Table of Contents
Definition
Stroke is defined as a condition that emerges due to an occurrence of neurological dysfunction caused by focal retinal, spinal cord or brain infarction, or non-traumatic subarachnoid bleeding or non-traumatic unprompted intracerebral bleeding. It also entails incidents of neurological dysfunction lasting for more than 24 hours, or causes death, following the exclusion of non-vascular origins (Grotta et al., 2015).
Causes
Causes of heart stroke differ by age. Cardioembolism and atherosclerosis secondary to atrial fibrillation comprise the leading causes of ischemic stroke among seniors. The differential diagnosis of causes of coronary stroke is more extensive among young people than among seniors. Chronic hypertension and cerebral amyloid angiopathy are the primary causes of intracerebral hemorrhage among seniors while vascular defects and aneurysms are the dominant causes among young adults (Barrett & Meschia, 2013).
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Risk factors
Many heart strokes emerge because of the complications of harm to the heart or blood vessels, especially blood vessel narrowing because of the accumulation of atheroma and toughening of the arteries due to increased blood pressure. Risk factors for vascular illness include increasing age, increased blood pressure, smoking cigarette, diabetes mellitus and increased levels of cholesterol in the blood. Consequently, these conventional vascular risk factors are also the primary heart stroke risk factors. For hemorrhage stroke, risk factors include excessive intake of alcohol, poor diet, increased blood pressure, obesity and increasing age. High blood pressure is the primary stroke risk factor because it causes both major stroke types, which include ischaemic and intracerebral hemorrhage. Other risk factors include physical inactivity, poor diet, and obesity (Grotta et al., 2015).
Pathophysiology
Stroke comprises a complex condition, and its pathophysiology includes different mechanisms and signals in various systems and cells. Regarding the cellular level, heart stroke affects hemostasis processes and disturbs interactions between elements circulating in the blood, blood vessels themselves, and brain parenchyma. Functionally, the main events include dysregulation and regulation of metabolism and hemodynamics. At the organ level, heart stroke stimulates histopathologic responses in all vascular, glial and neural cells. The following essential mechanisms are affected (Grotta et al., 2015).
Endothelium-derived nitric oxide, hyperpolarization and reactive oxygen species considerably modulate cerebral artery. Cerebral vascular function reacts to endothelial dysfunction that happens during a severe illness, which leads to damage to vasodilator processes. In turn, this leads to inflammation and oxidative stress in the cerebral circulation in reaction to the presence of cardiovascular risk factors during the chronic and atherosclerosis hypertension, for instance, high blood cholesterol levels (Hennerici, 2012).
Complications
Complications associated with stroke are both transitional and dynamic in their emergence and are varied in nature. Neuropsychiatric complications involve anxiety, depression, delirium, and cognitive impairment. Neurological problems as a direct stroke influence on the brain entail seizure events, hemorrhage changes of infarction, cerebral edema and death due to brain herniation. Complications that emerge because of impairments following stroke encompass malnutrition, falls, pressure sores, aspiration pneumonia, urinary tract infections, venous thromboembolism and complications that develop from the cardiac system. Consequently, stroke patients must be monitored closely to ensure early detection of these problems. A multidisciplinary unit dealing with stroke offers an excellent setting to manage and prevent these issues efficiently (Barrett & Meschia, 2013).
Test and Diagnosis
For stroke, early diagnostic imaging outcomes offer the first proof of the location and size of the hemorrhagic or ischemic lesion and regularly expose clues regarding stroke etiology. Ultrasound is the primary diagnostic mechanism for non-intrusive and simultaneous monitoring of brain blood flow. For example, transcranial high-frequency ultrasound and Doppler ultrasonography can detect recanalization after thrombolytic therapy instantly, which can improve thrombolysis efficacy. Non-contrast computed tomography is another fundamental diagnostic brain imaging technique for many patients with clinical conditions related to stroke, which should be performed before the initiation of intravenous thrombolysis. Advanced CT procedures like CT perfusion and CT angiography are also useful for diagnosing stroke. For example, endovascular therapy depends on CT angiography to identify required vessel occlusion before the endovascular intervention. Stroke MRI procedures also offer extra information besides CTs. Severe limitations in the movement of water proton can be visualized easily by ADC and DWI maps to provide a precise evaluation of the location and volume of early ischemic damage. A combination of MRI and MR perfusion procedures can identify patients who require severe stroke therapies. Both CT and MRI can detect severe intracerebral hemorrhage, and they can be applied as the primary imaging modalities for assessing patients with acute stroke. MR venography and angiography are essential mechanisms for determining arterial, venous pathology (Grotta et al., 2015).
Treatment and Drugs
Thrombolysis provides the most direct and straightforward treatment for strokes. Plasminogen activators offer medical improvement among patients with acute stroke, pulmonary embolism, venous thrombosis, peripheral vascular illness and coronary artery thrombosis. Intravenous tissue plasminogen activator also improves medical outcomes of all kinds of strokes if treatment begins three hours after the emergence of symptoms (Barrett & Meschia, 2013). Thrombolysis using intravenous tissue plasminogen is a safe treatment option for stroke as it improves patient outcome. It is recommended that treatment occurs early with the exclusion of intracranial hemorrhage patients and control of hypertension prior and following treatment. Management with antiplatelet and anticoagulants agents are prohibited within the initial 24 hours following thrombolysis. However, this treatment option cannot be used among young patients under the age of 18 years. For this group, endovascular arterial reperfusion is a recommended option. There are two kinds of endovascular reperfusion approaches (Hennerici, 2012). They are mechanical thrombectomy and intra-arterial thrombolysis. Intra-arterial thrombolysis entails direct application of a fibrinolytic medication into an embolus or thrombus through a tube supply mechanism. Mechanical thrombectomy includes extraction of an embolus or thrombus using device based on a catheter (Grotta et al., 2015).
Prevention
Large artery illness is mainly caused by and linked with stroke risk factors. Thus it should be managed accordingly and adequately controlled. Surgical or interventional management among patients with asymptomatic extracranial or intracranial cerebral arteries is not suggested because of the absence of proof of its importance in decreasing the risk of heart stroke beyond excellent medical management of risk factor (Barrett & Meschia, 2013).
It is also recommended that patients with atrial fibrillation use oral anticoagulation. It is also mandatory for the general public, healthcare practitioners and patients to be aware of atrial fibrillation and its related stroke. Primary prevention is fundamental in decreasing stroke burden among seniors as new approaches for atrial fibrillation, and new anticoagulants emerge in future (Hennerici, 2012). Primary prevention should also include attempts to update and inform the medical community and the public regarding the warning symptoms for stroke and other transient ischaemic attacks accompanied with an improved knowledge of early risk factors, for instance, lifestyle issues, smoking cigarettes, diabetes, and high blood pressure (Grotta et al., 2015). Patients’ history should be carefully assessed to identify possible risk factors, which include the family history of vascular conditions, recent symptoms of a vascular disease and other aspects related to vascular risk. More advanced tests like laboratory tests and brain imaging should follow based on the historical assessments.
- Barrett, K. M., & Meschia, J. F. (2013). Stroke. New York, NY: John Wiley & Sons.
- Grotta, J. C., Albers, G. W., Broderick, J. P., Kasner, S. E., Lo, E. H., Sacco, R. L., & Mendelow, A. D. (2015). Stroke: pathophysiology, diagnosis, and management. Elsevier Health Sciences.
- Hennerici, M. (2012). Stroke. Oxford: Oxford University Press.