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Rabu, 13 Januari 2016

BELAJAR TENTANG STROKE PADA CEREBROVASCULAR DAN ANTISIPASI PENCEGAHANNYA

Perpustakaan Keluarga : 
Helmut Todo Tua Simamora dan dr. Olga Yanti V. Hutapea



Berikut merupakan kutipan ilmiah kedokteran yang bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.






The first three hours after a person experiences the first symptom of a stroke, is referred to as the "golden window". The doctors call it the crucial period for patients to get to a hospital for medical care to restore blood flow tot he brain and minimize or reverse the damage.


"Timely treatment for stroke is probably more important than for almost any other medical problem there is," said David Liebeskind, MD, professor of neurology, Director of Outpatient Stroke and Neurovascular Programs and Director of the Neurovascular Imaging Research Core at Ronald Reagan UCLA Medical Center. "There is a very limited window in which to start treatment because the brain is very sensitive to a lack of blood flow or to bleeding, and the longer patients wait, the more devastating the consequences." 

Researchers asked more than a thousand people nationwide what they would be likely to do within the first three hours of experiencing weakness, numbness, difficulty speaking or difficulty seeing, all common symptoms of a stroke. Among those under age 45, only about one out of three said they would be very likely to go to the hospital. A staggering 73 percent said they would likely wait to see if their symptoms improved. 

"That's a real problem," said Liebeskind. "We need to educate younger people about the symptoms of stroke and convince them of the urgency of the situation, because the numbers are going up." 

In fact, since the mid-1990's, the number of young adults between 18-45 discharged from U.S. hospitals after suffering a stroke has jumped as much as 53 percent. It's estimated someone has a stroke about every 40 seconds in the U.S., totaling nearly 800,000 new stroke patients a year. 

In 2007, Jennifer Reilly was one of them. "I woke up in the middle of the night with an excruciating headache," said Reilly. "I was 27 years old, pretty active, pretty healthy and was not prone to headaches. I thought it was a really odd thing that happened." 

After arriving at work that day, Reilly shared her story with a co-worker who insisted she go to the hospital immediately. Reilly eventually ended up at Ronald Reagan UCLA Medical Center where Liebeskind told her she'd had a stroke. "I was really skeptical," said Reilly. "I didn't have any of what I thought were the classic symptoms of a stroke, nor did I fit the classic description of a stroke patient. I was 27 and healthy." 

Reilly says weeks before the headache, she would also experience numbness periodically in one of her hands. "Half of my left hand would turn numb, from just one second to the next," she said, "but, once again, I brushed it off as if it was nothing." 

Tests showed Reilly's stroke was caused by a rare condition called moyamoya that slowly causes certain blood vessels in the brain to narrow over time. Most patients, about 85 percent, suffer what are known as ischemic stroke, during which arteries in the brain become blocked, cutting off oxygen. 

Ischemic stroke can happen to anyone at any age, and is often associated with high blood pressure, diabetes, smoking and obesity. "The good news is, there are steps we can take to lower our risk of stroke," said Liebeskind. A healthy diet and regular exercise, as well as not smoking and limiting alcohol consumption, have all been shown to lower your risk of stroke. 

Just as important as knowing what puts you at a higher risk for stroke, is knowing the symptoms when you see them. Doctors urge you to know the signs of stroke and act "FAST." 

If you or someone near you experiences - face drooping, arm weakness or speech difficulty, they should be given medical care. "Believe it or not, it's on the order of minutes or hours when somebody has to seek medical attention," said Liebeskind. "There simply is no time to wait. It's a message that we clearly need to get to younger people more effectively." 



‘Stroke’ is a moniker that strikes fear in the mighty and the meek alike.



Many of us have seen or heard about people whose lives have been devastated by a ‘Stroke’! Maimed for life, these individuals exist in a twilight zone, suspended between life and death. What is Stroke? Its early warning signs, risk factors and how to rehab and treat these patients. Read on….


Stroke is a cerebrovascular accident that occurs when blood supply to a part of the brain is disrupted leading to brain cell death. When blood supply to the brain is compromised, it experiences a shortage of oxygen and glucose.


Stroke



Typically there are two types of stroke-Ischemic and Hemorrhagic. The former is the most prevalent type (88%) and occurs due to a clot in an artery supplying blood to the brain. The latter (12%) is caused by a leak in a blood vessel supplying the brainThis results in profuse bleeding inside the brain.

Early warning signs of stroke are important to recognize as they are often missed. These include -

1. Sudden weakness of - 

 facial muscles
 Arm 
 Legs

2. Sudden difficulty with speech 

3. Sudden loss of vision

4. Loss of co-ordination 

5. Sudden, severe headache for no apparent reason 

6. Unexplained dizziness

Every second is important and seeking help early can prevent permanent damage from occurring.

Transient Ischemic Attack (TIA) also known as "mini stroke" results from a temporary cessation of blood supply to a limited part of the brain. This results in a short –term neurologic dysfunction that lasts for, approximately, less than 24 hours. If the symptoms exceed the cut- off time the episode is classified as a stroke

In the United States, stroke is the third largest cause of death after cardiovascular diseases and cancer. There is a lot of money being spent in taking care of stroke patients. 

Indian Council of Medical Research estimates that by 2015, India will report 1.6 million cases of stroke every year and WHO warns that by 2050, 80% stroke cases in the world would come mainly from India and China and will occur among lower and middle income groups. An estimates in 2004 showed that there were 9.3 lakh cases of stroke and 6.4 lakh deaths due to stroke in India and most belonged to age group below 45 years. It was also estimated that if deaths and disability were counted together, then India lost 63 lakh of disability-adjusted life years in 2004. 

If the stroke patient is 50 years or above, age-related factors such as hypertension, increased cholesterol and diabetes are suspected to be the triggers. If the patient is young, a genetic predisposition to the condition may be considered. 

Typically the early signs of stroke are weakness, tingling sensation, slurred speech, abnormal gait, an inability to balance and difficulty in swallowing. The ultimate blow is the paralysis that sets in on one side of the body. 

A person who has suffered a suspected stroke must get emergency medical aid. Administering clot-busting drugs, like the TPA, can minimize complications, but it requires that the drug be administered without delay. 

Stroke often debilitates the sufferer, if they have succeeded in surviving it. The quality of life is often compromised in these patients. Some escape with minor abnormalities, like slurred speech or mild facial deformity. It is not surprising that many of them suffer from depression. Rehabilitation of the stroke patients may not be at its best in home surroundings and may require specialized attention.


It is possible to prevent stroke by taking steps to minimize risk factors such as high blood pressure, increased cholesterol, and diabetes and go easy on smoking, alcohol indulgence and other lifestyle habits that tend to aggravate the risk factors.

Did u know?

• One in every 15 deaths is due to stroke

• Stroke kills 157, 000 people each year

• Every 3 minutes stroke kills someone

• African Americans form a high risk group compared to Caucasians






Causes

Stroke is caused when blood supply to the brain is disrupted.



a) Blocked artery- The most common cause of a stroke is when an artery inside the brain gets blocked by a blood clot . This phenomenon is also known as thrombosis. In a typical case, the clot is formed in a blood vessel that has been constricted due to a variety of reasons (risk factors) such as hypertension, smoking, high cholesterol and diabetes. The region of the brain supplied by the blocked artery gets deprived of oxygen and eventually gets damaged. 



b) Embolism- In this condition, a blood clot or a portion of the atherosclerotic plaque formed in the heart may break free and find its way to the brain where it may plug or block an artery. This causes a depletion in oxygen -rich blood to the brain, leading to an ‘embolic’ stroke.  

c) Cerebral hemorrhage or ‘bleeding inside the brain’ occurs when a blood vessel inside the brain ruptures resulting in bleeding into the surrounding brain tissue. This may cause a reduction in oxygen- rich blood supply to the brain, leading to a stroke.

d) Subarachnoid hemorrhage-In this condition there is accumulation of blood beneath the arachnoid membrane that lines the brain. This may lead to stiff neck and headache and may lead to stroke and even death if not diagnosed early.

e) Vasculitis or inflammation of blood vessels can also lead to stroke.

f) Migraine headaches in a person predisposeato stroke. Certain migraine headaches even mimic symptoms of stroke.

Symptoms

Stroke symptoms vary in their severity depending on the area of the brain affected.



Shortage of oxygenated blood  to the brain prevents the normal functioning of the affected area. This leads to a range of symptoms. The type of symptoms and their severity depends on the area affected. 



Strokes that are devoid of glaring symptoms are known as silent strokes.



Five major symptoms include-



• Numbness on one side of the body involving the face, arms or leg. There may be an associated tingling sensation in the affected area 



• Sudden confusion in speech / comprehension



• Sudden problems in vision



• Sudden loss of balance /lack of coordination



• Sudden onslaught of severe headache 



Other associated symptoms include-



• Slurred speech



• Problems in swallowing



• Immobility



• Lung infection



• Pneumonia


Stroke



Complications may arise from a stroke episode.



Sometimes a stroke patient can suffer from heart attack too and it is not unusual for the condition of a stroke victim to worsen despite getting timely medical aid.



Strokes often result in immobility; therefore clots tend to develop in a vein of the patient’s leg (deep vein thrombosis) which may travel upwards and get lodged in the lungs, causing pulmonary embolism, a life -threatening situation.



Lying in an immobilized state for a prolonged period can cause pressure sores in a patient. This, of course, can be prevented by continuously repositioning the patient.

Diagnosis

Diagnosis of stroke is done by ruling out other conditions that can mimic stroke symptoms.



A stroke can be categorized as a medical emergency with the patient warranting immediate attention. The doctor begins by taking the medical history of the patient. This is done mostly by asking questions to relatives or friends.

There are several conditions like that mimic a stroke -

• brain tumor, 

• brain abscess, 

• bleeding within the brain, 

• meningitis,

• or migraine headaches

Overdose of certain medications or an imbalance of calcium, sodium or glucose can also produce symptoms similar to stroke. Therefore it is essential that these conditions be ruled out.

After the medical history of the patient is taken, his vital signs are checked. Simultaneously, blood tests will also be carried out. 

1. Blood tests for stroke patients include-

• Sedimentation rate 

• C-reactive protein test

• Screening for anemia

• Kidney function

• Potential infection 

• Electrolyte abnormalities 

Some of the specific tests employed in the diagnosis of stroke are listed below-

2) Computerized tomography: This is a special X-ray study to help determine the cause of stroke. A CT scan can detect bleeding or tumors (conditions can mimic a stroke) within the brain. A computerized tomography with angiography can give informations regarding aneurysms or other heart -associated malfunctions.

3) Magnetic Resonance Imaging (MRI) works by using magnetic waves instead of x-rays to image the brain. The MRI gives more detailed images than a CT scan but is not always carried out as the first diagnostic test. Specific tests like Magnetic Resonance Angiogram (MRA) or Diffusion Weighted Imaging (DWI) are also being carried out in some centres.

Some of the other diagnostic tests include-

4. Conventional angiogram

5. Carotid Doppler ultrasound

6. Heart tests such as ECG


Treatment & Rehabilitation

Treatment of stroke patients should focus on restoring the pre-stroke functional abilities of the patient.



Medical Treatment 

Medical intervention in some form is usually urgent in a patient with a major stroke. The American Stroke Associations says that “Time lost is brain lost!” and this is very true. For ischemic stroke due to a clot, immediate action to dissolve the clot can help in resolving the stroke effects and prevent its full sequelae.  

Tissue plasminogen activator (TPA) dissolves blood clots that causes the stroke.  If this drug is administered within a soon after the stroke the effect is more pronounced and the patient may not develop bleeding-related complications.

Heparin is ananticoagulant that is used to treat stroke patients. This may help more to prevent subsequent strokes than to improve the present condition. Warfarin, a blood thinner is also commonly used. Aspirin, when administered after a stroke, helps in the overall recovery.

Medications are administered according to the needs of the patient.

It is absolutely vital to keep conditions such as diabetes and hypertension in control in order to prevent future strokes.

Surgical option - Carotid endarterectomy: If a person suffers a stroke or a Transient Ischemic Attack (TIA) due to a constriction or ulceration of the carotid arteries  they may require a surgery, called thecarotid endarterectomy  that restores normal blood flow through these arteries. If left untreated, these patients stand a good chance of suffering subsequent strokes in the future. 

Angioplasty and stenting of Carotid Artery is a relatively new procedure that shows good potential in the treatment of carotid artery disease especially in patients who are not fit to undertake a surgery. This includes patients who have had an endarterectomy. In this procedure, a long hollow tube (catheter) is inserted in the artery in the groin and is threaded through to the constricted carotid artery. The inflated end of the small balloon located at the tip of the catheter is used to open the constricted area. A metal stent is placed in the artery to prevent it from further narrowing.


Rehabilitation and Current Research

Rehabilitation of stroke patients should focus on returning pre-stroke functional abilities. Stem cell research may hold the key to a permanent cure.



Rehabilitation

Rehabilitation of the patient who has suffered a stroke is of vital importance. It should focus on returning most of the pre-stroke functional abilities of the patient.  Stroke involves the permanent loss of brain cells. Therefore it may not be possible for the patient to return to a normal life. Some of the methods of rehabilitation involve the following-

• Physical therapy to improve the patient’s strength to regain mobility. This can be continued at home.

• Speech therapy to improve speech

• Occupational therapy to regain the best use of arms and also to improve co-ordination skills

If you suspect someone is suffering a stroke instruct them to do the following-

• Ask them to smile/lift up both hands/speak something

• If they are unable to do any of these please get immediate medical help

• Meanwhile, make the affected person to lie down flat to promote optimum flow of blood to brain

• If drowsy or nauseous, the person should be made to lie on the side to prevent chocking should he vomit

• Once the symptoms of stroke sets in, it is better not to administer aspirin to the patient.

Current Research 

The morbidity and mortality associated with stroke patients has led to a lot ofresearch being done to revolutionize its treatment. 

New drugs are being synthesized that will help dissolve clots. Drugs are being designed that will help to slow the degeneration process in the oxygen –depleted nerve cells.  

Stem cell research is also actively trying to zero in on a method that will replace brain cells permanently damaged by stroke.

Rehabilitation of stroke patients should focus on returning pre-stroke functional abilities. Stem cell research may hold the key to a permanent cure.


Rehabilitation

Rehabilitation of the patient who has suffered a stroke is of vital importance. It should focus on returning most of the pre-stroke functional abilities of the patient.  Stroke involves the permanent loss of brain cells. Therefore it may not be possible for the patient to return to a normal life. Some of the methods of rehabilitation involve the following-

• Physical therapy to improve the patient’s strength to regain mobility. This can be continued at home.

• Speech therapy to improve speech

• Occupational therapy to regain the best use of arms and also to improve co-ordination skills

If you suspect someone is suffering a stroke instruct them to do the following-

• Ask them to smile/lift up both hands/speak something

• If they are unable to do any of these please get immediate medical help

• Meanwhile, make the affected person to lie down flat to promote optimum flow of blood to brain

• If drowsy or nauseous, the person should be made to lie on the side to prevent chocking should he vomit

• Once the symptoms of stroke sets in, it is better not to administer aspirin to the patient.

Current Research 

The morbidity and mortality associated with stroke patients has led to a lot ofresearch being done to revolutionize its treatment. 

New drugs are being synthesized that will help dissolve clots. Drugs are being designed that will help to slow the degeneration process in the oxygen –depleted nerve cells.  

Stem cell research is also actively trying to zero in on a method that will replace brain cells permanently damaged by stroke.


Prognosis and Prevention

The prognosis of a stroke patient depends on the severity of brain damage. Some revert back to near-normal life while others are maimed for life.



The prognosis of a stroke patient depends on the severity of brain tissue damage. Some patients revert back to near-normal life with slight discrepancies, such as speech or gait defects. Others, though, are maimed for life with conditions such as hemiplegia (weakness on one side of the body), incontinence of the bladder or bowel and severe difficulty in speaking.

For many, a massive stroke may prove to be fatal. If the stroke is debilitating then the relatives of the patient along with health care takers should take the right decision regarding patient management or regarding prolonging the patient’s life.

Prognosis- Facts

• 50–70% of survivors regain near-normal status.

• 15–30% become permanently disabled.

• 20% require specialized health care.

• 14% of those who survive a TIA will have a subsequent one within 1 year.

• 22% of men and 25% of women who have a TIA will die in a year. The rate is higher among those above age 65.

• 51% of men and 53% of women below 65 years die in a span of 8 years.

Lifestyle Modifications to Prevent Stroke

The most common risk factors for stroke include the following-


• Hypertension

• Diabetes

• Increased levels of cholesterol

• Smoking

• Advanced Age

• Hormonal imbalance 

• Heart rhythm disturbances such as atrial fibrillation, patent foramen ovale,

• Illicit drugs like amphetamines or cocaine 

• Genetic predispositions to blood clotting as seen in patients with homocystinuria,

Controlling these risk factors especially hypertension, cholesterol and diabetes is a sure way to prevent stroke. Some of the lifestyle changes that will help to prevent stroke are listed below- 

• Avoid smoking as smoking damages the smooth lining of blood vessels and increases the chances of blocked arteries

• Eat a diet low in saturated fat, high in protein, high in fibre with plenty of fruits and vegetables.

• Avoid /reduce alcohol intake

• Exercise regularly

• Follow stress busting techniques to alleviate stress




Sumber : Internet

http://www.medindia.net/patients/patientinfo/stroke-lifestyle-prevent.htm

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