by The Welthi Bureau | 29TH OCTOBER, 2018
A stroke is defined as an abrupt onset of a neurologic deficit attributable to a focal vascular cause. Stroke is the second leading cause of death worldwide and third major cause of disability. Men have a higher incidence of stroke than women at younger ages, whereas women have a higher risk of stroke after 75 years.
Stroke is classified into two major types:
Brain Ischemia due to thrombosis, embolism, or systemic hypoperfusion.
Brain Haemorrhage due to intracerebral or subarachnoid Haemorrhage.
Old age, Hypertension, Diabetes, Hyperlipidemia, Smoking, Atrial Fibrillation, Carotid Stenosis, Myocardial Infarction, Rheumatic Heart Disease, ASD, PFO, Drug Abuse (cocaine, amphetamine), Hypercoagulable disorders, OC pill use, Vasculitis, Occult Malignancy, Moyamoya Disease.
Age: The risk of stroke increases with age, doubling for each decade after age 55.
Heredity: Africans, Asians, and Hispanics have higher rates of stroke than do Caucasians. People with a family history of stroke are at greater risk.
Stroke risk is increased in people suffering from Diabetes, Heart Disease (especially Atrial Fibrillation), High Blood Pressure, prior stroke, or TIA. The risk of stroke increases with Obesity, High Blood Cholesterol levels, Oral Contraceptive use and Polycythemia.
Lifestyle: Stroke risk increases with cigarette smoking, low level of physical activity, alcohol consumption above two drinks per day, and the use of cocaine or intravenous drugs.
Symptoms and signs: Sudden onset of weakness, numbness on one side of the body, change in vision, gait, or ability to speak or understand; dizziness, loss of balance or coordination, or a sudden severe headache.
Stroke mimics include seizure, intracranial tumour, migraine, and metabolic disturbances.
Diagnosis and management:An emergency brain imaging with head CT scan is necessary to determine if the cause of stroke is Ischemia or haemorrhage. The first goal is to prevent or reverse brain injury.
Early treatment is the most important factor in the successful treatment of Ischemic Stroke. The immediate goal is to restore blood flow to the regions of the brain that are at risk. The long term goal is to improve the outcome by reducing stroke related disability and mortality. Intravenous alteplase is the mainstay of treatment for Acute Ischemic Stroke, initiated within 4.5 hours of clearly defined symptom onset. As the benefit of alteplase is time dependent, it is critical to treat patients as quickly as possible. Patients with proximal intracranial large artery occlusion might also benefit from mechanical thrombectomy, if they can be treated within six hours of symptom onset.
Emergency treatment of haemorrhagic stroke is aimed at controlling intracranial pressure with intravenous mannitol, hyperventilation and surgical intervention if required.
Secondary prevention: Patients should be treated with all available risk reduction strategies that include blood pressure reduction, statin therapy, antithrombotic therapy, and lifestyle modification such as smoking cessation, limited alcohol consumption, weight control, regular aerobic physical activity, salt restriction, and a Mediterranean diet. Revascularization is important for patients with symptomatic carotid stenosis. Treatment of all major stroke risk factors would reduce the risk of recurrent stroke by 80%.
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