pathophysiology of a stroke #ischemic & hemorrhagic

pathophysiology of a stroke
pathophysiology of a stroke 

The brain is most important part of our body. 99% of all body systems are controlled by the brain.

In the stroke blood and oxygen are not sufficient to provide in the brain cell. in this condition, brain cells are die and produced imbalance to all the body systems. That’s why people die because of stroke.

Stroke is 3rd most common disease in the united kingdom. Around 1,10,000 people in England produce the first stroke each year and 30,000 people go on further strokes. Here, I will discuss the pathophysiology of a stroke in detail. So, stay tuned.

 What is the Pathophysiology of a stroke?

In a simple word, stroke means “insufficient blood provide to the brain by the body. to the poor blood flow in the brain that results in brain cell death. 

That is two types of stroke. 1) ischemic stroke and 2) hemorrhagic stroke.

Ischemic stroke produced because of  “lack of the blood flow”. In arterial and venous formed a clot or thrombus and vessel are obstructed. In this article, I will discuss the pathophysiology of ischemic stroke latter.

hemorrhagic stroke produced because of “Sudden blood loss”. The rupture of the blood vessel that causes a hemorrhage. Both types of strokes result in the brain doesn’t function properly. And patients are dying.

 What are the symptoms of a stroke?

 Symptoms appear after the stroke has occurred

➝ Inability to problem understanding

➝ Unable or problem in speaking

➝ To also a one side loss of vision  

➝ If the symptoms of the stroke are also less that one or two hours that’s called a “mini-stroke” or “transient ischemic attack”.

➝ These hemorrhage strokes are associated with several types of headaches.

➝ Pneumonia (if long term)

➝ Loss of bladder control (if long terms)

➝ Stroke symptoms are permanent.

 Pathophysiology of a stroke:

Brain cells die because of insufficient blood supply in the brain caused by any reason that’s called a stroke. 

Generally, around 85% stroke is ischemic stroke. Ischemic stroke caused by the formation of clots in the arteries and veins

hemorrhagic stroke caused by the rupture of a blood vessel. In the “hemorrhagic transformation” bleeding can be produced inside the ischemia.

 Pathophysiology of ischemic stroke:

In the ischemic stroke blood supply to the brain is reduced due to the less blood flow. That’s leading to the death of brain cells. So, the brain doesn’t work properly.

Why ischemic strokes are produced?

Here, I discuss the three main reason to reduce the blood flow in the brain

➝ Formation of thrombus in any arteries and veins. That obstructs the blood vessel. (thrombosis) and cerebral venous sinus thrombosis.

➝ Outside of the brain (in the body) formed a clot and reduced blood flow leads to cell death (embolism)

➝ In shock and any condition to decrease a blood supply leading to brain cell death. (systemic hypoperfusion)

Here, mainly two types of ischemic stroke classification.

⇨ Based on OCSP (Oxford community stroke project) ➝ classified based on initial extend of symptoms

➝ Total anterior circulatory infarct

➝ Partial anterior circulatory infract

➝ Lacunar anterior circulatory infract

➝ Posterior circulatory infract

⇨ Based on TOAST (Trial of org 10172 in acute stroke treatment) ➝ classified based on clinical symptoms

➝ Thrombosis & embolism.

➝ To fully blockage of a small vessel.

➝ To determined and undetermined causes (to no any causes identify or don’t complete investigation)

➝ Use of such high risk of ischemic drugs (methamphetamine and cocaine)

➠ Pathophysiology of hemorrhagic stroke:

Here, two type of hemorrhagic stroke

Intracerebral hemorrhagic stroke ➝ bleeding in the brain.

subarachnoid stroke ➝ bleeding outside of the brain.

Intracerebral hemorrhagic is also known as a “cerebral hemorrhage”. In this stroke, bleeding in the brain itself. When the artery in the brain is rupture leads to brain cell death in the brain.

intraparenchymal hemorrhage leads to bleeding in the brain tissue and intraventricular hemorrhage leads to bleeding in the brain’s ventricular system.

In subarachnoid hemorrhage, bleeding is outside of the brain that includes a skull. Also, A bleeding between pie mater and arachnoid mater.

Hemorrhagic stroke occurs to the accumulation and alteration of the blood vessel. Such as an intracranial aneurysm and cerebral amyloids.

 What is Causes a stroke?

➠ Causes of ischemic stroke

It is the most common stroke. Around an 85% stroke are ischemic strokes. Ischemic strokes are caused by the blockage of the arteries and veins that provide the blood in the brain. 

if thrombus or blockage formed arteries and veins are narrowed and not supply sufficient blood in the brain. The cholesterol and blood are formed in arteries and veins are called a “plaque”.

➝ Patients with hypertension

➝ Atrial fibrillation

➝ Patients with diabetes mellitus and dyslipidemia

➝ Thrombosis

➝ Alcohol over-drinking

➝ Obesity

➝ This all is risk factor or causes of the especially ischemic stroke.

➠ Causes of hemorrhagic stroke

Hemorrhagic stroke due to the bursting of the arteries in the brain or leaking the arteries or vein in the brain. That leaked puts have created pressure on the brain cell in the brain and damages the brain cell. 

it also a sending blood into space the brain and skull by the middle of the brain or near the surface of the brain.
This arteries or vein rupture are caused by the blood vessel weakness (that’s called aneurysms), trauma, and hypertension.

 How to Diagnosis of stroke?

Strokes are diagnosed is mainly to neurological examination. Here, some technique to diagnose a stroke

➝ CT scan

➝ MRI scan

➝ Arteriography and heart test that results to find out the blockage of your heart vessels.

➝ Echocardiographic and electrocardiogram

➝ Doppler ultrasound

all techniques are imaging techniques, these techniques determine the causes and subtype of stroke. Make sure to diagnose a stroke with your prescriber.

In stroke generally, the blood test is not used but, finding some clinical causes blood tests needed.

 What is the treatment of stroke?

➠ Treatment of ischemic stroke:

➝ Thrombolytic agents with the tissue plasminogen activator (rt-PA), this combination of medicine decreases the formed blood clot. 

This medicine combination are used within 4 hours or as soon as possible when firstly stroke symptoms are started.

Here, some thrombolytic agents examples

⇨ Streptase (kabikinase & streptokinase)
⇨ Retavase (Reteplase)
⇨ Anitreplase (Eminase)
⇨ TNKase (Tenecteplase)

➝ It also used a blood thinner medicine that helps to prevent the platelet clots formation in the blood vessel. Blood thinner medicine prevents blood clots.

Here, some example of blood thinner medicine example

⇨ Warfarin (Coumadin)
⇨ Edoxaban (Savaysa)
⇨ Fondaparinux (Arixtra)
⇨ Heparin (Declot)
⇨ Dabigatran (Pradaxa)

➝ In antiplatelet therapy, aspirin (150 – 300 mg) given within 48 hours of the onset of action that reduce the risk of ischemic stroke.

➝ Also, a large amount of neuroprotective agents are used in ischemic stroke but, these all are not beneficial for a longer time.

➠ Treatment of hemorrhagic stroke:

➝ Hemorrhagic stroke is due to blood loss. So, first, find the causes and then treated.

➝ If the blood loss due to blood pressure, take a blood pressure medication. its hypertension or hypotension.

➝ Formation of an aneurysm in the body. you may need to fix aneurysm with aneurysm clipping. Some surgeries prevent an aneurysm.

➝ Causes of hemorrhagic stroke are AVM (arteriovenous malformation). You need to fix the AVM helps the surgery or radiation treatments.

➝ Take any medication or else please, visit or ask your prescriber or doctor. Do not take any medicine of your own decision.

 Prevention of stroke:

➝ To prevent the further stroke following.

➝ Do not take much stress.

➝ Heart-healthy food has taken

➝ Maintain your blood level and cholesterol levels in the body.

➝ Do not smoke

➝ Doesn’t take over-drinking of alcohol.  
➝ Regular exercise

➝ Regular check-up for clotting and other tests.

➠ Primary and secondary prevention os stroke:

75 to 1500 mg/day dose of aspirin has reduced the risk of stroke 23% compared to its placebo. Because of its antiplatelet activity.

The combination of aspirin + extended dipyridamole has reduced the risk of stroke 20 to 30%, compared to alone aspirin.

Clopidogrel reduces the risk of stroke 8% compared with aspirin.

In transient ischemic attack, anticoagulation condition, warfarin is better used then aspirin.

An Anticoagulation is not used in patients with the sinus rhythm in secondary prevention.  

Warfarin drugs are not used regularly in stroke.

Also, Control diabetes, hyperlipidemia, hypertension, smoking, alcohol drinking. These factors are associated with the primary prevention of stroke.

➤ Infographic of stroke:

pathophysiology of a stroke
 stroke - infographic

in this article, I will discuss the pathophysiology of a stroke, its symptoms, causes, treatment, and its prevention. If you like this article, Comment out.