According to data from Strategy and Planning Division of Ministry of Public Health, Stroke is the 2nd leading cause of death in Thailand after cancer. Although stroke is more common in the elderly, it can happen to anyone at any age. In fact, research shows strokes are on the rise among younger people. Therefore, it is important to know the risk factors and work to prevent those that can be managed.
What is stroke?
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. A stroke may be caused by a blocked artery or the leaking or bursting of a blood vessel. It can sometimes cause temporary or permanent disabilities, depending on how long the brain cells are deprived of blood flow and which part was affected.
Effects of stroke
The effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected.
|
Left Brain |
Right Brain |
| Paralysis on the right side of the body |
Paralysis on the left side of the body |
| Ability to speak and understand language | Problems judging distance, size, and position |
| Slow, cautious behavioral style | Quick, inquisitive behavioral style |
| Loss of right side vision in each eye | Loss of left side vision in each eye |
If the damage is at the cerebellum, coordination and movement will be affected. When stroke occurs in the brain stem, depending on the severity of the injury, it can affect breathing or heartbeat. Severity of a stroke can be assessed by measuring stroke related neurological deficit.
Causes
You may think strokes only happen to the elderly but experts say you are never too young for a stroke. There are 3 main causes as below.
- Atherosclerosis About 80% of strokes are caused by atherosclerosis, the same process of narrowing and hardening of the arteries that causes heart attacks. Risk factors are age, high blood pressure, diabetes, hyperlipidemia, smoking, alcoholic drinking, vascular diseases, and obesity. Snoring in people who are overweight is a risk factor for a stroke, as it can reduce the amount of oxygen that reaches the brain.
- Embolic stroke When a blood clot that forms in a different region of the body travels to the brain’s blood vessels, where it becomes too large to pass through. Risk factors are atrial fibrillation, valvular heart disease, myocardial infarction, and cardiac hypertrophy. Stroke in young people are found in those who play extreme sports/activities e.g. bungee jumping. Other risk factor is post-partum women who take oral contraceptive pills.
- Hemorrhagic stroke About 20% of strokes are hemorrhagic strokes. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. The important risk factor is high blood pressure.
Symptoms
- Paralysis or numbness of the face, arm or leg
- Trouble with speaking, understanding, and seeing in one or both eyes
- Bladder and bowel incontinence in severe case
Risk factors
- Atherosclerosis – hardening of the arteries, high hemoglobin concentration
- Obesity, hyperlipidemia
- Heart disease, irregular heartbeat
- Smoking
- High blood pressure
- Diabetes
- Elderly
- Estrogen hormone use
- Ethnic – higher risk in African-American
- Sex – higher risk in male
- A family history of cardiovascular disease
- Activities that involve forceful twisting of the neck can lead to arterial dissection
Magic Number “4.5”
The quicker you recognize the signs of stroke and seek medical care, the higher your likelihood is of having a successful recovery. The magic number is 4.5 hours. This is the golden period of stroke.
1) Within 4.5 hours after stroke symptoms begin
The doctor will order a MRI scan in order to see a detailed view of the brain and the damage. The gold standard treatment for ischemic stroke is an injection of recombinant tissue plasminogen activator (rtPA). This potent clot-busting drug ideally is given 4.5 hours after stroke symptoms begin. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully.
2) For patients who come to the hospital later than 4.5 hours but within 24 hours
Doctors may use a catheter to maneuver a device into the blocked blood vessel in your brain and trap and remove the clot. This procedure is particularly beneficial for people who cannot receive rtPA injection. An interventional radiologist will evaluate the patient whether this treatment option is appropriate.
Treatment
The doctor will focus on helping you recover as much function as possible and return to independent living. The impact of stroke depends on the amount of tissue damaged and the area of the brain involved. The doctor will choose the treatment based on severity and symptoms.
Angioplasty
A surgeon usually accesses the carotid arteries through an artery in your groin. Here, the surgeon can safely navigate to the carotid arteries in your neck. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery.
Surgery
Minimally invasive surgery can be done in order to open the blocked artery in the brain. Bi-plane DSA (Biplane Digital Subtraction Angiography) offers visualization of blood flow inside brain vessels that is essential for the diagnosis and treatment of stroke. With this new technology, minimally invasive endovascular procedures can be done replacing the need for an open surgery. Doctors may insert a catheter through an artery in the groin and thread it to the brain. Then, the catheter can be used to maneuver a device into the blocked blood vessel in the brain and remove the clot or inject the clot-bursting drug.
Medication
- Anticoagulants: prevent blood clots by changing the chemical composition of the blood in a way that prevents clots occurring
- Antiplatelets: decrease platelet aggregation and inhibit clot formation
- Calcium channel blockers: act as neuroprotective agent after subarachnoid hemorrhage
- Thrombolytics: dissolves blood clots and restores blood flow to the brain
If the patient has any other comorbidities such as heart disease, high blood pressure, diabetes, and hyperlipidemia, these conditions should also be treated along with stroke treatment.
Stroke rehabilitation
Early recovery and rehabilitation can improve functions and sometimes remarkable recoveries for someone who suffered from a stroke. Early rehabilitation should begin in the ICU as soon as possible. This helps the patient to recover quickly and prevent other complications such as pneumonia, deep vein thrombosis, and airway obstruction. The patient and family have to work together with the doctors and stroke coordinators in order to meet stroke recovery goals.
- Physical therapy: improve moving and balance, suggest exercises to strengthen muscles for walking, standing and other activities
- Ocupational therapy: manage daily activities such as eating, bathing, dressing, writing, or cooking
- Speech therapy: re-learn language skills (talking, reading and writing) and help with swallowing problems
- Cognitive function: help the patient with cognitive skills such as learning, remembering, and understanding
- Depression and psychosocial: prevent depression and psychological support
The severity of stroke complications and the patient’s ability to recover vary widely. The goal of stroke rehabilitation is to help the patient relearn skills that were lost when a stroke affected part of your brain. The doctor will decide which treatment plan is appropriate for each patient.
Stroke screening: detect blockages early
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. Also, screening tests can help to detect the abnormality early.
Transcranial Doppler ultrasound (TCD)
This is a non-invasive ultrasound method uses to examine the blood circulation within the brain. During TCD, inaudible sound waves are transmitted through the tissues of the skull. These sound waves reflect off blood cells moving within the blood vessels, allowing the radiologist to interpret their speed and direction. The sound waves are recorded and displayed on a computer screen.
Carotid duplex ultrasound
Carotid duplex is an ultrasound test that shows how well blood is flowing through the carotid and vertebral arteries. Both arteries are located in the neck and supply blood directly to the brain. It can detect plaque, blockage or narrowing of the arteries which are the risk of stroke.
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. Bangkok hospital ensures specialized care for patients with even the most challenging strokes throughout the course of their diagnosis, treatment and recovery.