Cerebral Stroke Assignment Discussion Paper
Cerebral stroke is one type of major clinical issue, which can be prevented by leading healthy lifestyle. Cerebral stroke usually caused by reduction or interruption of the blood supply within the brain. The reduced or lack of blood supply in the brain results in poor oxygen supply leads to dying of brain cells that cause cerebral stroke (medlineplus.gov, 2021). The decreased flow of blood could also be caused due to blockage in the brain or ruptured artery. Cerebral stroke can be classified into 3 types such as ischemic Stroke, transient ischemic stroke and haemorrhagic stroke (mayoclinic.org, 2021). Ischemic stroke is the first type of cerebral stroke that includes a blockage result in by either clot formation or plaque formation in the artery. The severity and symptoms of ischemic stroke can remain for prolonged period compared to transient ischemic stroke (Hui, Tadi & Patti, 2018). Transient ischemic attack caused due to blood clotting that last for shorter period of time which normally reverse on its own. On other hand, ischemic stroke may become permanent (Amarenco, 2020). Another type is the haemorrhagic stroke that resulted in by either leaking or burst of blood vessel, which seeps into the brain.
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It has been seen that two major causes are there that cause cerebral stroke. First cause is the blockage in the artery and second one is bursting or leaking of the blood vessel in the brain. A transient ischemic stroke is a temporary interruption of flow of blood to the brain, which does not yield permanent symptoms in affected persons (mayoclinic.org, 2021).
The arteries delivering blood to the brain constrict or get clogged amidst an ischemic stroke. These obstructions are resulted in by blood clots or a substantial reduction in brain blood flow. They can also be caused by breaking off of plaques as well as obstructing a blood artery. A cerebral embolism (also known as an embolic stroke) happens when clotting of blood develops in another region of the body, most commonly the arteries connected to brain, and travels through the circulation until it reaches an artery that is too narrow to pass it. The clot becomes trapped, stopping the flow of blood and resulting in a stroke. On the other hand, cerebral thrombosis (thrombotic stroke) happens when a form of blood inside a blood vessel’s lipid plaque (radiologyinfo.org, 2021). Another is hemorrhagic stroke that occurs when a blood vessel presents in the brain spills or bursts. Blood flowing in that artery creates vast pressure in the skull and results in the brain to enlarge, and creating a damage to brain cells or tissues. Intracerebral hemorrhagic stroke is the most common kind of hemorrhagic stroke. It happens when an artery bursts, allowing blood to flood the tissues around the brain. A subarachnoid hemorrhagic stroke is a rare event. It causes bleeding in both the brain and the cells that around it (mayoclinic.org, 2021).
Figure 1: Causes of stroke
(Source: https://www.verywellhealth.com/stroke-causes-4014093)
Figure 2: Risk factors of stroke
(Source: https://www.chihealth.com/en/services/neuro/neurological-conditions/stroke/stroke-prevention.html)
First risk is lifestyle risk factors such as physical inactivity, being overweight or obese, heavy drinking. Following risk factor is medical risk such as high cholesterol, high blood pressure, active and passive smoking, diabetes, cardiovascular disease, including heart defects, heart failure, irregular heart rhythm or atrial fibrillation and family history (medlineplus.gov, 2021).
The first one is ischemic brain stroke, where ischemic occlusion generates embolic and thrombotic events in the brain. The constriction of the veins because of atherosclerosis affects flow of the blood in thrombosis. Buildup of plaque will ultimately narrow the vascular chamber as well as result in clots, causing thrombotic stroke. Minimal blood supply to the area of brain develops an embolism; and flow of blood to the brain reduces, creating acute stress as well as premature cell death (also termed as necrosis). After necrosis, the disruption of plasma membrane is taken place, organelles grow and leak components of cell into the extracellular environment, and the function of neuron is lost (Woodruff et al., 2011). Inflammation, energy depletion, homeostasis loss, increased intracellular calcium levels, acidosis, excitatory toxicity, free radical-mediated cytotoxicity, cytotoxicity mediated by cytokine, oxidative stress, impaired blood-brain barrier, and infiltration of leukocyte are all crucial factors in pathology of stroke.
Figure 3: Two types of strokes
(Source: https://www.cdc.gov/stroke/types_of_stroke.htm)
On other hand, in Hemorrhagic stroke, internal injury as well as stress result in the rupture of the blood vessels and tissues in the brain. It causes toxic effects in the cerebrovascular system, resulting in infarction. Hemorrhagic stroke is categorized into intracerebral hemorrhage and subarachnoid hemorrhage (Kuriakose & Xiao, 2020). In ICH, rupture of blood vessels, causing an accumulation of blood abnormally in the brain. The main causes of ICH include hypertension, altered vasculature, as well as excessive utilization of thrombolytic and anticoagulant medicines. In subarachnoid hemorrhage, blood gathers in the subarachnoid space of the brain as an outcome of a head injury or bitterly said as a cerebral aneurysm (Kuriakose & Xiao, 2020).
Computerized tomography (CT) scan: The first diagnosis test is CT scan, which employs a series of X-rays that provide a detailed image of the brain. CT scan effectively show the bleeding in the brain, presence of a tumor or any other conditions (Provost et al., 2019).
Magnetic resonance imaging (MRI): An MRI employs strong magnetic field as well as radio waves to develop a detailed image of the brain. An MRI can measure the damage of the brain tissue by an ischemic stroke as well as hemorrhages (Provost et al., 2019).
Figure 5: Brain imaging (MRI scan)
(Source: https://www.verywellhealth.com/mri-or-ct-scan-2488814)
Carotid ultrasound: Throughout this test, sound waves generate detailed images of the interior portions of the carotid arteries. This examination detects fatty deposits (plaques) as well as blood circulation in the carotid arteries.
Cerebral angiogram: This is not recommended very often. A flexible catheter is introduced by a tiny incision, commonly in the groyne, and guided through the main arteries and into the carotid or vertebral artery in more complicated instances. This method provides a thorough image of the brain and neck arteries.
There are several strategies that prevent the chances of cerebral stroke. Such as
Controlling high blood pressure (hypertension): High blood pressure or hypertension is a major cause of cerebral stroke. By lowering the blood pressure, a person can reduce the risk of developing clotting and plaque formation which prevent stroke or subsequent TIA (Boehme, Esenwa & Elkind, 2017).
Lowering the intake of cholesterol and saturated fat: Eating less cholesterol as well as fat, such as saturated and trans fats, decrease the build-up of plaque in the arteries. Amount of cholesterol can be reduced through dietary modifications alone, and hence a cholesterol-lowering medication can be taken (Boehme, Esenwa & Elkind, 2017).
Figure 5: Prevention of Stroke
(Source: https://www.saebo.com/blog/preventing-second-stroke-8-habits-need-rebuild/)
Tobacco usage needs to be discontinued. For active smokers and passive smokers, it increases the chance of stroke. Smoking cessation lowers the hazard of stroke.
Taking care of diabetes: Physical activity, diet, as well as weight loss can all help people maintain a healthy level of blood sugar. If lifestyle modification does not appear to be sufficient, diabetic medication can be used. By keeping a healthy body weight, other risk factors of stroke, such as increased blood pressure, heart disease, as well as diabetes, being overweight (Boehme, Esenwa & Elkind, 2017).
In a number of methods, regular aerobic activity reduces the risk of stroke. Exercise can help lower blood pressure, boost healthy cholesterol levels, and improve blood vessel as well as heart health in general. It also helps with weight reduction and diabetes control. (Pinckard et al., 2019).
Tissue plasminogen activator (tPA): Amidst a stroke, this essential drug might be administered to destroy up the blood clot that is triggering the stroke. This is the only medicine that can accomplish this right now, but it has to be taken within 3 -4.5 hours after the onset of stroke symptoms. This medicine is injected into a blood artery so that it can begin working as soon as possible, minimizing the risk of stroke consequences (Jilani & Siddiqui, 2021).
Anticoagulants: These drugs decrease the ability of blood to clot. Warfarin is known as the most abundantly used anticoagulant. This medication can moreover prevent existing clotting of blood from becoming severe (Abbas, Malicke & Schramski, 2019). Hence, this medication is prescribed the patients to prevent a stroke, or given just after occurrence of TIA or ischemic stroke.
Antiplatelet drugs: These drugs work by making it more difficult for platelets in the blood to bind together, preventing blood clots. Aspirin as well as clopidogrel are two of the most often used antiplatelet medications. Ischemic strokes can be prevented using these medications. They are particularly essential in the prevention of subsequent stroke (Hackam & Spence, 2019).
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The reduced or lack of blood supply in the brain results in poor oxygen supply leads to dying of brain cells that cause cerebral stroke. Cerebral stroke can be classified into three types such as ischemic Stroke, transient ischemic stroke and hemorrhagic stroke. lifestyle risk factors such as physical inactivity, being overweight or obese, heavy drinking, high blood pressure, high cholesterol, active and passive smoking, diabetes, cardiovascular disease are the major risk factors of cerebral stroke. People should take preventive actions such as lifestyle modification like physical exercises, healthy diets, avoid smoking and minimizing the cholesterol and blood glucose levels. Cerebral Stroke Assignment Discussion Paper