Acute Ischemic Strokes- Neurology
Acute Ischemic Stroke
A stroke, which occurs when there is a problem with blood flow to a portion of your brain, is the brain's counterpart to a heart attack. An ischemic stroke may occur if the blood vessels in the brain are obstructed. A stroke is an acute medical emergency that must be treated immediately to prevent death or severe damage.
The treatment of acute ischemic stroke comprises medications that break the clot or prevent them from forming. Surgery may also be required.
What Is Stroke?
A stroke occurs as a result of the brain's blood supply being cut off or due to a blood vessel in the brain bursting and bleeding. Blood and oxygen cannot reach the brain's tissues because of the rupture or obstruction. As a result, brain tissue and cells are damaged and die within minutes of being oxygen-deprived.
There are three main types of strokes:
1. Transient ischemic attack (TIA), which involves a blood clot and typically reverses on its own.
2. Ischemic stroke is an arterial obstruction brought on by a clot or plaque. Ischemic stroke signs and symptoms may persist permanently or last longer than those of a TIA.
3. Hemorrhagic stroke is due to a leaky or ruptured blood vessel that bleeds into the brain.
Ischemic Stroke
This is the most common type of stroke. Fat deposits that accumulate in blood vessels or blood clots or other debris that move through the bloodstream, typically from the heart, and lodge in the blood vessels in the brain, cause blocked or narrowed blood vessels.
Ischemic stroke typically occurs in one of the following ways:
- Formation of a clot in the brain (thrombosis)
- A fragment of a blood clot that forms somewhere else in your body breaks away and travels through your blood vessels before being lodged in your brain (embolism)
- Having long-term, untreated hypertension, hyperlipidemia, or excessive blood sugar (Type 2 diabetes) might result in small vessel blockage (lacunar stroke)
- Cryptogenic strokes; the word "cryptogenic" means "hidden origin", therefore they have an unknown cause
Who Are At Risk?
Everyone, including children and adults, is susceptible to having a stroke, but some people are more at risk than others. The risk of stroke can be increased by numerous circumstances and conditions, which include:
Lifestyle factors such as-
- Being obese or overweight
- Lack of physical exercise
- Binge or excessive drinking
- Using illicit substances like cocaine and methamphetamine
Certain diseases also increase the risk of ischemic stroke, such as-
- High blood pressure (hypertension)
- Cigarette smoking or passive smoking
- Diabetes
- High cholesterol (hyperlipidemia)
- Obstructive sleep apnea
- Cardiovascular diseases, such as atrial fibrillation, heart failure, congenital heart diseases, and heart infections
- Personal or family history of stroke, transient ischemic attack, or heart attack
- COVID-19 virus (Preliminary findings suggest that COVID-19 infection may raise the risk of ischemic stroke, although more research is needed)
Additional factors linked to an increased risk of stroke include:
- Age – Compared to younger people, those 55 or older have an increased risk of stroke
- Race or ethnicity – Hispanics and African Americans have a higher risk of stroke compared to people of other races or ethnicities
- Gender – Males are more likely to experience a stroke than women. Women are more likely than males to die from strokes because they tend to experience strokes when they are older
- Hormones – Using birth control pills or estrogen-containing hormone therapy increases the risk
Symptoms Of Acute Ischemic Stroke
Your brain is divided into several functional regions; thus, the symptoms of a stroke vary depending on which part is affected. A stroke that affects your brain's Broca's area, which controls how your face and mouth muscles work when you talk, is an example of this. That's why some people who experience a stroke talk clumsily or with difficulty.
The following are the symptoms of stroke:
- Weakness or paralysis on one side
- Aphasia (difficulty with or loss of speech skills)
- Garbled or slurred speech (Dysarthria)
- Loss of facial muscle control on one side
- Sudden loss of one or more senses, whether complete or partial (vision, hearing, smell, taste, and touch)
- Double (diplopia) or blurry vision
- Loss of coordination(ataxia)
- Vertigo or dizziness
- A stiff neck
- Nausea and vomiting
- Alterations in personality and emotional instability
- Agitation or confusion
- Seizures
- Headaches (typically sudden and severe)
- Memory loss (amnesia)
- Fainting or passing out
- Coma
The earlier a person with stroke receives treatment, the better the prognosis is likely to be. Because of this, being aware of the symptoms of a stroke will help you take prompt action.
Important to know
To spot the early warning signs of a stroke, think FAST (Face, Arms, Speech, Time)!
F: Ask them to smile. Check for drooping on one or both sides of the face, which is an indication of facial paralysis or muscle weakness.
A: Muscle weakness on one side is common in stroke patients. Ask them to raise their arms. One arm will remain higher while the other sags and drops below if they are experiencing one-sided weakness (and were not earlier).
S: Those who have strokes frequently lose their ability to talk. They can stumble over their words or have problems forming coherent sentences.
T: Get help right now because time is of the essence! If feasible, keep track of when symptoms first appear by looking at a watch or a clock. A healthcare professional can better determine the best course of treatment if they know when the sign first appeared.
Diagnosis Of Acute Ischemic Stroke
Your doctor will inquire about your symptoms and the circumstances surrounding their onset from you or a close relative. To determine your stroke risk factors, they will review your medical history. Moreover, they will:
- Ask about the medications you take
- Listen to your heart
- Check your blood pressure reading
In addition, you will undergo a physical examination, during which your physician will assess you for the following:
- Coordination
- Balance
- Weakness
- Signs of confusion
- Numbness in your face, arms, or legs
- Vision issues
To help confirm a stroke diagnosis, your doctor will perform a few tests. They can use these tests to identify if you had a stroke and, if so, to find out the following:
- What may have triggered it?
- What area of the brain is affected?
Tests to diagnose stroke
Your doctor may conduct several tests to help further determine whether you have had a stroke or to rule out another condition. These tests consist of the following:
Your doctor might take a blood sample for several blood tests. A blood test can reveal the following:
- Blood sugar levels
- Platelet counts
- Whether you have an infection
- Cholesterol levels
- How fast your blood clots
Your doctor may order a CT scan, an MRI, or both. During a CT scan, your brain can be examined in great detail and with clarity. This may reveal areas of damage. However, it can also show other brain disorders that could be the source of your symptoms.
An MRI can help see any damaged brain tissue or brain cells.
The arteries in your neck and brain can be seen in great detail in cerebral angiography. The test can show clots or blockages that may have caused symptoms.
An electrocardiogram (EKG) captures the heart's electrical activity, assessing its rhythm and timing of beats. The test can reveal whether you have any cardiac abnormalities, such as atrial fibrillation or a previous heart attack, that may have contributed to a stroke.
The carotid arteries, which carry blood to your face, brain, and neck, might have fatty deposits (plaque), which can be seen during a carotid ultrasound, also known as a carotid duplex scan.
Moreover, it might also reveal whether your carotid arteries are obstructed or constricted.
The blood clot in your heart can be tracked down with echocardiography. These clots could have affected your brain, leading to a stroke.
Treatment Of Acute Ischemic Stroke
Proper medical assessment and timely treatment are essential to recovering from a stroke. “Time lost is brain lost,” claim the American Heart Association and American Stroke Association. So as soon as you suspect a stroke is happening to you or someone else, call 911 or your local emergency services.
Treatment for acute ischemic stroke includes:
Clot-busting drugs
Blood clots in your brain's arteries can be dislodged by thrombolytic drugs, preventing a stroke and decreasing brain damage. One such medication, tissue plasminogen activator (tPA), also known as Alteplase IV r-tPA, is regarded as the gold standard in the treatment of ischemic stroke.
This emergency drug might be administered to dissolve the blood clot causing the stroke. It is the only medicine on the market that can accomplish this, but it must be administered between three and four hours after the onset of stroke symptoms.
Antiplatelet drugs
These drugs prevent blood clots by making it more difficult for platelets in the blood to adhere to one another. The two most widely used antiplatelet medications are aspirin and clopidogrel (Plavix).
Antiplatelet drugs can stop ischemic strokes. They are also crucial in preventing secondary stroke.
If you've never had a stroke before, use aspirin only as a preventive measure if you have a high risk of atherosclerotic heart disease (such as heart attack and stroke) and a low risk of bleeding.
Mechanical thrombectomy
During this procedure, a catheter is inserted into a large blood vessel inside your head by a doctor. The clot is subsequently extracted from the vessel using a device. The optimal window for doing this procedure is between six and twenty-four hours after the stroke begins.
Stents
If a doctor discovers a weak spot in the artery walls, they may perform surgery to expand the constricted artery and strengthen the artery walls with a stent.
Surgery
Surgery can be used to remove a blood clot and artery plaques in the rare instances that other therapies fail. A catheter might be used during this procedure. An artery may need to be opened by a surgeon if the clot is big.
Complications Of Acute Ischemic Stroke
Depending on the portion of the brain injured and the duration that the brain is without blood supply, a stroke may lead to temporary or permanent disabilities. Possible complications include:
Loss of muscle movement or paralysis: You could lose control of some muscles, including those on one side of your face or arm, or you could develop paralysis on one side of your body.
Talking or swallowing difficulties: A stroke may impair your ability to control your mouth and throat muscles, making it challenging for you to speak clearly, swallow food, or chew it. You could also struggle with language skills, including reading, writing, and speaking or interpreting speech.
Difficulty thinking or memory loss: Many stroke patients lose some or all of their memories. Others could struggle with thinking, reasoning, making decisions, and comprehending concepts.
Emotional issues: People who have had strokes may find it harder to control their emotions or may even get depressed.
Pain: The parts of the body damaged by a stroke may experience pain, numbness, or other unusual sensations. For instance, if a stroke has made your left arm numb, you can experience an unpleasant tingling in that arm.
Changes in behavior and self-care ability: Some people may withdraw more after a stroke. They could require assistance with grooming and daily tasks.
Recovery From Stroke
In the United States, stroke is one of the leading causes of long-term disability. However, according to the American Stroke Association, 10% of stroke survivors recover virtually completely, while another 25% only experience mild problems.
After a stroke, it is critical to begin recovery and rehabilitation as soon as possible. Recovery from a stroke should actually start in the hospital. A medical team can assess the stroke's consequences and stabilize your condition while in the hospital. They can pinpoint the underlying causes and start therapy to assist you in regaining some of your lost skills.
Recovery following a stroke typically focuses on the following four main areas:
Cognitive therapy
Many people may have changes in their ability to think and reason after a stroke. Changes in mood and behavior may result from this. You can manage your emotional responses and strive to reestablish your previous thought and behavior patterns with the help of a therapist.
Speech therapy
A stroke can bring on speech and language difficulties. You will work with a speech and language therapist to relearn how to talk. They can also assist you in finding alternative forms of communication if verbal interaction is challenging for you after a stroke.
Physical therapy
After a stroke, your muscle tone and strength may weaken, making it difficult to move your body as well as you once could. However, your strength and balance can be restored, and a physical therapist will help you find ways to work around any restrictions.
You can receive rehabilitation in your home, a skilled nursing facility, or a clinic.
Relearning sensory skills
Your senses may become "dull" or stop working if the area of your brain that sends sensory data is affected during the stroke. The result could be impaired sensations of pain, pressure or temperature perception. You can learn to adapt to this impairment with the help of a therapist.
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