Cerebro-Vascular disease

A stroke also called�as "brain attack", is an interruption of the blood supply to any part of the brain.

Causes

• A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke.
• A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

ISCHEMIC STROKE

This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. Fatty deposits collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:

• A clot that stays in place in the brain is called a cerebral thrombus.
• A clot that breaks loose and moves through the bloodstream to the brain is called a�cerebral embolism.

Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation.

HEMORRHAGIC STROKE

A second major cause of stroke is bleeding in the brain hemorrhagic stroke. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.

STROKE RISKS

High blood pressure, increased by age, family history of stroke, smoking, diabetes, high cholesterol and heart disease are factors that up the risk of a stroke. Certain medications like Birth control pills increase the chances of clot formation and up the risk for a stroke.

Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Usually, a SUDDEN development of one or more of the following indicates a stroke:

• Weakness or paralysis of an arm, leg, side of the face or any part of the body
• Numbness, tingling, decreased sensation
• Vision changes
• Slurred speech, inability to speak or understand speech, difficulty reading or writing
• Swallowing difficulties or drooling
• Loss of memory
• Vertigo (spinning sensation)
• Loss of balance or coordination
• Personality changes
• Mood changes (depression, apathy)
• Drowsiness, lethargy or loss of consciousness
• Uncontrollable eye movements or eyelid drooping

If one or more of these symptoms is present for less than 24 hours, it may be a transient�ischemic attack�which is a temporary loss of brain function and a warning for a possible future stroke.

Specific neurologic, motor and sensory deficits which correspond closely to the location of the injury in the brain are examined by the doctor. An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation and other changes. A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.

Other tests include:

• Head CT or head MRI
• ECG (electrocardiogram)
• Echocardiogram
• Carotid duplex (a type of ultrasound)
• Heart monitor
• Cerebral (head) angiography

Treatment
A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. The aim is to get immediate medical attention, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.

IMMEDIATE TREATMENT

Thrombolytic medicine, such as tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin may also be used.

Other medications may be needed to control associated symptoms. Pain killers may be needed to control severe headache. Medicine may be needed to control high blood pressure.

Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

For�hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.

The other Neurology Procedures are:

• Brachial Plexus Surgery
  
• Brain Surgery
  
• Carotid Artery Surgery / Endarterectomy�� etc

Few Major Hospitals for Treatment of Cerebrovascular Disease are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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