Stroke

Stroke is the primary neurologic problem in the United states. It is the third ranking cause of death, with an overall mortality rate of 18% to 37% for the first stroke and as high as 62% for subsequent strokes. According to a recent study, there are approximately 2 million people surviving strokes who have some disability, and of these there are 40% who need assistance with the activities of daily living.

A stroke, or cerebrovascular accident (CVA), is a sudden loss of brain function resulting from disruption of the blood supply to a part of the brain. A stroke usually results from one of the four events:

1. Thrombosis - A blood clot within a blood vessel of the brain or neck.
2. Cerebral embolism - A blood clot or other material carried to the brain from another part of the body.
3. Ischemia - Decrease of blood flow to an area of the brain.
4. Cerebral hemorrhage - Rupture of the cerebral blood vessel with bleeding into the brain tissue or spaces surrounding the brain.

The result is an interruption to the blood supply to the brain, causing temporary or permanent loss of movement, thought, memory, speech or sensation. The signs of stroke varies from person to person. The common cause of stroke is the cerebral thrombosis. The signs of cerebral thrombosis are headache, dizziness, cognitive changes, or seizures. The signs of cerebral thrombosis does not develop abruptly. There is transient loss of speech, hemiplegia, or paresthesias in one half of the body which may precede the onset of severe paralysis by a few hours or days.

When it comes to cerebral embolism, the onset of signs and symptoms are sudden. Hemiparesis or hemiplegia with or without loss of speech and loss of consciousness are the common symptoms. They are found in people who are already diagnosed with cardiac or pulmonary diseases like infective endocarditis, rheumatic heart disease, myocardial infarction, as well as pulmonary infections. These are the sites where the emboli originates.

The next common manifestation of stroke caused by cerebral ischemia is the TIA. TIA is the transient ischemic attack, which is a temporary episode of neurologic dysfunction commonly presents with sudden loss of motor, sensory, or visual function. It lasts for a few seconds or minutes but no longer than 24 hours. TIA is the warning sign of impending stroke, which has its greatest incidence in the first month after the first attack. The symptoms include

a. sudden and painless loss of vision of one eye,
b. dimming or graying out of the vision field,
c. diplopia,
d. disturbances of consciousness,
e. numbness,
f. Weakness in either a hand or leg,
g. difficulty in speaking,
h. difficulty in understanding speech,
i. apraxia (inability to perform a previously learned action).

Urinary and stool incontinence affects the person once he is affected with stroke. Homogenous hemianopsia (loss of half of the visual field), diplopia (double vision), hemiparesis (one sided weakness), hemiplegia (one sided paralysis), ataxia (unsteady gait), dysarthria (difficulty in speaking), dysphagia (difficulty in swallowing), paresthesia (numbness or tingling of body parts), aphasia (difficulty to form words), and apraxia (inability to perform a previously learned action) are the classical signs of stroke.

The management is mainly supportive. Prevention of stroke is the best possible approach. They can be prevented by controlling hypertension, high cholesterol, obesity, diabetes, smoking, drug abuse (especially cocaine) and alcohol consumption.