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Stroke - Medical Malpractice
Strictly speaking, there are two types of stroke. These include an ischemic stroke, in which there is a lack of circulation to the affected brain area due to blockage of an artery, and a hemorrhagic stroke, in which there is bleeding in the brain. A hemorrhagic stroke is less common and is commonly caused by a cerebral aneurysm, an arteriovenous malformation, or other cerebral hemorrhage. The brain cannot do without oxygen for even a few seconds and damage begins to occur in the brain cells.
In an ischemic stroke, a blood clot forms in a major artery leading to the brain or in a smaller artery within the brain. The artery is usually already narrowed by atherosclerosis and this makes it easier for platelets to aggregate and a clot to form. A clot can also break off from another body area, such as the heart, and can block off the brain artery. Technically, this is called an embolic stroke, which is similar to the thrombotic stroke described above. A cerebral embolism can come from just about anywhere in the body but often happen when the valves are abnormal in the left side of the heart.
There are drugs and certain medical conditions that can make the blood clot more easily, increasing your chances of getting a thrombotic or embolic stroke. For example, the carotid artery can dissect, tearing the lining and causing an interruption in blood flow to the brain. This is not usually due to having a plaque buildup in the artery.
As mentioned, hemorrhagic strokes are less common. They occur when the brain artery weakens, resulting in blood leaking into the space normally occupied by brain cells. Defects in the arteries make this problem worse and you can be born with the predisposition to have an embolic stroke.
Risk factors for having a stroke include high blood pressure, diabetes, atrial fibrillation, family history of stroke, heart disease, increasing age and high cholesterol. Some medications, such as birth control pills, increase your chance of having a stroke. Smoking can increase the risk for stroke in women over the age of 35. Males have more strokes than females although women can have a stroke during pregnancy or shortly after having a baby.
Bleeding into the brain can be predated by having excessive alcohol use, cocaine abuse, head injury, bleeding disorders, arteriovenous malformations or aneurysms.
The symptoms of having a stroke differ depending on the type and location of the stroke in the brain. If you have blockage or bleeding in the right side of the brain, you have symptoms on the left side of the brain. If you have problems on the left side of the brain, you have right sided symptoms. Small strokes can be completely silent. Headaches are possible but usually happen only with hemorrhagic strokes. The headache tends to be one of the worst you have ever had, is worse when lying down, wakes you up from a sound sleep and worsens when you bend, strain or have a cough.
Total body symptoms of having a stroke vary according to the location of the brain damage. There can be a decreased level of consciousness or a coma, hearing changes, clumsiness, taste changes, loss of memory, confusion, difficulty reading or writing, vertigo, problems swallowing, bladder control problems, muscle weakness on one side of the body, numbness on one side of the body, emotional or mood changes and poor vision. You can have difficulty understanding speech, garbled speech or complete loss of speech.
Doctors diagnose a stroke by means of a complete history and physical, including a neurological examination. A CT scan is done as soon as possible to determine whether or not the stroke is hemorrhagic or ischemic. Ischemic strokes often look normal under CT scan in the beginning and only show changes over time. Hemorrhagic strokes look obvious right away and show up as bright bleeding under CT scan. The treatment is based on the results of the physical examination and on the CT scan.
An MRI of the brain can be done to look for any abnormal blood vessels that might have resulted in the stroke but is not as good of a test as a CT scan in determining ischemic versus hemorrhagic strokes. A carotid angiogram can show blockages of the carotid artery on both sides of the brain and can affect the treatment plan.
Strokes must be treated promptly. In an ischemic stroke, there is a window of just about 4-5 hours after the onset of symptoms in which medications such as TPA can be given to break up the clot and restore circulation to the brain. After that time, the brain damage is usually irreversible. TPA is a clot busting drug that breaks up clots relatively quickly. It will, however, make a hemorrhagic stroke worse so this is why a CT scan must be done. In hemorrhagic strokes, the treatment is based on lowering the blood pressure to reduce the amount of bleeding that occurs. If the platelet count is low, matched platelets are given to stop the bleeding.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here