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The Danger of Ischemic Stroke

Each year stroke or paralysis that we are familiar with after seeing suffering of acquaintance or loved ones recently has tendency of higher death rate and disabilities than the past. It frequently affects people until there is WORLD PARALYSIS DAY on October 29th. The day is set to active and raises awareness in people. According to many disabled patients, now have become long-term burden of family and also confront with worse quality of life. Therefore, if people learn about the cause as well as risk factors of this disease then they can perceive ways to avoid the paralysis condition.

The Incidence of Ischemic Stroke in Thailand

In 2009, the number one death cause disease of Thai population both in males and females was ischemic stroke which caused disability to patients. There is 70-80% of patients suffering from the ischemic stroke while 20-30% of them suffering from cerebral hemorrhage. However, hypertension is a major factor of the Ischemic Stroke.

What is Ischemic Stroke Progression?

Medical Director from Phyathai1 Hospital Stroke Center, DR.Surat Boonyakarnkul explained that the cause of stroke starts from deterioration of blood vessel walls deriving from fats that attach to the arterial walls, found in the brain and neck. As a result, the arterial holes then become narrowed causing blood flow obstruction and being unable to apply to the brain. This symptom is usually found in the elderly including people with high blood pressure, diabetes, high blood lipids and those who smoke.

Apart from that, this disease can also happen to those who have heart disease and a risk for blood clot which the clot then spreads to the bloodstream and it can obstruct the cerebrovascular as well as blood supply of the brain.

From these two reasons show that there is not enough blood supplying in the brain or there is large blood clot that blocks the blood from flowing to the brain. However, the brain cells in that area later lack of the blood including ability to function organs in the body, a condition is known as “Paralysis”

What are risk factors of Ischemic Stroke?

Even though there are many risks contribute to the disease, the main categories can be identified as follows;

Inevitable Risk Factors

  • Age which is the most crucial factor it means that when you are older there is higher risk of cerebrovascular disorder according to arteries deterioration.
  • Nationality people with dark skin color have higher incidence of the disease than people with white skin.
  • Genetics those whose families have a history of stroke have high risk of the disease if compares to other people.

Evitable Risk Factors

  • High blood pressure which is the second important factor which is inferior to the age.
  • Atrial Fibrillation Heart Valve Disease or Myocardial Infarction are example of heart diseases that cause spreading of the blood clot from the heart to the cerebral blood vessel which later result in blood supplying obstruction.
  • Diabetes a risk factor of Atherosclerosis
  • Blood lipid with high cholesterol found being correlated with Stroke.
  • Smoking is associated with blood vessels weakness. Those who smoke are at risk for stroke more than people who do not smoke.
  • alcohol a result is that those who drink the alcohol moderately or heavily have the high risk for stroke.
  • Lack of exercise there is a great chance of stroke comparing to those who exercise regularly.

Symptoms of Ischemic Stroke

The doctor added that symptoms of stroke depend on severity of brain damage or where the damage occur inside the brain according to each part of human brain works differently.

<>Abnormal Symptoms are:

  • Facial Palsy; this symptom will be noticeable when a patient starts to grin or smile.
  • Motor Weakness; arms and legs on both or one side of your body feel sored or weak.
  • Speaking abnormally: unclear speaking or being unable to think while listening.
  • Blurred Vision
  • Acute Headache with dizziness

These abnormalities usually occur immediately. Some patients suffer from them temporarily. This condition called Mini stroke. Certain patients have one or more symptoms. However, as soon as you find yourself or people in a family suffer from the symptoms even disorders are temporary patients still must be sent to a hospital promptly.

Ischemic Stroke Diagnosis Procedure

It is important that a doctor has to perform multiple diagnostic tests as this following process helps the diagnosis being more precise as well as supporting an appropriate plan for further treatment :

  • Physical examinations of pulse screening are blood pressure screening, breathing screening, body temperature screening, heartbeat screening for heart disorder detection, Glascow Coma Scale by observing a conversation of patient including muscle strength tests, skin sensation test for numbness or sense defecation as well.
  • Computerized Tomography Scan and MRI are crucial for the diagnosis as they are able to distinguish a type of disease clearly including size and location of damaged tissues in the brain.
  • CAROTID DUPLEX ULTRASOUND is Carotid Artery Examination by ultrasonography using to assess the severity of carotid stenosis. A procedure is simple, precise and causes no side effects. It is also used for those who are at risk such as those with ischemic heart disease, diabetes or even if patient does not have symptoms of cerebral infarction before.
  • CT ANGIOGRAPHY is an injection procedure and computer X-ray used to detect pathology of blood vessels in the brain. When the stenosis is found more than 50 percent, angiography then will be provided to prevent the symptoms from getting worse.
  • Electrocardiogram, chest x-ray, blood tests will be applied to find the cause of the disease and evaluate the condition of patient for further treatment.

However, results from diagnostic methods above can lead to appropriate treatment guidelines which relevant to the symptoms in each patient. The doctor then will select the safest and most appropriate method for patients as well as the best results.

Treatment for Ischemic Stroke

The doctor explained about guidelines treatment that the goal of treating is to make the blood being able to flow to support the brain as usual according to following process as follows.

  • Using Thrombolysis by the time when symptoms start is effective within 3 hours, while at the present the effective result processes within 4.5 hours. In addition, applying intravenous can reduce rate death and disability, in fact, if the patient is treated promptly there is more possibilities for cure. Before giving this treatment, the doctor must carefully examine the symptoms according to indications and consequences of drug use and discuss with relative or family then make them sign on a permission paper for the thrombolysis treatment.
  • Arterial thrombosis makes thrombosis drug expose to blood clot directly which helps the clot accessing to a treatment, nevertheless, in the event of patient being sent to a hospital late contrast material injection will be provided to the blood clot for pathology detection by a doctor. The injection is made through catheter in addition; in order to have the best effective resulting, a process should be made within 6 hours after the symptoms showing.,/li.
  • HEPARIN is applied to patients with ischemic stroke caused by blood clots used to prevent them from disease recurrence.

Treatment for Carotid Stenosis

Carotid arteries locate on the left or right area of your neck ,they help transferring the blood from your heart to the brain. In case if there is plaque attached to the inner blood vessel walls causing the hole of blood vessels or size being small until the blood supply cannot be provided to the brain fully according to that, this case certainly results in cerebral infarction after. However, according to the blood function which is always served the brain regularly. The treatment is made by enlarging the hole of blood vessels to support the flowing of blood as follows:

  • Carotid Endarterectomy is the treatment used for removing or taking the plaque out of the arteries. This method is recommended for patients with severe Carotid Stenosis. Moreover, studies have shown that more than 60% of the patient’s symptoms were save from cerebral ischemia which is more effective than drug therapy.,/li>

During surgery, a surgeon may give anesthesia or local anesthesia and starts operating on your neck where the carotid arteries are located after, later, the blood vessels will be opened for plaque removal procedure then are closed by suture. Patient may need to rest in a hospital about 1 – 2 days for recovery.

Complications from surgery are cerebral infarction and death, fortunately the death rate is low on account of receiving the surgery from experienced surgeons with high standard of medical facility can save the patient from death .

  • Percutaneous Transluminal Coronary Angioplasty is used in certain patients when they have a limitation or contraindication for the surgery, however, the doctor then will give an injection via the groin then inserts catheter through the groin area where the arteries are until a medical substance reaches to the carotid stenosis. In addition, radiocontrast agent then is injected to expand a balloon so that the plaque can stuck to the vessel wall, next is expanding blood vessels tract then insert stent to prevent them from stenosis recurrence. Accordingly, the blood later can supply the brain comfortably. Patients may take at least one day resting after a procedure.

The doctor gave further explanation that after treatment some patients with cerebral infarction due to ischemic stroke are healed and cure by the process, however, some may have disability. Therefore, physical therapy becomes an important way to cure or help them especially those having paralysis so that they can return back to their normal life.

There are various ways of physical therapy depending on specific patients for example:

  • Standing training
  • Walking training
  • Wheelchair using training
  • Practice speaking
  • Practice swallowing food etc.

New innovations (Robotic Trainer)

Apart from regular exercise,at present there is new innovation for physical therapy by using the robot as a major training aid. This robot is part of body rehabilitation especially legs, arms and hands. It helps patients with weak muscles learning to provide themselves what they want and have a better quality of life.

The advantages of Physical Therapy by Innovative Robotics Trainer

  • Saying goodbye to traditional walk training that requires physiotherapists to support or train. However, the train should constantly be made which may cause fatigue and muscle injury. Moreover, an appropriate speed for walking is unstable.
  • Saying goodbye to limitations of traditional walking training again. According to what previously mentioned, they are the beginning of new innovation called robotics trainer used to reduce certain restrictions from the traditional training and recovers the body movement of patients effectively.
  • The advantages of training a walk by robot are very diverse for example many patients are able to walk longer regarding from their conditions. In addition, there is computer system used for collecting patient’s training data, the physiotherapist can also take the information to improve a way of treatment for the next time. Furthermore, this method can set the speed and force leg muscles to walk properly as well as assist patients with muscle weakness who cannot active or move the body physically to have an opportunity for physical rehabilitation.
  • Other benefits from robotic training are reducing complications in bedridden patients; it encourages them to practice walking with more interesting way. As a result, patients are more cooperative in rehabilitation.

How to prepare yourself for robotic physical training?

  • The doctor must assess the condition patient whether they have some serious diseases for example heart disease, severe pulmonary and ankle contracture etc.
  • patients must rest sufficiently and have food for about half an hour before the training.
  • Patients should wear an appropriate attire as well as shoes

After the treatment for ischemic stroke patients is finished. Those with paralysis condition requires to be treated properly. Accordingly, the doctor then recommends some guidelines for paraplegic care as follows:

  • Manage a convenient and safe place that suits with the condition of patients such as bedroom should be on the ground floor which is easy for a walk and bathroom should contain hanger or holder inside while threshold is not included etc.
  • Encouraging patients to do their own daily routines such as brushing teeth, eating, urinating or defecating is necessary while relatives or caregivers need to stand by for supporting them. On the other hand, in case when the patients are unable to perform their self-care routine for example, wiping the body or cleaning the teeth, the caregivers then should do that for them.
  • Provide them food which is suitable for diseases such as diabetes, high blood pressure, hyperlipidemia. However, if they have dysphagia, soft food must be given to them for choking prevention.
  • Avoid compressed ulcer, if the patients cannot move their body, someone must change their body posture in every 2 hour.
  • Exercising; stimulating the body by exercising or walking helps restore the muscles and prevent them from bedridden complications.
  • Excretory care is vital if the patients have constipation then they need to intake more foods that are rich in fiber as well as drinking enough water and moving the body by changing postures often. At the same time, in the event of having urine catheter, a urine bag then must be in lower position under the bladder. Those who take care of the patients must always take them to a hospital for a change of the catheter in order to prevent an infection.
  • Patient may have difficulty in speaking or interpreting relatives or family need to understand the problems and be gentle to the patients do not be stress over them by showing your frustration , on the other hand, please help them by writing, reading, or try communicating with them via pictures.
  • Follow doctor’s appointment and ensure that all medications are taken as required.
  • After observing disorder symptoms such as fever, urine turbidity, motor weakness, being confused or exhaustion are found please take patients to see the doctor immediately regardless of the appointment.

The Mental State of Patients and Responsibility of Family

When the patients have some physical deficiencies, a situation can drive them to stress and feel like they are problems. Some of them introvert from people, while another may be aggressive and stop eating food. Accordingly family must observe such symptoms including understand them and support them to do some favourite activities along with setting atmosphere to make them calm. Expressing your love toward them is a must as well as stop complaining about difficulties, in fact, try communicating with them by applying different ways of message sending such as writing or using picture etc.

Ischemic Stroke Prevention

The doctor added that although the ischemic stroke is dangerous and causes death or disability to people. However, there is way to prevent us from the disease as well as risks of paralysis as follows:

  • We can prevent the stroke by having healthy food; the food that does not contain these strong tastes for example sweet, oily or salty. Exercising regularly, having sufficient sleep or stress-free as well as quit smoking or drinking alcohol are required.
  • Receiving Annual Health Check, Blood Pressure Screening, Lipid Blood Screening and Blood Sugar Screening to find some abnormalities and consult a doctor to receive a proper remedy.
  • In case of having chronic disease referring to the stroke for example hypertension, diabetes, hyperlipidemia patients should maintain normal condition according to each disease. Moreover, if you have heart disease that could be a trigger or consistency of blood clot, then follow what your doctor recommends you to do for instance taking Anticoagulant.
  • When you have abnormal symptoms like signs of ischemic stroke then immediately go to a hospital to receive a treatment promptly . This can reduce a chance of disability and death.

Finally, the protection mentioned above is a way to avoid paralysis and death from stroke. In addition it is a process accredited by The Ministry of Health and The World Health Organization in order to make people know how to promote their quality of life, happiness, family responsibility and socializing.

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chronic stroke