STROKE

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 Case scenario:

                      A 61-year-old senior partner in a law firm. While eating breakfast he experienced sudden onset slurring of speech and had facial droop on his left-hand side with weakness in left lower and upper limbs. His wife spotted this sudden onset of symptoms and immediately called for an ambulance, which arrived within 15 minutes. His past medical history is that he was diagnosed with asthma when he was 8 years old, he has grade 1 hypertension which was diagnosed 5 years ago, He is also pre-diabetic and this was diagnosed 3 years ago. The patient is taking Seretide accuhaler, he was also taking Ventolin if it was required and he did not take it for a year, he was also taking thiazide for his hypertension. His social history was that at the Law firm he used to work for 40-50 hours and now he worked only 20-30 hours, he is also planning a retirement in 1 or 2 years, he lives in a bungalow with his wife who is a recently retired teacher, 2 married children one lives close by and the other lives overseas, lifestyle implementations since 3 years due to the diagnosis of prediabetes, he usually plays golf 23 times a week and he also plays bridge, took up walking 3 years ago and now walks 4 to 5 times a day for about 30 to 45 minutes, he is an Ex-smoker and quit smoking 3 years ago following the diagnosis of prediabetes before that he used to smoke around 10 to 15 a day and this habit had been going on for 30 years, standard drinker drinks 10 to 15 drinks a week and 3 to 4 every session.

Introduction:

                   The term stroke is generally reserved for more permanent blockages that do not rapidly and spontaneously resolve themselves. These blockages result in permanent brain damage and spontaneously resolve themselves.

Epidemiology:

                       Current epidemiological data indicate that 16.9 million people suffer a stroke each year, which represents a global incidence of 258/100,000/year, with marked differences between high- and low-income countries, and an age-adjusted incidence of 1.5 times higher in men than in women. 

Causes:

  1. A blocked artery(Ischemic stroke)
  2. Leaking or bursting of a blood vessel (hemorrhagic stroke)

Symptoms:

  1. Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
  2. Sudden confusion, trouble speaking, or difficulty understanding speech.
  3. Sudden trouble seeing in one or both eyes.
  4. Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
  5. Sudden severe headache without any known cause.

Complications: 

  1. Blood clots (deep vein thrombosis or pulmonary embolism)
  2. Brain swelling
  3. Seizures
  4. Memory loss 
  5. Vision and hearing problems 
  6. Muscle weakness 
  7. Bedsores 
  8. Depression

Diagnosis:

              Strokes are usually diagnosed by doing physical tests and studying images of the brain produced during a scan.

Treatment:

                     An IV injection of recombinant tissue plasminogen activator (TPA) — also called alteplase (Activase) or tenecteplase (TNKase) — is the gold standard treatment for ischemic stroke.

Prevention:

  1. Lower your blood pressure
  2. Don't smoke
  3. Manage your heart rate
  4. Control your sugar, cholesterol, and lipid levels.
  5. Exercise
  6. Eat a healthy diet.  

References:  

  1. The Case Scenario was taken from physiopedia and the URL to the website is https://www.physio-pedia.com/Stroke:Case_Study_Section_2   
  2. The Introduction was taken from mentalhelp.net and the URL is https://www.mentalhelp.net/stroke/#:~:text=The%20term%20stroke%20is%20generally,(or%20TIAs%20for%20short).
  3. The Epidemiology was taken from EM Consulte and its authors are Y. bejot, B Daubail, M Giroud the URL is https://www.em-consulte.com/article/1028007/alertePM
  4. The Causes were taken from mayo clinic and the URL is https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113#:~:text=There%20are%20two%20main%20causes,doesn't%20cause%20lasting%20symptoms.
  5. The symptoms of stroke were taken from the CDC official website and the URL is https://www.cdc.gov/stroke/signs_symptoms.htm
  6. The complications were taken from Cooper health and the URL is https://www.cooperhealth.org/services/stroke-program/complications-after-stroke
  7. The Diagnosis was taken from NHS and the URL is https://www.nhs.uk/conditions/stroke/diagnosis/#:~:text=Strokes%20are%20usually%20diagnosed%20by,they%20can%20about%20your%20symptoms.
  8. The treatment was taken from Mayoclinic and the URL is https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119#:~:text=An%20IV%20injection%20of%20recombinant,within%20the%20first%20three%20hours.
  9. The prevention was taken from WebMD and the URL is https://www.webmd.com/stroke/guide/understanding-stroke-prevention           

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