Ischemic Stroke

Overview

An ischemic stroke occurs when a blood clot blocks blood flow to the brain, causing the brain cells to die. It is the most common type of stroke and can lead to serious complications like speech, movement, or memory issues. Symptoms of this condition include sudden weakness, paralysis, and difficulty speaking or seeing. Earliest treatment with clot-busting drugs or surgery can reduce damage, while rehabilitation helps with recovery and regaining lost abilities.

What is Ischemic Stroke?

An ischemic stroke is a life-threatening medical emergency that occurs when a lack of oxygen-filled blood reaches a part of the brain. The limited blood flow is mostly caused by blood clots in a brain artery. This condition causes the cells in the brain to die, leading to the loss of movement or activities controlled by the affected brain parts. It also causes permanent brain damage and even death if not treated at the right time.

Types of Ischemic Stroke

Ischemic stroke is of 2 types, including the following:

Thrombotic Strokes: Caused by a blood clot that occurs in the arteries that supply oxygen-rich blood to the brain. It is commonly seen in older people with existing medical conditions such as diabetes, high cholesterol and atherosclerosis.

Embolic Strokes: Caused by a blood clot that forms in the embolus and reaches the brain through the bloodstream. It results from heart surgery or heart complications, occurring rapidly without exhibiting any warning signs. Approximately 15% of the embolic strokes develop in people with atrial fibrillation.

Symptoms of Ischemic Stroke

One must note the time when the symptoms begin to confirm if someone is having a stroke. The symptoms one may experience include trouble speaking and understanding speech, blurred or blackened vision in one or both eyes, headaches, dizziness, vomiting, numbness or paralysis in the arm, leg or face, and difficulty walking or keeping balance and coordination.

Other symptoms may include dysarthria, neck stiffness, fainting, emotional instability and personality changes, and coma in severe cases. Seeking immediate medical attention is significant if an individual experiences any one of the stroke symptoms. One can think ‘FAST’ and recognise the warning signs of ischemic stroke. This includes:

F (Face): When a person smiles, look for the signs of paralysis or muscle weakness on one or both sides of the face.
A (Arm): Ask the individual to raise their arms and look for one-sided weakness in coordination.
S (Speech): Identity slurred or garbled speaking or if the person finds it challenging to choose the right words.
T (Time): Remember when the symptoms start and keep track of time. Call a healthcare provider immediately as soon as you start noticing the symptoms.

Causes of Ischemic Stroke

Ischemic stroke is caused by an artery blockage in the brain, which is caused by a fatty build-up or blood clot, called plaque. This fatty build-up occurs when the blood clot breaks off the arteries and reaches the brain. Blockages in a brain artery (atherosclerosis) limit the brain from receiving enough oxygen-rich blood, causing the cells to die.

A more severe type of ischemic stroke, or global ischemia can be caused by a heart attack, or as a result of carbon monoxide poisoning.

Other related conditions that raise the risk of the risk include fat emboli, atrial fibrillation, sepsis, clotting disorders, atrial septal defect and ventricular septal defect. Lifestyle risk factors include physical inactivity, being overweight, use of illegal drugs and heavy alcohol consumption.

Medical factors such as obstructive sleep apnea, high cholesterol, high blood pressure, diabetes and a family history of heart disease also elevate the risk. In addition, individuals assigned male at birth, above the age of 55 and being Hispanic or African American pose as a risk factor for having a stroke. Birth control pills or hormone therapies can also increase risk.

Diagnosis of Ischemic Stroke

A medical expert uses a combination of neurological examinations and diagnostic tests to diagnose ischemic stroke. They will ask an individual to move their feet, hands, arms, eyes, legs and head in certain ways to examine signs of paralysis. They may also ask the individual some questions to look for signs of slurred speech. Upon suspecting an ischemic stroke, a doctor may recommend common tests including CT scan, blood tests, MRI scans, electrocardiogram (ECG or EKG), angiography, echocardiography and electroencephalogram (EEG).

Treatment for Ischemic Stroke

Ischemic stroke treatments and medications prioritise restoring blood flow to the affected brain areas. The main treatment comprises intravenous (IV) tissue plasminogen activator (tPA) to break up blood clots. Thrombolytic drugs can be given to a patient within the initial 3 - 4.5 hours of exhibiting stroke symptoms.

An endovascular mechanical thrombectomy may be conducted to remove a brain clot. Other supportive treatment plans include the use of blood thinners, mild hypothermia, blood sugar management and oxygen therapy. Long-term treatments include anticoagulants (to prevent further clots) or aspirin.

Rehabilitation treatment methods including cognitive therapy, physical therapy and speech therapy can help an individual return to the state they were before a stroke by helping them relearn to do certain things.

Prevention of Ischemic Stroke

An ischemic stroke cannot be prevented, but one can reduce the risk of having it. Such actions include improving lifestyle by consuming a healthy diet, exercising regularly, avoiding tobacco, alcohol or drug use, and getting enough sleep of up to 8 hours.

One must also manage certain health conditions such as high cholesterol, high blood pressure and Type 2 diabetes by taking medications and following up for a check-up. Getting annually screened for health problems that may increase the risk of a stroke is essential.

Myths and Facts Related to Ischemic Stroke

Here is a breakdown of the myths and facts about ischemic stroke:

Myth 1: Strokes Only Happen to Older People
Fact: While the risk of stroke increases with age, and is more common in individuals above the age of 55, younger adults can also be at risk if they have heart problems or other medical conditions.

Myth 2: Ischemic Strokes are Not Preventable
Fact: The risk of having Ischemic strokes can be prevented by incorporating lifestyle changes such as controlling blood pressure, maintaining a healthy weight, eating a balanced diet, exercising, and avoiding smoking and excessive alcohol consumption.

Myth 3: One Cannot Treat a Stroke Once It Happens
Fact: If treated immediately, especially within the first few hours, with the help of clot-dissolving drugs (tPA) or mechanical clot removal techniques, it is possible to reduce the damage caused by an ischemic stroke.