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Transcript of Stroke
Umema Rafay What is Stroke? 400 BCE Symptoms How a person's daily life is affected? Research on finding a cure Cost A stroke or brain attack is a sudden loss of brain function. Stroke causes the brain cells or neurons in the affected part of the brain to die and loose function.
There are two main types of stroke:
Ischemic stroke, which occurs when there is an interruption or lack of blood flow to the brain caused by a clot.
Hemorrhagic stroke, which occurs when there is an interruption of blood flow to the brain due to the rupture of blood vessels in the brain .
Stroke can be major or minor.
When permanent damage occurs, it is considered a major stroke.
A minor or mini stroke occurs when symptoms last less than 24 hours and generally does not cause permanent brain damage. These are known as transient ischemic attack (TIA). TIA is considered a warning sign of major stroke. A sudden weakness or loss of strength or sudden numbness in a part of the body; mostly face, arm or leg.
A sudden difficulty speaking or understanding or a sudden confusion.
A sudden trouble with vision.
A sudden loss of balance.
A sudden severe and unusual headache. Research in stroke is focused on preventing stroke from happening, finding a cure and improving the functional outcomes in stroke survivors.
Some important research projects include the following:
Education and measures to identify stroke symptoms early.
New diagnostic methods to image stroke and arteries.
Finding ways to decrease the burden of risk factors of stroke including smoking, obesity, heart disease, high blood pressure and cholesterol, etc.
Identifying genetic risks for having stroke and its risk factors.
Developing new and better clot busting drugs.
Facilitating regeneration of new neurons around dead neurons.
Improved rehabilitation therapy. A stroke does not just affect one person, it has a ripple effect. It affects the whole community and the country.
The annual cost of stroke in Canada is estimated to be $3.6 billion and the per person cost is $15,000 CAD for the first 30 days. The cost is related to money spent on doctors services, hospital expenses, medications and home care. In addition, the cost is related to the fact that the person is unable to work resulting in decreased productivity and loss of salary. Affects How our body fights the disease? Tests Some diagnostic tests your doctor may conduct if you have symptoms of a stroke may be:
Blood pressure measurement
Head CT or CAT scan
Brain Magnetic Resonance Imaging (MRI)
Blood test and urine test
Brain angiography or arteriography
Carotid Doppler ultrasound
Holter or event monitoring
Electroencephalogram (EEG) What causes brain damage? In stroke, damage to the brain is caused by either:
a decreased or absence of blood supply to a part of brain caused by a clot, or
damage caused by the large pool of blood causing pressure and decreased blood supply to a part of the brain.
Any interruption in blood supply to the brain results in lack of oxygen and nutrients. The longer the brain goes without oxygen and nutrients supplied by blood flow, the greater the risk of permanent brain damage. Ages Affected by Stroke Stroke can affect any age. Although it is common in adults, it can also occur in children.
As one gets older, the risk of stroke increases.
Most strokes occur in people over age 65.
Men over the age of 55 and older women are at a greater risk.
In children, there are 7 strokes for every 100,000 Canadian children under the age of 19. When someone has a stroke, they have difficulty with their own chores such as eating, dressing, walking, bathing and shopping. As a result they become either completely or partially dependent on others for their day to day activities. They may also have difficulty communicating or interacting with their friends and family because of speech and behavioral problems which leads to confusion and frustration. They may not be able to drive or learn or remember new things. These physical and mental difficulties lead to inability to work effectively on their jobs which is necessary to earn a living and support themselves and their family. Stroke Statistics in North America There are about 50,000 strokes in Canada each year (that’s one stroke every 10 minutes) and 795,000 strokes in America each year (that means, on average, one stroke occurs every 40 seconds).
Stroke is the third leading cause of death in Canada and fourth in USA.
Six percent of all deaths in Canada and USA are due to stroke. That means, every 4 minutes someone dies of stroke.
About 300,000 Canadians are currently living with stroke.
Nine in ten Canadians (90%) have at least one risk factor for stroke.
After age 55, the risk of stroke doubles every 10 years.
A stroke survivor has a 20% chance of having another stroke within 2 years. A stroke may lead to disability and death. It can affect ones ability to walk, talk, eat, understand, express emotions and learn or remember new information.
Of every 100 people who have a stroke:
10% recover completely and lead a normal life.
25% recover with a minor disability.
40% are left with a moderate to severe disability.
10% are quite severely disabled and would require long-term care.
Each hour the treatment is delayed, the brain loses many neurons which may be equal to 3.6 years of normal aging. Stroke leads to the death of neurons and hence loss of its connection with other neurons. This is how the brain function is affected. Most of the time death of the neurons is permanent with permanent loss of function. However, the brain tries to heal by growing new neurons and connections which helps to recover brain function. Most often, other areas of the brain take over function of the dead or damaged area of the brain. This mechanism is known as neuronal plasticity which only occurs in the brain and is not seen anywhere else in the body. This unique ability of the brain allows the body to recover function and fight back the diseased or damaged brain. F.A.S.T. F.A.S.T is a campaign run by Heart and Stroke Foundation Canada to reduce, prevent and treat stroke early.
The acronym F.A.S.T. stands for:
F = Face: Is one side of the face drooping down?
A = Arm: Can the person raise both arms, or is one arm weak?
S = Speech: Is speech slurred or confusing?
T = Time: Time is critical!! Call 9-1-1 immediately!
Heart and Stroke Foundation Canada advises everyone to remember the acronym F.A.S.T. since it will improve recognition and treatment of stroke early. Stroke Statistics The World Health Organization (WHO) estimates, stroke is one of the leading causes of death worldwide and may account for well over 10% of all deaths.
In stroke survivors it results in significant long-term physical and mental disability which then leads to decreased quality of life in the individual and economic burden affecting not just the stroke victim but also the whole community.
Each year, more women than men die from stroke. Stroke was first recognized by an ancient greek physician named Hippocrates around 400 BCE.
Stroke used to be called "apoplexy" which is greek for "struck down by violence". It was not until 1599 that the name was changed to stroke. Around 1658 Jacob Wepfer discovered that patients with stroke actually had a disruption of blood flow to the brain because of bleeding in the brain or blockage in one of the brain's blood vessels. Following that discovery, much has been done in the field of stroke especially with regards to identifying different types of stroke . History Cures and Treatments There are three main treatments for acute or new ischemic stroke.
One is to use tissue plasminogen activator (tPA) which is a thrombolytic drug (a drug that dissolves blood clots). This drug can only be given to a patient having an ischemic stroke. This drug must be given to the patient intravenously within four and a half hours of symptoms.
After four and a half hours of symptoms, the drug can be given directly into a brain artery through a catheter. A catheter is a thin, flexible tube that transports drugs or dyes into the blood vessels or the brain. However, tPA can not be given intravenously after four and a half hours and via catheter after six hours of onset symptoms because of the risk of brain hemorrhage that can be caused by the tPA.
Another way to treat ischemic stroke is surgery. Surgery may be used to reduce the brain swelling caused by stroke or to prevent another stroke from happening by removing the clot or the arterial disease. For example, to remove plaque from the neck artery. Ischemic Stroke Hemorrhagic Stroke Hemorrhagic stroke is either treated by treating the patient's high blood pressure or other causes that caused the bleeding in the brain. It can also be treated with surgery. Surgery is usually used for patients that have suffered large bleeds in their brain. In these patients surgery is done to remove blood that has pooled in the brain and is causing ongoing brain damage or to repair ruptured blood vessels. 1600s 1900s The major breakthrough in the diagnosis of stroke came in 1972 when computed tomography (CT) imaging was invented. The CT is a non-invasive X ray technology that generates computer processed images for the assessment of different body parts. CT head made its breakthrough in the late 1900`s to diagnose stroke and hemorrhage in brain.
Following that, during 1995 -1998, MRI brain, which is a more sophisticated test for brain imaging was invented. Since then, several improvements have been made and being made in the diagnosis and treatment of stroke. Conclusion In today's brief presentation, I have gone over some important and vital stroke facts. However, I do want you all to take into account the hard fact that during these 10 minutes, at least one person every 45 seconds somewhere in the world has suffered a stroke, that is 14-15 people and at least 2 people have died in Canada and USA due to stroke. Stroke Treatment Most of the stroke treatments are aimed at improving the effects of stroke (or recovery from stroke). However, some treatments discovered in the last 2 decades have completely modified acute stroke care and have led to complete cure or excellent recovery from stroke. The two main players are: the clot busting drug and the immediate surgery to remove blood clot or clots from the brain and or its arteries which results in prevention of permanent brain damage. However, the key is timely administration of these therapies in a narrow time window (usually 4 - 6 hours). hence the term, "TIME IS BRAIN" Stroke Treatment and Prevention In addition, to acute stroke treatment, an important component of stroke treatment is stroke prevention.
Stroke prevention means preventing any stroke from happening, either first stroke or another stroke following the initial stroke.
Treatments aimed at stroke prevention are:
Reduction or treatment of risk factors including
high blood pressure, smoking, obesity, high blood cholesterol, heart disease, diabetes, stress, physical inactivity, etc.
Prevention of blood clot formation by use of blood thinning medicines such as Aspirin, Warfarin and Heparin is another treatment aimed at stroke prevention.