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'Brain attack'

What to expect with the unexpected disability

By Dr Romayne Edwards

Tuesday, January 07, 2014    

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STROKE, also called "brain attack" or cerebrovascular accident, is the third leading cause of deaths in the United States of America and is the leading cause of disability in adults worldwide.

It occurs when the blood supply to areas of the brain is disrupted, resulting in a loss of both sensory and/or motor functions on one side of the face and body.

The risk factors for a "brain attack" may include hypertension, diabetes mellitus or 'sugar', high cholesterol, smoking, alcohol intake, obesity, and heart disease as well as age, race, genetics, and family history.

Strokes may result from ischemia, a blockage of an artery due to thrombus or embolus in the brain or reduced blood flow from the body, or haemorrhage (bleeding) in the brain.

The most common strokes in Jamaica are ischemic, followed by intraparenchymal and subarachnoid haemorrhage, respectively.

A person experiencing a stroke may have sudden or gradual symptoms, which include the inability to move one side of the face well, the inability to control an outstretched arm, and slurred words or inability to speak. There may also be abnormal alertness, where the patient may be confused or even fall into a coma.

When these symptoms pop up, the patient should get help immediately. Timing may determine treatment options.

In countries where there is an Emergency Medical System, this should be activated.

The patient should then be transported to the nearest emergency department where a rapid assessment is done by a team of specialised doctors and nurses trained to evaluate, treat and manage the acute stroke patient.

The patient would be assessed and stabilised by checking the airway, breathing and circulation. Oxygen would be administered, if necessary, and the vital signs - blood pressure, pulse rate, temperature, and respiratory rate - done. An evaluation would then be done by getting eyewitness accounts as well as using various stroke scales.

A bedside glucose and other blood tests, electrocardiogram (ECG) and a CT Scan of the brain would be done on the patient. The brain scan would indicate if there is haemorrhage in the brain or not.

If there is no haemorrhage, the patient would then be evaluated for fibrinolytic therapy "clot buster" then treated and admitted to intensive care or the stroke unit. If the patient does not meet the criteria for fibrinolytic therapy, then aspirin and other drugs would be given and the patient admitted to the hospital. However, if haemorrhage is present the patient should be referred to the neurologist and or neurosurgeon who will determine if surgical intervention is necessary. If no surgery is advised then the patient would be admitted to hospital for supportive care.

This would include stroke rehabilitation, which assists the patient in regaining and relearning skills of daily life such as speech and walking. The relatives and caregivers are also educated regarding the prevention of secondary complications, such as bedsores and falls, which may lead to the death of their relative.

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