
A stroke is a medical emergency that occurs when the brain is deprived of oxygen due to a blockage or rupture in the blood vessels supplying it with blood. This interruption in blood flow can lead to the death of brain cells, and if it occurs in a part of the brain that controls vital functions like breathing and heartbeat, it can be life-threatening. While not all strokes are fatal, the chances of survival depend on the region of the brain affected, the duration of the blood flow interruption, and the promptness of medical treatment. A massive stroke affects a significant portion of the brain and has a higher chance of causing death, either instantly or within days or weeks. The risk of death is also higher for people who have already had a stroke, with recurrent strokes being more likely to be fatal.
What You'll Learn
Brain death
A stroke is a life-threatening medical emergency that occurs when there is an interruption to the blood supply to the brain, resulting in brain cells becoming oxygen-starved and dying. A massive stroke can affect large portions of the brain and cause significant brain damage, which can lead to severe complications or even death. This is known as brain death.
The effects of a stroke depend on the type, severity, location, and number of strokes. Large strokes can directly cause death, while smaller strokes in certain parts of the brain can also be fatal. The cerebrum, cerebellum, and brainstem are the three main areas of the brain that can be affected by a stroke. The cerebrum controls movement, sensation, cognitive abilities, awareness of surroundings, and bowel and bladder control. The cerebellum is responsible for balance and coordination. The brainstem regulates vital "life-support" functions, including heartbeat, blood pressure, and breathing, as well as eye movement, hearing, speech, chewing, and swallowing.
The signs and symptoms of a massive stroke can vary depending on the location and size of the stroke. However, some common symptoms include sudden severe headache, vision loss or blurred vision, numbness or weakness on one side of the body or face, and difficulty swallowing. In severe cases, rigidity and coma can occur.
The treatment for a massive stroke aims to restore blood flow to the brain and control any bleeding. Emergency care is crucial, and the sooner the person receives treatment, the better their chances of survival and recovery. Treatment options may include clot-busting drugs, mechanical thrombectomy, surgery, and medication to lower blood pressure and slow the bleeding.
The complications of a massive stroke can be serious and may include paralysis, difficulty swallowing or talking, and difficulty managing emotions. Recovery from a massive stroke can be a long and challenging process, requiring physical therapy, occupational therapy, speech therapy, and mental health counselling.
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Paralysis
There are varying degrees of paralysis, including:
- Hemiparesis: weakness on one side of the body
- Hemiplegia: paralysis on one side of the body
- Paraplegia: paralysis of the lower part of the body
- Tetraplegia: paralysis of the body and all four limbs
Post-stroke paralysis symptoms may include:
- Spasticity/stiff muscles
- Dysphagia (difficulty swallowing)
- Partial paralysis (paresis)
Rehabilitation and therapy can help stroke patients regain movement, even years after their stroke. Treatments include:
- Modified constraint-induced therapy (mCIT): forcing the use of the weakened body part to improve nerve function through regular practice
- Electrical stimulation: using electrical charges to help muscles contract
- Cortical stimulation: sending an electrical current to the brain during rehabilitation exercises
- Mental imagery: imagining movement of the affected body part, activating the same brain areas as physical movement
- Assistive devices: braces, canes, walkers, and wheelchairs to increase strength and movement
In summary, paralysis is a common and serious consequence of a stroke, affecting mobility and independence. However, with proper rehabilitation and treatment, it is possible to regain movement and improve quality of life.
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Coma
A stroke occurs when the blood supply to the brain is interrupted, either by a blood clot or a ruptured blood vessel. When a stroke is lethal, or leaves a person severely impaired, it is considered a massive stroke. A massive stroke can cause death in several ways, one of which is a coma.
A coma is a state of unconsciousness where a person has minimal brain activity, cannot be awakened, and is unable to purposefully react to their environment. A person in a coma will not be able to open their eyes or respond to sound, pain, or touch. They will not have a normal sleep-wake cycle and cannot initiate any voluntary actions.
The Glasgow Coma Scale is a tool used to measure levels of consciousness and monitor a patient's progress. It rates a survivor's responses in three areas: eye opening, verbal responses, and motor responses.
There are several factors that increase the likelihood of a coma after a stroke:
- Hemorrhagic stroke: This type of stroke involves uncontrolled bleeding from a ruptured artery in the brain. A study found that 17% of individuals with hemorrhagic strokes were admitted to the hospital in a coma, compared to only 3% of those with ischemic strokes.
- Massive stroke: The larger impact of a massive stroke on the brain means it is more likely to lead to a coma. It also increases the risk of complications such as brain swelling and the need for surgical intervention.
- Brainstem stroke: The brainstem houses the Reticular Activating System (RAS), which controls our arousal states, including waking and sleeping. A stroke in this area can, therefore, result in a coma.
- Cerebral edema: This is swelling in the brain that occurs after a stroke, leading to increased intracranial pressure and further complications such as coma.
- Surgery: In some cases, surgery is required to re-establish blood flow after a stroke, and a coma can occur after the procedure. Additionally, some individuals may be placed in a medically-induced coma.
While in a coma, the medical team will support the person's health and monitor their condition. They will also provide comfort and support to family members or caregivers. It is important for loved ones to seek their own support during this difficult and uncertain time.
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Brain herniation
There are three main types of brain herniation: subfalcine, where brain tissue moves underneath a membrane in the middle of the brain; transtentorial, where the uncus (part of the temporal lobe) is shifted downward; and cerebellar tonsillar, where the cerebellar tonsils move downward through the foramen magnum, a natural opening at the base of the skull where the spinal cord connects to the brain.
Signs and symptoms of brain herniation include irregular or slow pulse, loss of consciousness, loss of reflexes, shortness of breath, abnormal body movements, and dilated pupils. Brain herniation is a medical emergency and requires immediate treatment to reduce swelling and pressure in the brain. Treatment may include placing a drain in the brain to remove cerebrospinal fluid, administering medicines to reduce swelling, increasing the breathing rate to reduce carbon dioxide in the blood, removing blood or blood clots, or performing surgery to remove part of the skull and give the brain more room.
The outlook for brain herniation depends on the type and severity of the injury, as well as the location of the herniation in the brain. Without treatment, death is likely, as brain herniation can cut off the blood supply to the brain and rapidly lead to death or brain death. Complications of brain herniation include respiratory or cardiac arrest and permanent brain damage.
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Pneumonia
Risk Factors
Several risk factors increase the likelihood of developing pneumonia following a stroke:
- Age: Individuals over the age of 65 are at a higher risk of developing pneumonia after a stroke.
- Dysarthria or no speech due to aphasia: Impaired speech or the inability to speak can increase the risk of aspiration and subsequent pneumonia.
- Cognitive impairment: Individuals with decreased cognition or altered mental status may have difficulty protecting their airways, increasing the risk of aspiration pneumonia.
- Dysphagia: Dysphagia, or difficulty swallowing, is a common complication of stroke. It can lead to aspiration when food or liquid is inhaled into the lungs, causing pneumonia.
- Recumbency: Lying down or being bedridden can increase the risk of aspiration and pneumonia.
- Malnutrition and tube feeding: Malnutrition and the need for tube feeding are often associated with dysphagia and can increase the risk of aspiration pneumonia.
- Severe dysphagia: More severe forms of dysphagia can increase the risk of aspiration and subsequent pneumonia.
- Female sex: Females may have a slightly higher risk of developing pneumonia after a stroke, although this requires further investigation.
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Frequently asked questions
A stroke occurs when the blood supply to a part of the brain is reduced or stopped, which can be due to a blood clot or a ruptured blood vessel. Without oxygen-rich blood, neurons start to die and the brain may not be able to perform vital functions.
A massive stroke may affect multiple areas of the brain and has a higher chance of fatality. The brain may become unable to function in a way that sustains life, which is known as brain death. This can occur when a stroke affects vital regions of the brain, such as the brainstem, which controls many important functions, including consciousness.
Signs of a stroke include sudden drooping of one side of the face, slurred speech, weakness in one arm or leg, vision problems, trouble walking, and a severe headache. The FAST method can help identify early signs of a stroke:
- Face: Drooping eyelid or corner of the mouth.
- Arm: One arm (or leg) is weaker than the other or can't be lifted as high.
- Speech: Words are slurred, and comprehension of what others say is reduced.
- Time: If any of these signs are present, immediate care is essential.