About of Stroke Disease

The function of brain cells need a consistent supply of oxygen and glucose in the blood. A racing accident, or stroke (CVA) occurs when the blood supply to part of the brain is disrupted, allowing brain cells to die. The blood flow through a variety of mechanisms are impaired. 

stroke

Blockage of an artery

- Narrowing of small arteries in the brain may be lacunar stroke (lack of means "empty space"). Blocking a single arteriole can affect a tiny area of ​​the brain, causing the tissue to die for (heart attack). 

- Hardening of the arteries (atherosclerosis), to the brain. There are four major blood vessels that supply blood to the brain. The anterior circulation of the brain that controls most of the activities of the engine feeling, thought, speech and emotion is supplied by the carotid arteries. Posterior circulation, which supplies the brain stem and cerebellum, which controls the automatic functions of the brain and coordination is supplied by the vertebrobasilar arteries. 

When these arteries narrow due to atherosclerosis, plaque or cholesterol deposits can break off and float downstream, blocking the blood supply to part of the brain. In contrast to lacunar strokes, the largest parts of the brain lose blood supply, and this can produce more than symptoms of a stroke, lacunar.

Embolism in the brain from the heart. In some cases, blood clots in the heart and it is possible to break them in order to travel from and (embolize) to the arteries in the brain and cause a stroke. 

Rupture of an artery (blood supply) 

Cerebral blood flow (in the brain matter). The most common reason to have a hemorrhage in the brain is not controlled blood pressure.Other situations are aneurysms that leak or rupture or arteriovenous malformations (AVM), where there are a collection of abnormal blood vessels fragile and bleed. 

Cause of a stroke: 

- Blockage of an artery 

The closure of an artery in the brain by a blood clot (thrombosis) is the most common cause of stroke. A portion of the brain that is supplied by the clotted blood vessel is then withdrawn from the blood and oxygen. Following the private blood and oxygen, the cells of the part of the matrix of the brain and the body part that the control can no longer function properly. As a rule, which bursts into a cholesterol plaque in a small blood vessel in the brain, the progressive narrowing of blood vessels and begin the process of formation of a small blood clot. 

Risk factors for the narrowed blood vessels in the brain are the same as those which cause a narrowing of blood vessels in heart attack and heart attack (myocardial infarction). These risk factors:

High blood pressure (hypertension), 

high cholesterol, 

Diabetes and 

Smoking.

- Embolic stroke 

Another type of stroke occurs, when a blood clot or a piece of plaque (cholesterol and calcium deposits on the wall inside the heart or artery) breaks loose, travels around the bloodstream and lodged in an artery in the brain. When blood flow stops, brain cells do not need to receive oxygen and glucose they need to work and a stroke occurs. This type of stroke is as embolic stroke. For example, a blood clot to form at the origin in the ventricle by an irregular heartbeat, as in atrial fibrillation. Usually, these blood clots remain in the lining of the heart, but sometimes they can break off, travel through the bloodstream form, a plug (embolism) in a brain artery and cause a stroke. Embolism may also consist of a large artery (eg, carotid artery, a main artery in the neck that supplies blood to the brain) and are then found downstream to clog a small artery in the brain. 

- Bleeding in the brain 

A cerebral hemorrhage occurs when a blood vessel bursts in the brain and bleeding into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes symptoms of stroke by blood and oxygen to escape to parts of the brain in a variety of ways. The blood flow is lost for some cells. In addition, the blood is very irritating and can cause swelling of brain tissue (cerebral edema). Edema and accumulation of blood from a cerebral hemorrhage increases the pressure in the skull and causes further damage by reducing the brain against the skull bone on the blood flow to the brain tissue and cells. 

Subarachnoid hemorrhage - 

In a subarachnoid hemorrhage, blood accumulates in the space under the arachnoid membrane that lines the brain. The blood comes from an abnormal blood vessel that leaks or ruptures. This is often an aneurysm (an abnormal ballooning of the vessel wall).Subarachnoid hemorrhage is usually a sudden, severe headache, nausea, vomiting, light intolerance, and a stiff neck. If it is not recognized and treated, can have serious neurological consequences occur, such as coma and brain death. 

- Vasculitis 

Another rare cause of stroke is vasculitis, a condition in which blood vessels are inflamed decreased blood flow to brain tissue caused. 

Migraines - 

There seems to be something very slight increase of stroke in people with migraine. The mechanism of migraine or vascular headaches includes narrowing of blood vessels in the brain. Some migraines can even mimic stroke with loss of function on one side of the body or difficulty speaking or seeing. Usually the symptoms such as headache disappears. 

A stroke is a medical emergency. Anyone who was a medical facility immediately for evaluation and treatment be taken with a suspected stroke. First, the doctor takes the patient's history, if possible, or by others familiar with the patient, if available. Important questions are, what the symptoms were when they started when they were getting better, worse or stays the same. Medical history adds important information about risk factors for stroke and for drugs that can cause bleeding research (eg, warfarin [Coumadin], clopidogrel [Plavix], prasugrel [Effient]). 

The physical examination is a key element in the confirmation of the body parts that have ceased to function and can help determine which part of the brain loses its blood supply. If available, a neurologist, a doctor who specializes in helping nervous system diseases and disorders of the brain in the diagnosis and treatment of stroke patients.

Just because a person has unclear speech or weakness on one side of the body has not necessarily indicate the occurrence of stroke. There are many other possibilities that may be responsible for these symptoms. Other conditions that can mimic a stroke include: 

- Brain tumors, 

Brain abscess (a collection of pus in the brain caused by bacteria or fungi), - 

Migraines - 

- Bleeding in the brain either spontaneously or by trauma, 

- Meningitis or encephalitis, 

- An overdose of certain medications or 

- An electrolyte imbalance in the body. Abnormal values ​​(too high or too low), sodium, calcium or glucose in the body can also be changes in the nervous system that can mimic a stroke. 

In the evaluation of acute stroke, many things are happening simultaneously. When the doctor takes the history and construction of the physical examination, nurses will begin, vital signs, blood tests and monitoring to perform an electrocardiogram (ECG). 

Some of the physical examination is becoming more standardized with a time scale. The American Heart Association has published a guide to help test the nervous system to health care practitioners to determine the severity of the stroke, whether published and aggressive intervention can be justified. 

There is a time in the vicinity in an acute stroke with drugs to intervene to prevent the loss of blood supply to part of the brain (see link below April) to undo. The patient should be properly evaluated and stabilized before any drugs that dissolve blood clots can potentially be used. 

- CT: To help you be the cause of a suspected stroke, called a special x-ray a brain scan is often performed. A scanner is used looking to for masses or bleeding in the brain, the symptoms that can cause a stroke, are similar, but not treated with thrombolysis with TPA.

- MRI: Magnetic resonance imaging (MRI) uses magnetic waves rather than X-rays for imaging the brain. MRI scans are more detailed than CT, but to do because of the length of time the test and the lack of availability of machines in many hospitals, is not a first line test in the race. During a scan can be completed in a few minutes, an MRI last acquisition of an hour. MRI can later in the course of patient care be performed when finer details are also required for the medical decision. People with certain medical devices (eg pacemakers) or other metals in their bodies can not be subjected to strong magnetic field of an MRI. 

- Other methods of MR technology: MRI can also be used to visualize blood vessels, specifically the non-invasive, are (without the use of tubes or injections), a procedure called MRA (magnetic resonance angiography). Another MRI diffusion-weighted imaging method is called (CFA) is offered in some medical centers. This technique detects the fault zone minutes after the blood flow to part of the brain has stopped, while a conventional MRI can not detect a stroke up to six hours after onset and a CT scan can not always detect up to 12 to 24 hours or less weight. Again, this is not a first line test in assessing a patient's stroke, when the time is short. 

- Computed tomography angiography with: With dye that is injected into a vein in your arm may, images of blood vessels in the brain with information about aneurysms and arteriovenous malformations.In addition, other abnormalities of cerebral blood flow can be assessed. With faster and better machine technology CT angiography can be performed simultaneously with the first CT scan to search for a blood clot in an artery in the brain. 

CT and MRI scans often require a radiologist to interpret their results. 

- Conventional Angiography: Angiography is another test that is sometimes used to visualize blood vessels. A long tube catheter into an artery in the groin or arm and introduced into the arteries of the brain. A dye is injected into X-rays are taken and the information can be found on the blood flow in the brain. The decision to perform CT angiography over conventional angiography depends on the specific situation of a patient and the technical capabilities of the hospital. 

- Carotid Doppler Ultrasound: Carotid Doppler ultrasound is a noninvasive test that uses sound waves to a narrowing or stenosis and a decreased blood flow in the carotid arteries (major arteries of the anterior neck can blood supply to the brain). 

- Cardiac Tests: Some tests to assess heart function in stroke patients are often carried out to find the source of the embolism.Electrocardiogram (ECG or electrocardiogram) can be used to detect cardiac arrhythmias such as atrial fibrillation, which are connected to an embolic stroke. 

Ambulatory rhythm monitoring considered if the patient complains of palpitations or passing episodes (syncope), and doctors can not find a reason to be on the ECG. The patient can wear a Holter monitor for 1-2 days and sometimes longer just looking for a potential electrical conduction problem with the heart.

Echocardiogram or ultrasound of the heart are used to assess the structure and function of the heart, including heart muscle, valves and the motion of the ventricle when the heart beats. In addition, especially for stroke patients, this test is able to clot in the heart and the presence of patent foramen ovale, found two possible causes of stroke. 

- Blood tests: In the acute situation, if the patient is in the middle of a stroke, blood tests are performed to check for anemia, kidney and liver function, electrolyte abnormalities, and the function of blood clotting. 

In other situations, when there is danger in delay, similar blood tests are performed. In addition, the test for inflammation as an ESR (erythrocyte sedimentation rate) and CRP (C reactive protein) to be extended. These are non-specific tests, the sense of medical care can afford. 

There is possibility of the use of alteplase (TPA) is destroyed as a drug to dissolve blood clots Blood clots cause of stroke is. There is a narrow window of opportunity to use this drug. The sooner it is given, the better the result and the least potential for complications from bleeding in the brain. 

Present in the American Heart Association guidelines recommend that, if used, the TPA in 4 1/2 hours must be administered after onset of symptoms. for patients who awaken from sleep with symptoms of a stroke, the clock starts when they were last seen in a normal state. 

TPA is injected into a vein in your arm, but the deadline for their use may be extended to 6 hours if it is blocked directly into the blood vessel commissioned drained angiography, which is performed by an interventional radiologist. All hospitals have access to this technology. 

TPA can do to reverse stroke symptoms in more than one third of patients, but can also cause bleeding in patients 6%, which could be the worst race. 

For posterior circulation stroke involving the vertebrobasilar, the time for treatment with TPA further increased to 18 hours.

- Heparin and aspirin 

The blood-thinning medications (anticoagulants, eg heparin) are sometimes used in the treatment of stroke patients in the hope of improving the recovery of the patient. It is not clear, but if the use of anticoagulation improves the outcome of the race in progress, or simply just to prevent subsequent stroke (see below). In some patients, aspirin has after the occurrence of a stroke administered a small but measurable recovery. The doctor will decide which medicines are used to the specific needs of a patient. 

- Management of other medical problems 

The blood pressure are closely monitored frequently to prevent the use of drugs intravenously to stroke symptoms progress. This applies if the stroke is ischemic or hemorrhagic. 

- Supplemental oxygen is often asked. 

In diabetics, the blood sugar (glucose) level is often elevated after a stroke. Control of blood glucose levels in these patients, the size of a stroke. 

Patients who suffered transient ischemic attacks may be delivered to the patient with blood pressure and cholesterol drugs, although blood pressure and cholesterol levels are at an acceptable level.Stopping smoking is mandatory. 

- Rehabilitation 

If a patient is more seriously ill after a stroke, focusing on the health care workers to maximize the functional capabilities of individuals.This is usually in a hospital or inpatient rehabilitation in a specific area of ​​a general hospital. Rehabilitation may also be in a nursing facility. 

The rehabilitation process can take some or all of the following: 

First Speech therapy to relearn talking and swallowing; 

Second Occupational therapy to regain as much dexterity in the arms and hands as possible; 

Third physical therapy to improve strength and walking; 

4th Family education to orient them in caring for their loved home and the challenges they will face. 

The goal is for the patient, so many back, if not all, of the pre-stroke activities and functions. Since a stroke resulting in permanent loss of brain cells, a total return to pre-stroke status of the patient is not necessarily a realistic goal in many cases. However, many stroke patients return to independent living dynamic. 

Depending on the severity of the stroke, some patients from acute hospital to a nursing home are placed to monitor and continue physical therapy and occupational therapy. 

Many times, can evaluate providers of home care services, the living situation at home and make recommendations to facilitate the transition home. Unfortunately, some stroke patients have significant long-term care, they can not be met by relatives and friends and long-term care in nursing homes may be required.