How To Recognise A Stroke
The symptoms of a stroke depend on the brain area in which the blood flow is disturbed and the size of that area.
Some possible symptoms include:
- Sudden paralysis of an arm or leg, usually only on one side of the body
- A crooked mouth
- Struggling with eating or swallowing
- No longer being able to speak or understanding words
- Balance disorder and dizziness
- Tingling or numbness.
What Is An Ischemic Stroke
An ischemic stroke is the sudden loss of circulation to an area of the brain that results in brain cell death and loss of neurological function. According to the centers for disease control and prevention, ischemic strokes account for 87% of all strokes.
An acute ischemic stroke results from the occlusion of one of the arteries that feed the brain. There are two types of ischemic stroke: thrombotic and ischemic
In a thrombotic stroke, the blood clot that obstructs the cerebral artery comes directly from that artery. In contrast, in an embolic stroke, the blood clot comes from somewhere else in the body .
The mechanisms involved in cerebral thrombotic infarction are very similar to those involved in acute myocardial infarction. Most acute cerebral infarction cases originate on ruptured atherosclerotic plaques that promote the production of an obstructive blood clot. However, in young patients who are unlikely to suffer from widespread atherosclerosis, other causes need to be considered. Causes such as:
- Substance abuse
- Venous thrombosis
Treatment Options In Acute Ischemic Stroke
- A) Thrombolysis In patients who are within the 4.5 hour time window, thrombolysis with tissue plasminogen activator can be done. The drug r TPA is administered through a vein by a trained neurologist.
- B) Mechanical thrombectomy In patients with intracranial major vessel occlusion an interventional procedure for removal of the clot is available. This is known as mechanical thrombectomy and is currently the standard practice in developed countries. This option can be offered within the 6 hour time window and can also be performed in an extended 16-24 hour window in suitable cases. This procedure is performed by a trained Neuro-interventional radiologist in Digital Subtraction Angiography lab.
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What Is Lacunar Infarct
Lacunar Infarct is a form of an ischemic stroke occuring within the deepest structures of the brain. Lacunar Infarct occurs when there is a blockage of an artery situated deep within the brain resulting in interrupted blood flow to this region. Studies suggest that of all the cases of infarcts occuring in the United States about 30% of them are Lacunar Infarcts.
Lacunar Infarct just like any other kind of infarct is a serious condition and needs to be taken care of emergently since the brain cells do not get sufficient oxygen due to blockage of the artery causing interrupted blood flow to the region and the brain cells may start to die within minutes if emergent treatment is not given.
Acute Ischemic Stroke Is An Emergency
It is said that âTime Is Brainâ in these circumstances. With every passing minute several thousand neuronal cells die. Treatment to recanalize the vessel is required to be undertaken at the earliest. The treatment options for good recovery need to be instituted in a very limited time window. This time window is up to 6 hours.
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Areas Of The Brain Affected By Stroke And Symptoms
Below, youll learn about the different parts of the brain that can be impacted by stroke. You will find a short summary of the effects of each type of stroke, and you can click the link in each section to learn more.
The effects of a stroke will vary from person to person, so its best to reference a full list of the secondary effects of stroke to get an even better idea of what to expect after stroke.
Here are the major areas of the brain that can be affectedby stroke:
Is There Such As Thing As An Asymptomatic Stroke
You can have a stroke and not notice it, it is a silent cerebral infarction. Conditions like carotid stenosis, hypertension, and atrial fibrillation are the most significant risk factors for having a silent stroke. Like symptomatic strokes, silent strokes occur because of a blood flow obstruction. The difference is that in asymptomatic strokes, the infarct occurs in an area that doesnt control visible functions like talking or walking. The fact that you dont notice the damage doesnt mean that damage isnt there. Silent strokes damage small parts of the brain. Still, if you have several asymptomatic strokes, damage cumulates, and eventually, you will start noticing some deficits. Symptoms of a silent cerebral infarction include:
- Difficulty concentrating
- Loss of memory
- Emotional issues
Having multiple silent strokes also increases the risk of suffering from an Alzheimer-like disease called vascular dementia or multi-infarct dementia.
The diagnosis of a silent stroke is commonly made after a routine CT or MRI. The damage produced by silent strokes isnt reversible. However, patients may benefit from cognitive therapy and regain some degree of function.
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What Are The Causes Of Multi
MID is caused by a series of small strokes. A stroke, or infarct, is the interruption or blockage of blood flow to any part of the brain. The term multi-infarct means many strokes and many areas of damage. If blood flow is stopped for more than a few seconds, brain cells can die from a lack of oxygen. This damage is usually permanent.
A stroke can be silent, which means it affects such a small area of the brain that it goes unnoticed. Over time, many silent strokes can lead to MID. Large strokes that cause noticeable physical and neurological symptoms can also lead to MID.
MID generally occurs in people aged 55 to 75 years and is more common in men than in women.
What Is A Brainstem Infarction
A brainstem infarction is a stroke that happens when blood cannot flow to your brainstem. When oxygen cannot get to an area of the brain, tissue in that area may be damaged. Your brainstem allows you to speak, hear, and swallow. It also controls your breathing, heartbeat, blood pressure, balance, and eye movements.
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What Is A Brain Stroke
The human brain is a complex organ which depends on continuous blood supply. A disruption in blood-flow can cut vital oxygen and glucose to the brain and lead to brain death within a couple of minutes.
Stroke is a medical condition where the blood supply to a portion of the brain decreases or gets severely interrupted. It is a medical emergency wherein the cells of the brain start dying within minutes of being deprived of nutrients and oxygen due to the restriction of blood supply. The inability of brain cells to regenerate results in permanent damage and irreversible consequences.
How To Treat Lacunar Infarct
The treatment of Lacunar Infarct should start as early as possible so that the chances of the individual surviving that stroke increases. The treatment for Lacunar Infarct starts immediately after the diagnosis is made. Early treatment also prevents any further damage to the brain. The first line of treatment is to give aspirin to minimize risk of having another infarct. The patient will be given supportive measures for assisting in respiratory and heart functioning. The patient may be given clot dissolving drugs either orally or intravenously. Under extreme circumstances, medications are directly administered to the brain for treatment of Lacunar Infarct.
As there is some amount of damage bound to happen due to Lacunar Infarct, the recovery of the patient depends on the amount of damage that has been done to the brain. In some cases, the damage is such that the patient finds it difficult to care for self and needs assistance from other people for performing tasks. In some cases, posttreatment the patient will be sent to a rehabilitation home where the patient needs to learn the lost skills again. This is done by a team of experts in speech, language and motor skills. This may take a lot of time and requires a lot of effort, cooperation, and patience from the patient and his or her family, as it is a long and consorted effort and takes a long time spanning from months to years before the patient can make some sort of improvement after a Lacunar Infarct.
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What Happens If When Alteplase Is Administered Too Late
In the best-case scenario, alteplase wont do anything if administered after four hours. In the worst-case scenario, thrombolytic therapy will produce a hemorrhage. Hemorrhagic transformation is a common complication of cerebral infarction, and the risk increases with alteplase administration. Severity ranges from a few blood spots to massive cerebral hemorrhage. After necrosis settles in, brain arteries lose their capacity to keep fluid from trespassing the brain. With blood flow restoration, blood leaks into the brain. Small hemorrhages do not alter the clinical outcome. Still, extensive hemorrhages can cause significant deterioration and an increase in the mortality rate.
How Can I Prevent A Cerebral Infarction
- Stop smoking: Smoking increases the risk of coronary artery disease and cerebrovascular disease.
- Eat healthily: A diet rich in fat and complex carbohydrates is one of the most significant risk factors for cardiovascular disease. Also, try lowering your salt intake, too much salt a day increases your blood pressure.
- Keep your blood pressure in check: If you suffer from hypertension, be consistent with your medication. Uncontrolled blood pressure leads to complications such as kidney disease, heart attack, and stroke.
- Keep your diabetes in check: Along with high blood pressure, diabetes is one of the most critical risk factors for heart and cerebrovascular disease.
- Manage your weight: Obesity and overweight are associated with a higher risk of metabolic and cardiovascular diseases.
- Exercise: Research shows that 30 minutes a day of moderate aerobic exercise can reduce your risk of having a stroke by 40%.
- Cut down on alcohol: Alcohol increases your blood pressure and can cause atrial fibrillation. Alcoholic beverages are high in calories and cause weight gain. Frequent alcohol consumption makes a stroke three times more likely.
- Have a yearly medical check-up: An annual visit to the doctor will help detect underlying conditions such as internal carotid artery stenosis, hypertension, and diabetes early. Early detection and treatment prevent complications such as stroke.
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What Increases My Risk Of A Bsi
- You are at least 55 years old.
- You are a man.
- You are a woman and use birth control pills, or you take hormone replacement medicine.
- Your father or mother had a stroke, or you had a low birthweight.
- You have high blood pressure, blood vessel disease, or sickle cell anemia that is not being treated.
- You have atrial fibrillation, diabetes, or another heart condition.
What Is Carotid Artery Stenosis
Carotid artery stenosis is a narrowing in the carotid artery due to atherosclerosis. The carotid artery is the most important source of blood to the brain, and complete blockage of the artery might lead to a stroke. Carotid artery stenosis can be diagnosed with a carotid ultrasound, CT angiogram, or magnetic resonance angiography.
Most of the time, carotid stenosis requires surgical care. Carotid endarterectomy is a procedure that removes the atheromatous plaque from the artery and restores blood flow. However, the plaque might grow again if you fail to control your risk factors.
The surgeon will make a small cut in your neck, exposing the blocked section of the artery, the surgeon will remove open the artery and remove the plaque. He will then repair the artery with stitches or a patch made with vein or artificial material.
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Treatment For Cerebral Infarction
The effects of a stroke may be irreversible, making it vital to recognize the signs and seek immediate help. To prevent permanent damage or death, doctors must first address the blood flow to the brain.
The treatment must be started within three hours of the attack for optimal results. This is done with the application of aspirin to prevent blood clots or an injection of tissue plasminogen activator . Because this latter treatment is given intravenously, it must be given within four and one-half hours from the onset of symptoms.
If necessary, the tPA may be given with a catheter at the groin site to directly target the brain through the artery. The blood clot may also be treated directly by inserting a mechanical device into a catheter and targeting the brain for removal of the clot. These particular treatments are only used at the discretion of the physician due to the possible risks.
After the initial cerebral infarction treatment, you can expect to have a discussion to prevent future episodes. There are various procedures recommended based on your existing condition. A carotid endarterectomy sees the built-up plaque in your carotid removed with a surgical procedure. A more common procedure is to place stents within the carotid artery to keep it from narrowing.
Lifestyle changes will be key in preventing another stroke. Some may be easier than others to undertake.
The Biggest Risk Factor For Silent Brain Infarcts
Why do some people develop silent brain infarcts and others do not? If youd like to lower your risk of developing lacunar infarcts, the best way to do it is to control your blood pressure. High blood pressure is the biggest risk factor because elevated pressure damages the walls of the arteries in the brain. However, people with silent brain infarcts have other characteristics in common. Studies show that men and women who have an exaggerated blood pressure response to mental stress or abrupt rises and falls in pressure are more likely to have them.
Research also finds that people who have a morning surge in blood pressure where their blood pressure shoots up to the highest point of the day upon awakening are at greater risk of silent brain infarcts. Another marker of a higher risk of lacunar infarcts is having a 20 mm. rise or fall in blood pressure when rising from a sitting to a standing position. So, hypertension is a risk factor but so are blood pressure spikes and falls when changing positions quickly. Morning spikes in blood pressure also increase the risk of developing lacunar infarcts. In addition, research finds that women have more silent brain infarcts than men do. According to one study, lacunar infarcts are 30% more common in women.
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Pathology Of Ischemic Infarcts
|Aspergillus arteritis||Mucor arteritis of the basilar artery and pontine infarct|
A.Systemic vasculitis with CNS involvement: giant cell arteritis, polyarteritis nodosa, Wegener granulomatosis, Takayasu arteritis, Kawasaki disease. The most common of these entities is giant cell arteritis which is more frequent in older people and women and is associated with polymyalgia rheumatica. GCA is also called temporal arteritis because it frequently involves the temporal artery. Biopsy of the temporal artery is done for diagnosis. However, GCA affects the aorta and other major extracranial and, less frequently, intracranial branches. Involvement of the ophthalmic artery causes visual loss in a significant number of cases. GCA is a T-cell mediated autoimmune condition that affects medium-size and large arteries. Lymphocytes and multinucleated giant cells infiltrate the vessel wall, disrupt the internal elastic lamina, and cause narrowing and thrombosis.
B. Secondary vasculitis: Infectious collagen-vascular disease drug-induced vasculitis. Fungal vasculitis is most frequently caused by aspergillus and mucor.
|MCA-ACA infarct in sickle cell disease|
Other causes of arterial occlusion and infarction include:
Hematologic disorders – Polycythemia, hemoglobinopathies , deficiencies of anticoagulant factors, thrombotic thrombocytopenic purpura.
Vascular Spasm. This is a complication of subarachnoid hemorrhage.
Cerebral Infarction: Types Causes Symptoms Treatments
Cerebral infarction is known to account for 90% of the strokes in the US. As per the Centers for Disease Control And Prevention, strokes kill around 130, 000 Americans each year. It is important to know more about cerebral infarction, the types, causes, and the treatments, read the following array of the article.
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Treatment Course For The Stroke Patient In The Hospital
The patients of having acute ischemic stroke are managed in Intensive care unit before and after undertaking the treatment option as well as in those where a conservative treatment is offered. The patient is looked after by Neuro-intensivist as well as specialist Neuro-radiologist and Neurologist.
Residual Neurological deficits due to stroke are managed and suitable physiotherapy is offered.
Once stabilized, the patient will then be transferred to the referring physician for further management and follow up.
What Are The Treatments For Cerebral Infarction
The treatment of cerebral infarction depends on the underlying cause, which is detected with appropriate investigations. CT or Computed tomography and MRI scanning will generally show the damaged area in your brain, showing that the symptoms were not because of a tumor, or any brain disorder. On the angiogram, the blockage will also appear. After the diagnosis of the cerebral infarction, you will have to undergo with the treatments for the same. Below are some of the options for treatment of cerebral infarction.
Thrombolytic Drugs Depending on the severity and the type of cerebral infarction, the treatment typically varies. Thrombolytic drugs are the commonest popularly used treatment of cerebral infarction. As per the American Heart Association, it is explained that the affected people have a better chance of survival as well as recovery from the infarction if thrombolytic drugs are taken within about 12 hours of the incident. Most of the affected people are administered with these thrombolytic drugs within 90 minutes of their arrival to the hospital. For patients who are not able to tolerate the thrombolytic drugs, there may be the use of mechanical embolectomy devices so as to restore the flow of blood.
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