What is a stroke? : Medical Management of Stroke

What is a stroke?
What is a stroke?

Introduction

Brain attack has recently taken the place of the outdated term “cerebrovascular accident.” Acute cardiovascular diseases include both heart attack and brain attack. Similar aetiologies can cause both heart attack and brain attack. Similar to how a heart attack is treated, a brain attack is likewise treated similarly. Cardiologists prefer Percutaneous Coronary Intervention (PCI), the cardiac version, over intravenous recombinant tissue plasminogen activator (rtPA), when treating heart attacks (e.g. IV rtPA). Within 12 hours after a symptom’s start, cardiac-PCI must be completed. Since PCI is not always available, IV rtPA is the second line of treatment for heart attacks.

Brain attack falls under a similar notion. The Percutaneous Cerebral Intervention (Neuro-PCI) procedure is preferred by vascular neurosurgeons over intravenous rtPA. Within 8 hours after a symptom’s beginning, the Neuro-PCI must be completed. The new Golden-8-hours Concept for brain attack is thus this. Nowadays, the majority of Comprehensive Stroke Centers in the US offer Neuro-PCI as their first-line standard treatment. The second-line treatment, administered only if Neuro-PCI is not available, is intravenous rtPA within Golden-3 hours.

 Concept of Stroke

The outdated idea of a cerebrovascular accident and the acceptance of the protracted neurological decline and eventual disability, or even death, should undergo a radical revision. The new phrase “Brain Attack” emphasises that a stroke is not an accident. Similar to a heart attack, a stroke is something that can be avoided, treated, or even prevented, without leaving patients with any neurological damage. Heart attacks and strokes can both be treated similarly. Acute ischemic stroke sufferers will have less suffering in the future.

What is a stroke?

The term “stroke” describes the abrupt onset of neurological impairment brought on by vascular issues. Strokes might come in two different forms: In the west, ischemic stroke makes about 87% of all stroke cases (compared to 70% in Hong Kong). The remaining 13% (around 30% in Hong Kong) of cases are explained by hemorrhagic stroke. However, hemorrhagic stroke has a greater mortality rate than the ischaemic condition; it is in charge of more than 30% of all stroke fatalities.

Pathophysiology

Individuals of any age, gender, or colour can experience strokes. A cerebral blood artery narrows or shuts down during an ischemic stroke. Oxygen cannot be delivered to the damaged area of the brain because of the obstruction, which disturbs blood flow. The stroke symptoms are brought on by the segment of brain tissue that is oxygen-deprived and “stuns,” or ceases to function normally.

 Time is Brain

An urgent medical situation exists with acute ischaemic stroke (AIS). It’s critical to act quickly. Untreated big vascular strokes can result in the loss of up to 1.9 million neurons, 14 billion synapses, and 7.5 miles of myelinated fibres per minute (32,000 neurons per second, 120 million per hour). The more time a stroke is left untreated, the higher the risk of permanent brain damage. The potential benefit of the treatment is reduced if it is postponed due to increased “infarction” (death of vital brain cells). To maximise the likelihood of a successful recovery, getting started on therapy quickly is essential. The brain’s cells begin to sustain irreparable damage after three hours, usually resulting in their demise. This is the rationale behind the three-hour time limit on thrombolytic therapy with rtPA. Time is therefore truly brain.

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