Stroke Overview: Types, Symptoms, Risk Factors, and Recovery Tips - Dr Vuppu Ravikanth

Stroke is a medical emergency where blood supply to part of the brain stopped, no oxygen and nutrients get to that area, thus causing brain tissue damage.

Symptoms can include paralysis on one side of the body, difficulty speaking, dizziness, loss of consciousness and vision problems.

Timely treatment is crucial for limiting damage to the brain and enhancing recovery prospects. Getting seen quickly can prevent lasting damage and improve the chances of recovering your function.

Types of Stroke

Stroke is of two main types: Ischaemic stroke (85%), Haemorrhagic stroke (15%).

1. Ischaemic Stroke (when blood flow to the brain is blocked) and this can come in three ways:

• Thrombosis: Clotting within a blood vessel in the brain
• Embolism: When a clot or other debris from the heart travels to the brain and plugs up a blood vessel.
• Stenosis: Blood vessels in the neck or brain narrow and limit blood flow.

2. Haemorrhagic Stroke: Blood vessel rupture and bleeding in the brain; explosions, haemorrhage reduces surrounding areas of this tissue.

Modifiable Risk Factors

There are a number of lifestyle factors and health conditions that can increase risk of stroke. These risk factors are not permanent and have the potential to be modified through treatment and lifestyle changes:

• High blood pressure (hypertension): The first and one of the most important causes as it leads to the damage of blood vessels which increases the risk of rupture or clot.
• Abnormal lipids: High levels of LDL ("bad" cholesterol) and low levels of HDL ("good" cholesterol) lead to plaque accumulation within arteries
• Tobacco use: Smoking speeds up plaque build-up and increases stroke risk.
• Uncontrolled diabetes damages blood vessels and makes stroke more likely.
• Stoutness: Being overweight causes hypertension and diabetes, which additionally increases stroke hazard.
• Bad diet: Diets rich in saturated fats and carbohydrates promote high cholesterol levels & obesity.
• Sedentary lifestyle: Physical inactivity favours hypertension, diabetes and obesity.
• Too much alcohol: Binge drinking can raise blood pressure and the risk for heart disease.
• Obstructive sleep apnoea: Breathing pauses during the night can drop blood oxygen levels and raise the risk of stroke.
• Illicit drug use: Substances such as cocaine can narrow your blood vessels and make your heart work harder, causing an increase in blood pressure.
• Psychological stress: Stress, depression and low social support have been associated with increased stroke risk.
• Cardiac disease:  Atrial fibrillation or valvular heart disease can lead to increased stroke risk from blood clots in the heart.

Non-Modifiable Risk Factors

Some things, however, are out of our control, but they do raise stroke risk:

• Age: Your chance of having a stroke doubles every decade after age 55.
• Sex: Strokes are more common in men, but outcome is worse for women (greater mortality after stroke).
• Family history: Having a family history of stroke makes one more susceptible, indicating that there is a genetic component.
• Genetics: Conditions such as hypercoagulable states can make it easier to form clots

Mental Health After a Stroke

Although the physical consequences of stroke are primarily visible, emotional and psychological rehabilitation is just as significant.

Around 30% of stroke survivors experience Post-stroke depression (PSD) which has been linked to decreased quality of life and increased mortality. One other common complaint, fatigue, can linger absent of any underlying re-injury (23% to 75% of stroke survivors).

Pre-existing depression is a risk factor for post-stroke depression (PSD) both in the general population and as well specific to stroke victims. Other risk factors include being female, living alone, and the location of the stroke in-urban brain (either left frontal lobe involvement or basal ganglia).

Post-stoke depression could also be strictly neuronal, where it results from damage due to limbic/Paralimbic disorders during acute stroke phase.

Besides depression, survivors can suffer from cognitive decline, trouble with communication and anxiety, among other emotional difficulties. All of these can disrupt recovery, family relationships/new dynamics, and quality of life.

Treatment and Therapy

Stroke has an impact physically and mentally both. To cover the depression psychological counselling, antidepressants such as SSRIs (selective serotonin reuptake inhibitors) and NARIs (norepinephrine-dopamine reuptake inhibitors) are commonly used in the treatment of depression.

Recent therapies aimed to optimize recovery include:

Repetitive transcranial magnetic stimulation (rTMS): A non-invasive procedure that delivers magnetic pulses to stimulate nerve cells in the brain with the aim of driving recovery of function.

Overhead full-spectrum light (light therapy): To treat fatigue and depression in stroke survivors

Lifestyle Modification and Prevention

With risk factors both modifiable and non-modifiable, avoiding a stroke is all about managing. Key strategies include:

• Engaging in routine exercise to boost heart health and control body weight
• A well-balanced diet low in saturated fats and high in fruits, vegetables, and whole grains.
• Managing stress with yoga, meditation, and relaxation methods
• Support and psychological counselling to cope with mental problems
• Frequent diagnostic check-ups to manage issues such as high blood pressure, diabetes, and cholesterol.

With these factors in place, the risk of stroke can be reduced to a significant extent and recovery post-stroke can also be improved.