(1888PressRelease)
September 03, 2007 - The most common symptoms are:
Weakness in one half of body, Deviation of face to one side, Loss of clarity of voice or inability to speak, Deviation of eyes to one side
Loss of sensation in one half of body,Alteration in consciousness.
Alteration in behavior.
There may occasionally be associated convulsions. These symptoms occur because of two problems; cessation of blood supply to a part of brain or bleeding (hemorrhage) in the brain. The disturbance of blood supply /occupation of brain substance by blood lead to impaired functioning of those areas leading to above focal symptoms. They commonly occur suddenly but at times may develop over few hours. Sometimes they develop and then spontaneously resolve over minutes to hours. This is called a transient ischemic attack. This should not be taken lightly as this good fortune is warning of a future brain attack and prompt evaluation and action may help in preventing a future attack.
As these symptoms suggestive of brain attack or transient ischemia occur, the patient should immediately be shifted to hospital without delay which has emergency imaging facilities like CT scan/MRI and a dedicated brain attack/ stroke team. . The CT scan can differentiate stoppage of blood supply due to clot from hemorrhage. An early CT scan may fail to show the infracted area but can reliably rule out hemorrhage. If symptoms and signs are suggestive a patient may be treated as ischemic stroke reliably in the absence of a demonstrable infarct. MRI brain is better as special sequences like diffusion images can pick up infarct in the hyperacute stage. However an emergency MRI may not be available at many centers. It also helps differentiate stroke from other diseases if diagnosis is suspect. That is why it is commonly said ‘Time is Brain’ This is Similar symptoms may occur in diabetics on treatment due to low blood sugar or alterations in electrolytes which can be rapidly diagnosed and treated with good outcome. A prompt treatment without observing the symptoms to resolve is very important as apart from areas that are irreversibly damaged the nearby areas are malfunctioning due reduction in blood supply but are still not irreversibly damaged.
A treatment called thrombolysis (dissolving the clot) can be given by trained stroke neurologists, which may restore the brain perfusion and decrease the resultant disability. Within four hours even percentages hemorrhages can be stopped from growing by treatments like factor VII A. Even if these treatments are not possible due to delay in reaching the hospital appropriate management of blood pressure (neither allowing it to go too high nor becoming too low) is vital in limiting brain damage. Similarly treatment of fever, prevention of venous thrombosis in legs and management of nutrition are vital.
Antiplatelet agents are a key part of the therapy of ischemic stroke and should be instituted as soon as possible. Early mobilization and prompt physiotherapy are vital for restoration of normal function. Physiotherapy more than any drugs is the vital element of stroke treatment. Besides this if patient is having convulsion he/she should be put in lateral position without trying to force things in mouth. An unconscious person should not be fed from mouth as the food/liquid may go into the airway and cause blockage. Surgical management is indicated in suitable cases of hemorrhages and in ischaemic stroke when intracranial pressure is rising rapidly.
Prevention of brain strokes is vital as this catastrophe causes significant disability and mortality. Suitable preventive actions are indicated in patients with stroke, those without stroke but at risk for stroke and people at large as with age they can later be at risk for stroke. As most strokes are caused either by blockage of arteries by a thrombus or a clot, or throwing of a thrombus from heart or artery itself, prevention of thrombosis and atherosclerosis are the main preventive principles.
High blood pressure plays vital role in causation of both ischemic and hemorrhagic strokes. So the vital elements in prevention of stroke are lifestyle changes aimed at reduction of cholesterol deposition in arteries. They include cessation of smoking, alcohol only in moderation, exercise, reduction of weight, and a diet rich in fruits and vegetables and low in salt and fat specially saturated fat.. Also of vital importance a periodic checking of blood pressure, lipid profile and blood sugar.
If a person is diabetic or hypertensive control of these with appropriate medication is vital in stroke prevention. If cholesterol is too high or is persistently high despite dietary modifications drugs to decrease cholesterol called statins are also indicated. In patients with a previous stroke, cardiac disease or significant risk factors prophylaxis with blood thinners or antiplatelet agents like low dose aspirin, aspirin dypiridamiole or clopidogrel is indicated. In patients with heart disease an echocardiography is also indicated to screen heart as a source of thrombi so that specific preventive actions can be undertaken.
A screening of arteries supplying blood to brain by Doppler or MRI Angiography is indicated after stroke so that symptomatic patients with severe blockage can be treated by angioplasty or surgery. In people on preventive medications without occurrence of brain attack for some time, a doubt may arise whether they still need medication, as treatment after stroke is designed for prevention and if on treatment strokes do not occur it means the treatment is working.
However as deposition of cholesterol in arteries occurs from an early age leading a healthy lifestyle from young age is the key to avoiding strokes and medicines later. It must be remembered that prevention is better than cure and the earlier we start more are the benefits. If still the brain comes under ‘attack’ immediate and specialized treatment is indicated as when brain is under attack ‘time really is brain.
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