Stroke – A Condition to Reckon With

My cousin’s father had a stroke last year and it was a terrible time the family had, handling the situation. But, the stroke had affected the peripheral nervous system and they had reached the hospital within the Golden Hour. So, the recovery was not a big issue. The incident shook us up and had us thinking – if we do not know much about stroke, do the common people? That gave us enough encouragement to ask Dr. Shirish Hastak, Neurologist consultant at Wockhardt Hospital, Mumbai Central about the condition. This is what he had to say, “Stroke is a blood vessel block or rupture of the blood vessel in the brain. A stroke is a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of the brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. Stroke frequently occurs due to atherosclerosis of the arteries, heart dysfunction, heart rhythm disturbance and blood clotting abnormalities.”

Symptoms: During a stroke, you get a sudden change in speech, a sudden change in hand/leg function, sudden loss of vision and sudden severe headache. Sometimes a stroke happens gradually, but you’re likely to have one or more sudden symptoms like these:

• Numbness or weakness in your face, arm, or leg, especially on one side.
• Confusion or trouble understanding other people.
• Difficulty in speaking.
• Trouble seeing with one or both the eyes.
• Problems in walking or staying balanced or coordinated.
• Dizziness.
• A severe headache that comes on for no reason.

Risk Factors: Patients, who are old, who have high blood pressure, high blood sugar, high cholesterol levels and who have a sedentary lifestyle, can get the condition. Yes, diabetes and blood pressure increase the risk of stroke by accelerating atherosclerosis.

Migraines and risk of stroke:

Research shows that women who have migraines accompanied by their distinctive ‘aura’ symptoms are at greater risk of having a stroke than those who don’t get migraines.

Why the link? Migraine headaches are caused by inflammation of the arteries surrounding the brain. Other arteries inside the brain may spasm during an attack as well, temporarily cutting off circulation, thus increasing the odds of a stroke.

Additional risks: Abnormalities in the lining of arteries may also allow blood to clot more readily. And in rare cases, arteries leading to the brain may tear more easily. These tears can cause vessels to narrow and clots to form. Extra estrogen from oral contraceptives or hormone therapy can further boost clotting factors to create a perfect storm for a stroke.

Treatment: Ischemic strokes happen when a blood clot in an artery blocks the flow of blood and oxygen to a portion of the brain. With this type of stroke, the goal is to restore blood flow to the brain as quickly as possible. A number of medications may be given at the hospital to help break up the clot and prevent the formation of new clots. Ischemic stroke can be treated with intravenous thrombolysis within 4-5 hours and sometimes it is possible to do mechanical clot retrieval within 12 hours.

Treatment for Hemorrhagic Stroke: Hemorrhagic strokes happen when blood vessels in or around the brain rupture or leak. This puts too much pressure on the surrounding brain tissue, cutting off circulation and starving the brain of oxygen. Treatment for hemorrhagic stroke will depend on the cause of the bleeding and what part of the brain is affected. Bleeding around the brain is often caused by abnormally formed blood vessels, called aneurysms. Bleeding in the brain is often caused by high blood pressure.

Non-surgical treatments for hemorrhagic stroke may include:

• Controlling blood pressure.
• Stopping any medications that could increase bleeding (e.g., aspirin).
• Blood transfusions with blood clotting factors to stop the ongoing bleeding.
• Measuring pressure within the brain using a device called a ventriculostomy tube that’s inserted in the skull.

Reducing Risks: By maintaining a proper blood pressure, blood sugar, blood cholesterol and active lifestyle, you can reduce the risk of getting a stroke. Ask your doctor about taking low-dose of headache medication. It has been shown to decrease stroke risk in women over 45 and may prevent migraines too. Your doctors can also help you reduce the risks associated with abnormal arteries. Maintaining healthy blood pressure is one way, but also ask your physician to order a routine blood test to determine whether you have markers for increased clotting.

Also, discuss with your doctor about anticlotting medications or alternatives to hormone therapy.