### Date : 2024-06-22 13:00 ### Topic : Ischemic Stroke #medicine #neurology ---- ### Ischemic Stroke Overview **Ischemic stroke** occurs when a blood clot blocks or narrows an artery supplying blood to the brain, leading to a reduction or cessation of blood flow and resulting in brain cell death. It is the most common type of stroke, accounting for about 87% of all strokes. ### Pathophysiology The brain requires a constant supply of oxygen and nutrients, which are delivered through the bloodstream. When a blood clot obstructs an artery in the brain, the affected brain tissue becomes ischemic and begins to die. The extent and location of brain damage depend on the size of the affected artery and the duration of the blockage. **Types of Ischemic Stroke:** 1. **Thrombotic Stroke:** - Caused by a blood clot (thrombus) that forms in one of the arteries supplying blood to the brain. - Often associated with atherosclerosis, where fatty deposits build up on the inner walls of the arteries. 2. **Embolic Stroke:** - Caused by a blood clot or debris that forms elsewhere in the body (commonly the heart) and travels through the bloodstream to lodge in a brain artery. - Often linked to heart conditions like atrial fibrillation, which can lead to clot formation. ### Risk Factors **Non-Modifiable Risk Factors:** - **Age:** Risk increases with age. - **Gender:** Males have a higher risk, although females have a higher risk of death from stroke. - **Family History:** A family history of stroke increases risk. - **Race/Ethnicity:** African Americans, Hispanics, and Asians have higher risk levels. **Modifiable Risk Factors:** - **Hypertension:** The most significant risk factor for ischemic stroke. - **Smoking:** Increases the risk of atherosclerosis and blood clot formation. - **Diabetes:** Increases the risk due to vascular damage. - **High Cholesterol:** Leads to atherosclerosis and plaque formation. - **Obesity:** Linked to hypertension, diabetes, and a sedentary lifestyle. - **Heart Disease:** Conditions like atrial fibrillation and heart failure increase the risk. - **Physical Inactivity:** Contributes to obesity, hypertension, and diabetes. - **Excessive Alcohol Intake:** Increases blood pressure and contributes to heart disease. - **Diet:** High in saturated fats, trans fats, and sodium can increase risk. ### Symptoms - **Sudden Numbness or Weakness:** Particularly on one side of the body (face, arm, or leg). - **Confusion:** Difficulty speaking or understanding speech. - **Vision Problems:** Sudden trouble seeing in one or both eyes. - **Trouble Walking:** Dizziness, loss of balance or coordination. - **Severe Headache:** Especially if accompanied by other symptoms. **FAST Acronym for Stroke Recognition:** - **F:** Face drooping (ask the person to smile; does one side droop?) - **A:** Arm weakness (ask the person to raise both arms; does one drift downward?) - **S:** Speech difficulty (ask the person to repeat a simple sentence; is it slurred or strange?) - **T:** Time to call emergency services (if any symptoms are present, call 911 immediately). ### Diagnosis **Clinical Evaluation:** - Detailed patient history and physical examination focusing on neurological deficits. **Imaging Studies:** - **CT Scan:** Quickly identifies hemorrhagic stroke and can help detect ischemic stroke. - **MRI:** Provides detailed images of brain tissue to detect ischemic areas. - **Carotid Ultrasound:** Evaluates blood flow in the carotid arteries. - **Cerebral Angiography:** Detailed imaging of blood vessels in the brain. - **Echocardiogram:** Assesses heart function and detects potential sources of emboli. **Laboratory Tests:** - Blood tests to check for risk factors like high cholesterol, diabetes, and coagulation abnormalities. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 60 - **Occupation:** Retired Engineer **Medical History:** - Sudden onset of weakness on the right side of the body, slurred speech, and confusion. - Risk factors include hypertension, diabetes, and a history of smoking. **Clinical Evaluation:** - Physical examination reveals right-sided weakness and facial droop. - Speech is slurred, and the patient appears confused. **Imaging Studies:** - **CT Scan:** Shows an ischemic stroke in the left hemisphere of the brain. **Diagnosis:** Based on symptoms, clinical evaluation, and imaging, Jee Hoon Ju is diagnosed with an ischemic stroke. ### Management 1. **Immediate Treatment:** - **Thrombolytic Therapy:** Administration of tissue plasminogen activator (tPA) within 3 to 4.5 hours of symptom onset to dissolve clots. - **Mechanical Thrombectomy:** A procedure to remove the clot using a catheter within 24 hours of symptom onset for certain patients. 2. **Medications:** - **Antiplatelets:** (e.g., aspirin) to prevent further clotting. - **Anticoagulants:** (e.g., warfarin, dabigatran) for patients with atrial fibrillation or other conditions that increase clot risk. - **Antihypertensives:** To control blood pressure. - **Cholesterol-Lowering Drugs:** (e.g., statins) to manage cholesterol levels. 3. **Rehabilitation:** - **Physical Therapy:** To regain strength and coordination. - **Occupational Therapy:** To improve daily living skills. - **Speech Therapy:** For speech and swallowing difficulties. 4. **Lifestyle Modifications:** - **Diet:** Eating a balanced diet low in saturated fats, cholesterol, and sodium. - **Exercise:** Regular physical activity. - **Smoking Cessation:** Quitting smoking to reduce risk. - **Alcohol Moderation:** Limiting alcohol intake. ### Prognosis - **Early Intervention:** Prompt treatment can significantly improve outcomes and reduce the extent of brain damage. - **Rehabilitation:** Intensive rehabilitation can help recover lost functions. - **Long-Term Management:** Controlling risk factors is crucial to prevent recurrence. ### Conclusion Ischemic stroke is a common and potentially devastating condition that requires immediate medical attention. Understanding the risk factors, symptoms, diagnostic procedures, and treatment options is essential for effective management and improving patient outcomes. Early intervention and comprehensive rehabilitation are key to recovery and reducing the risk of future strokes.