If you experience sudden paralysis or numbness on one side of the body, difficulty speaking, loss of balance, or vision loss on one side, call 911 immediately. Time is critical—getting to the hospital quickly can significantly improve outcomes for an ischemic stroke. Do not delay; every second counts.
Stroke
Stroke is a medical emergency caused by disrupted blood flow to the brain, either from a blockage (ischemic) or a ruptured blood vessel (hemorrhagic), leading to brain cell damage. Symptoms include sudden weakness, numbness (often on one side), confusion, speech difficulties, vision problems, balance loss, and severe headache. Prompt treatment is vital to reduce brain damage and improve recovery. While a leading cause of death and disability, many strokes are preventable through lifestyle changes and managing risk factors like high blood pressure, diabetes, and smoking.
Stroke Vs TIA
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Stroke:
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Think of your brain as a control center that manages everything your body does.
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Sometimes, the blood flow to a part of your brain can be blocked (ischemic stroke) or there can be bleeding in the brain (hemorrhagic stroke).
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When this happens, the affected part of the brain doesn't get the oxygen and nutrients it needs, and brain cells can start to die.
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This can lead to various problems, like difficulty moving, speaking, or even understanding things.
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TIA (Transient Ischemic Attack):
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It's like a mini-stroke, but temporary.
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Just as in a stroke, there's a brief disruption in the blood flow to a part of the brain, but it only lasts for a short time (usually a few minutes to a few hours).
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The symptoms might be similar to a stroke, like sudden weakness or difficulty speaking, but they go away on their own.
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Even though the symptoms don't last long, a TIA is a warning sign that there's a problem with blood flow to your brain, and it should be taken seriously.
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In summary, a stroke is a more serious and lasting condition where part of the brain is damaged due to a lack of blood flow, while a TIA is like a temporary glitch, indicating a potential problem with blood flow that needs attention to prevent a full-blown stroke. Both need prompt medical attention for proper diagnosis and treatment.
Acute Ischemic Stroke: Symptoms and Treatment
Acute Ischemic Stroke (AIS) occurs when blood flow to a part of the brain is blocked, typically due to a blood clot or narrowing of a blood vessel, leading to a lack of oxygen and nutrients. This can cause brain tissue damage or death if not treated promptly.
Symptoms
The symptoms of AIS appear suddenly and can vary depending on the area of the brain affected. Use the FAST acronym to recognize common signs:
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Face drooping: One side of the face may appear droopy or numb.
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Arm weakness: Sudden weakness or numbness in one arm or leg, often on one side.
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Speech difficulty: Slurred or incoherent speech; difficulty understanding others.
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Time to call emergency services: Immediate action is critical.
Other symptoms may include:
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Sudden vision problems (blurred or loss of vision in one or both eyes).
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Loss of balance, dizziness, or trouble walking.
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Severe, sudden headache with no known cause.
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Confusion or difficulty understanding.
Treatment
The goal of treatment is to restore blood flow to the brain as quickly as possible to minimize brain damage.
1. Emergency Treatments
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Intravenous Thrombolysis (tPA):
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Tissue Plasminogen Activator (tPA) is a clot-busting drug given within 4.5 hours of symptom onset.
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It dissolves the clot and restores blood flow.
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Endovascular Thrombectomy:
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A minimally invasive procedure to physically remove the blood clot using a catheter.
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Effective if performed within 6-24 hours of stroke onset, depending on eligibility.
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2. Supportive Care
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Blood Pressure Management: Keeping blood pressure at optimal levels.
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Blood Sugar Control: Monitoring and managing glucose levels.
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Oxygen Therapy: Ensuring sufficient oxygen delivery to the brain.
3. Prevention of Recurrence
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Antiplatelet Therapy: Aspirin or clopidogrel to prevent clot formation.
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Anticoagulants: For patients with atrial fibrillation or other clotting risks (e.g., warfarin, DOACs).
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Statins: Lower cholesterol levels to prevent further artery narrowing.
4. Rehabilitation
After acute treatment, rehabilitation focuses on recovering lost functions:
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Physical Therapy: Improve mobility and strength.
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Occupational Therapy: Assist with daily tasks and fine motor skills.
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Speech Therapy: Address language, swallowing, and communication difficulties.
Time is critical in treating an ischemic stroke. Immediate medical intervention can significantly improve outcomes and reduce long-term disability.
Secondary Prevention
The Canadian guidelines for optimal post-stroke or post-transient ischemic attack (TIA) management of risk factors focus on secondary prevention to reduce the risk of recurrent strokes. These are derived primarily from the Canadian Stroke Best Practice Recommendations and other Canadian cardiovascular prevention guidelines.
Here is a summary of key recommendations for managing risk factors post-stroke or TIA:
1. Hypertension Management
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Goal BP:
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For patients post-stroke or TIA: Target <140/90 mmHg.
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For patients with diabetes: Target <130/80 mmHg.
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Recommended Medications:
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ACE inhibitors, ARBs, or diuretics (thiazide) are first-line options, often in combination.
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Monitor blood pressure frequently, especially in the early post-stroke phase.
2. Antithrombotic Therapy
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Ischemic Stroke/TIA (non-cardioembolic):
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Use antiplatelet therapy: Aspirin (81 mg), clopidogrel (75 mg), or ASA-dipyridamole.
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Cardioembolic Stroke (e.g., atrial fibrillation):
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Oral anticoagulation with NOACs (e.g., apixaban, rivaroxaban, dabigatran) or warfarin.
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Ensure contraindications are assessed (e.g., bleeding risk).
3. Lipid Management
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Target LDL-C: <1.8 mmol/L or a 50% reduction from baseline levels.
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First-line Therapy:
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High-intensity statins (e.g., atorvastatin 40-80 mg or rosuvastatin 20-40 mg).
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Lifestyle modifications, such as reducing dietary saturated fats and increasing physical activity, are essential.
4. Diabetes Management
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Screen all stroke/TIA patients for diabetes (e.g., HbA1c).
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Target HbA1c: ≤ 7.0%.
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Optimize glycemic control with oral antihyperglycemic agents (e.g., SGLT2 inhibitors, GLP-1 receptor agonists) or insulin as needed.
5. Lifestyle Modifications
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Diet:
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Follow the Mediterranean or DASH diet (rich in fruits, vegetables, whole grains, lean protein, and healthy fats).
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Limit salt intake to <2 g/day.
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Physical Activity:
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Minimum 150 minutes per week of moderate-intensity aerobic activity. Include strength training twice a week.
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Smoking Cessation:
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Strongly encourage quitting with counseling, pharmacotherapy (e.g., NRT, varenicline), and support programs.
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Alcohol:
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Limit alcohol to ≤2 standard drinks/day (men) or ≤1 drink/day (women).
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6. Atrial Fibrillation Screening
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Screen for atrial fibrillation (AF) in all patients post-stroke/TIA, especially with cryptogenic strokes.
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Use long-term cardiac monitoring if needed.
7. Obstructive Sleep Apnea (OSA)
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Screen patients with a history of stroke/TIA for sleep apnea (e.g., STOP-BANG questionnaire).
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Treat with CPAP if OSA is confirmed.
8. Carotid Artery Management
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For symptomatic carotid stenosis:
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Recommend carotid endarterectomy (CEA) within 14 days if stenosis is ≥70%.
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Consider stenting for certain high-risk surgical candidates.
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9. Psychological and Cognitive Support
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Assess for post-stroke depression and cognitive impairment.
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Provide multidisciplinary rehabilitation, including counseling or pharmacotherapy for mood disorders.
10. Long-Term Follow-Up and Coordination
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Regular follow-up visits to monitor risk factors, adherence to medications, and lifestyle changes.
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Engage in stroke prevention education and support.