Saturday , March 6 2021


STROKEWhat is stroke?
Stroke is the fourth leading cause of death in the United States.  It causes death every four minutes and is responsible for reduced quality of life.  Stroke can either be ischemic or hemorrhagic in nature.  Ischemic strokes result from either a local clot occluding or preventing blood flow to the brain or a distant clot traveling to the cranial area and causing a lack of oxygen and blood flow.  Hemorrhagic strokes result from uncontrollable bleeding in the cranium.
How susceptible am I?
Stroke precautions exist.  Several risk factors have shown to be associated with stroke occurrence.  These include age > 65, female gender, vascular disease, prior stroke or transient ischemic attack, diabetes, high blood pressure, smoking, high cholesterol, physical inactivity, obesity, postmenopausal hormonal therapy, and atrial fibrillation.  Many of these factors can be modified to prevent stroke.
How can I behave to reduce stroke risks?
Controllable factors can prevent stroke 80% of the time.  Thus, important preventable actions include quitting smoking, reducing cholesterol, reducing blood pressure, reducing weight, increasing activity, and self-education.  Overall diet and exercise play very important roles in maintaining a healthy lifestyle.  A healthy diet encompasses approximately 40-60% complex carbohydrates, 20% lean sources of protein, 20% unsaturated fat, 1-2 liters of water per day, less than 2 grams of sodium per day.  Quick sugars and saturated fats can accumulate in the blood vessels leading to inhibited oxygen and blood flow, resulting in strokes.  Exercise approximately 30 minutes 5 times per week for both vascular and weight loss benefit.  Educate oneself on the risks, symptoms, consequences, and management of stroke.
How does stroke present?
There are warning signs of stroke.  The most common stroke symptoms include a quick onset of a one-sided numbness or weakness, sudden confusion or trouble speaking, severe unknown  headache origin, dizziness or loss of balance, or vision difficulties.  Upon presence of any these symptoms, report to 911.  Time is viable tissue.  For every one minute of untreated hypoxia 1.9 million neurons, 12.8 synapses, and 7 miles of fibers die.  Thus, immediate action results in optimal treatment.
In diagnosing, various stroke scales and imaging are used.  Standardized stroke scales are utilized in assessing stroke severity.  One specific stroke scale is the National Institutes of Health Stroke Scale evaluating 11 areas of functionality including consciousness, orientation, response visual fields, facial movement, motor function, sensory, language, articulation, extinction or inattention, and limb movement.  Other scales such as Barthel index and modified Rankin Scale focus on daily living and independence, respectively.  In addition, diagnostic parameters needed are non-contrast enhanced computed tomography to distinguish between vascular and nonvascular causes and/or magnetic resonance imaging used to identify small or minor ischemic areas.  Laboratory parameters involve oxygen saturation, electrolyte status, blood cell counts, glucose, bleed times, and heart monitoring.
How are strokes treated?
Time is a critical component of stroke care.  American Heart and American Stroke Association recommend less than or equal to 25 minutes from door to diagnostic testing and less than or equal to 60 minutes from door to drug delivery.  It is true every one second of oxygen absence leads to approximately 32,000 cell deaths.  This drug delivery includes thrombolytic therapy, or drugs that break up the clot.  Due to the high risks with this therapy, there are many cautions to its use.  In addition, to thrombolytic therapy includes blood pressure controlling medication.  Extensive monitoring is conducted with blood pressure control initiation.  Other therapies include aspirin, clopidrogel (generic Plavix), heparin or low molecular weight heparin, and statins or cholesterol agents.
What are the stroke consequences?
Studies have shown post-stroke of up to twelve weeks can result in complications.  Some of the most common include pain, urinary tract infections, chest infections, falls, brain disorders such as seizures, paralysis, cognition or thought difficulty, and re-occurring strokes or heart attacks.  Thus, preventative therapy exists to limit.  For example, baby aspirin and cholesterol lowering agents are significant for reducing further complications.
What are the stroke expectations?
Following a stroke, the patient is observed extensively.  Typically, the patient will be transferred to neuro critical care or stroke unit.  On this level, patient’s brain function and blood pressure are monitored approximately every 15 minutes for first 2 hours, slowing down for the next 4 hours.  Second, brain functioning is assessed ongoing to minimize cognition deterioration.  Third, several standards of care are initiated.  These include mobilizing or maintaining patient’ activity as tolerated, treating constipation, treating acid reflux, and protecting against leg and lung clots.  Depending on the severity of the original stroke, paralysis may be a result and thus physical therapy becomes part of the plan for continuing a quality driven life.
It is important to understand patients are critical components to the team care process.  Thus, reduce risks, educate oneself, and actively participate in the care to reduce stroke progression and complications.
Dr. Vallabhan (352) 750.2040
Rolling Oaks Professional Park
929 N. US Highway 441, Suite 201
Lady Lake, FL 32159

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