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Stroke

Background Knowledge 🧠

Definition

  • A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types: ischaemic (due to lack of blood flow) and haemorrhagic (due to bleeding).

Epidemiology

  • A leading cause of disability and death worldwide.
  • Risk increases with age, but strokes can occur at any age.

Pathophysiology

  • Ischaemic Stroke:
    • Accounts for about 85% of strokes.
    • Caused by interruption of blood flow due to a blood clot (thrombosis) or embolism.
    • Results in cerebral infarction.
  • Haemorrhagic Stroke:
    • Accounts for about 15% of strokes.
    • Caused by bleeding either within the brain (intracerebral) or into the subarachnoid space (subarachnoid haemorrhage).

Risk Factors

  • Hypertension
  • Diabetes
  • Smoking
  • Obesity
  • High cholesterol
  • Atrial fibrillation
  • Previous stroke or transient ischaemic attack (TIA)
  • Family history
  • Age

Clinical Features πŸŒ‘️

Clinical Presentation

  • Sudden onset of neurological deficit, such as weakness or numbness on one side of the body, difficulty speaking or understanding speech, vision problems, dizziness, and loss of balance.
  • FAST (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services) is a quick tool to recognize stroke symptoms.

Investigations πŸ§ͺ

Investigations

  • Clinical assessment using the National Institutes of Health Stroke Scale (NIHSS).
  • Imaging: CT scan or MRI to differentiate between ischaemic and haemorrhagic stroke.
  • Additional tests: Carotid ultrasound, echocardiogram, blood tests.

Management πŸ₯Ό

Management

  • Ischaemic Stroke: Thrombolysis (e.g., IV alteplase), mechanical thrombectomy.
  • Haemorrhagic Stroke: Control of blood pressure, surgery or endovascular proceduresΒ to control bleeding.
  • Secondary prevention: Antiplatelets (e.g., aspirin), anticoagulants (for atrial fibrillation), control of risk factors.

Rehabilitation

  • Physical, occupational, and speech therapy.
  • Multidisciplinary approach to help regain as much function as possible.

Prognosis

  • Depends on stroke type, severity, rapidity of treatment, and presence of comorbid conditions.
  • Early treatment improves outcomes significantly.

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