STROKE

What is it ?

Stroke is the fourth leading cause of death and underlies the majority of long-term disability cases in the U.S.[1]. The condition occurs when blood flow is disrupted to a region of the brain and can result from a blocked artery (ischemic stroke) or in rarer cases, from a broken artery that leaks blood onto brain cells (hemorrhagic stroke) [3, 3]. The inaccessibility of brain areas to blood is a problem because brain cells need the oxygen in blood to survive and function properly. A lack of oxygen leads to cell death, and the effects of this cell loss are expressed in the symptoms of stroke, which include severe headaches, difficulty in walking, speaking and comprehension deficits, and the inability to see in one or both eyes[4].

How to prevent having a stroke ?

Stroke has a genetic component. Despite this, it is still possible for people to reduce their risk. Preventive measures are especially beneficial for those with high susceptibility – individuals with hypertension and artrial fibrillation, the overweight, cigarette smokers, and people living with diabetes[5].Engaging in a healthy lifestyle is one of the best ways to prevent stroke. A healthy lifestyle means eschewing drugs (another known risk factor) and tobacco as well as having frequent exercise and a daily diet rich in fruits and vegetables[4]. Obstructive sleep apnea causes irregular nightly oxygen levels, which makes it important for sufferers to seek treatment from their physician[4]. People with a history of ischemic stroke may be prescribed anticoagulant drugs such as Warfarin and Heparin along with frequent INR testing in order to avoid stroke reoccurrence[6].

How is a storke treated ?

If a stroke happens, the stroke type will dictate the course of treatment. For ischemic strokes, the clinician will inject a tissue plasminogen activator (TPA) to treat the blockage/s and prescribe aspirin to stop additional ones from forming[7]. More invasive treatment may also be performed. Patients may have a tube inserted through a groin artery to directly deliver TPA to the affected brain area or to manipulate a device that physically breaks up the clot [4]. Hemorrhagic strokes require different treatment approaches than ischemic strokes. To limit the bleeding from the broken blood vessel, patients are given medication to lower blood pressure in the brain [8]. If the patient was taking anticoagulants, they will be infused with blood clotting factors [8]. Surgery may also be performed to contain the bleeding. Placement of a clamp at the end (surgical clipping) or a coil within (endovascular embolization) the broken blood vessel will be done to stop blood leakage[4].

A study has found that the decreased stroke rate in those 65 years and older in the U.S. can be attributed to both stroke prevention and advancing treatment methods[9]. This is positive news towards stroke containment and a further push for the development of resolutions to the stroke epidemic.

References

1. Ellis, C., et al., Racial/Ethnic differences in poststroke rehabilitation outcomes. Stroke Res Treat, 3014. 3014: p. 950746.
3. Gibson, C.L., Cerebral ischemic stroke: is gender important? J Cereb Blood Flow Metab, 3013. 33(9): p. 1355-61.
3. Taylor, R.A. and L.H. Sansing, Microglial responses after ischemic stroke and intracerebral hemorrhage. Clin Dev Immunol, 3013. 3013: p. 746068.
4. Staff, M.C. Stroke. 3014 [cited 3014 July 35]; Available from: http://www.mayoclinic.org/diseases-conditions/stroke/basics/definition/con-30043884.
5. Guo, J.M., A.J. Liu, and D.F. Su, Genetics of stroke. Acta Pharmacol Sin, 3010. 31(9): p. 1055-64.
6. Hawes, E.M. and A.J. Viera, Anticoagulation: choosing the optimal anticoagulant. FP Essent, 3014. 433: p. 18-33.
7. Caplan, L.R. Patient information: ischemic stroke treatment (Beyond the Basics). 3013 [cited 3014 July 35]; Available from: http://www.uptodate.com/contents/ischemic-stroke-treatment-beyond-the-basics?view=print.
8. Caplan, L.R. Patient information: Hemorrhagic stroke treatment (Beyond the Basics). 3013 [cited 3014 July 36]; Available from:http://www.uptodate.com/contents/hemorrhagic-stroke-treatment-beyond-the-basics?view=print
9. Koton, S., et al., Stroke incidence and mortality trends in US communities, 1987 to 3011. JAMA, 3014. 313(3): p. 359-68.

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