What is a stroke?

Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. Blood flow can be compromised by a variety of mechanisms. Blockage of an artery

Narrowing of the small arteries within the brain can cause a lacunar stroke, (lacune means "empty space"). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct). Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that supply the brain with blood. The anterior circulation of the brain that controls most motor activity, sensation, thought, speech, and emotion is supplied by the carotid arteries. The posterior circulation, which supplies the brainstem and the cerebellum, controlling the automatic parts of brain function and coordination, is supplied by the vertebrobasilar arteries.

(If these arteries become narrow as a result of atherosclerosis, plaque or cholesterol, debris can break off and float downstream, clogging the blood supply to a part of the brain. As opposed to lacunar strokes, larger parts of the brain can lose blood supply, and this may produce more symptoms than a lacunar stroke.)

Embolism to the brain from the heart. In some instances blood clots can form within the heart and the potential exists for them to break off and travel (embolize) to the arteries in the brain and cause a stroke.

Rupture of an artery (hemorrhage) Cerebral hemorrhage (bleeding within the brain substance). The most common reason to have bleeding within the brain is uncontrolled high blood pressure. Other situations include aneurysms that leak or rupture or arteriovenous malformations (AVM) in which there is an abnormal collection of blood vessels that are fragile and can bleed.

What are the risk factors for stroke?

Overall, the most common risk factors for stroke are:

high blood pressure, high cholesterol, smoking, diabetes and increasing age.

Heart rhythm disturbances like atrial fibrillation, patent foramen ovale, and heart valve disease can also be the cause. When strokes occur in younger individuals (less than 50 years old), less common risk factors to be considered include illicit drugs, such as cocaine or amphetamines, ruptured aneurysms, and inherited (genetic) predispositions to abnormal blood clotting.

What are stroke symptoms?

When brain cells are deprived of oxygen, they cease to perform their usual tasks. The symptoms that follow a stroke depend on the area of the brain that has been affected and the amount of brain tissue damage. Small strokes may not cause any symptoms, but can still damage brain tissue. These strokes that do not cause symptoms are referred to as silent strokes. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), these are the five major signs of stroke: 1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may be an associated tingling sensation in the affected area. 2. Sudden confusion or trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling. 3. Sudden trouble seeing in one or both eyes 4. Sudden trouble walking, dizziness, loss of balance or coordination 5. Sudden, severe headache with no known cause Physical deficits after stroke 1. Loss of movement or abnormal movement patterns on one side of the body (hemiplegia). Because the right side of the brain controls the left side of the body (and vice versa), hemiplegia occurs on the opposite side of the body where the stroke occurred. 2. Poor coordination. 3. Abnormal posture. 4. Difficulty with speaking and understanding, and with reading and writing. 5. Incontinence. 6. Partial loss of vision. 7. Inability to swallow. Cognitive deficits 1. 2. 3. 4. Becoming cautious, anxious and disorganized. Easily depressed, inability to control emotion. Poor concentration in learning new skills. Inability to understand speech.

Spatial-perceptual deficits 1. Inability to judge distance, size, position. 2. Loss of feeling in one side of the body. 3. Loss of body image.

What complications can occur after a stroke?

A stroke can become worse despite an early arrival at the hospital and appropriate medical treatment. Progression of symptoms may be due to brain swelling or bleeding into the brain tissue. It is not unusual for a stroke and a heart attack to occur at the same time or in very close proximity to each other. During the acute illness, swallowing may be affected. The weakness that affects the arm, leg, and side of the face can also impact the muscles of swallowing. A stroke that causes slurred speech seems to predispose the patient to abnormal swallowing mechanics. Should food and saliva enter the trachea instead of the esophagus when eating or swallowing, pneumonia or a lung infection can occur. Abnormal swallowing can also occur independently of slurred speech. Because a stroke often results in immobility, blood clots can develop in a leg vein (deep vein thrombosis). This poses a risk for a clot to travel upwards to and lodge in the lungs - a potentially life-threatening situation (pulmonary embolism). There are a number of ways in which the treating physician can help prevent these leg vein clots. Prolonged immobility can also lead to pressure sores (a breakdown of the skin, called decubitus ulcers), which can be prevented by frequent repositioning of the patient by the nurse or other caretakers. Stroke patients often have some problem with depression as part of the recovery process, which needs to be recognized and treated. The prognosis following a stroke is related to the severity of the stroke and how much of the brain has been damaged. Some patients return to a near-normal condition with minimal awkwardness or speech defects. Many stroke patients are left with permanent problems such as hemiplegia (weakness on one side of the body), aphasia (difficulty or the inability to speak), or incontinence of the bowel and/or bladder. A significant number of persons become unconscious and die following a major stroke.

What can be done to prevent a stroke?

Risk factor reduction High blood pressure: The possibility of suffering a stroke can be markedly decreased by controlling the risk factors. The most important risk factor for stroke is high blood pressure. When a person's blood pressure is persistently too high, roughly greater than 130/85, the risk of a stroke increases in proportion to the degree by which the blood pressure is elevated. Managing high blood pressure so that it is well controlled and in the normal range decreases the chances of a stroke.

Smoking: An important stroke risk factor is cigarette smoking or other tobacco use. Chemicals in cigarettes are associated with developing atherosclerosis or narrowing of the arteries in the body. This narrowing can involve the large carotid arteries as well as smaller arteries within the brain. Diabetes: Diabetes causes the small vessels to close prematurely. When these blood vessels close in the brain, small (lacunar) strokes may occur. Good control of blood sugar is important in decreasing the risk of stroke in people with diabetes. High cholesterol: Elevated cholesterol and/or triglycerides in the bloodstream are risk factors for a stroke due to the eventual blockage of blood vessels (atherosclerosis) and plaque formation. A healthy diet and medications can help normalize an elevated blood cholesterol level. Rehabilitation When a patient is no longer acutely ill after a stroke, the health care staff focuses on maximizing the individuals functional abilities. This is most often done in an inpatient rehabilitation hospital or in a special area of a general hospital. Rehabilitation can also take place at a nursing facility. The rehabilitation process can include some or all of the following: 1. speech therapy to relearn talking and swallowing; 2. occupational therapy to regain as much function dexterity in the arms and hands as possible; 3. physical therapy to improve strength and walking; and 4. family education to orient them in caring for their loved one at home and the challenges they will face. The goal is for the patient to resume as many, if not all, of their pre-stroke activities and functions. Since a stroke involves the permanent loss of brain cells, a total return to the patient's pre-stroke status is not necessarily a realistic goal in many cases. However, many stroke patients can return to vibrant independent lives. Many times, home health providers can assess the home living situation and make recommendations to ease the transition home. Unfortunately, some stroke patients have such significant nursing needs that they cannot be met by relatives and friends and long-term nursing home care may be required. Physiotherapy http://www.neurologicalphysiotherapy.com/neurological-conditions/stroke.html After a stroke many people experience difficulties performing everyday tasks which can make life more difficult. Neurological physiotherapy will provide treatment that will enable people to reach their maximum potential and make everyday tasks easier to achieve.

An initial assessment with a neurological physiotherapist will set short and long term goals tailored to the patients needs to help promote independence and improve quality of life. During treatment sessions, neurological physiotherapist will lead the patient through a graduated programme of functional exercises focused around daily tasks which aim to:

Increase muscle strength Stretch tight muscles to encourage lengthening and reduce stiffness. Promote normal movement Repetitive exercise to recruit muscles and increase control of movement of the arms, legs and trunk Exercises to get the affected side of the body working more effectively. Correcting and varying position to improve balance and coordination. Reduce pain and muscle spasms Teach transfers (rolling, moving in bed, sit to stand etc) Build stamina and increase energy levels through different exercises Promote independence with activities of daily living

WORDS blood clot - a semisolid mass of coagulated red and white blood cells (vere klomp nagu tromb ja embol) Cerebral hemorrhage - bleeding within the brain substance (ajuverejooks) Drooling- letting saliva run from the mouth Slurred speech- unclear, words and sounds are not correctly separated Aphasia- difficulty or the inability to speak (afaasia) Carotid artery- either of the two major arteries, one on each side of the neck, that carry blood to the head (unearter) Dexterity- skill and grace in physical movement, especially in the use of the hands (kteosavus) Plaque- a small disk-shaped formation or growth (naast) Brainstem- brain structure closest to the spinal cord (ajutvi) Cerebellum- the part of the brain involved in coordination of movement, walking and balance (vikeaju) Atrial fibrillation- a heart condition characterized by rapid random contractions of the atria (kodade virvendus) Hemiplegia- paralysis of one side of the body (he kehapoole halvatus) Pressure sores- a pressure-induced ulceration of the skin occurring in persons confined to bed for long periods of time (lamatised) Occupational therapy- the use of productive or creative activity in the treatment or rehabilitation of physically or emotionally disabled people (tegevusteraapia) Space perception - the awareness of the spatial properties and relations of an object, or of one's own body, in space; especially, the sensory appreciation of position, size, form, distance, and direction of an object, or of the observer himself, in space (ruumitaju) http://www.medicinenet.com/stroke/article.htm http://www.nasam.org/english/prevention-what_are_the_effects_of_stroke.php