Pres And Stroke: What's The Connection?

Strokes and seizures are two different medical conditions that can be difficult to tell apart. A stroke occurs when there is a lack of blood flow to a certain part of the brain, while a seizure happens when there is a sudden burst of abnormal electrical activity in the brain. Both conditions affect brain function and can have similar symptoms, such as numbness, vision problems, and loss of consciousness. In rare cases, a stroke can lead to a seizure, especially if it is severe or occurs in the cerebral cortex. Seizures after a stroke can increase the risk of death or disability, and those who experience them may be diagnosed with epilepsy.

Posterior Reversible Encephalopathy Syndrome (PRES)

The clinical presentation of PRES is varied. Common symptoms include encephalopathy (acute confusion, altered mental state, or decreased level of consciousness), visual disturbances (including reversible cortical blindness), seizures, headaches, and altered mentation. However, patients may also experience ataxia, focal neurological deficits, vertigo, or tinnitus.

The underlying mechanisms involved in PRES are not yet fully understood, but it is thought that they lead to an altered integrity of the blood-brain barrier. Three main precipitant theories have been proposed:

• High blood pressure leads to a loss of self-regulation, hyperperfusion, endothelial damage, and vasogenic edema.
• Vasospasm theory, which results in local ischemia and hypoperfusion.
• Endothelial dysfunction caused by circulating endogenous or exogenous toxins.

The exact pathophysiological mechanism of PRES remains unclear, and the reversible nature of the condition has been challenged by new reports of permanent neurological impairment and mortality in some cases.

The treatment of PRES is challenging. While there is general agreement on the importance of blood pressure control, no studies have established a direct correlation between blood pressure management and the resolution of PRES. A reduction in blood pressure of 25% within the first few hours is recommended, but caution must be taken as blood pressure can be labile. If a specific medication is identified as the cause of PRES, it should be discontinued immediately.

The prognosis of PRES is typically good, with a full recovery in most cases. However, severe forms of PRES can result in death, usually due to intracranial hemorrhage, posterior fossa edema with brainstem compression, or increased intracranial pressure resulting from diffuse cerebral edema. Long-term neurological sequelae, such as seizures, hemiparesis, decreased visual acuity, and residual dizziness, have been observed in 10-20% of patients.

Symptoms of a stroke

A stroke is a life-threatening condition that occurs when there is an interruption to the blood supply to the brain. This can be due to blocked or burst blood vessels in the brain. Stroke symptoms can vary from person to person and can happen suddenly. It is critical to seek immediate medical attention to prevent permanent damage or death.

• Weakness or numbness in the face, arm, or leg, typically on one side of the body.
• Trouble speaking or understanding speech, such as slurred speech or difficulty choosing the right words.
• Vision problems, including sudden loss of vision, double vision, or blurred vision in one or both eyes.
• Dizziness, loss of balance, or lack of coordination
• Severe headaches with no apparent cause
• Emotional instability and personality changes.
• Confusion, disorientation, or agitation.
• Memory loss.
• Nausea and vomiting.

If you or someone you know is experiencing any of these symptoms, it is crucial to act quickly and call for emergency medical help. The acronym FAST can help you remember the key signs of a stroke:

• Face: Ask the person to smile. Does one side of the face droop or appear numb?
• Arms: Ask the person to raise both arms. Does one arm drift downward?
• Speech: Check if the person's speech is slurred or difficult to understand.
• Time: If you observe any of these signs, call the emergency services immediately.

Warning signs of a stroke

Stroke symptoms often happen suddenly, and they vary from person to person. However, there are some key warning signs that you should be aware of, as they could indicate that someone is having a stroke. These include:

• Weakness or numbness of the face, arm, or leg, usually on one side of the body. Ask the person to smile and raise both arms. If one side of their face droops or one arm drifts downward, this could be a sign of a stroke.
• Trouble speaking or understanding speech. Ask the person to repeat a simple phrase. If their speech is slurred or hard to understand, this could be a sign of a stroke.
• Problems with vision, such as dimness or loss of vision in one or both eyes.
• Dizziness or problems with balance or coordination.
• Problems with movement or walking.
• Severe headaches with no known cause, especially if they are sudden.

Other less common symptoms of a stroke may include:

• Sudden nausea or vomiting not caused by a viral illness.
• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma.
• Transient ischemic attack (TIA), also known as a mini-stroke. TIA symptoms are passing and can last for a few minutes up to 24 hours. They may include some of the warning signs listed above.

If you or someone else is exhibiting any of these warning signs, it is important to act quickly and call for emergency medical help. The National Stroke Association's acronym FAST can help you remember the key warning signs and the importance of acting fast:

• F (Face): Does one side of the person's face droop?
• A (Arms): Does one arm drift downward when they try to raise both arms?
• S (Speech): Is the person's speech slurred or hard to understand?
• T (Time): If you observe any of these signs, call emergency services immediately.

Risk factors for stroke

Strokes are a leading cause of death and adult disability in the United States. They are caused by either blocked blood flow to the brain (ischemic stroke) or sudden bleeding in the brain (hemorrhagic stroke). While anyone can have a stroke at any age, certain factors can increase the chances of having one. These risk factors can be categorised into three groups: lifestyle choices, medical conditions, and uncontrollable factors.

Lifestyle Choices

Lifestyle choices that can increase the risk of stroke include:

• A diet high in saturated fats, trans fats, and cholesterol.
• Excessive salt (sodium) intake, which raises blood pressure levels.
• Lack of physical activity, which can lead to other health conditions such as obesity, high blood pressure, high cholesterol, and diabetes.
• Excessive alcohol consumption, which raises blood pressure levels and increases the risk of stroke.
• Tobacco use, which damages the heart and blood vessels and increases the risk of stroke.
• Illegal drug use, such as cocaine.

Medical Conditions

Certain medical conditions can also increase the risk of stroke:

• Previous stroke or transient ischemic attack (TIA), also known as a "mini-stroke."
• High blood pressure, which is the leading cause of stroke.
• High cholesterol levels, which can build up in the arteries, including those in the brain, leading to narrowing and blockage.
• Common heart disorders, such as coronary artery disease, heart valve defects, irregular heartbeat (including atrial fibrillation), and enlarged heart chambers.
• Diabetes, which causes a buildup of sugars in the blood and prevents oxygen and nutrients from reaching the brain.
• Obesity, which is linked to higher "bad" cholesterol and lower "good" cholesterol levels, as well as high blood pressure and diabetes.
• Sickle cell disease, a blood disorder that affects red blood cells and can block blood flow to the brain.
• Sleep apnea, kidney disease, and migraine headaches.

Uncontrollable Factors

Some risk factors for stroke are outside of an individual's control:

• Age: The risk of having a stroke increases with age, especially after 55, and doubles every 10 years.
• Genetics and family history: The risk of stroke is higher if a parent or family member has had a stroke, particularly at a younger age.
• Sex: Women are more likely than men to have a stroke and are also more likely to die from it. Pregnancy and the use of birth control pills or hormone replacement therapy further increase the risk for women.
• Race and ethnicity: In the United States, stroke occurs more frequently in Black, Alaska Native, American Indian, and Hispanic adults compared to White adults.
• Environment: Living or working in areas with air pollution can contribute to stroke risk.
• Social determinants of health: Factors such as living in a poor or rural area, having low education or income levels, and lacking health insurance can impact stroke risk.

Stroke prevention and treatment

A stroke is a life-threatening condition that requires immediate medical attention. It occurs when there is a disruption of blood flow to the brain, either due to a ruptured blood vessel or a blockage in the blood supply. Recognizing the signs of a stroke and acting quickly can significantly improve the outcome.

Prevention

Stroke prevention strategies aim to reduce the risk factors associated with the condition. Here are some key ways to reduce your risk of stroke:

• Lower blood pressure: High blood pressure is a significant risk factor for stroke, so maintaining a healthy blood pressure range is crucial. This can be achieved through a combination of lifestyle changes and, if necessary, medication. Aim for a blood pressure of less than 120/80, or work with your doctor to determine an appropriate target for you.
• Healthy diet: Adopt a diet low in salt, cholesterol, and saturated and trans fats. Increase your intake of fruits, vegetables, fish, whole grains, and low-fat dairy products.
• Weight management: Obesity increases the risk of stroke, so maintaining a healthy weight is important. Aim for a BMI of 25 or lower, and speak to your doctor about creating a personalised weight loss plan if needed.
• Exercise: Regular exercise can help lower your risk of stroke. Aim for at least 30 minutes of moderate-intensity activity, five days a week.
• Limit alcohol intake: Excessive alcohol consumption increases the risk of stroke. Limit yourself to no more than one drink per day, and choose red wine when possible, as it may have some cardiovascular benefits.
• Treat atrial fibrillation: Atrial fibrillation is an irregular heartbeat that can lead to blood clots, increasing the risk of stroke. If you experience symptoms such as heart palpitations or shortness of breath, consult your doctor and consider taking anticoagulant medication to reduce your risk.
• Quit smoking: Smoking accelerates clot formation and increases plaque buildup in the arteries, making it a significant risk factor for stroke. Quitting smoking is one of the most effective ways to reduce your risk.

Treatment

Prompt treatment is crucial for improving outcomes after a stroke. Treatment options depend on the type of stroke:

• Ischemic stroke: This type of stroke is caused by a blood clot or blockage in the brain. Treatment options include thrombolytic drugs to break up blood clots, mechanical thrombectomy, stents, surgery to remove plaque, and aspirin or other blood thinners to prevent further clots.
• Hemorrhagic stroke: This type of stroke occurs when an artery in the brain breaks open or leaks blood. Treatment may include medications to reduce blood pressure, prevent seizures, and constrict blood vessels. Surgery, such as coiling, clipping, or craniotomy, may be necessary to repair the aneurysm and relieve pressure on the brain.

In addition to emergency treatment, your healthcare team will provide guidance on preventing future strokes and managing any long-term complications.

Frequently asked questions