STROKE/CEREBROVASCULAR ACCIDENT (CVA)
A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues. Without oxygen, brain cells, tissue become damaged and begin to die within minutes.
According to the Centers for Disease Control and Prevention (CDC), stroke is the 5th leading trusted Source cause of death in the United States. Every year, more than 795,000 people diagnosed with stroke. In U.S also the prevalence of stroke is roughly 3% of the adult population, which translates to approximately 7 million individuals. Approximately 800,000 primary (first-time) or secondary (recurrent) with the majority being primary strokes (roughly 600,000).
In Nigeria, the most populous black nation in the world, stands to risk the further straining of its resources as a result of the increasing prevalence of stroke and other cardiovascular diseases due to epidemiological transition, the current prevalence of stroke in Nigeria is 1.14 per 1000. Management of the disease is largely conservative while there is little or no funding for high-quality research. Primary prevention is the key to reducing the burden of the disease in a country with such poor resources. However, stroke is more common in women than men do to biological compositions.
DEFINITION
STROKE: can be defined as disease commonly occur as a result of damage or blockage to the arteries supplying the brain's tissues with oxygen and nutrients. Also called CEREBROVASCULAR ACCIDENT (CVA) or BRAIN ATTACK, classified as EMERGENCY.
Stroke occur when the blood supply to the part of the brain is interrupted or reduced, preventing brain tissue from getting enough oxygen and nutrients. Brain cells begin to die in minutes.
CAUSES
•Bleeding
•Thrombosis (blood clot)
•Narrowing of the blood vessels' lumen
•Aneurysm (bulging of blood vessels)
•Higher blood pressure
•Blood vessels malformation
RISK FACTORS
According to the National heart, lung and blood institution below are some of the risk factors
•Diet e.g higher salt intake, saturated fat intake and cholesterol
•Lack of exercise
•Alcohol consumption
•Smoking
•Genetic/hereditary
•Age more common in elderly
•Sex more common in men
•Race & ethnicity
•Previous health history e.g diabetic, heart disease, sickle cell disease
•Chronic kidney disease
TYPES OF STROKE
1. Hemorrhagic stroke: occur as a result of blood loss
2. Ischaemic stroke: occur as a result of blockage or narrowing in the arteries supplying the brain
3. Embolic stroke: occur when the blood clot form in the other part of the body and move through the blood and block the blood vessels.
4. Transient ischaemic attack (TIA): occur when there's temporary blockage in the blood flow to the brain.
SIGN & SYMPTOMS OF STROKE
WARNING SIGNS
•Facial paralysis
•Paralysis of one part of the body (limbs)
•Severe headache
GENERAL SIGNS
•Paralysis
•Numbness or weakness in the arm, face, and leg, especially on one side of the body
•Trouble speaking or understanding speech
•Confusion
•Altered level of consciousness
•Slurring speech
•Vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
•Trouble walking
•Loss of balance or coordination
•Dizziness
•Severe, sudden headache with an unknown cause
•Eating difficult
SYMPTOMS IN WOMEN
•Nausea or vomiting
•Hallucination
•Pain
•General weakness
•Shortness of breath or trouble breathing
•Fainting or losing consciousness
•Seizures
•Confusion, disorientation, or lack of responsiveness
•Sudden behavioral changes, especially increased agitation
SYMPTOMS IN MEN
•Drooping on one side of the face or an uneven smile
•Slurred speech, difficulty speaking, and trouble understanding other speech
•Arm weakness or muscle weakness on one side of the body
The symptoms differs by sex
DIAGNOSTIC TESTS OF STROKE
•History taking and neurological examination
•Magnetic resonance imaging (MRI)
•Electrocardiogram
•Blood test e.g full blood count, thrombin time
•Computed tomography scan (CT scan)
•Carotic ultrasound (CU)
•Cerebral angiography
•Echocardiogram
TREATMENT
The treatment is multidisciplinary approach, include the followings:
1. Anticoagulant drugs
2. Anti platelet drugs
3. Antihypertensive drugs
4. Clot breaking drugs
5. Mechanical thrombectomy
6. Stents
7. Surgery
8. Coiling
9. Clamping
10. Statins
11. Speech therapy
12. Cognitive therapy
13. Relearning sensory skills
14. Physical therapy
15. Rehabilitation
COMPLICATIONS
•Brain damage
•Long term disabilities
•Paralysis
•Impaired memory functions
•Death
PREVENTIONS OF STROKE
•Early detection and prompt treatment
•Awareness
•Avoid self medication
•Blood monitoring (frequently)
•Dietary modifications
•Exercise
•Avoid smoking
•Avoid alcohol consumption
•Regular check of people with heart disease
•Special Care for old people
•Effective management of people with related diseases e.g diabetic
•Avoid food contain higher salt and fat
•Regular blood pressure checking
PROGNOSIS/OUTCOME
Stroke is a leading cause of long-term disabilities; more than three quarters of people who suffer stroke survive for a year and over half survive for more than five years. The patient prognosis after an ischaemic stroke is much more positive than after a hemorrhagic stroke thus, stroke lead irreversible disabilities.
SUMMARY
A stroke occurs when blood flow to part of the brain is interrupted, as a result of blockage, clot formation, bleeding, dietary consumption among others which leads to oxygen deprivation to brain tissue. The ability to recover from a stroke depends on the severity of the stroke and how quickly you get medical attention. A massive stroke can be fatal, as it affects large portions of the brain. But for many people experiencing a stroke, recovery is long.
REFERENCES.
American Heart Association/American Stroke Association. TIA (Transient Ischaemic Attack)external icon. Accessed October 6, 2016.
Center for disease control and prevention.
Mozzafarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 2016;133(4):e38–360.
National heart, lung and blood institution
Thank you.
Yours sincerely,
Nurse Abdullahi Musa,
Sokoto State Nigeria.
