STROKE: A Simple Explanation

What is Stroke?

Stroke is a medical condition that affects the brain. It is a medical emergency that results from a loss of blood supply to a part of the brain. It is most common among the elderly (people over 64), and its likelihood of occurrence increases with age. According to a 2021 research, Africa currently has some of the highest stroke indices globally.

What Are the Risk Factors of Stroke?

Factors that contribute to the likelihood of developing a stroke are divided into two groups based on whether they can be adjusted or not. They include:

• Modifiable Factors
• Non-modifiable Factors

Modifiable Factors

These are factors that you have control over. By controlling these factors, you can prevent – or at least reduce the likelihood of developing – a stroke. Some examples include:

Blood Pressure: High blood pressure (hypertension) is a common risk factor for stroke.

Diabetes Mellitus: Both Type 1 and 2 diabetes can increase a person’s chance of having a stroke if left uncontrolled.

Hyperlipidemia: Consistently having excess cholesterol circulating in the blood can also predispose to stroke.

Obesity: Obesity increases the risk of developing several medical conditions. Stroke is one of them.

Smoking: Smoking and exposure to secondhand smoke reduce the amount of oxygen in the blood, increase blood pressure, weaken blood vessels, and raise the risk of blood clots, all of which can lead to stroke.

Heart Diseases: Heart diseases like arrhythmias and heart failure can predispose to stroke.

Drugs: Psychoactive substances like cocaine and heroin can increase the risk of stroke. Certain analgesics, contraceptive pills, antipsychotics, and hormone replacement medications can also increase the risk of developing a stroke.

Alcoholism: Excessive alcohol drinking increases the risk of developing a stroke. The higher the alcohol consumption, the higher the risk.

Non-modifiable Factors

These are factors that you have no influence over, and they cannot be controlled. Some of them include:

Age: Aging increases the likelihood of developing a stroke; the age group with the highest incidence of stroke is the elderly.

Gender: Stroke is generally more common among men than women.

Race: Stroke is more common among black people than other races.

Family: If you have family members (particularly nuclear family members) who have had a stroke, you are at risk of developing one, too.

Personal History: A person who has had a stroke before is at risk of developing another one.

How Does Stroke Happen?

How a stroke occurs depends on the type of stroke it is. There are two types of stroke:

• Ischemic stroke
• Hemorrhagic stroke

Ischemic Stroke

Ischemic stroke occurs as a result of absent blood flow to a part(s) of the brain. When there is no blood flow to the brain, it is unable to get glucose and oxygen, and the affected area begins to die within minutes. Things that can cause reduced blood flow include:

Clots

In some cases, clots may form inside a blood vessel that delivers blood to the brain and obstruct the flow of blood within that vessel. This may happen over time, with the clot gradually getting bigger and its effects slowly setting in until it eventually becomes big enough to occlude the vessel completely.

Other times, blood clots and fatty plaques (clumps of fatty deposits) may form in different parts of the body and travel through the bloodstream to the brain, where they eventually clog a blood vessel and obstruct the flow of blood through that vessel to the brain.

Shock

In some severe situations, such as a heart attack, the heart is unable to pump blood to the brain effectively. This is known as cardiogenic shock, and the prolonged reduction or absence of blood supply to the brain can cause a stroke.

Hemorrhagic Stroke

This type of stroke is usually more fatal than ischemic stroke. It happens when an artery in the brain bursts and bleeds into the surrounding space or tissue. There are two types of hemorrhagic stroke, namely:

• Intracerebral hemorrhage
• Subarachnoid hemorrhage

Intracerebral hemorrhage occurs when an artery ruptures within the brain tissue known as the cerebrum and bleeds into it. The most common cause of intracerebral hemorrhage is hypertension. Long-standing hypertension can make arteries thicker, stiffer, and more prone to rupture. It can also lead to the formation of Charcot-Bouchard aneurysms, which can later rupture. Aside from hypertension, some other causes of intracerebral hemorrhage include arteriovenous malformations, coagulopathy, cerebral amyloid angiopathy, ischemic stroke, and vascular tumors.

Subarachnoid hemorrhage is the least common type of stroke but the most fatal. It refers to bleeding between the arachnoid and pia meninges that cover the brain. Some conditions that can predispose to spontaneous subarachnoid include arteriovenous malformations, sickle cell anemia, and autosomal dominant polycystic kidney disease.

What are the Symptoms of Stroke?

Symptoms of stroke depend on the area of the brain affected. This means that people with stroke can present with a wide range of symptoms. These include but are not limited to:

• Slurring of speech
• Difficulty communicating, such as inability to express or comprehend language via speaking, reading, or writing.
• Facial droop
• Weakness in one side of the body
• Numbness
• Difficulty with movement
• Partial or complete visual defects
• Urinary incontinence
• Altered sensation in one part of the body
• Reduced visual-motor coordination
• Headache
• Paralysis
• Loss of consciousness

A common mnemonic used to identify a person who may be having a stroke is F.A.S.T. It stands for:

F – Facial droop

A – Arm weakness

S – Speech difficulty

T – Time

Of course, time is not a sign or symptom of stroke. However, time plays a crucial role in the progression, treatment, and outcome of a stroke.

What Should You Do When Someone is Having a Stroke?

Call for Help: When you think someone is having a stroke, the first thing to do is call for help. You may choose to call an ambulance or take the person to a hospital; whichever option is faster.

Note the Time: Note the exact time you began to notice stroke symptoms or what time you found the person (this information will come in handy later).

Stay Calm and Reassure: Remain calm and reassure the patient while waiting for medical assistance.

Monitor Symptoms: Note every change in symptoms, including improvement, worsening, or development of new symptoms.

Act Fast: Try to get to the hospital as quickly as possible. The earlier (less than 4 hours), the better.

What Happens at The Hospital?

Initial Assessment: When a stroke patient gets to the hospital, the emergency medical team asks questions and takes several critical steps (including tests) to quickly assess and treat the patient. It is imperative that you cooperate with them and answer their questions as accurately and honestly as you can.

Gathering Information: While resuscitation measures are being taken, a quick but thorough history will be taken. You may be asked about the symptoms you noticed and the order in which they occurred. When asked about the time symptoms started or when you found the patient, try to be as specific as possible, e.g., 7:03 p.m. This will give the medical team an idea of how much brain damage may have occurred and what intervention measures to use.

Stabilizing the Patient: The medical team will ensure that the patient’s airway, breathing, and circulation are stable. They will perform tests to rule out stroke mimics, such as abnormal blood sugar levels, and immediately correct any issues found. An intravenous access will be secured, through which medications and fluids will be administered. If the person’s oxygen level is below 95%, supplemental oxygen will be given, and blood pressure will be closely monitored and managed.

Diagnostic Imaging: A non-contrast CT scan will be done to check for bleeding in the brain, which helps distinguish between different types of strokes. This test is essential in deciding the appropriate treatment and must be done quickly.

Specialized Care: After stabilization, the stroke patient is reviewed by a neurology team and admitted to a stroke unit. In the stroke unit, a specialized team treats the person and closely monitors for complications such as infections, blood clots, and difficulty swallowing.

Stroke care involves a team of professionals, including doctors, nurses, physiotherapists, speech therapists, and nutritionists, who work together to provide comprehensive care. During care, a number of tests may be carried out. Preventive measures, such as turning the patient in bed regularly, using compression devices, and managing infections, will also be taken to reduce complications.

What Happens After a Stroke?

Rehabilitation: Rehabilitation includes therapies to help the patient regain mobility, speech, and daily living skills. These therapies should start as soon as possible.

Secondary Prevention: A person who has had a stroke before is at risk of having another one. Hence, it is crucial to prevent another stroke by managing risk factors like high blood pressure, diabetes, and cholesterol and using medications like aspirin or anticoagulants as prescribed by a doctor.

Conclusion

Stroke is a severe medical condition that demands immediate attention. Understanding and managing risk factors such as high blood pressure, diabetes, and high cholesterol can help prevent stroke and its recurrence. By recognizing the signs early and acting quickly, you can help save lives and improve recovery chances. Early intervention is critical in minimizing brain damage and improving recovery chances. Remember, every minute counts when it comes to stroke care.

Stay informed, stay vigilant, and always act fast.