Stroke is a serious life-threatening medical condition. It occurs when the
blood supply to any part of brain is disrupted.
It may also be defined as the clinical syndrome of rapid onset of cerebral
deficit lasting more than 24 hours or leading to death with no apparent cause
other than a vascular one.
It is a rapid loss of brain function due to the disturbance in the blood
supply to brain. It happens when blood flow to a part of the brain stops, and it is
sometimes called a "Brain Attack".
TYPES OF STROKE:
There are mainly two types of stroke: Ischemic stroke and Hemorrhagic
stroke.
Ischemic Stroke:
it is a type of stroke that occurs due to Thrombus or Embolus. 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).
Hemorrhagic Stroke
It is type of stroke which is caused by the leaking or bursting of arteries in
the brain. Approximately, 15% of all strokes are Hemorrhagic strokes.
The ruptures can be caused by conditions such as hypertension, trauma,
blood-thinning medications, and aneurysms (weaknesses in blood vessel walls).
DIAGNOSIS OF STROKE:
Diagnosis of stroke is typically involved a combination of medical history
assessment, physical examination, and diagnostic tests. Medical history involves
the patients' symptoms, past medical history, and risk factors of stroke including
cardiac disease, hypertension, diabetes mellitus, smoking, or family history of
stroke. whereas physical examination involves in the assessment of neurological functions such as checking for weakness or numbness in the face, arms or legs,
difficulty in speaking and understanding speech, and coordination problems. On
the other hand, some diagnostic tests will be helpful lo diagnose stroke. These
include the following tests.
Computed Tomography (CT) Scan
imaging tests such as a CT scan or MRI scan of the brain can provide
detailed images lo identify areas of bleeding or blockage in the blood vessels.
During CT scan, a series of X-rays that can show hemorrhages, strokes, tumors,
and other conditions within the brain.
Magnetic Resonance Imaging (MRI)
In this scanning, radio waves and magnets create an image of the brain to
detect damaged brain tissue.
Carotid Doppler (CD) or Carotid Ultrasound
It is a type of ultrasound which uses sound waves to create images of the
carotid arteries in the neck, which supply blood to the brain. It can detect
narrowing or blockages in these arteries, which can increase the risk of stroke.
Electrocardiograph (ECG)
This test measures the electrical activity of the heart and can identify
irregular heart rhythms (arrhythmias) that may have caused a stroke. It is a
detailed image of the heart to check for any sources of clots that could have
travelled to the brain to cause a stroke.
Transthoracic echocardiogram (TTE)
Transthoracic echocardiogram (TIE) is a non-invasive imaging technique
used to assess the structure and function of the heart by generating ultrasound
images of the heart from the chest wall.
Transcranial Doppler (TCD)
Transcranial Doppler (TCD) is a non-invasive diagnostic technique used to
assess blood flow velocity in the major intracranial arteries. It involves the use of
ultrasound technology to measure the velocity of blood flow through the arteries
in the brain.
TREATMENT:
Treatment goals include:
reduce ongoing neurologic injury
Decrease mortality
Decrease long-term disability
Prevent complications and neurologic dysfunction
Prevent stroke recurrence
Ischemic Stroke Treatment
Alteplase initiated within 3 to 4.5hr of symptoms 0.9 mg/kg (max 90mg)
infuse over 1 hour, with 10% of dose as bolus over 1 min.
Aspirin 160-325 mg/ day started between 24-48 hours after completion of
Alteplase
Secondary Prevention of Stroke Treatment
Non-cardioembolic
• Aspirin 50-325 mg/ day
• Clopidogrel 75mg/ day
• Aspirin 25 mg + Dipyridamole (XR) 200mg twice daily
Cardioembolic (Atrial Fibrillation)
• warfarin (JNR =2.5)
For Atherosclerosis
• Statins
Hemorrhagic Stroke Treatment
Manage BP and intracranial Pressure (ICP)
For Subarachnoid Hemorrhage (SAH)
Nimodipine 60mg Q4H for 21 days
In DVT Prophylaxis
Enoxaparin
Heparin
NOTE: self medication is strictly prohibited. This is just a general guideline. Visit your doctor before taking any medication.
REFERENCES:
https://medlineplus.gov/stroke.html Assessed and Endorsed by the MedReport Medical Review Board