Stroke – Causes, Risk Factors, Symptoms, Diagnosis, Treatment & Prevention

 

Introduction:

A *stroke*, also known as a *cerebrovascular accident (CVA)*, occurs when blood flow to a part of the brain is interrupted or reduced, depriving brain cells of oxygen and nutrients. Within minutes, brain cells begin to die. Stroke is a medical emergency that requires immediate treatment to reduce brain damage and improve survival.

Pathophysiology:

There are two primary mechanisms:

1. *Ischemic stroke*: Blockage of a cerebral artery due to a *thrombus or embolus*.

2. *Hemorrhagic stroke*: Rupture of a blood vessel in the brain, causing bleeding.

Both lead to:

- *Neuronal injury*

- *Inflammation*

- *Brain edema*

- *Loss of neurological function* in the affected area

Types of Stroke:

1. *Ischemic Stroke* (≈ 85% cases)  

   - *Thrombotic*: Clot forms in the brain’s blood vessel  

   - *Embolic*: Clot travels from another part of the body

2. *Hemorrhagic Stroke*  

   - *Intracerebral hemorrhage* 

- *Subarachnoid hemorrhage*

3. *Transient Ischemic Attack (TIA)*  

   - Mini-stroke with symptoms <24 hrs; a warning sign of full stroke

Risk Factors:

- *High blood pressure (Hypertension)*

- *Diabetes mellitus*

- *High cholesterol*

- *Smoking*

- *Obesity*

- *Atrial fibrillation*

- *Sedentary lifestyle*

- *Excessive alcohol use*

- *Family history of stroke*

Symptoms and Signs:

- Sudden *numbness or weakness* (especially one side of the body)

- *Confusion*, trouble speaking or understanding

- *Blurred or lost vision*

- *Dizziness*, loss of coordination

- *Severe headache* with no known cause (more common in hemorrhagic stroke)

*Remember: FAST*

- *Face drooping  

- *Arm weakness  

- *Speech difficulty  

- *Time to call emergency

Diagnosis:

- *CT Scan (Non-contrast)* – First test to differentiate between ischemic and hemorrhagic stroke  

- *MRI Brain* – Detailed view of brain tissue damage  

- *Carotid Ultrasound* – Detects artery narrowing  

- *Echocardiogram* – Evaluates heart function  

- *EEG* – If seizures are suspected  

- *Blood tests* – Glucose, clotting profile, CBC, lipids

Prevention:

- *Control hypertension and diabetes*

- *Cholesterol management*

- *Regular physical activity*

- *Healthy diet* (low salt, low fat) 

- *Smoking cessation*

- *Moderate alcohol intake*

- *Antiplatelet therapy* (aspirin or clopidogrel) in high-risk individuals

Treatment:

*Ischemic Stroke*

1. *Thrombolytic Therapy*

*Alteplase (tPA - Actilyse)*

- *Use:* Dissolves blood clots (within 4.5 hrs of onset)

- *Dose:* 0.9 mg/kg IV (10% bolus, 90% infusion)

- *Side Effects:* Bleeding, angioedema

- *Form:* IV injection

2. *Antiplatelet Agents*

*Aspirin (Disprin, Ecosprin)*

- *Dose:* 150–325 mg daily

- *Side Effects:* GI upset, bleeding

*Clopidogrel (Plavix)*

- *Dose:* 75 mg daily

- *Side Effects:* Bleeding, rash

3. *Statins*

*Atorvastatin (Lipitor, Atorlip)*

- *Dose:* 20–80 mg at night

- *Use:* Lowers cholesterol, stabilizes plaques

- *Side Effects:* Muscle pain, liver enzyme elevation

4. *Anticoagulants* (for AF or embolic stroke)

*Apixaban (Eliquis), Rivaroxaban (Xarelto), Warfarin*

- *Use:* Prevents new clot formation

- *Monitor INR* with warfarin

- *Side Effects:* Bleeding risk

Hemorrhagic Stroke:

- *Blood pressure control*: IV *Labetalol* or *Nicardipine*

- *Mannitol* or *hypertonic saline* for reducing intracranial pressure

- *Anticonvulsants*: e.g., *Levetiracetam (Keppra)*

- *Surgery*: Hematoma evacuation if needed

Available Drug Forms:

| Alteplase | Actilyse | IV Injection |

| Aspirin | Disprin, Ecosprin | Tablet |

| Clopidogrel | Plavix | Tablet |

| Atorvastatin | Lipitor, Atorlip | Tablet |

| Apixaban | Eliquis | Tablet |

| Warfarin | Coumadin, Marevan | Tablet |

| Levetiracetam | Keppra | Tablet, IV |

Conclusion:

Stroke is a *medical emergency* with long-term implications. Early recognition, immediate intervention, and preventive strategies are crucial. With timely treatment and lifestyle changes, many patients recover and lead productive lives. Public education, regular health checkups, and risk factor management are key to reducing the global burden of stroke.

Epilepsy – Causes, Symptoms, Diagnosis & Treatment

 

Introduction:

*Epilepsy* is a *neurological disorder* marked by *recurrent, unprovoked seizures* caused by abnormal electrical activity in the brain. It affects people of all ages and can result from genetics, brain injury, infections, or unknown causes. With proper diagnosis and treatment, most people with epilepsy can lead normal lives.

Pathophysiology:

Seizures occur when there is a *sudden, excessive, and synchronous discharge of neurons* in the brain. This abnormal activity can be *focal* (originating in one part) or *generalized* (involving both hemispheres).

- *Excitatory neurotransmission (glutamate)* ↑  

- *Inhibitory neurotransmission (GABA)* ↓  

- Imbalance → Hyperexcitability of neurons → Seizures

Types of Seizures:

1. *Focal (Partial) Seizures*

   - *Simple Partial:* Consciousness preserved  

   - *Complex Partial:* Altered consciousness  

2. *Generalized Seizures*

   - *Tonic-Clonic (Grand Mal)*

- *Absence (Petit Mal)*  

   - *Myoclonic, Tonic, Atonic*

Symptoms and Signs:

- *Convulsions* (uncontrolled shaking)  

- *Loss of consciousness or awareness*  

- *Staring spells* (in absence seizures)  

- *Jerking movements of arms/legs*  

- *Confusion after the episode*  

- *Aura* (warning symptoms like smells or feelings)

Diagnosis:

- *Clinical History* – Type, duration, frequency of seizures  

- *EEG (Electroencephalogram)* – Detects abnormal brain activity  

- *MRI or CT Scan* – To identify structural abnormalities  

- *Blood tests* – Rule out infections, metabolic issues  

- *Video EEG monitoring* – In complex or unclear cases

Treatment:

*Goals:*  

- Control seizures  

- Minimize side effects  

- Improve quality of life  

Anti-Epileptic Drugs (AEDs):

*1. Sodium Valproate (Epival, Depakine)*  

- *Use:* Generalized & focal seizures  

- *Dose:* 10–15 mg/kg/day → Max 60 mg/kg/day  

- *Side Effects:* Weight gain, liver toxicity, tremor, hair loss  

- *Avoid in pregnancy* (teratogenic)

*2. Carbamazepine (Tegretol)*  

- *Use:* Focal seizures  

- *Dose:* 200–1200 mg/day in divided doses  

- *Side Effects:* Drowsiness, rash, hyponatremia, blood dyscrasias

*3. Phenytoin (Dilantin)*  

- *Use:* Generalized tonic-clonic seizures  

- *Dose:* 4–7 mg/kg/day  

- *Side Effects:* Gum hyperplasia, ataxia, hirsutism, rash

*4. Levetiracetam (Keppra)*  

- *Use:* Broad-spectrum AED  

- *Dose:* 500–3000 mg/day  

- *Side Effects:* Mood changes, fatigue, dizziness

*5. Lamotrigine (Lamictal)*  

- *Use:* Focal and generalized seizures  

- *Dose:* Start 25 mg/day → increase gradually  

- *Side Effects:* Rash (can be severe), insomnia

*6. Topiramate (Topamax)*  

- *Use:* Generalized seizures, migraine prevention  

- *Dose:* 25–400 mg/day  

- *Side Effects:* Weight loss, cognitive slowing, kidney stones

Other Treatments:

- *Surgery* – For drug-resistant epilepsy (e.g. temporal lobectomy)  

- *Vagus Nerve Stimulation (VNS)* – Implanted device to reduce seizures  

- *Ketogenic Diet* – High-fat, low-carb diet (especially in children)  

- *Psychological Support* – Especially in epilepsy with mood disorders

Conclusion:

Epilepsy is a manageable condition with a wide variety of treatment options. *Early diagnosis*, *appropriate medication*, and *lifestyle modifications* can help most patients live seizure-free lives. Continuous follow-up and medication compliance are key to long-term success.