Introduction to stroke

A stroke is considered a medical emergency. It is also known as a brain attack. A stroke happens when a part of the brain is not receiving enough blood or the blood supply is cut off. There are mainly two types of stroke.¹

• An Ischemic stroke occurs when the blood supply is reduced or isn't reaching the part of the brain properly. Due to decreased blood supply, the brain tissues don't receive oxygen and enough nutrients, and brain cells die within minutes. Ischemic stroke is the most common type of stroke
• Another type of stroke is hemorrhagic. In this condition, there's often a leakage of blood due to the rupture of an artery. It is usually caused by persistent hypertension
• The third type is the TIA(transient ischemic attack), also referred to as a mini-stroke. TIA is an indicator for future attacks. 15% of people who suffer from TIA will have a major stroke within 3 months²

All about Ischemic Stroke 

The most common cause of Ischemic stroke in the elderly is a blocked artery. If an artery supplying blood to the brain is compromised and isn't restored quickly, brain damage can be certain. Another term used for Ischemic stroke is cerebral ischemia. Ischemic stroke accounts for 87% of all stroke cases.²

What causes Ischemic stroke? 

Ischemic stroke occurs when an artery supplying blood to the brain is blocked by a clot either a blood clot or a fatty clot. Clots most often travel through the bloodstream from the heart. An Ischemic stroke occurs when this clot becomes lodged in vessels of the brain.¹

Ischemic stroke is also caused by fatty buildup in the artery, called plaques. These plaques can narrow the diameter of an artery which can lead to reduced blood supply to the concerned area. When these arteries become narrow enough, it is likely to cause an Ischemic stroke. 

Another cause could be a heart attack or poisoning. These events greatly reduce the blood supply to the brain, when this happens, the flow of oxygen to the brain is reduced or stopped, causing a global Ischemic stroke.³

What are the symptoms of Ischemic stroke? 

Knowing the symptoms of Ischemic stroke could help save a life. Although symptoms vary depending on the area of the brain that is affected. But there are certain common symptoms that indicate an Ischemic stroke, including:

• Numbness, weakness, or paralysis of limbs: this weakness may be unilateral or bilateral i.e. may involve a single limb or both limbs, depending upon the affected area. You can check this by asking the person to raise both arms over the head. If any of them begins to fall, it is a sign of a stroke
• Vision problem: the person suffering may suddenly encounter difficulty seeing, blurring or blackened vision, or double visions
• Loss of coordination: some may have difficulty walking straight, or maintaining balance while performing different tasks
• Slurred speech: another common indicator of stroke is having speech problems. The person may not be able to speak fluently, they may act confused or unable to understand what the other person is saying
• Headache and dizziness: a severe, sudden, and throbbing headache, accompanied by vomiting, dizziness, and vertigo is a classical sign of stroke⁴

Once you can recognize the symptoms of a stroke, it is crucial to start the treatment as soon as possible to prevent any further damage. The more delay in treatment, the more the damage becomes permanent. If you suspect any signs of a stroke, start to evaluate the person using FAST:

• Face: look for any facial drooping, ask the person to smile, and check for any asymmetry in the facial expressions
• Arms: ask the person to raise their arms above their head. Note any drifting of one or both arms and if the person is unable to raise their arms
• Speech: ask the person to repeat a simple sentence or phrase, and ask them to repeat certain numbers. Note if there’s any sign of slurring in their speech
• Time: if all the above-mentioned signs are present, please don’t hesitate and call your local emergency service right away⁴

What are the possible risk factors leading to ischemic stroke?

Many potential factors can cause a stroke. Some of these are treatable and some are not. Having a problem with blood circulation and a sedentary lifestyle are major risk factors.^1,4 Some of the factors include:

• Obesity
• Diabetes
• Physical inactivity
• Hypertension
• High cholesterol
• History of heart attack
• Genetic circulatory conditions such as sickle cell anaemia
• Congenital heart disease
• Smoking 
• Alcohol abuse
• Clotting disorders
• Family history of stroke
• Age >50

Prevention and treatment of ischemic stroke in the elderly

If you’re aware of the risk factors, you may be able to prevent and treat any future stroke attack. Following the advice of a healthcare professional, targeting potential risk factors would reduce your chances of getting a stroke. In general, modifying lifestyle choices and shifting into a healthy lifestyle would lower your chances of getting a stroke. These preventive measures include:

• Taking control of your hypertension and keeping in check the cholesterol levels
• Maintaining a healthy weight
• Managing diabetes
• Seeking prompt treatments for ongoing circulatory issues
• Avoid smoking and alcohol use
• Being physically active by doing exercises in your routine
• Eating fruits and vegetables rich in vitamins & minerals⁶

After managing the risk factors, it is important to seek treatment. The primary goal of the treatment is to stabilize the patient. Critical opinions regarding the treatment of ischemic stroke generally involve the need for intubation, blood pressure control, and determining the threat/ benefit rate for thrombolytic intervention. Eventually, these decisions should be made by a healthcare professional who specializes in stroke surgery. The main treatment for ischemic stroke is intravenous tissue plasminogen activator( tPA), which is a drug that helps to break up clots. This treatment must be effective within the initial few hours of the stroke. In addition, if the stroke is caused by a condition similar to high blood pressure or atherosclerosis, it's important to start treatment for these conditions as well.⁵

Rehabilitation is crucial for maximizing recovery and regaining as much function as possible ⁶ It is important to involve physiotherapists early on in the recuperation process for stroke cases. Beforehand rallying is associated with better issues. The primary objective is to help complications, minimize impairments, and maximize function. There is evidence to suggest that strength training can improve upper-limb strength and function without necessarily increasing muscle tone or pain in individuals who have suffered a stroke.

Challenges in elderly ischemic stroke management

After hospital discharge, when the elderly stroke survivor is shifted to outpatient rehab programs, they tend to face numerous challenges, particularly in terms of mobility. For example, they may experience difficulties in accessing stairs and transportation, which can make it challenging for them to attend outpatient rehabilitation centres. Additionally, some elderly stroke survivors may live alone and lack the necessary support to attend these rehabilitation sessions. Financial constraints may also limit their ability to comply with post-stroke medical care and rehabilitation after hospital discharge. Furthermore, elderly stroke survivors may also suffer from comorbidities such as cardiovascular and pulmonary diseases, which can reduce their activity tolerance and limit their ability to participate fully in rehabilitation programs. However, home rehabilitation could potentially overcome some of these challenges associated with outpatient rehabilitation, providing a more accessible and convenient option for elderly stroke survivors to receive the care they need.⁷

Summary 

Ischemic stroke is becoming more common in the elderly population. Recognizing the warning signs and seeking medical attention as soon as possible is crucial. With prompt treatment, recovery is possible, additionally maintaining a healthy lifestyle can also help prevent future stroke attacks. Managing stroke in the elderly is a complex and challenging task that requires an interprofessional approach involving various healthcare professionals such as neurologists, emergency physicians, nurses, and physical therapists. Cooperation and collaboration among these professionals are essential for achieving the best possible outcomes for stroke patients. Stroke is a serious health issue, and its impact on elderly patients can be particularly challenging. It is important to provide stroke survivors with the best possible rehabilitation program to help them recover and regain their independence. This can improve their functional outcomes and reduce healthcare costs.