Healthplus With Dr Hanna (MBBS, MRCS): Stroke


I guess by now looking at the topic of the day you may be interested to read and know more about this life-threatening condition that has claimed many lives and for those who survived has left them permanently disabled with a big hole in their pocket.
The aim of this article today is to educate more on what stroke is, its causes, symptoms, treatment and recovery process.
Stroke by definition is a condition caused by problems that affect the blood supply to the brain whereby one part of the brain is damaged by a lack of blood supply or bleeding into the brain from a burst vessel.
To function normally the brain needs oxygen and all the nutrients that are provided by the blood flowing through and to it, therefore any interruption to the supply of blood to any part of the brain for example by a blood clot leads to Stroke.
Strokes are a medical emergency and urgent treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.
There are two types of stroke- Ischemic and hemorrhagic. 
Ischemic type is caused by blood clot in the blood while hemorrhagic is caused from a burst vessel leading to bleeding in the brain.
Signs and symptoms
The main symptoms of stroke can be remembered with the word FAST: Face-Arms-Speech-Time. This acronyms are used and advertised in the UK all over media so as to create awareness to the public and also for them to act FAST and save a live.
•Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have dropped. 
•Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm. 
•Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake. 
•Time – it is time to dial an emergency number immediately if you see any of these signs or symptoms. Time is of the essence.
Other symptoms and signs may include:
•complete paralysis of one side of the body 
•sudden loss or blurring of vision  
•difficulty understanding what others are saying 
•problems with balance and co-ordination  
•difficulty swallowing (dysphagia) 
•a sudden and very severe headache resulting in a blinding pain unlike anything experienced before 
•loss of consciousness 
If you notice any of the above you ought to call an emergency number. I know there may be no coordinated number and hospitals to call in Nigeria in case of this but taking the person to a good teaching hospital or a specialist hospital that deals with stroke close by will save his/her life. Please don’t travel for hours in search of a good hospital. TIME IS OF THE ESSENCE IN ORDER TO SAVE LIFE.
Causes of stroke 
Ischaemic strokes are the most common type of stroke. They occur when a blood clot blocks the flow of blood and oxygen to the brain. 
These blood clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits known as plaques. This process is known as atherosclerosis.
As you get older, the arteries can naturally narrow, but certain things can dangerously accelerate the process. These include:
•high blood pressure (hypertension)  
•high cholesterol levels 
•an excessive alcohol intake. How I wish the drinking culture in Nigeria can be addressed.
Another possible cause of ischaemic stroke is a type of irregular heartbeat called atrial fibrillation, which can cause blood clots in the heart that break up and escape from the heart and become lodged in the blood vessels supplying the brain. 
Atrial fibrillation can have a number of different causes, including lung disease, heart valve disease, excessive alcohol intake, coronary heart disease, and an overactive thyroid gland  (hyperthyroidism). I will discuss atrial fibrillation in the future.
Hemorrhagic strokes (also known as cerebral hemorrhages or intracranial hemorrhages) are less common than ischemic strokes. They occur when a blood vessel within the skull bursts and bleeds into and around the brain.
Hemorrhagic strokes can also occur as the result of the rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly-formed blood vessels in the brain.
The main cause of hemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain and make them prone to split or rupture. I have discussed hypertension previously, please go back and read it up.
Things that increase the risk of high blood pressure include:
•being overweight or obese. Do all to remain within the acceptable weight for your height and gender.
•drinking excessive amounts of alcohol. I still can’t see any advantage of alcohol to human body, hence I don’t indulge in it.
•a lack of exercise  
•stress, which may cause a temporary rise in blood pressure. Don’t worry about what you can’t change and do all to live a simple peaceful life.
It's not possible to completely prevent strokes because some things that increase your risk of the condition cannot be changed, including:
•age – you are more likely to have a stroke if you are over 65 years old, although about a quarter of strokes happen in younger people 
•family history– if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher 
•ethnicity – if you are south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups 
•your medical history – if you have previously had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher 
However, in most cases it is possible to significantly reduce your risk of having a stroke by making lifestyle changes to avoid problems such as atherosclerosis and high blood pressure. These include:
Having a healthy diet- I will discuss this in future.
&bul l; Exercising regularly-30 mins brisk walk daily saves life.
Stopping smoking if you smoke.
Cutting down on the amount of alcohol you drink. 
As atrial fibrillation can also significantly increase your risk of having a stroke, it is also important to seek medical advice if you think you may have an irregular heartbeat. If you are diagnosed with the condition, you should talk to your doctor about the option of taking anticoagulant (blood thinning) medications to lower your stroke risk.
Diagnosis is made by doctors using physical test, blood tests, ecg, carotid ultrasound, echocardiogram and brain scans like MRI, CT scans. I will not bore you with these. The aim of this is to educate you on the causes, presentation and how to seek early treatment to avoid catastrophe.
Treatment depends on the cause of the stroke which ranges from:
anticoagulant (to thin the blood), 
to antiplatelet-also reduces blood clots, 
antihypertensive to reduce high blood pressure,
statins-to reduce cholesterol level in order to avoid narrowing of the vessels
carotid endarterectomy which is a surgical procedure to remove plaques from a narrowed artery
specialized surgery for hemorrhagic stroke 
Supportive treatment for acute phase.
In addition to the treatments mentioned above, you may also need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.
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 
Don’t worry about the treatment to be honest as this is reserved to the professional. 
Don’t patronize the nearest chemist or your nurse friend, not even your gynecology or psychiatric doctor friend if you have a strong risk factor to stroke.
See a neurologist for more information or at best use your android phone judiciously instead of looking for gossip sites.
Spread the news to your friends and families. If you know anyone whose close relative died of stroke or had a stroke, please advise such a person to please go through the causes as mentioned above and get an early diagnosis for treatable risk factors and also modify their lifestyles to reduce the risk of stroke.
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