Stroke 

Overview  

A stroke, also known as a brain attack, occurs when the blood flow to the brain is interrupted, causing brain cells to die due to a lack of oxygen and nutrients. This can lead to various impairments depending on the affected area of the brain, such as difficulty in movement, speech, eating, thinking, memory, emotional control, and other vital functions. It is a serious medical emergency that can happen to anyone at any time, and immediate treatment is crucial to minimize brain damage and complications.  

Ischemic stroke is a common type of stroke that happens when a part of the brain doesn’t receive enough blood supply due to a blockage or reduction in blood flow. As a result, brain tissue starts to die within minutes, further impairing brain function. Recognizing the symptoms and taking quick action is essential to improve the chances of recovery and prevent long–term disability. It is important to understand that a stroke is a life–threatening condition. Without a steady supply of blood, brain cells in the affected area begin to die, leading to potentially severe consequences.  

Therefore, it is critical to recognize the signs of a stroke and immediately seek medical assistance by calling 911 or the local emergency services number. Time is of the essence in stroke cases, as early treatment significantly increases the likelihood of recovery without disability.  

Symptoms   

If you or someone you are with shows signs of a stroke, it is crucial to note the time when the symptoms started. Some treatment options are most effective when administered shortly after the onset of a stroke. The specific symptoms of a stroke vary depending on the affected area of the brain. For example, if the stroke affects Broca’s area, which controls facial and oral muscle movements for speech, individuals may experience slurred speech or difficulty speaking. 

 Common signs and symptoms of a stroke include: 

• Difficulty speaking and understanding others: Confusion, slurred speech, and difficulty comprehending spoken language may occur. 
• Facial paralysis or numbness: Sudden numbness, weakness, or paralysis on one side of the face, arm, or leg may develop. Trying to raise both arms simultaneously can reveal if one arm starts to fall. Additionally, one side of the mouth may droop when attempting to smile. 
• Vision problems: Blurred or blackened vision in one or both eyes, or experiencing double vision, may occur suddenly. 
• Headache: A sudden and severe headache accompanied by vomiting, dizziness, or altered consciousness may be an indication of a stroke. 
• Trouble walking: Stumbling, loss of balance, sudden dizziness, or a lack of coordination may be observed. 

If you notice any signs or symptoms of a stroke, it is important to seek immediate medical attention, even if they appear to be temporary or disappear completely. Remember the acronym “FAST” and take the following actions: 

• Face: Ask the person to smile. Do they have drooping on one side of their face? 
• Arms: Ask the person to raise both arms. Does one arm drift downward or are they unable to raise one arm? 
• Speech: Ask the person to repeat a simple phrase. Is their speech slurred or unusual? 
• Time: If you observe any of these signs, call your local emergency number immediately. 

Do not wait to see if the symptoms go away. Every minute is crucial. The longer a stroke remains untreated, the higher the risk of brain damage and disability. If you are with someone you suspect is having a stroke, closely monitor them while waiting for emergency assistance. 

Causes

Strokes are primarily caused by two main factors: a blockage in an artery (known as ischemic stroke) or the leaking or bursting of a blood vessel (referred to as hemorrhagic stroke). In some cases, individuals may experience a temporary disruption of blood flow to the brain, which is known as a transient ischemic attack (TIA). TIAs do not cause lasting symptoms. 

Ischemic stroke

Ischemic stroke is the most common type of stroke. It occurs when the blood vessels in the brain become narrowed or blocked, resulting in reduced blood flow (ischemia). This blockage is typically caused by the buildup of fatty deposits in the blood vessels or the presence of blood clots or debris that travel through the bloodstream, often originating from the heart, and get lodged in the brain’s blood vessels. 

 These clots can form due to different reasons, including: 

• Atherosclerosis (buildup of plaque in the arteries) 
• Clotting disorders 
• Atrial fibrillation (particularly when it occurs due to sleep apnea) 
• Heart defects such as atrial septal defect or ventricular septal defect 
• Microvascular ischemic disease, which can block smaller blood vessels in the brain. 

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in the brain ruptures or leaks, leading to bleeding. There are various factors associated with the development of hemorrhagic stroke, including:   

• Uncontrolled high blood pressure: When blood pressure remains consistently high, it can weaken blood vessels in the brain and increase the risk of rupture.  
• Overuse of blood thinners (anticoagulants): Excessive or improper use of medications that prevent blood clotting can contribute to hemorrhagic strokes by increasing the likelihood of bleeding.  
• Aneurysms: Weak areas in blood vessel walls can bulge and potentially rupture, causing bleeding in the brain.  
• Trauma: Head injuries, such as those resulting from car accidents, can lead to hemorrhagic strokes if blood vessels in the brain are damaged.  
• Cerebral amyloid angiopathy: Protein deposits in the walls of blood vessels can weaken them, making them more prone to rupture and causing hemorrhagic strokes.  
• Ischemic stroke leading to hemorrhage: In some cases, a blockage in a blood vessel in the brain (ischemic stroke) can lead to subsequent bleeding (hemorrhage). 

Transient ischemic attack (TIA)

Transient ischemic attack is a temporary episode characterized by stroke–like symptoms. Unlike a stroke, a TIA does not result in permanent damage. It occurs when there is a temporary reduction or blockage of blood flow to a specific part of the brain, often caused by a clot or debris. The duration of a TIA can be as short as five minutes. It is crucial to seek immediate medical attention, even if the symptoms improve, as it is difficult to distinguish between a TIA and a stroke based solely on symptoms. A TIA indicates the presence of a partially blocked or narrowed artery supplying the brain, increasing the risk of experiencing a full–blown stroke in the future. 

Risk factors

The risk of stroke can be raised by numerous circumstances. stroke risk elements that may be managed include:  

Lifestyle risk factors  

• Sedentary lifestyle  
• Utilization of illicit substances like cocaine and methamphetamine  
• Alcohol abuse  
• Obesity  

Medical risk factors  

• Diabetes  
• Elevated blood pressure  
• Increased cholesterol  
• Having COVID–19   
• Obstructive sleep apnea  
• A history of stroke, heart attack, or transient ischemic attack in oneself or one’s family  
• Exposure to secondhand smoke or smoking cigarettes  
• Cardiovascular illness, such as heart failure, heart defects, infections of the heart, or abnormal heart rhythms like atrial fibrillation  

Other elements linked to an increased risk of stroke include:  

• Age: A stroke is more likely to occur in adults over the age of 55 than in those under that age.  
• Race or ethnicity: People of all other races and ethnicities have a lower risk of stroke than African Americans and Hispanics do.  
• Sex: Stroke risk is higher in men than in women. Women are more likely than males to die from strokes because they tend to experience strokes when they are older. 
• Hormones: Risk is increased by using birth control pills or hormone treatments that contain estrogen.