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As a child in an Asian household, it is not uncommon to hear your mum yell at you “you are so naughty that you almost gave me a stroke!”
While it is true that anger may trigger a stroke; but as we will discuss later, stroke is a result of various physiologic and lifestyle factors.
Stroke happens when a part of the brain is damaged because of a problem with blood flow. Strokes can happen when:
An artery (i.e. the blood vessels that carry blood away from the heart out to the body) going to the brain gets clogged or closes off, and part of the brain goes without blood for too long. This is known as ischemic stroke.
When the blood flow to the brain is blocked temporarily, it can cause ‘mini stroke’, i.e. transient ischemic attack (TIA). It is a milder stroke that does not damage the brain and the symptoms only last for a short amount of time. With that being said, people who experience TIA must receive medical attention as they are at higher risk for future ischemic stroke. Medical treatment should be initiated to prevent future stroke from happening.
An artery breaks open and starts bleeding into or around the brain. This can lead to pressure within the head, which can cause damage to the brain. Also, blood is irritating to the brain tissue, and can cause it to swell. This is known as haemorrhagic stroke.
Image credit: Blausen Medical Communications, Inc., CC BY 3.0 , via Wikimedia Commons
Most strokes (87%) are ischemic strokes.Then what gives rise to the blockage of blood vessels in the case of ischemic stroke and TIA? Well, it is usually caused by a condition called atherosclerosis. Atherosclerosis is a condition in which fatty deposits called "plaques" build up inside the arteries in the body. It is usually caused by high blood cholesterol.
Whereas hemorrhagic stroke is usually caused by uncontrolled high blood pressure.
It can be lifesaving to know the classical symptoms of stroke. They can be recalled with the acronym FAST:
Face – Sudden weakness or drooping of the face, or problems with vision
Arm – Sudden weakness or numbness of one or both arms
Speech – Difficulty speaking, slurred speech, or garbled speech
Time – Time is very important in stroke treatment. The sooner treatment begins, the better the chances are for recovery. Therefore, call an ambulance (dial 999) right away.
Beside these, a person experiencing stroke can also show signs of sudden confusion, trouble walking and severe headache with unknown causes. Signs and symptoms of stroke often develop suddenly and then may temporarily improve or slowly worsen, depending upon the type of stroke and area of the brain affected.
The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at the hospital in time.
It will be a mistake to regard stroke as an one-off event. Without proper after-stroke care and treatment, the person may experience stroke again, and the complications can be more severe than the previous stroke. Third time is not a charm when it comes to stroke.
Many people who have had a stroke or TIA take 3 medicines or more. That might seem like a lot, but each of them does a different job.
Medicines to prevent blood clots or "thin" the blood reduce the chance clots will form. E.g. warfarin, dabigatran, aspirin, clopidogrel.
Medicines that lower blood pressure help prevent the damage to blood vessels caused by high blood pressure. These medicines also help make sure the brain gets all the blood it needs. E.g. perindopril, enalapril,valsartan.
Medicines that lower LDL ("bad") cholesterol levels.These medicines also help keep the arteries from getting damaged, which makes it less likely that clots will form in the first place. E.g. atorvastatin, simvastatin.
People with other medical conditions, such as diabetes, need different medicines to treat those conditions as well.
In the hospital, doctors will do a CT scan or MRI. These are imaging tests that create pictures of the brain. They can show if there is bleeding in or around the brain.
If the scan shows a hemorrhagic stroke, your doctor might:
Give you medicines and other treatments to reduce the brain damage caused by the bleeding
Give you medicines to lower your blood pressure, if your blood pressure is too high
Stop any medicines you take that thin the blood or prevent it from clotting. If you take blood-thinning medicines, he or she might give you treatments to help your blood clot so that you stop bleeding. Note: This is the opposite to what is used in treating ischemic stroke. That is why it is important for doctors to identify whether a person’s stroke is ischemic or hemorrhagic in nature.
Do tests to figure out the cause of the bleeding
Watch the pressure in your brain to make sure that it doesn't get too high
Some people are also treated with surgery, depending on their symptoms and other factors. Doctors can do surgery to:
Remove a collection of blood, if it is pressing down on the brain or causing the brain to swell
Stop the bleeding in the brain and fix the blood vessel that was bleeding
In the long run, physiotherapy is also provided to stroke survivors to help them regain mobility and prevent muscle wasting.
Whatever medicines your doctor prescribes, it's important that you take them exactly as directed. If your medicines cause unwanted side effects or if you can't afford them, talk to your healthcare professional. They might have ways to deal with these problems. Do not forgo your stroke treatment without talking to your healthcare professional. It can be a heavy price to pay.
If you have ever seen a person who survived a severe stroke before, you would know how damaging it can be. The sequelae of a stroke depends on the severity and the site of damage of the stroke. Some things happen as a direct result of injury to the brain due to stroke, which often results in immobility (unable to move). Others are because of a change in your abilities.
These can happen after a stroke:
Brain edema, i.e. swelling of the brain
Pneumonia, which is the infection of the lung that occurs as a result of not being able to move as a result of the stroke. Swallowing problems after stroke can sometimes result in things ‘going down the wrong pipe’, leading to aspiration pneumonia. It can lead to difficulty in breathing and can be tough to treat.
Urinary tract infection (UTI) and/or bladder control. UTI can occur as a result of having a foley catheter placed to collect urine when the stroke survivor cannot control bladder function.
Seizures — abnormal electrical activity in the brain causing convulsions. These are common in larger strokes.
Bedsores — pressure ulcers that result from decreased ability to move and pressure on areas of the body because of immobility.
Deep venous thrombosis (DVT) — blood clots form in veins of the legs because of immobility from stroke.
Shoulder pain — stems from lack of support of an arm due to weakness or paralysis. This usually is caused when the affected arm hangs resulting in pulling of the arm on the shoulder.
Limb contractures — shortened muscles in an arm or leg from reduced ability to move the affected limb or lack of exercise.
Clinical depression — a treatable illness that often occurs with stroke and causes unwanted emotional and physical reactions to changes and losses. This is very common after stroke or may be worsened in someone who had depression before the stroke.
It is not exaggerating to think that stroke has the ability to change one’s life for the worse. It can strip away a person’s ability and freedom to live an enjoyable and productive life.
That is why stroke prevention is so, so important. Protect yourself and avoid stroke, regardless of your age or family history. Here are seven ways to start reining in your risks today to avoid stroke, before a stroke has the chance to strike.
Maintain an optimal blood pressure of less than 120/80 if possible, or at least at the target blood pressure your doctor sets for you. To achieve this, it is important to have a low salt diet and stick to your high blood pressure treatment diligently.
Lose that extra weight. Obesity, as well as the complications linked to it (including high blood pressure and diabetes), raises your odds of having a stroke. If you're overweight, losing as little as 10 pounds (approx. 5kg) can have a real impact on your stroke risk. However, we encourage you to work with a healthcare professional in your weight loss journey. Do not harm your health by practising harmful weight loss practices.
Stay physically active. Exercise at a moderate intensity at least five days a week. This can be as effortless as taking a walk around your neighbourhood or taking the stairs instead of an elevator.
Drink alcohol moderately. Strive to have no more than one glass of alcohol a day. Make red wine your first choice, because it contains resveratrol, which is thought to protect the heart and brain.
If you have been diagnosed with irregular heartbeat (atrial fibrillation), it is important that you stick to your treatment regimen. This is because atrial fibrillation puts you at a higher risk for stroke, and the medications are prescribed to you to prevent potential stroke.
If you have diabetes, it is important that you control it by sticking to your assigned diet plan and medication treatment. This is because in the case of diabetes, having high blood sugar damages blood vessels over time, making clots more likely to form inside them, thus increasing risk of stroke.
If you have high blood cholesterol, it is important that you keep it under control by sticking to your assigned diet plan and medication treatment.
Quit smoking if you are a smoker. Smoking accelerates clot formation in a couple of different ways. It thickens your blood, and it increases the amount of plaque buildup in the arteries. Along with a healthy diet and regular exercise, smoking cessation is one of the most powerful lifestyle changes that will help you reduce your stroke risk significantly.
If you have medical conditions that can increase risk of stroke (diabetes, high blood cholesterol, high blood pressure, atrial fibrillation,migraine with aura etc.), we can’t stress enough the importance of attending appointments with your doctor regularly. This allows your doctor to evaluate your treatment progress and advise you accordingly.
If you have any questions related to stroke, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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Till then, stay at home and take care!
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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Cover image credit: Blausen Medical Communications, Inc., CC BY 3.0 , via Wikimedia Commons
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