Dr. Rahul Chakor Neurologist
Special Interest in Neuroimmunology, Epilepsy

Stroke, Cerebrovascular accident (CVA), Cerebrovascular disorder (CVD)

Stroke also called paralysis, lakwa, ardhangavayu is a leading cause of death world over. It is the third most common cause of death after heart disease and cancer. Stroke is a medical emergency. It results from a sudden decrease in blood supply to the brain cells. This leads to death of brain cells due to poor oxygen supply. There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or around the brain. About 88% of strokes are ischemic—usually due to a blocked artery.

Transient ischemic attacks (TIAs), sometimes called ministrokes, are often an early warning sign of an impending ischemic stroke. They are caused by a brief interruption of the blood supply to part of the brain. Because the blood supply is restored quickly, brain tissue may not die, as it does in a stroke.

Causes of stroke:

There is no one cause for stroke. There are several risk factors for stroke. Some of these are not modifiable while the others can be kept under control.

Risk factors

Non modifiable:
- Age
- Sex
- male
- Hereditary factors

Modifiable

- Atherosclerosis
- Hypertension
- Diabetes
- Sedentary lifestyle
- Obesity
- High cholesterol
- Smoking
- Alcohol
- Cardiac rhythm disturbance

Symptoms

Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.

The five most common signs and symptoms of stroke are:

1. Sudden numbness or weakness of the face, arm, or leg - like weakness of half of the body called as hemiplegia.
2. Sudden confusion or trouble speaking or understanding others called aphasia in medical terms.
3. Sudden trouble seeing in one or both eyes called as mono or binocular vision disturbance. This could be due a stroke anywhere in the visual pathway.
4. Sudden dizziness, trouble walking, or loss of balance or coordination, this is commonly due to posterior circulation strokes.
5. Sudden severe headache with no known cause is due to hemorrhage or sometimes infarction.

The life-saving acronym for stroke is B. E. F. A. S. T. B - balance disturbance, E - eye, disturbance in vision double vision, F - facial drooping or asymmetry, A - arm weakness, S - speech disturbance, T - time of onset should be noted and the patient be shifted to a stroke ready hospital.

Diagnosis:

The diagnosis Is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.

Treatment:

Anyone with sudden neurologic symptoms could be having stroke and should seek medical attention immediately. Specific treatment to open the blocked blood vessel supplying an area of brain is possible. Intravenous thrombolysis is a highly effective therapy if administered with the golden window period of 4.5 hours to dissolve the clot and reverse the neurological deficit. In selected patients mechanical thrombectomy done by endovascular procedure can reverse the deficit. Hence it is critical for the patient to reach the hospital immediately at the onset of symptoms. Other treatments used include drugs such as antiplatelet drugs, anticoagulants and drugs to control high blood pressure to prevent recurrence.

Later treatments focus on preventing subsequent strokes, treating and preventing problems that strokes can cause, and rehabilitation.

Prevention:

The main strategy is managing the major risk factors. High blood pressure and diabetes should be controlled. Cholesterol levels should be measured and, if high, lowered to reduce the risk of atherosclerosis. Anti-platelet medicines, typically aspirin is prescribed to prevent ischemic strokes. Anticoagulants are prescribed in cases of cardioembolic stroke with atrial fibrillation.

Smoking should be stopped, and alcohol should be limited to no more than 2 drinks a day. Exercising regularly and, if overweight, losing weight will help control high blood pressure, diabetes, and high cholesterol levels. Having regular checkups enables a doctor to identify risk factors for stroke so that they can be managed quickly. Lifestyle modification is a key element of prevention (stress free life, healthy food, regular exercise, weight control, no smoking)..