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Stroke – Signs and Symptoms of Stroke | Causes of Stroke

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What is a stroke?

Stroke is a condition where a part of the brain stops functioning due to a lack of blood flow or rupture of a blood vessel within the brain.

brain stroke

When a stroke occurs due to blockage of blood vessel supplying a part of the brain, it is called an ischemic stroke. This is the commonest form of stroke comprising about 85% of all cases of stroke.

When it occurs due to the rupture of a blood vessel inside the brain it is called a hemorrhagic stroke. It comprises 10–15% of all strokes in the USA, Europe and Australia, and 20–30% of strokes in Asia. This type is associated with more serious outcomes accounting for deaths in 40% to 54% of the cases.

In some people, an event of stroke resolves on its own within a period of 24 hours, usually within 5 minutes, and is called a transient ischemic attack (TIA). It is thought to be due to a temporary blockage of blood supply to a part of the brain.

Stroke is the 2nd commonest cause of death in the world.

The important thing to understand is that stroke is both:

Preventable: 80 percent of strokes are preventable.

Treatable: Getting treatment as early as possible is key to preventing death and disability from stroke.

Patients of ischemic stroke treated with tPA are more likely to recover completely or have less impairment.

How common is stroke and how many people have died due to stroke?

Stroke is the second leading cause of death in the world and the third leading cause of death in India only after ischemic heart disease and chronic obstructive lung disease.

The lancet journal estimated that about 11.2 lakh people in India, suffered from a stroke and about 7 lakh people died of a stroke in 2016.

It also estimated that globally 1.3 crore people suffered from a stroke and about 55 lakh died of it.

It is also the leading cause of neurologic disability in adults.

What are the causes of a stroke?

The stroke is caused by an event that affects the vessels that supply blood to the brain.

The vessel may get blocked or burst open releasing blood in or around the brain.

Both conditions damage an area of the brain which results in cessation of functioning of that part of the brain.

On the basis of etiology and mechanism the stroke has been classified into 3 major types:

1. Ischemic stroke

2. Hemorrhagic stroke

3. Transient ischemic attack (TIA)

1. Ischemic stroke:

This is commonest cause of stroke comprising about 85% of all cases.

Ischemic stroke occurs due to lack of blood supply to the brain cells called as ischemia. The lack of blood supply is caused by significant narrowing or complete blockage of the blood vessels supplying the brain. This blockage occur due to two reasons which further divides it into two types:

• Thrombotic stroke: here, blockage or narrowing occurs due to formation of a clot at the site of fatty plaque present within the brain vessel.

• Embolic stroke: here, blockage occurs due to dislodgment of the clot called an embolus, from heart or a large vessel that brings blood from heart. The clot formed in heart or larger blood vessel travel along with the blood until it reaches a small enough vessel inside the brain to get stuck and cause blockage of blood supply. The commonest reason of embolus formation is atrial fibrillation where the heart beats irregularly.

2. Hemorrhagic stroke:

It is less common than ischemic stroke accounting for 10-30% cases. However this is generally associated with more serious outcomes with death occurring 40% to 54% of the cases.

Hemorrhagic stroke occurs due to rupture of blood from brain vessels resulting into accumulation of blood in and around the tightly packed brain tissue resulting into mechanical injury to the brain cells. The rupture may be due to hypertension or bursting of abnormal vessel aneurysm- balloon like abnormality in blood vessels or arteriovenous malformation.

Hemorrhagic strokes is also of two types:

• Intracerebral hemorrhage: is the commonest type of hemorrhagic stroke, where an artery traveling inside the brain tissue ruptures resulting into accumulation of the blood within the brain matter.

• Subarachnoid hemorrhage: is a less common type of hemorrhagic stroke which occurs due to rupture of an artery that travels in close proximity to the brain surface which results into the accumulation of blood in the area between brain and thin covering around the brain called subarachnoid space.

3. Transient ischemic attack (TIA):

It is also called as mini-stroke. The stroke occurs due to temporary blockage of the brain vessel or due to formation of new collateral blood pathways.

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What are the risk factors in development of stroke?

The global risk of developing a stroke is quit high. It has been estimated that there are 25% chances that a person aged 25 years or above would develop stroke.

Non-modifiable risk factors:

• Age: Stroke can occur at any age but the risk of getting stroke increases with age. One out of 5 women and one in 6 men develop stroke after 55 years of age. The mean age of developing stroke in India is 63 years.

• Race — Blacks and Asians have a higher risk of stroke than Caucasians. Blacks aged between 45-54 years have a 3 times higher risk of dying than white counterparts.

• SexAsian and Indian men are at a higher risk of developing stroke than women. Women are usually older when they develop a stroke, and they’re more likely to die from stroke.

• History of stroke, heart attack, or transient ischemic attack in family or self.

Modifiable risk factors:

These are important risk factors for the development of stroke. These factors can be managed or kept under control. These are as follows:

Lifestyle risk factors

• Increased body weight: overweight or being obese

• Reduced physical activity

• Tobacco in any form such as smoking, chewing, and others or passive smoke exposure. It damages the blood vessels and increases blood pressure.

• Drinking alcohol especially with heavy or binge drinking.

• Drugs such as cocaine and others

• Hormones — Use of birth control pills or hormone therapies such as estrogen therapy increases risk.

Disease or conditions- this comprises of conditions that can be kept under control to prevent the development of stroke.

• High blood pressure- was found present in about 61% of patients of stroke.

• High cholesterol

• Diabetes- seen in about 36% of patients.

• Obstructive sleep apnea

• Cardiovascular disease, such as atrial fibrillation, heart defects, heart failure, heart infection.

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What are the signs and symptoms of a stroke?

The signs and symptoms of stroke develop immediately bringing an immediate loss of function governed by a part of the brain. These signs and symptoms are as follows.

 

Signs-and-symtoms-of-stroke1.Sudden weakness or numbness in the face, arm, or leg: there is a development of sudden weakness/paralysis or numbness in the face, arm, or leg usually on one side of the body.

Face develops asymmetry in appearance and a person is not able to use facial muscles properly on the affected side.

Arms, on lifting both arms the affected arm falls suggesting muscle weakness

Legs, a person is unable to walk or stand or lift leg due to muscle weakness of the affected leg.

This may be accompanied by a feeling of numbness or tingling on the affected side.

2. Sudden problem in walking or standing which may be accompanied by dizziness, loss of balance or coordination

3. Sudden confusion

4. Sudden problem in speaking, or difficulty in understanding what others are speaking

5. Sudden problem in seeing from one or both eyes: sudden development of blurred or diminished or even loss of vision in one or both eyes. Some people may start seeing a single thing as double.

6. Sudden severe headache that may be accompanied by vomiting or altered conciseness.

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How to identify a stroke? Or when to call an emergency?

After the development of a stroke, every minute counts!

Immediate medical care can significantly lower the risk of disability and death.

It is very important to reach to the hospital early and get thrombolytic treatment started before 3 hours of the onset of symptoms.

To increase the ability to diagnose stroke early amongst people certain identifying features have been developed known as “FAST”:

F- Face drooping– Ask the person to smile. Does one side droop?

A-Arm weakness -Ask the person to raise both arms. Does one arm drift downward?

S- Speech difficulty -Ask the person to repeat a simple sentence. Is speech slurred or person is unable to speak?

T- Time to call Emergency– If the person shows any of these signs, even if the symptoms go away, call for medical emergency services and take him or her to the hospital.

signs of brain stroke

 

It is very important to note the time of onset of symptoms. This information helps doctors decide the best treatment for each person.

If a quick and good ambulance facility is available then it’s better to take the patient on ambulance where his life saving treatment can be initiated immediately.

It has been found that patients who reach the hospital emergency within 3 hours of the onset of the first symptom often suffer from less disability 3 months after the episode of stroke than people who received delayed treatment.

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What are the complications of stroke?

Complications

A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:

• Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm.

• Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly, swallow, or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing.

• Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments, and understanding concepts.

• Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.

• Pain. Pain, numbness, or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.

• Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores.

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How stroke is treated?

The first and most crucial step in the treatment is to identify the stroke and to reach hospital emergency as early as possible (within 3 hours).

Early initiation of treatment can bring a significant difference in the outcome of stroke. It is preferred to use an ambulance service so that the life-saving treatment can begin on the way.

At Hospital:

The person is taken to an emergency department where a quick evaluation is done. The doctor takes clinical history, typically focusing on the duration of the symptom onset.

The vitals of the person such as BP, heart rate, breathing, etc. is taken, and the treatment is started.

The treatment of stroke consists of:

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