Medically reviewed by Dr Halima Al-Mujtaba
In simple terms, a stroke is best described as a ‘brain attack’ which means that it can safely be called a medical emergency. Just like in a heart attack, stroke happens when there is a sudden rapid attack of the cerebral part of the brain denying it the blood supply and oxygen it needs to work. This interruption causes the brain tissues to begin to die in a matter of minutes.
According to the World Health Organization, a stroke is a clinical syndrome consisting of rapid development of focal (at times global) disturbance of cerebral function, lasting for more than 24 hours or leading to death with no apparent cause other than that of a vascular origin. It can be described as any injury to a blood vessel that impairs or blocks a part of the brain thereby causing injury to the brain cells due to lack of blood supply. Studies show that about 15 million people suffer stroke worldwide every year. Of these, 5 million die and another 5 million are permanently disabled. In Nigeria, in every 100,000 admissions of patients over the age of 50, 26 are suffering from stroke. From the foregoing, stroke is a common cause of death and disability worldwide, therefore in this article, we highlight its types, causes, symptoms, prevention and treatments.
There are Two Major Types of Stroke:
- Ischemic stroke: This occurs when a part of the brain loses blood flow. This type is most common as it accounts for 80% of all strokes. It is further categorized into two kinds – thrombotic stroke which occurs as a result of blood clot that forms within a blood vessel usually around fatty deposits in blood vessels and embolic stroke that happens as a result of disease of the heart or blood vessels.
- Hemorrhagic stroke: This happens when bleeding occurs within the brain. Hemorrhagic stroke is less common as it causes 20% of all strokes. These can be either within the brain tissues or between the coverings of the brain. It usually occurs during brain trauma as a result of car accidents.
There is also Partial stroke, medically called transient ischemic attack (TIA). It occurs when a person experiences similar symptoms of stroke but temporarily. Partial or mini stroke happens when the blood supply to the brain is temporarily reduced.
Causes of Stroke
It is not unusual for the average Nigerian to have or have had an older person in the family suffering from stroke. It could be grandparents, elderly uncles and aunts, older parents, amongst others. Since the condition is not rare in this clime, one may then wonder what the risk factors of having stroke include. The causes of stroke are not far-fetched from the common ailments that plague Africans and other older people around the world. Interestingly, the African race is much more prone to stroke than any other race. From age 55 and above, common illnesses that affect Africans include Hypertension and Diabetes. For younger people, stroke can be caused by underlying cardiovascular diseases like abnormal heart rhythm, and heart infections, high blood level and elevated lipids.
Other causes of stroke can be linked to an unhealthy consumption of large amounts of alcohol, drug abuse and indiscriminate smoking or secondary smoking. Conditions like syphilis and sickle cell anemia also make a person more prone to suffer stroke.
Also note that there can be involuntary causes of stroke like heredity and genetics. If one’s grandparents and parents suffered from stroke, there is a high likelihood that he/she may experience stroke at some point in their life too. Thus a family history of stroke can be a potential risk to a person.
Signs and Symptoms of Stroke
It is not easy to recognize signs of stroke. Since stroke has been earlier stated to be a medical emergency, it is important to know the signs of stroke in case of eventuality. One has to bear in mind that stroke just like a heart attack has a sudden onset. Well, it is possible that a lot must have gone wrong in the body system to culminate into a sudden blockage of oxygen and blood vessel to the brain, but outwardly, it can be difficult to notice until it happens. If you happen to experience stroke or be around someone who might be having a stroke, the following are the major general symptoms to look out for:
- Face drooping – weakness of one side of the face with deviation of the mouth. Hence, you can find out if you are experiencing face drooping by trying to smile. It is stroke if one side of the face droops
- Arm weakness – weakness usually involving one side of the body. Try to raise an arm; if it proves difficult to do, then it is likely a stroke. Other parts of the body that can be numb include the legs and eyes.
- Speech difficulty – There may be slurred speech. Knowing what to say but finding it difficult to get the words out properly as well as finding it difficult to understand what others are saying can also be a sign of stroke.
In case of a haemorrhagic stroke, look out for other symptoms like neck stiffness, severe headache, dizziness, confusion and rapid progression to coma. When these happen, the best point of call at the moment is to take the person to the hospital as soon as possible because prompt treatment is needed. If you already found the person in an unconscious state, you can try to perform a cardiopulmonary resuscitation (CPR) on them to avoid them drifting away. This is done by repeatedly compressing their chest by placing both of your arms on their chest.
Prevention of Stroke
So many people wonder if stroke can be prevented since it almost always happens unexpectedly. Being more alert and avoiding certain lifestyle habits have been proving to help reduce the incidence of stroke. There are however, two major ways one can endeavor to prevent stroke.
Primary prevention (before any stroke):
It is important to pay attention to avoiding underlying ailments that may lead to a stroke. In cases where they have already manifested, ensure to treat these illnesses effectively. For instance, look and treat risk factors such as hypertension, diabetes, elevated lipids and cardiovascular disease. This may begin with the following;
Healthy lifestyle: Living a healthy lifestyle by not drinking too much alcohol decreases the chances of having diabetes. Also staying away from junk foods can prevent diabetes and by extension, stroke.
Regular exercise: Exercising three times or more in a week helps to increase high density lipoprotein that are protective as well as enhances blood circulation to the brain.
Quit smoking: Stroke can also be prevented by quitting cigarrete smoking and staying away from secondary smoking.
Healthy diet: Maintaining a healthy diet, among many advantages, helps one to maintain a healthy weight. Eating healthy prevents obesity which in turn lowers the tendency for stroke.
Secondary prevention (preventing further strokes):
When one is also managing a stroke, maybe a mini stroke, it is important to avoid subsequent strokes. This entails controlling risk factors that may cause further damage to the patient.
Prevention at this stage is usually monitored by a healthcare provider. Lowering blood pressure and cholesterol even if not particularly raised, has been shown to be beneficial. Antiplatelet agents should be given to the patient in intervals if there is no bleeding on the computerized tomography (CT) scan. Anticoagulant medication that prevents the formation of clots should be started in patients that had a stroke as a result of atrial fibrillation. A classic example is the administration of Warfarin which can be started 2 weeks after the stroke.
Treatment for Stroke
Treatment for stroke must begin with emergency measures. It usually starts with checking the patient’s airway, breathing and circulation (ABCs). The airway should be protected to avoid hypoxia/aspiration. The patient is then placed on oxygen with the head elevated at 30 degrees, and his vital signs monitored closely. Keep hydrated with intravenous fluids like saline are administered periodically to keep the patient hydrated. If the blood sugar is high, Insulin is to be given in order to maintain the blood sugar level at 90-140mg/dl. At this point, all that the patient is given to take is administered intravenously and not orally to avoid choking.
It is recommended that blood pressure above 220/120mmHg be lowered using intravenous labetalol 10-20mg over 1-2mins which can be repeated if required. Other drugs that can be used include nicardipine and nitroprusside.Thrombolysis should be considered for ischaemic stroke with onset of symptoms of less than 4-5 hours ago. Drugs used for thrombolysis include: alteplase and streptokinase. However, a systolic blood pressure greater than 185/110mm Hg is a contraindication to the use of thrombolysis.
Once haemorrhagic stroke is excluded, antiplatelet medication such as aspirin 300mg can be given. Cerebellar haematomas (collection of blood in the brain) may need urgent surgery for evacuation.
The managing team should communicate fully with the patient, the relatives, and care givers especially in cases where difficult decisions need to be made. Ideally, stroke patients are to be taken to a stroke unit with Special Nursing Care and physiotherapy to save life and help in motivating the patient. Are you dealing with a loved one with stroke? KompleteCare’s Nurses Care takes the burden of care off you by placing your loved one in the care of certified nurses and guaranteeing an all-round care for them.
MEDICINET: Stroke; Benjamin Wedrow, MD; https://www.medicinenet.com/stroke_symptoms_and_treatment/article.htm
THE INTERNET STROKE CENTER: Stroke Statistics; http://www.strokecenter.org/patients/about-stroke/stroke-statistics/#:~:text=According%20to%20the%20World%20Health,650%2C000%20stroke%20deaths%20each%20year.
American Stroke Association: Types of stroke; https://www.stroke.org/en/about-stroke/types-of-stroke
Web MD: Stroke signs and symptoms; https://www.webmd.com/stroke/guide/understanding-stroke-symptoms
MEDSCAPE: Acute Management of stroke; https://emedicine.medscape.com/article/1159752-overview#a7
Oxford Handbook of clinical Medicine 9th Edition: Murry Longmore; Ian. B. Wilkinson
Harrison’s Principles of Internal Medicine; 19th Edition: Kasper; Fauci
Dr Halima Al-Mujtaba is a registrar in the department of Family Medicine, National Hospital Abuja.