‘Brain attack’ or ‘Stroke’ occurs when a blood clot blocks an artery, or when an artery ruptures, interfering with the blood flow to an area of the brain. When a “brain attack” occurs, brain cells in the immediate area die and the dead area becomes an “infarct”. Death of brain cells occurs within three hours after the stroke.
There are four main types of stroke: two caused by blood clots, and two by haemorrhages. Cerebral thrombosis and cerebral embolism are the most common categories. They are caused by clots plugging arteries. Cerebral and subarachnoid haemorrhages result from rupture of arteries. They have a much higher mortality than thrombosis.
What causes a stroke?
A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot. Because of this rupture or blockage, part of the brain does not get the oxygen and nutrients it requires. Deprived of oxygen, nerve cells in the affected area of the brain cannot function and die within minutes. And when nerve cells cannot function, the part of the body controlled by these cells cannot function either. These devastating effects of stroke are often permanent because dead brain cells cannot regenerate.
The Common Symptoms of Stroke Include:
Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden loss of vision in one or both eyes.
Sudden difficulty in walking or balance.
Sudden severe headache and dizziness.
Sudden severe vomiting.
Patient with any of these symptoms requires immediate medical attention in a well-equipped hospital.
Diagnosis of Stroke:
After admission into the hospital, investigations begin with:-
General assessment of condition of other body systems.
Detail neurological assessment.
Computed tomography scan (CT scan) of brain – as soon as possible.
Magnetic resonance imaging (MRI) – MRI can give very accurate images of the brain determining the presence, location and size of infarct, haematoma, saccular aneurysms or arteriovenous malformations.
Stroke Treatment:
In the management of cerebral and subarachnoid haemorrhages caused by ruptures of atherosclerotic artery, saccular aneurysms or arteriovenous malformation microneurosurgery and neurovascular interventional techniques may be required.
The use of recombinant tissue plasminogen activator (rTPA) or urokinese intravenously to treat stroke in the first three hours following the onset of symptoms may dissolve the blood clots inside the artery responsible for stroke with good result after three hours but within first six hours however rTPA or Urokinese may have to be delivered intraarterially to be effective. When a neck artery (carotid) has become blocked, surgery may be required to remove the atherosclerotic plaque. This is called Carotid Endarterectomy. Sometimes, angioplasty is used to unblock the artery. Balloon catheters and stents are used.
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