|
A Stroke, sometimes called a “brain attack”, occurs when the blood supply to part of the brain is suddenly interrupted.
If a part of the brain does not receive blood brain cells in that area die. And when brain cells die the corresponding motor and cognitive functions of that area of the brain are affected.
1. What is a stroke?
A Stroke, sometimes called a “brain attack”, occurs when the blood supply to part of the brain is suddenly interrupted.
This can happen in one of two ways:
(1) A clot blocks a blood vessel (like a heart attack in the brain). This is referred to as ischemic stroke
(2) A blood vessel in the brain bursts. This is reffered to as hemorrhagic stroke
2. How common are strokes?
Worldwide, every year two out of 1000 people have a stroke. Five out of six strokes happen in people over the age of 60 years.
Why should patients suffering from a stroke receive emergent treatment?
(1) The longer blood flow is cut off, the greater the damage
(2) Every minute counts, with the window of opportunity to correct the damage being three hours. Therefore, patients should get to a hospital within 60 minutes of having a stroke ensuring they receive treatment within this time frame.
3. Stroke - Warning Signs
4. What are the risk factors for stroke? By taking steps to reduce the number of risk factors one has, an individual can greatly lower his/her chances of suffering from a stroke.
Modifiable risk factors:
Medical conditions such as the following place individuals at risk of stroke
(1) uncontrolled high blood pressure
(2) atrial fibrillation
(3) high cholesterol
(4) diabetes
Lifestyle
(1) smoking
(2) being overweight or obese (considered to be a BMI of 25 to 29.9 and 30 or greater respectively)
(3) sedentary lifestyle
(4) stress
(5) alcohol
(6) diet
Non-modifiable risk factors include:
(1) age
(2) gender
(3) race
(4) family history
(5) genetic disease
(6) prior stroke/heart attack
5. Is recovery possible?
Recovery from a stroke is usually a gradual process and can often take months. The severity of symptoms varies from person to person and ranges from those who are left with only a slight disability to those with a more serious one. Rehabilitation supports and maximizes the return to previous functioning although one may never completely return to their pre-stroke state.
6. Will it happen again?
Having a subsequent stroke is a common occurrence. Approximately 25 percent of those who have experienced one stroke will suffer from another one within 5 years.
(1) What can be done? Try to keep your laboratory levels and blood pressure within normal limits!
• LDL (bad cholesterol) < 100 mg/dl
• HDL (good cholesterol) > 40 mg/dl
• Blood Pressure <= 120/80 mmHg
• Blood Sugar <= 100 mg/dl
(2) Eat a healthy diet as a strategy to maintain healthy cholesterol levels, blood pressure, and blood sugar levels.
(3) Take medications as prescribed
(4) Control diabetes by checking blood sugar regularly
(5) Maintain an active lifestyle by moving more, and sitting less
(6) Limit alcohol intake < 1 drink per day (women), 2 drinks per day (men)
(7) Do not use drugs including heroin, cocaine, or marijuana
7. How to prevent a second stroke
(1) Quit Smoking
(2) Take medicines properly to control blood pressure and sugar
(3) If necessary, take blood thinners such as aspirin and warfarin as directed
(4) Exercise for at least 30 minutes per day, most days
(5) See a physician as recommended for follow up and monitoring
8. Discover the path to recovery
(1) Work together with caregiver(s) to achieve independence at home and/or at work
(2) Consult with a physician for follow up and monitoring of ones condition. After being discharged from in-patient rehabilitation the first visit should take place within 1 month
(3) Continue a recommended home exercise program
(4) Assess and address the home environment for anything that would put the individual at risk for falls/injury (for example: poor lighting and uneven tiles/carpet)
(5) Try to continue to do the things enjoyed before the stroke—build up gradually!
(6) Develop a support system within the community, church, among family, and/or co-workers
9. What to do if someone has a stroke
(1) Call 0-2378-9000
(2) Bring him/her to the hospital immediately
10. Where can individuals learn more?
(1) Ask your doctor Tel. 0-2378-9000
(2) Visit our website: www.samitivejhospitals.com
11. Investigations used to assess the level of damage to the brain and heart:
(1) Computer tomography (CT) or Magnetic resonance imaging (MRI) of the brain
(2) Carotid duplex and transcranial droppler ultrasound
(3) CT angiography or Magnetic resonance angiography (MRA)
(4) Echocardiography
12. Management
(1) Medical treatment
• Antiplatelet agents: aspirin. Clopidrogrel, aspirin plus extended release dypiridamole
• Anticoagulants: Heparin, low molecular weight heparin (LMWH), Warfarin
• Lipid lowering agents such as HMG CoA reductase (statins)
• Antihypertensive agents such as hydrochlorathiazide and ACE inhibitors
(2) Surgical treatment
• In some cases of hemorrhagic stroke or large infarctions
(3) Rehabilitation
13. Nutritional therapy for stroke patients
Patients who suffered from stroke have specific nutritional needs due to:
(1) Dysphagia (difficulty swallowing) usually occurs after one suffers from a stroke. As such, stroke patients are at risk for aspiration (where food, drink, and/or stomach contents enter the lungs), which can then cause pneumonia. Aspiration pneumonia is one of the most common complications in stroke victims and negatively impacts recovery. During the acute phase following the stroke, patients should eat soft or semi-solid food in order to stimulate the swallowing mechanism and reduce the chance of aspiration. Jelly, thick congee soup, and thick cream soups are suitable. Patients may try to eat more solid food once his/her strength is regained and a normal gag reflex is present.
(2) Stroke patient frequently have other underlying chronic disease(s) such as diabetes mellitus, hypertension, dyslipidemia (high LDL, low HDL, and/or high triglyceride levels). A healthy diet has major positive impact on disease management.
(3) Recommended energy intake is usually low during the acute phase post-stroke. Energy requirements increase as patients recover and start becoming increasingly activity. In general, a daily intake of approximately 1500 – 1800 kilocalories is sufficient when hospitalized.
Food should provide normal macronutrients and micronutrients that match to co-morbidities. Patients who have pre-existing hypertension should limit their salt intake. Less than 2 grams per day of salt is all that is required. Trying to use products with decreased/no sodium such as potassium based salt is a healthy step in controlling ones blood pressure.
Patients with dyslipidemia should limit their intake of fat and oil. Vegetable-derived oils do not reduce cholesterol levels because triglycerides are a main component in these oils. Cholesterol is abundant in animal-derived fats i.e. butter, cream, soft cheese, shellfish, etc. However, fats should never be completely removed from ones diet as cholesterol is necessary to produce hormones especially sex-hormones.
Diabetic patients should reduce their intake of refined starches or processed carbohydrates such as white rice, white bread, pasta and noodle. Limiting ones intake will help control ones blood sugar levels throughout the day. Instead choose complex carbohydrates such as brown bread and bran, which are broken down into simple sugars and released into the blood stream at a slower rate.
Samitivej, We Care
For further information, please contact:
Samitivej Srinakarin Hospital
4th Floor
Tel: 66 (0) 2378-9000 ext. 24103
Call Center: 66 (0) 2378-9000
|