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Stroke

Index

• What it is
• Signs and symptoms
• Transmission
• Diagnosis
• Prevention
• Treatment
• Prognosis
• Epidemiology

Stroke

Stroke (or cerebral stroke) is a vascular accident that occurs when there is a low blood perfusion in one part of the brain that causes cell death. Commonly, this reduced perfusion is necessary for the formation of a thrombus that occludes a cerebral artery, preventing the blood from reaching the various districts. The outcomes of ischemic stroke expand a second affected area and, in particular, the extent of the ischemic brain area. A differentiation from ischemic stroke is hemorrhagic stroke, commonly called cerebral hemorrhage, which can lead to a similar symptomatology and similar outcomes, but treatment in the acute phase is completely different.

The most common type of stroke occurs when a blood vessel in the neck or brain is blocked (Wallace, 2016). The blockage can be caused by the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body, such as the heart to the brain, called embolism; or a severe narrowing of an artery in or leading to the brain, called stenosis. It is believed that this increase in strokes among younger adults is caused by the same lifestyle factors associated with stroke in older individuals (i.e., hypertension, hypercholesterolemia, diabetes, smoking, and obesity).

Hemorrhagic stroke

A pathological condition also known as cerebral hemorrhage, consists in the loss and significant accumulation of blood in the brain tissues due to the rupture of blood vessels; this accumulation of blood affects the function of the brain tissues themselves. From a physiopathological point of view, cerebral hemorrhages are mainly divided into intraparenchymal hemorrhage and atraumatic hemorrhage in the subarachnoid space.

Signs and symptoms

Signs and symptoms of hemorrhagic stroke: Patients with intracerebral hemorrhage are more likely to have headaches, impaired mental status, seizures, nausea and vomiting, and/or marked hypertension than those with ischemic stroke. Most, if not all, intracranial and subarachnoid hemorrhages are characterized by focal neurological deficits. The type of deficit depends on the area of the brain involved.

The five common signs and symptoms of stroke are sudden numbness or weakness of the face, arm, or leg; sudden confusion or trouble speaking or trouble understanding others; sudden trouble seeing in one or both eyes; sudden dizziness, trouble walking, or loss of balance or coordination; and sudden severe headache with no known cause (CDC, 2015). Sometimes the warning signs may last a short time and go away. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes” (NINDS, 2016). They indicate an underlying serious health condition. Immediate action is required to treat the individual and limit the disability caused by stroke.

Diagnosis and prevention

Laboratory tests should include a complete blood count, a metabolic panel and, especially in patients taking oral anticoagulants, clotting status (i.e., prothrombin time or international normalized INR ratio and activated thromboplastin part time). Programs should be offered to reduce the risk factors associated with stroke including screening and monitoring for hypertension.