Introduction

Stroke is defined as rapidly developing clinical signs of disorder of cerebral function lasting more than 24 hours with no apparent cause other than one of vascular origin. It may be caused by a hemorrhage secondary to arterial rupture, but mostly the cause is ischemia which occurs if the blood supply to the brain is cut off, due to an embolus or thrombosis blocking an artery. As neurons are starved of oxygen, they rapidly begin to die and the brain becomes damaged at the site of attack. Body functions such as speech, movement, vision and memory may be affected within minutes. If the symptoms disappear within 24 hours, the condition is defined as a Transient Ischemic Attack (TIA).

A stroke is a sudden stoppage in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke). Other strokes are caused by bleeding into brain tissue when a blood vessel bursts (hemorrhagic stroke). Because stroke occurs rapidly and requires immediate treatment, stroke is also called a brain attack. When the symptoms of a stroke last only for a short time (less than an hour), it is called a transient ischemic attack (TIA) or mini-stroke. Stroke has many consequences.

The effects of stroke depend on which part of the brain is injured, and how severely it is injured. Strokes may cause sudden weakness, loss of sensation, or difficulty with speaking, seeing, or walking. Since different parts of the brain control different areas and functions, it is usually the area immediately surrounding the stroke that is affected. Sometimes people with stroke have a headache, but stroke can also be completely painless. It is very important to realize the warning signs of stroke and to get immediate medical attention if they occur.

The most usual sign of stroke is sudden weakness of the face, arm or leg, most often on one side of the body.

Other warning signs can include:

How a Stroke is diagnosed:

If you have had a stroke, or have had stroke warning signs or risk factors, it is very important to look for prompt medical attention. Your doctor will work with you to find the cause of the problem and decide the best treatment. Even if your symptoms resolve without treatment, you should still discuss them with your doctor. Don't assume that a problem is not that important if it goes away on its own. Never try to make a diagnosis by yourself.

The first step in understanding your problem is to get a careful medical history. Your doctor will question about your situation. If you can't communicate, a family member or friend will be asked to provide the information. Your doctor will ask about the symptoms you are having now and have had in the past, previous medical problems or operations and any illnesses which run in your family. Be sure to show a current list of all the medicines you take (prescription and non-prescription). If your symptoms lasted only a while, your doctor might also want to talk with someone else who was with you at the time.

The next step would be a thorough physical examination. The doctor will check your pulse and blood pressure, and examine the rest of your body (heart, lungs, etc). The neurological examination includes detailed tests of your muscles and nerves. The doctor will check your strength, sensation, coordination and reflexes. In addition, you will be asked questions to check your memory, speech and thinking.

Depending on the results of the evaluation, the doctor may need additional tests to fully understand your problem.

You may also be referred to a medical specialist in brain disorders (neurologist), brain surgery (neurosurgery) or another area.

Be patient. Sometimes it takes a while to discover the cause of stroke symptoms, and sometimes the cause of a stroke cannot be determined.

Be sure to discuss any questions or concerns with your doctor or health care provider.

 

The treatment of stroke can be divided into two main types: treatment given as soon as possible after stroke onset, surgery and rehabilitation.

Treatment given as soon as possible after onset:
As soon as the patient arrives at hospital, tests are normally given to verify the type of stroke that the person has experienced. These tests usually include a brain scan called a CT-SCAN. The patient may be given treatment to support essential life functions such as breathing, to reduce pain and stress, and to maintain sodium, potassium and calcium in their body fluids and eventually infections and fever may be treated.

Medications are also given soon after the stroke has occurred including blood clot-dissolving drugs and drugs that prevent further blood clotting.

Blood clot-dissolving drugs:
Drugs that dissolve blood clots, such as tissue plasminogen activator (t-PA), are given to patients who have suffered an ischemic stroke, and can administered up to 3 hours after the stroke. Patients who receive t-PA have a significantly good chance of functional improvement compared with people who are not given the drug. Patients receiving t-PA do have a slightly higher risk of dying from hemorrhage, but the benefits of the drug are believed to outweigh this risk.

Drugs that prevent further clotting:
To prevent the progression of stroke symptoms heparin (a blood-thinning drug) and vitamin K antagonists (warfarin) are often used. Furthermore, people who have experienced an ischemic stroke are often treated with aspirin which prevents the aggregation of blood platelets.

Rehabilitation:
In addition to drug treatments and surgery, rehabilitation is an important part of the treatment of a person who has had a stroke. Stroke affects different parts of the brain in each individual, and so the rehabilitation program that a person follows will very much be specific to their needs. The patient may need physical, speech, language, and occupational therapy. In addition the person may need counseling and drugs to help treat other illnesses secondary to the stroke, such as depression. The support of medical staff, family and friends is also important in order to maintain or improve the condition.