Posted On: June 18, 2019
A stroke also known as cerebrovascular accident or CVA is a condition when there is a cut in supply of blood to a section of the brain, causing the brain to stop functioning. This is usually caused by a blockage in a blood vessel leading to the brain. Another situation that could result in a stroke is when there is an accident known as CVA (cerebrovascular accident) leading to a bleed in the brain.
Blood transports oxygen and essential nutrients to the brain. Therefore, a stroke occurs when the brain cells are damaged due to lack of blood and its essential supplies.
Strokes impact people’s lives differently. This depends on the affected area of the brain, the extent of the damage and the medical condition of the affected individual before the stroke. A stroke can impact on various aspects of life of a stroke patient. It could affect the way they talk, their thought processes and even self-esteem and awareness. It could also cause emotional degradation leading to a state of depression and total breakdown.
On some occasions, the symptoms could be mild and temporary, which could signal a mini stroke rather than a major one.
Most of the incidents of a stroke occur when a blood clot blocks the arteries carrying blood to the brain. This usually happens where there is a narrowing of the arteries due to cholesterol build-up, a condition called atherosclerosis. This situation prevents the oxygen-rich blood from being delivered to the brain.
The reason incidents of stroke are common in older people is because, with aging, the arteries and veins get narrower providing lesser room for passage. Individual habits, lifestyle and medical conditions are other factors that can contribute to the impact and extent of a stroke. Lifestyle and habits may include smoking, excessive alcohol consumption, drug abuse and diet.
Persons suffering from high blood pressure or diabetes may have high chances of having a stroke. Other people with high risk of a stroke are those with heart rhythm problems and high level of cholesterol.
Small vessel disease is another cause of stroke. This occurs when the tiny blood vessels within the brain become blocked. It is believed that about 25% of strokes that are blocked vessels related, are caused by small vessel disease.
Arterial dissection occurs when there are tears in the wall of an artery and allows blood to form between the layers of the wall. This could occur as a result of an injury or a symptom of other serious medical conditions.
A stroke is usually diagnosed using brain scanner, either a computer tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Other procedures may be through the patient’s symptoms, family background, medical history, lifestyle check and blood and imaging tests. Mechanical thrombectomy is a quick way to drain the blocked arteries and remove the blood clot. But this depends on the situations like the neurologic examination and severity of stroke in a patient.
Medications available for treating a stroke caused by blood clot may include a clot-bursting medicine known as thrombolysis. The medicines prescribed depend on individual patients and their medical condition. Patients prescribed with certain types of drugs such as warfarin have a low risk of having stroke but are at risk of bleeding complications.
Surgery is sometimes required to remove any blood causing a blockage, lessen the pressure that has built up and repair the blood vessels. This is usually done through a procedure called a craniotomy. It normally involves the surgeons cutting away a small piece of the skull to get to the problem area of the brain.
A mini stroke is a condition known as Transient Ischaemic Attack (TIA). This is a short-term temporary stroke that may last between 12 and 24 hours without any treatments. TIA is caused by a blockage of blood supply to the brain, but the blockage is only temporary. The sufferers would usually recover when the blood clot dissolves on its own and the blood traffic returns to normal.
Other rare occurrence of Transient Ischaemic Attack is a bleeding in the brain called a Haemorrhage. This could be more severe than blood clotting. However, all cases of TIA require immediate medical attention. If they are attended urgently, there are chances the risk of having a stroke will be minimal.
The symptoms may be temporary, but Transient Ischaemic Attack is equally catastrophic, especially for those with other serious conditions. TIA is a sign that something is wrong and the risk of having a stroke later is very high.
About 8.5% of people who experience TIA for the first time may have a stroke within one week of having TIA. Therefore, Transient Ischaemic Attack is always referred to as a warning stroke. So, if you think that someone might be having a stroke, it is good to observe them and be ready to call for emergency.
There are two major types of stroke namely Ischaemic strokes and Haemorrhagic strokes.
Ischaemic strokes occur when there is a blockage in the blood-transporting arteries, cutting blood supply to the brain. This could be caused by blood clot forming on the walls of the arteries, air bubble or fatty deposits and tiny blockages in the brain blood vessels (thrombosis).
The most common cause of blood clots is a heart arrhythmia called atrial fibrillation. This occurs when the heart fails to beat and pump the blood in the normal rhythm. A low and disorganized pressure causes some blood to form on the walls of the atrium. This accumulation is what later becomes an obstruction to the traffic, hence a failed delivery of oxygen to the destination, the brain.
Haemorrhagic strokes happen when a blood vessel bursts and bleeds into the brain. This is usually caused by poorly controlled high blood pressure that weakens the arteries over time. Haemorrhage could be a vessel bursting within the brain causing a bleeding in the brain. It could otherwise be a blood vessel bleeding into the area between the brain and the skull.
Between Ischaemic stroke and Haemorrhagic stroke, cases of strokes are further broken into different categories depending of the nature of the stroke between the two.
This occur when there is a burst in the brain blood vessels causing bleeding inside of the brain. About 11% of all stroke cases are of this type.
The blood that leaks from the burst vessels accumulates and forms clotting underneath the arachnoid membrane that cushions the brain. Some of the symptoms of subarachnoid haemorrhage include sudden severe headache, nausea, vomiting and stiff neck. This may lead to major neurological complications including brain death if not treated urgently. Subarachnoid haemorrhages are very dangerous and about 50% of people who have one will not survive.
Embolic stroke occurs when blood clots or deposits of blood fat and calcium break loose from the wall of the arteries and then travel with bloodstream to the brain. When these blockers get to the brain blood vessels, they again settle on the wall of the tiny brain vessels leading to further blockage. When normal flow is hindered, the brain cells lack the oxygen and glucose needed to function, then a stroke occurs.
This occurs when a blood vessel in the brain bursts and bleeds into the surrounding brain tissue. Blood clots due to cerebral haemorrhage causes irritation and inflammation of the brain tissue. This increases pressure and squeezes the brain against the skull, resulting in further damage and shortage of blood supply to the brain.
Vasculitis is a category of stroke that occurs when the blood vessels become inflamed and cause a decreased blood flow to the brain.
This condition may appear light, but has in some cases, led to a stroke with some sufferers of migraine headache. The case of a stroke caused by a migraine involves narrowing of the blood vessels in the brain. Some episodes of migraine headache may have a stroke-like effect by causing vision impairment, speech impediment and other neurological complications.
On a general note, high blood pressure is the major cause of all strokes. When the pressure is too much for the arteries to bear, they become weakened and more likely to burst. Uncontrolled high blood pressure can weaken the brain blood vessels and can also cause blood clots to form, blocking the normal flow of blood to the brain.
Another condition called Cerebral Amyloid Angiopathy (CAA) also known as congophilic angiopathy occurs when a protein called amyloid builds up in the brain blood vessels. This is a common cause of a haemorrhagic stroke.
Sometimes the walls of arteries may have been stretched over time, making them thin and weak. The weakened location in the blood vessels is known as aneurysm. The vessels have a high risk of bursting at any slight incidence of a high blood pressure.
Some people are born with anomalies in their blood vessels called vascular malformations. Vascular malformations could be of various types depending on the location of the abnormality. There are malformations that affect just the veins called venous malformation (VM) and there are those affecting the lymph vessels known as lymphatic malformations (LM). In some other cases, it could affect both the arteries and the veins. In all cases, people with these anomalies are at risk of having a stroke because a burst or blockage could be easily triggered in the blood vessels.
Anticoagulants are drugs prescribed to patients with blood clotting condition. The main purpose of the drug is to thin the blood and dissolve any potential clots that may want to form. Anticoagulants are commonly taken for a heart condition called atrial fibrillation. Therefore, if this medication is poorly managed, it could cause a haemorrhagic stroke.
Life is rarely the same after someone had suffered a stroke. There is a long list of long-term difficulties that a stroke patient might continue to face after the first instance of a stroke.
The most common is the communication problems. If the stroke has damaged the parts of the brain controlling speech and language, there will be communication problems. Also, if the muscles in the face, tongue and throat are affected, stroke patients might find it difficult or impossible to speak and understand what other people say. It may also affect their reading and writing abilities but in most cases does not affect their intelligence.
If a stroke damages the part of the brain that controls emotions, the resultant effects could be changes in the way people think, feel and behave. There may be feelings of anxiety or fear. They may sweat rapidly with constant heart rate and shortness of breath.
A stroke sufferer could suddenly become a stranger due to personality changes. They may feel constantly angry and frustrated over the changes a stroke has caused to their normal life.
They may also feel fatigued and constantly unwell. Every little activity may result in energy drainage and extreme tiredness. Post-stroke fatigue does not always improve with rest as this is not a typical tiredness.
Depression can occur any time after a stroke. It is believed about half of survivors experience depression in the first year of a stroke. The depression could be mild or severe and may also last for a long time.
The feelings of depression may include loss of interest in things of life or even a suicidal feeling. They may find it hard to focus or make decisions. Changes in appetite and sleeping pattern are common problems. Loss of self-esteem or confidence often make them withdraw from people and tend to keep to themselves.
On many occasions, they may suffer constant aches and pains and be more dependent on pain killers.
Stroke patients experiencing depression may need a psychologist or mind therapist for proper rehabilitation out of depression.
The most common aftermaths of a stroke are physical weakness and paralysis. Stroke always take life away from an arm, a leg or both on one part of the body. The paralysis makes them lose the ability to move or control a part of their body.
After a stroke, muscles can become continuously contracted, stiff and painful, a condition known as spasticity. Spasticity is a common problem following a stroke due to the damage to the voluntary movement control system. Central post-stroke pain, often described as icy burning sensation, may occur months after the stroke. Other painful conditions may include headaches, frozen shoulder and swollen painful hands or feet.
Another physical problem following a stroke is the lack of ability to walk properly. Walking can become more difficult with people feeling unsteady and constant struggle to keep their balance.
A physiotherapy or some other forms of treatment may be successful in helping a stroke patient deal better with post-stroke physical problems.
Following a stroke, a person may not be sensitive to a touch, taste, smell, a hurt or damage to a part of their body. On the other hand, they may experience abnormally increased sensitivity to taste, touch or exceptional sensitivity to pain.
They may also experience sensation to a range of feelings such as tingling, burning, stinging or numbness.
Rehabilitation such as physical therapy, occupational therapy and speech pathology may be needed for a stroke patient to try to take back the control of their life.
Visual problems are quite common following a stroke. Depending on the part of the brain affected by the stroke, some patients’ vision may improve with time while others may not.
Some of the visual problems may include the difficulty in moving the eyes around. This may be due to a breakdown in visual nervous system. Others may include central vision loss, where a person could be partially or wholly blind in one or both eyes.
Other visual problem is a visual field loss, where someone is unable to see properly to the right or left of the field vision center. Another problem could be difficulty in processing visual activities. This is an inability to process a series of events taking place, which sometimes brings about confusion and frustration. Other visual processing problems may include inability to recognize colors, objects or faces.
In all cases, an eye specialist may be required to assess the visual problems and give professional advice or treatment.
Due to the severity of the damage done to the brain neuro system which controls balance, this problem is quite common after a stroke. The person may feel dizzy and unsteady which could lead to a fall or other serious accidents.
A physiotherapist may need to asses a stroke patient to advise on the appropriate therapy or exercise that may help deliver recovery.
More than half of people who have suffered a stroke would have had a problem called incontinence. This is a lost in bladder and/or bowel control. The stroke may have damaged the part of the brain that controls the bladder and the bowel. The ratio of post-stroke sufferers of urinary incontinence is slightly higher than those with bowel incontinence. The treatment received will depend largely on the type and severity of the incontinence.
The most common treatment may include bladder and bowel training where a therapist provides an awareness training on bladder and bowel control. Other forms of treatments are pelvic floor exercise, medication for constipation and weight loss control or dietary changes.
A healthcare professional would usually provide recommendations on appropriate treatment plan specially tailored to individual circumstances.
Swallowing problems known as Dysphagia occur when a stroke damages the nervous system that controls swallowing. Following a stroke, about 40% of sufferers experience some difficulty swallowing certain types of food and fluids.
Some people may recover quickly from this problem while it may take a long time for others. Recovery time depends on the severity of the stroke and the part of the brain damaged by the stroke.
Symptoms of dysphagia may include a feeling that food is stuck in one’s throat, drooling and difficulty in chewing and controlling food in the mouth. Other signs include food coming back up sometimes through the nose. At other times, the person may be coughing incessantly or chocking during and after eating and drinking.
If dysphagia is not treated or attended quickly enough, it could lead to malnutrition and dehydration in a stroke patient. It could also lead to recurrent chest infections and aspiration pneumonia caused by food and fluids damaging the lungs.
Therapies for dysphagia may include food alterations and meal changes. Others may be swallowing techniques or some exercise for chewing and swallowing.
It remains uncertain how long it takes a stroke survivor to recover or how much of a recovery is possible. It all depends on how well individuals take and/or respond to rehabilitation, treatments and therapies. Other factors are people’s other medical conditions, their frame of mind and attitude toward the stroke. Stroke or any medical condition affects everyone differently.
Many stroke survivors experience rapid recovery a few months after the stroke. But other survivors continue to improve over a longer period of time.
A stroke does a major damage to a person’s body and mind. The survivors are left with dealing with the impacts of the damage. But as long as they are still alive, life must go on. This is where rehabilitation plays an important role in helping stroke survivors get back to normal or at least live as independently as possible. Part of the rehab process may involve helping survivors to learn new and interesting things in life to make them happy. They can acquire new skills and learn to adapt to their new way of life, taking each day as it comes. It should also include social, emotional and practical support especially from friends and family members.
If you are a stroke survivor and you are able to read this article, it is perfectly normal to have negative emotions. You may feel angry, desperate and depressed after a stroke. But staying positive will help with your rehabilitation. Constant negative feelings will only stand in the way of progress.
Make the most of the support you could get from the healthcare professionals, your care workers, the social and financial services, as well as from friends and family.
At this point in life, do whatever it takes to make yourself happy. Three things are most important to you right now! Eat, laugh and sleep.
Stroke may strike and damage things. But with positive mental attitude and the determination to fight on, we can strike back and overcome the power of stroke.