Stroke: pathophysiology, clinical presentation, and treatment approaches

Stroke is one of the leading health concerns in the United States affecting approximately more than 795,000 people every year. With more than 143,579 deaths per year, stroke is the third leading cause of mortality in the country. [Washington University] Also stroke is the leading cause of disability in the U.S. Stroke survivors carry a high risk of recurrence and hence preventive intervention strategies are an important part of stroke management. The fact that we have an aging population and that almost three quarters of stroke attacks occur in those aged 65 and above suggests a health care crisis.[Washington University] Given the high risk for severe disability, it is important to initiate effective rehabilitative interventions immediately following a stroke attack. A brief overview of the risk factors, the adverse effects and stroke prevention strategies would provide better insight into Stroke and its management.

Stroke (The Risk Factors)

Age is undoubtedly one of the most significant risk factors for stroke with the elderly population above 65 years of age carrying the greatest risk. The American Heart Association has published a detailed list of both modifiable and non-modifiable risk factors for stroke. In fact, the list includes more than 30 individual risk factors that could cause stroke. Some of these, which are clinically identified to be the most important risk factors include a history of hypertension, diabetes, cigarette smoking, and several cardiovascular conditions. [Larry B. Goldstein, 2009, pg 6] These are clinically referred to as the 'First tier Risk Factors'. Additionally Atrial Fibrillation is by itself considered as a high risk factor for stroke. Obesity is also considered an important factor, though it is not included in the 'First tier risk factors', as it is considered to be a significant factor for hypertension and diabetes among both men and women. [Larry B. Goldstein, 2009, pg 9]

Stroke Induced disability

As mentioned above, stroke is one of the leading causes of disabilities and therefore rehabilitative management is very critical. For this reason, a stroke patient is usually started on rehabilitative therapy as soon as he/she is normalized or out of serious danger. Depending on the region of the brain that is affected, a stroke attack can lead to a variety of disabilities including reduced motor functions or paralysis, loss of speech functions (Aphasia) and thinking ability, emotional disturbance, Apraxia, etc. One of the important impairments caused by stroke is paralysis. In most cases, a patient loses motor functions in one side of the body, a condition that is commonly referred to as hemiplegia. Similarly dysphagia, a condition where the patient has difficulty in swallowing, is a commonly observed problem with some stroke patients. More than one fourth of all stroke patients also suffer from a condition called aphasia in which case the language centers of the brain such as the Broca's area or the Wernicke's area may have been affected. Patients with aphasia struggle with language disorders including both oral and written communication problems. Also, clinical depression is found to be common among many stroke victims. [NINDS]

Stroke Prevention

Given the high stakes involving both mortality and morbidity, stroke prevention is considered a very vital health care policy. Prevention strategies are usually targeted on controlling the important 'first tier risk factors' which were mentioned earlier. First and foremost among these is to control hypertension. Based on evidence-based practices, the American Heart association recommends that antihypertensive treatment including the use of diuretics and class 1 ACEI drugs be standardized for all patients to prevent recurrent strokes as well as to serve as a proactive intervention against other cardiovascular complications. Since diabetes is considered a high risk factor for stroke, clinical practice also recommends that glucose levels for all diabetic patients with ischemic stroke be maintained near-normoglycemic levels. The AHA guidelines also recommend that BP levels of diabetic patients be more rigorously monitored and controlled with appropriate class 2 hypertensive drugs. Cholesterol level management is also considered crucial in stroke prevention interventions. For patients with high lipid levels, the regimen includes treatment with appropriate satin agents. Since smoking is clearly accepted as one of the high risk factors for stroke, smoking cessation is high on the list of physician recommendations for prevention of stroke and other cardio vascular complications. Besides general counseling, physicians may also recommend smoking cessation medications. Last but not least is the stress on leading an active lifestyle. Regular walking and other controlled exercises are integral in managing hypertension, improving circulation and the overall cardiovascular functioning of the body. [Ralph L. Sacco et.al (2006)]