Stroke is a dangerous and scary disease.

There are many causes of ischemic stroke.

 

1. It can be caused by atherothrombosis, which leads to widespread brain death and possibly swelling inside the brain that puts pressure on nearby brain tissues to cause side effects.

2. It can be caused by small blood clots that are transported along the bloodstream and block major arteries in the brain (embolism), which can be either cardioembolic or artery-to-artery in nature.

3. It can be caused by lacunar infarction. Although the amount of brain tissue damage might be minimal, this condition can cause the patient to experience severe weakness.

 

1. Intracranial hemorrhage due to degeneration of the blood vessel walls, especially in patients who have experienced hypertension over an extended period of time or who have poor blood pressure control.

2. Brain hemorrhaging caused by amyloid angiopathy, which causes blood vessels to rupture. Usually, this condition is present along with symptoms of dementia and is often found in elderly people, although not very frequently. 

3. Ruptured aneurysm with subarachnoid hemorrhaging. Patients with this condition usually also have hypertension.

4. Arteriovenous malformation leading to brain hemorrhaging and subarachnoid hemorrhaging.

 

This type of stroke is caused by obstruction in a cerebral artery that causes abnormal physical function in the parts regulated by the affected section of the brain. 

If symptoms do not last for more than 24 hours, this condition will be referred to as transient ischemic attack or TIA or mini-stroke. Usually, symptoms do not last longer than half an hour.

Importantly, up to 1 out of 10 patients who experience TIA will experience an actual stroke within the one week later, and 2 out of 10 of these patients will experience stroke within the first month before the odds decrease to about 4-5 out of 100 patients per year. As a result, doctors emphasize that patients who suspect TIA seek medical consultation as soon as possible.

 

1. Rapid or sudden onset of neurological symptoms.

2. Weakness or numbness in half of the body or loss of vision in one side.

3. Temporary blindness.

4. Incoherent speech or loss of ability to comprehend language.

5. Constant dizziness that is not related to changes in posture.

6. Sudden onset of loss of balance, double vision or cross eyes.

 

The risk of developing stroke depends on each person according to their risk factors. For example, older males with family history of ischemic stroke are more likely to experience stroke than younger females with no family history of stroke, and these factors cannot be avoided or changed.

 

Meanwhile, there are also other risk factors like hypertension, diabetes, smoking, not exercising, high cholesterol, ischemic heart disease and cardiac arrhythmia that are controllable and changeable through continuous treatment and the patient’s attentive self-care.

 

Furthermore, it has been reported that drinking a small amount of alcohol by no more than 1 glass per day can contribute to less stiffening of the blood vessels, although regular heavy alcohol consumption is toxic to the liver and causes cirrhosis, obesity, pancreatitis, diabetes and ruptured aneurisms. Because the study findings are inconclusive and there are only minor benefits, doctors generally do not recommend patients to consume alcohol for the aforementioned reason.

 

1. Use of drugs such as anti-platelet medications like aspirin, clopidogrel and dipyridamole or anti-coagulants like warfarin, in cases where the patient experiences cardiac arrhythmia.

2. Surgery is the method of treatment in some cases, depending on the case, stage of the disease and the patient’s response to treatment. For example, if death to parts of the brain led to significant swelling and pressure on other parts of the brain, surgery will be necessary. Otherwise, surgery might also be necessary in cases of carotid artery stenosis, which leads to ischemic stroke. In any case, doctors will decide the appropriate treatment for each individual patient.

 

Factors we can control include modifying behaviors to reduce risks, for example, by controlling diabetes, cholesterol and blood pressure to be within normal levels and treating co-morbidities like myocardial infarction and chronic cardiac arrhythmia and quitting smoking and drinking while exercising regularly.

 

Although patients will be administered anti-platelet medications long-term, 1 out of 4 ischemic stroke patients are likely to experience a recurrence within 5 years. Aspirin can reduce risk of recurrent stroke by 18% (for example, from 5 people to 4 people), but this means that it cannot prevent recurrence in every case. Even worse, recurrent stroke increases the risk of developing dementia in the future. Therefore, patients have to take medications for the rest of their lives, take care of themselves and control risk factors in order to have a good quality of life.