Introduction to the Guidelines for the Prevention and Management of Strokes

A stroke also known as Cerebro – Vascular – Accident or brain attack is a neurological disease that happens when a clot also known as thrombus generally blocks the blood vessels supplying to the brain arteries/vessels or when blood vessel(s) of the brain ruptures allowing the blood to leak inside the brain causing edema and elevated pressure inside the brain or otherwise known as Intracranial Pressure.

Types of Strokes:

1. Hemorrhagic – This is a type of stroke when a blood vessel inside the brain ruptures allowing the blood to leak in the brain which in turn causes swelling and edema and raised or elevated cranial pressures.
2. Ischemic – These are very common stroke attacks that happen to most of the population generally a thrombus (plaque) is release to the brain vessels which reduces the flow of the blood and oxygen to the brain hence allowing the affected neurons and brain cells to die. Nearly 1.9 billion brain cells die (As per American Stroke Association) when stroke is left untreated.
3. TIA (Transient Ischemic Attack) – This is also known as temporary stroke, normally a small plaque or thrombus gets clogged into the critical brain vessels and floats away generally in matter of a few minutes.

Risk Factors of Strokes:

1. Smoking – Smoking not only does harm to other body and critical organs but also does a lot of damage to the arteries that supply blood to the brain. This phenomenon is also known as vascular disease (vasculopathy – Vasculo – denotes vessels while pathy denotes problem), Smoking damages the internal lining of the vessels hence the plaque easily get formulated inside the vessels thereby increasing the risk of stroke.
2. Alcohol – has an indirect stroke risk, it means whenever we consume alcohol the liver takes a hit and since the liver is known to regulate blood clots in the body, damage to the liver invariably causes more blood clots to form and increasing the risk of stroke.
3. Uncontrolled Diabetes – Diabetes is also linked to various organ failures and malfunction of the human organs over period of time, however with regards to stroke risk excessive blood sugar levels promotes the production of more fatty deposits and clots in the blood vessels, these clots will eventually get deposited in arteries and brain vessels and will reduce their size and make them narrow, hence making them prone to stroke attacks in long run.
4. Hypertension – Whenever our blood pressure elevates it puts pressures on the arteries and vessels over the period of time uncontrolled and untreated blood pressure can make these arteries and vessels narrow or fragile enough to rupture and leak blood inside the brain thereby causing hemorrhagic stroke.
5. High Lipid (Cholesterol) levels – as it suggests excessive cholesterol levels in the blood, can put a patient at higher risk of getting stroke attack. This is the reason when a patient with stroke is treated they are already started on statins (cholesterol lowering medications). So any further reoccurrence of stroke can be avoided.
6. Obesity – As per World Stroke Organization, being overweight increases stroke risk by 22% and if a person is obese that risk increases to 64%. That is because overweight and obesity both carry equal amount of risk for a patient to develop high blood pressure, type 2 diabetes and high lipid (cholesterol) levels.

Treatment option of Ischemic Stroke:

1. if the patient develops the symptoms of stroke, immediately bringing the patient to a dedicated stroke center can help your patient recover faster and allowing the doctors to alleviate their symptoms.
2. Normally if the patient is coming in a time window of 4.5 hrs or less from the onset of stroke, then we can inject a clot busting drug also known as rTpa (recombinant tissue plasminogen activator), this drug breaks the clot and restores the blood flow to the affected artery/vessels in the brain.
3. Endovascular Procedure (Mechanical Thrombectomy) – This is a very recent intervention procedure that has caught the eyes of patients as well as Neuro-interventionist due to its complexity level. In MT a catheter guide along with an aspirator is sent across patients leg (such as cardio-angioplasty). once the catheter wire reaches the affected area of the brain/artery the clot is sucked via the aspirator and then supply to the brain is restored.
4. Medications (Antiplatelets/Blood Thinners) – Medications such as asprin and cloporidgel are used to the thin out the blood so it reaches to the affected arteries and vessels without any obstruction, however not every patient has the same need of blood thinners in certain cases we also run patients on anticoagulant.
5. Rehabilitation of Stroke Patients – Often neglected part of the therapy for stroke patients but one of the most important aspects in stroke recovery, patients who suffer from limb weaknesses after stroke attack are required to go for complete physiotherapy so they can retrain and regain the strength in the affected region of the limb.

Remember this synonym “B.E.F.A.S.T”

1. B – Balancing issues or problems
2. E – Eyes changes – double vision or blur vision for a long period of time
3. F – Facial Droopiness – one sided facial weakness.
4. A – Arms – Arms or limbs weakness either one side or both side.
5. S – Slurry Speech – Speech getting slurred and uncomprehensive
6. T – Time – Timely action and calling a stroke unit/hospital

Conclusion

80% percent of the strokes are preventable, this means that we can prevent them if small modifications such as lifestyle changes, including moderate exercises, eating healthy, sleeping on time, reducing screen time from your daily life style will definitely help you prevent stroke in a long run, however there is nothing as such “fool proof concept” hence it is imperative that you keep getting a regular blood work and preventive health checkups with a neurologist to avoid stroke in all possibilities.