|
It is defined as a "neurological deficit of cerebro vascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". The 24-hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. Classification
Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemic strokes are those that are due to interruption of the blood supply, while hemorrhagic strokes are the ones which are due to rupture of a blood vessel or an abnormal vascular structure. 80% of strokes are due to ischemia; the remaining are due to hemorrhage
1.Ischemic stroke
There are four reasons why this might happen:
1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
2. Embolism (obstruction due to an embolus from elsewhere in the body, see below)
3. general decrease in the blood supply for example in the condition of shock
4. venous thrombosis
Hemorrhagic stroke
Intracranial hemorrhage is the accumulation of blood any where within the skull vault.
The main types of extra axial hemorrhagea are as follows: 1.epidural hemorrhage 2.sub dural hemorrhage 3.sub arachniod hemorrhage Most of the hemorrhagic stroke syndromes have specific symptoms (e.g. headache, previous head injury). Intra cerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging hematoma Risk factors
The most important modifiable risk factors for stroke are
1. high blood pressure
2. atrial fibrillation
3. high blood cholesterol levels,
4. diabetes,
5. cigarette smoking
6. heavy alcohol consumption
7. drug use
8. lack ofphysical activity
9. obesity
10. Unhealthy diet
Alcohol use could predispose to ischemic stroke, and intracerebral and subarachnoid hemorrhage via multiple mechanisms. Signs and symptoms
Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive the area of brain affected, the more functions that are likely to be lost. • Hemiplegia and muscle weakness of the face
• numbness
• reduction in sensory or vibratory sensation
• altered smell, taste, hearing, or vision (total or partial)
• drooping of eyelid (ptosis)and weakness of ocular muscles
• decreased reflexes: gag, swallow, pupil reactivity to light
• balance problems and nystagmus
• altered breathing and heart rate
• weakness in sterno cleido mastoid muscle with inability to turn head to one side
• weakness in tongue (inability to protrude and/or move from side to side)
If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms:
• aphasia (inability to speak or understand language from involvement of brocas or wernicks area)
• apraxia (altered voluntary movements)
• visual field defect
• memory deficits
• disorganized thinking, confusion
• anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)
If the cerebellum is involved, the patient may have the following:
• trouble walking
• altered movement coordination
• vertigo and or disequilibrium
DIAGNOSIS: Signs and symptoms at the onset of the attack Physical examination
INVESTIGATIONS:
• CT scan of the brain • MRI scan of the brain • CSF examination • Positron emission tomography • Complete blood picture MANAGEMENT: • Avoidance of alcohol • Cessation of the smoking habit • Good nutritious food • Regular physiotherapy exercise • Control of blood pressure • Reduction of weight • Control of blood lipids HOMOEOPATHIC APPROACH CAUSTICUM: • Paralysis from exposure to the cold of winter
• Face is usually affected
• The paralysis remaining after the patient has recovered other wise
• Aphonia
• Weakness of sphincter vesicae
• Ptosis of rheumatic origin
BARYTA CARBONICA:
• Paralysis produced by degeneration of coats of blood vessels
• Paralysis after apoplexy
• Want of stediness
• Facial paralysis where tongue is implicated
• Suited to the paralysis of old people ACONITUM NAPELLUS • For the acute cases of paralysis
• Numbness and tingling of the affected parts
• Facial paralysis accompanied with coldness from exposure to dry cold winds
• Paraplegia with tingling GELSEMIUM: • Complete motor paralysis
• Paralysis of the ocular muscles, ptosis
• Speech is thick from the paretic conditions of the tongue
• Paralysis from the emotions
• Aphonia, paralysis of the larynx
Dr Guptha, Director for the medical coding services and medical coding training
|
