Research Assessment #2

Date: October 13, 2017

Subject: Cardiac Surgery
MLA or APA Citation: McIntosh, James. “Stroke: Causes, Symptoms, Diagnosis, and
Treatment.” Medical News Today, MediLexicon International, 17 July 2017,
www.medicalnewstoday.com/articles/7624.php.
<https://www.medicalnewstoday.com/articles/7624.php>

Analysis:

The heart is a vital component of our body. It keeps our body alive and
breathing. However, if it gets inflicted by damage, the entire individual’s chance at
living reduces. There are various disorders that cause a heart to stop functioning, but all
would lead to some drastic effect on the entire body. Thus, I decided to investigate a
common heart disorder that drastically impacts our heart, but also correlates with brain.
Thus, I chose to research Stroke because it’s common cardiovascular disorder that
affects many individuals and because it corresponds to the neurosurgery, which I
studied during my ISM 1 journey.
Stroke occurs when the supply of blood to the brain is either interrupted or
reduced. When this happens, the brain does not get enough oxygen or nutrients, which
causes brain cells to die. There are three main kinds of stroke; ischemic, hemorrhagic,
and TIA. All three are caused by different reasons, however, the ending result is always
the same across all three types. Ischemic stroke is the most common form, accounting
for around 85 percent of strokes. It’s caused by blockages or narrowing of the arteries
that provide blood to the brain, resulting in ischemia, which is severely reduced blood
flow that damages brain cells. On the other hand, Hemorrhagic strokes are caused by
arteries in the brain either leaking blood or bursting open. The leaked blood puts
pressure on brain cells and damages them. It also reduces the blood supply reaching the
brain tissue after the hemorrhage point. 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 an artery in the
subarachnoid space. Lastly, TIAs are similar to ischemic strokes in that they are often
caused by blood clots or other clots, but they serve as warning signs for future strokes
and indicate that there is a partially blocked artery or clot source in the heart. Stroke is a
severe disorder that greatly damages the brain, heart, and overall body, but
understanding the three types can help further reduce emergency situations involving
this stroke.
Due to the intense damage Stroke causes, the signs and symptoms associated
with it are severe and quite impactful. Since strokes occurs quickly, symptoms appear
suddenly. Some of the major signs and symptoms are: confusion, headache, numbness
or inability to move parts of the face, arm, or leg, trouble seeing, and trouble walking.
Furthermore, Stroke may lead to long-term problems such as: 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, and
trouble controlling or expressing emotions. The signs and long-term problems are
essentially extremely harmful to the body, thus, it’s important for an individual to know
when a person has so that person will receive medical attention immediately.
Specifically, if an individual has a drooping face, weakness in the arms, or difficulty
speaking, then someone should call 911. All in all, as described, having stroke is
essentially very harmful, thus, the most important thing is to treat it through various
remedies.
Before treatment of Stroke, diagnosis is crucial in determining what treatment is
the best option. Ischemic strokes and hemorrhagic strokes require different kinds of
treatment, thus diagnosis determine what stroke has happened and what. There are
several different types of diagnostic tests that doctors can use to determine which type
of stroke has occurred. Some various types are physical examination, blood tests, CT
scan, MRI scan, Carotid ultrasound, Cerebral angiogram, and Echocardiogram. These
various diagnostic tests determine what type of stroke an individual has, thus
determining what treatment is necessary for the person exhibiting stroke. As the
ischemic and hemorrhagic strokes are caused by different factors, both require different
forms of treatment. It is not only important that the type of stroke is diagnosed quickly
to reduce the damage done to the brain, but also because treatment suitable for one
kind of stroke can be harmful to someone who has had a different kind. Ischemic
strokes are caused by arteries being blocked or narrowed, and so treatment focuses on
restoring an adequate flow of blood to the brain. Treatment can begin with drugs to
break down clots and prevent others from forming. Emergency procedures include
administering TPA directly into an artery in the brain or using a catheter to physically
remove the clot. Recent studies have questioned the effectiveness of these methods, and
so research is still ongoing as to how beneficial these procedures are. Hemorrhagic
strokes are caused by bleeding into the brain, so treatment focuses on controlling the
bleeding and reducing the pressure on the brain. Since Strokes are life-changing events
that can affect a person both physically and emotionally, temporarily or permanently,
treatment is an important step in reaching reductions of Stroke from the body, however,
to ensure successful recovery, a person must attend rehab. Regarding Rehab, some
types of therapy associated with Stroke are: speech/physical/occupational therapy,
joining a group, support, and support from family and friends. Stroke is life-threatening
disorder, but through diagnosis, treatment, and Rehab to ensure successful recovery, a
person can be saved. However, as in all cases, the best way to not have a disorder is
through prevention.
In conclusion, I learned about a very severe heart disorder that not only
drastically impacts the vital heart and brain, but also the entire body. I learned about
the intense signs and symptoms of an individual with this disorder. Furthermore, I
learned about the medication treatments and the ways to ensure an individual can
prevent this disorder but also not obtain another drastic disorder. This information is
essentially relevant to me because I learned about a a disorder concerning the career I’m
going into, thus I was able to obtain more knowledge about various diseases of the
heart. A Cardiac Surgeon should continuously learn, thus, due to this, I think I gained a
better understanding of what kinds of aspects they have to learn and investigate in
order to ensure the best treatment. This is important in my ISM experience and topic
learning because it enables me to get a better insight on the type of learning Cardiac
Surgeons(general surgeons) constantly research. I actually found this entire study very
interesting because it consists of a heart disorder that can affect the overall functioning
of the body. Overall, all of this knowledge will help me in my ISM experience because it
provides in depth information on diseases of the medical field and particularly on the
aspects Cardiac Surgeons have to constantly learn about.
Stroke: Causes, symptoms, diagnosis, and treatment

Last updated Mon 17 July 2017

By James McIntosh

Reviewed by Nancy Choi, MD

Strokes occur due to problems with the blood supply to the brain: either the blood supply is
blocked, or a blood vessel within the brain ruptures, causing brain tissue to die. A stroke is a Commented [1]: General cause of stroke
medical emergency, and treatment must be sought as quickly as possible.
Stroke is the 5th leading cause of death in the United States, with one person dying every 4
minutes as a result. For black people, stroke is the 3rd leading cause of death. Commented [2]: A reason as to why Stroke is very
impactful in our world

Approximately 800,000 people have a stroke each year; about one every 40 seconds. Only
heart disease, cancer, chronic lower respiratory diseases, and accidents are more deadly.

There are three main kinds of stroke:

● Ischemic strokes
● Hemorrhagic strokes
● Transient ischemic attacks (TIAs), also referred to as mini-strokes
In this article, we will explain why these types of stroke occur, and how they are treated and
diagnosed.

Contents of this article:

1. What is stroke?
2. Causes
3. Symptoms
4. Diagnosis
5. Treatment
6. Rehabilitation
7. Prevention
Fast facts on stroke:
 ● During a stroke, the brain does not receive enough oxygen or nutrients, causing brain
cells to die.
● Ischemic strokes are caused by a narrowing or blocking of arteries to the brain.
● Hemorrhagic strokes are caused by blood vessels in and around the brain bursting or
leaking.
● Strokes need to be diagnosed and treated as quickly as possible to minimize brain
damage.
● Treatment depends on the type of stroke.
● The most effective way to prevent strokes is through maintaining a healthy lifestyle
and treating underlying conditions that are a risk factor.

What is stroke?

Stroke occurs when the supply of blood to the brain is either interrupted or reduced. When this
happens, the brain does not get enough oxygen or nutrients, which causes brain cells to die. Commented [3]: Stroke occurs because supply of
blood to the brain is interrupted/reduced
-brain does not get enough oxygen or nutrients
There are three main kinds of stroke; ischemic, hemorrhagic, and TIA. This article will focus on --causes brain cells to die

ischemic and hemorrhagic strokes, as there is a separate Knowledge Center article for TIAs,
which goes into specific detail about them.

In the U.S., approximately 40 percent of stroke deaths are in males, with 60 percent in females. Commented [4]: Male to Female ratio of Stroke deaths
According to the American Heart Association (AHA), compared with white people, black people
have nearly twice the risk of a first-ever stroke and a much higher death rate from stroke.

In 2009, stroke was listed as the underlying cause of death in 128,842 persons in the U.S.,
resulting in an age-adjusted rate of 38.9 deaths per 100,000 population. The rate was almost
twice as high among non-Hispanic blacks (73.6 per 100,000), and the rate of premature death
from stroke was also higher among non-Hispanic blacks than their white counterparts (25.0
versus 10.2).

Stroke is more likely to affect people if they are overweight, aged 55 or older, have a personal or
family history of stroke, do not exercise much, drink heavily, smoke, or use illicit drugs.
What causes stroke?

The different forms of stroke have different specific causes.

Causes of ischemic stroke

Ischemic stroke is the most common form, accounting for around 85 percent 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 that damages brain cells.

These blockages are often caused by blood clots, which can form either in the arteries within
the brain, or in other blood vessels in the body before being swept through the bloodstream and
into narrower arteries within the brain. Fatty deposits within the arteries called plaque can cause
clots that result in ischemia.

Causes of hemorrhagic stroke

Hemorrhagic strokes are caused by arteries in the brain either leaking blood or bursting open.
The leaked blood puts pressure on brain cells and damages them. It also reduces the blood
supply reaching the brain tissue after the hemorrhage point. Blood vessels can burst and spill
blood within 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 an artery in the subarachnoid space - the area between the brain and the thin tissues
that cover it.
Causes of transient ischemic attack (TIA)

TIAs are different from the kinds above because the flow of blood to the brain is only briefly
interrupted. TIAs are similar to ischemic strokes in that they are often caused by blood clots or
other clots.

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

According to the Centers for Disease Control and Prevention (CDC), over a third of people who
experience a TIA go on to have a major stroke within a year if they have not received any
treatment. Between 10-15 percent will have a major stroke within 3 months of a TIA.

Symptoms of stroke

Strokes occur quickly, so symptoms often appear suddenly and without warning.

The main symptoms of stroke are:

● Confusion - including trouble with speaking and understanding.

● Headache - possibly with altered consciousness or vomiting.
● Numbness or inability to move parts of the face, arm, or leg - particularly on one side of
the body.
● Trouble seeing - in one or both eyes.
● Trouble walking - including dizziness and lack of coordination. Commented [5]: Main Symptoms
-confusion
Strokes can lead to long-term problems. Depending on how quickly it is diagnosed and treated, -headache
-can't move a body part
the patient can experience temporary or permanent disabilities in the aftermath of a stroke. In -trouble with sight
addition to the persistence of the problems listed above, patients may also experience the -trouble moving around

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 Commented [6]: potential long-term problems that
Stroke can put over certain patients that are
Symptoms vary among patients and may range in severity. experiencing high, extreme symptoms

The acronym 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 droop?
● Arm weakness - if the person tries to raise both their arms does one arm drift
downward?
● Speech difficulty - if the person tries to repeat a simple phrase is their speech slurred or
strange?
● Time to call 911 - if any of these signs are observed, contact the emergency services. Commented [7]: To determine when to call 911
-drooping face
The faster a person with suspected stroke receives medical attention, the better their prognosis -weak arms
-difficulty speaking
and the less likely they will be to experience lasting damage or death.

How is a stroke diagnosed?

Signs of a stroke require immediate medical attention.

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

For a stroke patient to get the best diagnosis and treatment possible, they should be treated at a
hospital within 3 hours of their symptoms first appearing.

Ischemic strokes and hemorrhagic strokes require different kinds of treatment.

Unfortunately, it is only possible to be sure of what type of stroke someone has had by giving
them a brain scan in a hospital environment.
There are several different types of diagnostic tests that doctors can use 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 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 in 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, to give a detailed view of the brain and neck blood vessels.
● 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. Commented [8]: The common types of diagnostic
tests utilized to find out what type of Stroke an
individual has

Treatments for stroke

As the ischemic and hemorrhagic strokes are caused by different factors, both require different
forms of treatment. It is not only important that the type of stroke is diagnosed quickly to reduce
the damage done to the brain, but also because treatment suitable for one kind of stroke can be
harmful to someone who has had a different kind.

How is ischemic stroke treated?

Ischemic strokes are caused by arteries being blocked or narrowed, and so treatment focuses
on restoring an adequate flow of blood to the brain.
Treatment can begin with drugs to break down clots and prevent others from forming. Aspirin
can be given, as can an injection of a tissue plasminogen activator (TPA). TPA is very effective
at dissolving clots but needs to be injected within 4.5 hours of stroke symptoms starting.

Emergency procedures include administering TPA directly into an artery in the brain or using a
catheter to physically remove the clot. Recent studies have questioned the effectiveness of
these methods, and so research is still ongoing as to how beneficial these procedures are.

There are other procedures that can be carried out to decrease the risk of strokes or TIAs. A
carotid endarterectomy involves a surgeon opening the carotid artery and removing any plaque
that might be blocking it.

Alternatively, an angioplasty involves a surgeon inflating a small balloon in a narrowed artery via
catheter and then inserting a stent (a mesh tube) into the opening to prevent the artery from
narrowing again. Commented [9]: Ischemic Stroke treatment is focused
on restoring an adequate flow of blood to the brain
-Aspirin
-TPA
-Carotid Endarterectomy
How is hemorrhagic stroke treated? Angioplasty

Hemorrhagic strokes are caused by bleeding into the brain, so treatment focuses on controlling
the bleeding and reducing the pressure on the brain.

Treatment can begin with drugs given to reduce the pressure in the brain, control overall blood
pressure, prevent seizures and prevent sudden constrictions of blood vessels. If the patient is
taking blood-thinning anti-coagulants or an anti-platelet medication like Warfarin or Clopidogrel,
they can be given drugs to counter the medication's effects or blood transfusions to make up for
blood loss.

Surgery can be used to repair any problems with blood vessels that have led or could lead to
hemorrhagic strokes. Surgeons can place small clamps at the base of aneurysms or fill them
with detachable coils to stop blood flow and prevent rupture.

If the hemorrhage was caused by arteriovenous malformations (AVMs), surgery can also be
used to remove small them if they are not too big and not too deep within the brain. AVMs are
tangled connections between arteries and veins that are weaker and burst more easily than
other normal blood vessels. Commented [10]: Hemorrhagic Strokes treatment
focuses on controlling the bleeding and reducing the
pressure on the brain
-drugs
-surgery
Rehabilitation

Strokes are life-changing events that can affect a person both physically and emotionally,
temporarily or permanently. After a stroke, successful recovery will often involve specific
rehabilitative activities such as:

Speech therapy - to help with problems producing or understanding speech. Practice,

relaxation, and changing communication style, using gestures or different tones for example, all
help.

Physical therapy - to help a person relearn movement and co-ordination. It is important to get
out and about, even if it is difficult at first.

Occupational therapy - to help a person to improve their ability to carry out routine daily
activities, such as bathing, cooking, dressing, eating, reading, and writing.

Joining a support group - to help with common mental health problems such as depression that
can occur after a stroke. Many find it useful to share common experiences and exchange
information.

Support from friends and family - to provide practical support and comfort. Letting friends and
family know what can be done to help is very important.

Rehabilitation is an important and long part of treatment. With the right help, rehabilitation to a
normal quality of life is possible, depending on the severity of the stroke.

Preventing a stroke

The best way to prevent a stroke is to address the underlying causes. This is best done by living
healthfully, which means:

● Eating a healthy diet.

● Maintaining a healthy weight.
● Exercise regularly.
 ● Don't smoke.
● Avoiding alcohol or drink moderately. Commented [11]: Basic remedies to not obtain any
disorder or disease
Eating a healthful diet means plenty of fruits, vegetables, and healthy whole grains, nuts, seeds,
and legumes; eating little or no red or processed meat; limiting intake of cholesterol and
saturated fat (typically found in foods of animal origin); and minimizing salt intake so as to
support healthy blood pressure.

Other measures taken to help reduce the risk of stroke include:

● Keeping blood pressure under control.

● Managing diabetes.
● Treating obstructive sleep apnea (if present).
As well as these lifestyle changes, a doctor can help to reduce the risk of future ischemic
strokes through prescribing anti-coagulant and/or anti-platelet medication. In addition to this, the
arterial surgery previously mentioned can also be used to lower the risk of repeat strokes, as
well as some other surgical options still being studied.