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Lối sống lành mạnh : Glossary
Cerebral stroke
[2007-09-18 09:33] (1,245)

Outline

Most of the patients in the neurology department of a hospital are hospitalized due to cerebral strokes or paralysis. The annual incidence of cerebrovascular diseases may vary depending on the location, but it is generally estimated as 150-200 per 100,000 people. In Korea, we have been successful in decreasing cases of cerebrovascular diseases by treating high blood pressure, lowering the number of heart diseases, and controlling other risk factors that cause cerebrovascular diseases. However, cerebral strokes remain the third most common cause of death, following heart failures and body tumors.

 

Synonym

 

Stroke (中風), brain infarction, intracranial hemorrhage, CVA(cerebrovascular accident), Apoplexy

 

Definition

 

When the cerebral arteries are blocked or when they rupture, sudden symptoms appear including loss of awareness, loss of consciousness, paralysis, convulsions, etc. A patient having these symptoms would be diagnosed as having a cerebral stroke.

 

Symptoms

 

Cerebral strokes have various symptoms. Doctors should be careful in the diagnosis, since it is difficult to distinguish between ischemic and hemorrhagic strokes just based on the symptoms. A person having symptoms of cerebral stroke does not necessarily mean that the person definitely has cerebral stroke. However, a patient should be suspected of having a cerebral stroke if he/she shows the following symptoms:

  1. Change in awareness - the patient wakes up when awoken, but falls back to sleep or is in a state of coma, where he or she does not react to the environment
  2. Loss of consciousness - the patient has no strength and is lethargic. Before fainting, he/she may feel that the world has gone yellow and he/she loses consciousness for a short while
  3. Convulsions - involuntary movement of a part or parts of the body. The arms and legs may stiffen and the eyes may roll around
  4. Dementia and behavioral changes - the patient may forget what happened just moments ago and may show inappropriate behavior such as sudden crying or laughing without an apparent reason. He/she may show a completely different personality and seems to be a completely different person.
  5. Difficulty in walking - the patient may walk in small steps but is unable to lift the feet high up. He/she may walk like a drunk or worse may even be unable to walk due to paralysis.
  6. Headaches - headaches caused in cerebral strokes may occur before, after, or during the same time as the other symptoms.
  7. Difficulties in Language - the patient may be unable to articulate or may have an inaccurate accent. He/she may show problems in pronouncing certain words, may be able to comprehend, but is unable to talk.
  8. Problems in the body  - the patient may be unable to feel strength in the arms and the legs and may have paralysis or random movements of parts of the body

Cause, conditions and physiological Risk factors

    1. High blood pressure: High blood pressure is one of the main risk factors that increase the occurrence of thrombotic cerebral infarction and intracranial hemorrhage. There are no special standards regarding how high you can maintain your blood pressure, but cerebrovascular diseases have some correlation with the blood pressure. Usually, as the blood pressure increases, of the risk of having cerebral stroke also increases.
    2. Cardiac diseases: cardiac enlargement, cardiac failure, arrhythmia, rheumatic heart disease, and mitral valve disease are risk factors for cerebral strokes.
    3. Diabetes: The probability of having a cerebral stroke doubles if you have diabetes. Even if you effectively control the diabetic symptoms, the risk of having cerebral strokes does not decrease.
    4. Genetics: If a close relative had suffered from cerebral strokes, you have a much higher chance of getting a cerebral stroke.
    5. Blood fat, smoking, diet, and obesity: When comparing with the influence of these factors in coronary artery disease, the influence of these factors on the development of cerebral stroke is relatively lower.
    6. Hematocrit (hemoglobin): It is known that at high levels of hematocrit more cerebral strokes occur. Other than hematocrit, hematologic opinions, low dissolution of cellulose are also risk factors.

The pre-development phase of cerebrovascular disease is usually caused by unhealthy conditions of the cerebral arteries or problems in the blood circulation within the brain. These conditions cause a secondary cerebral disease, which can develop when any of the following occurs:

  • If the blood coagulates and block the arteries
  • If the vessel walls rupture
  • If there is too much atheroma on the vessel walls
  • If there is a problem with the normal components of the blood

When any of these occurs, two categories of brain injuries can happen:

    • ischemia or infarction - 85%
    • hemorrhagic disruption - 15%

Diagnosis

 

The preliminary diagnosis of cerebral stroke is made by listening to the symptoms of the patients from the patient or the guardian, determining the time when the symptoms started and inquiring about the different symptoms. The physician also auscultates, measures the blood pressure, reviews the other physical tests, and does a neurologic examination including the use of a rubber hammer (reflex hammer) and a pin or needle (for sensory exam) to determine the location and type of the cerebrovascular disease. Afterwards, the patient undergoes special tests such as the CT (computerized tomography) scan, magnetic resonance imaging (MRI), and vascular filming to determine the cause and location of the disease.

Progress, prognosis

 

Once a cerebral stroke occurs, the patient has a 30% fatality rate. The age of the patient, anatomic size of the clot, severity of damages and symptoms, and diseases related to the development of the stroke are all factors that determine the progress and prognosis of the cerebral stroke.

  1. Immediate result
    • Intracranial hemorrhage: mortality rate is estimated at 70%.
    • Cerebral infarction: Immediate death is relatively low at 25%. It is more fatal is when the injury causes complications such as brain edema and brain displacements. Embolic strokes (blood lumps from another location circulates the arteries and blocks a vessel) cause damage in the vessel itself, and has a better prognosis than thrombotic strokes (lumps form on the area of damage).  Also, deaths from strokes are caused by complications in the cardiac arteries and lungs, and occur within 1 week of the stroke. The level of consciousness of the patient when he reached the hospital also has an important relation with the short term results.
  2. Long term results
    • If the stroke was caused by blood clot originating from the neck arteries or the cardiovascular arteries, the long term prognosis is affected by the condition of the existing arteriosclerotic disease.
    • In case of intracranial hemorrhage, the possibility of survival depends on the cause of the bleeding and whether or not the patient received appropriate treatment.
    • Recent research shows that cerebral strokes recur in 40% of men and 20% of women.

Treatment

  1. The treatment of acute cerebral stroke: Once the patient is diagnosed as having a cerebral stroke through clinical history, neurologic exam, and diagnostic procedures, he/she should be treated immediately. It is important to use the CT scan before the treatment to distinguish between cerebral infarction and cerebral hemorrhage and to distinguish between types of intracranial hemorrhages. Basic treatment can repair the tissues near the stroke region and comprises of supplying adequate glucose and oxygen to prevent the worsening of injury and complications. Treatment also includes prevention of infection, cardiac insufficiencies, and cardiac arrhythmia as well as maintenance of hydration, oxygen, and blood pressure to protect the ischemic penumbra from further ischemia. Anticoagulant medications are also used to treat cerebral strokes. However, these medications can cause hemorrhagic strokes, thus limiting their use. If there is an embolic source in the heart, a relapse may occur, and anticoagulants are used. Recent treatment methods use blood solvents to reestablish blood flow, if the brain recovers its functions in a short time after the stroke (In practice, blood solvents are used when the patient presents within 3-6 hours after time of onset of symptoms. After this time period, blood solvents have limited use).
  2. The treatment method for each patient differs depending on the location of bleeding and the amount of bleeding. For hemorrhage of the cerebellum or deformity of arteries caused by outside pressure on the vessels, surgery can be used to remove the bleeding. If the hemorrhage or bleeding involves a vital part of the brain such that surgery may cause serious side effects, or if the hemorrhage is surgically inaccessible, it is treated with medications.

Preventions

 

The causes of cerebral strokes are relatively well-known and you can prevent this disease if you pay more attention. Once dead, the affected brain cells are unable to recover, so it is important to follow the preventive measures after the stroke as well. It is important to note the risk factors of cerebral stroke that you have and to follow the preventive measures below to prevent stroke.

  • Treatment of high blood pressure
  • No smoking
  • Correction of hyperlipidemia
  • Use anti-plaque medications: aspirin
  • Treating the conditions that can cause embolism such as irregular heartbeat

Consult a doctor in the following cases


When you experience symptoms of sudden difficulty in language, partial paralysis, abnormal senses, and abnormal eye sight; and then recover from these symptoms within 24 hours; this condition is called a Transient Ischemic Attack (TIA). It may be a preliminary sign of cerebral stroke, so do not rely on folk remedies and go to a hospital immediately for checkup. 

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