Stroke / Hemiplegia

Hemiplegia is paralysis of one side of the body; usually caused by a brain lesion, such as a tumor, or by Stroke. The paralysis occurs on the side opposite the brain disorder; this is explained by the fact that motor axons from the cerebral cortex enter the medulla oblongata and form two well-defined bands known as the pyramidal tracts. The majority of the fibers in these tracts cross to the opposite side; therefore damage to the right cerebral hemisphere affects motor control of the left half of the body.

A stroke is a sudden loss of brain function. It is caused by the interruption of flow of blood to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke). The interruption of blood flow or the rupture of blood vessels causes brain cells (neurons) in the affected area to die.

The effects of a stroke depend on where the brain was injured, as well as how much damage occurred. A stroke can impact any number of areas including your ability to move, see, remember, speak, reason and read and write. Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A stroke occurs when blood supply to part of the brain is disrupted, leading to inadequate oxygen supply and causing brain cells to die. Blood flow can be compromised in a variety of ways. Stroke is also referred to as cerebrovascular accident (CVA).



Heart conditions like atrial fibrillation, patent foramen ovale, and heart valve disease can also be the potential cause of stroke.

Factors such as oral contraceptive use, hormone replacement therapy, or pregnancy and childbirth in women with pre-existing medical conditions may increase the risk of stroke in specific cases.

Narrowing of the small arteries within the brain can cause a lacunar stroke (lacune means "empty space"). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct).

Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that supply the brain with blood. The anterior circulation of the brain's two cerebral cortices controls most motor activity, sensation, thought, speech, and emotion is supplied by the two carotid arteries. The posterior circulation, which supplies the brainstem and the cerebellum, controlling the automatic parts of brain function and coordination, is supplied by the two vertebrobasilar arteries.

If these main arteries become narrowed as a result of atherosclerosis, plaque or cholesterol debris can break off and float downstream, clogging the blood supply to a part of the brain. As opposed to lacunar strokes, larger parts of the brain can lose blood supply, and this may produce more symptoms, with loss of brain and body function, more than seen with a lacunar stroke.

Embolism to the brain from the heart. In some instances a thrombus or blood clot can form within the heart and the potential exists for them to break off and travel (embolize) to the arteries in the brain and cause a stroke. Atrial fibrillation,  an irregular heart rhythm, is the most common cause of thrombus formation.

Rupture of an Artery-Hemorrhage : Cerebral hemorrhage (bleeding within the brain substance). The most common reason to have bleeding within the brain is uncontrolled high blood pressure. Other situations include aneurysms that leak or rupture or arteriovenous malformations (AVM) in which there is an abnormal collection of blood vessels that are fragile and can bleed.

Thrombotic stroke

The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops working. Typically, a cholesterol plaque in one of the brain's small blood vessels ruptures and starts the clotting process.

Risk factors for narrowed blood vessels in the brain are the same as those that cause narrowing blood vessels in the heart and heart attack (myocardial infarction). These risk factors include: High blood pressure (hypertension), high cholesterol, diabetes, and smoking.

Embolic stroke

Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through the bloodstream, and lodges in an artery in the brain. When blood flow stops, brain cells do not receive the oxygen and glucose they require to function and a stroke occurs. This type of stroke is referred to as an embolic stroke. For example, a blood clot might originally form in the heart chamber as a result of an irregular heart rhythm, like atrial fibrillation. Usually, these clots remain attached to the inner lining of the heart, but occasionally they can break off, travel through the bloodstream (embolize), form a plug in a brain artery, and cause a stroke. An embolism can also originate in a large artery (for example, the carotid artery, a major artery in the neck that supplies blood to the brain) and then travel downstream to clog a small artery within the brain.

Cerebral hemorrhage

A cerebral hemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral hemorrhage (bleeding in the brain) causes stroke symptoms by depriving blood and oxygen to parts of the brain in a variety of ways. Blood flow is lost to some cells. Additionally, blood is very irritating and can cause swelling of brain tissue (cerebral edema). Edema and the accumulation of blood from a cerebral hemorrhage increases pressure within the skull and causes further damage by squeezing the brain against the bony skull. This further decreases blood flow to brain tissue and its cells.

Subarachnoid hemorrhage

In a subarachnoid hemorrhage, blood accumulates in the space beneath the arachnoid membrane that lines the brain. The blood originates from an abnormal blood vessel that leaks or ruptures. Often this is from an aneurysm (an abnormal ballooning out of the blood vessel). Subarachnoid hemorrhages usually cause a sudden, severe headache, nausea, vomiting, light intolerance, and a stiff neck.  If not recognized and treated, major neurological consequences, such as coma, and brain death may occur.

Vasculitis

Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed causing decreased blood flow to brain tissue.

Migraine headache

There appears to be a very slight increased occurrence of stroke in people with migraine headache. The mechanism for migraine or vascular headaches includes narrowing of the brain blood vessels. Some migraine headache episodes can even mimic stroke with loss of function of one side of the body or vision or speech problems. Usually, the symptoms resolve as the headache resolves.


Five major signs of stroke:

    1) Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may an associated tingling sensation in the affected area. 2) Sudden confusion or trouble speaking or understanding, sometimes weakness in the muscles of the face can cause drooling. 3) Sudden trouble seeing in one or both eyes.4) Sudden trouble walking ,diziness or loss of balance or coordination. 5) Sudden severe headache with no known cause.
Treatment for stroke should begin immediately. Each person has to be evaluated according to existing situations and the severity of the stroke.

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