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Magnetic resonance imaging (or MRI) provides accurate pictures of the brains and arteries. MRIs are useful for detecting a wide array of blood vessel and brain abnormalities, and is the most accurate technique to determine which areas of the brain have been irreversibly damaged by ischemic stroke. They take longer than a CT scan so they are not used as the primary scan to help with the diagnoses. During an MRI loud knocking can be created which could damage hearing.

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Magnetic resonance imaging (or MRI) is a test the provides very accurate pictures of the brains and arteries. MRIs are useful for detecting a wide array of blood vessel and brain abnormalities, and is the most accurate technique to determine which areas of the brain have been irreversibly damaged by ischemic stroke. In addition to stroke, MRIs can be used to diagnose several other abnormalities, such as tumors, blood clots, infections and even disorders like multiple sclerosis.

In comparison with CT scans, MRIs are often more accurate, demonstrating brain abnormalities that are too small or precisely located for a CT scan to detect. Another distinction (and benefit) of MRI is that unlike a CT scan, an MRI can be performed without X-rays or iodinated contrast. But the MRI scan takes longer, and caution must be taken if the patient has metal medical devices (pacemakers, etc.) or other metal in the body, because it can either cause poor images or pose a danger to the patient in the magnetic field.

How MRIs work

During an MRI, the patient lies on a table that moves into the opening of the MRI machine. This machine creates a magnetic field, which serves to briefly alter polarity of the water molecules in the patient's body. The response to this magnetic field is then detected and used to create a highly accurate and detailed image of the patient's brain. The test usually takes between 30 to 90 minutes and is completely painless with no known side effects.

One common difficulty some patients face during an MRI is the need to lie flat, without moving, in a relatively confined space for up to an hour. If you're claustrophobic or otherwise believe this might be a problem for you, you should discuss this with your care team.

Types of MRI

There are several types of MRI scans, known as image sequences. Each sequence highlights different aspects of brain tissue, so it can be used to answer different questions. A diffusion-weighted MRI, for instance, can be useful for detecting abnormalities in the first few hours after ischemic stroke. An MRI can also be used to obtain an image of the blood vessels that supply the brain, which is known as a magnetic resonance angiography (or MRA).

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Magnetic Resonance Imaging (MRI/MRA) for Stroke

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Magnetic resonance imaging (or MRI) is a test the provides very accurate pictures of the brains and arteries. MRIs are useful for detecting a wide array of blood vessel and brain abnormalities, and is the most accurate technique to determine which areas of the brain have been irreversibly damaged by ischemic stroke.

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Have it checked regularly; however, you might get prescribed medicine, lifestyle changes, or food with lower sodium consumption if you have high blood pressure. The target systolic blood pressure is consistently lower than 130 mm Hg.

Special challenges:

lack of adequate treatment

failure to take medications

lack of follow up

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One way to prevent a stroke is to keep a healthy diet. Eating organic and not processed foods can help decrease the chance of you getting a heart attack. Buying good and healthy foods all the time can add up. It might be financially hard to maintain a healthy diet depending on your situation.

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As we get older, our arteries naturally become narrower and harder. They are also more likely to become clogged which can lead to strokes, because a stroke is a result of the brain not receiving blood supply. In addition, an older person’s lifestyle can also contribute to their risk of stroke. Poor diet with a lack of physical activity, can lead to weight gain. Many older people find exercise extremely difficult, making them more likely to live a sedentary life. The elderly may also face a challenge for receiving care if they do not have a safe and fast way to get to a clinic or therapy session.

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Stroke affects more than 700,000 people in the United States each year. It is currently the fifth leading cause of death, killing more than 130,000 annually, and is the leading cause of adult disability. While strokes can happen at any age, they are most prevalent among the elderly. Despite our society's awareness of the prevalence of stroke, we may not know how best to help our senior loved ones prevent or recover from such life-altering attacks.

What causes a stroke?

A stroke occurs when blood is unable to reach an area of the brain. Deprived of the necessary oxygen, the brain cells in the affected region begin to die, resulting in various degrees of brain damage or, in a worst-case scenario, death. Though not all stroke survivors are crippled by their accident, an estimated 2/3 of survivors are left with some sort of disability.

There are two types of stroke. The first, Ischemic Stroke, is the more prominent of the two (approximately 80% of cases) and has a greater impact on the elderly. Ischemic Stroke occurs when a clot blocks the blood flow to a certain area of the brain; these clots may originate in the brain or, in some cases, they travel to the brain from a different part of the body. The second type, Hemorrhagic Stroke, occurs when a blood vessel bursts or leaks; this excess of blood places immense pressure on the brain, depriving certain areas of oxygen. Though not nearly as common as Ischemic Stroke, Hemorrhagic Stroke is more likely to prove fatal.

Stroke's prevalence among older individuals depends upon several factors. Perhaps the most likely explanation is that the longer we live, the more chronic health conditions we acquire. For instance, diabetes, high blood pressure, heart disease, cardiovascular problems, and high cholesterol can all increase a person's risk of having a stroke. However, certain aspects of an older person's lifestyle can also contribute to their risk of stroke; a poor diet often exacerbates the aforementioned health conditions and, coupled with a lack of physical activity, can lead to weight gain. Many older people find exercise extremely difficult, making them more likely to live a sedentary life.

Given these conditions, we might mistakenly assume that there is little that can be done to prevent stroke in our older loved ones. While there is no foolproof method by which we can entirely protect them from stroke, there are steps we can take to help them lower their risk.

Your senior loved one may find grocery shopping and food preparation physically difficult, time-consuming, and expensive. Instead of eating a balanced diet full of fresh fruits and vegetables, they may choose quick, instant options like microwave meals or fast food. Help them come up with a plan; you could help them find simple, healthy recipes, assist them in making their grocery list and doing the shopping, or brainstorm new ways to make food prep easier.

In previous blog posts, we've addressed the challenges seniors face when it comes to regular, effective exercise. Physical limitations can force older people into a sedentary life, which in turn increases their risk of developing severe health problems. Talk to your senior loved one about seeing a physical therapist, who will help them devise an exercise regimen that is tailored to their needs. You can also suggest more gentle forms of exercise, like Tai Chi and swimming.

Reduce Smoking and Alcohol Consumption

Both smoking and excessive alcohol consumption increase a person's risk of stroke. If your senior loved one frequently smokes or drinks, voice your concerns to their regular physician. A doctor may be able to have that difficult conversation with them, relieving you of the burden; the advice of a professional may seem less judgmental and prove more effective in the long-term.

Make sure that your senior loved one is taking their medication. Diabetes, high blood pressure, high cholesterol, and heart disease all require careful monitoring; life can be busy and overwhelming, and our senior loved ones may forget to test their blood glucose levels or check their blood pressure. They may view such necessary maintenance as a hassle, or find the process too involved. If you notice or strongly suspect that they are neglecting their health, consciously or unconsciously, do not hesitate to make your concerns known.

These are just a few of the steps we can take to lower our senior loved ones' risk of having a stroke. However, if your senior loved one does have a stroke, knowing the signs and symptoms is of the utmost importance. The following commonly precede a stroke event:

Numbness in the face, arm, or leg, usually on one side of the body.

Sudden changes in eyesight, including blurred and blackened vision.

Difficulty speaking, particularly slurring words.

Confusion and difficulty understanding.

Sudden, severe headaches, vomiting and / or dizziness.

Difficulty walking, impaired movement and loss of balance.

It goes without saying that when a stroke occurs, time is of the essence. The longer the affected area of the brain is deprived of oxygen, the more damage is done. Recovery is possible, but it can be extremely difficult, particularly on the elderly. If you notice any of the symptoms listed above, do not take any chances; caution is always prudent, and in the case of a stroke, it can mean all the difference in the severity of their injury. It can mean the difference between life and death.

Stroke is sometimes, though not always, fatal. Survival is often accompanied by significant physical and cognitive changes; depending on which area of the brain was affected, a person may now struggle with speech impairment, limited motor function, or the loss of certain senses. Recovery is a slow, strenuous process of adjustments and, of course, frustrations. As their loved ones, we can and should provide them with all the love and support they need as they adapt to these enormous changes.

Though we have no way to guard our older loved ones from stroke, it should comfort us to know that there are actions we can take to improve their overall health that will also lessen their risk. We must recognize that a healthy lifestyle is often more than a simple matter of choice; living healthily is far more complicated for the elderly, but we can help them by providing the resources and encouragement necessary to transform a seemingly unattainable ideal into an accessible reality.

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Elderly Stroke: Causes, Symptoms, and Prevention - Aegis Home Care

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Stroke affects more than 700,000 people in the United States each year. It is currently the fifth leading cause of death, killing more than 130,000 annually, and is the leading cause of adult disability. While strokes can happen at any age, they are most prevalent among the elderly.

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Women are usually older when they have strokes, and they're more likely to die of strokes than men. Women are more likely to experience high blood pressure, especially while pregnant, which is the number one contributor to women being more likely to have a stroke during their lifetime. Certain birth control medications also affect the likelihood of women getting a stroke. Estrogen in women is likely to influence blood flow and the formation of blood clots. Female patients have greater difficulty than male patients in recovering from a disabled state after acute stroke, several studies have found that women receive less active treatment. The in-hospital mortality rate was significantly higher in females than in males, females also tend to live longer but with greater disability than males following acute stroke. Women are less likely to schedule a hospital visit, as women tend to have symptoms like headaches and dizziness that resemble stroke symptoms and do not think anything major of them.

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lifestyle changes necessary for stroke condition:

Control blood pressure

Diet

Rate for difficulty, how hard it might be for a patient to make that lifestyle change:

10

Both life style changes go hand in hand; a controlled blood pressure life style change is managed by a nutritionalist, pharmacist, or cardiologist. They may promote an increase in activity and a change in diet. This is because an increase in blood pressure can lead to a more likely chance of getting blood clots. A. type pf professional to help a person with diet life style change; dietitians. It is strongly encouraged to avoid processed foods, sugars, salt, and reduce fat intake. Instead eat more whole foods, poultry, or fish.

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Paralyzation is a common occurrence after a stroke. It can happen anywhere on your body. Physical therapy is a treatment for paralyzation. Physical Therapy helps gain strength in muscles and joint from previous muscle loss or injuries. Physical therapists carry out physical therapy practices.

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Cognitive Behavioral therapy is available to stroke survivors that experience emotional changes. Cognitive behavioral therapy is used to reduce mental health conditions such as anxiety and depression. CBT focuses on the connection between personal thoughts and behavior.

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Women are more at risk for having a stroke because they typically live longer than men. Women also have additional unique risk factors including high blood pressure during pregnancy. High blood pressure increases the chance of a stroke. Certain birth control medications can also put women at a higher risk.

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Unfortunately depression is a common experience for people who have suffered from a stroke .In some cases psychotherapy will not help psychosocial issues alone. Medication can be prescribes to address specific emotional and behavioral issues after TBI. Medications that may be prescribed are antidepressants, mood stabilizers, and anxiolytics. Physiatrists and pharmacists are professionals that will help manage medication to assist stroke survivors in short-term affects by improving anxiety or depression.

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One treatment for stroke is cognitive rehabilitation. In order to enhance the persons ability to process and interpret information and to improve the person s ability to perform mental function that might have been injured from a stroke. The expected cost of cognitive rehab (assuming the person needs training from a personal trainer or other certified professional) is between $85,000 to $3 million for a life time cost. On a scale of 1-5, the likelihood of this treatment being fully covered is 3. ACA mandates that health insurance companies must cover mental health and substance use disorder.

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The expected cost of Aphasia therapy after experiencing a stroke is between $150-$400 per hour .
For insurance to cover the cost of speech therapy for patients with aphasia the possibility of the session being fully covered by the insurance is likely but insurance coverage depends from person to person, depending on where the patient lives, the type of treatment, the extremity of the illness/injury etc. This will determine how much the session will be covered.
If the person decided not to get speech therapy then communication problems can increase such as talking.

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One long term treatment is tissue Plasminogen Activator (tPA). If you were to use this certain treatment, it would cost around $2,750. This treatment has a low success rate of 8-32 percent success rate. If you refuse the treatment, you could have permanently impaired speech, restricted physical abilities, paralysis, or delayed speech.

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2) Paralysis or numbness of the face, arms, or leg 

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2) Paralysis or numbness of the face, arms, or leg 

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These are common problems that occur with stroke. It is the loss of sensation it can be partial or complete.

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With a stroke, dizziness and lack of coordination is common in patients. This can be both common and short-term.

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When experiencing a stroke, treatment after  involves...
Mild stroke; rest, monitoring symptoms, prescribed medication.
Moderate stroke; surgery(certain cases), rehabilitation, and prescribed medication.
Severe Stroke; emergency surgery, rehabilitation, prescribed medication, medically induced coma (certain cases).
Additional evaluation after any type of stroke should be scheduled with primary doctor.

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It is common that with a stroke, there will be a feeling of numbness or significant weakness of the facial muscles.

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An MRI uses powerful radio waves and a magnetic field to create a detailed view of the brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow.

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There are a few ways to diagnose a stroke. One way to diagnose a stroke would be to get a brain CT scan.

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During a stroke, different areas of the brain can be damaged lobe including Broca's area, is located in the left hemisphere. This is associated with speech and articulation. Aphaia affects your ability to speak and understand what others say. It can also affect your ability to read and write. Aphasia is a common problem after stroke and around a third of stroke survivors have it.

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Abstract

Stroke is the second leading cause of death and a major contributor to disability worldwide. The prevalence of stroke is highest in developing countries, with ischemic stroke being the most common type. Considerable progress has been made in our understanding of the pathophysiology of stroke and the underlying mechanisms leading to ischemic insult. Stroke therapy primarily focuses on restoring blood flow to the brain and treating stroke-induced neurological damage. Lack of success in recent clinical trials has led to significant refinement of animal models, focus-driven study design and use of new technologies in stroke research. Simultaneously, despite progress in stroke management, post-stroke care exerts a substantial impact on families, the healthcare system and the economy. Improvements in pre-clinical and clinical care are likely to underpin successful stroke treatment, recovery, rehabilitation and prevention. In this review, we focus on the pathophysiology of stroke, major advances in the identification of therapeutic targets and recent trends in stroke research.

Keywords: stroke, pathophysiology, treatment, neurological deficit, recovery, rehabilitation

1. Introduction

Stroke is a neurological disorder characterized by blockage of blood vessels. Clots form in the brain and interrupt blood flow, clogging arteries and causing blood vessels to break, leading to bleeding. Rupture of the arteries leading to the brain during stroke results in the sudden death of brain cells owing to a lack of oxygen. Stroke can also lead to depression and dementia.

Until the International Classification of Disease 11 (ICD-11) was released in 2018, stroke was classified as a disease of the blood vessels. Under the previous ICD coding rationale, clinical data generated from stroke patients were included as part of the cardiovascular diseases chapter, greatly misrepresenting the severity and specific disease burden of stroke. Due to this misclassification within the ICD, stroke patients and researchers did not benefit from government support or grant funding directed towards neurological disease. After prolonged advocacy from a group of clinicians, the true nature and significance of stroke was acknowledged in the ICD-11; stroke was re-categorized into the neurological chapter [ 1]. The reclassification of stroke as a neurological disorder has led to more accurate documentation of data and statistical analysis, supporting improvements in acute healthcare and acquisition of research funding for stroke.

2. Epidemiology of Stroke

Stroke is the second leading cause of death globally. It affects roughly 13.7 million people and kills around 5.5 million annually. Approximately 87% of strokes are ischemic infarctions, a prevalence which increased substantially between 1990 and 2016, attributed to decreased mortality and improved clinical interventions. Primary (first-time) hemorrhages comprise the majority of strokes, with secondary (second-time) hemorrhages constituting an estimated 10-25% [ 2, 3]. The incidence of stroke doubled in low-and-middle income countries over 1990-2016 but declined by 42% in high-income countries over the same period. According to the Global Burden of Disease Study (GBD), although the prevalence of stroke has decreased, the age of those affected, their sex and their geographic location mean that the socio-economic burden of stroke has increased over time [ 3].

Gender-specific stroke: The occurrence of stroke in men and women also depends on age. It is higher at younger ages in women, whereas incidence increases slightly with older age in men. The higher risk for stroke in women is due to factors related to pregnancy, such as preeclampsia, contraceptive use and hormonal therapy, as well as migraine with aura. Atrial fibrillation increases stroke risk in women over 75 years by 20%. Based on the National Institutes of Health Stroke Scale (0 = no stroke, 1-4 = minor stroke, 5-15 = moderate stroke, 15-20 = moderate/severe stroke, 21-42 = severe stroke), mean stroke severity was estimated at 10 for women and 8.2 for men. Both brain infarction and intracerebral hemorrhage (ICH) are common in men, but cardioembolic stroke, a more severe form of stroke, is more prevalent among women. The fatality rate for stroke is also higher among women [ 5, 6, 7]. Women live longer than men, which is one reason for their higher incidence of stroke; another important concern is women's delay in accepting help for ongoing symptoms [ 8]. For men, the most common causes of stroke are tobacco smoking, excessive alcohol consumption, myocardial infarction and arterial disorders [ 9].

Socioeconomic variation: There is a strong inverse relationship between stroke and socioeconomic status, attributable to inadequate hospital facilities and post-stroke care among low-income populations [ 14]. A case study conducted in the US showed that people with high financial status had better stroke treatment options than deprived individuals [ 15]. A study in China linked low income and lack of health insurance to prevention of secondary stroke attack [ 16]. Research conducted in Austria associated level of education with take-up of treatments such as echocardiography and speech therapy; however, there was no difference in administration of thrombolysis, occupational therapy, physiotherapy or stroke care for secondary attack by socioeconomic status [ 17]. Similarly, in the Scottish healthcare system, basic treatments like thrombolysis were provided irrespective of the economic status of patients [ 18].

3. Pathophysiology of Stroke

Stroke is defined as an abrupt neurological outburst caused by impaired perfusion through the blood vessels to the brain. It is important to understand the neurovascular anatomy to study the clinical manifestation of the stroke. The blood flow to the brain is managed by two internal carotids anteriorly and two vertebral arteries posteriorly (the circle of Willis). Ischemic stroke is caused by deficient blood and oxygen supply to the brain; hemorrhagic stroke is caused by bleeding or leaky blood vessels.

Ischemic occlusions contribute to around 85% of casualties in stroke patients, with the remainder due to intracerebral bleeding. Ischemic occlusion generates thrombotic and embolic conditions in the brain [ 19]. In thrombosis, the blood flow is affected by narrowing of vessels due to atherosclerosis. The build-up of plaque will eventually constrict the vascular chamber and form clots, causing thrombotic stroke. In an embolic stroke, decreased blood flow to the brain region causes an embolism; the blood flow to the brain reduces, causing severe stress and untimely cell death (necrosis). Necrosis is followed by disruption of the plasma membrane, organelle swelling and leaking of cellular contents into extracellular space [ 20], and loss of neuronal function. Other key events contributing to stroke pathology are inflammation, energy failure, loss of homeostasis, acidosis, increased intracellular calcium levels, excitotoxicity, free radical-mediated toxicity, cytokine-mediated cytotoxicity, complement activation, impairment of the blood-brain barrier, activation of glial cells, oxidative stress and infiltration of leukocytes [ 21, 22, 23, 24, 25].

Hemorrhagic stroke accounts for approximately 10-15% of all strokes and has a high mortality rate. In this condition, stress in the brain tissue and internal injury cause blood vessels to rupture. It produces toxic effects in the vascular system, resulting in infarction [ 26]. It is classified into intracerebral and subarachnoid hemorrhage. In ICH, blood vessels rupture and cause abnormal accumulation of blood within the brain. The main reasons for ICH are hypertension, disrupted vasculature, excessive use of anticoagulants and thrombolytic agents. In subarachnoid hemorrhage, blood accumulates in the subarachnoid space of the brain due to a head injury or cerebral aneurysm ( Figure 1 ) [ 27, 28].

4. Risk Factors for Stroke

As noted earlier, the risk of stroke increases with age and doubles over the age of 55 years in both men and women. Risk is increased further when an individual has an existing medical condition like hypertension, coronary artery disease or hyperlipidemia. Nearly 60% of strokes are in patients with a history of transient ischemic attack (TIA). Some of the risk factors for stroke are modifiable, and some are non-modifiable ( Figure 2 ).

4.1. Non-Modifiable Risk Factors

These include age, sex, ethnicity, TIA and hereditary characteristics. In the US in 2005, the average age of incidence of stroke was 69.2 years [ 2, 29, 30]. Recent research has indicated that people aged 20-54 years are at increasing risk of stroke, probably due to pre-existing secondary factors [ 31]. Women are at equal or greater risk of stroke than men, irrespective of age [ 32]. US research shows that Hispanic and black populations are at higher risk of stroke than white populations; notably, the incidence of hemorrhagic stroke is significantly higher in black people than in age-matched white populations [ 33, 34, 35].

Transient ischemic attack is classified as a mini stroke; the underlying mechanism is the same as for full-blown stroke. In TIA, the blood supply to part of the brain is blocked temporarily. It acts as a warning sign before the actual event, providing an opportunity to change lifestyle and commence medications to reduce the chance of stroke [ 36, 37].

Genetics contribute to both modifiable and non-modifiable risk factors for stroke. Genetic risk is proportional to the age, sex and race of the individual [ 38, 39], but a multitude of genetic mechanisms can increase the risk of stroke. Firstly, a parental or family history of stroke increases the chance of an individual developing this neurological disorder. Secondly, a rare single gene mutation can contribute to pathophysiology in which stroke is the primary clinical manifestation, such as in cerebral autosomal dominant arteriopathy. Thirdly, stroke can be one of many after-effects of multiple syndromes caused by genetic mutation, such as sickle cell anemia. Fourthly, some common genetic variants are associated with increased stroke risk, such as genetic polymorphism in 9p21 [ 40]. A genome-wide association study of stroke showed high heritability (around 40%) for large blood vessel disease, and low heritability (16.7%) for small vessel disorders. Recent evidence suggests that studying heritability will improve the understanding of stroke sub-types, improve patient management and enable earlier and more efficient prognosis [ 5, 41].

4.2. Modifiable Risk Factors

These are of paramount importance, because timely and appropriate medical intervention can reduce the risk of stroke in susceptible individuals. The major modifiable risk factors for stroke are hypertension, diabetes, lack of physical exercise, alcohol and drug abuse, cholesterol, diet management and genetics.

Hypertension: It is one of the predominant risk factors for stroke. In one study, a blood pressure (BP) of at least 160/90 mmHg and a history of hypertension were considered equally important predispositions for stroke, with 54% of the stroke-affected population having these characteristics [ 42, 43]. BP and prevalence of stroke are correlated in both hypertensive and normal individuals. A study reported that a 5-6 mm Hg reduction in BP lowered the relative risk of stroke by 42% [ 44]. Randomized trials of interventions to reduce hypertension in people aged 60+ have shown similar results, lowering the incidences of symptoms of stroke by 36% and 42%, respectively [ 45, 46].

Diabetes: It doubles the risk of ischemic stroke and confers an approximately 20% higher mortality rate. Moreover, the prognosis for diabetic individuals after a stroke is worse than for non-diabetic patients, including higher rates of severe disability and slower recovery [ 47, 48]. Tight regulation of glycemic levels alone is ineffective; medical intervention plus behavioral modifications could help decrease the severity of stroke for diabetic individuals [ 49].

Alcohol and drug abuse: The relationship between stroke risk and alcohol intake follows a curvilinear pattern, with the risk related to the amount of alcohol consumed daily. Low to moderate consumption of alcohol (≤2 standard drinks daily for men and ≤1 for women) reduces stroke risk, whereas high intake increases it. In contrast, even low consumption of alcohol escalates the risk of hemorrhagic stroke [ 57, 58, 59]. Regular use of illegitimate substances such as cocaine, heroin, phencyclidine (PCP), lysergic acid diethylamide (LSD), cannabis/marijuana or amphetamines is related to increased risk of all subtypes of strokes [ 60]. Illicit drug use is a common predisposing factor for stroke among individuals aged below 35 years. US research showed that the proportion of illicit drug users among stroke patients aged 15-44 years was six times higher than among age-matched patients admitted with other serious conditions [ 61]. However, there is no strong evidence to confirm these findings, and the relationship between these drugs and stroke is anecdotal [ 62].

Smoking: Tobacco smoking is directly linked to increased risk of stroke. An average smoker has twice the chance of suffering from a stroke of a non-smoker. Smoking contributes to 15% of stroke-related mortality. Research suggests that an individual who stops smoking reduces the relative risk of stroke, while prolonged second-hand smoking confers a 30% elevation in the risk of stroke [ 63, 64, 65].

Insufficient physical inactivity and poor diet are associated with increased risk for stroke. Lack of exercise increases the chances of stroke attack in an individual. Insufficient physical activity is also linked to other health issues like high BP, obesity and diabetes, all conditions related to high stroke incidence [ 66, 67]. Poor diet influences the risk of stroke, contributing to hypertension, hyperlipidemia, obesity and diabetes. Certain dietary components are well known to heighten risk; for example, excessive salt intake is linked to high hypertension and stroke. Conversely, a diet high in fruit and vegetables (notably, the Mediterranean diet) has been shown to decrease the risk of stroke [ 68, 69, 70, 71, 72].

5. Animal Models of Stroke

Animal models usually used for research include induced, spontaneous, negative and orphan models. In the induced model, a disease condition is induced in the animal with a view to studying the effects, whereas in the spontaneous model, an animal is selected with a similar disease state naturally present in the model. Negative animal models are used to study the resistance mechanisms underlying a particular disease condition. Orphan models are deployed to understand the pathology of a newly characterized disease in human subjects [ 73, 74].

Many animal models have been developed to study the pathophysiology associated with stroke; they offer several advantages over studying stroke in humans or in vitro. The nature of stroke in humans is unpredictable, with diverse clinical manifestation and localization, whereas animal models are highly predictable and reproducible. Pathophysiological investigation often requires direct access to brain tissue, which is possible with animal models but not in humans. Moreover, current imaging techniques are unable to characterize events occurring within the first few minutes of a stroke. Finally, some aspects of stroke, such as vasculature and perfusion, cannot be studied in in vitro models [ 75]. Different stroke models used in animals are described in the session below ( Table 1 ).

Table 1

Stroke Models

Advantages

Disadvantages

Intraluminal suture MCAo model

Mimics human ischemic stroke,
Exhibits a penumbra,
Highly reproducible,
No craniectomy

Hyper-/hypothermia,
Increased haemorrhage,
Not suitable for thrombolysis studies

Craniotomy model

High long-term survival rates,
Visual confirmation of successful MCAo

Highly invasive and procedural complications,
Requires surgical skills

Photo-thrombosis model

Enables well-defined localization of an ischemic lesion,
Highly reproducible,
Less invasive

Causes early vasogenic edema,
Not suitable for investigating neuroprotective agents

Endothelin-1 model

Less invasive,
Induction of ischemic lesion in cortical regions,
Low mortality

Duration of ischemia not controllable, Induction of astrocytosis and axonal sprouting

Embolic stroke model

Mimics the pathogenesis of human stroke

Low reproducibility of infarcts, Spontaneous recanalization

Neurorehabilitation

Rapid establishment of independence in activities of daily living
Improves outcomes for cognitive, language, and motor skills

Develop cost-effective rehabilitative services
Lack of in-depth studies on efficacy related to neurorehabilitation

Biomaterial testing

Reduction in lesion volume
Bridge the lesion with neural tissue for neural reorganization
Reduce secondary damage
Improve neurological behaviour

Long-term experiments with the same biomaterial are challenging because of the degradation of material which might affect the treatment

Photo-thrombosis model: This model is based on photo-oxidation of the vasculature leading to lesion formation in the cortex and striatum. In this method, the skull is irradiated with a photoactive dye that causes endothelial damage, intraparenchymal vessel aggregation and platelet stimulation in the affected area. It is injected intraperitoneally in mice and intravenously in rats [ 91]. This model is highly reproducible, with a low mortality rate and no surgery. The pathophysiology of this method is slightly different to that seen in human stroke due to little collateral blood flow or formation of ischemic penumbra. However, recent researchers modified the photothrombotic ischemia model to include hypoperfusion in an attempt to mimic penumbra. It has also been deployed in freely moving mice to evaluate the development of motor cortex ischemia and motor deficits. This model permits assessment of the ongoing infarction and improves our understanding of the neuronal insult and repair process [ 92, 93].

Neurorehabilitation in animal models: Various rehabilitative devices and forced training strategies have been deployed in stroke-affected animals to study neurological behavior. Robotic and electric devices have also been developed for training purposes in animal models to evaluate the functionality and effectiveness of the rehabilitation process. Similarly, forced exercise regimes, such as running on a treadmill or task-oriented motor training, are used to study rehabilitation scope in humans. Housing environments that provide social, motor and sensory stimuli and support cell engraftment, creating a more realistic approximation of human treatment, can be tested using animal models [ 103, 104, 105].

Animal models in biomaterial testing: Animal models have been well characterized for the study of brain tissues via brain atlases ( http://www.med.harvard.edu/AANLIB/, https://portal.brain-map.org) for the required species. Stereotaxic techniques are utilized to introduce biomaterials or cells into particular coordinates of the target tissue. Microlesions can be studied precisely, and targeted localization can be confirmed using magnetic resonance imaging (MRI)-based lesion cartography [ 106, 107, 108].

6. Prevention and Treatment Strategies for Stroke

Stroke prevention involves modifying risk factors within a population or individuals, while stroke management depends on treating its pathophysiology. Despite an enormous amount of research into stroke over the last two decades, no simple means of treating or preventing all the clinical causes of stroke has been established. The overall direction of current stroke research is to generate novel therapies that modulate factors leading to primary and secondary stroke. Recent and current strategies for stroke prevention and treatment are discussed below ( Figure 3 ).

Excitotoxicity: Neuronal death is a key manifestation of stroke. A key reason for this phenomenon is neuronal depolarization and inability to maintain membrane potential within the cell. This process is mediated by glutamate receptors N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), which were among the first neuroprotective agents tested in stroke prevention. However, the untimely release of glutamate overpowers the system that removes glutamate from the cell and causes abnormal release of NMDA and AMPA molecules, leading to uninhibited calcium influx and protein damage. As a result, these agents have not been shown to reduce neuronal death in human subjects. Targeting the molecular pathways downstream of excitotoxicity signaling, rather than directly targeting glutamatergic signaling, might reduce the side effects of the process [ 109, 110].

Gamma aminobutyric acid (GABA) agonists: Clomethiazole is a GABA agonist that has been tested for its ability to improve stroke symptoms in patients, but failed to reduce the toxicity induced by the glutamate receptor [ 111].

Sodium (Na⁺) channel blockers: Na⁺ channel blockers have been used as neuroprotective agents in various animal models of stroke. They prevent neuronal death and reduce white matter damage. Many voltage-gated Na⁺ channel blockers have been tested in clinical trials, but most have proved to be ineffective [ 112]. Mexiletine is a neuroprotectant and Na⁺ channel blocker that proved effective in grey and white matter ischemic stroke, though further evaluation is required to confirm its role [ 113]. Lubeluzole was shown to reduce mortality in stroke in initial clinical trials, but successive trials failed to reproduce similar outcomes. Similarly, sipatrigine is a Na⁺ and Ca ²⁺channel blocker which failed in a Phase II clinical trial in stroke patients. Amiodarone was shown to aggravate brain injury due to defective transportation and accumulation of Na⁺ ions in the brain after stroke [ 114].

Calcium (Ca²⁺) channel blockers: Voltage-dependent Ca ²⁺ ion channel blockers have been shown to decrease the ischemic insult in animal models of brain injury. The Ca ²⁺ ion chelator DP-b99 proved efficient and safe in Phase I and II clinical trials when administered to stroke patients. Similarly, Phase II trials significantly improved clinical symptoms in stroke patients treated within 12 h of onset [ 115]. In another study, Ca ²⁺ channel blockers reduced the risk of stroke by 13.5% in comparison to diuretics and β-blockers [ 116].

6.1. Reperfusion

Intra-arterial thrombolysis (IAT): IAT is another approach designed to combat acute stroke. This treatment is most effective in the first six hours of onset of MCA occlusion, and requires experienced clinicians and angiographic techniques [ 115]. Prolyse in Acute Cerebral Thromboembolism II (PROACT II) and Middle Cerebral Artery Embolism Local Fibrinolytic Intervention (MELT) were randomized clinical trials (RCTs) undertaken to test the efficacy and safety of a recombinant pro-urokinase drug [ 126, 127], but did not produce any data useful for stroke treatment. Thrombolytics and glycoprotein IIb/IIIa antagonists were combined in two small clinical trials; this approach was helpful in treating atherosclerotic occlusions but less effective for cardioembolism [ 128, 129]. The Interventional Management of Stroke (IMS) III trial tested IVT and IAT together to assess the benefits of combining rapid administration of therapy (IVT) and a superior recanalization methodology for faster relief (IAT) [ 130]. The IMS III trial was fruitful with bridging therapy (combination of IVT and IAT) as compared to IVT alone. There was an increase of 69.6% in the recanalization rate using bridging therapy in stroke patients [ 131, 132].

Fibrinogen-depleting agents: Research has found a strong correlation between high fibrinogen levels in stroke patients and poor diagnosis for clinical outcomes. Fibrinogen-depleting agents decrease blood plasma levels of fibrinogen, hence reduce blood thickness and increase blood flow. They also remove the blood clot in the artery and restore blood flow in the affected regions of the brain. However, although some RCTs of defibrinogen therapy identified beneficial effects of fibrinogen-depleting agents in stroke patients, others failed to show positive effects on clinical outcomes after stroke [ 133]. Moreover, some studies reported bleeding after treatment with defibrinogen agents. Ancrod is a defibrinogenating agent derived from snake venom that has been studied for its ability to treat ischemic stroke within three hours of onset [ 134]. The European Stroke Treatment with Ancrod Trial (ESTAT) concluded that controlled administration of ancrod at 70 mg/dL fibrinogen was efficacious and safe, and achieved lower prevalence of ICH than observed at lower fibrinogen levels [ 135].

6.2. Others

Antihypertensive therapy: Hypertension is a risk factor for stroke. There are many reasons for high BP in stroke, including a history of hypertension, acute neuroendocrine stimulation, increased intracranial pressure, stress linked to hospital admission and intermittent painful spells [ 136]. Correct treatment of high BP during stroke is uncertain due to contradictory outcomes of clinical studies. Some research shows positive correlations between high BP and stroke-related mortality, hematoma expansion or intracerebral damage, suggesting that high BP should be treated. In other studies, low BP levels led to tissue perfusion and increased lesion size, thereby worsening the clinical outcome [ 137, 138]. The multi-center Acute Candesartan Cilexetil Therapy in Stroke Survivors (ACCESS) Phase II study proved that taking medication (candesartan) for BP during stroke was safe, with no orchestrated cerebrovascular events reported due to hypotension. Similar research has been performed with antihypertensive drugs, such as the Continue Or Stop post Stroke Antihypertensives Collaborative Study (COSSACS) to study the efficacy of antihypertensive therapy in stroke; the Control of Hypertension and Hypotension Immediately Post Stroke (CHHIPS) study, designed to determine the cut-off value for BP during an attack; and the Scandinavian Candesartan Acute Stroke Trial (SCAST), which aimed to measure the effectiveness of the drug candesartan on stroke and cardiovascular disease [ 115, 139]. In the COSSACS study, continuing antihypertensive drugs for a two-week period produced no extra harm as compared to stopping it and might be associated with reduced two-week mortality in patients with ischemic stroke [ 140]. The CHHIPS study demonstrated that a relatively moderate reduction in blood pressure lowered the mortality rate [ 141], whereas the SCAST study suggested that a careful BP-lowering treatment was associated with a higher risk of poor clinical outcome [ 142].

Glucose management: Hyperglycemia (elevated blood glucose) is common in stroke patients, so targeting blood glucose levels is an efficient stroke management strategy. Hyperglycemia > 6.0 mmol/L (108 mg/dL) is observed in most stroke patients; it initiates lipid peroxidation and cell lysis in compromised tissue, leading to stroke complications. An experimental study conducted in a rat model of collagenase-induced ICH found that hyperglycemia worsens edema formation and increases cell death, accelerating the course of ischemic injury. Increased blood glucose level is also associated with progression of infarction, reduced recanalization and poor clinical outcome [ 143]. Continuous glucose monitoring systems have been deployed to reduce stroke-related risks in both diabetic and non-diabetic stroke patients [ 144].

Antiplatelet therapy: This therapy is used for acute ischemic stroke management and for prevention of stroke incidence. It is also vital in controlling non-cardioembolic ischemic stroke and TIA. Antiplatelet agents like aspirin, clopidogrel and ticagrelor are the most widely used drugs administered to stroke sufferers within the first few days of attack [ 145]. Dual antiplatelet therapy, which involves a combination of clopidogrel, prasugrel or ticagrelor with aspirin, has become popular; many studies have tested the efficacy and safety of this dual therapy. It has been claimed that clopidogrel and aspirin combination therapy is most beneficial if introduced within 24 h of stroke and continued for 4-12 weeks [ 146].

Stem cell therapy: It offers promising therapeutic opportunities, safety and efficacy to stroke patients. Research on embryonic stem cells, mesenchymal cells and induced pluripotent stem cells has assessed their potential for tissue regeneration, maintenance, migration and proliferation, rewiring of neural circuitry and physical and behavioral rejuvenation [ 147]. Recently, a new type of mesenchymal stem cells (MSCs), called multilineage differentiating stress-enduring (Muse) cells, has been found in connective tissue. These cells offer great regenerative capacity and have been tested as a stroke treatment. After intravenous transplantation of Muse cells in a mouse model, they were found to engraft into the damaged host tissue and differentiate to provide functional recovery in the host [ 148]. Neovascularization is another mode of action of cell therapies in stroke; studies conducted in vitro and in vivo have shown that transplanted cells promote angiogenesis [ 149, 150]. Furthermore, multiple stroke studies have reported that MSCs stimulate neurogenesis; this was confirmed in human embryonic neural stem cells using BrdU-labelling [ 151, 152]. Stem cell therapy enhances the proliferation of neural stem cells and neuritogenesis [ 153]. Careful experimental design and clinical trials of stem cell therapies are likely to usher in a new era of treatment for stroke by promoting neurogenesis, rebuilding neural networks and boosting axonal growth and synaptogenesis.

Neural repair: This is an alternative therapy to neuroprotection. It is used to rejuvenate the tissue when the damage is already done and is therefore not time-bound but is most effective when administered 24 h after stroke attack. Many animal models have been used in attempts to stimulate neurogenesis and initiate the neuronal repair process [ 154]. Neural repair utilizes stem cell therapy to initiate repair mechanisms through cell integration into the wound or use of neurotrophic factors to block neuronal growth inhibitors. These cells may be channeled to any injured region to facilitate greater synaptic connectivity. Clinical trials using neural stem cells have proven beneficial in stroke patients. However, trials of myelin-associated glycoprotein, neurite outgrowth inhibitor (NOGO) proteins and chondroitin sulphate proteoglycans have shown these agents to be insufficiently effective; more clinical trials are required to increase treatment efficacy [ 155]. Biological intrusions may foster regeneration of newer cells, improve axonal guidance and enhance neural circuitry. Pharmacological and immunological interventions may target receptors to provide signaling cues for regeneration or block inhibitory factors in stroke-affected regions of the brain [ 156].

7. Trends in Stroke Research

The incidence of stroke-related emergencies has decreased substantially over recent years due to improved understanding of the pathophysiology of stroke and identification of new drugs designed to treat the multitude of possible targets. Technological advancements like telestroke [ 161] and mobile stroke [ 162] units have reduced mortality and morbidity. Therefore, stroke management systems should include post-stroke care facilities on top of existing primary care and access to occupational, speech or any physical therapy following hospital discharge. Hospitals should develop standardized policies to handle emergencies in a timely fashion to avoid casualties and prevent secondary stroke [ 163]. Recently, the role of physiotherapists has emerged as an important aspect of post-stroke care management. Physiotherapists have initiated clinical trials of stroke recovery processes and rehabilitation therapy sessions. One ongoing study includes a strategy to manage disability by improving mobility using treadmill exercise, electromechanical device therapy and circuit class therapy [ 164, 165]. Stroke Recovery and Rehabilitation Roundtables bring physiotherapists and other experts together to recommend research directions and produce guidance for the post-stroke healthcare system. Optimized delivery of stroke care systems and access to rehabilitation services are the future of healthcare for stroke [ 166].

Animal models used in stroke research reflect only a portion of the consequences of the condition in human subjects. Moreover, experiments conducted within a single laboratory are often constrained in terms of their research output. In vivo animal models of stroke should include aged populations to maximize their relevance, but most recent studies involve young and adult animals. Stroke studies should be conducted in both male and female subjects to exclude gender bias, and should take account of other confounders like hypertension, diabetes and obesity. All these issues make stroke research complex and expensive, and imply that it should be carried out collaboratively, across multiple labs. Ideally, an international multicenter platform for clinical trials would be established to increase the validity of research outcomes with respect to efficacy, safety, translational value, dose-response relationships and proof-of-principle. This strategy will help to overcome the current hurdles in transforming laboratory data into therapeutics for stroke.

Advancements in stem cell technologies and genomics have led to regenerative therapy to rebuild neural networks and repair damaged neurons due to ischemic insult [ 167, 168]. The WIP1 gene is a regulator of Wnt signaling and a promising target for drug development. Studies in mice models showed that knockdown of WIP1 downregulates the stroke functional recovery process after injury, and that the presence of this gene regulates neurogenesis through activation of β-Catenin/Wnt signaling [ 169]. Similarly, NB-3 (contactin-6) plays a vital role in neuroprotection, as shown by knockdown of NB-3 in mice after stroke attack. NB-3-deficient mice had increased brain damage after MCAo, which also affected neurite outgrowth and neuronal survival rate. NB-3 is believed to have therapeutic benefits for ischemic insult [ 170]. Therefore, WIP1 and NB-3 are promising candidates for future drug trials. This is a vast field, and more research must be conducted in the coming years to enable the development of therapeutic drugs.

Numerous natural compounds have proven to be beneficial for stroke prevention and treatment. They can be synthesized at a lower cost than synthetic compounds and offer competitive efficacy and safety. Honokiol is a natural product that showed neuroprotective effects in animal models, and appears to have a role in reducing oxidative stress and inhibiting inflammatory responses [ 171]. Gastrodin, a compound extracted from Gastrodia elata, is a promising candidate in stroke treatment. In a mouse model, it improved neurogenesis and activated β-Catenin-dependent Wnt signaling to provide neuroprotection after ischemic insult. It also has antioxidative effects which protects the neural progenitor cells from neuron functional impairment. Gastrodin's safety has been proved in clinical trials, hence it is an option for stroke management in the coming years [ 172].

The Utstein methodology is a process of standardizing and reporting research on out-of-hospital stroke and defining the essential elements of management tools. Its growing popularity led to the establishment of the Global Resuscitation Alliance (GRA), an organization that governs best practices. The primary aim of GRA is to facilitate stroke care from pre-hospital admission to rehabilitation and recovery. It has developed 10 guidelines to ensure smooth transitioning of services during and after attack. It has implemented a stroke registry, public awareness and educational programs, promoted techniques for early stroke recognition by first responders, sought to optimize prehospital and in-hospital stroke care, advocated the use of advanced neuroimaging techniques and promoted a culture of excellence. The Utstein community has developed comprehensive plans to improve early diagnosis and treatment of stroke patients globally [ 173].

Future clinical trials should aim not only to determine the efficacy and safety of drugs but to characterize recovery and clinical outcomes. Clinical trials of pharmacological therapies for post-stroke recovery should adhere to the following guidelines [ 174]. Patients should be enrolled within two weeks of stroke whenever possible. Studies should include sampling from a multicenter platform and include global scale criteria for data analysis. The underlying mechanism of action of the tested drugs on target molecules should be thoroughly understood. Secondary measurements like day-to-day progress of recovery, length of rehabilitation, treatment endpoint analysis and any other compounding factors should also be recorded. Overall, research on stoke management has advanced rapidly in recent years and is certain to make additional valuable discoveries through the application of new technologies in hypothesis-driven clinical trials.

8. Translational Challenges for the Current Stroke Therapeutic Strategies

Stroke research has seen fundamental advancements over recent years. The improvements in the selection of animal models, imaging techniques and methodological progress have led to immense drug targets and therapeutic interventions. In spite of this, the subsequent clinical trials failed to prove pre-clinical outcomes. Recanalization therapy showed some promising results in the clinical trials but only a small section of stroke patients benefited from this treatment [ 175]. Hence, the translational potential of stroke research is still under-investigated.

The key challenges that hinder the smooth transition of pre-clinical research into successful drugs include relevant endpoint selection, confounding diseases models like hypertension and diabetes, modelling age and gender effects in stroke patients, development of medical devices, investigating medical conditions that co-exist during stroke incidence, reproducibility of pre-clinical stroke research data and modelling functional and behavioral outcome [ 176, 177, 178]. Multiple causality of the stroke occurrence is another problem that is often over-looked. Homogeneity in stroke models to exhibit the broad spectrum of stroke pathophysiology associated with ischemic lesions or cortical or intracerebral damage is critical. Therefore, stroke animal models that target specific causes of stroke should be included. Latent interaction between comorbidities and stroke treatment should be identified to increase the safety and efficacy of the clinical outcome [ 179]. Short-term experimental trials often result in failed therapeutic development due to false-negative outcomes in the clinical settings [ 180]. Understanding the functional and behavioral output which might mislead true recovery is problematic in clinical trials wherein animal models have greater ability to mask the functional benefits [ 181]. This affects the affecting translational capability of the research. Adapting a combined approach to model recovery and rehabilitation is also important for successful transition.

One of the other problems with the clinical trials for stroke is the lack of efficient data management. The impact of large data generated from numerous clinical experiments is over-whelming and there should be a standardized system to manage such data. Moreover, these data should be deposited into a public data repository for easy access.

Industry and academic corroborations in stroke research are critical to improve the translational value [ 182]. A consensus between industry and academic interests is vital for successful transition. The industry collaborations are mostly monetary driven and have time constraints which might compromise the pre-clinical study protocol design, appropriate sample sizes and overestimation of treatment effects. IP protection and publication of research data may discord between these groups. A multicenter approach, long-term collaborations, effective project management, use of advanced methodologies and establishment of functional endpoints will probably advance the translational roadblocks in stroke research [ 183].

9. Conclusions

Stroke is the second leading cause of death and contributor to disability worldwide and has significant economic costs. Thus, more effective therapeutic interventions and improved post-stroke management are global health priorities. The last 25 years of stroke research has brought considerable progress with respect to animal experimental models, therapeutic drugs, clinical trials and post-stroke rehabilitation studies, but large gaps of knowledge about stroke treatment remain. Despite our increased understanding of stroke pathophysiology and the large number of studies targeting multiple pathways causing stroke, the inability to translate research into clinical settings has significantly hampered advances in stroke research. Most research has focused on restoring blood flow to the brain and minimizing neuronal deficits after ischemic insult. The major challenges for stroke investigators are to characterize the key mechanisms underlying therapies, generate reproducible data, perform multicenter pre-clinical trials and increase the translational value of their data before proceeding to clinical studies.

Author Contributions

Conceptualization, D.K.; writing-original draft preparation, D.K.; writing-review and editing, Z.X.; funding acquisition, Z.X. All authors have read and agreed to the published version of the manuscript.

Funding

This research and The APC was funded by Apex Biotech Research.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

Publisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Articles from International Journal of Molecular Sciences are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

# data[].attributes.attachment_link.title
Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives

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Stroke is the second leading cause of death and a major contributor to disability worldwide. The prevalence of stroke is highest in developing countries, with ischemic stroke being the most common type. Considerable progress has been made in our understanding ...

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A lifestyle change to help could be changing your diet, and eating healthier. You can lso exercise more. Eating healthier like white meats, greens, and grains can keep your body healthier, and may help prevent another stroke. Staying fit will also help prevent another stroke. Depending on your current diet, it my be a 5 difficulty. Staying fit is a 5 difficulty as well. A nutritionist can help with your diet, and a personal trainer can. help with exercise.

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The following physiological process are involved in strokes. Clots form in the brain and interrupt blood flow, clogging arteries and causing blood vessels to break, leading to bleeding. More specifically Ischemic stroke involves an abrupt blockage of an artery that does not allow for blood flow to get to the brain. In all cases of this condition the brain becomes damaged or parts of it die.

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Stroke is believed to occur consequently to an embolus within the system of the MCA.
Stroke will occur when blood flow from the MCA is suddenly interrupted or stopped altogether, as it is one of the largest arteries of the brain. This great loss of blood flow will cause tissue death and lead to serious and potentially permanent brain injury.

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A Hemorrhagic stroke is causing by internal bleeding in the brain from the rupture of a blood vessel. Two factors that cause Hemorrhagic strokes are high blood pressure, and trauma. Blood thinning medicine can also increase your risk for a Hemorrhagic stroke. The severity and symptoms may vary due to the location on the brain. Emergency care is required for this. It calls for medication, and close monitoring. Surgery may also be a possibility depending on the severity of it.

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Internal carotid arteries are branches in the common carotid arteries that divide into the internal and external carotids. Internal carotid arteries consist of 3-layers, the tunica intima, tunica media, and tunica adventitia. They supply blood up the head but mostly to the brain through the carotid sheath. There are 2 internal carotid arteries in total, one on each side of the neck.

# data[].attributes.headline
Intro post - Represents our focus problem

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Intro post - Represents our focus problem

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Our selected focus problem is Stroke, which is a sudden interruption of blood supply to the brain. It occurs when a blood vessel gets blocked by a clot or burst not allowing the oxygen and nutrients to the brain. There are two types of strokes. Hemorrhagic stroke is the most dangerous having a higher death rate; it occurs from bleeding in the tissue when a blood vessel bursts. The most common strokes are Ischemic strokes caused by an abrupt blockage of an artery. Normally where the stroke occurs, the function in that area will be affected also classifying what type of stroke occurred. Depending on the area affected; a person may have problems speaking, walking, seeing, or thinking. Stroke warnings to be aware of are sudden weakness, loss of sensation, difficulty with speaking, seeing, walking, blurred vision, unstable (balance or dizziness). Many causes' are due to the age, gender, race, and lifestyle of a person. Both types of strokes have similar risk factors being high blood pressure, smoking, weight, diabetes, heart disease, have history of stroke or TIA.

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People from all ages are in risk of strokes. The most common age group affected by strokes are people ages 55 and older. After the age of 55 people have a higher risk of having a stroke as the years go by. The possibility of having a stroke increases every 10 years. As for young adults and children, the most common reason for having a stroke between the ages 15 and 50 are due to health issues, such as High Blood Pressure, Obesity, Diabetes, Blood Thinners, and Aneurysms. Lack of exercise, smoking, and poor nutrition have a significant impact on the chances of having a stroke. Children mostly infants are at risk of having strokes due to heart defects, immune disorders, anemia, and blood disorders.

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One reason people can suffer from a stroke is an unhealthy lifestyle. People consume foods, drinks, and drugs that negatively impact their life, and raise the risk of suffering from a stroke. A known factor for causing strokes is smoking cigarettes. People that smoke are more likely to suffer from strokes. Also people who drink alcohol and take opioids are at risk as well.

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Black and Latino Communities have a greater risk of developing stroke

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Black and Latino Communities have a greater risk of developing stroke

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Black people had the highest mortality rate from stroke compared to other racial groups and were also more likely to be disabled afterward. Black people are more at risk because of a higher risk for high blood pressure, diabetes, and obesity, all of which contribute to stroke. Hispanics also have some of the highest rates of high blood pressure, diabetes, and obesity; also making them extremely susceptible to strokes.

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May include a long process of therapies and or medicine. The road to recovery may range form months to years. It is a gradual process also known as stroke rehabilitation.

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Stroke treatment is different depending on the type of stroke. You may be given medicines or have medical procedures or surgery to treat your stroke.

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How to Know if you are in risk of a stroke....

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How to Know if you are in risk of a stroke....

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Centers for Disease Control and Prevention

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Learn about stroke risk and which risk factors you can manage.

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Speech therapy is a form of therapy aimed at improving communication and speech disorders. It involves techniques and exercises designed to enhance speech clarity, language development, and communication skills, often tailored to the specific needs of each person. This type of treatment helps people who suffered from a stroke that may have delayed or impaired speech. Someone who could deliver this treatment would be speech pathologist.

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1) Trouble speaking and understanding what others are saying

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1) Trouble speaking and understanding what others are saying

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It is known as Aphasia, a language disorder that affects your ability to communicate. which occurs when a stroke takes place on the left side of the brain affecting apart of your cognitive communication skills and motor speech.

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10/12/2023- Rehabilitation treatment that may be necessary for someone with stroke focus condition.

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10/12/2023- Rehabilitation treatment that may be necessary for someone with stroke focus condition.

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Speech therapy, a form of therapy aimed to improving communication and speech disorders. The care plan may differ but overall involve techniques for neuromuscular re-education. This treatment is delivered by a Speech - language Pathologist(SLP). They find exercises and treatments that address your specific need. Designed to enhance speech clarity, language development, communication skills. Those who are having language problems such as with their fluency, stuttering, cluttering, etc

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Computed tomography (CT)

Diagnose

Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. Following a suspected stroke, a brain CT scan is usually conducted to determine the presence of bleeding in the brain or any damage to the brain cells caused by the stroke. There is a risk from exposure to ionizing radiation, and the exposure to ionizing radiation can cause a slight increase in a person's lifetime, thus a risk of developing cancer.

Stroke Awareness Foundation App

prevent

treat

San Francisco App Development Company Core Mobile Apps built the Stroke Awareness Foundation app. This app helps identify stroke signs and locate certified stroke centers. Anxiety to over-diagnoses can be a negative aspect when using the app.