizes the brain’s blood vessels.

Pathophysiology of Stroke

1. Ischemic: Blockage of a blood vessel supplying the brain, usually due to a blood clot, leading to tissue ischemia and infarction.
2. Hemorrhagic: Rupture of a blood vessel causing bleeding in or around the brain, leading to increased intracranial pressure and tissue damage.
3. Neuronal Injury: Lack of oxygen and nutrients results in neuronal death and brain damage.

Treatment

1. Ischemic Stroke:

   • Clot-Busting Medications: Intravenous tissue plasminogen activator (tPA) within a few hours of symptom onset.
   • Endovascular Procedures: Mechanical thrombectomy to remove the clot.
   • Antiplatelet Agents: Aspirin or clopidogrel to prevent further clots.
   • Anticoagulants: For patients with atrial fibrillation or other risk factors.

2. Hemorrhagic Stroke:

   • Emergency Measures: Controlling bleeding, reducing intracranial pressure.
   • Surgical Interventions: Repairing blood vessel anomalies or removing the blood clot.
   • Medications: To control blood pressure, prevent seizures, and manage symptoms.

3. Rehabilitation:

   • Physical Therapy: To improve motor skills and mobility.
   • Occupational Therapy: To regain skills for daily activities.
   • Speech Therapy: To improve communication and swallowing.
   • Supportive Care: Psychological support and counseling for patients and families.

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