A stroke (cerebrovascular accident) is an acute loss of blood perfusion to the brain that causes brain ischemia (lack of blood supply to the brain) and loss of neurologic function that lasts longer than 24 hours. As blood flow to the brain decreases, neurons cease to function and irreversible injury occurs.
A stroke manifests itself as a sudden onset of weakness, sensory deficit or difficulties with language. A stroke in progress or in evolution describes a neurological deficit that occurs in a stepwise or progressive fashion. Symptoms associated with a stroke include:
Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
Sudden confusion, difficulty in speaking or understanding
Sudden deterioration of vision of one or both eyes
Sudden difficulty in walking
Sudden loss of balance or coordination
Sudden severe headache with no known cause
Stroke is the third leading cause of death in the United States following cardiac and cancer related deaths. Stroke is the leading cause of adult disability. Approximately 30% of stroke survivors need assistance with daily living and 15% will require admission to a long-term care facility. Approximately one third of stroke survivors will suffer depression as well as many of their care providers.
Strokes can occur in patients of all ages. In patients younger than 60 years, the incidence of stroke is greater in men by a 3 to 2 ratio compared with women. The incidence of stroke is greater in the black population than in the white population. Black males also have a greater death rate from stroke (approximately 50%) when compared with white males (approximately 25%).
Strokes can be divided into ischemic infarctions (which may be bland or hemorrhagic) and hemorrhages which include intracerebral hemorrhages and subarachnoid hemorrhages. Ischemic strokes can be due to a local vascular occlusion (a thrombus) or by an occlusion of an artery from material that originated from the heart or other vessels (an embolus). Atherosclerosis of the arteries that supply the brain is the most common cause of ischemic stroke.
Embolism of brain arteries accounts for up to 20% to 30% of strokes. Approximately 20% of ischemic strokes come from or through the heart. Once a stroke due to cardiac embolism has occurred, the likelihood of recurrence is relatively high and secondary prevention becomes essential. Cardiac sources of emboli include:
Recent myocardial infarction
Native valvular disease
Cardiac wall thrombi
Patent foramen ovale
Approximately 80% of emboli to the brain involve the anterior circulation (Carotid artery territory) and the remaining 20% involves the vertebro-basilar distribution.
Thrombotic strokes are due to on-site occlusions on atherosclerotic lesions of the carotid, vertebrobasilar and cerebral arteries typically closer to major branches. Thrombotic strokes are thought to originates from ruptured atherosclerotic plaques. Factors that facilitate the formation of a thrombus include injury to the inner lining of a blood vessel with activation of the clotting cascade, inhibition of fibrinolysis and blood stasis (blood pooling) . Brain hemorrhages can be subarachoid (bleeding into the subarachnoid space), intraparenchymal (bleeding directly into the brain tissue) or a combination of both. The accumulation of blood within the brain tissue may form a brain parenchyma hematoma (a dangerous condition involving swelling and pressure in the affected area of the brain).
Early diagnosis and management within the first few hours after symptoms of a stroke appear are critical. Because proper management of a stroke requires an accurate diagnosis, it is essential to differentiate between an ischemic stroke and a hemorrhagic stroke. Administration of t-PA (thrombolytic therapy) to a patient with an acute stroke attempts to establish revascularization to rescue brain cells before irreversible injury occurs.
Patients who are at an increased risk for ischemic stroke can be identified, and appropriate intervention and management started.
If you are suffering from complications due to a delayed diagnosis of a stroke or the mismanagement of a stroke, let Dr. Borten and the medical malpractice attorneys at Gorovitz & Borten review the specifics of your case. At Gorovitz & Borten we have the necessary experience, understanding and resources available to properly evaluate the complications of a stroke, and give you a timely assessment of its merits.
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