About A Stroke: What You Need To Know

Overview 

Understanding stroke

Stroke is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury (infarction, haemorrhage) of the central nervous system, and is the second leading cause of disability and death around the world. It is an implication of multiple risk factors, varying disease processes, and mechanisms, as it is not a single disease.¹

It is a burden that has reached epidemic proportions. Globally, 1 in 4 adults over the age of 25 will experience a stroke in their lifetime, 12.2 million people experience their first stroke each year, and around 6.5 million deaths from stroke are reported annually.² This is what makes a stroke so scary, that it can ultimately lead to abrupt fatalities, and those who survive it suffer from subsequent disabilities (loss of speech, movement, or memory impairment). If you’re reading this article, time for changing your lifestyle might be essential, so without further ado, let’s talk about stroke.

Common causes

A stroke occurs when the blood supply to a part of the brain is reduced, eventually leading to the death of the brain cells. It can either be due to a blockage in the blood supply to the brain (ischaemic stroke) or due to the rupture of the blood vessels in the brain (haemorrhagic stroke).²

The majority (85%) of strokes are ischaemic and are caused by cerebral small vessel disease, cardioembolism, and large-atherosclerosis-related thromboembolism. The remaining 15% is a result of intracerebral haemorrhage, which can be deep, cerebellar, or lobar. They are mostly a result of cerebral small vessel diseases like deep perforator arteriopathies and cerebral amyloid angiopathies.¹

Warning signs and symptoms

The following, according to the CDC, are signs of stroke in individuals assigned male at birth (AMAB) and in individuals assigned female at birth (AFAB):

• Sudden or abrupt numbness in the extremities, especially on one side of the body 
• Sudden confusion, impaired speech, or difficulty understanding speech
• Sudden blindness or difficulty in seeing in one or both eyes
• Sudden loss of coordination, feeling nauseated, difficulty in walking, or loss of balance
• An abruptly intense headache with no explainable cause

Risk factors

What can trigger a stroke?

The risk factors of stroke that may or may not be part of your lifestyle can build up to a stroke, here are the causes of strokes/certain factors that raise your chances of a stroke:

• An unhealthy diet
• Lack of physical activity
• Obesity
• Smoking
• Alcohol consumption
• High blood pressure and cholesterol
• Blood sugar levels
• Atrial fibrillation (abnormal heart rhythm)

At baseline, strokes are classified into ischaemic and haemorrhagic. Although they have similar risk factors (modifiable and non-modifiable), they also have some notable differences.³

The risk factors that overlap for both types of stroke are the non-modifiable risk factors such as your family genetics, age, sex, and race/ethnicity, among extraneous modifiable factors such as hypertension, current smoking, diet, alcohol consumption, and waist-to-hip ratio.³

Ischaemic strokes alone have more modifiable risk factors like physical inactivity, hyperlipidemia (increased cholesterol levels), diabetes and previous history of heart diseases.³

Among all of these risk factors, hypertension is the most important factor to modify, given the strong, linear, and continuous relationship between blood pressure and stroke risk.³ A case-control study by O’Donnell and his team on risk factors for both types of strokes in 22 countries implied a major effect of blood pressure on stroke risk, where blood pressure had a greater effect on haemorrhagic strokes.⁴  

Diagnosis

A medical professional will diagnose a stroke based on your symptoms, medical history, a physical exam, and results after tests. Diagnosing the correct type of stroke is imperative in treating the patient.⁵ Your doctor needs to find out whether you’ve had a haemorrhagic stroke from a ruptured blood vessel, or if you’ve experienced a blocked artery in the brain from an ischaemic attack.

In order to rule out other possibilities that present with similar signs and symptoms, certain diagnostic tests must be performed to image blood vessels in your brain. These tests can determine what type of stroke you have and where it occurred. Imaging tests for diagnosing strokes include:

• Computed Tomography (CT) scans: Helps identify bleeding in the brain or damage to brain cells from a stroke. These X-ray scans show detailed images of your brain and  are performed right after a suspected stroke
• Magnetic resonance imaging (MRI): It is used in tandem with a CT scan to diagnose a stroke. They produce images of your brain using magnetic and radio waves and detect changes in your brain’s tissues and/or damage to the brain cells
• Other imaging tests are performed to detect tangled blood vessels or aneurysms in the brain. Others look for narrowed blood vessels in the neck

Your doctor, in addition to imaging tests, may choose to order a few more tests such as:

• Blood tests: To determine blood and platelet counts and blood glucose levels, it can help your doctor determine if a certain type of treatment is suitable for you. These tests can also detect your clotting levels, and whether some muscles have been damaged from the stroke
• Electrocardiogram (EKG): It helps detect heart problems that may have led to stroke
• Lumbar punctures or spinal taps: If imaging becomes inconclusive of any bleeding but your doctor still believes it might have been a haemorrhagic stroke, fluid will be taken from your spine to detect any substances from broken-down cells

Can we stop a stroke in progress?

Unfortunately, once a stroke is underway, there is no way of stopping it. Only a doctor can treat a stroke, and any instance of a stroke must be treated as a medical emergency.

When a stroke is in progress, it is highly advised to do the following:

• Call the paramedics
• Do not take any medications
• Maintain consciousness, stay awake
• Do not attempt to drive yourself or someone else to the hospital; wait for the paramedics to arrive and perform the necessary life-saving protocols
• Do not consume anything, neither food nor drink

Things to remember during a stroke

There are numerous things one must remember when indications of stroke arise:

The F.A.S.T. method 

Using the letters in the word F.A.S.T can help spot a stroke in progress:

• F = Face Drooping: Does one side of the face start to droop, or does numbing occur? When asking the potential patient to smile, do they struggle? Is it uneven? If this is the case, it might be a stroke
• A = Arm Weakness: Is one arm numb? Have extremities to one side of the body begun to lose feeling? If this is the case, it might be a stroke
• S = Speech Difficulty: Is the person’s speech slurred?
• T  = Time: it’s now time to call the paramedics as every second matters

Noting the time

It is essential to note down the time when the first symptom started to develop as it would help the emergency staff decide the treatment options. For example, a medication called tPA or tissue plasminogen activator can be given to the patient within 4.5 hours of first experiencing symptoms of a stroke. It has the potential to reverse or stop the symptoms from developing into a full-blown stroke.

Ischaemic stroke patients can also receive surgery within 24 hours of symptom onset, these surgeries are called endovascular treatments that involve surgically removing the clot causing the stroke.

Performing CPR 

If the patient you believe is experiencing a stroke and has fallen unconscious, check for their pulse and breathing. If neither are found, call the paramedics and perform CPR, if you are not trained in CPR, ask the dispatcher to assist and guide you through what you need to do.

When to seek a medical specialist?

Before a stroke could occur, your regular check-ups with your general physician might reveal the identified risk factors that can potentially lead to a stroke. Do not wait until a stroke occurs to change your lifestyle.

If the stroke has already occurred, you must have had medical attention within 24 hours of the symptoms arising. After an initial assessment, you will be referred to a specialist who will diagnose your stroke and identify its causes. Treatment or surgery will then begin soon after.

Summary

Stoke occurs when a part of the brain does not receive sufficient blood either due to blockages in the blood supply (Ischaemic stroke) or due to the rupture of the blood vessels (Haemorrhagic). Out of the two, ischaemic stroke is the most predominant. 25% of the global population over 25 will experience a stroke in their lifetime, and education on this particular topic could not be more crucial. Risk factors overlap for both types, and blood pressure has the greatest relationship to the possibility of a stroke. Changing an individual’s lifestyle can lower the chances of a stroke, which is an extremely life-threatening situation.

When faced with an actual stroke, remember the FAST test, keep the patient conscious, and call paramedics immediately. In an unfortunate situation where no pulse or breathing is detected in the patient, perform CPR or seek guidance to perform it; time is of the essence. Ensure that the patient is tended to by a medical professional within 24 hours of the onset of symptoms.