Stroke Clinic

Overview

A stroke is a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost. How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged.

For example, someone who had a small stroke may only have minor problems such as temporary weakness of an arm or leg. People who have larger strokes may be permanently paralyzed on one side of their body or lose their ability to speak. Some people recover completely from strokes, but generally more than 2/3 of survivors will have some type of disability.

Different Forms of Strokes:

Ischemic stroke

Ischemic stroke is the most common form of stroke, accounting for around 85% of strokes. This type of stroke is caused by blockages or narrowing of the arteries that provide blood to the brain, resulting in ischemia – severely reduced blood flow.

These blockages are often caused by blood clots, which can form either in the arteries connecting to the brain, or in other blood vessels before being swept through the bloodstream and into narrower arteries within the brain. Clots can be caused by fatty deposits within the arteries called plaque. Hypertension can lead to rupturing of blood vessels and hemorrhagic stroke.

Hemorrhagic stroke

Hemorrhagic stroke are caused by arteries in the brain either leaking blood or bursting open. The leaked blood puts pressure on brain cells and damages them. Blood vessels can burst or spill blood in the middle of the brain or near the surface of the brain, sending blood into the space between the brain and the skull. The ruptures can be caused by conditions such as hypertension, , trauma, blood-thinning medications and aneurysms (weaknesses in blood vessel walls).

Intracerebral hemorrhage is the most common type of hemorrhagic stroke and occurs when brain tissue is flooded with blood after an artery in the brain bursts.
Subarachnoid hemorrhage is the second type of hemorrhagic stroke and is less common. In this type of stroke, bleeding occurs in the subarachnoid space – the area between the brain and the thin tissues that cover it.

Transient ischemic attack (TIA)

Transient ischemic attacks are different from the aforementioned kinds of stroke because the flow of blood to the brain is only briefly interrupted. These are similar to ischemic strokes in that they are often caused by blood clots or other debris.

TIAs should be regarded as medical emergencies just like the other kinds of stroke, even if the blockage of the artery is temporary. They serve as warning signs for future strokes and indicate that there is a partially blocked artery or clot source in the heart.

Symptoms

Symptoms of stroke often appear suddenly without warning. The main symptoms of stroke are as follows:

Confusion, including trouble with speaking and understanding
Headache, possibly with altered consciousness or vomiting
Numbness of the face, arm or leg, particularly on one side of the body
Trouble with seeing, in one or both eyes
Trouble with walking, including dizziness and lack of co-ordination.

Depending on how quickly it is diagnosed and treated, the patient can experience temporary or permanent disabilities in the aftermath of a stroke.

In addition to the persistence of the problems listed above, patients may also experience the following:

Bladder or bowel control problems
Depression
Pain in the hands and feet that gets worse with movement and temperature changes
Paralysis or weakness on one or both sides of the body
Trouble controlling or expressing emotions.

Diagnosis

Strokes happen fast and will often occur before an individual can be seen by a doctor for a proper diagnosis.

F.A.S.T. is a way to remember the signs of stroke, and can help identify the onset of stroke more quickly:

Face drooping: if the person tries to smile does one side of the face droops
Arm weakness: if the person tries to raise both their arms does one arm drift downwards
Speech difficulty: if the person tries to repeat a simple phrase is their speech slurred or strange
Time to call: if any of these signs are observed, contact the emergency services.

The faster a person with suspected stroke receives medical attention, the better their prognosis and the less likely they will be to experience lasting damage or death. In order for a stroke patient to get the best diagnosis and treatment possible, they will need to be treated at a hospital within 3 hours of their symptoms first appearing.

There are several different types of diagnostic tests that doctors can use in order to determine which type of stroke has occurred:

Physical examination: a doctor will ask about the patient’s symptoms and medical history. They may check blood pressure, listen to the carotid arteries in the neck and examine the blood vessels at the back of the eyes, all to check for indications of clotting.
Blood tests: a doctor may perform blood tests in order to find out how quickly the patient’s blood clots, the levels of particular substances (including clotting factors) in the blood, and whether or not the patient has an infection.
CT scan: a series of X-rays that can show hemorrhages, strokes, tumors and other conditions within the brain.
MRI scan: radio waves and magnets create an image of the brain to detect damaged brain tissue
Carotid ultrasound: an ultrasound scan to check the blood flow of the carotid arteries and to see if there is any plaque present.
Cerebral angiogram: dyes are injected into the brain’s blood vessels to make them visible under X-ray, in order to give a detailed view of the brain and neck arteries.
Echocardiogram: a detailed image of the heart is created to check for any sources of clots that could have traveled to the brain to cause a stroke.