The meaning of stroke
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Understanding the Meaning of Stroke
Definition of Stroke
Classic and Updated Definitions
Stroke is traditionally defined as the abrupt onset of symptoms of focal neurological dysfunction lasting more than 24 hours or leading to earlier death, caused by acute vascular injury to part of the brain. The World Health Organization (WHO) describes stroke as a clinical syndrome with rapidly developing signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin . However, this definition is considered outdated due to advancements in imaging techniques that can diagnose pathology at an early stage or identify silent infarcts.
The American Heart Association/American Stroke Association (AHA/ASA) has updated the definition to include central nervous system infarction, which is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. This updated definition also encompasses intracerebral hemorrhage and subarachnoid hemorrhage.
Types of Stroke
Strokes can be broadly categorized into ischemic and hemorrhagic types. Ischemic strokes, which account for approximately 85% of all strokes, are caused by inadequate blood supply to the brain due to arterial or venous blockages . Hemorrhagic strokes, making up about 15% of cases, result from spontaneous bleeding into the brain tissue or surrounding areas.
Clinical and Diagnostic Challenges
Rapid Diagnosis and Misdiagnosis
Stroke is increasingly common and often fatal or disabling, necessitating rapid and accurate diagnosis to enable emergency interventions that can restore brain perfusion and improve outcomes. The absence of a definitive diagnostic test for stroke complicates this process, making clinical judgment crucial .
Pediatric Stroke
Stroke in children, although rare, presents unique challenges. It often results from a variety of etiologies, including congenital heart disease, metabolic disorders, and vasospastic conditions like migraines. The diagnostic evaluation aims to confirm the presence of a cerebrovascular lesion, exclude other neurological dysfunctions, and identify the stroke's etiology.
Advances in Treatment and Prevention
Acute Treatment
Significant advances have been made in the treatment of acute ischemic stroke, including the use of endovascular thrombectomy in addition to intravenous alteplase, which increases functional independence in patients. For acute intracerebral hemorrhage, ongoing trials are assessing the effectiveness of various therapies, including acute blood pressure lowering, haemostatic therapy, and minimally invasive surgery.
Prevention Strategies
Preventive measures for recurrent stroke now include the use of direct oral anticoagulants as an alternative to warfarin for atrial fibrillation and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis. Aspirin has also been recognized for its greater-than-previously-understood benefits in preventing early recurrent ischemic stroke.
Conclusion
The definition of stroke has evolved significantly, incorporating both clinical and tissue criteria to better reflect advances in medical science and technology. Understanding the various types of stroke, the challenges in rapid diagnosis, and the latest advancements in treatment and prevention is crucial for improving patient outcomes. Despite these advancements, the global burden of stroke continues to rise, underscoring the need for comprehensive prevention strategies that address common risk factors shared with other diseases.
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