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Stroke Rehabilitation/Stroke is a neurological deficit of cerebrovascular causes the sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain. Sudden loss of speech, weakness, or paralysis of one side of the body can be symptoms. A suspected stroke may be confirmed by scanning the brain.
Stroke is defined by the World Health Organization[rx] as ‘a clinical syndrome consisting of rapidly developing clinical signs of focal (or global in case of coma) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin.’ A transient ischaemic attack (TIA) is defined as stroke symptoms and signs that resolve within 24 hours. There are limitations to these definitions. The symptoms of a TIA usually resolve within minutes or a few hours at most and anyone with continuing neurological signs when first assessed should be assumed to have had a stroke. ‘Brain Attack’ is sometimes used to describe any neurovascular event and maybe a clearer and less ambiguous term to use.
Stroke a cerebrovascular accident is prevalent across patient populations and can be a significant cause of morbidity and mortality. Stroke can be categorized as ischemic, hemorrhagic, or subarachnoid. Among ischemic strokes, the Trial Org 10172 in Acute Stroke Treatment (TOAST) classification is used to subdivide the categories that include cardioembolism, small-vessel occlusion, large-artery atherosclerosis, a stroke of other undetermined etiology, and stroke of undetermined etiology.
Symptoms of Stroke
The words BE FAST can help you recognize stroke signs:
- (B)Balance: Sudden loss of balance.
- (E)Eyes: Sudden loss of vision in one or both eyes
- (F)ACE. Ask the person to smile. Check to see if one side of the face droops.
- (A)RMS. Ask the person to raise both arms. See if one arm drifts downward.
- (S)PEECH. Ask the person to repeat a simple sentence. Check to see if words are slurred and if the sentence is repeated correctly.
- (T)IME. If a person shows any of these symptoms, time is essential. It is important to get to the hospital as quickly as possible.
Common Signs of Stroke
The type and severity of stroke symptoms depend on the area of the brain that is affected.
Signs and symptoms of stroke in both men and women may include:
- Sudden numbness, weakness, or inability to move the face, arm, or leg (especially on one side of the body)
- Trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Dizziness, trouble walking, or loss of balance or coordination
- Sudden, severe headache (often described as “the worst headache of my life”)
- Trouble breathing
- Loss of consciousness
If the area of the brain affected contains one of the three prominent central nervous system pathways—the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:
- hemiplegia and muscle weakness of the face
- reduction in sensory or vibratory sensation
- initial flaccidity (reduced muscle tone), replaced by spasticity (increased muscle tone), excessive reflexes, and obligatory synergies.
- altered smell, taste, hearing, or vision (total or partial)
- drooping of eyelid (ptosis) and weakness of ocular muscles
- decreased reflexes: gag, swallow, pupil reactivity to light
- decreased sensation and muscle weakness of the face
- balance problems and nystagmus
- altered breathing and heart rate
- weakness in sternocleidomastoid muscle with the inability to turn head to one side
- weakness in tongue (inability to stick out the tongue or move it from side to side)
If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms:
- aphasia (difficulty with verbal expression, auditory comprehension, reading, and writing; Broca’s or Wernicke’s area typically involved)
- dysarthria (motor speech disorder resulting from neurological injury)
- apraxia (altered voluntary movements)
- visual field defect
- memory deficits (involvement of temporal lobe)
- hemineglect (involvement of parietal lobe)
- disorganized thinking, confusion, hypersexual gestures (with the involvement of frontal lobe)
- lack of insight of his or her, usually stroke-related, disability
If the cerebellum is involved, ataxia might be present and this includes:
- altered walking gait
- altered movement coordination
- vertigo and or disequilibrium
Stroke Symptoms in Women
Stroke is the third leading cause of death in women (and the fifth leading cause of death in men).
Each year stroke kills twice as many women as breast cancer, according to the National Stroke Association.
The stroke symptoms women may experience can be different from those experienced by men. These include:
- Difficulty or shortness of breath
- Sudden behavioral changes
- Nausea or vomiting
Here are common signs of a stroke. Read them, study them, and if someday someone around you shows any signs of having a stroke, you’ll know what to do.
Weakness In The Face, Arms Or Legs
Is the person’s face drooping on one side? When sudden numbness or weakness of the face occurs, resulting in something like an uneven smile, this is a warning sign of a stroke. Ask the person to raise his or her arms. If the person isn’t able to move an arm (or leg), this is because it suddenly has gone weak and numb. These changes involve either one side of the body or the other. It’s uncommon to have a stroke that affects both arms at the same time. The reason this happens is because the left side of the brain controls the right side of the body, and the right side of the brain controls the left side of the body. Therefore, a stroke in the left side of the brain translates into right-sided weakness and numbness.
Trouble Walking Or Sudden Loss Of Balance
When having a stroke, you could lose balance and coordination. Showing signs of troubled walking, you would find it hard to stand on your feet due to sudden fatigue and confusion. You feel this way because the blood supply to your brain gets blocked or reduced.
This sign is not hard to recognize. Do a simple test: make the person repeat a common phrase, for instance, “A cat with gloves catches no mice.” Is the speech slurred? Does the person say the words wrong? Sudden confused or slurred speech is a sign to take into account. If something like this happens, there is an 80% chance the individual is suffering a stroke.
Typically, what happens in a stroke is that you lose one-half (or one-quarter) of your visual field; you don’t go entirely blind. When looking straight ahead, you can’t see past midline in one direction. In other words, you lose some peripheral vision in both eyes. So, if you or someone else experiences trouble seeing, with partial loss of the field of vision, this can be a sign of a stroke.
Dizziness can be either a one-time event or a chronic problem; however, dizziness alone isn’t necessarily a sign of a stroke. Occasionally, we all get lightheaded due to stress, overworking, depression, illness, or medication, but we eventually get better. If dizziness occurs, persists, and is associated with trouble walking, loss of coordination, and difficulty in speaking, it should be considered a sign of a stroke.
There is evidence that people who experience painful headaches are at higher risk of strokes and heart disease. A sudden severe headache that comes out of nowhere with no clear cause (like stress, anxiety, or work exhaustion) should alert you to the possibility of a stroke. This occurs particularly with the hemorrhagic-type of stroke, when a blood vessel in the brain ruptures and bleeds, causing brain cell death. The pain of this kind of a headache is extreme and may be followed by vomiting in some cases. A headache may also occur with the ischemic-type of stroke.
Fatigue is a persistent symptom that affects stroke sufferers. Though everyone feels tired at some point in time, it can typically be explained by not getting enough sleep or having had a hectic day. Fatigue in those who survive a stroke is common and quite different. A sense of exhaustion and weariness that may not improve with rest could represent a sign of a stroke.
Loss of Swallowing Reflex
A decrease or loss of the swallowing reflex is a common sign of a person who is on the brink of a stroke. Many stroke sufferers report issues with swallowing their food, to the point of gagging. In fact, one study found that 65% of stroke patients developed a swallowing disorder called dysphagia. This important sign of a stroke is typically examined upon reaching the hospital. Doctors will carry out a swallow test and, upon failing it, a speech-language pathologist will be required for treatment.
Loss of Sensation
A gradual or complete loss of sensation on areas of the skin is quite typical for a person who is having a stroke. During a stroke, the brain is no longer able to receive touch, pressure and temperature signals from those body parts. This reduced sensation can be experienced in one or different parts of the body, depending upon the area of the brain that was affected. Other senses that can be equally affected are hearing, smelling, and tasting.
A feeling that you are losing your breath or your heart is fluttering is a potential sign of a stroke. Women are more susceptible to this symptom than men. The condition can become quite uncomfortable as the pressure in the brain increases as the stroke evolves. The symptoms of a stroke can be quite similar to those of a heart attack.
Treatment of Stroke
Initial Treatment imed at limiting the size of the stroke and preventing further stroke. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischaemic stroke or by stopping the bleeding of a hemorrhagic stroke. This will involve administering medications and may involve surgery in some cases.