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A STROKE, SOMETIMES REFERRED TO AS A CEREBROVASCULAR ACCIDENT (CVA), CEREBROVASCULAR INSULT (CVI), OR BRAIN ATTACK IS THE LOSS OF BRAIN FUNCTION DUE TO A DISTURBANCE IN THE BLOOD SUPPLY TO THE BRAIN. THIS DISTURBANCE IS DUE TO EITHER ISCHEMIA (LACK OF BLOOD FLOW) OR HEMORRHAGE. AS A RESULT, THE AFFECTED AREA OF THE BRAIN CANNOT FUNCTION NORMALLY.
Types of stroke:
HEMORRHAGIC STROKE: are less common, in this condition blood spills into or around the brain due to weakened blood vessel leak and creates swelling and pressure, damaging cells and tissue in the brain.
ISCHEMIC STROKE:occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. This causes blood not to reach the brain. High blood pressure is the most important risk factor for this type of stroke.
TRANSIENT ISCHEMIC ATTACK (TIA): It occurs when blood flow to part of the brain stops for a short period of time; it can mimic stroke-like symptoms. These symptoms appear and last less than 24 hours before disappearing. While TIAs generally do not cause permanent brain damage, they are a serious warning sign that a stroke may happen in the future and should not be ignored.
For more detailed description about STROKE you can watch:
Knowing the signs and symptoms of a stroke is the first step to ensure medical help immediately.For each minute a stroke goes untreated and blood flow to the brain continues to be blocked, a person loses about 1.9 million neurons. This could mean that a person's speech, movement, memory, and so much more can be affected. Learn as many stroke symptoms as possible so you can recognize stroke FAST and save a life!
SUDDEN numbness or weakness of face, arm or leg, especially on one side of the body.
SUDDEN confusion, trouble speaking, or understanding
SUDDEN trouble seeing in one or both eyes
SUDDEN trouble walking, dizziness, loss of balance or coordination
SUDDEN severe headache with unknown cause
FACE: Ask the person to smile. Does one side of the face
Effective treatment of stroke can prevent long-term disability and save lives.The specific treatments recommended depend on whether a stroke is caused by a blood clot obstructing the flow of blood to the brain (ischemic stroke) or by bleeding in or around the brain (hemorrhagic stroke). Treatment will usually involve taking one or more different medications, although some people may also need surgery.
Emergency treatment with medications. Therapy with clot-busting drugs must start within 3 to 4.5 hours if they're given into the vein and the sooner, the better.
You may be given:
Aspirin: Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.
Intravenous injection of tissue plasminogen activator (TPA)
Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain, and then release TPA directly into the area where the stroke is occurring.
Minimally invasive mechanical clot removal: Doctors may use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot.
Angioplasty and stents.
Emergency measures. If you take warfarin (Coumadin) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract these blood thinners' effects.
Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
Surgery for hydrocephalus
Surgery can also be carried out to treat a complication of hemorrhagic
Strokes called hydrocephalus
Intracranial bypass. In some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
Stroke recovery and rehabilitation
Most stroke survivors receive treatment in a rehabilitation program.
Depending on your condition, your care team may also include:
Doctor trained in brain conditions (neurologist)
Rehabilitation doctor (physiatrist)
Psychologist or psychiatrist
In addition to the treatments mentioned above, you may also need further short-term treatment to help manage some of the problems that can affect people who have had a stroke.
For example, you may require:
A feeding tube inserted into your stomach through your nose (nasogastric tube) to provide nutrition if you have difficulty swallowing (dysphagia)
Nutritional supplements if you are malnourished
Fluids given directly into a vein (intravenously) if you are at risk of dehydration
Oxygen through a nasal tube or face mask if you have low levels of oxygen in your blood
Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.
A number of tests can then be carried out to help confirm the diagnosis and determine the cause of the stroke.
This may include blood tests to determine your cholesterol and blood sugar levels, checking your pulse for an irregular heartbeat and taking a blood pressure measurement.
ARMS: Ask the person to raise both arms. Does one arm drift downward?
SPEECH: Ask the person to repeat a simple phrase. Is their speech
slurred or strange?
TIME: If you observe any of these signs, call your doctor immediately.
Even if the physical symptoms of a stroke are obvious, brain scans should also be carried out to determine:
If the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
Which part of the brain has been affected
How severe the stroke is
Different treatment is required for the different types of stroke, so a rapid diagnosis will make treatment more straightforward.
Everyone with suspected stroke should receive a brain scan within 24 hours and some people should be scanned within an hour of the onset of symptoms, especially those who:
Might benefit from clot-busting drugs (thrombolysis) such as alteplase or early anticoagulant treatment
Are already on anticoagulant treatments
Have a lower level of consciousness
A CT scan is like an X-ray, but uses multiple images to build up a more detailed, three-dimensional picture of your brain to help your doctor identify any problem areas.
An MRI uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.
A swallow test is essential for anybody who has had a stroke, as swallowing ability is commonly affected early after a stroke.
Heart and blood vessel tests
Further tests on the heart and blood vessels might be carried out later to confirm what caused your stroke. Some of the tests that may be carried out are described below.
A carotid ultrasound scan can help show if there is any narrowing or blockages in the neck arteries leading to your brain.
In some cases another type of ultrasound scan called an echocardiogram may be carried out to produce images of your heart and check for any problem with it that could be related to your stroke.
Recovering after a stroke :
The injury to the brain caused by a stroke can lead to widespread and long-lasting problems.
Cognitive problem (thinking, memory, and reasoning),
Communication problems (expression and understanding)
High Blood Pressure: People who have high blood pressure have one and a half times the risk of having a stroke compared to those who consistently have optimal blood pressure of 120/80.
High Cholesterol level: High cholesterol in the arteries can block normal flow to the brain and cause a stroke. Total cholesterol levels under 200 are recommended.
Heart Disease: One of the major circulation problems is atherosclerosis, progressive fatty deposits in the arteries that cause hardening and buildup of cholesterol plaque.
Diabetes Mellitus: People with diabetes are up to four times more likely to have a stroke than people who don't.
ATRIAL FIBRILLATION: Heart condition called atrial fibrillation is a type of irregular heartbeat, more common in people 65 years and older. Atrial fibrillation raises stroke risk because it allows blood to pool in the heart. When blood pools, it tends to form clots which can then be carried to the brain, causing a stroke.
Sickle Cell Disease: The disease causes some red blood cells to form an abnormal sickle shape. A stroke can happen if sickle cells get stuck in a blood vessel and block the flow of blood to the brain.
Unhealthy Diet: Diets high in saturated fats, trans fat, and cholesterol have been linked to stroke and related conditions, such as heart disease. Also, too much salt (sodium) in the diet can raise blood pressure levels.
Physical Inactivity: Not getting enough physical activity can increase the chances of having other risk factors for stroke, including obesity, high blood pressure, high cholesterol, and diabetes. Regular physical activity can lower your risk for stroke.
Obesity:is excess body fat. Obesity is linked to higher "bad" cholesterol and triglyceride levels and to lower "good" cholesterol levels. In addition to heart disease, obesity can also lead to high blood pressure and diabetes.
Too Much Alcohol: Drinking too much alcohol can raise blood pressure levels and the risk for stroke. It also increases levels of triglycerides, a form of fat in your blood, which can harden your arteries.
Tobacco use increases the risk for stroke. Cigarette smoking can damage the heart and blood vessels, which increases your risk for stroke. Also, nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that your blood can carry. Exposure to other people's secondhand smoke can increase the risk for stroke even for nonsmokers.
Women experience more strokes each year than men, mainly because women live longer than men and stroke occurs more often at older ages.
Family History: Your stroke risk increases if a family member (parent, grandparent, or sibling) has had a stroke or a heart attack at an early age.
Age: After the age of 55, stroke risk doubles for every decade a person is alive.
Age is the single most important risk factor for stroke. The older you are, the more likely you are to have a stroke.
A patient is often overwhelmed by the number of stroke rehab exercises especially after being in the hospital for acute phase and inpatient rehab center.
Below is a list of various types of stroke rehab exercises.
Passive Range of Motion - This refers to an external force moving a body part rather than it moving on its own volition. For more detailed understanding you can watch:
Active Assistive Range of Motion (AAROM) : This type of range of motion occurs when a weak limb is assisted through movement.
Active Assistive Range of Motion (AAROM): This type of range of motion occurs when a weak limb is assisted through movement.
Active Range of Motion (AROM) : This occurs when a person can move a body part on their own without assistance.
Strengthening or Resistance Training Stroke rehab exercises often consist of strengthening activities that involve moving a body part against resistance. This type of exercise will gradually and progressively overload the muscles so that they will get stronger. There are many types of strengthening exercise equipment including bands, dumbbells, tubing, putty, and exercise machines.
Stretching Exercises Muscles often become tight or have tone after a stroke. Stretching on a regular basis can help prevent joint contracture and muscle shortening.
Weight Bearing Exercises: Weight bearing can help reduce excessive tone brought on by a stroke and strengthens weak muscles.
Scapular mobilization exercises: help move or mobilize the scapula in order to maintain or improve shoulder range of motion and prevent pain.
A person recovering from STROKE will require close monitoring of their nutritional status in the acute and rehabilitation phase.
Foods to Avoid: Try to avoid the following foods
Excessive sweets and candy
If a person's oral intake is poor, then they will need to be supplemented with liquid formulas or to explore food habits and preferences to encourage a person to eat through consistency of food and planning a balanced diet. The speech therapist and dietician will be able to determine the appropriate modified consistency of food (i.e. blended, soft and moist or easy chew) and fluids (i.e. pudding, honey, nectar or thin) of a person Planning a balanced diet is important to allow adequate nutrition for the recovery in a person with TBI. The table below will be a guide to choosing and planning meals from the four major food groups.
For more details about DIET IN STROKE you can watch:
Post-hospitalisation, many patients experience poor appetite. To boost your appetite, consume small portions of food about 7-9 snacks/meals throughout the day. Nausea is another common complaint that could be caused due to medications. Take the prescribed medicines on full stomach. Consult your doctor if nausea persists.
A day's meal comprises of several food items. Generally, all food items can be classified into six major groups (5) as shown in the Healthy Heart pyramid.(6)
Immediate Diet Plan
1.Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables in your daily diet.
2.Add plenty of Whole Grains (whole wheat flour, brown rice, whole beans).
3.Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish, walnuts, flaxseeds. If you do not eat fish, talk to your doctor about taking fish supplements.
4.Instead of whole milk, choose low fat or skim milk.
5.Include food sources rich in Magnesium and Potassium to increase heart health.
1.Say NO to all Sugary and Refined foods (cakes, pastries) and do not add any sugar to beverages.
2.Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanspati.
3.No Carbonated, Caffeinated and Alcoholic beverages.
4.Curb Salt intake, as it can increase blood pressure. Don't add salt while cooking and reduce packaged food consumption.
Sample Diet Plan
Below is a sample Diet Plan for a patient who has undergone angioplasty. Make sure to check the correct portion sizes for each food item by going to these links.(8), (9), (10)
Talk to you doctor or dietician about any restrictions on fluid or water intake. Do not add SALT or SUGAR while cooking or as seasoning. For cooking, use only Olive Oil.
- 1 Cup lukewarm water with 1 Tbsp. freshly squeezed lemon juice and 1/2 tsp. honey
- 1 Cup Dahlia, porridge made with Skim Milk OR 1 Moong Dal Dosa(Recipe)OR 1 Ragi Dosa(Recipe)
- 1 medium Apple OR medium Orange OR 1/2 Cup pomegranate seeds
Early Morning Snack
- 1 Cup boiled Sweet potatoes, sprinkled with lemon juice OR 1 Cup Brown rice Poha with low fat yoghurt
- 1 Cup Coconut water (discard the "malai")
- 2 dried apricots and 1 whole walnut OR 2 dried figs and 2 almonds (unsalted)
- 1 large bowl of Salad (carrots, cucumbers, beets, tomatoes and onions)
(Dressing is important , use - Olive oil, lemon juice and pepper)