Stroke:a blow out of blue



Stroke is one of the top leading causes of death and disabilities worldwide, impact of which could be understood by the statement- “there is one new stroke every other second, every six seconds stroke killssomeone, and one in six will have stroke during his lifetime”.





Types of stroke:

It is mainly of two types,viz ischemic stroke, wherein the blood supply to the brain is blocked ,and hemorrhagicstroke, wherein the blood vessels get ruptured within the brain .

How to recognize stroke:

Stroke can be recognized by the acronym FAST(Face,Arms,Speech,and Time) -explained below:

Face – Sudden numbness or dropping of face

Arm - Weakness of Arm (or any leg)

Speech–Sudden confusion or trouble in speaking

Time: Act fast within 3 Hrs.to reduces brain damage and disability

Risk factors :
There are mainly two types of risk factors, modifiable and non-modifiable risk factors, important ones are as follow:

a) Non modifiable –
 •Age
 •Gender
 •Race/ethnicity
 •Family history
 •Genetics

b) Modifiable -
 •Arterial Hypertension
 •Transient ischemic attack
 •Prior stroke
 •Asymptomatic carotid bruit/stenosis
 •Cardiac disease
 •Diabetes mellitus
 •Dyslipidemia
 •Cigarrete smoking
 •Alcohol consumption
 •Increased fibrinogen
 •Lack of physical activity
 •Low serum folate
 •Oral contraceptive use
 •Obesity
 •Elevated homocysteine 

Diagnosis

Diagnosis is chiefly clinical aided by imaging. Sudden onset symptoms include weakness of one side of face or limbs, slurred speech difficulty swallowing, doublevision, vertigo or sensory complaints. CT scan and MRI of brain are the two diagnostic tools for evaluating stroke patients, MRI being superior to CT.

Treatments:

Treatment depends on the types of stroke but basics to all treatment is the time “time means brain “, earlier the treatment started better the result.

For ischemic stroke within golden period (< 3 Hrs.) IV TPA (Clot buster medicine) is used in selected [patients with fairly good result .Anti platelets, anticoagulantsetc. are used for secondary prophylaxis.
For hemorrhagic stroke, normalization of intracranial pressure with watch on other risk factors like hypertension, diabetesdyslipidemias, etc mainstay of treatment. Rescue surgery like hemicraniectomy may be done to allow the brain to expand and relieve the intracranial pressure.

Prevention: 

The best way to prevent a stroke is to address the underlying causes: this is best done by staying healthy which means eating a healthy diet 

 •Maintaining a healthy weight
 •Exercise regularly
 •Not smoking
 •Avoiding alcohol or moderating consumption
 •Rehabilitation  

Stroke not only has physical but emotional dimensions too,hence stroke management includes physical as well as social and emotional rehabilitation. Following are the components of stroke rehabilitation.

a) Speech therapy- to help with problems related to producing or understanding speech. Practice relaxation and changing communication style &using gestures or different tones.

b) Physical therapy- to help a person regain movement and coordination.

c) Occupational therapy: to help a person to improve their ability to carry out routine dailyactivities.

d) Joining a support group: to help with common mental health problems such as depression that can occur after stroke. Manyfind it useful to share common experiences and exchange information.

By Dr.SwayamPrakash, MD, DM (Neurology),SCE (Neurology RCP-UK)
Sr.Consultant Neurology
NeotiaGetwel HealthcareCentre

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