Full Answer Section

1. • Embolism:A blood clot or other debris traveling from elsewhere in the body and lodging in a cerebral artery.
2. Hemorrhagic Stroke (13% of strokes): Caused by bleeding within the brain tissue due to a ruptured blood vessel. This can occur due to:
   • Hypertension (high blood pressure):The leading cause of hemorrhagic stroke, as it weakens blood vessel walls.
   • Aneurysm:A weakened bulge in a blood vessel wall that can rupture.
   • Arteriovenous malformation (AVM):An abnormal connection between arteries and veins that can cause bleeding.

Clinical Manifestations:

Symptoms of stroke can vary depending on the affected brain region. Here’s a general breakdown:

Ischemic Stroke:

• Sudden weakness or numbness on one side of the body (face, arm, or leg).
• Difficulty speaking or understanding speech (aphasia).
• Paralysis or loss of coordination.
• Vision problems in one or both eyes.
• Dizziness or loss of balance.
• Severe headache (not always present).

Hemorrhagic Stroke:

• Similar symptoms to ischemic stroke, but often more severe and sudden onset.
• Intense headache, the worst headache of their life (common).
• Seizures (more common than in ischemic stroke).
• Loss of consciousness or coma (more common than in ischemic stroke).

Risk Factors:

Both ischemic and hemorrhagic stroke share some risk factors:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Physical inactivity
• Family history of stroke

Timely Diagnosis and Treatment:

Rapid diagnosis and treatment are essential in stroke cases. Brain tissue starts dying within minutes of a stroke, so minimizing the time of blood flow interruption is critical to limit damage and improve the chance of recovery.

Diagnostic Tests:

Several tests help differentiate stroke type and guide treatment:

• Non-contrast CT scan:The initial and crucial test to rule out hemorrhagic stroke (bleeding).
• MRI scan:Provides detailed images of the brain, sometimes needed to confirm ischemic stroke or identify specific stroke subtypes.
• Angiography:X-ray imaging of blood vessels to visualize blockages or abnormalities.

Treatment Goals:

• Restore blood flow to the brain as quickly as possible.
• Minimize brain damage and prevent further complications.
• Promote recovery and improve functional abilities.
• Prevent future strokes through risk factor management.

Intravenous tPA (tissue plasminogen activator):

tPA is a clot-busting medication used in ischemic stroke within a specific time window (usually up to 4.5 hours) to dissolve blood clots and restore blood flow. It’s crucial to administer tPA promptly, as it carries a risk of bleeding in the brain.

Case Study:

Based on the 62-year-old female’s symptoms (right-sided arm weakness and aphasia), the involved cerebral artery is likely the left middle cerebral artery (MCA). The MCA supplies blood to the left hemisphere of the brain, controlling movement and speech functions on the right side of the body.

A negative initial CT scan suggests ischemic stroke, but it might be too early to detect damage. Further evaluation is needed:

• MRI scan:This could reveal signs of early ischemic changes or rule out other diagnoses like a brain tumor.
• Angiography:This can visualize any blockages within the MCA or other cerebral arteries.

Conclusion:

Stroke is a serious medical emergency. Understanding the different types, risk factors, and symptoms can help with early recognition and prompt medical attention. Timely diagnosis and treatment are critical for minimizing brain damage and improving patient outcomes.