Brain Mass And Stroke: What's The Connection?

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. This can be due to blocked blood vessels or bleeding in the brain, resulting in brain cells dying from a lack of oxygen. While strokes are typically associated with blocked blood flow, they can also be caused by masses or tumours in the brain, leading to intracranial haemorrhage or bleeding within the brain. This is a less common but extremely serious complication that demands immediate medical attention.

Brain tumours and the risk of stroke

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. This can be due to blocked arteries or bleeding in the brain, resulting in brain cells dying from a lack of oxygen. Brain tumours can increase the risk of stroke, particularly certain types of tumours and in people who have had radiation treatment.

Types of Stroke

There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes are the most common, accounting for about 80% of all strokes. They occur when a blood vessel in the brain is blocked, often by a blood clot. Hemorrhagic strokes, on the other way, are caused by bleeding in or around the brain.

Brain Tumours and Stroke Risk

Although rare, brain tumours can increase the risk of stroke, particularly hemorrhagic strokes. This is because tumours can cause bleeding within the brain, known as an intracranial hemorrhage, which can lead to a hemorrhagic stroke. This type of complication is more common in people over 60 with certain types of brain cancer or who have had radiation treatments.

The symptoms of a stroke caused by a brain tumour can develop over days, weeks, or months rather than the sudden onset typically seen in ischemic strokes. The most common symptoms include:

• Weakness or paralysis on one side of the body
• Numbness on one side of the body
• Inability to understand spoken language
• Difficulty writing or reading
• Changes in vision or vision loss
• Seizures or convulsions

The prognosis for people who experience a stroke as a result of a brain tumour is generally poor, with a median survival time of 11.7 months from the time of surgery. However, survival times can increase with early detection and treatment.

Tumour Characteristics and Stroke Risk

The risk of stroke associated with a brain tumour depends on several factors, including the size, location, and biology of the tumour. Larger tumours are more likely to compress blood vessels, reducing blood flow and increasing the risk of ischemic stroke. Malignant cancers can also invade blood vessels directly, leading to intracranial hemorrhage.

Certain types of brain tumours are also more prone to bleeding. For example, gliomas, which develop in sticky cells surrounding nerve cells, are more vulnerable to bleeding because they are fast-growing. Pituitary tumours are also prone to bleeding. Additionally, tumours that produce coagulation-promoting factors, such as glioblastoma, increase the risk of thromboembolism, including ischemic stroke.

Treatment and Prevention

The treatment for a stroke caused by a brain tumour typically involves removing the blood and tumour simultaneously. However, if the bleeding is minimal and symptoms are mild, surgery may not be necessary.

To prevent stroke in people with brain tumours, a multidisciplinary approach is necessary, involving specialists such as neuro-oncologists, neurologists, and neurosurgeons. This may include managing risk factors such as hypertension, diabetes, and hyperlipidemia, as well as considering the risks and benefits of radiation and chemotherapy treatments.

Symptoms of a stroke

A stroke is a life-threatening medical emergency that requires immediate attention. It occurs when there is an issue with blood flow to the brain, either due to blocked blood vessels or bleeding in the brain. The effects of a stroke depend on the location and extent of the damage to the brain tissue. The brain controls various motor and sensory functions, so a disruption in blood flow can result in a range of symptoms.

• Face Drooping: One side of the face may droop or feel numb. Ask the person to smile and check if their smile is uneven.
• Arm Weakness: One arm may feel weak or numb. Ask the person to raise both arms and observe if one arm drifts downward.
• Speech Difficulty: The person may have slurred speech or difficulty speaking and understanding speech.
• Time to Act: It is crucial to act fast and call for emergency medical help. Note the time when the symptoms first appear, as this information is vital for determining the appropriate treatment.
• Numbness: There may be a sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Confusion: The person may experience confusion, disorientation, or memory problems.
• Vision Problems: They may have trouble seeing in one or both eyes, experience double vision, or have other vision issues.
• Balance and Coordination Issues: The person may have difficulty walking, maintaining balance, or experience a loss of coordination.
• Headache: A sudden severe headache with no apparent cause can be a symptom of a stroke.

It is important to note that these symptoms can vary between individuals, and some may experience additional or subtler signs. Stroke is a medical emergency, and early treatment is crucial to minimize brain damage and improve the chances of recovery.

Diagnosing a stroke

The most common tests that are performed when a stroke is suspected include:

• Computerized Tomography (CT) scan: This combines special X-ray equipment with sophisticated computers to produce multiple images of the inside of the body, helping to detect a stroke from a blood clot or bleeding within the brain.
• Magnetic Resonance Imaging (MRI) scans: MRI uses a powerful magnetic field, radio frequency pulses, and a computer to produce detailed pictures of organs, soft tissues, bone, and other internal body structures.
• Electrocardiogram (ECG or EKG): This test checks the heart's electrical activity to determine whether heart problems caused the stroke.
• Lab blood tests: Blood tests can look for signs of infections or heart damage, check clotting ability and blood sugar levels, and test how well the kidneys and liver are functioning.
• Carotid ultrasound: Ultrasound imaging uses high-frequency sound waves to produce pictures of the inside of the body and check for narrowing and blockages in the carotid arteries, which carry blood from the heart to the brain.
• Cerebral angiography: This test uses imaging technologies such as X-rays, CT, or MRI, and sometimes a contrast material, to produce pictures of major blood vessels in the brain, helping to detect abnormalities such as blood clots or narrowed arteries.

These tests can help determine the type, location, and cause of the stroke, and rule out other potential disorders.

Treating a stroke

A stroke is a life-threatening medical emergency that requires immediate attention to prevent permanent damage or death. Treatment for a stroke depends on the type of stroke, the location and severity of the bleeding, and whether the patient has any other medical conditions. Here are some detailed instructions on treating a stroke:

Ischemic Stroke Treatment:

• The main treatment for ischemic strokes is thrombolysis, which involves administering medication called tissue plasminogen activator (tPA) to break up blood clots that block blood flow to the brain. This treatment is time-sensitive and must be given within 3 to 4.5 hours of the onset of stroke symptoms.
• If tPA is not an option, anticoagulants or blood-thinning medications such as aspirin or clopidogrel may be given to prevent clots from forming or enlarging.
• A thrombectomy is a surgical procedure that can be performed within 24 hours of symptom onset to remove the clot from the blood vessel. This involves inserting a catheter (a long, flexible tube) into the upper thigh and guiding it to the blocked artery in the neck or brain.
• Angioplasty and stenting procedures use a thin tube to insert a balloon or small mesh tube into the blocked artery, creating space for blood to flow more easily to the brain.
• Carotid endarterectomy is a surgical procedure to remove plaque from the carotid artery in the neck if carotid artery disease caused the stroke.

Hemorrhagic Stroke Treatment:

• Hemorrhagic strokes require reducing blood pressure to minimise bleeding and prevent further complications.
• Stop any anticoagulant or blood-thinning medications that may have contributed to the bleeding.
• Aneurysm clipping is a surgical procedure that blocks off the aneurysm from the blood vessels in the brain, helping to stop the bleeding and prevent it from bursting again.
• Blood transfusion may be necessary to replace blood lost through surgery or injury.
• Coil embolization is a procedure where a surgeon inserts a catheter into an artery in the upper thigh and threads it to the aneurysm in the brain. A tiny coil is pushed through the catheter, causing a blood clot to form and block blood flow through the aneurysm.
• Draining excess fluid that has built up in the brain can relieve pressure and reduce damage.
• Surgery may be performed to temporarily remove part of the skull to accommodate swelling and reduce pressure on the brain.
• Surgery or radiation may be used to remove or shrink an arteriovenous malformation (AVM), which is a tangle of arteries and veins that can break open in the brain.

Additional Care and Support:

• Breathing support, such as ventilator assistance, may be required if the stroke affects the patient's ability to breathe.
• Compression therapy using an air-filled sleeve on the leg can reduce the risk of venous thromboembolism.
• A feeding tube may be necessary if the patient has difficulty swallowing.
• Fluids may be administered to restore proper blood pressure or blood volume.
• Medication may be given to lower a fever and prevent additional brain damage.
• Rehabilitation plans, including speech, physical, occupational, and cognitive therapy, are crucial for helping patients regain abilities and adapt to changes in their brain after a stroke.
• Skin care is important to prevent skin irritation or sores, especially if the patient has limited mobility.
• Palliative care or hospice care may be considered to improve the quality of life and manage symptoms.

Remember, time is critical in treating a stroke. If you or someone you know is exhibiting signs of a stroke, seek immediate medical attention by calling emergency services.

Long-term effects of a stroke

A stroke is a life-threatening medical emergency that occurs when there is an issue with blood flow to the brain. It is the brain's equivalent of a heart attack. The long-term effects of a stroke depend on which part of the brain was damaged and how extensive the damage is.

If a stroke occurs in the left side of the brain, the right side of the body will be affected. This can result in paralysis on the right side, sensory changes, problems with speech and language, issues with thinking and memory, and a slow, cautious behavioural style.

On the other hand, if the stroke occurs in the right side of the brain, the left side of the body will be impacted. This can lead to paralysis on the left side, sensory changes, spatial thinking or imagery difficulties, problems with thinking and memory, and a quick, inquisitive behavioural style.

A stroke in the brain stem can be particularly severe, potentially resulting in a "locked-in" state, where the patient is conscious but unable to speak or move, except for vertical eye movements and blinking.

The long-term physical changes after a stroke can include difficulty with gripping or holding things, fatigue or tiredness, incontinence, pain, restricted physical abilities, and weakness or paralysis on one side of the body. Emotional and personality changes are also common, including irritability, aggressiveness, apathy, repetitive behaviour, disinhibition, and impulsiveness.

Cognitive skills, such as the ability to learn new skills, problem-solve, pay attention, and remember things, can also be affected. Additionally, perception changes can occur, impacting how an individual sees, hears, and feels the world.

Early treatment and rehabilitation are crucial for improving recovery, and many individuals can regain a significant amount of their abilities. However, a stroke can cause permanent loss of function, and even with treatment, most people will take weeks or months to recover, with progress continuing to be challenging after the first 6-18 months.

Frequently asked questions