Stroke; Defination, Types, Causes, Symptoms, Diagnosis, Treatment

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Stroke or Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood vessel.A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die.

Alternative Names of Stroke

Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke – ischemic; Cerebrovascular accident; Stroke – hemorrhagic

Possible affected area of brain

Area of damage Possible effects
Brain stem A stroke in the brain stem is uncommon, but often fatal. Brain stem strokes may cause problems with breathing, heart function, balance and coordination, chewing, swallowing, speaking, and seeing, as well as weakness and paralysis on both sides of your body.
Cerebellum Strokes in the cerebellum are less common than in the cerebrum (the large part of the brain), but can cause severe effects including problems with balance and coordination, dizziness, headaches, nausea and vomiting.
Cerebrum – Left hemisphere Strokes in the left hemisphere typically cause weakness or paralysis on the right side of your body, and cognitive problems including difficulties with reading, talking and thinking, and learning and remembering new information.
Cerebrum – Right hemisphere Strokes in the right hemisphere typically cause problems with vision, depth perception, short-term memory loss, and judgement, as well as weakness or paralysis on the left side, and a tendency to ignore things on your left side including your own left arm and leg.

Causes of  Stroke

Hemorrhagic strokes are caused by bleeding in or around the brain.

Bleeding occurs when a weakened blood vessel in the brain ruptures and leaks into the surrounding brain tissue.

The leaked blood can put too much pressure on the blood cells in the brain, causing damage.

Chronic high blood pressure is the most common reason for hemorrhagic stroke.

Two types of weakened blood vessels can cause hemorrhagic stroke:
  • Aneurysm, an abnormally shaped weak point in a blood vessel
  • Arteriovenous malformations (AVMs), clusters of abnormally formed blood vessels

Major Risk Factors for Stroke

Certain environmental factors, medical conditions, and lifestyle habits increase your risk of stroke.

Some risk factors can be treated or controlled, while other risk factors cannot.

Factors that can’t be changed include:

  • Family history: Stroke often runs in families. Your stroke risk may be higher if a grandparent, parent, or sibling has suffered a stroke in the past.
  • Age: Stroke is most common in adults over the age of 65. The chance of having a stroke doubles for each decade of life after 55, according to the American Stroke Association.
  • Gender: Women have more strokes than men, and strokes kill more women than men each year.
  • Race: African Americans, Hispanics, American Indians, and Alaska Natives have a higher risk of stroke than non-Hispanic whites or Asians.
  • Personal history of a previous stroke.

Stroke risk factors that can be prevented or controlled include:

  • High blood pressure: High blood pressure is the main risk factor for stroke. It can damage and weaken arteries throughout the body so that they burst or clog more easily.
  • High cholesterol: Cholesterol is a fatty substance that contributes to plaques in the arteries that can block blood flow to the brain.
  • Heart disease: Coronary artery disease, the build-up of plaque in the arteries, can increase your risk of stroke. So can other heart conditions, including heart valve defects and irregular heartbeat (atrial fibrillation).
  • Diabetes: People with diabetes are four times as likely to have a stroke as people without diabetes, according to the National Stroke Association.
  • Sickle cell anemia.
  • Heart disease – people with coronary heart disease are at more risk than people with normal functioning of the heart.
  • Diabetes – people with diabetes have more chances to develop apoplexy
  • Coronary artery disease – coronary arteries supply blood to the brain, they get narrowed by fatty deposition from artherosclerosis , and may become blocked by clot which results in to apoplexy or stroke.
  • High blood cholesterol – high levels of low density cholesterol and triglycerides increase the risk of apoplexy.
  • 10 Physical inactivity and obesity – increases the risk of developing hypertension, diabetes, high blood cholesterol, which may ultimately result in to apoplexy.
  • Liver disease – causes increased risk of bleeding

Other Risk Factors for Stroke

Certain lifestyle habits and conditions can also increase your risk of stroke.

These risk factors include:

  • Smoking
  • Poor diet
  • Obesity
  • Low physical activity
  • Stress and depression
  • Heavy alcohol use
  • Use of illicit drugs, including cocaine and amphetamines

Symptoms

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

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)
  • Confusion
  • 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

Subtypes

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
  • numbness
  • reduction in sensory or vibratory sensation
  • initial flaccidity (reduced muscle tone), replaced by spasticity (increased muscle tone), excessive reflexes, and obligatory synergies.

In most cases, the symptoms affect only one side of the body (unilateral). Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body. However, since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms, the presence of any one of these symptoms does not necessarily indicate a stroke.In addition to the above CNS pathways, the brainstem gives rise to most of the twelve cranial nerves. A brainstem stroke affecting the brainstem and brain, therefore, can produce symptoms relating to deficits in these cranial nerves

  • 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 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 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:

  • Fainting
  • Difficulty or shortness of breath
  • Sudden behavioral changes
  • Agitation
  • Hallucination
  • Nausea or vomiting
  • Seizures
  • Hiccups

The sort of problems that may occur include one or more of the following:

  • Weakness of one side of the body. This may cause problems with walking if a leg is affected or problems using an arm or hand properly.
  • Problems with balance and co-ordination.
  • Swallowing problems are common. In some cases this can be dangerous, as food may go down the windpipe rather than down the gullet when you eat. Because of this, it is usual to do a swallow test on all people with a stroke before they are allowed to eat or drink. This is to make sure that swallowing is safe. If there is severe difficulty with swallowing then you may need to have food and drinks passed into your stomach via a tube.
  • Speech and communication difficulties. This may range from a difficulty in finding the correct words to say in the middle of a sentence to being completely unable to speak. Also, understanding speech, reading or writing may be affected.
  • Difficulty with vision. If a part of the brain that deals with vision is affected then problems may arise. For example, some people who have had a stroke have double vision. Some people lose half of their field of vision.
  • Difficulties with mental processes. For example, difficulty in learning, concentrating, remembering, etc.
  • Inappropriate emotions. For example, following a stroke, some people cry or laugh at times for no apparent reason.
  • Tiredness.

  Types of Strokes

stroke

Ischemic Stroke

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This slide shows a CT scan of an ischemic stroke, which is responsible for about 80% to 90% of all strokes. Ischemic strokes are caused by clots that reduce or stop blood flow to the brain. The clot may develop elsewhere in the body and circulate to become lodged in a blood vessel in the brain, or the clot may originate in the brain.

Symptoms of

The symptoms of a transient ischemic attack (TIA) and early ischemic stroke are similar. In the case of a TIA, however, the symptoms resolve within 24 hours. Symptoms depend on where the injury in the brain occurs. The origin of the stroke is usually either the carotid or basilar arteries.

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Symptoms From Blockage in the Carotid Arteries.

The carotid arteries stem off of the aorta (the primary artery leading from the heart) and lead up through the neck, around the windpipe, and on into the brain. When TIAs or stroke occur from blockage in the carotid artery, which they often do, symptoms may occur in either the retina of the eye or the cerebral hemisphere (the large top part of the brain).

Symptoms include the following:

  • When oxygen to the eye is reduced, people describe the visual effect as a shade being pulled down. People may develop poor night vision. About 35% of TIAs are associated with temporary lost vision in one eye.
  • When the cerebral hemisphere is affected, a person can experience problems with speech and partial and temporary paralysis, drooping eyelid, tingling, and numbness, usually on one side of the body. The stroke victim may be unable to express thoughts verbally or to understand spoken words. If the stroke injuries are on the right side of the brain, the symptoms will develop on the left side of the body and vice versa.
  • Uncommonly, patients may experience seizures.

Symptoms From Blockage in the Basilar Artery. The other major site of trouble, the basilar artery, is formed at the base of the skull from the vertebral arteries, which run up along the spine and join at the back of the head. When stroke or TIAs occur here, both hemispheres of the brain may be affected so that symptoms occur on both sides of the body. The following symptoms may develop:

  • Temporarily dim, gray, blurry, or lost vision
  • Tingling or numbness in the mouth, cheeks, or gums
  • Headache, usually in the back of the head
  • Dizziness
  • Nausea and vomiting
  • Difficulty swallowing
  • Weakness in the arms and legs, sometimes causing a sudden fall

Such strokes usually occur in the brain stem, which can have profound affects on breathing, blood pressure, heart rate, and other vital functions, but have no affect on thinking or language.

Speed of Symptom Onset. The speed of symptom onset of a major ischemic stroke may indicate its source:

  • If the stroke is caused by a large embolus (a clot that has traveled to an artery in the brain), the onset is sudden. Headache and seizures can occur within seconds of the blockage.
  • When thrombosis (a blood clot that has formed within the brain) causes the stroke, the onset usually occurs more gradually, over minutes to hours. On rare occasions it progresses over days to weeks.

Ischemic strokes are usually divided into two main subtypes: thrombotic and embolic.

Thrombotic Stroke

Nearly half of all strokes are thrombotic strokes. Thrombotic strokes are caused when blood clots form in the brain due to a diseased or damaged cerebral artery.

Embolic Stroke

Blood clots also cause embolic strokes. However, in the case of embolic strokes, the blood clot forms in an artery outside the brain. Often these blood clots start in the heart and travel until they become lodged in an artery of the brain. The physical and neurological damage embolic strokes cause is nearly immediate.

Hemorrhagic Stroke

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This picture shows a hemorrhagic stroke using an MRI image. The circle insert outlines what composes a hemorrhagic stroke. A blood vessel in the brain breaks open and blood escapes into the brain under pressure, compressing other blood vessels and brain cells causing damage and death. This bleeding into the brain is difficult to stop and is more likely to be fatal.

SYMPTOMS OF HEMORRHAGIC STROKE

Intracerebral Hemorrhage Symptoms. Symptoms of an intracerebral, or parenchymal, hemorrhage typically begin very suddenly and evolve over several hours and include:

  • Headache
  • Nausea and vomiting
  • Altered mental states
  • Seizures

Subarachnoid Hemorrhage. When the hemorrhage is a subarachnoid type, warning signs may occur from the leaky blood vessel a few days to a month before the aneurysm fully develops and ruptures. Warning signs may include:

  • Abrupt headaches
  • Nausea and vomiting
  • Sensitivity to light
  • Various neurologic abnormalities. Seizures, for example, occur in about 8% of patients.

When the aneurysm ruptures, the stroke victim may experience:

  • A terrible headache
  • Neck stiffness
  • Vomiting
  • Altered states of consciousness
  • Eyes may become fixed in one direction or lose vision
  • Stupor, rigidity, and coma

There are two types of hemorrhagic strokes: intracerebral and subarachnoid.

Intracerebral Stroke

“Intracerebral” means “within the brain,” and it refers to a stroke caused by a diseased blood vessel bursting within the brain. Intracerebral strokes are usually caused by high blood pressure.

Subarachnoid Stroke

A subarachnoid hemorrhage refers to bleeding immediately surrounding the brain in the area of the head called the subarachnoid space. The main symptom of a subarachnoid stroke is a sudden, severe headache, possibly following a popping or snapping feeling. Many factors can cause a subarachnoid stroke, including head injury, blood thinners, bleeding disorders and bleeding from a tangle of blood vessels known as an arteriovenous malformation.

Mini-Stroke (TIA)

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“Mini-strokes” (also termed transient ischemic attacks or TIAs) are temporary blockages of blood vessels in the brain. TIAs can produce mild stroke symptoms that resolve. TIAs often occur before a stroke happens, so they serve as warning signs that the person may need stroke preventive therapy.

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How is a stroke evaluated?

The first step in assessing a stroke patient is to determine whether the patient is experiencing an ischemic or hemorrhagic stroke so that the correct treatment can begin. A CT scan or MRI of the head is typically the first test performed.

  •  Computed Tromography
  • Imaging

    For diagnosing ischemic stroke in the emergency setting

    • CT scans (without contrast enhancements)
    sensitivity= 16%
    specificity= 96%
    • MRI scan
    sensitivity= 83%
    specificity= 98%

    For diagnosing hemorrhagic stroke in the emergency setting:

    • CT scans (without contrast enhancements)
    sensitivity= 89%
    specificity= 100%
    • MRI scan
    sensitivity= 81%
    specificity= 100%

    For detecting chronic hemorrhages, MRI scan is more sensitive.

  • CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. Physicians use CT of the head to detect a stroke from a blood clot or bleeding within the brain. To improve the detection and characterization of stroke, CT angiography (CTA) may be performed. In CTA, a contrast material may be injected intravenously and images are obtained of the cerebral blood vessels. Images that detect blood flow, called CT perfusion (CTP), may be obtained at the same time. The combination of CT, CTA and CTP can help physicians decide on the best therapy for a patient experiencing a stroke.
  • Magnetic resonance angiography (MRA)
    MRA is a noninvasive technology for imaging the cerebral blood vessels, and yields valuable information regarding blood supply to the brain. The use of intravenous contrast agents has provided great improvements in accurately viewing the cerebral blood vessels. Many such techniques have been pioneered by researchers at Stanford.
  • Related image
  • Transcranial doppler (TCD)
    TCD a new, noninvasive ultrasound procedure that allows the assessment of blood flow through the cerebral vessels via a small probe placed against the skull. TCD is a portable test that can be performed frequently at the patient’s bedside to follow the progress of medical treatment for stroke.
  • Carotid duplex scanning
    This is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
  • Radionuclide SPECT scanning
    This provides data on relative blood flow using the radionuclide Technetium99.
  • Positron emission tomography (PET) scanning
    A PET Scan measures brain cell metabolism, can determine if brain tissue is functioning even if blood flow to that area appears to be diminished.
  • Cerebral angiography (angiogram)
    This method requires injection of a contrast dye through a major artery (usually the femoral artery in the thigh) for evaluation of blood flow to the brain. This procedure is completed in Stanford’s Cath/Angio lab. The procedure time is approximately two to three hours; bed rest for six hours is required after the procedure.
  • Transesophageal echocardiography
    This involves placing a flexible tube in the esophagus (tube to stomach) to directly image the heart and assess its function and structures.
  • Ultrasound
    An ultrasound is a diagnostic test that uses high frequency waves of sound to help examine the movement, size and shape of blood vessels.

To help determine the type, location, and cause of a stroke and to rule out other disorders, physicians may use:

  • Blood tests.
  • CBC,ESR,Hb
  • RBS,serum creatinine
  • Serum choletrol,
  • Electrocardiogram (ECG, EKG): An electrocardiogram, which checks the hearts’ electrical activity, can help determine whether heart problems caused the stroke.
  • Carotid ultrasound/Doppler ultrasound: Ultrasound imaging involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Physicians use a special ultrasound technique called Doppler ultrasound to check for narrowing and blockages in the body’s two carotid arteries, which are located on each side of the neck and carry blood from the heart to the brain. Doppler ultrasound produces detailed pictures of these blood vessels and information on blood flow.
  • Cerebral angiography. Angiography is a medical test that is performed with one of three imaging technologies—x-rays, CT or MRI, and in some cases a contrast material, to produce pictures of major blood vessels in the brain. Cerebral angiography helps physicians detect or confirm abnormalities such as a blood clot or narrowing of the arteries.

Treatment 

INITIAL TREATMENT

Immediate treatment is aimed 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.

Emergency treatment with medications.

Therapy with clot-busting drugs must start within 3 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:

  • Aspirin. Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.
  • Anticoagulants (eg: heparin) these medications help to prevent blot clots getting bigger and prevent new blood clots from forming
  • Vinpocetin group of medicine to reached oxygen & nutrition to the heamorrhagic/ischemic area of brain.
  • Vesodilator medicine for inischemic stroke  to reapedly reached blood to the obstracle area of brain.
  •  Prednisolone /methaileprednisolone for eradication of inflamation in the blood cloted area of brain.
  • NSAID for inflamation & removed pain .
  • Gaba Pentine & Pregabaline to recover damage nerve & inhabite the pain impulse to the brain.
  • Lipid lowering agent to removed the excessive fat & pluque that are accumulated in the blood vessel in the  body.
  • Thrombolytic therapy these medications dissolve blood clots allowing blood flow to be re-established
  • Antihypertensives drug  in cases of haemorrhagic stroke these medications may be prescribed to help lower high blood pressure
  • Antidepressants drug for better sleep & Removed anxiety.
  • Muscle Relexant to improved muscle tone & avoid spasticity or bed sore.
  • Anti ulcerant drug used to avoid the constipation & normalising the boil movement.
  • Medications of diuretic  to reduce swelling in the brain and medications to treat underlying causes for the stroke eg: heart rhythm disorders may also be given.
  • Intravenous injection of tissue plasminogen activator (TPA). Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it’s given in the vein.
  • TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.

Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible, depending on features of the blood clot:

  • Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver TPA directly into the area where the stroke is occurring. The time window for this treatment is somewhat longer than for intravenous TPA but is still limited.
  • Mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot.

However, recent studies suggest that for most people, delivering medication directly to the brain (intra-arterial thrombolysis) or using a device to break up or remove clots (mechanical thrombectomy) may not be beneficial. Researchers are working to determine who might benefit from this procedure.

Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that’s narrowed by fatty deposits (plaques). Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation:

  • Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaques that block the carotid artery.Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
  • Angioplasty and stents. In an angioplasty, a surgeon gains access to your carotid arteries most often through an artery in your groin. Here, he or she can gently and safely navigate to the carotid arteries in your neck. A balloon is then used to expand the narrowed artery. Then a stent can be inserted to support the opened artery.

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.

Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners’ effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.

Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.

Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke:

  • Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
  • Coiling (endovascular embolization). In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
  • Surgical AVM removal. Surgeons may remove a smaller AVM if it’s located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it’s large or located deep within your brain.
  • Intracranial bypass. In some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
  • Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations.

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Thrombolysis

Ischaemic strokes can often be treated using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain. This use of “clot-busting” medication is known as thrombolysis.

Alteplase is most effective if started as soon as possible after the stroke occurs. It isn’t generally recommended if more than 4.5 hours have passed, as it’s not clear how beneficial it is when used after this time.

Before alteplase can be used, it’s very important that a brain scan is carried out to confirm a diagnosis of an ischaemic stroke. This is because the medication can make the bleeding that occurs in haemorrhagic strokes worse.

Thrombectomy

A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy. This removes blood clots and helps restore blood flow to the brain.

Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain. It’s most effective when started as soon as possible after a stroke.

The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the artery in the brain.

The blood clot can then be removed using the device, or through suction. The procedure can be carried out under local or general anaesthetic.

Antiplatelets

Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is an antiplatelet, which reduces the chances of another clot forming.

In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.

Anticoagulants

Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future.

Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots occurring.

Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use.

There are also a number of anticoagulants called heparins that can only be given by injection and are used short term.

Anticoagulants may be offered if you:

  • have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
  • have a history of blood clots
  • develop a blood clot in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs

Stroke Recovery

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Strokes that cause long-term damage are usually severe and/or not treated or treated after large sections of the brain have been damaged or killed. The type of damage depends on where in the brain the stroke occurred (for example, the motor cortex for movement problems or the brain area that controls speech). Although some problems will be permanent, many people that do rehabilitation can regain some or many of the abilities lost in the stroke.

Speech Therapy

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If a stroke damages a person’s ability to use language and to speak or swallow, rehabilitation with a speech therapist, can help a person regain some or most of the abilities they lost initially with the stroke. For those who have severe damage, rehabilitation can provide methods and skills that can help a person to adapt and compensate for severe damage.

Physical Therapy

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LONGER TERM TREATMENT:

Brain cells do not generally regenerate (regrow). Following a stroke, surviving brain cells can take over the function of areas that are dead or damaged, but only to a certain degree. The adaptive ability of the brain requires the relearning of various skills.

As each person who suffers a stroke is affected differently, individual rehabilitation plans are developed in conjunction with the patient, family and healthcare team. These aim to teach skills and maximise function so that the person can achieve maximum independence.

Rehabilitation may involve:

Physiotherapy

Treatment of hemiplegia requires coordination of several health professionals. A physiotherapist, occupational therapists, a physician, a surgeon and support from family etc.

  • Treatment is focused to find the causative factor and check its further progression. Secondly after few days, rehabilitation therapy helps to minimize disability.
  • Several medicines are prescribed to control the primary cause such as anti hypertensive, anti-thrombolytic agents to dissolve the clot, drugs to control cerebral edema etc.
  • Intensive physical therapy is begun after few days. Activities such as walking, standing are done repeatedly under the guidance of physiotherapist. It helps to improve the muscular functions which have become rigid. It is aimed to make the patient self sufficient to perform his daily activities.
  • Patient is taught to move his affected arm with his strong arm. With exercise it is possible to maintain flexibility of joints and it also prevents tightening and shortening of muscles. Speech therapy is simultaneously begun to improve communication and speaking skills.
  • Speech therapy – to improve communication
  • Occupational therapy – to improve daily functions such as eating, cooking, toileting and washing.
Recovery can take months and it may be several days or weeks after the stroke before doctors are able to give an accurate prediction for recovery.

Occupational therapy

Occupational therapy Occupational Therapists may specifically help with hemiplegia with tasks such as improving hand function, strengthening hand, shoulder and torso, and participating in activities of daily living (ADLs), such as eating and dressing. Therapists may also recommend a hand splint for active use or for stretching at night. Some therapists actually make the splint; others may measure your child’s hand and order a splint. OTs educate patients and family on compensatory techniques to continue participating in daily living, fostering independence for the individual – which may include, environmental modification, use of adaptive equipment, sensory integration, etc.

Rehabilitation & Thearapy for Hemiplegia

1. Improving motor control

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  a.Neurofacilitatory Techniques

In Stroke Physical Therapy these therapeutic interventions use sensory stimuli (e.g. quick stretch, brushing, reflex stimulation and associated reactions) ,which are based on neurological theories, to facilitate movement in patients following stroke (Duncan,1997). The following are the different approaches: –

i.Bobath

Berta & Karel Bobath’s approach focuses to control responses from damaged postural reflex mechanism. Emphasis is placed on affected inputs facilitation and normal movement patterns (Bobath, 1990).

ii.Brunnstrom

Brunnstrom approach is one form of neurological exercise therapy in the rehabilitation of stroke patients. The relative effectiveness of Neuro-developmental treatment (N.D.T.) versus the Brunnstrom method was studied by Wagenaar and colleagues (1990) from the perspective of the functional recovery of stroke patients. The result of this study showed no clear differences in the effectiveness between the two methods within the framework of functional recovery.

iii.Rood

Emphasise the use of activities in developmental sequences, sensation stimulation and muscle work classification. Cutaneous stimuli such as icing, tapping and brushing are employed to facilitate activities.

iv. Proprioceptive neuromuscular facilitation (PNF)

Developed by Knott and Voss, they advocated the use of peripheral inputs as stretch and resisted movement to reinforce existing motor response. Total patterns of movement are used in treatment and are followed in a developmental sequence.

It was shown that the commutative effect of PNF is beneficial to stroke patient (Wong, 1994). Comparing the effectiveness of PNF, Bobath approach and traditional exercise, Dickstein et al (1986)demonstrated that no one approach is superior to the rest of the others (AHCPR, 1995).

b. Learning theory approach

i. Conductive education

In Stroke Physical Therapy, Conductive education is one of the methods in treating neurological conditions including hemiplegic patients. Cotton and Kinsman (1984) demonstrated a neuropsychological approach using the concept of CE for adult hemiplegia. The patient is taught how to guide his movements towards each task-part of the task by using his own speech – rhythmical intention.

ii. Motor relearning theory

Carr & Shepherd, both are Australian physiotherapists, developed this approach in 1980. It emphasises the practice of functional tasks and importance of relearning real-life activities for patients. Principles of learning and biomechanical analysis of movements and tasks are important. (Carr and Shepherd, 1987)

There is no evidence adequately supporting the superiority of one type of exercise approaches over another. However, the aim of therapeutic approach is to increase physical independence and to facilitate the motor control of skill acquisition and there is strong evidence to support the effect of rehabilitation in terms of improved functional independence and reduced mortality.

c. Functional electrical stimulation (FES)

FES is a modality that applied a short burst of electrical current to the hemiplegic muscle or nerve. In Stroke Physical Therapy, FES has been demonstrated to be beneficial to restore motor control, spasticity, and reduction of hemiplegic shoulder pain and subluxation. It is concluded that FES can enhance the upper extremity motor recovery of acute stroke patient (Chae et al., 1998; Faghri et al., 1994; Francisco, 1998). Alfieri (1982) and Levin et al (1992) suggested that FES could reduce spasticity in stroke patient. A recent meta- analysis of randomized controlled trial study showed that FES improves motor strength (Glanz 1996). Study by Faghri et al (1994) have identified that FES can significantly improve arm function, electromygraphic activity of posterior deltoid, range of motion and reduction of severity of subluxation and pain of hemiplegic shoulder.

d. Biofeedback

Biofeedback is a modality that facilitates the cognizant of electromyographic activity in selected muscle or awareness of joint position sense via visual or auditory cues. In Stroke Physical Therapy the result of studies in biofeedback is controversial. A meta-analysis of 8 randomized controlled trials of biofeedback therapy demonstrated that electromyographic biofeedback could improve motor function in stroke patient (Schleenbaker, 1993). Another meta-analysis study on EMG has showed that EMG biofeedbcak is superior to conventional therapy alone for improving ankle dorsiflexion muscle strength (Moreland et al., 1998. Erbil and co-workers (1996) showed that biofeedback could improve earlier postural control to improve impaired sitting balance. Conflicting meta-analysis study by Glanz et al (1995) showing that biofeedback was not efficacious in improving range of motion in ankle and shoulder in stroke patient. Moreland (1994) conducted another meta-analysis concluded that EMG biofeedback alone or with conventional therapy did not superior to conventional physical therapy in improving upper- extremity function in adult stroke patient.

2. Hemiplegic shoulder management

Shoulder subluxation and pain of the affected arm is not uncommon in at least 30% of all patient after stroke (RCP, 1998) ,whereas subluxation is found in 80% of stroke patients (Najenson et al., 1971). It is associated with severity of disability and is common in patients in rehabilitation setting. Suggested interventions are as follows:

a. Exercise

Active weight bearing exercise can be used as a means of improving motor control of the affected arm; introducing and grading tactile, proprioceptive, and kinesthetic stimulation; and preventing edema and pain. In Stroke Physical Therapy, Upper extremity weight bearing can be used to lengthen or inhibit tight or spastic muscles while simultaneously facilitating muscles that are not active (Donatelli, 1991). According to Robert (1992), the amount of shoulder pain in hemipelgia was related most to loss of motion. He advocated that the provision of ROM exercise (caution to avoid imprigement) as treatment as early as possible.

b. Functional electrical stimulation

Functional electrical stimulation (FES) is an increasingly popular treatment for the hemiplegic stroke patient. It has been applied in stroke physical therapy for the treatment of shoulder subluxation (Faghri et al.,1994), spasticity (Stefanovska et al., 1991) and functionally, for the restoration of function in the upper and lower limb (Kralji et al., 1993). In Stroke Physical Therapy, Electrical stimulation is effective in reducing pain and severity of subluxation, and possibly in facilitating recovery of arm function (Faghri, et al., 1994; Linn, et al., 1999).

c. Positioning & proper handling

In Stroke Physical Therapy, proper positioning and handling of hemiplegic shoulder, whenever in bed, sitting and standing or during lifting, can prevent shoulder injury is recommended in the AHCPR & SIGN guidelines for stroke rehabilitation. In Stroke Physical Therapy, positioning can be therapeutic for tone control and neuro-facilitation of stroke patients (Davies, 1991). Braus et al 94 found shoulder hand syndrome reduced from 27% to 8% by instruction to every one including family on handling technique.

d. Neuro-facilitation

e. Passive limb physiotherapy

Maintenance of full pain-free range of movement without traumatizing the joint and the structures can be carried out. In Stroke Physical Therapy, at no time should pain in or around the shoulder joint be produced during treatment. (Davies, 1991).

f. Pain relief physiotherapy

Passive mobilisation as described by Maitland, can be useful in gaining relief of pain and range of movement (Davies, 1991). In Stroke Physical Therapy other treatment modalities such as thermal, electrical, cryotherapy etc. can be applied for shoulder pains of musculoskeletal in nature.

g. Reciprocal pulley

 The use of reciprocal pulley appears to increase risk of developing shoulder pain in stroke patients. It is not related to the presence of subluxation or to muscle strength. (Kumar et al., 1990)

h. Sling

In Stroke Physical Therapy the use of sling is controversial. No shoulder support will correct glenohumeral joint subluxation. However, it may prevent the flaccid arm from hanging against the body during functional activities, thus decreasing shoulder joint pain. They also help to relieve downward traction on the shoulder capsule caused by the weight of the arm (Hurd, Farrell, and Waylonis, 1974 ; Donatelli ,1991).

3. Limb physiotherapy

Limb physiotherapy/Stroke Physical Therapy includes passive, assisted-active and active range-of-motion exercise for the hemiplegic limbs. This can be an effective management for prevention of limb contractures and spasticity and is recommended within AHCPR (1995). Self-assisted limb exercise is effective for reducing spasticity and shoulder protection (Davis, 1991). Adams and coworkers (1994) recommended passive full-range-of-motion exercise for parlysed limb for potential reduction of complication for stroke patients

4. Chest physiotherapy

In Stroke Physical Therapy, evidence shows that both cough and forced expiratory technique (FET) can eliminate induced radio aerosol particles in lung field. Directed coughing and FET can be used as a technique for bronchial hygiene clearance in stroke patient.

5. Positioning

 In Stroke Physical Therapy consistent “reflex-inhibitory” patterns of posture in resting is encouraged to discourage physical complication of stroke and to improve recovery (Bobath, 1990).

Meanwhile, therapeutic positioning is a widely advocated strategy to discourage the development of abnormal tone, contractures, pain and respiratory complications. It is an important element in maximizing the patient’s functional gains and quality of life.

6. Tone management

A goal of Stroke Physical Therapy interventions has been to “normalize tone to normalize movement.” Therapy modalities for reducing tone include stretching, prolonged stretching, passive manipulation by therapists, weight bearing, ice, contraction of muscles antagonistic to spastic muscles, splinting, and casting. Research on tone-reducing techniques has been hampered by the inadequacies of methods to measure spasticity (Knutsson and Martensson, 1980) and the uncertainty about the relationship between spasticity and volitional motor control (Knutsson and Martensson, 1980; Sahrmann and Norton, 1977). Manual stretch of finger muscles, pressure splints, and dantrolene sodium do not produce apparent long-term improvement in motor control (Carey, 1990; Katrak, Cole, Poulus, and McCauley, 1992; Poole, Whitney, Hangeland, and Baker, 1990). Dorsal resting hand splints reduced spasticity more than volar splints, but the effect on motor control is uncertain (Charait, 1968) while TENS stimulation showed improvement for chronic spasticity of lower extremities (Hui-Chan and Levin, 1992).

7. Sensory re-education

Bobath and other therapy approaches recommend the use of sensory stimulation to promote sensory recovery of stroke patients.

8. Balance retraining

Re-establishment of balance function in patients following stroke has been advocated as an essential component in the practice of stroke physical therapy (Nichols, 1997). Some studies of patients with hemiparesis revealed that these patients have greater amount of postural sway, asymmetry with greater weight on the non-paretic leg, and a decreased ability to move within a weight-bearing posture (Dickstein, Nissan, Pillar, and Scheer, 1984; Horak, Esselman, Anderson, and Lynch, 1984). Meanwhile, research has demonstrated moderate relationships between balance function and parameters such as gait speed, independence, wheelchair mobility, reaching, as well as dressing (Dickstein et al., 1984; Horak et al., 1984; Bohannon, 1987; Fishman, Nichols, Colby, and Sachs, 1996; Liston and Brouwer, 1996; Nichols, Miller, Colby and Pease, 1996). Some tenable support on the effectiveness of treatment of disturbed balance can be found in studies comparing effects of balance retraining plus physiotherapy treatment and physiotherapy treatment alone.

9. Fall prevention

In Stroke Physical Therapy, falls are one of the most frequent complications( Dromerick and Reading, 1994), and the consequences of which are likely to have a negative effect on the rehabilitation process and its outcome. According to the systematic review of the Cochrane Library (1999), which evaluatedthe effectiveness of several fall prevention interventions in the elderly, there was significant protection against falling from interventions which targeted multiple, identified, risk factors in individual patients. The same is true for interventions which focused on behavioural interventions targeting environmental hazards plus other risk factors

10. Gait re-education

Recovery of independent mobility is an important goal for the immobile patient, and much therapy is devoted to gait-reeducation. Bobath assume abnormal postural reflex activity is caused of dysfunction so gait training involved tone normalization and preparatory activity for gait activity. In contrast Carr and Shepherd advocates task-related training with methods to increase strength, coordination and flexible MS system to develop skill in walking while Treadmill training combined with use of suspension tube. Some patient’s body weight can effective in regaining walking ability, when used as an adjunct to convention therapy 3 months after active training (Visintin et al., 1998; Wall and Tunbal 1987; Richards et al., 1993).

11. Functional Mobility Training

To handle through the functional limitations of stroke patients, functional tasks are taught to them based on movement analysis principles. In Stroke Physical Therapy these tasks include bridging, rolling to sit to stand and vice versa, transfer skills, walking and stairing etc (Mak et al., 2000).

Published studies report that many patients improve during rehabilitation. The strongest evidence of benefit is from studies that have enrolled patients with chronic deficits or have included a no-treatment control group (Wade et al., 1992; Smith and Ashburn et al., 1981).

Meanwhile, early mobilization helps prevent compilations e.g. DVT, skin breakdown contracture and pneumonia. Evidence have shown better orthrostatic tolerance (Asberg, 1989) and earlier ambulation (Hayes and Carroll, 1986).

12. Upper limb training

By 3 months poststroke, approximately 37% of the individuals continues to have decreased upper extremities (UE) function. Recovery of UE function lags behind that of the lower extremities because of the more complex motor skill required of the UE in daily life tasks. That means many individuals who have a stroke are at risk for lowered quality of life.

Many approaches to the physical rehabilitation of adults post-stroke exist that attempt to maximize motor skill recovery. However the literature does not support the efficacy of any single approach. The followings are the current approaches to motor rehabilitation of the UE.

a. Facilitation modelsThey are the most common methods of intervention for the deficits in UE motor skills including Bobath, proprioceptive neuromuscular facilitation, Brunnstrom’s movement therapy and Rood’s sensorimotor approach. There is some evidence that practice based on the facilitation models can result in improved motor control of UE ( Dickstein et al,1986, Grade A; Wagenaar et al, 1990 ). However, intervention based on the facilitation models has not been effective in restoring the fine hand coordination required for the performance of actions ( Kraft, Fitts & Hammond, 1992; Butefisch et al, 1995 ).

b. Functional electric stimulation

 

In Stroke Physical Therapy, Functional electric stimulation (FES) can be effective in increasing the electric activity of muscles or increased active range of motion in individuals with stroke ( Dimitrijevic et al., 1996; Fields, 1987; Faghri et al., 1994,; Kraft, Fitts and Hammond, 1992 ). Some evidence shown that FES may be more effective than facilitation approaches ( Bowman, Baker and Waters, 1979; Hummelsheim, Maier-Loth and Eickhof, 1997 ).

c. Electromyographic biofeedback

In Stroke Physical Therapy, biofeedback can contribute to improvements in motor control at the neuromuscular and movement levels ( Kraft, Fitts and Hammond, 1992; Moreland and Thomson, 1994; Wissel et al., 1989; Wolf and Binder-MacLoed, 1983; Wolf, LeCraw and Barton,1989; Wolf et al., 1994 ). Some studies have shown improvments in the ability to perform actions during post-testing after biofeedback training ( Wissel et al.,1989; Wolf and Binder-MacLoed, 1983; Moreland and Thomson, 1994). However, the ability to generalize these skills and incorporate them into daily life is not measured.

d. Constraint-induced therapy

 

Constraint-Induced (CI) therapy was designed to overcome the learned nonuse of the affected UE. In the most extreme form of CI therapy, individual post-stroke are prevented from using the less affected UE by keeping it in a splint and sling for at least 90% of their waking hours. Studies have found that the most extreme of CI therapy can effect rapid improvement in UE motor skill ( Nudo et al., 1996; Taub and Wolf, 1997; Taub et al., 1993; Wolf et al., 1989 ) and that is retained for at least as long as 2 years ( Taub and Wolf, 1997 ). However, CI therapy, currently are effective only in those with distal voluntary movement ( Taub and Wolf, 1997 ).

13. Mobility appliances and equipment

Small changes in an individual’s local ‘environment’ can greatly increase independence, use of a wheelchair or walking stick. However, little research has been done for these ‘treatments’. It is acknowledged that walking aids and mobility appliances may benefit selected patients.

Tyson and Ashburn (1994) showed that walking aids had effect in poor walkers – a benefical effect on gait (Level of evidence = III, Recommendation = Grade B). Lu and coworkers (1997) concluded that wrist crease stick is better than stick measured to greater trochanter. (Level of evidence = IIb, Recommendation = Grade A

14. Acupuncture 

The World Health Organisation (WHO) has listed acupuncture as a possible treatment for pariesis after stroke. Studies had sown its beneficial effects in strike rehabilitation.

Chen et al. (1990) had performed a controlled clinical trial of acupuncture in 108 stroke patients. They stated that the total effective rate of increasing average muscle power by at least one grade was 83.3% in the acupuncture group compared with the controlled group which was 63.4% (p<0.05).

Hua et al. (1993) had reported a significant difference in changes of neurological score between the acupuncture group and the control group after 4 weeks of treatment in a RCT and no adverse effects were observed in patients treated with acupuncture.

15. Vasomotor training 

Early stimulation of the muscle pump can reduce the venous stasis and enhance the general circulation of the body. It then hastens the recovery process.

16. Oedema management

Read research articles about Physical Therapy interventions in Stroke on Pub Med

Use of intermittent pneumatic pump, elastic stocking or bandages and massage can facilitate the venous return of the oedematous limbs. Therefore, the elasticity and flexibility of  musculoskeletal system can be maintained and enhance recovery process and prevent complications like pressure ulcer.

17.Acupuncture

Acupuncture is an alternative therapy which people have been making use of over centuries. Although it is rarely utilized by stroke patients in the US, it is an accepted practice on stroke sufferers in some countries, including China. This therapy is considered to be able to boost the blood flow to the parts which do not have feature. This is the reason why it is often utilized in cases of paralysis, where the blood flow increases, helping to bring the muscles with function. Acupuncture is widely used in cases of language issues and balance troubles. Although some researchers have actually stated that acupuncture is very useful and effective, often these studies are skewed or small.

18. Talk Therapy

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Some people have problems coping with their new disabilities after a stroke. It is common for people to have emotional reactions after a stroke. A psychologist or other mental health professional can help people adjust to their new challenges and situations. These professionals use talk therapy and other methods to help people with reactions such as depression, fear, worries, grief, and anger.

19. Lifestyle

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The methods previously discussed that may prevent or decrease a person’s stroke risk are essentially the same for people who have had a stroke (or TIA) and want to prevent or decrease their chances of having another stroke. In summary, quit smoking, exercise, and if obese, lose weight. Limit alcohol, salt, and fat intake and get into the habit of eating more vegetables, fruits, whole grains, and more fish and less meat.

Prescribed Medications and Side Effects

Aspirin to help lower risk of stroke.

Medications are usually prescribed for people with a high risk of stroke. The medicines are designed to lower risk by inhibiting clot formation (aspirin, warfarin and/or other antiplatelet medicines). Also, antihypertensive medications can help by reducing high blood pressure. Medications have side effects so discuss these with you doctor.

Preventing Another Stroke: Surgery

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There are some surgical options for stroke prevention. Some patients have plaque- narrowed carotid arteries. The plaque can participate in clot formation in the artery and can even shed clots to other areas in the brain’s blood vessels. Carotid endarterectomy is a surgical procedure where the surgeon removes plaque from the inside of the arteries to reduce the chance of strokes in the future.

Preventing Another Stroke: Balloon and Stent

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Some clinicians also treat plaque-narrowed carotid (and occasionally other brain arteries) with a balloon on the end of a narrow catheter. Inflating the balloon pushes plaque aside and increases the vessel’s lumen (opens up the vessel). This opened artery then is reinforced (kept open) by an expandable stent that, when expanded, becomes rigid.

Life After a Stroke

A rehabilitated stroke victim cooking at home.

About two-thirds of people (over 700,000) that have a stroke each year survive and usually need some level of rehabilitation. Some who get clot-busting drugs may recover completely, others will not. Many people who have disability after a stroke can function independently with therapy and rehabilitation methods. Although the risk of having a second stroke is higher after the first stroke, individuals can take the steps outlined in previous slides to reduce this risk.

MANAGING STROKE COMPLICATIONS

Ataxia, Gait Disturbance, and/or Falls

Mobilize patients within 24 hours, provided that they are alert and hemodynamically stable. Rehabilitation includes lower limb strength training to increase walking distance after stroke. Gait and/or standing post-stroke are improved with gait retraining (including task-specific), balance training, electromyography (EMG)-biofeedback training, and functional electrical stimulation.

Deterixcity

Consider referral of patients with upper limb weakness or decreased coordination for physical and occupational therapy. Mental practice is associated with improved motor performance and activities of daily living performance.

Cognitive Dysfunction

Compensatory strategies (e.g., reminders, day planners) improve memory outcomes. Consider referral of patients with cognitive deficits either for neuropsychological assessment or to an OT trained in cognitive evaluation. Also consider referral to driving simulation training or assessment programs.

Neglect: Visual scanning techniques and limb activation therapies improve neglect. Consider referral of patients with hemisensory neglect for perceptual retraining by an OT and/or neuropsychologist.

Dysarthria and Dysphasia

Consider referral of patients with impaired speech for assessment and training. Intensive speech and language therapy in the acute phase, especially with severely aphasic patients, showed significant improvement in language outcomes.

Hemianopsia

Consider ophthalmologist referral regarding optical prisms for patients with homonymous hemianopsia as this improves visual perception scores.

Community Re-Integration

Referral to community-based support services is associated with increased social activity. Education and information also have a positive benefit.

Maintain Adequate Delivery of Oxygen
It is very important to maintain oxygen levels. In some cases, airway ventilation may be required. Supplemental oxygen may also be necessary for patients when tests suggest low blood levels of oxygen.Manage FeverFever should be monitored and aggressively treated with medication, since its presence predicts a poorer outlook.Evaluate Swallowing

Patients should have their swallowing function evaluated before they are given any food, fluid, or medication by mouth. If patients cannot adequately swallow they are at risk of choking. Patients who cannot swallow on their own may require nutrition and fluids delivered intravenously or through a tube placed in the nose.

Maintain Electrolytes

Maintaining a healthy electrolyte balance (the ratio of sodium, calcium, and potassium in the body”s fluids) is critical.

Control Blood Pressure

Managing blood pressure is essential and complicated. Blood pressure often declines spontaneously in the first 24 hours after stroke. Patients whose blood pressure remains elevated should be treated with antihypertensive medications.

Monitor Increased Brain Pressure

Hospital staff should watch carefully for evidence of increased pressure on the brain (cerebral edema), which is a frequent complication of hemorrhagic strokes. It can also occur a few days after ischemic strokes. Early symptoms of increased brain pressure are drowsiness, confusion, lethargy, weakness, and headache. Medications such as mannitol may be given during a stroke to reduce pressure or the risk for it.

Keeping the top of the body higher than the lower part, such as by elevating the head of the bed, can reduce pressure in the brain and is standard practice for patients with ischemic stroke. However, this practice also lowers blood pressure in general, which may be dangerous for patients with massive stroke.

Monitor the Heart

Patients must be monitored using electrocardiographic tracings to check for atrial fibrillation and other heart rhythm problems. Patients are at high risk for heart attack following stroke.

Control Blood Sugar (Glucose) Levels

Elevated blood sugar (glucose) levels can occur with severe stroke and may be a marker of serious trouble. Patients with high blood glucose levels may require insulin therapy.

Monitor Blood Coagulation

Regular tests for blood coagulation are important to make sure that the blood is not so thick that it will clot nor so thin that it causes bleeding.

Check for Deep Venous Thrombosis

Deep venous thrombosis is a blood clot in the veins of the lower leg or thigh. It can be a serious post-stroke complication because there is a risk of the clot breaking off and traveling to the brain or heart. Deep venous thrombosis can also cause pulmonary embolism if the blood clot travels to the lungs. If necessary, an anticoagulant drug such as heparin may be given, but this increases the risk of hemorrhage. Patients who have had a stroke are also at risk for pulmonary embolisms

Prevent Infection

Patients who have had a stroke are at increased risk for pneumonia, urinary tract infections, and other widespread infections.

 Brief Causes Of Stroke

Epidemiological studies in the world recognized that those who have one of the following factors will increase the chances of having a stroke (or recurrent stroke)

  • Hypertension (high blood pressure): is one of the leading risk factors of stroke
  • Diabetes
  • Cardiovascular disease: especially atrial fibrillation, coronary artery disease, valvular heart disease
  • The previous history of stroke or transient ischemic attacks
  • Blowing sound of carotid artery does not show symptoms
  • Smoking: This is a factor that increases the risk of stroke and other diseases such as atherosclerosis, hypertension…
  • Obesity, increased cholesterol, increased blood fat
  • Less active
  • Drinking alcohol
  • Old Age: the possibility of stroke increases with age, particularly in people over 60 years old.
  • Men: men are at higher risk for stroke than women
  • Have a family history of stroke.

Home Treatments

Changing Your Diet

This is the very first one out on the list of the most effective tips on how to treat stroke naturally at home within a short time period that we would like to introduce in the article and everyone should make use as soon as possible.

Eating Ginkgo Biloba

Ginkgo biloba is used to treat stroke. It aids to prevent the blood clots from growing and increases the blood stream to the brain. The herb has been proven to inhibit the free-radical formation.

This herb is used widely in Europe in order to treat complications of stroke containing balance and memory problems, vertigo as well as disturbed thought processes

Eating Turmeric

Turmeric is one of the home remedies on how to treat stroke that you and my other readers should know and make use of it for good. Many studies say that the compound curcumin containing in turmeric can reduce the formation of blood clots. Turmeric is a key ingredient in cooking and may be found in most of the curry spice blends. You should consider eating more curry dishes to reduce and even treat your stroke.

 Eating Ginger

Ginger is a cardiac tonic because it can treat stroke, decrease the cholesterol levels, aid poor circulation and prevent blood clots excessively. Take 2 tsp of ginger daily for about 7 days can neutralize the blood clotting effects of 100 mg of butter. You can take advantage ginger in your cooking or you can take ginger tea by using 1-2 tsp of fresh grated ginger root per cup of hot water. Steep it until cool. Besides, you can also add ginger in salads. Continue reading this entire article to discover other home remedies for stroke that you can follow easily at home. In brief, this is also one of the most useful tips on how to treat stroke naturally and fast at home that people should not look down yet try making use right from today to be free from this stubborn and serious health issue!

 Eating Carrot

In a study, consumption of carrots can reduce risks  of stroke. Women who eat 5 servings of carrots per week suffer 68% fewer stroke risk than those who eat carrots less than 2 times a month. Carrots are high in beta-carotene and other essential carotenoids. So, eat more carrots to see how to treat stroke naturally. They are great as snacks, especially the baby carrots. Add them to vegetable soups or make carrot juice. In case you want to do better, add some pieces of garlic and ginger in order to provide them with zest.

Using Pigweed

Some experts think that pigweed can prevent stroke as it can reduce the risk of heart attack while there are biological similarities between heart attack and ischemic strokes. Pigweed is a great plant source of calcium. Use young leaves in salads or steam more mature leaves.

 Using Apple Cider Vinegar

It is helpful to stroke problems in a lot of ways. It is a natural purifier and detoxifier, so its functions are to cleanse the blood of any toxins that can contribute to the stroke problem. This vinegar also helps thin the blood, making it easier to flow throughout the body.

Taking Vitamin C

It is a natural antioxidant. This vitamin can eliminate free radicals that contribute to the condition. Beside, the vitamin also aids the immune function and replenishment of tissues. As you know that stroke can be risky, but it is a condition that is able to be treated. With the proper nutritional supplements as well as treatment considerations, people can experience a nearly full recovery from this condition.

Using Coconut Oil

Coconut oil is high in medium fatty acids. These fats function to boost nutrient absorption, which contributes to improve recovery. The unique composition of this oil also boosts the neutral passageways to boost brain functioning as well as recovery. This is also a great natural ingredient and the use of it is also among the best tips on how to treat stroke naturally at home without requiring any type of drugs, pills, or medical interventions so that people should try making use of it as soon as possible to achieve the best result as desired!

 Taking Vitamin B6

Vitamin B6 is a water-soluble vitamin that can be a useful plus to stroke victims fighting against related illnesses. Vitamin B6 is best taken sublingually as oral administration is less efficient in allowing it to enter the bloodstream quickly. It is inexpensive and available at most health food stores and pharmacies. More importantly, it has no toxicity; in other words, it is difficult to overdose on B6, so you can use it without any worry.

Taking Vitamin B12

B12 is also a water-soluble vitamin that allows the function of physical, emotional and mental abilities. It involves in the metabolic function of each body cell, which makes it essential to those who have the body’s systems weakened by stroke. Besides, B12 also plays an important role in aiding the body to absorb fatty acids. This is important as omega-3 fats are responsible for maintaining the health of brain as well as nerve tissue.

 Using Fish Oil

Fish oil is also a great and nutritious natural ingredient that can help when it comes to tips and home remedies on how to treat stroke naturally at home! Omega-3 fatty acids have been proven to offer positive benefits, including treating stroke. Fish oil, especially from fatty fish like salmon, are very high in healthy fatty acids and has an ideal ratio of DHA, EPA and ALA. An alternative for vegetarian people is hempseed oil, although it is more expensive.

 Using Taurine

A component of many drinks, taurine is a natural organic acid. It has been used to regulate hypoglycemia, hypertension, and diabetes which may be risk factors among patients who are finding ways how to treat stroke. It helps stroke treatment by increasing oxygen uptake to the brain, and by stabilizing the cellular membranes’ health. Besides, it also prevents free-radical damage to the body.

 Using Chinese Motherwort

Some practitioners in traditional Chinese medicine take the aerial parts in order to treat stroke. This herb works on the liver, heart and kidney meridians, and relieves blood stagnation. A study found that the extract could reduce the area affected by a stroke, improve neurological damage caused by a stroke and have a protective effect on cells of the brain. This study also supports the traditional use of this herb for boosting recovery after a stroke. Never combine this remedy with other blood thinning or stroke medicines.

 Using Baikal Skullcap

It is one of the fundamental herbs in Chinese medicine and it is used to treat stroke. The root has 4 potent flavonoids: norwogonoside, baicalin, oroxyloside as well as wogonoside. Skullcap extract may help stroke recovery by treating paralysis and cerebral thrombosis resulting from stroke.  This study also shows that the skullcap extract in treating stroke-related brain damage and helping stroke recovery. Consult your doctor before taking this herb or combining it with other blood thinners.

Using Ginseng

Ginseng is an herb used to encourage your body’s defenses against stress and disease. A study tested ginseng extract containing ginsenoside Rb1 with induced stroke. This study also found that the extract boosted the recovery of neural behavior and simultaneously stimulated the formation of new brain neurons. Consult your doctor before taking it in case you suffer from heart or blood pressure problems.

Drinking Raw Fresh Juices

A patient suffering from a stroke needs to add raw fresh juices to the daily diet as this will help to relieve the severity of the stroke. Besides, taking raw fresh juices will also help to relieve the side effects and then allow this person to get back to normality effectively and slowly.

Taking A Bath In Epsom Salt

Taking a bath in Epsom salt several times a week has been shown to be a god home remedy how to treat stroke. This aids to relax the muscles and rejuvenate them as well. This method is suggested to help lessen a person who has suffered from a stroke to get back to normality a lot faster.

 Reducing Stress

Stress contributes to cardiovascular problem and if severe, it can lead to a heart attack or stroke. There are a lot of options that help you reduce stress levels such as adequate sleep, regular exercise, laughing or volunteering. Watching television does not relieve, but may aggravate tress. Besides, try to avoid situations that make you angry or anxious.

 Herbal Remedies

Many natural remedies are based on the standard Chinese medication to cure the impairments causing by ischemic stroke. Most of the natural supplements are designed to help to increase the blood flow to the brain regions that were damaged during the cerebral mishap. Some supplements are known for their neuroprotective effects. That means they can protect the brain cells from the further harms.

 Massage

Massage is a special kind of touch therapy which has been shown and well-known to lesser blood pressure, assistance improve depression, and advertise leisure. Some researchers have actually revealed that it is very useful for stroke survivors since it can help to decrease the quantity of depression and anxiety they feel over the restrictions. Massage can also enhance the blood flow to the muscles that are either spastic or paralyzed.

 Drinking Soy Milk 

This is actually an interesting tip on how to treat stroke and prevent this disease naturally without meeting any difficulty (excepting the case that you are a soy hater!). Soy milk is an ideal drink for people with high blood pressure as it has effects on preventing atherosclerosis, adjusting blood lipid disorders and lowering the blood pressure. Every day, for good, people should consume about 500ml soy milk mixed with 50g white sugar for times throughout the day.

Eating Grape

Grapes, including fresh grapes and raisins, are good for people with high blood pressure, because the composition of grape contains high level of potassium salt which has the antihypertensive, diuretic effects, and it can enrich the amount of potassium lost by the use of Western medicine.

Eating Apple

Apple is always good for health. Some people even believe that if they eat apple every day, they will not have risks of any disease. Apple contains a high level of potassium, combine with and push the extra sodium out of the body. This will help the body manage and maintain the normal level of blood pressure. For good, you should eat 3 apples or drink the apple juice three times (about 50ml/time) per day. This is actually one of the best tips on how to treat stroke naturally people should not miss!

 Eating Grapefruit 

Grapefruit contains high level of naringenin – an antioxidant that can help the liver to burn excessive fat effectively. Grapefruit also helps to improve the control of blood sugar, lower blood sugar level, and it is very good for people with cardiovascular disease or obesity.

 Eating Garlic

Garlic has the effects on lowering hyperlipidemia and hypertensive. Every day, if you eat 2 cloves of raw garlic, pickled garlic, or drink 5ml of vinegar with pickled garlic, it can help to maintain stable blood pressure levels. In addition, the diet with garlic can help to reduce the risk of colon cancer, prevent esophageal cancer, and inhibit breast cancer. Eating one or two cloves of garlic every day will help to reduce 13-25% of the triglycerides level, lower the risk of blood pressure, cholesterol, and blood clotting.

 Eating Tomato 

This is one of the best tips on how to treat stroke at home that I would like to show my readers in this article. In fact, tomato is very rich in vitamin C and P, and if people eat raw tomato regularly every 1-2 days, they will be able to prevent high blood pressure effectively, especially when there is bleeding complications of the eye. In addition, Vitamin A, C and lycophene contained in tomatoes can help to prevent prostate, lung, and stomach cancer. Tomatoes also have the effects on lowering blood pressure, preventing the atherosclerosis – one of the dangerous factors which lead to coronary artery disease in the heart and stroke.

 Eating Water Spinach

Water spinach is very good for health. It contains high level of calcium so that it is very useful for maintaining the osmotic pressure of the circuits and blood pressure at normal levels. Water spinach is a special veggie which is perfect for people with high blood pressure with the sign of headache – a main cause of stroke. This is the last tip on how to treat stroke naturally which people should try!

Homeopathic treatment

There are following remedies which are helpful in the treatment of  stroke:

Aconite Nap. –remarkable remedy for cerebral stroke, it is the first remedy to be employed in sudden and violent attack

Baryta carb – it is a very useful remedy in this case where bleeding is associated with one sided paralysis

Kali brom – this remedy is indicated when there is sudden rupture of blood vessels in the brain with paralysis and comma

Opium – excellent medicine for apoplexy; comma and obstructed respiration; patient lies down; loss of consciousness with eyes half open after the brain hemorrhage.

Pituitrinum – well known medicine for cerebral stroke; checks the cerebral hemorrhage; helps in the absorption of blood clots; apoplexy due to hypertension.

Zincum met – acts well in the cases of cerebral stroke; brain fag; paralysis of the brain

Hyoscscyamus – brain hemorrhage with involuntary stools and urination; patient falls down and screams; with red face

Glonoinum – threatened apoplexy due to sun stroke

Nux Vomica – threatened brain hemorrhage with giddiness; pain and fullness of head; apoplexy in alcoholics

Strontium carb – threatened cerebral hemorrhage from shock after high blood pressure and as a sequence of chronic hemorrhage

Asterias rub – threatened cerebrovascular bleeding; sudden rush of blood to the head.

References

  1. Donnan GA, Fisher M, Macleod M, Davis SM (May 2008). “Stroke”. Lancet. 371 (9624): 1612–23. doi:10.1016/S0140-6736(08)60694-7PMID 18468545.(subscription required)
  2. “What Are the Signs and Symptoms of a Stroke?”http://www.nhlbi.nih.gov. March 26, 2014. Retrieved 27 February2015. External link in |website= (help)
  3. What Is a Stroke?”. www.nhlbi.nih.gov/. March 26, 2014. Retrieved 26 February 2015.
  4. “Who Is at Risk for a Stroke?”. www.nhlbi.nih.gov. March 26, 2014“How Is a Stroke Diagnosed?”http://www.nhlbi.nih.gov. March 26, 2014. Retrieved 27 February 2015. External link in  (help)
  5. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016).
  6.  “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.”. Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6PMC 5055577
  7. PMID 27733282.1544. doi:10.1016/S0140-6736(16)31012-1PMID 27733281.
  8. “Types of Stroke”http://www.nhlbi.nih.gov. March 26, 2014. Retrieved 27 February 2015. External link in |website=(help)
  9. Roos, Karen L. (2012). Emergency Neurology. Springer Science & Business Media. p. 360. ISBN 9780387885841.
  10. Wityk, Robert J.; Llinas, Rafael H. (2007). Stroke. ACP Press. p. 296. ISBN 9781930513709.
  11. Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS (2005). “Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies”. Stroke. 36 (12): 2773–80. doi:10.1161/01.STR.0000190838.02954.e8PMID 16282541.
  12. Global Burden of Disease Study 2013, Collaborators (22 August 2015). “Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.”. Lancet. 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4PMC 4561509Freely accessiblePMID 26063472.
  13. 2010”. Lancet. 383 (9913): 245–54. doi:10.1016/S0140-6736(13)61953-4PMID 24449944.
  14. “Brain Basics: Preventing Stroke”. National Institute of Neurological Disorders and Stroke. Retrieved 2009-10-24.
  15. World Health Organisation (1978). Cerebrovascular Disorders (Offset Publications). Geneva: World Health OrganizationISBN 92-4-170043-2OCLC 4757533.
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