STROKE, when the brain is under attack! ~Dr. Domenico Pratico', MD, FCPP

Stroke is an acute medical condition caused by a blockage of blood flow to an area of ​​the brain or sudden bleeding in the brain.

In the first case, called Ischemic Stroke, the brain is deprived of oxygen and nutrients, so cells begin to die within minutes.

In the second case, called Hemorrhagic Stroke, the leaking blood puts pressure on brain cells, damaging them rapidly.

Most strokes are ischemic (80%), which occur when blood clots block blood vessels in the brain. A hemorrhagic stroke occurs when the wall of an artery in the brain ruptures. High blood pressure and aneurysms – balloon-like bulges in an artery that can rupture – are examples of conditions that can cause hemorrhagic stroke.

Stroke, when the brain is under attack

There is a third type of stroke called a “Transient Ischemic Attack” (TIA) or “mini-stroke” that typically occurs due to an obstruction of blood flow but resolves within an hour, so there is no damage to the brain. A TIA should never be underestimated because if left untreated there is a very high probability that within a few months a real stroke will occur with irreversible brain damage.

What happens in the brain during a stroke?

The brain controls our movements, stores our memories and is the source of our thoughts and language, but it is also responsible for other functions such as breathing and digestion. For all of this to work properly, the brain needs a constant flow of oxygen and nutrients that are supplied by the blood vessels. If something blocks the blood flow, or blood spills out if the vessels, brain cells begin to die within minutes. This clinically will manifest as a stroke.

Symptoms and signs of stroke

They are typically sudden and include:

·       Weakness or numbness of the face, arm or leg, usually on one side of the body.

·       Difficulty speaking or understanding.

·       Vision problems, such as blurred or loss of vision in one or both eyes. Dizziness or problems with balance or coordination.

·       Problems moving or walking.

·       Severe headaches with no known cause, especially if they come on suddenly.

Stroke symptoms and signs are sudden. Act F.A.S.T.

What to do if you suspect a stroke?

Here is a list of some very simple tests that can help quickly determine if someone is having a stroke. We must act F.A.S.T. and do the following tests:

F. Face. Ask the person to smile. Is one side of the face drooping?

A. Arm. Ask the person to raise both arms. Does one arm go up but the other doesn't?

S. Speech. Ask to repeat a simple sentence. Is the speech slurred or difficult to understand?

T. Time to act. If the answer is "yes" to any of these questions, call 911 immediately or take the person to the nearest hospital as soon as possible.

Treatment

The main treatment for an ischemic stroke is the intravenous infusion of tissue Plasminogen Activator (t-PA) (Alteplase). A newer version of this drug is now also available, Tenecteplase, which can be given faster than the old version. These drugs dissolve blood clots that block blood flow to the brain. The treatment is extremely effective but only if it can be done within 3 hours of the onset of the symptoms of an ischemic stroke.

The primary goal of treating hemorrhagic stroke is to control the bleeding, minimize brain damage, and improve recovery. Medical interventions are aimed at reducing the blood pressure that is pushing on the brain vessels. Any blood thinning medications that may have caused the bleeding should also be stopped. This is combined with surgical procedures that aim to repair the aneurysm or damage to the blood vessel wall.

Once again, time is a key factor in effectively resolving the clinical picture (the first 3 hours).

Brain CT scan after an ischemic stroke

Prevention

Many studies have shown that the prevention of cerebral stroke is based on the adoption of correct lifestyles that help significantly reduce the risk: low-sodium and low-calorie diet, regular physical activity, quitting smoking. For other risk factors, medical therapy should be taken into consideration, among these: high blood pressure (hypertension), type 2 diabetes mellitus, hypercholesterolemia and atrial fibrillation.

If you are interested in reading more of my blogs, check out this one:

Stroke does not affect only older people -Domenico Pratico, MD, FCPP

Dr. Domenico Pratico' , MD, FCPP

Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor and Founding Director of the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.

For more information on the research conducted by Dr. Domenico Pratico, please visit this link.

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