Stroke rehabilitation can help you regain independence and improve your quality of life. The severity of stroke complications and each person's ability to recover lost abilities varies widely. Researchers have found that the central nervous system is adaptive and can recover some functions.
Strokes occur due to problems with the blood supply to the brain: either the blood supply is blocked or a blood vessel within the brain ruptures. When this happens, the brain does not get enough oxygen or nutrients which cause brain cells to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.
How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability.
A stroke is a medical emergency, and treatment must be sought as quickly as possible. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.
There are three main kinds of stroke:
Transient ischemic attacks (TIAs), also referred to as mini-strokes
Ischemic stroke is the most common form of stroke, accounting for around 85% of strokes. This type of stroke is caused by blockages or narrowing of the arteries that provide blood to the brain, resulting in ischemia - severely reduced blood flow.
These blockages are often caused by blood clots, which can form either in the arteries connecting to the brain, or in other blood vessels before being swept through the bloodstream and into narrower arteries within the brain. Clots can be caused by fatty deposits within the arteries called plaque.
The most common ischemic strokes include:
Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.
Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes.
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain haemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension), overtreatment with anticoagulants and weak spots in your blood vessel walls (aneurysms).
A less common cause of haemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation) present at birth. Types of hemorrhagic stroke include:
Intracerebral haemorrhage. In an intracerebral haemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and also damaged.
High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an intracerebral haemorrhage.
Subarachnoid haemorrhage. In a subarachnoid haemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signalled by a sudden, severe headache.
A subarachnoid haemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped out-pouching on an artery known as an aneurysm. After the haemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.
Transient ischemic attack (TIA)
TIAs are different from the aforementioned kinds of stroke because the flow of blood to the brain is only briefly interrupted. TIAs are similar to ischemic strokes in that they are often caused by blood clots or other debris.
TIAs should be regarded as medical emergencies just like the other kinds of stroke, even if the blockage of the artery is temporary. They serve as warning signs for future strokes and indicate that there is a partially blocked artery or clot source in the heart.
According to the Centres for Disease Control and Prevention (CDC), over a third of people who experience a TIA go on to have a major stroke within a year if they have not received any treatment. Between 10-15% will have a major stroke within 3 months of a TIA.
Symptoms of Stroke
Strokes occur quickly and, as such, symptoms of stroke often appear suddenly without warning.
The main symptoms of stroke are as follows:
Confusion, including trouble with speaking and understanding
Headache, possibly with altered consciousness or vomiting
Numbness of the face, arm or leg, particularly on one side of the body
Trouble with seeing, in one or both eyes
Trouble with walking, including dizziness and lack of co-ordination.
Strokes can lead to long-term problems. Depending on how quickly it is diagnosed and treated, the patient can experience temporary or permanent disabilities in the aftermath of a stroke. In addition to the persistence of the problems listed above, patients may also experience the following:
Bladder or bowel control problems
Pain in the hands and feet that gets worse with movement and temperature changes
Paralysis or weakness on one or both sides of the body
Trouble controlling or expressing emotions.
How To Diagnose A Stroke
Strokes happen fast and will often occur before an individual can be seen by a doctor for a proper diagnosis.
The acronym F.A.S.T. is a way to remember the signs of stroke, and can help identify the onset of stroke more quickly:
Face drooping: if the person tries to smile does one side of the face droop?
Arm weakness: if the person tries to raise both their arms does one arm drift downward?
Speech difficulty: if the person tries to repeat a simple phrase is their speech slurred or strange?
Time to call: if any of these signs are observed, contact the emergency services.
The faster a person with suspected stroke receives medical attention, the better their prognosis and the less likely they will be to experience lasting damage or death.
In order for a stroke patient to get the best diagnosis and treatment possible, they will need to be treated at a hospital within 3 hours of their symptoms first appearing.
Both ischemic strokes and hemorrhagic strokes require different kinds of treatment. Unfortunately, it is only possible to be sure of what type of stroke someone has had by giving them a brain scan in a hospital environment.
There are several different types of diagnostic tests that doctors can use in order to determine which type of stroke has occurred:
Physical examination: a doctor will ask about the patient's symptoms and medical history. They may check blood pressure, listen to the carotid arteries in the neck and examine the blood vessels at the back of the eyes, all to check for indications of clotting
Blood tests: a doctor may perform blood tests in order to find out how quickly the patient's blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection
CT scan: a series of X-rays that can show haemorrhages, strokes, tumours and other conditions within the brain
MRI scan: radio waves and magnets create an image of the brain to detect damaged brain tissue
Carotid ultrasound: an ultrasound scan to check the blood flow of the carotid arteries and to see if there is any plaque present
Cerebral angiogram: dyes are injected into the brain's blood vessels to make them visible under X-ray, in order to give a detailed view of the brain and neck arteries
Echocardiogram: a detailed image of the heart is created to check for any sources of clots that could have travelled to the brain to cause a stroke.
Treatments for stroke
Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a haemorrhagic stroke that involves bleeding into the brain.
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
Emergency treatment with medications. Therapy with clot-busting drugs must start within 3 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:
Aspirin. Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.
Intravenous injection of tissue plasminogen activator (TPA). Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it's given in the vein.
TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.
Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible, depending on features of the blood clot:
Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but is still limited.
Mechanical clot removal. Doctors may use a catheter to manoeuvre a tiny device into your brain to physically break up or grab and remove the clot.
However, recent studies suggest that for most people, delivering medication directly to the brain (intra-arterial thrombolysis) or using a device to break up or remove clots (mechanical thrombectomy) may not be beneficial. Researchers are working to determine who might benefit from this procedure.
Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by fatty deposits (plaques). Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation:
Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaques that block the carotid artery.
Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
Angioplasty and stents. In an angioplasty, a surgeon gains access to your carotid arteries most often through an artery in your groin. Here, he or she can gently and safely navigate to the carotid arteries in your neck. A balloon is then used to expand the narrowed artery. Then a stent can be inserted to support the opened artery.
Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.
Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.
Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.
Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke:
Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently haemorrhaged.
Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it's large or located deep within your brain.
Intracranial bypass. In some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations.
Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated area in a hospital staffed by nurses and therapists with experience in stroke treatment. It has been shown that people admitted to a stroke unit have a higher chance of surviving than those admitted elsewhere in hospital, even if they are being cared for by doctors without experience in stroke.
Stroke recovery and rehabilitation
Following emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged.
If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders.
In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision.
Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Every person's stroke recovery is different. Depending on your condition, your treatment team may include:
Doctor trained in brain conditions (neurologist)
Rehabilitation doctor (physiatrist)
Psychologist or psychiatrist
Preventing A Stroke
The best way to prevent a stroke is to address the underlying causes. This is best done by living healthily, which means:
Eating a healthy diet
Maintaining a healthy weight
Avoiding alcohol or moderating consumption.
Eating a healthy diet means getting plenty of fruits, vegetables and healthy whole grains, nuts, seeds and legumes; eating little or no red or processed meat; limiting intake of cholesterol and saturated fat (typically found in foods of animal origin); and minimizing salt intake so as to support healthy blood pressure.
Other measures taken to help reduce the risk of stroke include:
Keeping blood pressure under control
Managing diabetes well
Treating obstructive sleep apnea (if present).
As well as these lifestyle changes, a health care provider can help to reduce the risk of future strokes through prescribing anti-coagulant and anti-platelet medication. In addition to this, the arterial surgery previously mentioned can also be used to lower the risk of repeat strokes.
When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear.
If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.
Many factors can increase your risk of a stroke. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:
Lifestyle risk factors
Being overweight or obese
Heavy or binge drinking
Use of illicit drugs such as cocaine and methamphetamines
Medical risk factors
High blood pressure — the risk of stroke begins to increase at blood pressure readings higher than 120/80 millimetres of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
Cigarette smoking or exposure to second-hand smoke.
Obstructive sleep apnea — a sleep disorder in which the oxygen level intermittently drops during the night.
Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.
Other factors associated with a higher risk of stroke include:
Personal or family history of stroke, heart attack or transient ischemic attack.
Being age 55 or older.
Race — African-Americans have a higher risk of stroke than do people of other races.
Gender — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. Also, they may have some risk from some birth control pills or hormone therapies that include estrogen, as well as from pregnancy and childbirth.
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:
Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities hampered by paralysis, such as walking, eating and dressing.
Difficulty talking or swallowing. A stroke may cause you to have less control over the way the muscles in your mouth and throat move, making it difficult for you to talk clearly (dysarthria), swallow or eat (dysphagia). You also may have difficulty with language (aphasia), including speaking or understanding speech, reading or writing. Therapy with a speech and language pathologist may help.
Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.
Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
Pain. People who have had strokes may have pain, numbness or other strange sensations in parts of their bodies affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.
People also may be sensitive to temperature changes, especially extreme cold after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments.
Changes in behaviour and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores.
As with any brain injury, the success of treating these complications will vary from person to person.
Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.
Here are some key points about stroke.
During a stroke, the brain does not receive enough oxygen or nutrients, causing brain cells to die.
There are three main kinds of stroke: ischemic strokes, hemorrhagic strokes and transient ischemic attacks.
Ischemic strokes are caused by a narrowing or blocking of arteries to the brain.
Hemorrhagic strokes are caused by blood vessels in and around the brain bursting or leaking.
Strokes need to be diagnosed and treated as quickly as possible in order to minimize brain damage.
Treatment depends on the type of stroke.
Ischemic strokes can be treated with 'clot-busting' drugs.
Hemorrhagic strokes can be treated with surgery to repair or block blood vessel weaknesses.
The most effective way to prevent stroke is through maintaining a healthy lifestyle.
Stroke is also more likely to affect people if they are overweight, aged 55 or older, have a personal or family history of stroke, do not exercise much, drink heavily, smoke or use illicit drugs.
....making effort to "STAYWELL"
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