Crash course into strokes (AKA stroke 101)

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If you have discovered my site chances are you have suffered a stroke or someone you love has. I decided to write this post for the following reasons:

• To help provide a simple overview of a relatively complex medical condition. Especially since when it happens to you (or your loved one) chances are that you are not in the state of mind for details.
• Like you I felt that it was super important to understand what was happening to me and share this information.

The information in this post is purely, and entirely, my own research that I gathered. I do not claim to be, nor make an effort to be, a medical expert. Just an individual that suffered a stroke and felt compelled to write about this medical condition for Stroke In The Young patients and their loved ones.

A stroke is defined as either poor blood flow (or lack of) to the brain or bleeding within the brain.There three major types of stroke:

• Ischemic stroke - poor or blocked blood flow to the brain. 
• Hemorrhagic stroke - bleeding in the brain that is caused by a ruptured blood vessel or an abnormal vascular structure. 
• Transient ischemic attack (TIA) - or mini stroke in which stroke symptoms last two hours or less. TIA is caused by poor or blocked blood flow to the brain.

In all the above cases damage to the brain is caused due to a lack of oxygen to the brain via blood flow.

Symptoms of a stroke:

• Inability of feeling or movement within one side on the body
• Loss of speech or difficulty speaking
• Loss of cognitive function
• Dizziness
• Problems with eyesight

In most cases symptoms will affect one side of the body (left or right) 

Stroke risk factors:

• High blood pressure (biggest risk factor)
• High blood cholesterol
• Smoking
• Obesity
• Diabetes
• End stage kidney disease 
• Atrial fibrillation 
• Artery dissection  

Diagnosis of stroke:

National Institutes of Health Stroke Scale - a process first published by neurologist Dr. Patrick Lyden and colleagues in 2001 in order to quantify the impairments of a stroke and its severity on a scale of 0 to 44 and plan a treatment for the patient. Zero being no stroke symptoms and 42 being severe stroke symptoms. The process is composed of a 11 items:

• Level of consciousness (LOC)
  • patient's responsiveness
  • patient's ability to answer questions
  • patient's ability to follow verbal commands to perform simple task
• Horizontal eye movement - test ability for patient to track a pen or finger from side to side only using his or her eyes
• Visual field test - patient covers one of his/her eyes, looks at the physician and is shown a number of fingers in the upper and lower space quadrants and is asked how many fingers were shown. This test is done to both eyes.
• Facial palsy - check paralysis of the face
• Motor arm - check arm for downward movement
• Motor leg - check leg for downward movement
• Limb ataxia - test for the presence of a unilateral cerebellar lesion by asking the patient to touch the physician's finger with his/her finger and then touch their nose and repeat 3-4 times. In addition, they will be instructed to use their heel to move up and down the opposite shin and repeat a few times on both legs.
• Sensory - testing the sensory of the patients 4 limbs by pricking them and asking if they feel the prick and if there are any difference is sensation 
• Language - tests the patient’s language skills
• Speech - tests the patient’s motor ability to speak
• Extinction and inattention - Double simultaneous stimulation test in order to evaluate if the patient lacks feeling to one side of the body. In addition, test vision of the patient by holding one finger by each eye and wiggling either right or left or both fingers and asking the patient which finger is moving.

Imaging:

• CT scan
• MRI scan
• Doppler ultrasound
• Arteriography 

Treatments of Ischemic stroke:

• Thrombolysis - is the breakdown of blood clots via medication such as Tissue plasminogen activator (tPA). Usually this treatment is administered within 3 hours of Ischemic stroke onset. There is some controversy in the medical community if this treatment is effective for treating an ischemic stroke patient.
• Endovascular treatment - Physical removal of the blood clot (thrombus) via a medical procedure called endovascular thrombectomy (EVT). It is performed by inserting a coaxial catheter into the arterial circulation in order to remove the blood clot that is causing the Ischemic stroke. It is commonly performed in cerebral arteries and has proven to be very effective in treating Ischemic stroke patients. EVT personally saved my life after my left carotid artery dissected and an Ischemic stroke. 
• Craniectomy - Which is the removal (temporary) of a bone flap in the skull in order to reduce swelling of the brain due a stroke affecting large portions of the brain. This procedure has proven to reduce the risk of death of the patient, but with disability following recovery from the procedure.

Treatments of Hemorrhagic stroke: 

Patients that suffer hemorrhagic stroke are monitored in order control their:

• Blood pressure
• Blood sugar
• Oxygenation

Some patients might benefit from surgical intervention of the Hemorrhagic stroke, but it depends on the area of the brain that suffered.

I hope this post was useful in enriching your knowledge about strokes. After writing this post I reviewed my medical records and a lot more things became clear to me about my experience as a stroke in the young survivor. As mentioned at the beginning of the article I am not a medical expert and I recommend you use this information as a starting point in your journey of understanding this medical condition.

Stay strong,

Martin