Understanding Strokes

Nikki – Year 9 Student

Before I start writing this article, I would like to reiterate how vital it is to recognise strokes and share this awareness. One in four adults above the age of twenty-five suffer from a stroke during their lifetime showing it is much more common than we think.

What is a stroke?

Stroke is a condition that occurs due to the abrupt disruption of blood supply to various areas of the brain. Strokes are considered medical emergencies and an ambulance should be called via 999 without delay if any symptoms of stroke are present. Time is crucial when it comes to dealing with a stroke. If treatment is received rapidly, the chances of recovery are higher, and the damage is less likely to be permanent. 

Aetiology (causes)

The ideal way of thinking about a stroke is a “brain attack”, similar to that of a heart attack, but occurring inside your brain. These “brain attacks” come in two different types: ischemic and hemorrhagic. Now, do not be put off by the length of these words; they are simply just names of stroke, similar to the names of apples being “pink lady” or “gala”. The first type of stroke, ischemic strokes, are the more common type which are caused by a blood clot blocking an artery to the brain. Remember, arteries carry blood from the heart to the body (including brain), meaning that the brain’s blood circulation is cut off and this could be fatal.

The second type of stroke, which is less common, is called a hemorrhagic stroke and this happens when a blood vessel bursts and bleeds inside or on the surface of the brain. This bursting of a blood vessel mainly occurs due to high blood pressure or a weak blood vessel wall, which increases the risk of bursting. In addition, there can be a precursor to a stroke called a TIA (transient ischaemic attack) and they are often alluded to as “mini strokes”, since the blood supply is only cut off temporarily and no permanent damage is done to the brain. The length can last from a few minutes to an hour, but leaves no permanent damage. These should not be taken mildly, as this can be foreshadowing of a full-blown stroke in the future.

Recognition and diagnosis

FAST is an acronym used to provide prompt recognition of a stroke.

Face- Is it droopy on one side? Can they smile?

Arms- Can they lift both arms in the air? Any weakness in one arm?

Speech- Is it slurred? Can they talk and understand what you’re saying?

Time- Time to ring 999 if any of the above symptoms are answered “yes”.

After an ambulance arrives, a doctor may carry out the following tests to provide treatment:

  • Physical examination- a doctor usually checks muscle strength, reflexes, balance, vision and hand-eye coordination;
  • Blood tests- used to detect the severity and risk of blood clots or bleeding, infections and clotting factors levels;
  • CT scan- a series of spiral X-rays of the brain;
  • MRI scan- magnets and radio waves to sense destroyed tissue;
  • Carotid ultrasound- an ultrasound scan in carotid arteries to check the flow of blood/narrowing of arteries.

How are strokes treated?

Ischemic strokes are treated by an alteplase injection, a drug that dissolves blood clots. Think of the clot like a big blob of jelly and alteplase like a secret agent that transforms the jelly into its original liquid state (just before the jelly sets). This process is known as “clot-busting”. You can remember this like the alteplase secret agent “busting” the bad jelly. The dissolution process of a blood clot is known as thrombolysis.

Thrombectomy is an emergency procedure carried out in major stroke treatment centres like Leeds. It involves inserting a catheter into an artery in the groin and removing blood clots by grabbing/sucking them, and restoring the blood supply in ischemic strokes.

However, let us not forget about hemorrhagic strokes. This one is a bit tricky. To keep it short, a surgeon evacuates the bulge from the bleed by a procedure called craniotomy. The only thing you should not do is give the patient aspirin and anticoagulants.

Prevention is the best cure

“Prevention is the best cure” is not wrong when it comes to strokes. There are a number of prevention techniques to reduce your risk of getting a stroke. Lifestyle changes include:

  • eating a nutritious diet;
  • maintaining a healthy weight;
  • exercising regularly;
  • not smoking;
  • avoiding alcohol, or only drinking minimally;
  • controlling blood lipid levels and blood pressure.

References

https://www.medicalnewstoday.com/articles/7624#symptoms

https://www.statpearls.com/ArticleLibrary/viewarticle/17174

https://www.nhs.uk/conditions/stroke/

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