Hemorrhagic Strokes & Brain Blood Supply

• The brain receives 15-20% of the body's blood supply, despite being only about 2% of body weight, due to its high metabolic demands.
• The brain cannot store oxygen or glucose, rendering it highly susceptible to blood flow interruptions.
• Brain cell damage can occur after just 3-5 minutes of interrupted blood flow.
• The fibrovascular system maintains consistent blood flow under varying conditions.

Hemorrhagic Strokes

• Hemorrhagic strokes involve bleeding that damages brain tissue through multiple mechanisms.
• In a healthy brain, blood vessels deliver oxygen and nutrients.
• A hemorrhagic stroke occurs when a blood vessel ruptures, leading to bleeding in or around the brain.
• Blood is toxic to brain cells, which becomes the primary mechanism of damage.
• Accumulated blood creates pressure that damages surrounding brain tissues.
• The affected area experiences a loss of normal blood supply, further damaging brain tissue.
• Intraerebral hemorrhage involves blood vessel rupture within the brain tissue.
• Subactoid hemorrhage involves bleeding in the space between the brain and surrounding membranes.
• Hypertension can lead to hemorrhagic stroke by weakening vessel walls over time.
• Aneurysms are weakened areas of blood vessel walls that can rupture suddenly.
• Arteriovenous malformations are abnormal tangles of blood vessels prone to bleeding.
• Blood-thinning medications can increase the risk of hemorrhagic stroke, especially at high doses.

Modifiable Lifestyle Factors

• Smoking doubles stroke risk by promoting atherosclerosis, increasing blood clot formation, and raising blood pressure.
• Physical inactivity contributes to obesity, hypertension, and diabetes, all of which are independent stroke risk factors.
• Poor diet, high in sodium, saturated fats, and processed foods, increases stroke risk.
• Excessive alcohol consumption raises blood pressure and can trigger atrial fibrillation, both significant risk factors for stroke.
• Chronic stress might contribute to stroke risk through its effects on blood pressure and systemic inflammation.

Positive Lifestyle Changes

• Positive lifestyle changes to reduce risk include quitting smoking
• Increase physical activity
• Improve diet
• Limit alcohol consumption
• Manage stress

The FAST Method

• FAST recognition and action can mean the difference between recovery and permanent disability regarding strokes
• F stands for Face; ask the person to smile; one side may droop if they are having a stroke
• A stands for Arms; ask the person to raise both arms; one arm may drift downward if they are having a stroke due to weakness or paralysis
• S stands for Speech; ask the person to repeat a simple phrase; speech may be slurred or not be able to speak at all if they are having a stroke
• T stands for Time; call emergency services immediately, as every minute a stroke goes untreated, nearly 2 million brain cells die
• Early recognition and immediate action can save lives and improve outcomes.

Additional Warning Signs

• Sudden severe headache with no known cause is a critical warning sign, particularly common in hemorrhagic strokes.
• Vision problems, including sudden trouble seeing in one or both eyes, can indicate a stroke.
• Dizziness and problems with balance is a significant warning sign.
• Coordination problems, including sudden clumsiness or difficulty with fine motor skills, can indicate brain damage.
• Sudden confusion or trouble understanding speech are often overlooked, but are critical symptoms.
• Symptoms can vary depending on which brain region is affected.
• Posterior circulation strokes, affecting the back of the brain, often present differently than the classic FAST symptoms.
• Not all strokes present with typical FAST symptoms.
• Recognizing less common warning signs could be life-saving.

Rehabilitation

• Rehabilitation begins as soon as the patient is medically stable after a stroke.
• Physical therapy focuses on improving mobility, strength, balance, and coordination through targeted exercises.
• Therapists guide patients through progressively challenging activities to help them regain functional movement and independence.
• Occupational therapy helps patients relearn daily activities like dressing, eating, and bathing.
• Adaptive techniques and specialized equipment help patients overcome limitations and regain independence.
• Both therapies employ neuroplasticity principles, helping the brain form new connections to compensate for damaged areas.
• The brain creates and strengthens new neural pathways through repeated practice of therapeutic activities.
• Early intensive rehabilitation significantly improves functional outcomes and independence.

Long-Term Challenges

• Stroke survivors often face long-term challenges impacting their quality of life.
• Physical effects can include hemiparesis (weakness on one side of the body) affecting movement and coordination.
• Survivors may experience spasticity, causing muscle stiffness and involuntary contractions, along with sensory changes and vision problems.
• Post-stroke fatigue is common, affecting up to 70% of survivors.
• Physical adaptations include home modifications and assistive devices.
• Psychological adaptation involves coping strategies, support groups, and counseling.

Stroke Recovery

• Recovery is not linear; many survivors continue to improve for months or even years.
• Recovery tends to be more rapid initially, with about 50% achieved within the first 3 months.
• By the 1-year mark, recovery typically reaches around 80%.
• After 2 years, many survivors achieve about 95% of their recovery, though some continue to see smaller improvements for many years.
• Ongoing adaptation strategies and support continue to improve quality of life for stroke survivors.

Prevention

• Prevention of cerebrovascular disorders requires comprehensive individual strategies and public health initiatives.
• Individual prevention strategies focus on modifiable risk factors.
• Strategies include blood pressure control, smoking cessation, diabetes management, and cholesterol reduction.
• Maintaining a healthy diet, regular exercise, and limiting alcohol reduces stroke risk.
• Public health initiatives include educational campaigns about stroke symptoms, risk factor screening programs, and improved emergency response systems.
• Community-based interventions targeting high-risk populations have demonstrated success.
• These programs focus on local needs and cultural considerations.
• Community programs have reduced stroke incidents, lead to earlier treatment initiation, and improved overall recovery rates.
• A comprehensive approach combining individual strategies with public health initiatives offers the most effective framework for reducing cerebrovascular disorders.