ISCHEMIC STROKE

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ISCHEMIC STROKE

Stroke is one of the main causes of death and morbidity worldwide. In the United States approximately 750,000 people per year suffer.

a stroke, of which one third dies while half of the survivors retain some degree of disability.

A stroke is defined facility neurological symptoms for more than 24 hours due to decreased blood flow or occlusion of one of the arteries that irrigate the brain. The symptoms last for days or longer, or may be permanent. As a TIA is defined as the installation of neurological symptoms for less than 24 hours and usually disappears within an hour. The TIA is considered important because often precede more serious stroke. It has been found that 33% of patients with TIA will develop ischemic infarction in the next five years with a higher risk in the first two weeks.

75% of strokes are ischemic, while the rest are due to intracerebral hemorrhage.

Ischemic stroke (ischemic infarction) may cause any condition brought about reduction or interruption of blood flow to an area of the brain. Ischemic stroke is either thrombotic or emvoliko.isxemiko4

In thrombotic stroke, a blood clot formed in an artery of the brain, as is acute myocardial infarction with arteries of the heart. The clot is usually formed in a region of the vessel with atherosclerotic plaques.

In embolic stroke, the clot “travels” with the blood circulation and leads to occlude (as a piston) the vessel lumen. The origin is usually from the heart eg atrial fibrillation.

Whether coagulant, or embolic stroke, the end result is the same: the brain is deprived of blood, and therefore oxygen and other nutrients. This causes necrosis of that area of the brain corresponding to the occluded vessel. This region does not function properly, thus manifesting the analog neurological deficit e.g. weakness in the arms or legs, difficulty speaking, impaired vision, etc. or even coma in extensive ischemic infarcts.

 

Factors that increase the likelihood of someone suffering a stroke are:

  1. The existence of a similar incident in the past
  2. the existence of acute stroke
  3. The existence of myocardial infarction (mean extended vasculature suffers)
  4. age. If one is over 55 years clearly more likely to be infected, although stroke is described in every age, even in children
  5. hypertension
  6. stenosis of carotid atherosclerotic disease
  7. Smoking
  8. high blood cholesterol
  9. diabetes
  10. Obesity
  11. sedentary
  12. other disorders of the heart e.g. heart failure, arrhythmias such as atrial fibrillation, etc.
  13. estrogen therapy / contraceptives
  14. alcoholism
  15. diseases associated with blood coagulation
  16. The use efforiogonon substances eg cocaine, amphetamines
  17. Separating an artery
  18. vasculitides

Note that in a significant number of strokes (at least 25%) never found a specific cause.

 

Ischemic stroke presents with sudden onset of one or more symptoms of the most common of which are:

  1. weakness in the hands or feet isxemiko5
  2. numbness in the hands or feet
  3. difficulty speaking
  4. difficulty walking (gait instability)
  5. vertigo and dizziness
  6. reduction of vision or double vision
  7. headache and vomiting
  8. unconsciousness, coma.

All these symptoms may be due to other neurological diseases. The sharp entry is one that directs the diagnosis to a stroke.

In an ischemic stroke is usually weakness on one side of the body, called hemiparesis (whether partial paralysis) and hemiplegia (paralysis if it is full). Also, often attacked and face, which results in a drop in the angle of the mouth.

 

The diagnosis of stroke was made with:

  1. background
  2. neurological examination
  3. CT scan of the brain
  4. other imaging tests eg MRI, angiography, etc.
  5. other diagnostic tests to find the cause of the obstruction eg carotid triplex, triplex heart, transcranial Doppler examination, blood tests

The stroke should also to distinguish between the other conditions that could cause similar symptoms, such as multiple sclerosis (MS), vasculitis, seizures, discopathy etc.

The CT scan is a key consideration in the diagnosis of stroke. It gives us quick answer to a key question: whether the stroke is ischemic or hemorrhagic.

If it is cerebral hemorrhage, CT always brings out the problem directly.

By contrast, ischemic stroke, can the CT scan does not show something (especially in the first 12 hours of installation of symptoms) or only exist indications. In this case, the patient is in the hospital and CT repeated after e.g. 24 hours, or (if possible) is MRI.

CT and MRI have a role to rule out other diseases with similar symptoms.

Of the various causes of strokes has given special attention to atherosclerotic disease of the carotid arteries.

isxemiko2Afto is because clinical studies have shown that a significant carotid injury, endarterectomy better results than the simple medication in the prevention of stroke.

According to reliable study NASCET significant carotid injury is any injury that causes stenosis greater than 70%. The significant carotid injury puts the patient at risk carotid thrombosis, occlusion, peripheral embolism, and stroke.

Ischemic stroke does not occur exclusively in individuals with significant stenoses, but also a significant number of individuals with lesser degrees of stenoses. In these cases, it seems important that the texture of plaque causing stenosis in particular the stability, it has been found that unstable atherosclerotic plaques can produce pistons.

The ultrasound examination of the carotid arteries (carotid triplex) is simple and painless method of examination of the carotid arteries and provides important information on the degree of stenosis and texture of atherosclerotic plaques.

Stroke is relatively common and serious disease, with consequences for the quality of life and life itself. Addressing the good is to be organized Hospital, with the possibility for imaging studies (CT or MRI, angiography), intensive care unit, neurologist, neurosurgeon etc.

But it is important to know that if control risk factors, significantly reduces the probability to suffer a stroke.

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