Brain Dead: Stroke Management

Stroke Overview

It has been 8 years since my grandfather suffered from Stroke. A known diabetic, he stayed in the hospital for a month and had been a frequent patient for the next 6 months until he died in May of 2008. Friends, who are not medically inclined, would usually ask what caused it and sometimes confuse stroke with “heart attack” or myocardial infarction.

Risks

Stroke is what they call “brain attack.” It is a neurological condition when oxygenation to the brain is compromised by way of obstruction or bleed. Stroke is usually a consequence of another condition usually Diabetes or Hypertension. Patients with this condition are most likely to develop stroke and the following:

a. Smoking
b. Obesity
c. Excessive Alcohol Consumption
d. Old age

Types

Stroke has two types: Ischemic and Hemorrhagic.

Ischemic Stroke
The primary cause of this type is blockage of oxygen-carrying blood to the brain usually by fat deposits on the artery or a blood clot.

Hemorrhagic Stroke
Aneurysm, hypertension and trauma are one of the primary cause of this type. Decreased oxygenation of the brain due to bleeding is one way of defining this type.

Symptoms

When my grandfather suffered from stroke, there are definite signs and symptoms that point out that he is experiencing it. But how do we determine stroke on its early stage?

Patients would usually exhibit the following symptoms:

a. Unaware of persons or object on side of visual loss (Homonymous hemianopsia)
b. Loss of peripheral vision
c. Double vision (Diplopia)
d. One-sided weakness and paralysis (Hemiparesis and Hemiplegia)
e. Unsteady gait (Ataxia)
f. Difficulty in forming words (Dysarthria)
g. Difficulty in swallowing (Dysphagia)
e.Unable to speak in single word responses (Expressive aphasia) or comprehend spoken work (Receptive Aphasia)

Early detection is important especially to ischemic stroke. Early management can lead to better prognosis among patients. Once a patient manifested the mentioned symptoms, it is important to bring the patient to the nearest hospital or facility at once. Medications such as Thrombolytics (dissolves clot) can be administered within the first 3 hours can decrease the incidence of neurologic defect substantially. The window period is within the 3–6 hours to minimize neuro defects.

More about Thrombolytic Management HERE.

Laboratories

Laboratories are requested for a patient to determine the extent of damage and as a baseline for management.

a. CT Scan
- Produces a 3D image of the brain to determine the location and the type of stroke the patient has.

b. Magnetic Resonance Imaging (MRI)
- Produces the same image as that of a CT Scan but more detailed.
- Patients with tattoos or metal plates are NOT ALLOWED to undergo this procedure.

c. Lipid Profile Tests
- This is to determine the cholesterol and lipid levels and serves as a basis for anti-lipid therapy.
Normal values for the following are:
Cholesterol: Less than 200 mg/dL
Low Density Lipoprotein (Bad Cholesterol): Less than 100 mg/dL
High Density Lipoprotein (Good Cholesterol): more than 60 mg/dL

d. Creatinine and BUN Levels
- This is used to determine kidney function that contributes to chronic or acute hypertension.

More on Laboratories HERE.

Management

Patients will ultimately have to undergo long-term treatment after suffering from this condition.

1. Continuous Thrombolytic Therapy
- patients would receive this therapy to prevent the formation of blood clots.
- It is important to monitor patients signs of bleeding.
- There are two medications given, Heparin and Warfarin (Coumadin)
- Antidotes for Heparin is Protamin sulfate and Warfarin is Vitamin K. To remember this easily, remember the mnemonic:

Harry Potter (Heparin = Protamine) and;

Western Visayas (Warfarin = Vitamin K)

2. Anti-Lipid drugs
- Statins are prescribed to decrease the incidence of fat deposits in the artery causing blockage to the brain.
- Statins are usually taken before bedtime for maximum effect.

3. Physiological Rehabilitation
- Patients are scheduled to do exercises guided by a Physical Therapist to regain strength on the affected part or minimize and avoid atrophy of the muscles.

Tips!!!

It is a fact that stroke can be avoided. Here are some tips that will help you:

a. Eat Healthy. Vegetables and fruits is a must in a healthy diet. Minimize consumption of food high in fat, salt and sugar.

b. Exercise Regularly. Keep your circulation active.

c. Be Compliant. If you are a known Diabetic or Hypertensive, always take your medications regularly.

d. No Smoking. Smoking has been associated with hypertension.

e. If predisposed to Stroke, monitor your labs regularly.

Stroke accounts to one death every nine minutes in the Philippines (Interaksyon.com, 2014) and maintains its position on the Top 10 cause of death in the country. Keep in mind the tips in avoiding the incidence of Stroke. Maintain and monitor your laboratories by signing up to MyLabs which helps you archive and compare lab results.

You can view your test results online through MYLABS. Click the button to create an account!

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