Stroke is easily preventable; we have a long way to go, as it remains one of the leading and alarming causes of death worldwide.
Today stroke is the Number 2 cause of death in both developed and developing countries of the world, and the leading cause of adult disability in the world.
Every year in this country alone nearly 16 lakh people suffer from strokes, of which at least 1/3 are affected by some form of deformity.
It is also a major cause for loss of life, limbs and speech in India.
Experts say that almost 80% stroke cases in the world would occur in low and middle income countries mainly India and China.
< Weakness of the face, arm, and/or leg on one side of body
< Numbness in the face, arm, and/or leg on one side of body
< Inability to understand spoken language
< Inability to speak
< Inability to write
< Vertigo and/or gait imbalance
< Double vision
< An unusually severe headache
1. Ischemic Stroke
A stroke caused by a blood clot is called an ischemic stroke due to the lack of blood supply, oxygen and vital nutrients, to a region of brain tissue, or, it may be the result of vasospasm.
2. Haemorrhagic Stroke
Sometimes the rupture of a brain aneurysm causes bleeding. Extreme changes in blood pressure may trigger the rupture of a brain aneurysm causing a haemorrhagic stroke. Sometimes a region of the brain that has been damaged by ischemia can bleed within the first few days after a stroke, causing a secondary haemorrhage.
3.Transient ischemic attack (TIA)
Neurologic dysfunction caused by ischemia (loss of blood flow) – without acute infarction (tissue death), are often referred to as mini-strokes or mega-strokes. Symptoms caused by a TIA resolve in 24 hours or less. TIAs cause the same symptoms associated with stroke, such as contra lateral paralysis (opposite side of body from affected brain hemisphere) or sudden weakness or numbness. A TIA may cause sudden dimming or loss of vision (amaurosis fugax), aphasia, slurred speech (dysarthria) and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or within 24 hours. Brain injury may still occur in a TIA lasting only a few minutes. Having a TIA is a risk factor for eventually having a stroke or a silent stroke.
People who suffer ischemic strokes have a much better chance for survival than those who experience hemorrhagic strokes.
< Getting involved in rehabilitation as early as possible makes a big difference in recovery.
< Stroke rehabilitation programs include physical and occupational therapy to help patients regain motor skills
< A proper stroke rehabilitation program helps patients regain control of their lives and relearn skills lost as a result of the stroke.
< Many stroke patients are able to live and function normally after a stroke with a successful rehab program.
< Eat a healthy, well-balanced diet. A nutritious diet will help the body regain strength and promote healing.
Risk factors for recurrence include:
< Older age
< Evidence of blocked arteries (a history of coronary artery disease, carotid artery disease, peripheral artery disease, ischemic stroke, or TIA)
< Hemorrhagic or embolic stroke
< Valvular heart disease
< Atrial fibrillation
Effective treatment of stroke can prevent long-term disability and save lives. Treatment will usually involve taking one or more different medications, although some people may also need surgery.
1.Treating ischemic strokes: A combination of medications will usually be recommended to treat the condition and prevent it from happening again.Some of these medications will need to be taken immediately and only for a short time. Others may only be started once the stroke has been treated and may need to be taken in the long-term.
2.Treating haemorrhagic strokes: Some people who have had a haemorrhagic stroke will also be offered medication, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.Taking anticoagulant medication before onset of stroke may need treatment to reverse the effects of the medication and reduce risk of further bleeding.
In addition to the treatments mentioned above, further short-term treatment to help manage some of the problems may be needed.
For example, you may require:
< A feeding tube inserted into your stomach through your nose (nasogastric tube) to provide nutrition if you have difficulty swallowing (dysphagia)
< nutritional supplements if you are malnourished
< fluids given directly into a vein (intravenously) if you are at risk of dehydration
< oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood.
3. Stroke Physiotherapy: Stroke Physiotheraphy plays an important role in the process of rehabilitation, or stroke management (recovery of normal movements). A physiotherapist will assess the stroke survivor and plan. The stroke physical therapy rehabilitation program involves.The whole rehabilitation program is predicated on two general components.The first includes preventive measure targeted at maintaining physical integrity and minimizing complications. These measures should begin immediately post stroke and continue as long as necessary.The second component is restorative treatment aimed at promoting functional recovery. This phase should begin as soon as the patient is medically and neurologically stable and is able to participate actively in the programme.
Medical history, physical examination and several tests may have to be conducted to find the possible causes and to determine the most appropriate course of medication. The tests would include several blood test, computerized tomography (CT) scan, Magnetic resonance imaging (MRI), Carotid ultrasound. Cerebral angiogram. Echocardiogram. (clear, detailed ultrasound images of your heart).
Primary stroke prevention refers to the treatment of individuals with no history of stroke. Secondary stroke prevention refers to the treatment of individuals who have already had a stroke or transient ischemic attack.
New recommendations include the following:
< Use of new oral anticoagulants, including dabigatran, apixaban, and rivaroxaban, in patients with nonvalvular atrial fibrillation
< Home self-monitoring of blood pressure in hypertensive patients
< Use of nonestrogen oral contraceptives in female patients with migraine with aura
< All patients should follow the Mediterranean diet supplemented with nuts and reduce sodium intake
< Screening for sleep apnea
< Smoking cessation
Modifiable risk factors include the following:
< Cigarette smoking
< Atrial fibrillation
< Sickle cell disease
< Postmenopausal HRT
< Diet and activity
< Weight and body fat
Secondary Prevention of Stroke-summarized, as follows:
A – Antiaggregants (aspirin, clopidogrel, extended-release dipyridamole, ticlopidine) and anticoagulants (warfarin)
B – Blood pressure–lowering medications
C – Cessation of cigarette smoking, cholesterol-lowering medications, carotid revascularization
D – Diet
E – Exercise
Here are eight ways to start reining in risks today, before a stroke has the chance to strike.
1. Lower blood pressure.
2. Lose weight.
3. Exercise more.
4. Drink—in moderation.
5. Take a baby aspirin.
6. Treat atrial fibrillation.
7. Treat diabetes.
8. Quit smoking.
< During the first few months after a stroke, family caregivers must quickly learn how to care for the stroke survivor in the home setting.
< Follow the strategies that address the needs and concerns of stroke victim and deal with them accordingly.
< Concerns, strategies, and advice of family caregivers of stroke survivors during the first 6 months after hospital discharge must be taken into consideration for ongoing care.
< The use of this list of strategies and advice, may help to identify relevant areas for caregiver intervention.
< (C) 2002 American Association of Neuroscience Nurses