Stroke (aka cerebrovascular accident, CVA) is the brain version of a heart attack, and is where there is disturbance in blood supply to an area of the brain.
Patient information
What is a stroke?
It's the brain version of a heart attack. So remember, a heart attack is when there's not enough blood supplying the heart. So for a brain attack, there's not enough blood supplying the brain.
What, that sounds a bit like a TIA, what's the difference?
TIA is a temporary version of stroke. So it's a bit like the angina of stroke. And just like how heart attack causes permanent damage, so does stroke.
Sx
Loss of function supplied by the relevant area of the brain, including:
Contralateral paralysis (i.e. inability to move limbs)
Sudden weakness or numbness
Amaurosis fugax (i.e. sudden dimming or loss of vision)
Homonymous hemianopia (loss of vision on 1 side)
Receptive aphasia (i.e. failure to understand) or expressive aphasia (i.e. failure to express language)
Dysarthria (i.e. slurred speech)
Vertigo (feeling like the world is spinning)
Mental confusion
Sx often appear soon after the stroke has occurred
If Sx last <2 hours, it is known as TIA (transient ischemic attack)
Patient information
What's going to happen in a stroke then?
Any and everything the brain controls, can be affected. It can be weakness in movement. Loss of vision. Loss of ability to understand, or to speak. Feeling confused.
Pathophysiology
It results in pat of the brain not functioning properly, including:
Middle cerebral artery (MCA) is one of the major paired arteries that supply brain to the cerebrum, but not considered apart of the Circle of Willis per se
Classification
Ischemic stroke, where blood supply to part of the brain is decreased, causing dysfunction of brain tissue in that area. This can happen because:
Thrombosis (obstruction of a blood vessel by a blood clot forming locally), called thrombotic stroke
Embolism (aka embolic stroke), caused by an arterial embolism (i.e. blockage of an artery), by an embolus from elsewhere in the body. This can be caused by:
The heart, most commonly, especially in Fib, including:
Atrial fibrillation and paroxysmal atrial fibrillation
Rheumatic disease of the mitral or aortic valve disease
Artificial heart valves, known as cardiac thrombus of the atrium or ventricle
Sick sinus syndrome
Sustained atrial flutter
Recent MI
Chronic myocardial infarction together w/ EF<28%
Sx CHF w/ EF<30%
Dilated cardiomyopathy
Libman-Sacks endocarditis
Marantic endocarditis
Infective endocarditis
Papillary fibroelastoma
L atrial myxoma
CABG (coronary artery bypas graft) surgery
Paradoxical embolism, where a DVT embolizes through an atrial or ventricular septal defect in the heart into the brain
Systemic hypoperfusion (general decrease in blood supply, e.g. in shock), called cerebral hypoperfusion
Venous thrombosis
Hemorrhagic stroke (i.e. bleeding), caused by bleeding of blood vessels of the brain, either:
Directly into brain parenchyma, called intracerebral hemorrhage
Into surrounding subarachnoid space (i.e. space surrounding brain tissue)
Silent stroke (see page)
Patient information
What causes not enough brain to get to the brain?
A blood clot, preventing blood from getting to the brain. Or a bleed in the brain, so blood can't get to where it's supposed to, in the brain.
Risk factors
Old age
Hypertension
Previous stroke or TIA
Diabetes
Hypercholesterolemia
Tobacco smoking
Atrial fibrillation
Patient information
What makes it more likely for not enough blood getting to the brain?
It's the same stuff that's bad for your heart. So high blood pressure. Diabetes. High cholesterol. Smoking. And of course, a previous episode of stroke.
Tx
Stroke rehabilitation, is Tx to recover any lost function, ideally in a stroke unit, involving a team approach, involving speech and language therapy, physiotherapy, and occupational therapy
Address risk factors, including controlling:
Hypertension
Hypercholesterolemia (statins)
Specifically for ischemic stroke:
Thrombolysis, if detected within 3-4.5 hours
Prevention of occurrence may involve administration of:
Aspirin
Anticoagulants
Carotid endarterectomy (i.e. surgery used to remove atherosclerotic material stenosing the carotid artery), even
Specifically for hemorrhagic stroke, some may benefit from neurosurgery
Patient information
What can you do if not enough blood is getting to the brain?
For whatever loss of function that there is, you can try to recover as much as you can. You can also address address risk factors, like lowering blood pressure and cholesterol.
What about imemdiately, what can you do immediately?
It depends on if it's caused by a bleed in the brain, or a clot. If there's a bleed in the brain, you need to wait for it to clot, then maybe you can do brain surgery. If there's a clot, you can use a drug to break up the clot, if it's within 4 hours of the stroke. You can also prevent future clots causing problems, by using aspirin, anticoagulants. You can even use surgery to remove atherosclerotic material, wherever it is.
Prognosis
Stroke is a medical emergency, that can cause permanent neurological damage, or death
It is the second most leading cause of death, after ischemic heart disease
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