Stroke: Pathophysiology and Treatment

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Table of Contents

Introduction
The Known Pathophysiology of Stroke
Management of Stroke
The Current Pharmacological Treatments for the Prevention of Stroke
Future Strategies to Prevent and Manage Stroke
Conclusion
References

Introduction

Across the globe, stroke has remained one of the disorders causing a significant number of disabilities and mortality. Even though most countries have created awareness among the public, its prevalence is yet to be reduced accordingly. Based on the research study, over 100,000 people in the UK suffer from stroke every year [1]. According to the above number, it is evident that despite the improvement in the level of technology in the healthcare sector, it is still a challenge for individuals to manage the condition. Several medical approaches are in place to assist in the treatment of the disorder. In most cases, the management processes are influenced by the type of stroke and the health status of the patient. Generally, major signs and symptoms of stroke include difficulty in coordinating legs and legs, improper speech, confusion, and even dizziness. In order to lower cases of disability and death rates associated with the prevalence of the condition, it is necessary to have the proper insight into the pathophysiology of stroke, possible management practices, and effective pharmacological treatments.

The Known Pathophysiology of Stroke

Generally, a stroke is a health condition caused by over-sudden disruption of blood flow to the human brain. In most cases, factors including bleeding or blockage of the blood vessels and clotting result in a stroke. When such incidents occur, the patient most likely experiences issues such as the inability to balance the body effectively and other vital signs, as mentioned earlier. There are two different types of strokes, namely, ischemic stroke and hemorrhagic stroke.

In the event of a stroke, there are various physical and chemical processes that take place within the patient’s body. Therefore, the pathophysiology of stroke can be deemed as more complicated. The processes involved are mainly determined by the respective type of stroke the individual is suffering from. Based on the research findings by Kuriakose and Xiao [2], whenever the passage of blood within the vessels to reach the brain is hindered, the quantity of blood to the organ diminishes, leading to stroke. In other words, the disruption limits the supply of adequate oxygen needed in the brain, causing the death of cells in the organ. An ischemic stroke is caused by the deprivation of oxygen to the brain, which makes the organ stop undertaking its normal functions on some of its parts. Unlike the ischemic condition, hemorrhagic stroke occurs following bleeding of the blood vessels.

In the case of hemorrhagic stroke, the brain tissue experiences a high level of stress, making the blood vessels to burst. When the rapture takes place, the vascular system encounters significant toxic effects that lead to the death of the tissue since there is a limited flow of blood to it. The hemorrhagic condition is grouped into two classes namely, intracerebral hemorrhage and subarachnoid hemorrhage. The intracerebral condition is caused by factors such as frequent use of anticoagulants, hypertension, and thrombolytic agents [3]. The elements have the ability to insert pressure on the blood vessel, making it to burst and causing blood to accumulate in the brain. On the other hand, the subarachnoid occurs when there is bleeding between the organ and the tissues covering it which might be a result of head injuries.

Ischemic occlusion on the other hand is caused by factors such as the narrowing of the blood passage. When the blood vessels are thick, a significant amount of pressure is developed, leading to the formation of clots within the vessels and thrombotic stroke [4]. Similarly, a narrow blood vessel reduces the capacity of blood to reach the brain. Therefore, the organ receives inadequate blood, causing necrosis. After the cells have died, the plasma and other organelles are disrupted and various cellular contents are released to the brain dysfunction of neurons thus causing an embolic stroke.

Management of Stroke

Scientists and medical professionals have conducted a number of research studies to identify medical practices that can be applied to manage stroke effectively. Based on the findings, there is no explicit approach that can be used to treat stroke conditions leaving the disorder to remain a significant challenge for people. In order to ensure the disorder is managed accordingly, physicians have adopted various practices, including surgery, emergency medical treatment, and rehabilitation to reduce the impact as well as the prevalence of the condition.

In the case of an ischemic condition, clot-bursting medications, including reteplase and tenecteplase, can be prescribed to assist in managing the disorder. When the drugs are taken, they dismantle the possible clots within the blood vessels, hence facilitating the smooth flow of blood to the human brain. In the event of a stroke, it is advisable that upon determining the type of condition, the medication is administered immediately to enhance its effectiveness. Even though in some cases, thrombolytics may fail to reduce the effect of stroke in the body, other measures such as undertaking mechanical thrombectomy, are applied as an alternative to ensure the patient regains their normal body functions. The procedure entails the removal of the clot from the vessel to enable a sufficient supply of blood and oxygen to the affected parts of the brain.

When an individual is suffering from acute hemorrhagic stroke, the need to perform surgery is prioritized as a measure to reduce excessive bleeding. Generally, the pressure in the brain is built following the narrowing of the blood vessels or the presence of a blockage. Medical surgery is performed to remove the available blockage and allow the smooth passage of blood to the brain to reduce stress. Similarly, the hemorrhagic condition is linked to excess bleeding; therefore, it might require the doctor to undertake surgical procedures to repair blood vessels that rupture following intensive pressure.

Apart from the medical management approaches, another useful stroke management approach is rehabilitation. The procedure usually comes after the patient has undergone emergency treatment, including surgery. Generally, the reintegration process entails a number of practices such as speech therapy, physical exercise, and other effective techniques that can easily influence stroke patients’ ability to regain their neural functions quickly [5]. The approach is vital especially when the victim suffers from disabilities that need frequent practice to better functionality. Rehabilitation procedure is essential as it allows the patient to develop the ability to be independent and be able to perform basic tasks. For the recuperation processes to be fruitful and effective, it is necessary to involve the family members in the recovery process to ensure the patient obtains the needed physical, emotional, and psychological support.

The Current Pharmacological Treatments for the Prevention of Stroke

Physicians use a number of pharmacological treatments to enable stroke patients to regain their normal neuron functions. Before issuing the medications, the professionals first consider risk factors contributing to the stroke. In addition, doctors take into consideration the health status of the victim in order to avoid cases of drug reactions that can cause harmful effects to the patient. Since stroke is directly linked to blood pressure, physicians give drugs that lower the individual’s blood pressure. The approach is aimed at reducing the aspect of hypertension that can easily cause the condition [6]. When the blood flows at a higher speed in the blood vessels, the tissues can easily rupture, causing severe bleeding in the brain. Therefore, to avoid such circumstances, medications, including the Angiotensin-Converting Enzyme (ACE) and beta blockers are essential in controlling and reducing the pressure, thus preventing possible vessel bursts [7]. By taking the ACE medicine, the blood vessels remain wide enough to facilitate the effective passage of blood, leading to minimal pressure.

When the patient is suffering from an ischemic stroke, medications such as antiplatelets and anticoagulants are most preferred for the treatment process. In most cases, when the victim cannot undergo through thrombolytic therapy, antiplatelets such as cilostazol and aspirin are used as the remedy. If a patient takes the antiplatelet drug, the medication reduces the clotting of the tiny cells within the blood making the blood pass freely to the human brain. The usage of antiplatelets has proven effective; however, sometimes, when used more than once they are more likely to cause excessive bleeding in the brain. In addition, when a clot is already formed, the antiplatelet cannot dissolve it, hence calling for a different approach to remove the blockage.

Similarly, anticoagulants such as Heparin have proven effective in making the individual’s blood thinner thus facilitating proper blood passage through the blood vessels. The drug reduces the cases of disrupted blood flow to the brain because of its ability to prevent clotting. Even though the usage of anticoagulants is common, physicians usually use them to prevent excessive bleeding, especially when dealing with acute ischemic stroke conditions.

In addition, diabetes is a common risk factor for stroke and its control is vital for lowering the stroke hazard. Currently, physicians prescribe medications such as metformin and thiazolidinediones to enable individuals to reduce their overall blood sugar levels. When the content of glucose in the body is low, chances of experiencing blood pressure are limited thus making a person be free from a possible stroke.

Moreover, on the basis of risk factors, doctors have adopted the tendency to prescribe statin drugs to individuals who have high cholesterol in their bodies. Statins are effective in prohibiting the production of enzymes that produce cholesterol [8]. When enzyme production is reduced, the body does not manufacture more lipids and fats. Some examples of statin medicines include simvastatin, rosuvastatin, fluvastatin, and pitavastatin. If an individual takes the mentioned drugs, they lower the level of cholesterol in their body, hence minimizing the chances of experiencing a stroke. Despite its effectiveness, statin medications are associated with a number of side effects, including muscle pain.

Future Strategies to Prevent and Manage Stroke

Considering the prevalence of stroke and the death rates and disabilities it causes people, it is important for both the government and the public to formulate effective strategies to prevent and manage the condition accordingly. Some of the approaches should include increasing access to healthcare facilities specialized in stroke management practices [9]. In order to achieve this goal, the UK government and other responsible agencies should ensure there are adequate numbers of well-trained medics with the ability to handle different types of stroke conditions. The approach will make it easier for the patients to obtain the necessary services in time, thus preventing possible deaths and disabilities. In addition, it is important to create awareness of the disorder. The government, through social workers, should conduct campaigns geared towards teaching people about the categories of strokes, their causes, and preventive measures [10]. When such approaches are undertaken, it will be easier to manage and control the impacts of stroke in the country.

Conclusion

In the UK, stroke is a major concern and it threatens the majority of people, especially individuals having underlying risk factors. Even though there is significant progress in the healthcare system, stroke treatments are still a challenge. The condition is caused by the improper passage of blood to the brain. When the brain receives less oxygen, the cells die, leading to ischemic stroke. Similarly, in case of bleeding in the brain due to rapture of the blood vessels, hemorrhagic stroke occurs. In order to manage stroke conditions, there are different approaches used by physicians. For instance, patients may be subjected to emergency medical attention or even taken to surgical procedures. Currently, there are several pharmacological treatments that assist in managing stroke. They include the use of anticoagulants and antiplatelets to reduce pressure and prevent clotting within the blood vessels, respectively. In the future, strategies such as educating the public about the causes and management of stroke will be an effective approach to preventing the prevalence of the disorder in the country.

References

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Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: present status and future perspectives. International journal of molecular sciences. 2020;21(20):7609.

Sarvari S, Moakedi F, Hone E, Simpkins JW, Ren X. Mechanisms in blood-brain barrier opening and metabolism-challenged cerebrovascular ischemia with emphasis on ischemic stroke. Metabolic brain disease. 2020;35(6):851-68.

Kaiser EE, West FD. Large animal ischemic stroke models: replicating human stroke pathophysiology. Neural Regeneration Research. 2020 Aug;15(8):1377.

Uwishema O, Berjaoui C, Correia IF, Anis H, Karabulut E, Essayli D, Mhanna M, Oluyemisi A. Current management of acute ischemic stroke in Africa: a review of the literature. European journal of neurology. 2022;29(11):3460-5.

Nasi LA, Martins SC, Gus M, Weiss G, de Almeida AG, Brondani R, Rebello LC, DalPizzol A, Fuchs FD, Valença MJ, Wirth LF. Early manipulation of arterial blood pressure in acute ischemic stroke (MAPAS): results of a randomized controlled trial. Neurocritical care. 2019 Apr;30(2):372-9.

Atzema CL, Jackevicius CA, Chong A, Dorian P, Ivers NM, Parkash R, Austin PC. Prescribing of oral anticoagulants in the emergency department and subsequent long-term use by older adults with atrial fibrillation. CMAJ. 2019;191(49):E1345-54.

Strandberg TE. Role of statin therapy in primary prevention of cardiovascular disease in elderly patients. Current Atherosclerosis Reports. 2019;21(8):1-7.

Owolabi MO, Thrift AG, Mahal A, Ishida M, Martins S, Johnson WD, Pandian J, Abd-Allah F, Yaria J, Phan HT, Roth G. Primary stroke prevention worldwide: translating evidence into action. The Lancet Public Health. 2022;7(1):e74-85.

Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(4):411-7.

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