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Post by Admin on Nov 1, 2020 21:34:59 GMT
The type of stroke you have affects your treatment and recovery.  The three main types of stroke are: Ischemic stroke. Hemorrhagic stroke. Transient ischemic attack (a warning or “mini-stroke”). Learn about the health conditions and lifestyle habits that can increase your risk for stroke. Ischemic Stroke Most strokes (87%) are ischemic strokes.1 An ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. Hemorrhagic Stroke A hemorrhagic stroke happens when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them. High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke. There are two types of hemorrhagic strokes: Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood. Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it. Transient Ischemic Attack (TIA) A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.2 It is important to know that: A TIA is a warning sign of a future stroke. A TIA is a medical emergency, just like a major stroke. Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a stroke or see symptoms in someone around you. There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke. Like ischemic strokes, blood clots often cause TIAs. More than a third of people who have a TIA and don’t get treatment have a major stroke within 1 year. As many as 10% to 15% of people will have a major stroke within 3 months of a TIA.2 Recognizing and treating TIAs can lower the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke. References 1. Mozzafarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 2016;133(4):e38–360. 2. American Heart Association/American Stroke Association. TIA (Transient Ischemic Attack)external icon. Accessed October 6, 2016. |
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Post by Admin on Nov 3, 2020 21:27:58 GMT
A stroke is a devastating health issue, but often a preventable one. High blood pressure, smoking, diabetes and poor diet are among factors that could put you at risk for stroke.
“The same foods that help us keep our weight at a manageable level and prevent diabetes and heart disease can help prevent a stroke because heart health and stroke are closely linked,” said Geisinger vascular neurologist Ramin Zand, M.D. “Focusing on nutrient-rich foods that are good for your heart can help you cut your stroke risk.”
Focus on these brain-healthy foods to help prevent stroke.
Fruits and vegetables
It’s no surprise that fruits and vegetables, which can help you maintain a healthy weight and keep your heart in good shape, can also help you prevent stroke. They’re naturally low in fat and calories, but they are rich in fiber, which can help you feel full. Fruits and vegetables also contain nutrients such as potassium, fiber, folate, vitamin A and vitamin C.
Foods high in potassium, such as sweet and white potatoes, bananas, tomatoes, prunes, melon and soybeans, can help you maintain a healthy blood pressure, which is the leading risk factor of stroke.
Magnesium-rich foods, such as spinach, are also linked to a lower risk of stroke.
“Eating four to five servings of fruits and vegetables each day can help to lower your risk of having a stroke, help you keep your heart healthy and generally keep you at a healthy weight,” said Dr. Zand.
Fish
Salmon, albacore tuna, trout and mackerel are high in omega-3 fatty acids, which can help you keep your blood pressure and cholesterol low, your heart healthy and reduce your risk of stroke.
In an analysis of studies linking fish to stroke risk in the journal Stroke, researchers found that people who ate two servings of fish per week lowered their stroke risk by 6 percent.
“Omega-3s are healthy fats that are found in oily fish,” said Dr. Zand. “Eating two to three servings of salmon or herring each week can promote heart health and lower your risk of stroke.”
Whole grains
On your next grocery trip, reach for the whole grain bread rather than refined white bread.
“When grains are refined to make white bread, English muffins and white rice, many of the healthy nutrients are stripped out,” said Dr. Zand. “That’s why we recommend choosing whole grain bread and cereal, oatmeal and brown rice.”
Whole grains are high in fiber, B vitamins such as folate and thiamin, magnesium and iron—all of which can promote heart health, which can help you prevent stroke.
Low-fat dairy
Cheese, milk, yogurt and other dairy products deliver calcium, protein, vitamin D and potassium—but full-fat dairy products also add saturated fat and cholesterol, which could lead to heart disease and stroke. Instead, low-fat and no-fat milk, yogurt and cheese provide the healthy nutrients that can lower your risk of heart disease, type 2 diabetes and high blood pressure—all of which are risk factors for stroke.
“Generally, eating a diet full of heart-healthy foods will help you prevent stroke,” said Dr. Zand. “Getting exercise and maintaining a healthy weight, which is also easier if you eat a healthy diet, will also help you avoid a stroke.”
Vascular neurologist Ramin Zand, M.D., is the northeastern regional stroke director for Geisinger Wyoming Valley Medical Center (GWV) in Wilkes-Barre and Geisinger Community Medical Center (GCMC) in Scranton.
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Post by Admin on Feb 26, 2022 4:19:36 GMT
What is dysarthria?
Dysarthria is a speech disorder that happens because of muscle weakness. Motor speech disorders like dysarthria result from damage to the nervous system. Many neuromuscular conditions (diseases that affect the nerves controlling certain muscles) can result in dysarthria. In dysarthria, the muscles used to speak become damaged, paralyzed or weakened.
How does dysarthria affect me?
If you have dysarthria, you may have difficulty forming and pronouncing words. Other people may have trouble understanding what you say. Speech problems can cause difficulties in social situations, jobs and school.
Dysarthria affects many parts of the body needed for speech, including the:
Tongue.
Larynx (voice box).
Surrounding muscles.
What are the types of dysarthria?
The type of dysarthria depends on the part of the nervous system affected:
Central dysarthria: Caused by damage to the brain.
Peripheral dysarthria: Caused by damage to what the organs needed for speech.
Dysarthria can be developmental or acquired:
Developmental dysarthria happens as a result of brain damage, either before a baby is born or at birth. For example, cerebral palsy can cause dysarthria. Children tend to have developmental dysarthria.
Acquired dysarthria happens as a result of brain damage later in life. For example, a stroke, a brain tumor or Parkinson’s disease can result in dysarthria. Adults tend to have acquired dysarthria.
How common is dysarthria?
Researchers don’t know exactly how common dysarthria is. It is more common in people who have certain neurological conditions, such as:
Amyotrophic lateral sclerosis (ALS): Up to 30% of people with ALS (Lou Gehrig’s disease) have dysarthria.
Multiple sclerosis (MS): Around 25% to 50% of people with MS get dysarthria at some point.
Parkinson’s disease: Dysarthria affects 70% to 100% of people with Parkinson’s disease.
Stroke: About 8% to 60% of people with stroke have dysarthria.
Traumatic brain injury: Some 10% to 65% of people with traumatic brain injury have dysarthria.
Is dysarthria the same as apraxia?
Apraxia is another motor speech condition. It’s similar to dysarthria because both involve problems with muscle tone or motor planning (the plan and act of moving muscle). In apraxia, people have normal muscle function but have difficulty making voluntary movements like speaking. There’s a problem getting the message from the brain to the muscles that tells the muscles to move.
Other speech conditions can be related to dysarthria:
Dysphagia: Trouble swallowing, which may be a symptom of dysarthria.
Aphasia: Difficulty understanding others or explaining your thoughts.
SYMPTOMS AND CAUSES
What causes dysarthria?
The causes of dysarthria depend on the type of disorder. Both types can occur at birth or develop later in life.
Central dysarthria may result from any illness or injury that leads to brain damage. Some examples are:
Brain tumors.
Dementia.
Side effects of certain medications, such as sedatives and anti-seizure drugs.
Stroke.
Traumatic brain injury.
Neuromuscular diseases also can cause central dysarthria:
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
Cerebral palsy.
Huntington’s disease.
Multiple sclerosis.
Muscular dystrophy.
Myasthenia gravis.
Parkinson’s disease.
Peripheral dysarthria develops from damage to the speech organs that changes the way a person sounds. Causes include:
Congenital (being born with) structural problems.
Surgery to the head, neck, tongue or voice box.
Trauma to the face or mouth.
What are the symptoms of dysarthria?
The main symptom of dysarthria is a change in the way you talk. People may have trouble understanding you because you:
Speak more quickly, slowly or softly than intended.
Have speech that becomes slurred, mumbled, robotic or choppy.
Have difficulty moving your lips, jaw or tongue.
Sound hoarse, breathy or nasal.
DIAGNOSIS AND TESTS
How is dysarthria diagnosed?
Your healthcare provider will ask you about your medical history and do a physical exam. A speech-language pathologist may also evaluate you to help figure out how severe the problem is. These providers will check your ability to breathe and move your lips, tongue and face. You may need to do some movement and language tasks, such as:
Bite your lower lip.
Blow out a candle.
Count.
Repeat words and sentences.
Sing.
Stick out your tongue.
What tests might I need to diagnose dysarthria?
Other tests you may need include:
MRI or CT scans of the neck and brain.
Evaluation of your ability to swallow.
Electromyography to test the electrical function of your muscles and nerves.
Blood tests (to look for signs of infection or inflammation).
MANAGEMENT AND TREATMENT
How is dysarthria treated?
Your healthcare provider will create a treatment plan for you based on the severity of your symptoms. People with dysarthric speech benefit from speech therapy to improve communication. Speech-language pathologists can also work with your family and loved ones to help them learn how to better communicate with you.
During speech therapy sessions, you can learn:
Exercises to strengthen mouth muscles.
Ways to slow down speech.
Strategies to speak louder, such as using more breath.
Ways to say sounds clearly.
Movements to chew and swallow safely.
Different communication techniques, such as gestures or writing.
If the condition is severe, you may need a device to communicate with people. These devices include a letter or picture board or a special computer with a keyboard and message display.
PREVENTION
Are there conditions that put me at higher risk for dysarthria?
Any condition that affects the brain can increase your risk for dysarthria. If you have a neuromuscular disease, brain tumor or brain injury, talk to your healthcare provider. They will discuss your risk for dysarthria and help you manage it.
OUTLOOK / PROGNOSIS
What are some tips for speaking with dysarthria?
If you have dysarthria, these tips can help you communicate better:
Speak slowly and loudly.
Start with a topic word, so listeners know what you want to talk about.
Avoid talking when you feel tired.
Pause frequently.
Use shorter sentences.
Check to make sure your listeners understand.
Write or draw if you’re having difficulty talking.
What tips can others use to talk to me?
Your family, friends and loved ones can use these strategies to improve communication with you. They should:
Talk to you in a quiet area with good lighting.
Pay close attention to you when you’re talking.
Let you know if they don’t understand what you’re saying.
Repeat what they did understand, so you don’t have to start from the beginning.
Ask yes or no questions to help you communicate.
Encourage you to write or point if you’re having trouble.
LIVING WITH
When should I see my healthcare provider about dysarthria?
If speaking becomes difficult, contact your healthcare provider. Seek immediate medical attention if you experience choking, repeated coughing or pneumonia.
What else should I ask my healthcare provider if I have dysarthria?
If you have dysarthria or difficulty speaking, ask your healthcare provider:
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Post by Admin on Feb 26, 2022 18:07:12 GMT
What is lacunar infarct?
Lacunar stroke is a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked.
A stroke occurs when a blockage interrupts or prevents blood flow to the brain. Strokes that occur due to blockages in blood vessels within the brain are called ischemic strokes.
According to the National Institutes of HealthTrusted Source (NIH), lacunar strokes represent about one-fifth of all strokes. Any type of stroke can affect your health by depriving brain cells of oxygen, meaning that the cells start to die within minutes.
We explain essential information about lacunar strokes, including the symptoms, causes, and treatments, as well as how to reduce your risk.
What are the symptoms of lacunar infarct?
As lacunar infarcts are small, they often do not cause symptoms. Often, they show up on brain scans before people are even aware they’ve happened.
When symptomatic, a lacunar stroke usually comes on suddenly and without warning. Symptoms may include:
slurred speech
inability to raise one arm
drooping on one side of the face
numbness, often on only one side of the body
difficulty walking or moving your arms
confusion
memory problems
difficulty speaking or understanding spoken language
headache
loss of consciousness or coma
The death of brain cells can disrupt some of the bodily functions the cells supported. For this reason, symptoms can vary depending on the location of the stroke.
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What causes lacunar infarct?
A lacunar stroke occurs due to a lack of blood flow in smaller arteries that supply deep brain structures. The most important risk factor for the development of lacunar stroke is chronic high blood pressure. The condition can cause the arteries to narrow. This makes it easier for cholesterol plaques or blood clots to block blood flow to the deep brain tissues.
Who is at risk for lacunar infarct?
A few different groups of people might have a higher risk for lacunar stroke than others.
Older adults
Your risk of lacunar stroke increases with age. Those at risk include people with chronic high blood pressure, heart disorders, or diabetes.
People with underlying health conditions
Some chronic health problems can cause a lacunar infarct as a complication, including:
chronic high blood pressure
heart disorders
diabetes
atherosclerosis, which causes plaque to develop on the walls of your arteries
peripheral artery disease, which can lead to narrowed blood vessels
high levels of an amino acid called homocysteine that usually suggests a vitamin B-12 or folate deficiency
a history of transient ischemic attacks, or ministrokes
Black people
Some research has indicated that lacunar infarct might occur more often in Black people than in white people.
A review compared two studies. One study took place in a community consisting mostly of Black people, and the researchers found that 52 in every 100,000 people had experienced a lacunar stroke. Another used a sample that had a majority white population and found an incidence of 29 in every 100,000 people.
More research needs to take place, and the studies didn’t clarify whether this difference in risk was due to genetic or socioeconomic factors.
Those with genetic factors
People with a family history of stroke might also have a higher risk for lacunar infarct than other groups.
Other factors
Additional factors that increase the likelihood of lacunar stroke include:
smoking or exposure to secondhand smoke
excessive alcohol and drug use
pregnancy
using birth control pills
a sedentary lifestyle
a diet that doesn’t provide a wide enough range of nutrients
high cholesterol
obstructive sleep apnea
It’s important to have annual physical examinations to screen for health issues that could raise your risk for stroke, including high cholesterol and obstructive sleep apnea.
How do doctors diagnose lacunar infarct?
Emergency treatment is necessary for any type of stroke, so it’s imperative to seek diagnosis immediately upon noticing any symptoms.
If your symptoms are consistent with stroke and present a medical emergency, immediate diagnostic testing will likely include a CT scan to take detailed images of your brain. Because lacunar strokes are so small and don’t show up clearly on CT imaging, a doctor may not be able to confirm diagnosis unless other tests are performed.
Magnetic resonance imaging (MRI) is a more accurate imaging option for lacunar infarct.
The doctor might also request a CT angiography. This will help them check your blood vessels for blockages.
Your doctor may take your blood pressure and ask about your symptoms. They may also carry out a detailed neurological exam to see if there is any damage to the parts of the brain that control your bodily functions.
Heart function tests, such as electrocardiogram and echocardiogram may be necessary, alongside kidney and liver function testing and various blood tests.
What is the treatment for lacunar infarct?
Early treatment for a lacunar stroke increases your chances of survival and may prevent further damage.
When you get to hospital
Once you arrive at the emergency room, a healthcare professional will likely recommend aspirin and other medications. This reduces your risk of having another stroke.
While you’re staying in the hospital
Supportive measures may be necessary to assist your breathing and heart function.
You may receive intravenous clot-busting drugs. For people with severe lacunar infarct, a doctor can deliver medications directly into the brain.
If these anti-clotting treatments don’t have the desired effects, a neurosurgeon can remove a clot or blockage from the brain in a procedure called a mechanical thrombectomy.
Rehabilitation
Lacunar stroke can result in some brain damage. Depending on how badly the underlying structures are damaged, you may not be able to care for yourself following a stroke. Recovery varies for each person and depends on the severity of the stroke.
Some people who experience a lacunar stroke transition from the hospital to a rehabilitation center or nursing home, at least for a short period of time. Stroke patients often have to relearn physical movements and regain their strength.
This can take weeks, months, or years.
Long-term treatment
Most people who experience a stroke require long-term treatment to reduce their risk for another stroke. This might include medications to manage:
high blood pressure
diabetes
high cholesterol
After a lacunar stroke, some people also require:
physical therapy to restore function
occupational therapy to improve skills needed for everyday living
speech therapy to restore spoken communication skills
What is the long-term outlook of lacunar infarct?
Some early research has indicated that lacunar infarct has a better outlook than other types of strokes. But it can still lead to an increased risk of further strokes, dementia, and death from cardiovascular causes.
Quality of life after lacunar stroke depends on many factors, including your age and how quickly your treatment began after symptoms started. Some people live with permanent disabilities. These can include:
paralysis
numbness
loss of muscle control on one side of the body
a tingling sensation in affected limb
Even after rehabilitation and stroke recovery, some stroke survivors have problems with short-term memory. Some may also have difficulty with thinking, reasoning, and controlling emotions. Depression can also be an issue for some stroke survivors.
Having a lacunar stroke increases your risk of subsequent strokes, so regular medical care is crucial for recovery.
Prevention
Lacunar stroke can be a life-threatening emergency.
Some risk factors, such as aging and family history, are beyond your control, but certain lifestyle behaviors can influence risk, like maintaining a healthy diet, avoiding smoking, and exercising for at least 150 minutes per week. Together, these habits can help lower your risk of having a lacunar stroke.
If you have high blood pressure, heart disease, or diabetes, try to keep it under control and see your doctor regularly. Most importantly, seek medical attention at the first sign of stroke — every second could save your life.
Last medically reviewed on January 4, 2022
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Post by Admin on Feb 27, 2022 18:51:23 GMT
Atherothrombosis: A widespread disease with unpredictable and life-threatening consequences Juan F Viles-Gonzalez, Valentin Fuster, Juan J Badimon European Heart Journal, Volume 25, Issue 14, 1 July 2004, Pages 1197–1207, doi.org/10.1016/j.ehj.2004.03.011Abstract Atherothrombosis, characterised by atherosclerotic lesion disruption with superimposed thrombus formation, is the major cause of acute coronary syndromes (ACS) and cardiovascular death. It is the leading cause of mortality in the industrialised world. Atherosclerosis is a diffuse process that starts early in childhood and progresses asymptomatically through adult life. Later in life, it is clinically manifested as coronary artery disease, stroke, transient ischaemic attack, and peripheral arterial disease. From the clinical point of view, we should envision this disease as a single pathologic entity that affects different vascular territories. Available antithrombotic therapy is very safe and efficient but the morbidity and mortality due to atherothrombosis is still unacceptably high. Recent evidence suggests that inhibition of tissue factor or elements in the tissue factor pathway (i.e., factors VIIa and Xa, or thrombin) has the potential to further improve outcomes in atherothrombosis. Here, we will review the most important concepts and advances in the pathogenesis, prevention, and antithrombotic treatment of this widespread disease. Introduction Atherothrombosis, defined as atherosclerotic plaque disruption with superimposed thrombosis, is the leading cause of mortality in the Western world. Atherosclerosis is a diffuse process that starts early in childhood and progresses asymptomatically through adult life. Later in life, it is clinically manifested as coronary artery disease (CAD), stroke, transient ischaemic attack (TIA), and peripheral arterial disease (PAD). From the clinical point of view, we should envision this disease as a single pathologic entity that affects different vascular territories. A suggestive analogy is that TIA and intermittent claudication are the unstable angina of the brain and lower limbs, respectively; and stroke and gangrene are the myocardial infarction (Fig. 1). Endothelial dysfunction is a systemic, reversible disorder considered the earliest pathologic process of atherothrombosis.2,3 It is involved in the recruitment of inflammatory cells into the vessel wall and in the initiation of atherosclerosis (Fig. 2). Endothelial cells produce cytokines, express adhesion molecules such as ICAM-1, VCAM, and selectins, and assist leukocytes and other blood-derived cells in “homing” and atheroma infiltration. Secondary changes may occur in the underlying media and adventitia, particularly in advanced disease stages. Fatty streaks have been found to be present already in the intima of infants.4 Lesions progress to fibroatheroma by developing a cap of smooth muscle cells and collagen. Atherosclerotic lesions can progress without compromising the lumen because of compensatory vascular enlargement (positive remodelling).5 Importantly, lipid-rich lesions leading to acute coronary syndromes (ACS) are often mildly stenotic, due to significant positive remodelling, and therefore are not detectable by angiography. Plaque disruption and subsequent thrombus formation is responsible for the onset of most ACSs and strokes. The magnitude of the thrombotic process triggered upon plaque disruption is modulated by different elements that determine plaque and blood thrombogenicity: local shear rate, tissue factor (TF), apoptotic microparticles, circulating monocytes, and others. The atherosclerotic and thrombotic processes appear to be interdependent and could therefore be integrated under the term “atherothrombosis”, a broader term that includes both atherosclerosis and its thrombotic complications (Fig. 1).1,6  |
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