Definition

A stroke is a condition where a blood vessel in the brain becomes blocked or bursts. Our brain requires a constant supply of oxygen-rich blood to function properly. When brain tissue doesn't receive oxygen for more than three minutes, brain cells begin to die and can cease to function. Strokes can be divided into several types as explained below.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel in the brain weakens and bursts, causing sudden bleeding from the vessel. The blood from the ruptured vessel can also damage the surrounding brain tissue. Hemorrhagic strokes are the most serious type of stroke, accounting for about 13% of all stroke cases.

In medical terms, hemorrhagic means bleeding. There are two types of hemorrhagic strokes:

• Intracerebral hemorrhage, which occurs due to the rupture of a blood vessel inside the brain.
• Subarachnoid hemorrhage, which occurs when a blood vessel in the tissues around the brain enlarges and then bursts. The blood then enters the space between the brain and the skull, typically caused by high blood pressure in the brain's blood vessels.

Ischemic Stroke

 An ischemic stroke occurs when there is a blockage in a blood vessel that stops the blood flow to the brain. This interrupts the oxygen supply to the brain, causing the brain to stop functioning. The blockage is usually caused by a blood clot or fatty plaque. Ischemic strokes account for about 87% of all stroke cases.

Transient Ischemic Attack (TIA)

TIA, also known as a mini-stroke, has symptoms similar to a stroke, but the blood flow to the brain is only blocked for less than five minutes. Unlike a stroke, TIA does not kill brain cells, so there is no long-term brain damage. However, TIA is considered a warning sign and a serious symptom of stroke.

Approximately one-third of people who experience TIA and do not receive treatment have a stroke within a year. Additionally, about 10-15% of individuals who have had TIA may experience a stroke within three months.

Causes

The causes of stroke depend on the type. Uncontrolled high blood pressure can cause blood vessels in the brain to burst, leading to a hemorrhagic stroke. Other causes include head injury.

Blockages in brain blood vessels, such as fatty plaques or blood clots, can hinder the delivery of oxygen to brain cells, causing an ischemic stroke. These blockages can originate from other areas, such as the heart, and travel through blood vessels to the brain.

Risk factor

Although strokes are more common in older adults, they can occur at any age. Understanding stroke risk factors and recognizing symptoms can help prevent strokes. Risk factors for stroke include:

• Age over 55 years.
• Female gender.
• Smoking habits.
• High blood pressure.
• Previous stroke or mini-stroke.
• Family history of stroke.
• Diabetes mellitus or heart disease.
• High cholesterol levels.
• Sedentary and inactive lifestyle.
• Excessive alcohol consumption.
• Obesity.
• Pregnancy

Symptoms

Stroke symptoms vary in severity and how quickly they are detected. Warning signs and symptoms include:

• Dizziness, nausea, or vomiting.
• Loss of consciousness.
• Severe headache.
• Disorientation, confusion, memory loss.
• Numbness, tingling, and weakness in limbs or face on one side.
• Speech difficulties or slurred speech.
• Difficulty understanding others.
• Reduced vision.
• Impaired balance, coordination, and walking ability.

Diagnosis

Diagnosing a stroke requires a medical interview, physical examination, and diagnostic tests.

Medical Interview

If the patient is conscious and able to respond, the doctor will ask about:

• Main complaints and any accompanying symptoms.
• How long the symptoms have been present.
• Medical history.
• Family medical history.
• Previous treatments.

Physical Examination

The doctor will perform a physical examination, including:

• Initial examination of the patient's general condition, such as consciousness level, blood pressure, respiratory rate, pulse, and body temperature.
• Specific neurological examination of the face and limbs to check for weakness and balance disorders.
• Sensory response examination to check if sensory functions are intact.

Supporting Examination

Diagnostic tests that can be performed include:

• CT Scan: A radiological examination to detect blockages and the type of stroke. This is the standard method for diagnosing strokes.
• MRI Scan: An advanced examination method that can detect old or new blockages but is only available at certain healthcare facilities.
• Complete blood lab tests: To detect any underlying conditions contributing to the symptoms.
• Electrocardiogram (ECG): A heart record test to detect heart rhythm disorders and blockages, especially if an ischemic stroke is suspected.
• Doppler Ultrasound: Can be performed on patients with symptoms indicating blockage in the middle or front brain arteries.

Management

Stroke management aims to quickly restore oxygen delivery and blood flow to brain vessels, hoping to return brain function to normal. Treatment depends on the type of stroke and the severity of symptoms. Treatment options also depend on the patient's condition, so patients are generally observed under the care of a neurologist. The following are treatments for stroke.

Hemorrhagic Stroke

Treatment focuses on reducing high blood pressure, controlling bleeding, and preventing further brain damage. Blood pressure is gradually lowered with antihypertensive drugs and blood clotting factors if needed. Patients also receive fluids to replace those lost due to bleeding. In addition to medication, doctors may perform surgery to reduce pressure in the brain.

Ischemic Stroke

Treatment focuses on saving brain tissue deprived of blood due to blockage. Doctors may prescribe anticoagulants or rTPA (recombinant tissue plasminogen activator) as blood thinners. This therapy aims to dissolve blood clots blocking brain vessels. Patients with high cholesterol may also receive statins to lower cholesterol levels.

TIA

In some cases, TIA resolves within 24 hours. However, risk factors need to be controlled to prevent future strokes.

Doctors usually recommend physiotherapy and rehabilitation training to help patients regain body function and muscle strength lost during the stroke.

Complications

Stroke complications can include:

• Sleep disorders.
• Depression.
• Urinary incontinence (loss of bladder control).
• Swallowing disorders.
• Lung infection.
• Malnutrition.
• Urinary tract infection.
• Muscle mass loss.
• Pressure ulcers (skin wounds from prolonged immobility).

Prevention

Stroke can be prevented by knowing its risk factors and taking the following steps:

• Controlling blood pressure to normal ranges.
• Doing light exercise five times a week for at least 30 minutes each session.
• Quitting smoking and avoiding smoke exposure.
• Avoiding alcohol consumption.
• Controlling cholesterol levels.
• Eating a balanced diet with plenty of fruits and vegetables and reducing salt.
• Maintaining an ideal weight.
• Controlling blood sugar levels.
• Reading educational materials about stroke for general knowledge.

When to see a doctor?

Anyone experiencing a decrease in consciousness, speech difficulties, and limb weakness should be taken to an emergency facility immediately. Stroke treatment depends on how long symptoms have been present. The sooner a stroke is diagnosed, the better the treatment outcome.

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