Stroking your way out?

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An uncle in my wife’s family has just died from a stroke in her village, so I may as well use that as the reason for this week’s column.  It is also a very common condition and one of the major causes of death and disability.

A stroke (also called a ‘cerebrovascular accident’ or CVA) occurs when blood vessels carrying oxygen to a specific part of the brain suddenly burst or become blocked.  When oxygen-rich blood fails to get through to the affected parts of the brain, the oxygen supply is cut off, and brain cells begin to die.

Strokes fall into several major categories, based on whether the disrupted blood supply is caused by a blocked blood vessel (also known as an ischemic stroke) or a hemorrhage.  Since each type of stroke has a different type of treatment, it is very important for the physician to determine the cause of the stroke, as well as the location, as quickly as possible.

Fortunately, it is no longer a case of guesswork, but several diagnostic studies may be needed to pinpoint the problem area, and to work out whether the stroke is from blockage or bleed.

Some of the treatment modalities include Computerized Tomography (CT) Scan which is generally the first diagnostic test done after a patient with a suspected stroke arrives in the emergency room.  It is used to quickly distinguish between an ischemic or hemorrhagic stroke.

Magnetic Resonance Imaging (MRI) is an advanced diagnostic tool that provides a high level of anatomic detail for precisely locating the stroke and determining the extent of damage.  Due to its high level of sensitivity, MRI is considered especially useful when the stroke involves small blood vessels.

Magnetic Resonance Angiography (MRA) is a new noninvasive technology for imaging the cerebral blood vessels, which yields valuable information regarding collateral (alternative) blood vessels in the brain. Carotid Duplex Scanning is a noninvasive study to diagnose blockage in the carotid arteries.  This technology involves recording sound waves that reflect the velocity of blood flow.

Transcranial Doppler (TCD) is a newer, noninvasive ultrasound procedure that allows the assessment of blood flow through the cerebral vessels via a small probe placed against the skull.  TCD is a portable test, which can be performed frequently at the patient’s bedside to follow the progress of medical treatment for stroke.

PET Scanning, which measures brain cell metabolism, can determine if brain tissue is functioning even if blood flow to that area appears to be diminished.

Cerebral Angiography (angiogram) is a diagnostic study that requires injection of a contrast dye through a major artery (usually the femoral artery in the thigh) for evaluation of blood flow to the brain.

So, are you having a stroke?  The warning signs of stroke include sudden weakness, numbness or paralysis of the face, arm or leg (especially on one side of the body), loss of speech or trouble talking or understanding language, sudden loss of vision, particularly in only one eye, sudden, severe headache with no apparent cause, unexplained dizziness, loss of balance or coordination (especially if associated with any of the above symptoms).

There are several risk factors, including:

Hypertension – having high blood pressure means the blood vessels are under more tension, and certain weaknesses (called aneurysms) can rupture.

Smoking – Smokers get more strokes than non-smokers.

Atherosclerosis – Deposits of cholesterol on the inside of the arteries predispose to blood clots being formed.

Diabetes – Uncontrolled diabetes puts the sufferer into a high risk category.

Alcohol and drug abuse – neither of these make life ‘better’!

Age – The chance of having a stroke increases with age.  Two-thirds of strokes occur in persons over the age of 65.

Gender – Stroke is 25 percent more common in men than in women.

Race – The incidence of stroke varies among races.  African-Americans have a higher incidence of hypertension than Caucasians, and also a higher rate of stroke.

Family or Individual History – A history of cerebrovascular disease in a family appears to be a contributing factor to stroke.

While you have no control over your family history, you can take steps to decrease your risk with medical advice.

Is it time to consult a brain specialist?