A stroke is a medical emergency. It occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts, resulting in damage to the brain from interruption of its blood supply. Stroke is a disease that affects the arteries leading to and within the brain.
There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn’t cause lasting symptoms.
Sometimes stress can cause inflammation, hypertension, or other vascular conditions — and it’s these that can lead to stroke or heart attack.
The three main types of stroke are:
- Ischemic stroke.
- Hemorrhagic stroke.
- Transient ischemic attack (a warning or “mini-stroke”)
SYMPTOMS: Usually, it requires a medical diagnosis to detect a stroke. However, symptoms of stroke include trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm or leg.
Stroke symptoms typically last more than 24 hours, and may or may not resolve, even with therapy. Some stroke symptoms may never resolve or get better. TIA symptoms last for a short time.
Symptoms can begin to resolve in about 1 to 5 minutes, which is typical, but some may take about 24 hours to resolve. People may experience the following;
Muscular: Difficulty walking, paralysis with weak muscles, problems with coordination, stiff muscles, overactive reflexes, or paralysis of one side of the body
Visual: Blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye
Speech: Difficulty speaking, slurred speech, or speech loss
Whole-body: fatigue, light-headedness, or vertigo
Limbs: numbness or weakness
Sensory: pins and needles or reduced sensation of touch
Facial: muscle weakness or numbness
Also common: balance disorder, difficulty swallowing, headache, inability to understand, mental confusion, or nystagmus.
- Sudden vision problems in one or both eyes.
- Sudden difficulty walking or dizziness, loss of balance or problems with coordination.
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
- Sudden confusion, trouble speaking, or difficulty understanding speech.
- Sudden trouble seeing in one or both eyes.
PREVENTION: Healthy Living – Viscous blood causes the body to retain sodium and increases blood pressure. Drinking enough water regularly prevents dehydration. This may play a role in keeping the blood less viscous, which in turn prevents a stroke
- Choose healthy foods and drinks. Choosing healthy meal and snack options can help you prevent stroke,
- Keep a healthy weight. Having overweight or obesity increases your risk for stroke,
- Get regular physical activity,
- Avoid smoking
- Avoid or minimize drinking alcoholic drinks
- Check cholesterol,
- Keep your blood pressure under control,
- Control diabetes.
Treatment of stroke consists of blood thinners. Early treatment with medication like tPA (clot buster) can minimise brain damage. Other treatments focus on limiting complications and preventing additional strokes. Medications may include but are not limited to the following; Alteplase, Anticoagulant, Statin, Antihypertensive drug, and ACE inhibitor.
Alteplase is recommended for treating blood clots. Alteplase is a thrombolytic medication, used to treat acute ischemic stroke, acute ST-elevation myocardial infarction, pulmonary embolism associated with low blood pressure, and blocked central venous catheter. It is given by injection into a vein or artery.
Alteplase injection is used to dissolve blood clots that have formed in the blood vessels. It is used immediately after symptoms of a heart attack occur to improve patient survival. It is also used after symptoms of a stroke and to treat blood clots in the lungs (pulmonary embolism)
Alteplase converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen. Intravenous alteplase is cleared primarily by the liver with an initial half-life of fewer than 5 minutes and a terminal half-life of 72 minutes.
The recommended treatment dose of Activase is 0.9 mg/kg (not to exceed 90 mg total treatment dose) infused over 60 minutes. 6
- 10% of the total treatment dose should be administered as an initial bolus over 1 minute.
- The remaining treatment dose should be infused intravenously over 60 minutes.
Side effects: The most common side effect of Activase is bleeding, including gastrointestinal bleeding, genitourinary bleeding, bruising, nosebleed, and bleeding gums. Other side effects of Activase include Nausea, Vomiting, Low blood pressure (hypotension), Dizziness, Mild fever, or allergic reactions (swelling, rash, hives).
Anticoagulant – Unwanted reactions from taking drugs that inhibit blood clotting. The most common problem is too much bleeding, which can be very serious.
Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce the coagulation of blood, prolonging the clotting time.
Advil – Ibuprofen (Advil) is considered a blood thinner. It doesn’t actually “thin” your blood, but slows down your blood clotting time. For example, if you cut yourself or have an injury where you bleed, it may take longer for you to form a blood clot.
Turmeric – The active ingredient in turmeric is curcumin which has anti-inflammatory and blood-thinning or anticoagulant properties. A study published in 2012 suggests that taking a daily dose of turmeric spice may help people maintain the anticoagulant status of their blood.
Contraindications to anticoagulation used to define the contraindication group were: haemorrhagic stroke, major bleeding (gastrointestinal, intracranial, intraocular, retroperitoneal), and bleeding disorders (haemophilia, other haemorrhagic disorders, thrombocytopenia), peptic ulcer, oesophageal varices, aneurysm, etc.
Statin – Decreases the liver’s production of harmful cholesterol.
Statins, also known as HMG-CoA reductase inhibitors, are a class of lipid-lowering medications that reduce illness and mortality in those who are at high risk of cardiovascular disease. They are the most common cholesterol-lowering drugs.
Some cholesterol-lowering alternatives to statins are as follows;
- Fibrates. Mostly used for lowering triglyceride levels in patients whose levels are very high and could cause pancreatitis,
- Plant stanols and sterols,
- Cholestyramine and other bile acid-binding resins,
- Niacin,
- Policosanol,
- Red yeast rice extract (RYRE),
- Natural products.
Experts advise that statins should never be used in patients during pregnancy. However, most patients should still stop statins once they learn they are pregnant.
Indications of statin in clinical practice. Statins are indicated as an adjunct to diet to reduce elevated total cholesterol, LDL cholesterol, apolipoprotein B and triglycerides; and to increase HDL cholesterol in patients with: Primary hypercholesterolaemia.
Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Antihypertensive drug lowers blood pressure.
Many antihypertensive drugs have their primary action on systemic vascular resistance. Some of these drugs produce vasodilation by interfering with sympathetic adrenergic vascular tone (sympatholytics) or by blocking the formation of angiotensin II or its vascular receptors.
Antihypertensive drugs are administered once a day, in principle, but as it is more important to control the blood pressure over 24 h, splitting the dose into twice a day is desirable in some situations. The use of two or three drugs in combination is often necessary to achieve the target of blood pressure control.
Antihypertensives treat high blood pressure, or hypertension, with the goal of keeping your heart strong and preventing heart failure, a heart attack, kidney failure or a stroke. High blood pressure makes your heart’s job more difficult and more demanding.
Most antihypertensives are taken in the morning at about 6 am to 7 am and achieve peak concentrations in 60 to 90 minutes. Therefore, when BP is measured in the usual clinical setting, the antihypertensive effect is at its maximum.
ACE inhibitor – Relaxes blood vessels, lowers blood pressure and prevents diabetes-related kidney damage.
- Angiotensin-converting-enzyme inhibitors are a class of medication used primarily for the treatment of high blood pressure and heart failure. They work by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart
- ACE inhibitors and ARBs reduce proteinuria by lowering the intraglomerular pressure, reducing hyperfiltration. These drugs tend to raise the serum potassium level and reduce the glomerular filtration rate (GFR). Monitoring the serum potassium and creatinine levels and the GFR is therefore
- Contraindications to ACEI use include hyperkalemia (>5.5 mmol/L), renal artery stenosis, pregnancy (ACEI or Australian Drug Evaluation Committee [ADEC] pregnancy category D), or prior adverse reaction to an ACEI including angioedema.
- ACE inhibitors have few interactions with other drugs. Since ACE inhibitors may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body’s potassium may result in excessive blood potassium levels.
