Brain Stroke: What Causes It and How to Avoid It?

What is Stroke?

A Brain Stroke is a medical emergency in which a blood vessel in the brain ruptures and bleeds. It can also happen when the blood supply to the brain is cut off. Blood and oxygen can’t arrive at the brain’s tissues because of the rupture or obstruction. Brain cells and tissue are damaged and begin to die within minutes of being starved of oxygen.

What are the types of Brain Stroke?

Types of Brain Stroke:

1. Ischemic Stroke

2. Hemorrhagic Stroke

1. Ischemic Stroke: Ischemic Stroke is also known as Brain ischemia or cerebral ischemia is the most common type of brain stroke that accounts for almost 85% of all stroke attacks. This type of brain stroke is brought occurred by a blockage in an artery that provisions blood to the brain. The blockage reduces the bloodstream and oxygen to the brain, leading to damage or death of brain cells. If Blood circulation is not restored quickly, brain damage can be permanent

The reason for ischemic stroke is Atherosclerosis “Fatty deposits lining in the blood vessel walls called as  Atherosclerosis”.

Atherosclerosis can cause two types of obstruction:

• Cerebral Thrombotic stroke: It is caused by a blood clot that forms in an artery that supplies blood to the brain.
• Cerebral Embolic stroke: It happens when a clot forms somewhere else in the body and travels through the blood vessels to the brain. It gets struck there and stops the blood flow.

Transient Ischemic Attack (TIA): A transient ischemic attack or TIA, also known as TIA ministroke, could be a condition where there is a temporary blockage of the bloodstream to the brain. It’s regularly overlooked because it does not cause any permanent damage in spite of the fact that it’s exceedingly not fitting to do so. Most of the common initial symptoms of blood clot formation close the brain indicate a TIA attack and ought to be diagnosed and treated at the earliest. TIAs give the patient and the doctor the leading opportunity for treatment and disease prevention, so this should not be missed.

2. Hemorrhagic Stroke: Almost 13 to 15% of all brain stroke cases are Hemorrhagic Stroke. Hemorrhagic Stroke occurs when a blood vessel in your brain leaks (or) ruptures and bleeds into the surrounding brain. The causes for this stroke are mainly high blood pressure, injury, abnormal blood vessels (AVMs), aneurysm or bleeding disorder.

There are two types of Hemorrhagic Stroke are there they are:

• Subarachnoid hemorrhage: Bleeding happens in the area between the brain and skull.
• Intracerebral hemorrhage: Bleeding inside the Brain.

What are the warning signs of a Stroke?

FAST is an acronym to readily identify the stroke signs:

• Face Drooping: One side of the face droops or is numb.
• Arm Weakness: One arm is weak or numb. One arm drifts downward when they try to raise both arms.
• Speech Difficulty: Speech is slurred or unable to speak or hard to understand.
• Time: Time for specialist treatment

If anyone observes the above symptoms seek medical help as fast as possible

What are the Symptoms of stroke?

• Sudden and severe headache
• Vision problem, inability to look at bright light
• Loss of balance (or) coordination
• Becoming unable to move
• Numbness (or) weakness on one side of the body
• Loss of speech (or) difficulty in understand speech
• Confusion (or) loss of alertness
• Paralysis
• Age over 55

What are the Risks factors for stroke?

• Smoking
• Obesity
• Medications
• Heart disease
• Physical inactivity
• Stress
• Alcohol
• High Blood pressure
• Diabetes
• High blood cholesterol
• Difficulty walking

How is Brain Stroke Diagnosed?

Brain Stroke is diagnosed by:

• Physical and neurological examination
• Blood tests

Imaging techniques are:

• CT Scan
• Magnetic Resonance Imaging (MRI)
• Carotid ultrasound
• Cerebral angiogram
• Echocardiogram

What are the Advanced Treatment options for brain stroke?

Stroke is a medical emergency because if not treated promptly, it can result in death or lifelong disability. When an ischemic stroke occurs, the ischemia process causes a progressive loss of brain cells with each passing minute. Early blood supply restoration to the ischemic brain will avoid further neuronal loss and favor a good overall recovery.

In the event of an ischemic stroke, there are treatment options available to restore blood flow, but treatment must begin within the first few hours of the onset of the stroke. When a stroke is detected, the patient must be taken to a well-equipped hospital right away. In this blog, we have to discuss advanced interventional treatments for ischemic stroke.

The main treatments for ischemic stroke are:

Treatments for Ischemic Stroke:

Time plays a huge role as bringing the patient to a hospital within 4.5 hours of stroke onset can change the prognosis. Hence these 4.5 hours are rightfully called the golden hours.

A CT scan will be performed once the patient arrives at the hospital, and if it is normal, the Interventional Radiologist will take efforts to break the clot and restore blood flow.

tPA and Tenecteplase are two medications that can help with this. The IR will choose the specific medication. Thrombolysis is the medical term for the process of breaking up clots with medicines.

If the patient has high blood pressure, is pregnant, has just undergone surgery, is on blood thinners, has recently suffered head trauma, or has bleeding difficulties, thrombolysis will not be performed.

When a doctor decides that thrombolysis is appropriate, the drug must be provided within 4 .5 hours after the commencement of the stroke

Thrombolytic therapy (clot-busting drug) can only be given within the first 3 to 4.5 hours after a stroke has occurred. It helps in the re-establishment of blood supply and the survival of brain tissue from death.

Thrombolytic therapy:

A drug called tissue plasminogen activator, often known as “tPA,” is injected into a vein to break up a clot that may be limiting blood flow to the brain. When taken intravenously (IV), the therapy should be given within 4.5 hours of the onset of symptoms. A quick tPA treatment not only increases a person’s chances of survival, but it also reduces complications. To restore blood flow, tPA destroys the blood clot. A catheter, which is a long, thin tube inserted into an artery in the groin and gradually advanced to the brain to inject tPA directly at the site of the stroke, can sometimes be used to deliver tPA directly into the brain. The time window for this treatment is also limited, however, it is slightly longer than with injectable tPA.

If the patient had an acute ischemic stroke or The Patient is not eligible or has failed in intravenous thrombolysis then mechanical thrombectomy could be a great option and the mechanical thrombectomy treatment is performed by An Interventional Radiologist based on age, Severity of stroke, time window and Test results. In selected patients with stroke, an interventional procedure known as “mechanical thrombectomy” can be used to remove the clot from an occluded blood vessel within the first 6 to 24 hours.

Mechanical thrombectomy Procedure:

Mechanical thrombectomy is a minimally invasive and endovascular procedure which means that we go through the groin blood vessels and then advance small catheters all the way up to the neck muscles eventually to the brain. Through those catheters, we can use several different types of devices to remove blood clots from the brain. In this procedure surgeon makes a small incision in the groin region. A catheter (A thin, hollow type) is guided slowly through the brain. A stent-like device is passed through the catheter to remove the blood clot and finally, the catheter is removed and the incision is closed. The patient will recover to near normalcy 60-70 percent of the time after receiving the medication.

Recovery is not really dependent on the procedure itself. Once remove the catheter is the hole seals up within a few hours. It depends on how severe the stroke symptoms or how severe the stroke was and recovery. In an optimal case if the procedure goes well and there’s no significant brain damage. The patient walks the next day after the stroke. If there is more damage then it could take a couple of days and even a rehabilitation stay.

Prevention:

Some lifestyle changes can help you avoid having a stroke. They are also crucial for people who have already had a stroke in order to prevent another one.

• Blood hypertension, diabetes, and cholesterol levels are all under control.
• Eating a balanced diet
• Physical activity on a regular basis
• Smoking cessation
• Stress management

Frequently Asked Questions:

Why Time plays a critical role in Brain stroke?

The current therapeutic options for stroke are limited to a 4.5-hour time window. The clots that restrict the arteries in ischemic strokes can be removed using TPA, which must be administered within 4.5 hours of the onset of symptoms. Only a few endovascular procedures that last up to 24 hours are available beyond 4.5 hours. Also, keep in mind that even if you arrive at the hospital on time, one hour will be spent on thorough examination and necessary diagnostic tests such as a CT scan and an MRI scan. As a result, time is crucial.

Can a survivor have another stroke?

Treatments that can prevent the patient have another stroke include drugs that help lower blood pressure and cholesterol anticoagulation for atrial fibrillation, getting surgery or stenting for a few selected patients that have severe carotid artery narrowing.

What is the “golden hour”?

The golden hour is an overall idea in medication wherein rapid therapy is more viable than later therapy. The reason it’s “golden” is that a stroke patient who arrives at the hospital and receives treatment within the first hour has a significantly better chance of surviving and avoiding long-term brain damage.

Why does a stroke usually just affect one side of the body’s movement?

 It’s all about brain anatomy. Typically, a stroke affects only one side of the brain. Because the opposite side of the brain controls movement for one side of the body, if your stroke impacted the right side of your brain, you will have problems with the left side of your body.

What steps need to be taken for appropriate stroke rehabilitation?

The purpose of rehabilitation is to assist you in relearning the skills you have lost. Rehab usually begins 24 to 48 hours after a stroke, depending on the severity of the stroke and any associated consequences. While some stroke survivors recover rapidly, the majority will require long-term therapy. Inpatient, outpatient, and home health care rehabilitation are all options. Your rehabilitation strategy will alter as you regain skills and your needs change during your recovery. 

About the Author:

Name: DR .SURESH GIRAGANI

INTERVENTIONAL RADIOLOGIST

DR. SURESH GIRAGANI CONSULTANT INTERVENTIONAL RADIOLOGIST at Yashoda group of hospitals, has more than sixteen years of clinical experience in vascular interventions with a special interest in neurovascular and peripheral vascular disease interventional procedures.

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