Stroke

What is a stroke?
Strokes occur either when a blood vessel in the brain bursts (a type known as a hemorrhagic stroke) or more commonly, when a blood vessel becomes blocked (known as an ischemic stroke). Either way, unless blood flow is restored, brain cells in the area quickly die, leaving permanent disability. Sometimes, a temporary blockage occurs, causing symptoms of a stroke only briefly. Known as a transient ischemic attack (TIA), it is often a harbinger of a serious stroke.




What causes a stroke?
Blood pressure profile: High blood pressure is the primary cause of stroke. Work with your doctor to maintain an acceptable level of no more than 140/90 mm Hg. If side effects of blood pressure medications bother you, change to a different drug or use a lower dose and add another medication that works differently. Don't give up!

Cholesterol profile: As with blood pressure, find a combination of diet, exercise and medications that brings you to acceptable levels: total cholesterol less than 200 mg/dl, LDL below 130 mg/dl, and HDL above 35 mg/dl.






If you have diabetes, aim for optimum control. Again, diet, exercise and medications are the keys

If you are over 50, you are due for a baseline EKG. Your doctor may mention that you have signs of atrial fibrillation, a defective movement of the heart's upper chambers (the atria). It increases the likelihood of a stroke caused by a blood clot forming in the heart and traveling to the brain. In most cases, atrial fibrillation should be treated with the blood thinner, warfarin (Coumadin).

If you have had a TIA or stroke recently, you should also discuss with your doctor the option of having a carotid endarterectomy. This procedure involves clearing fatty plaque from one or both carotid arteries, the main arteries that run up the neck on the way to the brain. The procedure is not without risks, and the potential benefits must be carefully considered for each individual. It is more likely to be worthwhile for those with severe artery disease, and for those who have recently experienced a stroke or TIA.

What is a transient ischemic attack (TIA)?
A transient ischemic attack (TIA) is a short-lived episode (less than 24 hours) of temporary impairment to the brain that is caused by a loss of blood supply. A TIA causes a loss of function in the area of the body that is controlled by the portion of the brain affected. The loss of blood supply to the brain is most often caused by a clot that spontaneously forms in a blood vessel within the brain (thrombosis). However, it can also result from a clot that forms elsewhere in the body, dislodges from that location, and travels to lodge in an artery of the brain (emboli). A spasm and, rarely, a bleed are other causes of a TIA. Many people refer to a TIA as a "mini-stroke."

Some TIAs develop slowly, while others develop rapidly. By definition, all TIAs resolve within 24 hours. Strokes take longer to resolve than TIAs, and with strokes, complete function may never return and reflect a more permanent and serious problem. Although most TIAs often last only a few minutes, all TIAs should be evaluated with the same urgency as a stroke in an effort to prevent recurrences and/or strokes. TIAs can occur once, multiple times, or precede a permanent stroke.

A transient ischemic attack should be considered an emergency because there is no guarantee that the situation will resolve and function will return.

A TIA from a clot to the eye can cause temporary visual loss (amaurosis fugax), which is often described as the sensation of a curtain coming down. A TIA that involves the carotid artery (the largest blood vessel supplying the brain) can produce problems with movement or sensation on one side of the body, which is the side opposite to the actual blockage. An affected patient may experience paralysis of the arm, leg, and face, all on one side. Double vision, dizziness (vertigo), and loss of speech, understanding, and balance can also be symptoms depending on what part of the brain is lacking blood supply.
What are stroke symptoms?
When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage.

Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke:

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.

2. Sudden confusionor trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.

3. Sudden trouble seeing in one or both eyes

4. Sudden trouble walking, dizziness, loss of balance or coordination

5. Sudden, severe headache with no known cause

If any one of these occurs, call a heart specialist immediately. Because strokes don't cause pain, many people with minor or only fleeting symptoms adopt a "wait-and-see" approach, a mistake that can lead to permanent disability or even be fatal

What can be done to prevent a stroke?
Risk factor reduction:

High blood pressure: The possibility of suffering a stroke can be markedly decreased by controlling the risk factors. The most important risk factor for stroke is high blood pressure. When a person's blood pressure is persistently too high, roughly greater than 130/85, the risk of a stroke increases in proportion to the degree by which the blood pressure is elevated. Controlling blood pressure in the normal range decreases the chances of a stroke.
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Smoking: Another important risk factor is cigarette or other tobacco use. Cigarettes cause the carotid arteries to develop severe atherosclerosis, which can lead to their closure and block the blood flow to the brain. Atherosclerosis in general, including involvement of the arteries that supply blood to the heart, is accelerated by smoking. So, when an individual smokes, the main question becomes - which will occur first; a stroke, heart attack, or lung cancer?
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Diabetes: Another risk factor for developing a stroke is diabetes mellitus. Diabetes causes the small vessels to close prematurely. When these blood vessels close in the brain, small (lacunar) strokes may occur. Good control of blood sugar is important in decreasing the risk of stroke in diabetic patients. An elevated level of blood cholesterol is also a risk factor for a stroke due to the eventual blockage of blood vessels (atherosclerosis). A healthy diet and medications can help normalize an elevated blood cholesterol level.
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Blood thinner/warfarin: An irregular heart beat (atrial fibrillation in particular) is associated with an increased risk of an embolic stroke, in which the blood clot travels from the heart, through the bloodstream, and into the brain. Warfarin (Coumadin) is a blood "thinner" that prevents the blood from clotting. This medication is often used in patients with atrial fibrillation to decrease this risk. Warfarin is also sometimes used to prevent the recurrence of a stroke in other situations, such as with certain other heart conditions and conditions in which the blood has a tendency to clot on its own (hypercoagulable states). Patients taking warfarin need to have periodic blood checks to make sure that their current dose is producing the desired effect. Patients on warfarin also need to know that they are at increased risk for bleeding, either externally or internally.
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Aspirin and other antiplatelet therapy: Many stroke patients who do not require warfarin can use another class of medicines called "antiplatelet" drugs to reduce their risk of suffering another stroke. These medicines reduce the tendency of the blood to clot (clog) in the arteries. As a side effect, patients on these medicines usually have a higher likelihood of bleeding, but this risk is less than when taking an anticoagulant like warfarin. The most commonly prescribed first-choice antiplatelet agent for preventing a stroke recurrence is aspirin. If the patient has an adverse reaction to aspirin or has a stroke despite being on aspirin, newer antiplatelet preparations can be used [clopidogrel (Plavix), dipyridamole (Persantine).
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Carotid endarterectomy: In many cases, a person may suffer a TIA or a stroke that is caused by the narrowing or ulceration (sores) of the carotid arteries (the major arteries in the neck that supply blood to the brain). If left untreated, patients with these conditions have a high risk of experiencing a major stroke in the future. An operation that cleans out the carotid artery and restores normal blood flow is known as a carotid endarterectomy. This procedure has been shown to markedly reduce the incidence of a subsequent stroke. In patients who have a narrowed carotid artery, but no symptoms, this operation may be indicated in order to prevent the occurrence of a first stroke.
Stroke At A Glance

* Stroke is the sudden death of brain cells due to lack of oxygen.
* Stroke is caused by the blockage of blood flow or rupture of an artery to the brain.
* Sudden tingling, weakness, or paralysis on one side of the body or difficulty with balance, speaking, swallowing, or vision can be a symptom of a stroke.
* Any person suspected of having a stroke or TIA should present for emergency care immediately
* Clot-busting drugs like TPA can be used to reverse a stroke, but the time frame for their use is very narrow. Patients need to present for care as soon as possible so that TPA therapy can be considered.

Stroke prevention involves minimizing risk factors, such as controlling high blood pressure, elevated cholesterol, tobacco abuse, and diabetes

How to survive a Heart Attack when alone ?
Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. Tell as many other people as possible about this. It could save their lives!!


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