In this article, I will try to explain brain stroke and FAQs related to brain stroke in layman’s terms. If you had a brain stroke or mini-stroke or if you know someone suffered from these conditions then this article is a must to read for you. First thing first, what is brain stroke?
Brain stroke
All our living cells need blood and oxygen to survive. Our brain cells also need oxygen. Brain cells are highly metabolically active, so, they need a constant supply of blood and nutrients. There are many blood channels supplying blood in every part of the brain. If one of the blood channels suddenly gets blocked (ischemic stroke) or bursts (hemorrhagic stroke) then the blood supply to the brain area supplied by this blood vessel is terminated. This causes brain cell death in that area, and it is called a brain stroke.
Now you understand there are two types of strokes:
- Ischemic stroke (85% cases): When there is a blockage in the blood vessel (usually by a blood clot).
- Hemorrhagic stroke (15%): When one of the blood vessels burst and there is bleeding in the brain.
What is a mini-stroke?
If a blood channel supplying blood in the brain gets blocked for a transient period then it causes some injury to brain cells supplying by it, but it does not cause actual cell deaths. It is called a mini-stroke. Most of the time mini strokes happen for such a short duration of time that it doesn’t produce any permanent damage to the brain. This is the reason why these are not picked by CT scans and in in most of the cases MRI scans.
How to diagnose a stroke?
Clearly, the patient’s history is very important. The presence of stroke risk factors in patient’s history increases the chance of having a stroke. Some stroke risk factors are:
- Cigarette smoking
- Alcohol intake
- Obesity
- High cholesterol in the blood
- Drug abuse (especially in young stroke patients)
- Presence of certain heart diseases such as ‘atrial fibrillation’ – a type of heart rhythm problem
- High blood pressure
- Diabetes
- Family history of stroke
- Certain medical conditions causing blood clots
- History of previous stroke or mini-stroke
There are many other stroke risk factors, I have mentioned a few!
After history comes the clinical examination. The signs and symptoms of stroke are variable because it depends on which part of the brain was involved, how big the brain stroke is, presence of stroke risk factors, patient’s baseline mobility, and many other complex factors. Sometimes a tiny stroke can cause significant disability whereas a much larger volume of stroke may not cause that much disability. Some of the common symptoms of stroke are:
- Paralysis of one side of the body, one arm, or one leg
- Drooping of one side of the face
- Feeling of pins and needles or numbness
- Slurring of speech
- Word finding difficulty (patients can think what they want to say but the speech they produce doesn’t make any sense).
- Loss of balance
- Loss of complete or partial vision
- Vacant look and many more
After history taking, and examining the patients for stroke signs and symptoms we do a CT scan of the brain and also some blood tests.
The primary purpose of doing a CT scan as soon as a stroke-suspected patient arrives in the hospital is to rule out bleeding in the brain. CT brain scans are excellent in detecting blood in the brain (hemorrhagic stroke). However, it is not very great at detecting strokes caused by blood channel blockage (ischemic stroke). For many patients, a further MRI head can is needed to detect an ischemic stroke.
Stroke mimics
There are many medical conditions that can mimic many of the stroke symptoms. These are:
- Migraine headache: Atypical migraines can easily come up with one sided paralysis or sensory loss or visual blurring. For more information on migraine headache please read my article: https://costamedic.com/migraine/
- Seizure: Epilepsy/ seizure can cause transient weakness and confusion after the episode. It can confuse patients or even healthcare professional thinking it as a probable stroke.
- Functional neurological disorder (FND): It is sometimes called ‘functional stroke’. The problem here is with how the brain sends and receives information to the rest of the body. The FND symptoms are real, but it is called functional because it is not caused by the damage to the brain, rather it is caused by the disorder of nervous system. The actual cause behind FND are not clearly understood, but there is some association with stress, and trauma. Some common symptoms of FND are:
- Generalized weakness
- Speech problem
- Functional seizures
- Visual symptoms
- Cognitive symptoms
- Low blood sugar (hypoglycemia): It can cause confusion, weakness, and disorientation.
- Brain inflammation: It there is inflammation to brain, or brain’s covering (meninges), it can cause any symptoms of brain dysfunction.
- Other stroke mimics: Blood electrolyte imbalance, thyroid problems, kidney dysfunction causing accumulation of toxic substances in the blood.
Common problems after having a stroke
- Depression:
- Impaired mobility:
- Diminished motivation, reduced goal-directed behavior, and decreased emotional responsiveness.
- Speech deficit
- Swallowing difficulty
- Persistent weakness
- Stiffness
