Carina Tong
Christina Thomas
Nicole Serrano
Anoushka Pandit
Jibraan Saeed
Eva Tamayo
Lei Helton
Avishai D’Souza
Neel R
Julian Niuafe
William Chen
Erin Suh
Introduction
A stroke occurs when the brain is not supplied with enough oxygen, which prevents brain cells from functioning properly. Symptoms tend to be spontaneous, including sudden numbness or weakness in the body, particularly with a specific limb or specific side of the body. Trouble with sight, speech, and sound are the most common symptoms of a stroke. Those who undergo strokes also tend to visually display dizziness and trouble maintaining balance and walking straight, feel very severe headaches, and exhibit mental confusion. Other symptoms for strokes include fatigue and exhaustion as well as rapid eye movement, formally known as REM. Stroke symptoms vary from patient to patient and also range according to stroke location, type, and severity (CDC, 2019).
The causes of a stroke vary based on the type of stroke. The general causes include blocked arteries, interruption of blood supply to the brain, trauma, and uncontrolled high blood pressure. For Transmatic Ischemic Attacks, which are a less common type of stroke that have temporary stroke symptoms, the main causes are a temporary decrease in blood flow to the brain and reduced blood flow to the nervous system caused by a clot or debris. Ischemic strokes occur when the brain’s blood vessels become narrowed or blocked, reducing blood flow. These blockages or narrowings are mainly caused by blood clots and fatty deposits in blood vessels (CDC, 2019).
Diagnoses
There are several methods of stroke diagnosis, where doctors often look for blockages in arteries, the source of the stroke. One method is physical examination, which examines blood pressure, the heart, and nervous system. Another form of diagnosis is blood tests, which find the speed of blood clots, blood sugar levels, and whether or not there is infection. There are also several imaging tests: computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, carotid ultrasound, and an echocardiogram. A cerebral angiogram is sometimes used, but is much less common. Through utilizing different methods of diagnosis, doctors can move on to treatment (Mayo Clinic, 2021).
Medical Treatments
The treatments for strokes can be broken up based on the type of stroke: ischemic or hemorrhagic. For ischemic strokes, the usual option for treatment is a tPA (tissue plasminogen activator) injection that works by dissolving a blood clot in the blood vessel. A limitation of this, however, is that it must be given within 4.5 hours of the stroke occurring, in order to restore some cognitive or physical function to the patient. Another option for ischemic strokes are endovascular treatments, which insert the medication directly into the blood vessel, and can also have a looser time constraint compared to an injection.
Stent retrievers are another option when a blood clot is too large, and they work by physically grabbing and extracting a blood clot. Additional options include carotid endarterectomies, which remove plaque from the carotid artery, and angioplasty and stents, which insert a catheter through an artery in the groin and expand the artery with a balloon, supporting it with a stent. For hemorrhagic strokes, drugs can be taken to counteract blood thinners, usually taken to prevent blood clots. In addition, drugs can be taken to reduce intracranial pressure, blood pressure and prevent blood vessel spasms and seizures. Surgery is an option if the bleeding and pressure on the brain is severe and if a doctor prescribes it. A surgical clip can be placed on a blood vessel and are usually placed on a hemorrhaged vessel to stop bleeding. Coiling can be used to block a hemorrhaged blood vessel by inserting a catheter through a vessel in the groin and guiding it to the brain, detaching coils to obstruct the flow of blood (Mayo Clinic, 2021).
Non-drug treatments for strokes include occupational therapy. Stroke survivors often face struggles, such as weakness on one side of the body, a decline in cognitive and emotional functioning, inability to walk or care for themselves, and a decrease in community participation. Occupational therapy is meant to address these struggles, and work towards recovery through interdisciplinary care over a long period of time. This focuses on helping patients achieve health, well-being, and the ability to participate in life again by having them engage in occupations and activities. Occupational therapy is personalized for each individual client, and the therapist collaborates with the family and caregivers of the client to help determine what activities are best suited for the individual based on necessity, fulfillment, and relevance. This encourages and engages stroke survivors and family members into taking charge of their lives, creating human connections, and leading towards healthier lifestyles.
Current Research
Current research has increased the quality and effectiveness of stroke treatment as multiple therapies have been introduced along with medications (Stroke: Hope Through Research. National Institutes of Health., 2021). As of now, less severe strokes can be treated and cared for quickly, ensuring patient survival (Stroke: Hope Through Research. National Institutes of Health., 2021). For ischemic stroke, medications include antiplatelet drugs that can prevent the activity of platelets which help clot the blood and anticoagulants that reduce the clotting property of blood to reduce risks (Stroke: Hope Through Research. National Institutes of Health., 2021). These two types of treatments are known as antithrombotics that prevent the formation of blood clots, which can either get stuck in the brain arteries and cause strokes (Stroke: Hope Through Research. National Institutes of Health., 2021). Medications for hemorrhagic stroke “involve finding the source of the blood leak and controlling it.” Rehabilitation physical therapies are also a major treatment for curing stroke patients (Temple, 2021). Research methodology regarding stroke treatments have improved research quality, timeliness and translational capacity (Temple, 2021). Some new techniques that have been discovered through current research are antithrombotic interventions, restoring blood flow and observing genetic factors, observation of health disparities, environmental, or dietary factors, and neuroprotection and outreach programs (Macrae, 2021). As scientists experiment with further research techniques and technological advancements on how to find cures for different types of strokes, they allow for many advantages to lessen the drastic problems that can harm a person’s life.
However, while there are many advantages of stroke research, there are also some disadvantages. First, most models that are created from experiments use rodents instead of humans (Narayan, S. K. et al., 2021). While rodents are biologically similar to humans, there are key differences. If not acknowledged, it can result in flawed evidence and an unreliable model. Next, most medications tested in clinical trials do not have high efficacy rates and if they do, they have serious side effects that can potentially harm the patient. In addition, current stroke medication research is focused on having a small therapeutic window, since strokes need to be cured as soon as possible. However, researchers need to focus on having an even narrower therapeutic window in order to cure strokes even quicker because it is more practical.
Works Cited
Centers for Disease Control and Prevention. (2019). Stroke Signs and Symptoms. Centers for Disease Control and Prevention, from https://www.cdc.gov/stroke/signs_symptoms.htm.
Macrae I. M. (2011). Preclinical stroke research--advantages and disadvantages of the most common rodent models of focal ischaemia. British journal of pharmacology, 164(4), 1062–1078.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229752/
Macrae, I. (2011). Preclinical stroke research - advantages and disadvantages of the most common rodent models of focal ischaemia. British Journal of Pharmacology, 164(4), 1062–1078. doi:10.1111/j.1476-5381.2011.01398.x.
https://doi.org/10.1111/j.1476-5381.2011.01398.x
Macrae, I. M. (2012, February 9). BPS Publications. British Pharmacological Society | Journals. Retrieved October 9, 2021, from https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2011.01398.x.
Mayo Foundation for Medical Education and Research. (2021, February 9). Stroke. Mayo Clinic. Retrieved October 9, 2021, from https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119.
Mergenthaler, P., & Meisel, A. (2012). Do stroke models model stroke? Disease Models & Mechanisms, 5(6), 718–725. https://doi.org/10.1242/dmm.010033.
Narayan, S. K., Cherian, S. G., Phaniti, P. B., Chidambaram, S. B., Vasanthi, A. H. R., & Arumugam, M. (2021, April 23). Preclinical animal studies in ischemic stroke: Challenges and some solutions. Wiley Online Library. Retrieved October 9, 2021, from https://onlinelibrary.wiley.com/doi/full/10.1002/ame2.12166.
Perna, Roberta, Jessica Temple. (2015, July 12). Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes. Behavioural Neurology, vol. 2015, Article ID 891651, 6 pages, 2015. https://doi.org/10.1155/2015/891651.
Stroke: Hope Through Research. National Institutes of Health. Retrieved October 9, 2021, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Stroke-Hope-Through-Research.
The Role of Occupational Therapy in Stroke Rehabilitation. (2015). American
Occupational Therapy Association. Retrieved October 9, 2021, from
https://www.aota.org/about-occupational-therapy/professionals/rdp/stroke.aspx
