A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted. In brain tissue, a reduction of blood flow, ischemia, leads to an ischemic cascade that can damage or kill brain cells. Death of brain tissue can lead to loss of the function controlled by that tissue. Thus stroke is the third leading cause of death and leading cause of adult disability in the US and industrialized European nations (Jauch, 2005), and is a medical emergency. To underscore the seriousness of stroke, in recent years the term brain attack has become increasingly popular, in relation to the established term "heart attack" used for myocardial infarction. The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Red blood cells (erythrocytes) are present in the blood and help carry oxygen to the rest of the cells in the body Blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). ... Comparative brain sizes In the anatomy of animals, the brain, or encephalon (Greek for in the head), is the higher, supervisory center of the nervous system. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... The ischemic cascade is a series of biochemical reactions that take place in the brain after seconds to minutes of ischemia (inadequate blood supply) (Arnold, 2003). ... Drawing by Santiago Ramón y Cajal of cells in the pigeon cerebellum. ... Death is the cessation of physical life in a living organism, or the state of the organism after that event. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ...

Types of stroke

Ischemic stroke

Stroke is classified by its cause into two main types: ischemic and hemorrhagic. In ischemic stroke, which occurs in approximately 85-90% of strokes, a blood vessel becomes occluded and the blood supply to part of the brain is totally or partially blocked. Ischemic stroke is commonly divided into thrombotic and embolic (Stroke Center, 2005). Rarer types of stroke can occur (see below) Hemorrhagic stroke, or cerebral hemorrhage is a form of stroke that occurs when a blood vessel in the brain ruptures. ... The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...

Embolic stroke

In embolic stroke, an embolus, or a travelling particle in a blood vessel, flows with the bloodstream into progressively smaller arteries until it becomes lodged, inhibiting passage of blood. An embolus is most frequently a blood clot, but it can also be a plaque broken off from an atherosclerotic blood vessel or a number of other things including fat, air, and even cancerous cells (Perry and Miller 1961). An embolism may also be formed when the heart pumps ineffectively, allowing the blood to pool and coagulate, as occurs in certain heart arrhythmia such as atrial fibrillation (NINDS 1999). In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Atherosclerosis is a disease affecting arterial blood vessels (as well as veins that have been surgically moved to function as arteries). ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... This page is about the muscular organ, the Heart. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (an abnormality of heart rate or rhythm) originating in the atria. ...

Thrombotic stroke

In thrombotic stroke, the clot does not travel; it builds up and finally occludes the artery where it forms. When there is a tear in an artery wall, platelets and clotting factors in the blood are drawn to the area and aggregate there, forming a clot. They send out chemicals that can trigger a clotting cascade. Arterial clots usually form around atherosclerotic plaques (NINDS 1999). Since occlusion takes longer, onset of thrombotic strokes is slower. A 250 ml bag of newly collected platelets. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... The coagulation of blood is a complex process during which blood forms solid clots. ... Atherosclerosis is a disease affecting arterial blood vessels (as well as veins that have been surgically moved to function as arteries). ...

Blood flow can also be restricted in a condition called arterial stenosis, in which plaques build up on the artery wall, causing the vessel to become narrow and stiff (NINDS 1999). A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ...

Hemorrhagic stroke

See full article: Hemorrhagic stroke.

Hemorrhagic stroke, or intracranial hemorrhage, occurs in about 10% of strokes, when a blood vessel in the brain bursts, spilling blood into the spaces surrounding the brain cells. Hemorrhagic strokes generally carry a greater risk of death and permanent disability than ischemic strokes. Hemorrhagic stroke, or cerebral hemorrhage is a form of stroke that occurs when a blood vessel in the brain ruptures. ... This article needs cleanup. ... The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...

Watershed stroke

A small proportion of strokes are watershed strokes caused by hypoperfusion (usually due to hypotension) or other vascular problems including vasculitis. A watershed stroke is where the brain tissue between major arteries has been damaged from lack of blood flow. Hypoperfusion is a lack of blood flow which may have various causes. Hypotension is low blood pressure. In a watershed stroke blood flow to the area is not stopped, but is instead lessened to the point where brain damage occurs. In medicine, shock (hypoperfusion) is a life-threatening medical emergency characterized by inability of the body to supply enough oxygen to meet tissue requirements. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels. ...

Rarer types of stroke

Venous obstruction can obstruct flow so that an infarction occurs. This commonly occurs in the rare disease sinus vein thrombosis.

Causes

Ischemic stroke

Ischemic stroke is usually caused by atherosclerosis (fatty lumps in the artery wall), embolism (obstruction of blood vessels by blood clots from elsewhere in the body), or microangiopathy (small artery disease, the occlusion of small cerebral vessels). In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Microangiopathy is a disease process affecting small blood vessels. ...

Atrial fibrillation and other arrhythmias can lead to clot formation in the heart, which can become emboli and lodge in the brain. Some forms of thrombophilia (increased coagulation tendency) have a predilection for arterial thrombosis and stroke; these include polycythemia vera and the rare paroxysmal nocturnal hemoglobinuria. Atrial fibrillation (AF or afib) is a cardiac arrhythmia (an abnormality of heart rate or rhythm) originating in the atria. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Thrombophilia is the propensity to develop thrombosis (blood clots) due to an abnormality in the system of coagulation. ... Polycythemia is a condition in which there is a net increase in the total circulating erythrocyte (red blood cell) mass of the body. ... Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease characterised by aplastic anemia, thrombosis and red urine in the morning due to breakdown of red blood cells. ...

Risk factors (for atherosclerosis and small vessel disease) are advanced age, hypertension (high blood pressure), diabetes mellitus, high cholesterol, and cigarette smoking. High blood pressure is the most important modifiable risk factor of stroke. For other forms of hypertension see hypertension (disambiguation) Hypertension or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Tobacco smoking is the act of smoking tobacco products, especially cigarettes and cigars. ...

Hemorrhagic stroke

Causes of hemorrhagic stroke include hypertension, cerebral AVM, cerebral aneurysms, cerebral arteriosclerosis, head injury, congophilic angiopathy, congenital artery defects and prematurity. Hemorrhagic stroke, or cerebral hemorrhage is a form of stroke that occurs when a blood vessel in the brain ruptures. ... For other forms of hypertension see hypertension (disambiguation) Hypertension or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Cerebral arteriovenous malformation (AVM) is a congenital disorder of the blood vessels characterized by tangle(s) of veins and arteries located in various parts of the brain. ... A cerebral or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. ... // Introduction Arteriosclerosis means the hardening of the arteries in Greek. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... This is a condition in which the same amyloid protein associated with Alzheimers disease (Amyloid beta) is deposited in the walls of the blood vessels of the brain. ... Premature birth (also known as preterm birth) is defined medically as birth occurring earlier than 37 completed weeks of gestation. ...

Watershed stroke

As opposed to hemorrhagic stroke or embolic (or other atherogenic) stroke, watershed strokes occur in parts of the brain that lie at the boundary between zones of arterial distribution from different arteries. When there is hypotension from any cause, these watershed areas are more susceptible to damage than other areas of the brain.

Signs and symptoms

The symptoms of stroke include the following:

• sudden numbness or weakness, especially on one side of the body (hemiplegia);
  • reflexes can initially be decreased on the affected side, but are often more exaggerated than on the unaffected side;
  • the face is normally spared (as this is served by both hemispheres), but the corner of the mouth can be affected on the same side as the limb symptoms;
• sudden confusion or aphasia (trouble speaking) or understanding speech;
• sudden trouble seeing in one eye (or rarely both);
• pupils of unequal size;
• impaired swallowing reflex;
• sudden trouble walking, dizziness, or loss of balance or coordination.

Some patients lose consciousness as part of the initial presentation. This occurs more often in hemorrhagic stroke than in thrombosis. Paresthesia (paraesthesia in British) is a sensation of tingling, pricking, or numbness of the skin with no apparent physical cause, more generally known as the feeling of pins and needles. ... A reflex action or reflex is a biological control system linking stimulus to response and mediated by a reflex arc. ... Confusion can have the following meanings: Unclarity, e. ... Aphasia is a loss or impairment of the ability to produce or comprehend language, due to brain damage. ... Speech: (n. ... Visual perception is one of the senses, consisting of the ability to detect light and interpret (see) it as the perception known as sight or naked eye vision. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... The human eye The pupil is the central transparent area (showing as black). ... Walking is the main form of animal locomotion on land, distinguished from running and crawling. ... Dizziness (Latin: Vertigo) is the sensation of instability. ...

A sudden-onset severe headache can denote subarachnoid hemorrhage, which is a stroke-like clinical entity. Some other forms of stroke can feature headaches. A headache (medically known as cephalgia) is a condition of mild to severe pain in the head; sometimes upper back or neck pain may also be interpreted as a headache. ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ...

If the symptoms resolve within an hour, or maximum 24 hours, the diagnosis is transient ischemic attack (TIA), and not a stroke. This syndrome may be a warning sign, and a proportion of patients develop strokes in the future. The chances of suffering a stroke can be reduced by using aspirin, which inhibits platelets from aggregating and forming obstructive clots. Transient ischemic attacks (TIA) are caused by temporary disturbance of blood supply to a restricted area of brain and cause recurrent and brief (less than 24 hours) neurologic dysfunctions. ... Aspirin or acetylsalicylic acid is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ...

Diagnosis

Stroke is diagnosed through several techniques: a neurological examination, blood tests, CT scans (without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ... Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ...

If a stroke is confirmed on imaging, various other studies may be performed to determine whether there is a peripheral source of emboli: In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ...

• an ultrasound/doppler study of the carotid arteries (to detect carotid stenosis)
• an electrocardiogram (ECG) and echocardiogram (to identify arrhythmias and resultant clots in the heart which may spread to the brain vessels through the bloodstream)
• a Holter monitor study to identify intermittent arrhythmias
• an angiogram of the cerebral vasculature (if a bleed is thought to have originated from an aneurysm or arteriovenous malformation)

Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize internal organs, their size, structure and any pathological lesions. ... In human anatomy, the carotid artery is a major artery of the head and neck. ... Carotid artery stenosis is obstruction of the carotid artery, usually by atheroma (a fatty lump, the result of atherosclerosis). ... Lead II An electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... The echocardiogram is an ultrasound of the heart. ... Cardiac arrhythmia is a group of conditions in which the muscle contraction of the heart is irregular or is faster or slower than normal. ... Holter monitor In medicine, a Holter monitor (also called an ambulatory electrocardiography device), named after its inventor, Dr. Norman Holter, is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. ... Patient about to undergo an angiogram, image coutesy of WHO. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ...

Pathophysiology

When neurons and glia receive insufficient oxygen and nutrients due to inadequate blood supply, a biochemical cascade called the ischemic cascade is unleashed. The ischemic cascade, as well as sudden bleeding from ruptured blood vessels into or around the brain, can injure and kill cells. These damaged cells can linger in a compromised state for several hours. With timely treatment, these cells can be saved. Intriguingly, when the brain cells suffer the ischemia, they begin to fill up with free zinc ions which are released from some of their proteins, especially metallothionein, which can release 7 zinc ions per molecule. This released zinc is a major player in the ensuing death of the brain cells. Drugs that buffer the zinc and reduce the level of free zinc are already being tested to reduce brain cell death after stroke. Drawing by Santiago Ramón y Cajal of cells in the pigeon cerebellum. ... Neuroglia cells of the brain shown by Golgis method. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Chalcogens Group, Period, Block 16, 2, p Appearance colorless Atomic mass 15. ... // Nutrients and the body A nutrient is any element or compound necessary for or contributing to an organisms metabolism, growth, or other functioning. ... A Biochemical Cascade is a series of chemical reactions in which the products of one reaction are consumed in the next reaction. ... The ischemic cascade is a series of biochemical reactions that take place in the brain after seconds to minutes of ischemia (inadequate blood supply) (Arnold, 2003). ...

Prevention

Prevention is an important public health concern. Identification of patients with treatable risk factors for stroke is paramount. Treatment of risk factors in patients who have already had strokes (secondary prevention) is also very important as they are at high risk of subsequent events compared with those who have never had a stroke. Medication or drug therapy is the most common method of stroke prevention. Surgery such as Carotid endarterectomy can be used to remove significant narrowing of the neck (internal) carotid artery which supplies blood to the brain. This operation has been shown to be an effective way to prevent stroke in particular groups of patients. Carotid entarterectomy is a surgical procedure used to correct carotid stenosis (obstruction of the carotid artery by atheroma), used particularly when this causes medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). ... In human anatomy, the carotid artery is a major artery of the head and neck. ...

Some brain damage that results from stroke may be secondary to the initial death of brain cells caused by the lack of blood flow to the brain tissue. This brain damage is a result of a toxic reaction to the primary damage. Researchers are studying the mechanisms of this toxic reaction and ways to prevent this secondary injury to the brain. Scientists hope to develop neuroprotective agents to prevent this damage.

Another area of research involves experiments with vasodilators, medications that expand or dilate blood vessels to increase the blood flow to the brain.

Basic research has also focused on the genetics of stroke and stroke risk factors. One area of research involving genetics is gene therapy. A promising area of stroke animal research involves hibernation. The dramatic decrease of blood flow to the brain in hibernating animals is extensive enough that it would kill a non-hibernating animal. If scientists can discover how animals hibernate without experiencing brain damage, then maybe they can discover ways to stop the brain damage associated with decreased blood flow in stroke patients. Gene therapy using an Adenovirus vector. ...

Other studies are looking at the role of hypothermia, or decreased body temperature, on metabolism and neuroprotection. Scientists are working to develop new and better ways to help the brain repair itself and restore important functions to stroke patients. Some evidence suggests that transcranial magnetic stimulation (TMS), in which a small magnetic current is delivered to an area of the brain, may possibly increase brain plasticity and speed up recovery of function after stroke. Hypothermia is a medical condition in which the victims core body temperature has dropped to significantly below normal and normal metabolism begins to be impaired. ... Santorio Santorio (1561-1636) in his steelyard balance, from Ars de statica medecina, first published 1614 Metabolism (from μεταβολισμος (metabolismos), the Greek word for change, or overthrow (Etymonline)), is the biochemical modification of chemical compounds in living organisms and cells. ... Transcranial magnetic stimulation (TMS) is the use of powerful rapidly changing magnetic fields to induce electric fields in the brain by electromagnetic induction without the need for surgery or external electrodes. ... Plasticity has four meanings: Plasticity (physics): In physics and engineering, plasticity is the propensity of a material to undergo permanent deformation under load. ...

Treatment

Early assessment

It is important to identify a stroke as early as possible because patients who are treated earlier are more likely to survive and have better recoveries.

If a patient is suspected of having a stroke, emergency services should be contacted immediately. The patient should be transported to the nearest hospital that can provide a rapid evaluation and treatment with the latest available therapies targeted to the type of stroke. The faster these therapies are started for hemorrhagic and ischemic stroke, the chances for recovery from each type improves greatly. Quick decisions about medication and the need for surgery have been shown to improve outcome.

Only detailed physical examination and medical imaging provide information on the presence, type, and extent of stroke. In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Medical imaging is the process by which physicians evaluate an area of the subjects body that is not normally visible. ...

Recent research has shown that brain cells die after stroke by a signaling cascade using a protein called IKK2, presenting the possibility that cell death may be prevented by blocking this signaling [1].

Studies show that patients treated in hospitals with a dedicated Stroke Team or Stroke Unit and a specialized care program for stroke patients have improved odds of recovery.

Ischemic stroke

As ischemic stroke is due to a thrombus (blood clot) occluding a cerebral artery, a patient is given antiplatelet medication (aspirin, clopidogrel, dipyridamole), or anticoagulant medication (warfarin), dependent on the cause, when this type of stroke has been found. Hemorrhagic stroke must be ruled out with medical imaging, since this therapy would be harmful to patients with that type of stroke. A thrombus or blood clot is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... Aspirin or acetylsalicylic acid is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ... Clopidogrel, which is often prescribed under the brand name Plavix® (clopidogrel bisulfate; produced by Bristol-Myers Squibb and Sanofi-Aventis), is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Dipyridamole is a drug that inhibits platelet aggregation. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Warfarin (also known under the brand names of Coumadin® and Marevan®) is an anticoagulant medication that is administered orally. ...

In increasing numbers of specialist centers, thrombolysis ("clot busting") is used to dissolve the clot and unblock the artery. However, this treatment is new, expensive, potentially dangerous, and often contraindicated. There is also a time constraint: studies indicate that after three hours of symptom onset, the damage to the brain is irreversible. After three hours, thrombolysis provides no benefit. These requirements prevent routine thrombolysis of ischemic stroke in most hospitals, especially when no stroke expert is available. Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...

Whether thrombolysis is performed or not, the following investigations are required:

• Stroke symptoms are documented, often using scoring systems such as the National Institutes of Health Stroke Scale, the Cincinnati Stroke Scale, and the Los Angeles Prehospital Stroke Scale. The latter is used by emergency medical technicians (EMTs) to determine whether a patient needs transport to a stroke center.
• A CT scan is performed to rule out hemorrhagic stroke
• Blood tests, such as a full blood count, coagulation studies (PT/INR and APTT), and tests of electrolytes, renal function, liver function tests and glucose levels are carried out.

Other immediate strategies to protect the brain during stroke include ensuring that blood sugar is as normal as possible (such as commencement of an insulin sliding scale in known diabetics), and that the stroke patient is receiving adequate oxygen and intravenous fluids. The patient may be positioned so that his or her head is flat on the stretcher, rather than sitting up, since studies have shown that this increases blood flow to the brain. Additional therapies for ischemic stroke include aspirin (50 to 325 mg daily), clopidogrel (75 mg daily), and combined aspirin and dipyridamole extended release (25/200 mg twice daily). An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ... CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... The coagulation of blood is a complex process during which blood forms solid clots. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is a performance indicator measuring the efficacy of both the intrinsic and the common coagulation pathways. ... An electrolyte is a substance which dissociates free ions when dissolved (or molten), to produce an electrically conductive medium. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... Glucose (Glc), a monosaccharide, is one of the most important carbohydrates. ... This article is about the disease that features high blood sugar. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Chalcogens Group, Period, Block 16, 2, p Appearance colorless Atomic mass 15. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Aspirin or acetylsalicylic acid is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ... Clopidogrel, which is often prescribed under the brand name Plavix® (clopidogrel bisulfate; produced by Bristol-Myers Squibb and Sanofi-Aventis), is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Dipyridamole is a drug that inhibits platelet aggregation. ...

It is common for the blood pressure to be elevated immediately following a stroke. Studies indicated that while high blood pressure causes stroke, it is actually beneficial in the emergency period to allow better blood flow to the brain. Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...

If studies show carotid stenosis, and the patient has residual function in the affected side, carotid endarterectomy (surgical removal of the stenosis) may decrease the risk of recurrence. Carotid artery stenosis is obstruction of the carotid artery, usually by atheroma (a fatty lump, the result of atherosclerosis). ... Carotid entarterectomy is a surgical procedure used to correct carotid stenosis (obstruction of the carotid artery by atheroma), used particularly when this causes medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). ...

If the stroke has been the result of cardiac arrhythmia (such as atrial fibrillation) with cardiogenic emboli, treatment of the arrhythmia and anticoagulation with warfarin or high-dose aspirin may decrease the risk of recurrence. Cardiac arrhythmia is a group of conditions in which the muscle contraction of the heart is irregular or is faster or slower than normal. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (an abnormality of heart rate or rhythm) originating in the atria. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Warfarin (also known under the brand names of Coumadin® and Marevan®) is an anticoagulant medication that is administered orally. ...

Hemorrhagic stroke

Patients with bleeding into (intracerebral hemorrhage) or around the brain (subarachnoid hemorrhage), require neurosurgical evaluation to detect and treat the cause of the bleeding. Anticoagulants and antithrombotics, key in treating ischemic stroke, can make bleeding worse and cannot be used in intracerebral hemorrhage. Patients are monitored and their blood pressure, blood sugar, and oxygenation are kept at optimum levels. ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous system diseases amenable to mechanical intervention. ...

Care and rehabilitation

Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It is multidisciplinary because involves a team with different skills working together to help the patient. These include nursing staff, physiotherapy, occupational therapy, speech and language therapy, and usually a physician trained in rehabiliation medicine. Some teams may also include psychologists, social workers, and pharmacists. Physical therapy can help restore lost functionality in many people. ... Occupational therapy is skilled treatment that helps individuals achieve independence in all facets of their lives. ... Speech pathology, also termed speech-language pathology and speech & language therapy (SLT, mainly in the UK) is the study of disorders that affect a persons speech, language and swallowing. ... Physician examining a child The word physician should not be confused with physicist, which means a scientist in the area of physics. ... Physical medicine and rehabilitation or physiatry is a particular field of medicine. ... A psychologist is a researcher and/or a practitioner of psychology. ... Social Work is a helping profession focused on social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being (IASSW & IFSW 2001). ... Pharmacists are health professionals who practice the art and science of pharmacy. ...

Good nursing care is fundamental in maintaining skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure. Stroke rehabilitation begins almost immediately.

For most stroke patients, physical therapy is the cornerstone of the rehabilitation process. Another type of therapy involving relearning daily activities is occupational therapy (OT). OT involves exercise and training to help the stroke patient relearn everyday activities sometimes called the Activities of daily living (ADLs) such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. Speech and language therapy is appropriate for patients with problems understanding speech or written words, or problems forming speech. Physical therapy (also known as physiotherapy) is a health profession concerned with the assessment, diagnosis, and treatment of disease and disability through physical means. ... Occupational therapy is skilled treatment that helps individuals achieve independence in all facets of their lives. ... Activities of daily living (ADL), is a way to describe the functional status of a person. ... Speech pathology, also termed speech-language pathology and speech & language therapy (SLT, mainly in the UK) is the study of disorders that affect a persons speech, language and swallowing. ...

Patients may have particular problems, such as complete or partial inability to swallow, which can cause swallowed material to pass into the lungs and cause aspiration pneumonia. The condition may improve with time, but in the interim, a nasogastric tube may be inserted, enabling liquid food to be given directly into the stomach. If swallowing is still unsafe after a week, then a percutaneous endoscopic gastrostomy (PEG) tube is passed and this can remain indefinitely. Aspiration pneumonia is a specific form of lung infection (pneumonia) that develops when oral or gastric contents (including food, saliva, or nasal secretions) enter the bronchial tree. ... A percutaneous endoscopic gastrostomy (PEG) is the making of access to the digestive tract through the abdominal wall. ...

Stroke rehabilitation can last anywhere from a few days to several months. Most return of function is seen in the first few days and weeks, and then improvement falls off. Complete recovery is unusual but not impossible. Most patients will improve to some extent.

Prognosis

Disability affects 75% of stroke survivors enough to decrease their employability (Coffey et al., 2000 p.601). Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion (Stanford, 2005). Dysfunctions correspond to areas in the brain that have been damaged.

Some of the physical disabilities that can result from stroke include paralysis, numbness, pressure sores, pneumonia, incontinence, apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, vision loss, and pain. If the stroke is severe enough, coma or death can result. Paralysis is the complete loss of muscle function for one or more muscle groups. ... Bedsores, also called pressure sores or decubitus ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body. ... Pneumonia is an illness of the lungs and respiratory system in which the microscopic, air-filled sacs (alveoli) responsible for absorbing oxygen from the atmosphere become inflamed and flooded with fluid. ... The word incontinence has several distinct meanings: urinary incontinence is the inability to control urination fecal incontinence is the inability to control defecation the word incontinence can also be used to mean a lack of self-control governing morality. ... Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements. ... Pain is an unpleasant sensation which may be associated with actual or potential tissue damage and which may have physical and emotional components. ... This article is in need of attention from an expert on the subject. ... Death is the cessation of physical life in a living organism, or the state of the organism after that event. ...

Emotional problems resulting from stroke can result from direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy, and psychosis. Anxiety is a complex combination of the feeling of fear, apprehension and worry often accompanied by physical sensations such as palpitations, chest pain and/or shortness of breath. ... A panic attack is a period of intense fear or discomfort, typically with an abrupt onset and usually lasting no more than thirty minutes. ... This article is about the medical condition. ... This article is about the mental state. ...

30 to 50% of stroke survivors suffer post stroke depression, which is characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal (Senelick et al., 1994). Depression can reduce motivation and worsen outcome, but can be treated with antidepressants. Clinical depression is state of debilitating sadness or melancholy. ... An antidepressant is a medication designed to treat or alleviate the symptoms of clinical depression. ...

Emotional lability, another consequence of stroke, causes the patient to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the patient's actual emotions, a more severe form of emotional lability causes patients to laugh and cry pathologically, without regard to context or emotion (Coffey et al., 2000 p.613). Some patients show the opposite of what they feel, for example crying when they are happy (Villarosa et al., 1993). Emotional lability occurs in about 20% of stroke patients. A mood disorder is a condition where the prevailing emotional mood is distorted or inappropriate to the circumstances. ...

Cognitive deficits resulting from stroke include perceptual disorders, speech problems, dementia, and problems with attention and memory. A stroke sufferer may be perpetually unaware of his or her own disabilities or even the fact that he or she has suffered a stroke. In a condition called agnosia, or neglect, a patient is unable to see anything on the left or right side and is unaware of and unable to conceive of anything on the neglected side. Dementia (from Latin demens) is progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. ... Agnosia (a-gnosis, non-knowledge) is a loss of ability to recognize objects, persons, sounds, shapes or smells while the specific sense is not defective nor is there any significant memory loss. ...

Risk factors

The most important risk factors for stroke are hypertension, heart disease, diabetes, and cigarette smoking. Other risks include heavy alcohol consumption, high blood cholesterol levels, illicit drug use, and genetic or congenital conditions. Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke. Having had a stroke in the past greatly increases one's risk of future strokes. For other forms of hypertension see hypertension (disambiguation) Hypertension or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... There are different forms of heart disease: Coronary heart disease Ischaemic heart disease Cardiovascular disease The study of the heart (and diseases of the heart) is Cardiology This is a disambiguation page, a list of pages that otherwise might share the same title. ... This article is about the disease that features high blood sugar. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Genetics (from the Greek genno γεννώ= give birth) is the science of genes, heredity, and the variation of organisms. ...

One of the most significant stroke risk factors is advanced age. 95% of strokes occur in people age 45 and older (Senelick, Rossi, Dougherty 1994), and two-thirds of strokes occur in those over the age of 65 (NINDS 1999, Senelick et al., 1994). A person's risk of dying if he or she does have a stroke also increases with age. However, stroke can occur at any age, including in fetuses.

Sickle cell anemia, which can cause blood cells to clump up and block blood vessels, also increases stroke risk. Stroke is the second leading killer of people under 20 who suffer from sickle-cell anemia (NINDS 1999). Sickle-shaped red blood cells Sickle cell anemia (American English), sickle cell anaemia (British English) or sickle cell disease is a genetic disease in which red blood cells may change shape under certain circumstances. ...

Men are 1.25 times more likely to suffer CVA's than women (NINDS 1999), yet 60% of deaths from stroke occur in women (Villarosa et al., 1993). Since women live longer, they are older on average when they have their strokes and thus more often killed (NINDS 1999, NIMH 2002). Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, menopause and the treatment thereof (HRT). Stroke seems to run in some families. Hormone replacement therapy (HRT) is a system of medical treatment for postmenopausal women, based on the assumption that it may prevent discomfort and health problems caused by diminished circulating estrogen hormones. ...

History

Over 2,400 years ago, Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis, which we now know is caused by stroke. Apoplexy, from the Greek word meaning "struck down with violence,” first appeared in Hippocratic writings to describe stroke symptoms (Kopito 2001; Thompson 1996). Hippocrates: a conventionalized image in a Roman portrait bust (19th century engraving) Hippocrates of Cos (c. ... Paralysis is the complete loss of muscle function for one or more muscle groups. ... Apoplexy is an old-fashioned medical term, generally used interchangeably with cerebrovascular accident (CVA or stroke) but having other meanings as well. ...

In 1658, in his Apoplexia, Johann Jacob Wepfer (1620-1695) identified the cause of hemorrhagic stroke when he suggested that people who had died of apoplexy had bleeding in their brains (NINDS 1999; Thompson 1996). Wepfer also identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the cause of ischemic stroke when he suggested that apoplexy might be caused by a blockage to those vessels (NINDS 1999). Hemorrhagic stroke, or cerebral hemorrhage is a form of stroke that occurs when a blood vessel in the brain ruptures. ... The vertebral arteries are branches of the subclavian arteries. ... In human anatomy, the carotid artery is a major artery of the head and neck. ...

See also

• Transient ischemic attack
• Apoplexy

Transient ischemic attacks (TIA) are caused by temporary disturbance of blood supply to a restricted area of brain and cause recurrent and brief (less than 24 hours) neurologic dysfunctions. ... Apoplexy is an old-fashioned medical term, generally used interchangeably with cerebrovascular accident (CVA or stroke) but having other meanings as well. ...

References

1. Coffey C. Edward, Cummings Jeffrey L, Starkstein Sergio, Robinson Robert. "Stroke". The American Psychiatric Press Textbook of Geriatric Neuropsychiatry, Second Edition. Washington DC: American Psychiatric Press, Inc, 2000. pp.601-617.
2. Jauch, Edward C. 2005. “Acute Stroke Management.” eMedicine.com, Inc.
3. Kopito, Jeff. 1996. "A Stroke in Time". MERGINET.com, September 2001, Volume 6 Number 9. Available.
4. National Institute of Neurological Disorders and Stroke (NINDS). 1999. National Institutes of Health., Stroke: Hope Through Research.
5. Perry, Thomas and Miller Frank. Pathology: A Dynamic Introduction to Medicine and Surgery. Boston: Little, Brown and Company, 1961.
6. Senelick Richard C., Rossi, Peter W., Dougherty, Karla. Living with Stroke: A Guide For Families. Contemporary Books, Inc., Chicago IL, 1994.
7. Stanford Hospital & Clinics. 2005. Cardiovascular Diseases: Effects of Stroke.
8. Stroke Center of the Washington University School of Medicine.
9. Thompson, Jesse E. " The Evolution of Surgery for the Treatment and Prevention of Stroke: The Willis Lecture". Stroke. 27:1427-1434.
10. Villarosa, Linda, Ed., Singleton, LaFayette, MD, Johnson, Kirk A., Black Health Library Guide to Stroke. Henry Holt and Company, New York, 1993.

External links

• The original text for this article was taken from the National Institute of Neurological Disorders and Stroke public domain resource at this page
• Cerebrovascular disease and risk of stroke
• Stroke Center of the Washington University School of Medicine
• Stroke Engine. Heart and Stroke Foundation of Canada. Edited by a consorsium of researchers of McGill University, Canada. Information on stroke rehabilitation.
• www.stroke.org.uk The Stroke Association, UK