Stroke

A stroke occurs when the flow of blood to a portion of the brain is completely cut off or significantly reduced.  When this happens, brain cells in the affected region become deprived of oxygen normally delivered through blood, and as a result, they rapidly begin to die.  The death of numerous brain cells can lead to long-term damage, and that’s why it’s essential that urgent care be sought out for the 750,000 people that suffer from a stroke each year in the U.S.

Strokes can range drastically in terms of their severity and are generally classified based on their location and mechanism of action.  The two main types are ischemic stroke and hemorrhagic stroke, each of which will be explained below.

Ischemic stroke

Ischemic strokes account for the majority, or about 87%, of all strokes.  They occur due to an obstruction within a blood vessel that supplies blood to the brain.  Fatty deposits that line the vessel walls—from a condition called atherosclerosis, or hardening of the arteries—are typically responsible for this obstruction of blood flow, and do so in one of two ways:

  • Cerebral thrombosis: in these cases, a thrombus (or blood clot) develops in diseased or damaged arteries within the brain
  • Cerebral embolism: a blood clot forms somewhere else in the circulatory system, usually in the heart or large arteries of the upper chest and neck; from here, a portion of the clot breaks loose and enters the bloodstream, traveling until it can no longer pass through blood vessels, and then restricting the flow of blood as a result

Symptoms of ischemic stroke usually occur suddenly and may include:

  • Muscle weakness
  • Paralysis
  • Lost or abnormal sensation on one side of the body
  • Difficulty speaking
  • Problems with vision
  • Confusion
  • Dizziness or loss of balance and coordination.

Surgical procedures for ischemic stroke

Strokes are a medical emergency, if you experience any of the above symptoms that suggest an ischemic stroke you should go to the emergency room immediately.  Initial treatment will focus on restoring the breathing, heart rate, blood pressure and temperature back to normal.  From there, medications and other additional treatments may be necessary depending on the severity of the stroke.

Once an ischemic stroke is completed—meaning the stroke remains stable and no further damage is being done—surgery may be necessary to remove the blood clots.  At Raleigh Neurosurgical Clinic Inc, we offer the following surgical procedures for ischemic stroke:

  • Microcatheter-based surgical interventions/tPA
  • Clot retrieval (Merci Retriever)
  • Carotid endarterectomy and carotid angioplasty
  • Stenting (preventative surgery)

Hemorrhagic stroke

Hemorrhagic strokes are less common, accounting for only about 13% of all strokes.  These strokes result from a weakened blood vessel that ruptures and bleeds into the surrounding brain.  This leads to an accumulation of blood and a loss of blood to areas of the brain that the broken vessel went to, as well as increased pressure in the tissue that surrounds the brain.  There are two types of hemorrhagic stroke:

Intracerebral hemorrhage: much more common of the two, these occur within the brain itself

Symptoms include total or limited loss of consciousness, nausea/vomiting, sudden and severe headache, weakness or numbness in face, leg, arm or one side of the body

Subarachnoid hemorrhage: less common; blood vessels on the surface of the brain rupture and bleed into the space between the brain and skull (subarachnoid space)

Symptoms include severe headache, nausea/vomiting, stiff neck, inability to tolerate light, confusion, seizure and loss of consciousness

In addition to these two major types of hemorrhagic stroke, they can be further classified by the two types of weakened blood vessels that may cause them:

  • Aneurysm: a ballooning of a weakened region of a blood vessel; if left untreated, it will continue to weaken until it ruptures and bleeds into the brain
  • Arteriovenous malformation (AVM): a cluster of blood vessels gets tangled together, increasing the chances of one of them rupturing; once this happens, it leads to bleeding in the brain

Surgical procedures for hemorrhagic stroke

As with ischemic strokes, hemorrhagic strokes also require that you seek immediate medical attention if suspicious symptoms are noticed.  Initial treatment will focus on controlling the bleeding of the brain and reducing pressure caused by the bleeding.  Once the stroke is brought under control, further action may be necessary.  If the rupture is small, bed rest may be sufficient for recovery.

If the stroke is severe, surgery may be needed to repair the ruptured blood vessels and stop the bleeding in the brain.  Depending on the severity of the stroke and the patient’s condition, surgery may be performed within 48-72 hours after the hemorrhage, or it may be delayed 1-2 weeks to allow the patient to stabilize.  At Raleigh Neurosurgical Clinic Inc, we offer the following surgical procedures for hemorrhagic strokes:

  • Surgical clipping
  • Endovascular coiling

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