Strokes

Within minutes, brain cells begin to die. A stroke is a medical emergency and prompt treatment is crucial. Early action can minimise brain damage and potential complications. The good news is that strokes can be treated and prevented, though a couple of Gambians die of stroke attributed to late presentation at the hospital. There are three main kinds of stroke; ischemic, hemorrhagic and TIA. Stroke is also more likely to affect people if they are overweight, aged 55 or older, have a personal or family history of stroke, do not exercise much, drink heavily or use illicit drugs.

Strokes occur due to problems with the blood supply to the brain; either the blood supply is blocked or a blood vessel within the brain ruptures.

 

What causes stroke?

The different forms of stroke have different specific causes. 

1.     Ischemic strokes: Ischemic strokes are the most common form of stroke, with around 85% of strokes being of this type. They are caused by the arteries that connect to the brain becoming blocked or narrowed, resulting in ischemia – severely reduced blood flow. These blockages are often caused by blood clots, which can form either in the arteries connecting to the brain, or further away before being swept through the bloodstream and into narrower arteries within the brain. Clots can be caused by fatty deposits within the arteries called plaque.  Hypertension can lead to blood vessel ruptures and hemorrhagic strokes.

2.     Hemorrhagic strokes: Hemorrhagic strokes are caused by arteries in the brain either leaking blood or bursting open. The hemorrhaged blood puts pressure on brain cells and damages them. Blood vessels can burst or spill blood in the middle of the brain or near the surface of the brain, sending blood into the space between the brain and the skull. The ruptures can be caused by conditions such as hypertension, trauma, blood-thinning medications and aneurysms (weaknesses in blood vessel walls). 

3.     Transient ischemic attack (TIA): TIAs are different from the aforementioned kinds of stroke because the flow of blood to the brain is only disrupted temporarily for a short time. They are similar to ischemic strokes in that they are often caused by blood clots or other debris. TIAs should be regarded as medical emergencies just like the other kinds of stroke, even if the blockage of the artery is temporary. They serve as warning signs for future strokes and indicate that there is a partially blocked artery or clot source in the heart. 

 

Symptoms       

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when your signs and symptoms begin, because the length of time they have been present may guide your treatment decisions: 

Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.

Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.

Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.

Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, and you may see double.

Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you’re having a stroke.

 

When to see a doctor

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think “FAST” and do the following:

Face. Ask the person to smile. Does one side of the face droop?

Arms. Ask the person to raise both arms. Does one arm drift downward?

Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

Time. If you observe any of these signs, rush to the hospital immediately.  Don’t wait to see if symptoms go away. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximise the effectiveness of evaluation and treatment, you’ll need to be treated at a hospital within three hours after your first symptoms appeared. If you’re with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. 

 

Risk factors 

Many factors can increase your risk of a stroke. Some factors can also increase your chances of having a heart attack. Stroke risk factors include: 

Modifiable (lifestyles) risk factors

Being overweight or obese

Physical inactivity

Heavy or binge drinking

Use of illicit drugs such as cocaine and methamphetamines

 

Non-modifiable risk factors

Personal or family history of stroke, heart attack or transient ischemic attack.

Being age 55 or older.

Race — African-Americans have higher risk of stroke than do people of other races.

Gender — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they are more likely to die of strokes than are men. Also, they may have some risk from some birth control pills or hormone therapies that include estrogen, as well as from pregnancy and childbirth.

 

Potentially treatable risk factors

High blood pressure 

Cigarette smoking or exposure to secondhand smoke.

High cholesterol 

Diabetes.

Obstructive sleep apnea — a sleep disorder in which the oxygen level intermittently drops during the night.

Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.

 

Complications

A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:

Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities hampered by paralysis, such as walking, eating and dressing.

Difficulty talking or swallowing. A stroke may cause you to have less control over the way the muscles in your mouth and throat move, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. 

Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.

Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.

Pain. People who have had strokes may have pain, numbness or other strange sensations in parts of their bodies affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. People also may be sensitive to temperature changes, especially extreme cold. This complication generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, instead of a physical injury, there are few treatments.

Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores. As with any brain injury, the success of treating these complications will vary from person to person.

 

Stroke recovery and rehabilitation

Following emergency treatment, stroke care focuses on helping you regain your strength; recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you’ve had a stroke, you may have problems with breathing, swallowing, balancing and vision. Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home. Every person’s stroke recovery is different. 

 

Coping and support

A stroke is a life-changing event that can affect your emotional well-being as much as your physical function. You may experience feelings of helplessness, frustration, depression and apathy. You may also have mood changes and less of a sex drive. Maintaining your self-esteem, connections to others and interest in the world are essential parts of your recovery. Several strategies may help you and your caregivers, including:

Don’t be hard on yourself. Accept that physical and emotional recovery will involve tough work and that it will take time. Aim for a “new normal,” and celebrate your progress. Allow time for rest.

Get out of the house even if it’s hard. Try not to be discouraged or self-conscious if you move slowly and need a cane, walker or wheelchair to get around. Getting out is good for you.

Join a support group. Meeting with others who are coping with a stroke lets you get out and share experiences, exchange information, and forge new friendships.

Let friends and family know what you need. People may want to help, but they may not know what to do. Let them know how they can help, such as by bringing over a meal and staying to eat with you and talk, or attending social events or religious activities.

 

Prevention 

Knowing your stroke risk factors, following your doctor’s recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you’ve had a stroke or a transient ischemic attack (TIA), these measures may help you avoid having another stroke. The follow-up care you receive in the hospital and afterward may play a role as well. Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

Controlling high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you’ve had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting the amount of sodium and alcohol you eat and drink are all ways to keep high blood pressure in check. Adding more potassium (e.g. liquid in cocoa nut) to your diet also may help. In addition to recommending lifestyle changes, your doctor may prescribe medications to treat high blood pressure.

Lowering the amount of cholesterol and saturated fat in your diet. 

Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke. 

Controlling diabetes. You can manage diabetes with diet, exercise, weight control and medication. 

Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Weight loss may lower your blood pressure and improve your cholesterol levels. 

Eating a diet rich in fruits and vegetables. 

Exercising regularly. Exercise can lower your blood pressure, increase your level of high-density lipoprotein cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week. 

Quitting alcohol use  

Avoiding illicit drugs. Certain street drugs, such as cocaine and methamphetamines, are established risk factors for a TIA or a stroke. Cocaine reduces blood flow and can cause narrowing of arteries.

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