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Stroke and the Brain

The brain is the control centre of your body. It controls how you think, feel, communicate and move. Knowing how your brain works can help you understand your stroke.

Brain cells

The brain is full of specialized cells called neurons. These neurons make the brain work. To work properly — and even to survive — they need to be fed by a constant supply of blood.

To survive vessels need to be fed by a constant supply of blood.

Blood vessels of the brain

Arteries and veins are types of blood vessels in your body. Arteries carry blood, rich in oxygen and nutrients, to your organs. Veins carry waste products away from your organs. Cerebral arteries are the arteries of the brain. Normal brain function needs a constant supply of oxygen and nutrients.

When a stroke happens, the blood flow is disrupted. Some brain cells do not get the oxygen and nutrients they need. When the cells die, that area of the brain cannot function as it did before.

Hemispheres

The brain is divided into two parts called hemispheres, the right and the left. The right hemisphere of your brain controls the left side of your body. The left hemisphere of your brain controls the right side of your body. Some functions are controlled by both. This picture shows the functions of the two hemispheres of the brain.

 

 

Regions of the brain and what they control

Each hemisphere is divided into six regions or lobes that control different functions. This picture shows the 6 regions and what they control.

The first hours at the emergency department

The first hours after stroke can be very scary and fast-paced. The healthcare team will be working quickly to figure out the type of stroke you have had so that they can take action to prevent further damage to brain cells.

There are three goals for treatment in the first few hours after a stroke:

  • To stabilize: you by managing breathing, heart function, blood pressure, bleeding, swallowing and other symptoms.
  • To make a diagnosis: You should receive a brain scan soon after you arrive at the hospital. This is usually a CT (computed tomography) scan. The scan may show the type of the stroke (a clot or a broken artery). A CT scan also finds the location of the stroke. Scan results help your healthcare team choose the best treatment options. Blood tests may be a part of your assessment.
  • To provide early treatment:The type of treatment depends on the type of stroke. Ideally, treatment takes place in a special stroke unit in the hospital.

Early treatment for ischemic stroke (clot)

If a clot caused the stroke, doctors will decide whether you could benefit from a clot-busting drug called tPA (tissue Plasminogen Activator – also known as Activase®). This medication can help reopen blocked arteries in some people with ischemic stroke. It must be given as soon as possible, within 4½ hours after stroke symptoms started. tPA can reduce the severity of the stroke and reverse some stroke effects. Not everyone who has an ischemic stroke can receive tPA.

After you receive tPA, the healthcare team will be watching extra closely for the first day. To make sure the tPA worked, a repeat CT scan will be done within a day or two after the stroke.

Endovascular thrombectomy (EVT) is a new breakthrough procedure where doctors insert a thin tube through an artery in the patient’s groin, guiding it with X-ray imaging through blood vessels to the brain. Then, a retrievable stent is used to remove large clots in order to restore blood flow.

EVT saves lives, reduces disability and is now considered the gold standard for treatment of patients with major ischemic strokes. EVT procedures are recommended for eligible patients within six hours of stroke onset, or even up to 24 hours in select patients. However, the faster it can be initiated, the better.

Learn more about breakthrough endovascular thrombectomy research co-funded by Heart & Stroke.

Early treatment for hemorrhagic stroke (bleed)

Hemorrhagic stroke can be very serious and cannot be treated with tPA. It has a longer recovery time than ischemic stroke.

A neurosurgeon will determine with the team if an operation is needed. This might be needed to control the bleeding in your brain, to fix the damaged artery or to lower the pressure in your brain.

The team will check often to make sure symptoms are not getting worse. They will monitor blood pressure and check for alertness, headache, weakness or paralysis, and other stroke symptoms.

The first days in hospital

Two-thirds of people with stroke are admitted to hospital. Each person recovers at his or her own pace. Your care and length of stay is based on your needs. A team of healthcare providers will work with you. Here is what your in-hospital care will focus on:

Understanding what happened

During the first few days after your stroke, you might be very tired and need to recover from the initial event. Meanwhile, your team will identify the type of stroke, where it occurred, the type and amount of damage, and the effects. They may perform more tests and blood work.

Monitoring and managing risk factors

If you had an ischemic stroke, you may be prescribed blood thinners (anti-platelet medication such as ASA, acetylsalicylic acid or Aspirin®) to prevent more clots.

Your blood pressure will be checked regularly. If it is high, medication may be prescribed.

If the team suspects your stroke was caused by blocked carotid arteries in your neck, they may do scans. If necessary, they will have you see a surgeon.

Atrial fibrillation or irregular heart rhythm is a significant risk factor for stroke. You may be tested for this during hospitalization.

If you have diabetes – a risk factor for stroke – the team will review how you manage it.

The team will review other risk factors for stroke and work with you to set goals and make a plan to prevent another stroke.

Preventing complications

The team will be checking for some of the more common complications of stroke. Starting treatment early helps to prevent further complications.

If you are unable to move around in bed, the team will be working to prevent clots (deep vein thrombosis) from forming in your legs. They will also try to prevent pressure sores on your skin. As soon as you are able, the team will work with you to get you sitting, standing and walking safely.

Weakness and balance problems may put you at risk of falling. The team will assess your risk. They will work with you to make sure you understand the risk and how to prevent falls. If the team gives you a mobility device such as a walker, it is important to use it.

You should have a swallowing test before you are given any liquids, food or medication. Problems swallowing, if not identified, can lead to complications such as:

  • pneumonia
  • not getting enough to eat (malnutrition)
  • not drinking enough (dehydration).

 

For this article and more information from HSF

October 4, 2019 article

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