Ischemic stroke is cause by an interruption of blood flow to the brain, while hemorrhagic stroke is caused by bleeding inside the head. The following defines the various types of stroke:
When blood cannot get to the brain cells, they die within minutes to a few hours. Doctors call this area of dead cells an infarct.
The lack of normal blood flow to brain cells sets off a chain reaction called the "ischemic cascade." Over hours, this chain reaction endangers brain cells in a progressively larger area of brain where blood supply is compromised but not completely cut off. Prompt medical treatment offers the best chance of salvaging this region of brain cells, called the "penumbra."
Immediate medical care is critical. New treatments work only if given within a few hours after the onset of a stroke. For example, a clot-busting drug recently approved by FDA must be given within three hours.
Before treatment, the neurologist or emergency physician must carefully examine the patient to determine the patientís condition and what caused the stroke. Diagnostic tests to determine treatment could include:
Once the doctor completes these tests, the treatment is selected. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blockage of blood to the brain, treatment could include:
If the stroke is caused by bleeding, treatment could include:
After having a stroke, many people will be left with some disability. The disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body and in right-handed individuals it is important for attention and visual-spatial skills. The left side of the brain controls the right side of the body and in right-handed individuals (and 50 percent of left-handed individuals) controls language- speaking and understanding. Language disorders are also called "aphasias."
Rehabilitation helps restore functions lost from damage due to stroke. During rehabilitation, most patients will improve to some degree, but many do not recover completely. Unlike skin cells, brain cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable and patients can learn new ways of functioning, using other, undamaged brain cells. This stage is often a challenge as the patient and family work as part of the medical team.
A stroke patientís rehabilitation team may include physical, occupational, and speech therapists; nurses; and doctors. Most of the improvement will take place in the first three to six months of the rehabilitation process, but some patients can make excellent progress over longer periods of time.
Some risk factors- age, sex, race, and a history of stroke in the family-cannot be changed, but others can be controlled. Most controllable risk factors relate to the health of the heart and blood vessels. The following can help prevent stroke:
A massive effort is underway throughout the United States and the world, involving thousands of scientists studying all aspects of stroke: genetic factors; new diagnostic tools to detect early stroke; drugs and techniques to prevent or reduce stroke; drugs to improve stroke recovery; new ways of opening blocked blood vessels; and improved methods in prevention and rehabilitation. To date, the most significant progress has been increased understanding and prevention of the causes of stroke and improved emergency care of stroke patients. Much of this process and all new treatments have come from studies using animal models of stroke. Continues research is needed and should improve prevention and survival of stroke.
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