STROKE

STROKE

Strokes occur due to problems with the blood supply to the brain: either the blood supply is blocked, or a blood vessel within the brain ruptures, causing brain tissue to die. A stroke is a medical emergency and treatment must be sought as quickly as possible.
Stroke is the 5th leading cause of death in the United States, with one person dying every 4 minutes as a result. For black people, stroke is the 3rd leading cause of death.
Approximately 800,000 people have a stroke each year; about one every 40 seconds. Only heart disease, cancer, chronic lower respiratory diseases, and accidents are more deadly.
What is stroke?
Stroke occurs when the supply of blood to the brain is either interrupted or reduced. When this happens, the brain does not get enough oxygen or nutrients, which causes brain cells to die.
Fast facts on stroke:
 During a stroke, the brain does not receive enough oxygen or nutrients, causing brain cells to die.
 Ischemic strokes are caused by a narrowing or blocking of arteries to the brain.
 Hemorrhagic strokes are caused by blood vessels in and around the brain bursting or leaking.
 Strokes need to be diagnosed and treated as quickly as possible to minimize brain damage.
 Treatment depends on the type of stroke.
 The most effective way to prevent strokes is through maintaining a healthy lifestyle and treating underlying conditions that are a risk factor.

What causes stroke?

The different forms of stroke have different specific causes.

Types of stroke:
There are three main kinds of stroke:
 Ischemic strokes
 Hemorrhagic strokes
 Transient ischemic attacks (TIAs), also referred to as mini-strokes
Strokes can appear as hemorrhagic strokes, ischemic strokes or transient ischemic attacks.
 Hemorrhagic stroke —



 This type of stroke takes place when a weakened blood vessel in the brain ruptures. A hemorrhage, or bleeding from the blood vessel, occurs suddenly. The force of blood that escapes from the blood vessel can also damage surrounding brain tissue. Hemorrhagic stroke is the most serious kind of stroke. About 13% of all strokes are hemorrhagic. There are two types of hemorrhagic strokes: intracerebral and subarachnoid. Intracerebral hemorrhages are more common and occur when a blood vessel in the deep tissue of the brain ruptures. Subarachnoid hemorrhages usually occur when an aneurysm (a blood-filled pouch ballooned out from an artery) ruptures and bleeds into the space between the brain and the skull. This type of hemorrhagic stroke is most often caused by high blood pressure.












 Ischemic stroke —



 This type of stroke occurs when a blood vessel in the brain develops a clot and cuts off the blood supply to the brain. A blood clot that forms in a blood vessel in the brain is called a “thrombus.” A blood clot that forms in another part of the body, such as the neck or lining of the heart, and travels to the brain is called an “embolus.” Blood clots often result from a condition called “atherosclerosis,” the build-up of plaque with fatty deposits within blood vessel walls. About 87% of all strokes are ischemic. Treatment for ischemic strokes depends on how quickly after the symptoms start the stroke victim arrives at the hospital. In eligible patients, a medication called tPA (tissue plasminogen activator) may be given. This medication works to dissolve the clot and help restore blood flow. In other patients, a stroke specialist may recommend a mechanical thrombectomy. This is where a specialized doctor threads a catheter through an artery in the groin up through the body to the brain and uses a clot retrieval device to grab the clot and pull it out.

 Transient ischemic attack (TIA) — A TIA should be treated as seriously as a stroke. A TIA has the same symptoms as a stroke, but they only last several minutes, or up to 24 hours. Unlike a stroke, a TIA does not kill the brain cells, so there is no lasting damage to the brain. A TIA is considered a serious warning sign of stroke. About 1 in 3 people who have a TIA will go on to have a stroke.
Stroke & the Brain


Right-brain stroke and communication difficulties
Right-brain communication difficulties may be hard to notice at first. These difficulties can include poor attention and decreased perception. A right-brain stroke survivor may have a hard time with processing information (visual and verbal) and decreased cognitive (thinking) skills such as poor judgment, short attention span, and short-term memory loss.

Functions of the right side of the brain include:
 Control of vision
 Knowledge of shapes, objects, people and distance.
 Creative, artistic and musical sense
 Control of happy or good feelings and sad or bad feelings.
 The left side of the brain is more logical. It helps in making decisions, putting words in the right order to speak and do math.

A right brain stroke may result in several types of deficits including:
 moving the left side of the body and seeing objects on the left side of the room. Some people may even ignore everything on their left side.
 Chewing, swallowing, and talking
 Recognizing familiar faces
 Dressing
 Reading and doing simple math
 Paying attention or staying alert
 Laughing or crying at the wrong times
 Making decisions or remembering.

Caregivers can take steps to help stroke survivors deal with limitations of right-brain injury, once their limitations are recognized.
The following are some tips:
 Keep a safe environment. All items that have the potential to be dangerous (like poisons, cleaning chemicals, and sharp objects) should be kept in a secured place.
 Encourage the stroke survivor to fully scan (turn their head from side to side to see) their surroundings to compensate for any visual field cut or left-side neglect.
 Acknowledge the affected part of their body as still part of the stroke survivor.
 Offer help, and encourage the stroke survivor to accept help when offered.
 Be sensitive to the stroke survivor’s visual and sensory difficulties. For instance, place items the person may need to their right side if they have trouble seeing or sensing things on their left side.
 Minimize environmental clutter and distractions. Too much visual or auditory stimulation in the environment may be dangerous and may be confusing. Calm and quiet surroundings can help a person focus on a given task.
 Help prevent injuries that may result from an inability to determine depth and distance.
 Make sure that pointed edges on things such as furniture and doorways are clearly marked or protected.
Stroke survivors with right-brain injuries frequently have speech and communication problems. Many of these individuals have a hard time pronouncing speech sounds properly because of the weakness or lack of control in the muscles on the left side of the mouth and face. This is called “dysarthria.”

Left-brain stroke and communication difficulties
Left-brain stroke survivors may experience communication problems and paralysis (loss of use) on the right side. Communication problems can affect the survivor’s receptive abilities (understanding) or expressive abilities (getting the words out). This is referred to as “aphasia.” They may also have slurred speech from the right sided face and/or mouth weakness which is referred to as “dysarthria.”

The person with left brain injury has weakness or paralysis on the right side of the body and typically these types of deficits :
 Weakness or paralysis on the right side of the body
 Wrong use of yes and no
 Knowing right from left
 Naming objects
 Math
 Speech may seem confused or sound as if the person is drunk
 Caution or hesitation with speech and action, making the person afraid to try something new.

When communicating with a stroke survivor that has communication problems (aphasia), it is helpful to:
 Be patient.
 Eliminate distractions. Turn off the TV, limit extraneous noise.
 Keep the questions simple, so that the survivor may reply using yes or no.
 Keep commands and directions simple.
 Speak in a normal voice at normal loudness.
 Allow the person time to process the information, as well as form a response to questions or commands.
 Do not rush the survivor to answer your questions or comments.
 Resist the temptation to answer questions for him or her.
Stroke survivors may have difficulty with their communication skills following a stroke. Communication problems can be classified into two basic categories: aphasia and motor speech disorders.
Aphasia
Simply defined, aphasia is the loss of ability to communicate normally resulting from damage, typically to the left side of the brain, which houses the communication center.
The condition can affect a person's ability to understand what is being said to them or asked of them (auditory comprehension).
Aphasia may also affect their ability to read, write, and deal with numbers. Your speech pathologist can provide you with additional information on aphasia and motor speech disorders.
Motor speech disorders
Some stroke survivors may have slurred or garbled speech as a result of muscle weakness (dysarthria) or difficulty with motor programming and coordination of the speech muscles (apraxia).
A speech-language pathologist may be asked to assess the patient’s communication skills and discuss with the family ways to help improve communication with the stroke survivor. The speech-language pathologist will also recommend any further follow-up after discharge from the hospital.
Symptoms of stroke
Strokes occur quickly, so symptoms often appear suddenly and without warning.

The main symptoms of stroke are:
 Confusion - including trouble with speaking and understanding.
 Headache - possibly with altered consciousness or vomiting.
 Numbness or inability to move parts of the face, arm, or leg - particularly on one side of the body.
 Trouble seeing - in one or both eyes.
 Trouble walking - including dizziness and lack of co-ordination.
Strokes can lead to long-term problems. Depending on how quickly it is diagnosed and treated, the patient can experience temporary or permanent disabilities in the aftermath of a stroke.
In addition to the persistence of the problems listed above, patients may also experience the following:
 bladder or bowel control problems
 depression
 pain in the hands and feet that gets worse with movement and temperature changes
 paralysis or weakness on one or both sides of the body
 trouble controlling or expressing emotions

Symptoms vary among patients and may range in severity.

The acronym F.A.S.T. is a way to remember the signs of stroke, and can help identify the onset of stroke more quickly:
 Face drooping - if the person tries to smile does one side of the face droop?
 Arm weakness - if the person tries to raise both their arms does one arm drift downward?
 Speech difficulty - if the person tries to repeat a simple phrase is their speech slurred or strange?
 Time to call 911 - if any of these signs are observed, contact the emergency services.

The faster a person with suspected stroke receives medical attention, the better their prognosis and the less likely they will be to experience lasting damage or death.
How is a stroke diagnosed?

Signs of a stroke require immediate medical attention.
Strokes happen fast and will often occur before an individual can be seen by a doctor for a proper diagnosis.
For a stroke patient to get the best diagnosis and treatment possible, they should be treated at a hospital within 3 hours of their symptoms first appearing.
Ischemic strokes and hemorrhagic strokes require different kinds of treatment.
Unfortunately, it is only possible to be sure of what type of stroke someone has had by giving them a brain scan in a hospital environment.
There are several different types of diagnostic tests that doctors can use to determine which type of stroke has occurred:
 Physical examination - a doctor will ask about the patient's symptoms and medical history. They may check blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes, all to check for indications of clotting.
 Blood tests - a doctor may perform blood tests to find out how quickly the patient's blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection.
 CT scan - a series of X-rays that can show hemorrhages, strokes, tumors, and other conditions within the brain.
 MRI scan - radio waves and magnets create an image of the brain to detect damaged brain tissue.
 Carotid ultrasound – an ultrasound scan to check the blood flow in the carotid arteries and to see if there is any plaque present.
 Cerebral angiogram - dyes are injected into the brain's blood vessels to make them visible under X-ray, to give a detailed view of the brain and neck blood vessels.
 Echocardiogram - a detailed image of the heart is created to check for any sources of clots that could have traveled to the brain to cause a stroke.
Treatments for stroke
As the ischemic and hemorrhagic strokes are caused by different factors, both require different forms of treatment. It is not only important that the type of stroke is diagnosed quickly to reduce the damage done to the brain, but also because treatment suitable for one kind of stroke can be harmful to someone who has had a different kind.
For more information on treatments for Stroke, please feel free to ask, I will gladly send you more information on the topic.

Rehabilitation
Strokes are life-changing events that can affect a person both physically and emotionally, temporarily or permanently. After a stroke, successful recovery will often involve specific rehabilitative activities such as:
 Speech therapy - to help with problems producing or understanding speech. Practice, relaxation, and changing communication style, using gestures or different tones for example, all help.
 Physical therapy - to help a person relearn movement and co-ordination. It is important to get out and about, even if it is difficult at first.
 Occupational therapy - to help a person to improve their ability to carry out routine daily activities, such as bathing, cooking, dressing, eating, reading, and writing.
 Joining a support group - to help with common mental health problems such as depression that can occur after a stroke. Many find it useful to share common experiences and exchange information.
 Support from friends and family - to provide practical support and comfort. Letting friends and family know what can be done to help is very important.
Rehabilitation is an important and long part of treatment. With the right help, rehabilitation to a normal quality of life is possible, depending on the severity of the stroke.
Preventing a stroke
The best way to prevent a stroke is to address the underlying causes. This is best done by living healthfully, which means:
 Eating a healthy diet.
 Maintaining a healthy weight.
 Exercise regularly.
 Don't smoke.
 Avoiding alcohol or drink moderately.

Eating a healthful diet means plenty of fruits, vegetables, and healthy whole grains, nuts, seeds, and legumes; eating little or no red or processed meat; limiting intake of cholesterol and saturated fat (typically found in foods of animal origin); and minimizing salt intake so as to support healthy blood pressure.
Other measures taken to help reduce the risk of stroke include:
 Keeping blood pressure under control.
 Managing diabetes.
 Treating obstructive sleep apnea (if present).

As well as these lifestyle changes, a doctor can help to reduce the risk of future ischemic strokes through prescribing anti-coagulant and/or anti-platelet medication.  In addition to this, the arterial surgery previously mentioned can also be used to lower the risk of repeat strokes, as well as some other surgical options still being studied.
Tips for Caregivers: Stroke
Some tips to help family and friends cope with a loved one's stroke:
 Ask the doctor questions if you accompany your loved one to appointments. Talk with the patient before the appointment about the questions you will ask and be sensitive when asking questions, especially those questions to which the patient may not want to hear the answer.
 Be prepared for changes in your loved one’s behavior and mood. Medications, discomforts, and stress can cause your loved one to become depressed or angry.
 Encourage your loved one to be active and independent, as much as possible, to help him or her regain a sense of self-reliance and confidence.
 Be realistic about your own needs. If you take care of your needs, it may be easier to meet the needs of your loved one.
 Be sure you are sleeping enough, eating properly, and taking some time off for yourself. It is hard to offer much help when you are exhausted.
 Don't hesitate to ask other family members and friends for help. They may appreciate the opportunity to help.
 Keep a positive attitude.
 Accept that there are events you cannot control.
 Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
 Learn how to manage stress. Try a variety of relaxation techniques to help you manage stress.
 Exercise regularly. Your body can fight stress better when you are physically fit.
 Eat well-balanced meals.
 Don't rely on alcohol or drugs to reduce stress.
 Use the resource of support groups. Talking with people who are in similar situations can help you to feel that you are not alone.
Some people believe that a right brain stroke is more dangerous than a left brain stroke.  They may be correct, but I believe that no matter the brain stroke be it left or right, any damage to the brain is dangerous.

In conclusion, I want to say that giving HOPE to someone is the same as giving LIFE to that person.  So keep up the good work and God Bless You.
Like I said in our last meeting we will meet once month till end of this year and from January we will continue our fortnightly Meetings.
I want to say that giving HOPE to someone is the same as giving LIFE to that person.  So keep up the good work and God Bless You.