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Stroke
A stroke or cerebrovascular accident (CVA) occurs when the blood
supply to a part of the brain is suddenly interrupted by occlusion (an
ischemic stroke) or by hemorrhage (a hemorrhagic stroke). The latter
occur when a blood vessel in the brain bursts, spilling blood into the
spaces surrounding the brain cells or when a cerebral aneurysm
ruptures.
Overview
The ischemic stroke is usually caused by atherosclerosis
(hardening) of blood vessels, embolus (a piece of blood clot
originating from atherosclerotic plaque or heart) or small artery
disease (the occlusion of small cerebral vessels by the influence of
such presumed factors as diabetes mellitus, elevated blood lipid
levels, hypertension and cigarette smoking).
The symptoms of stroke are usually easy to spot: sudden numbness or
weakness, especially on one side of the body; sudden confusion or
trouble speaking or understanding speech; sudden trouble seeing in one
or both eyes; sudden trouble walking; dizziness; or loss of balance or
coordination. Despite this, it is possible for someone to have a minor
stroke and discover it anywhere from hours to years later.
Brain cells die when they no longer receive oxygen and nutrients
from the blood or when they are damaged by sudden bleeding into or
around the brain. These damaged cells can linger in a compromised
state for several hours. With timely treatment, these cells can be
saved.
Stroke is diagnosed through several techniques: a short
neurological examination, blood tests, CT scans, MRI scans, Doppler
ultrasound, and arteriography. Stroke seems to run in some families.
Family members may have a genetic tendency for stroke or share a
lifestyle that contributes to stroke. The most important risk factors
for stroke are hypertension, heart disease, diabetes, and cigarette
smoking. Other risks include heavy alcohol consumption, high blood
cholesterol levels, illicit drug use, and genetic or congenital
conditions. Some risk factors for stroke apply only to women. Primary
among these are pregnancy, childbirth, and the menopause and treatment
thereof (HRT).
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Treatment
Generally, there are three treatment stages for stroke: prevention,
therapy immediately after stroke, and post-stroke rehabilitation.
Therapies to prevent stroke are based on treating underlying risk
factors. Acute stroke therapies try to stop a stroke while it is
happening. Post-stroke rehabilitation is to overcome disabilities that
result from stroke damage. Medication or drug therapy is the most
common treatment for stroke. Surgery can be used to prevent stroke, to
treat acute stroke, or to repair vascular damage or malformations in
and around the brain. For most stroke patients, physical therapy is
the cornerstone of the rehabilitation process. Another type of therapy
involving relearning daily activities is occupational therapy (OT). OT
also involves exercise and training to help the stroke patient relearn
everyday activities such as eating, drinking and swallowing, dressing,
bathing, cooking, reading and writing, and toileting. Speech therapy
is appropriate for patients who have no deficits in cognition or
thinking, but have problems understanding speech or written words, or
problems forming speech.
Prognosis
Although stroke is a disease of the brain, it can affect the entire
body. Some of the disabilities that can result from stroke include
paralysis, cognitive deficits, speech problems, emotional
difficulties, daily living problems, and pain. If the stroke is severe
enough, coma or death can result.
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