Combination Therapies for Stroke Recovery: Synergizing Solutions

20 Dec Combination Therapies for Stroke Recovery: Synergizing Solutions

Stroke is assessed as a medical emergency when there is interrupted blood flow to the brain cells and they start to die. It can cause serious debilitating symptoms like paralysis and even death.

It can happen out of nowhere, without any warning. If you notice yourself or someone close to you having unbearable chest pain with breathlessness and uneasiness, you should immediately call an ambulance.

It can manifest subtly and reach its maximum peak within minutes. To know more about stroke and its types, contact the best neuropsychiatrist in Patna, Dr. Vivek Pratap Singh. 

What are the 4 types of stroke? 

The stroke can be categorized into two main types that is ischemic and hemorrhage. This is more commonly seen in elderly from age 50-60. The types of stroke in elderly are 

Ischemic stroke occurs due to blockage in the artery or rarely in veins. It is the most common type of stroke and accounts for 87% of the cases.

When a blood vessel supplying blood and oxygen to the brain gets clogged it restricts the blood flow. The types of ischemic stroke are the following. 

What are the 3 types of stroke?  

A blood clot that develops in the brain. This is called thrombotic stroke characterized by a thrombus developing in the arteries supplying the brain.

It is usually seen in older people with underlying comorbidities such as hypertension, atherosclerosis, high cholesterol, or diabetes.

Some neurons in the brain die when there is decreased perfusion for less than 5 minutes.

However, the extent of damage depends upon how much the ischemia severity is. Sometimes, if the blood flow is restricted to only >40% there is a window period of 3-6 hours before complete tissue death.

If the tissue is not irreversibly damaged, intervention for perfusion can repair the damages to tissue. 

Large vessel atherosclerosis can affect the arteries in the brain with partial or complete obstruction near the brain bifurcation.

Sometimes, there are ‘mini-strokes’ that occur before thrombotic strokes. These kinds of strokes are warning signs of a major stroke. Transient ischemic attack is a stroke that lasts for around minutes or even 24 hours. 

There are infarcts in small blood vessels that result from obstruction of small arteries and are called lacunar infarcts.

There is a build up of lipids and collagen in the small arteries. It is mostly found in people with diabetes or high blood pressure. Lacunar infarcts causes 

• Motor paralysis 
• Ataxic hemiparesis 

When a clot is formed in some other organ but a part of it travels through blood vessels and gets stuck in the brain called an embolism.

It results due to heart disease or underlying cardiovascular problems. This is more commonly seen in people with atrial fibrillation with abnormal rhythm in the heart. 

Ischemic stroke can cause symptoms such as 

• Neurologic dysfunction that is in one rm and spread ipsilaterally 
• Seizure can precede the onset of a stroke
• Occasionally, fever 
• Impaired consciousness 

Hemorrhagic stroke is when the blood vessels that are supplying the brain get ruptured and bleed in the brain cells.

These cells and tissue are deprived of oxygen and nutrients leading to pressure buildup. This causes irritation and swelling in the brain leading to further brain damage. It can happen in one of the two ways that is 

Intracerebral hemorrhage is when the blood vessel inside the brain tears or ruptures leading to bleeding inside the brain. It comes without warning and can have fatal consequences. 

Subarachnoid hemorrhage is true to its name causing blood vessels to leak between the brain and meninges in the subarachnoid space. This is most commonly preceded with aneurysm or arteriovenous malformation. 

• Aneurysm is a condition characterized by a balloon shaped area on an artery that has a risk of rupturing if left untreated. It can be congenital or develop due to high blood pressure and heart diseases. 
• A complex tangled web of arteries and veins is known as arteriovenous malformation. 

The worst type of stroke is called hemorrhagic stroke because when the arteries ruptures the blood can cause hydrocephalus that is the worst outcome.

This can impair consciousness leading to coma and death. An intracerebral hemorrhage causes blood to accumulate in brain tissues resulting in neuronal dysfunction.

The symptoms of hemorrhagic stroke can start with 

• Headache 
• Loss of consciousness within seconds or minutes
• Nausea or vomiting
• Delirium 
• After this, the neurologic deficits tend to occur that can be sudden and progressive. 
• Large hemorrhages in the hemisphere regions can cause partial paralysis. This type can lead to coma and death. 
• Hemorrhages in the posterior region can cause symptoms like pinpoint pupils, eye deviation, or irregular breathing. 

Rare Types of Stroke 

The common types of stroke like ischemic stroke, hemorrhagic stroke or transient ischemic attack all can occur in the elderly people. Although, at times there are rare causes of stroke in younger people such as 

• Blood disorders in some people that cause clotting can increase the risk of stroke. These disorders are inherited or can be diagnosed through blood tests. 
• Congenital heart conditions in children allows blood clots in the heart to travel toward brain. One of the common condition that causes this is a patent foramen ovale that is a hole in the heart that does not get closed within the first few months of birth. 
• A kidney disorder called polycystic kidney disorder is hereditary and leads to formation of cysts on the kidney. People with this disorder have an increased risk of aneurysms and should have a regular check up done. 
• Migraine is a neurological disorder characterized by severe headaches accompanied with vomiting and nausea. These headaches can rarely cause ischemic or hemorrhagic strokes. 
• Stroke in young people can even be caused by tears in the blood vessels supplying the neck. It can happen by minor trauma or in rare cases spontaneously. The tears can cause blood clots forming in the neck that can travel to the brain. Sometimes, these tears can cause aneurysms. 
• Birth control pills are one of the other reasons there is an increase in stroke. 
• Poor health in young adults is one of the major posing risk factors like eating junk food, sedentary lifestyle, and no physical activity can increase the stroke risk. 

One should remember the first aid symptoms of stroke with the mnemonic FAST 

• F suggests checking for face abnormalities. Ask the person to smile and look out for a droop on one or both the sides. 
• A is for the arm. Ask the person to raise both the arms and see if one arm drops downward. 
• S is for speech, if the person has slurred speech or not finding right words. 
• T is time taken since the symptoms started. One should keep a tab on the elapsed time to inform the paramedics. 

Common signs and symptoms in a stroke patient 

The symptoms of a stroke can depend on the region affected and the type of the stroke a person is suffering from. However, the common symptoms one experiences are 

• One sided paralysis
• Aphasia known as inability to speak 
• Loss of muscle control 
• Loss of sensations like touch, vision, hearing or smell
• Blurry vision
• Loss of coordination called ataxia
• Vertigo
• Neck stiffness
• Confusion or agitation
• Memory loss
• Coma 

Diagnosis of Stroke

To diagnose a stroke, the healthcare provider might suggest some lab examinations, perform physical examination and history taking to know the person’s symptoms well.

One is given certain tasks or answer questions to determine the condition. Common laboratory examination that are performed are 

• CT scan to detect the brain regions and structures if they are properly functioning. 
• Lab tests such as CBC, sugar levels, clotting function tests, kidney and liver function tests. These tests are done to rule out infections or any chronic underlying medical condition. 
• ECG to rule out heart abnormalities 
• MRI scans
• EEG to detect seizures or epilepsy 

Treatment of Stroke 

The stroke treatment depends on the type of stroke a person has. Ischemic stroke treatment depends on restoring the blood flow and circulation as soon as possible to prevent permanent damage.

This restoration can be done by thrombolytics by the catheterization procedure. 

Hemorrhagic stroke treatment’s goals are focused on reducing blood pressure around the tissues to decrease bleeding. It is recommended to give drugs to improve clotting.

Sometimes surgery is suggested to relieve the pressure on the brain due to blood accumulation. 

Ischemic stroke is treated by thrombolytic drugs within 3-4 hours. After that thrombectomy within 24 hrs if there’s no brain damage.

Eventually, blood pressure management by taking calcium channel blockers or approved therapy.

If there’s a presence of thrombi or an emboli, it should be treated by antiplatelets, anticoagulants or mechanical thrombectomy. 

Hemorrhagic stroke treatment depends on modifying risk factors and controlling blood pressure by approved medications.

Antiplatelets and anticoagulants are contraindicated in this condition. Hematomas that are more than considerable size are treated by surgical evacuation.

People with this type of stroke are at increased risk of hydrocephalus which is treated by a ventricular drain to reduce the intracranial pressure. 

Clotting support is done by infusion of medications or blood factors such as vitamin K therapy, prothrombin or clotting factor infusions. 

After a person suffers a stroke, it is important for them to recover the changes in the brain. The following therapies like

• Speech therapy aids with regaining ability to speak and language recognition skills. It can control muscles that help eating, and drinking. 
• Physical therapy is used to regulate the ability to use hands, arms and legs. It helps with balance issues and weakness in muscles. 

Stroke can have grave consequences and sometimes fatal outcomes.

It’s important for people to recognize the symptoms and seek immediate treatment. The neuropsychiatric illness treatment in Patna, Dr. Vivek Pratap Singh.