The strokes bad decisions
A risk factor is something that increases your chance of getting a disease or health problem. Some stroke risk factors cannot be changed, but others can. Changing risk factors that you have control over will help you live a longer, healthier life.Risk factors you can’t change
You can’t change these stroke risk factors:Blood clots from the heart can travel to the brain, block blood vessels there, and cause a stroke. This can happen in people with artificial or infected heart valves. It can also happen because of a heart defect you were born with.A very weak heart and an abnormal heart rate, such as atrial fibrillation, can also cause blood clots.Risk Factors You Can Change
American Diabetes Association. Standards of medical care in diabetes – 2020. Diabetes Care. 2020 Jan;43(Suppl 1). clinical.diabetesjournals.org/content/38/1/10.full-text.pdf.Biller J, Schneck MJ, Ruland S. Ischemic cerebrovascular disease. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 65.Campbell BCV, Khatri P. Stroke. Lancet. 2020;396(10244):129-142. PMID: 32653056 pubmed.ncbi.nlm.nih.gov/32653056/.
However, because of the sometimes nonspecific clinical presentation and normal/low scores on established stroke assessment scales (e.g., FAST: Face Arm Speech Test, NIHSS: National Institute of Health Stroke Scale) [ 2 , 33 , 37 ], PCS is three times more often than ACS in the acute phase [ 37 ]. In addition, patients with SCA have a longer median time from symptom onset to admission and are more likely to arrive at the hospital beyond the 4.5-h time window [ 29 ], which may imply increased door-to-needle times [ 32 ] or a completely missed opportunity for IVT [ 17 , 28 ].
Identifying the patient with a PCS among many other dizzy patients with benign peripheral-vestibular or non-vestibular disease in the ED can be quite easy if the patient shows severe focal neurologic abnormalities (e.g., hemiparesis, aphasia/ anarthria, or hemianopsia) that clearly point to a central nervous system (CNS) lesion. Furthermore, these significant deficits are often considered to be clearly disabling symptoms that justify IVT per se, regardless of vestibular impairment. However, there is considerable uncertainty in making the diagnosis of SCA and initiating IVT if the patient presents primarily with AVS / AIS and does not have vague or mild clinical signs of CNS involvement, e.g., focal abnormalities such as hemiataxia, dysarthria, and sensory or central deficits. oculomotor signs [ 18, 28 ]. Even the HINTS triad (head impulse, nystagmus, s kew test), which has been shown to have a high sensitivity for detecting stroke as a central cause of AVS [ 12 ], has not been investigated in the context of IVT decision making .
A stroke is an injury to the brain, which occurs when the blood flow to the brain is interrupted or reduced. The brain is then deprived of oxygen and its cells begin to die rapidly.
Arteriosclerosis and thrombosis. A cerebral thrombosis usually occurs when a blood clot obstructs an artery in the brain; the blood clot forms as a result of arteriosclerosis, an involutive process of hardening of the arteries.
Emboli can also originate from blood clots located at the site of artificial heart valves, following a myocardial infarction, or as a result of the alteration of a heart valve.
Emboli can also occur after myocardial infarction or in connection with heart failure. (Rarely an embolus is formed from fat particles, tumor cells, or air bubbles circulating through the bloodstream).
Subarachnoid hemorrhage, the other main type of hemorrhagic embolism, occurs in the tissues surrounding the brain. They are usually caused by the rupture of an aneurysm, a weakened blood vessel wall, which is often an inherited condition.
Stroke victims often experience an immediate impairment in their ability to think and reason. But a new study shows that a stroke can also have a more insidious, long-term effect on mental processes.
The impairment centered primarily around two domains fundamentally affected by stroke: global cognition and executive function, Levine said. Global cognition reflects a person’s overall ability to think and reason, while executive function reflects his or her ability to organize, prioritize, manage time and make decisions.
Lubin found the results particularly surprising given that the researchers ruled out patients who had suffered aphasia (an impairment of their language abilities) as a result of their stroke.
«They left out one of the big symptoms that make patients look like they are suffering from cognitive impairment,» Lubin commented. «I think it’s interesting that they still found a connection even after excluding these patients.»