According to the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading illness that causes death in the United States. It is described as one of the primary causes of adult disability (Centers for Disease Control and Prevention). Approximately 800,000 people in the U.S alone suffer from a stroke annually. This figure translates to one American dying after every four minutes (Caplan 19). Owing to the serious prevalence the disease represents, the illness has received requisite attention regarding prevention and treatment techniques in an attempt to reduce its incidence. As a result of its quick and devastating consequences, fast action is encouraged to prevent disability, or in worst instances, death. This paper will analyze and evaluate the disease process to enhance understanding of the illness.
Overview (history) of Stroke
Medical research has identified the cause of stroke as the disruption of blood flow to the brain or in instances where a rupture of a blood vessel in the brain occurs hence resulting in the death of vital brain tissue. As a result, the different body parts which the brain controls of which the supply of oxygenated blood has been disrupted is adversely affected, resulting in effects such as numbness of the limbs or face, or a sudden weakness.
The general condition of stroke is currently well understood as a result of intensive research in the area. However, this situation has not always been so. In the past, the underlying causes of stroke were not well understood. The first individual to recognize stroke was the father of modern medicine, Hippocrates, almost 2,400 years ago. He termed the illness as apoplexy, a Greek word that means ‘struck down by violence.’ The name explains the unexpected effects resulted from a stroke occurrence although, it did not explain what was happening to the brain.
The mystery behind the cause of the illness was solved by Jacob Wepfer, a doctor, who realized the status of blood supply to the brains of individuals who suffered from apoplexy. In this case, he recognized that in some instances, there was massive bleeding that occurred in the brains of some people, while in others, there were blocked arteries. This discovery proved vital to medicine as further research sought to unearth more about the disease regarding its causes, symptoms, and treatments. In this regard, the illness was divided into various categories which were based on the condition’s causes. As a result, terms such as ‘stroke’ and Cerebral Vascular Accident (CVA) were introduced. Today, medical and technological advancements have facilitated and enhanced comprehension of the illness and the respective treatments that have proved successful, resulting to more stroke survivors.
Classification of Stroke
As indicated above, the different types of strokes are classified in accordance with their underlying causes. According to CDC (2013), there are three main types of strokes as indicated below:
• Ischemic stroke
• Hemorrhagic stroke
• Transient Ischemic Attack (TIA)
Ischemic Stroke
Approximately 85% of all strokes that occur are ischemic strokes (Caplan 25). This type of stroke occurs when the artery that supplies blood rich in oxygen to the brain becomes blocked. This leads to blood clotting thereby preventing any flow of the vital elements, blood, and oxygen to the brain. The blockage of the arteries has been identified as fatty deposits referred to as plaques. The plaques cause the narrowing and the eventual blockage of arteries leading to a blood clot, a process called atherosclerosis.
Hemorrhagic stroke
This type is also referred to as cerebral hemorrhages or intracranial hemorrhages and is less common than compared to the ischemic stroke. In this case, such strokes occur as a result of the breaking of the artery lodged in the brain or a blood leak from the artery in the brain. As a result, this leads to the accumulation of blood in the brain. From this instance, the blood accumulation leads to an increase in pressure on the brain cells in which case consequently destroys them. In most cases, high blood pressure and aneurysms, which take the form of balloon bulges in the artery, leads to stretching of the artery hence causing it to stretch and eventually burst. Hemorrhagic strokes are further subdivided into the following:
1. Intracerebral hemorrhage- this represents the most common hemorrhagic stroke and which occurs as a result of the bursting of the artery in the brain, leading to the flooding of blood in the brain tissue.
2. Subarachnoid Hemorrhage- This is the least common type and is explained by the occurrence of bleeding in the area between the surrounding thin tissues in the brain and the brain itself.
Transient Ischemic Attack (TIA)
According to the CDC (2013), TIA differs from the above types of strokes as it is temporary in nature as the flow of blood to the brain is interrupted for only a short duration, usually less than five minutes (Centers for Disease Control and Prevention). This condition is reversible and results in no neurologic damage after its occurrence. The TIA Working Group has recently modified the definition of the disease as a consequence of the limitations that exist in its original definition of TIA as a focal brain dysfunction that usually lasts for a period less than 24 hours. In this regard, the agreed new definition is, a neurologic dysfunction that lasts for a short time and whose consequential effects lasts in less than 24 hours, with no evidence of occurrence of a stroke from the use of neuroimaging techniques (Fisher 20)
In most instances, it is virtually impossible to differentiate a TIA stroke and other serious forms such as ischemic stroke. For this reason, individuals suffering from a possible stroke are advised to seek medical attention with immediate effect. In addition, just like the ischemic strokes, TIA strokes are caused by blood clots around brain regions. Their occurrence is often a warning to an individual of a possible future stroke. In this regard, CDC indicate that approximately one-third of persons who suffer from a TIA stroke end up experiencing a major stroke within a year unless urgent attention is not provided. In addition, almost 10-15% of those suffering from a TIA stroke will be victims of a major stroke within three months (Fisher 26).
Signs and Symptoms
As indicated above, a stroke is caused by the lack of oxygenated blood supply to different areas of the brain. As such, the significant symptoms and signs of its occurrence are pegged around brain functions. According to Caplan (22), stroke symptoms often occur immediately upon its commencement, mostly within seconds or minutes. In this case, the symptoms one experiences are often dependent on the area of the brain affected. In this instance, in the event a large area of the brain is affected, the resulting body functions which the affected section controls and manages are consequently affected.
Individuals are advised to look for potential signs and symptoms to quicken the diagnosis process and, therefore, treatment of the stroke. In this regard, various systems have been developed to aid in this endeavor. According to Fisher (33), the occurrence of an arm drift, which occurs when an individual is asked to raise both arms but involuntary lowers one arm, or sudden face weakness is often reliable indicators of the possibility of a stroke. In this instance, the likelihood of a stroke increases by approximately 5.5 in the event one of these symptoms are present. One of the systems proposed for the occurrence of a stroke is the FAST System as described further below (Fisher 35):
• F- Face: When an individual is asked to smile, one side of the face may droop
• Arms: When a person is requested to raise both arms, one arm may be involuntary drift downwards
• S-Speech: In the event an individual is requested to repeat a simple phrase, their speech may be slurred or strange
• T- Time: In the instance one positively identifies the occurrence of the above signs, one is advised to contact emergency services immediately.
In the event the part of the brain that controls the pathways of the central nervous system, the corticospinal track, or spinothalamic tract, or the dorsal column, the following are the associated symptoms:
• Numbness
• Reduction in vibratory or sensory sensation
• Weakness of muscles in the face
• Reduced muscle tone, excessive reflexes, or increased muscle tone.
According to Caplan (30), in most instances, the above symptoms mostly occur unilaterally, that is mostly, affect one side of the body. In accordance with the brain section affected, the brain defect mostly occurs on an individual’s opposite side of the body. In addition, since the pathways also travel along the spinal cord, any lesion in this part can produce such symptoms. However, the experience of any one of the above symptoms does not signify for certain the occurrence of a stroke.
In other instances, when the stroke affects the brainstem, it gives rise of some of the symptoms below:
• Altered heart and breathing rate
• Weakness in tongue muscles (an individual is not able to move his/her tongue from side-to-side, or stick it out)
• A person is also unable to turn his/her head from side to side
• Decreased reflexes that is, the eye pupil’s sensitivity to light, gag reflexes, or swallowing ability
• Drooping of eyelid and general weakness of ocular muscles
• In the event the cerebral cortex is affected, the Central Nervous System (CNS) pathways can be affected producing the following symptoms:
• General confusion or disorganized thinking
• Memory deficits as a result of the stroke’s impact on the temporal lobe
• Altered voluntary movements
• Neurological injury can lead to motor speech disorder
• Difficulty in auditory comprehension and verbal expression
In the instance of hemorrhagic strokes, they are often accompanied by a general loss of consciousness, vomiting, and headaches as a result of increased pressure resulting from the leaked blood that compresses the brain.
Causes of Strokes
The identification of the underlying causes of strokes is often associated with the type of stroke one suffers from. In the event one suffers from an anischemic stroke which is as a result of a blood clot, the causes of the clot are different from those in a hemorrhagic stroke. In this case, various causes of the narrowing of arteries have been identified, ranging from natural to lifestyle causes. In the first instance, age has been attributed as the underlying cause of occurrence of the stroke. In this regard, the older one gets, the narrower the arteries become. As a result, the formation of a blood clot is, therefore, easier as the oxygenated blood is not able to reach the brain at the required pace.
In the case of ischemic stroke, an irregular heartbeat referred to as an atrial fibrillation is identified as a cause of this type of stroke. Such instances lead to the formation of blood clots which separate from the heart. These runaway clots later become lodged in blood vessels supplying blood to the brain. The causes of atrial fibrillation have been identified as lung cancer, excessive alcohol intake, heart valve disease, and an overactive thyroid gland.
In the case of hemorrhagic strokes, the primary cause is identified to be high blood pressure. This condition weakens the brain’s arteries making them prone to split, and in worst cases, burst. The causes of high blood pressure have been associated mostly with lifestyle choices such as smoking, a lack of exercise, being overweight, and stress which leads to a temporary rise in blood pressure. In addition, hemorrhagic strokes can also be caused by a rupture of a brain aneurysm, or a balloon-like expanded blood vessel, or the bursting of blood vessels formed poorly in the brain.
Diagnosis of Stroke
• Blood tests- These determine the levels of cholesterol and blood sugar in the body. In addition, medical practitioners often check the pulse to determine the heartbeat rate to aid in the determination of the patient’s blood pressure levels.
• Brain Scans- in as much as physical manifestations of a stroke are distinct, it is advised to undertake brain scans in order to determine the type of stroke an individual is suffering from, that is, whether it has been caused by the rupture of blood vessels (Hemorrhagic strokes) or has been caused by a blood clot (ischemic strokes). In addition, additional tests assist in the determination of the area of the brain that has been affected as well as the severity of the condition. The identification of the type of stroke one suffers from assists doctors to recommend the appropriate type of treatment and therefore enables a rapid and accurate diagnosis. The two categories of scans usually applied in such instances are, Computerized Tomography (CT) Scan and the Magnetic Resonance Imaging (MRI) Scan (Fisher 58). In the first case, a CT scan applies similar technology as that of an X-Ray machine. In this case, the scan develops three-dimensional images that assist in easier troubleshooting of problem areas. An MRI Scan, on the other hand, uses strong radio waves and magnetic field to produce accurate images of the brain under study. If complex symptoms exist, an MRI is identified to be a better choice owing to its ability to generate high-quality images and also provides more detail on the affected areas of the brain.
• Swallow tests- this technique applies to those who have previously suffered a stroke. In most instances, the doctor can check whether a patient can swallow correctly. This prevents the occurrence of situations involving the swallowing of food or drink, which may cause choking.
Pathophysiology
The primary pathophysiology of strokes has been identified as an underlying blood vessel or heart disease. The secondary manifestations that occur in the brain have been caused by the potential risk factors and underlying ailments. In this instance, primary pathologies include dyslipidemia, coronary artery disease caused by atherosclerosis, and hypertension.
Preventing the Occurrence of Strokes
Two fronts exist in the prevention of stroke development as explained below (CDC, 2013):
• Maintaining a healthy lifestyle
• Observance of other medical conditions
Healthy Living
One can prevent the occurrence of a stroke by embracing a healthy way of life. In this regards, one is advised to eat a healthy diet. Individuals should eat foods low in saturated and trans-fats as well as those with low cholesterol levels. This is because these components are responsible for piling up and blocking the arteries, hence raising the risk of succumbing to a stroke. Also, low salt intake is advised to lower blood pressure. Heavyweight or obesity increases the risk of a stroke. As such, individuals should embrace physical activity to maintain a healthy weight. Individuals are also advised to stay away from harmful habits such as smoking and excessive alcohol intake which increases chances of developing a stroke. For instance, alcohol is proven to raise blood pressure, one of the underlying causes of strokes.
Medical Conditions
For individuals suffering from ailments such as heart disease, high blood pressure, high cholesterol, or diabetes, they are provided various means of reducing their risk from succumbing to strokes. In this regard, they are advised to seek medical checkups on a frequent basis to assess their health condition and also to adopt a healthy lifestyle as explained above.
Management of Stroke
Individuals experiencing the signs and symptoms of a stroke are advised to seek medical assistance with immediate effect. This is because it is proven that within one to three hours of reporting a potential stroke; chances of preventing disability are increased by approximately 10% (Fisher 46). When diagnosed with an ischemic stroke, definitive therapy is undertaken to remove any clot or blockage in the arteries. This clot can also be removed mechanically, and a process referred to as thrombectomy.
For those suffering from a hemorrhagic stroke, neurologic evaluation is proposed to check the cause and extent of bleeding before further action is taken. In most cases, individuals do not undergo surgery. In instances where some people suffer from the disabling strokes, rehabilitation is advised to enable their full recovery.
Prognosis of Stroke
The occurrence of a stroke can cause devastating emotional, physical, and mental effects. The impact of a stroke is dependent on the extent and location of damage caused to the brain. Regarding physical implications, strokes can cause various forms of disabilities as witnessed in face muscle weaknesses, pneumonia, and speech and vision loss among others.
The psychological effects of a stroke is that it causes lability, in that, individuals suffering from a stroke can quickly switch between different emotional states, the highs, and lows. A person’s personal relationships are also adversely affected as well as their identities.
A stroke can cause cognitive deficits as individuals suffer from ailments such as aphasia, dementia, or lead to the development of memory or attention issues.
Works Cited
Caplan, Louis. Stroke. New York: Routledge Publishers, 2010. Print.
Centers for Disease Control and Prevention. Stroke. 2013, Web. <http://www.cdc.gov/stroke/types_of_stroke.htm>
Fisher, Marc. Stroke: Investigation and management. Edinburgh: Elsevier, 2008. Print.
