Stroke. For Stroke Rehabilitation, please click here

Definition

Stroke refers to a condtion whereby a person shows signs and experiences symptoms of disruption on brain functions. It is sudden(onset is seconds to minutes) and usually lasts for more than twenty four hours. Stroke usually results into three things:
  • Full recovery
  • Permanent disability
  • Death

How does stroke come about?

Stroke usually comes in because blood supply to some sections of the brain was interupted. It can be either that the blood pressure was too high (malignant hypertension) or it was too low. Malignant hypertension or severe high blood pressure, in non medical language, can damage the blood vessels in the brain and this damage may lead to rupture of the blood vessel and it's consequential haemorrhage (bleeding).

The number one cause of stroke is degenerative arterial disease i.e. the artery strength is compromised and this usually happens due to atherosclerosis i.e. deposition of lipid(fatty) substance in the inner blood vessel. Artherosclerosis oftentimes occur in the large or medium sized blood vessels and results in:

  • Narrowing of blood vessels
  • This would eventually lead to increased blood pressure Calcium accumulating in the walls of the blood vessel.This hardens the blood vessels and reduces it's ability to stretch when blood volume increases. This eventually may facilitate rupture of the blood vessel in times of increased blood pressure within limited elastic control.
  • Fibrosis i.e. formation of fibrous tissue as a reparative process since the blood vessels has been damaged

When the denegeration involves small blood vessels, it is called lipohyalinosis

Risk factors for catching a stroke

  • Aging

    As you age, your blood vessels naturally harden and fatty deposists increase. This reduces the ability of the vessels to accomodate huge fluid volumes. This puts much strain on the walls of the blood vessels and eventually a rupture may happen

  • Smoking

    Somking is the most evil of all the risk factors in terms of cardiovascular problems. Smoking is very destructive to your heart

  • Alcoholism

    Excessive intake of alcohol has profound detrimental effects on the circulatory system. Alcohol may lead to fluid loss (dehydration) through suppression of the hypothalumus and the eventual loss of huge amounts of water a from the body. This results in substatial falls of blood pressure which can then deprive the brain of adequate supplies of oxygen

  • Family history of blood vessel disease: Other connditions are genetic
  • Diabetes melitus
  • HIV/AIDS
  • Sedentary lifestyle
  • Plasma fibrinogen
  • Hypercholesterolaemia: increased cholesterol in the blood from food intake or other metabolic conditions
  • Oestrogen oral contraceptives

Through my clinical experience, a major cause/risk of Stroke in Malawi is High Blood Pressure(Hypertension)

Blood Vessel Mechanisms through which Stroke develops

There are two widely known mechanisms on which a stroke can develop through:

  • Death of some parts of the brain i.e. Infarction

    Parts of the brain may die because they did not receive oxygen in time. This can happen due to blockade of the blood vessesl by a clot (thrombus) or any foreign body (embolus). Thrombolism or clot formation can happend in the blood vessels because of different factors. Well studied factors are what is reffered to as the Virchow's triad:

    • blood vessels having abnormalities e.g. rough surfaces of the blood vessel
    • blood itself having abnormalities e.g. the blood being more thin or being more thick (viscosity issues)
    • blood flow disturbances e.g. the blood flowing with turbulence because of the increased blood pressure
    Embolism or presence of a foreign substance in the blood can also cause stroke. This foreign material/substance can be a solid thing such as a fatty deposit os some gas. If this interupts oxygene supply to some section of the brain for some time, it can lead to a stroke.

  • Bleeding

    Bleeding (haemorrhage) can take place in the brain due to multiple reasons. For instance, a person can have clotting probles and if this is coupled with increased blood pressure, bleeding may happen in the brain. This would lead to some parts of the brain being deprived of oxygen and hence death of that brain section. This is what is called crerebral infarction i.e. brain death. Sometimes the blood may be thinned because of medicines that you are taking so it may also pose a stroke risk. You need not to take medicines anyhow.

Signs of Stroke: What do you see when one has a stroke

How can you know if someone is having a stroke?

The FAST approach

  • Face: When you look at their face the mouth may look deviated to one side
  • Arms: They may fail to lift both arms.
  • Speech: Their speechmay be slurred and they may not unnderstand you
  • Time: Time is critical. It may help a lot if their receive medical intervention within the first 3 hours of the incident.

This FAST approach should be a common knowledge to everyone if we are to improve outcomes after a stroke.

What you observe or see when someone has a stroke it depends on the part of the brain affected. For example, if the much of the right side of the brain has been affected, you'll note that the person fails to move left side organs. When the left side of the brain has been affected, the problems are noted to the right side of the body. Some of the common things you may be able to notice include:

  • Paralysis of the limbs: legs and arms may lose function
  • Loss of sight: a person may not be able to see
  • Difficulties with speaking or swallowing
  • Difficulties hearing
  • Stiffening of the limbs: arms and legs
  • Loss of sexual function
  • Pain of the shoulders
  • Facial appearance changes

Complications of Stroke

Stroke has several complications. The first is death. If one survives stroke, they may be at a risk of many conditions including the following:

  • Aspiration penumonia: pneumonia due to foreign material getting into the lungs because a person fails to control swallowing
  • Pressure sores due to immobility
  • Septicaemia i.e. blood infection through the open wounds that may come in due to immobility
  • Deep vein thrombosis that usually result due to the effects of immobility
  • Loss of joint range of motion
  • Loss of independence
  • Muscle wasting
  • Reduced bone density and consequential osteoporosis
  • Reduced lung capacity
  • Depression
  • Contractures
  • Epilepsy
  • Falls and fractures

Treatment of Stroke

Stroke management depends on the phase and presetation of the patient. Stroke is managed by a team of different professional for optimal outcomes

Medical Management

Medical management involves addressing the causative agent of the condition. It also looks at dealing with life-threatening complications usualy in the acute phase of stroke

Rehabilitation

Stroke patients benefit a lot from rehabilitation. The team of rehabilitation professionals include Physiotherapists, who look at movement problems; occupational therapists, who address problems to do with activities of daily living; Speech/language pathologists/therapist, who help with swallowing and speech problems; social workers, who help with community reintegration of the patient. There are also many other who help in the management of stroke for the meaning outcomes in the patient. The clergy are also a reliable pillar in stroke management

How to prevent Stroke

The risk of developing a stroke can be reduced greatly by modifying our lifestyles, especially quitting smoking. Some of the preventive ways include:

  • Stopping alcoholism
  • Eating diets with less fat and low salt
  • Doing exercises regularly
  • Taking antihypertensive medicines as prescribed
  • Use of cholesterol lowering medicines for those at risk
  • Regular blood pressure checks

Transient Ischaemic Attack (TIA)

Sometimes a person can experience a stroke-like episode but that resolves within 24 hours. This is called a transient ischaemic attack. Recovery is complete but there is a need to seek medical attention because it means you are at an increased risk of developing a fully blown stroke. Transient ischaemic attacks that lasts for more than 24hours but with complete recovery are called reversible ischaemic neurologic deficits

References


Cardiopulmonary Physiotherapy
Chimwemwe Masina, PT

Author: Chimwemwe Masina

Chimwemwe Masina is currently working as a Resident Physiotherapist at DDT College of Medicine in Gaborone, Botswana. Before joining DDT College of Medicine, he worked in the Ministry of Health at Kamuzu Central Hospital in Malawi, MagWaz Physiotherapy and Wellness Services in Lilongwe, Malawi. as well as Volunteering at Physiopedia.
His interest is in Neuromusculoskeletal Physiotherapy and currently he is an assisting lecturer in Manual Therapy and Lumbar Spine Management.

Disclaimer! Information provided on this page is for educational purposes only and is not meant for specific medical intervention. If you have a medical problem, please contact us or consult a certified medical professional