There are two types of stroke:
- Hemorrhagic stroke.
- Ischemic stroke.
Hemorrhagic stroke occurs when a blood vessel within an area of the brain bursts and blood flows into that area. This can be from uncontrolled hypertension, aneurysm, trauma and other rare causes. The treatment is limited for the hemorrhagic stroke depending on the cause. However, this is a medical emergency that needs to be treated in the hospital.
Ischemic strokes can be thrombotic or embolic. A thrombotic stoke is when a blood vessels clogs locally within the area of the brain, and an embolic stroke is when a blood clot breaks off a distal location, such as the heart, the aorta, or the carotids and migraines into the brain area. When blood supply stops from that area of the brain, a stroke occurs.
Stroke symptoms include but not limited to weakness, numbness, tingling (of one side of the body or a limb), double vision, gait disturbance, speech disturbance and many other symptoms. In hemorrhagic stroke, headache is very common and the onset is much quicker.
The treatment of ischemic stroke comprise of two components; acute and preventative. In acute treatment, it is essential that the patient reaches the hospital within three hours from the onset of the symptoms; this allows the administration of tissue plasminogen activator (TPA) or “a clot buster” (must be given within three hours from the onset of the symptom) and can result in better outcomes. If the patient does not qualify for this medication, Aspirin, Plavix, or Aggrenox can be used. In embolic strokes Coumadin, Pradaxa or Xarelto maybe used. A stroke patient is typically admitted to the hospital to observe and do further testing and treatment. Depending on the symptoms, the patient may need physical, occupational and/or speech therapy.
Stroke risk factors are divided into modifiable and non-modifiable risks. The non-modifiable risks include age above 50, family history, and male gender. Modifiable risks are hypertension, diabetes, hypercholesterolemia, smoking, carotid artery disease, atrial fibrillation, and obstructive sleep apnea. The focus of our practice is to prevent strokes by correcting these modifiable risks. Smoking cessation is the most important of all risks since it increases risk of stroke by five folds.
We follow up with each patient after returning from the hospital to assess whether additional therapy is required such as physical, occupational, and/or speech therapy. Our goal is do everything possible to bring that patient fully back to health.