Types of Stroke - Causes, Complications and Lingzhi's Preventive Role

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Our brain single-handedly controls all our body's function and it is what makes us human. Different parts of the brain have different functions:

1) Frontal lobe - thinking and problem-solving.
2) Parietal lobe - sensory and motor function.
3) Hippocampus - memory.
4) Thalamus - relay station for almost all information coming into the brain.
5) Hypothalamus - relay stations for the systems regulating our body's functions.
6) Midbrain - relay specific sensory information from the sense organs to the brain.
7) Pons and medulla oblongata (hind brains) - control breathing and heart functions.
8) Cerebellum - controls movement and cognitive processes that require precise timing.

The brain's functions depend on a constant blood supply to bring the oxygen and nutrients needed by its cells. A stroke happens when there's a restriction or stoppage of this supply, which leads to damage/death of the brain cells.

Strokes are the 3rd most common cause of death in Malaysia. It is estimated that there are about 52,000 strokes per annum.

There are 2 main types of stroke:
1) Ischaemic Stroke - when blood supply to the brain stops because the vessel is blocked by a blood clot. It is the most common type. This may be due to:

(a) Thrombosis - blood clot forms in one of the brain's arteries.
(b) Embolism - blood clot formed elsewhere in the body gets into the brain's arteries.

Blood clots form where the arteries are narrowed, and this is hastened by factors like:

• high blood pressure
• poorly controlled diabetes
• raised blood cholesterol
• smoking
• excessive alcohol intake
• obesity
• family history of diabetes or heart disease.

Transient ischaemic attack (TIA or mini-stroke) - temporary interruption of blood supply to part of the brain.
2) Haemorrhagic Stroke - when a blood vessel of the brain bursts, resulting in bleeding in the brain itself (intracerebral haemorrhage) or brain surface (subarachnoid haemorrhage).

The main causes are:

• High blood pressure - the primary cause. Risk factors include smoking, overweight, lack of exercise, excessive alcohol intake and stress.
• Blood-thinning medicines. 
• Blood vessel malformations in the brain.
• Aneurysm (ballon-like swelling of a blood vessel).
• Trauma.

Risks of Stroke which are Not Preventable:

• Age - the older a person, the higher the risk.
• Ethnicity - Indians and Malays have higher risk as the incidence of diabetes and hypertension are higher in these groups.
• Medical history - higher if one has had a heart attack, stroke or TIA.
• Family history - higher if a close relative has had a stroke.

Signs and Symptoms

• Face - inability to smile, open the mouth, or the face or eye may hang downwards.
• Arms - inability to lift arms due to numbness or weakness.
• Legs - inability to move legs due to numbness or weakness.
• Speech - slurring of speech or inability to talk at all.
• Others - sudden vision loss, dizziness, difficulty talking and understanding what others say, difficulty swallowing, balancing problems, sudden and severe headache, blacking out.

Complications of Stroke

• Dysphagia - swallowing problem, which can cause lung infection (pneumonia).
• Hydrocephalus - excess cerebrospinal fluid (CSF) in the brain's ventricles. CSF is a fluid produced by the brain which is continuously drained away and absorbed by the body. When its drainage is stopped following a haemorrhagic stroke, the excess CSF causes headache, loss of balance, nausea and vomiting.
• Deep vein thrombosis - blood clot formation in the legs. The features include swelling, pain, tenderness, warmth and redness.