A Simple Guide to Stroke

A Simple Guide to Stroke
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What is a Stroke?
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A stroke is also known as a cerebrovascular accident(CVA).
It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.
The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.

What Causes Stroke?
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A stroke occurs when:

1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the brain cells.
As a result the brain cells died leading to loss of function of the part of the body controlled by the brain cells.

2.there is a rupture of an artery in the brain leading to internal bleeding and damage to the brain cells.
This can be caused by high blood pressure, head injury or a weak artery wall from birth(aneurym).

3.there is compression by a brain tumour or tightening of the artery wall.

What are the risk factors in Stroke:
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1.High Blood pressure-
Hypertension damages the arteries of the brain by causing bleeding or blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.

4.Heart disease
People with heart disease are more likely to have poor blood flow to the brain.
Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain

5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.

7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

8.Cerebral aneurysm, tumour,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain

9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain

10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a temporary Stroke or Transient ischaemic attack(TIA)?
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It is a early warning sign of a stroke .
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.

It may last seconds to up to 24 hours.

The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face

2.temporary difficulty in speaking or slurring of speech

3.sudden difficulty in seeing or 'blackout' in one eye

4.temporary dizziness or fainting or loss of balance

5.Temporary confusion, poor coordination or understanding

6.unexplained headaches or a change in the usual headache pattern

Early treatment of a TIA can help prevent a stroke from occurring in the future.

What are the symptoms and signs of a Stroke?
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The affected person may have:

1.sudden numbness or weakness, usually on one side of the body,often with loss of feeling

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.loss of concentration and memory

5.sudden difficulty walking

6.loss of control of passing urine or passing motion

7.behaviour changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.

8.sudden severe giddiness, loss of balance and coordination

9.sudden severe headache with no known cause

10.sudden vision loss in one eye

Treatment and caring for stroke patient will be in the Simple Guide to Stroke 2.

A Simple Guide to Glaucoma

A Simple Guide to Glaucoma
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What is Glaucoma?
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Glaucoma is a condition in which there is an increase in the pressure in the eye.

Because of the increase of this intraocular pressure, the nerve that connects the eye to the brain(the optic nerve) may be damaged.

This can result in decreased peripheral vision and, eventually, blindness.

Who is affected by Glaucoma?
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The following are at risk from Glaucoma:
1. age above 65 yrs
2. family history of glaucoma
3.history of serious eye injury or eye surgery
4.very short sighted
5. long term usage of steroid-containing eye drops
6. Diabetes

What is the cause of Glaucoma?
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The pressure in the eye (Intraocular pressure) is increased when there is poor drainage of the fluid that flows in and out of the anterior chamber of the eye.

The higher pressure can then cause damage to the nerve.

What are symptoms of Glaucoma?
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There are two major types of glaucoma:

1.Chronic Glaucoma( or Primary open angle Glaucoma )is sometimes referred to as a "silent thief of eyesight".

This is because it progress slowly and does not produce any symptom until it is very advanced. By that time irreversible damage of the optic nerve may have occured causing blurring of vision.

2.A less common form of Glaucoma known as acute closed angled Glaucoma causes sudden symptoms of intense eye pain, headaches, haloes around lights, dilated pupils, vision loss, red eyes, nausea and vomiting.

These signs may last for a few hours, then return again for another round. Each attack takes with it part of your field of vision. This requires emergency treatment.

Other variations include
3.congenital glaucoma:
It's difficult to spot signs for congenital glaucoma because the children are too young to understand. If you notice a cloudy, white, hazy, enlarged or protruding eye, consult your eye doctor
4. pigmentary glaucoma:
Pigmentary glaucoma often exhibits no symptoms at all. You may notice some pain and blurry vision after exercise. Pigmentary glaucoma affects mostly males in their mid-30s to mid-40s.
5.secondary glaucoma:
Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma.

How is Glaucoma diagnosed?
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Glaucoma is diagnosed using specialised instruments.
These may show:
Raised intraocular pressure(in most cases)
Your eye pressure (intraocular pressure) will be measured with a tonometer. Some tonometers blow a puff of air onto your eye's surface.

damaged optic nerve

abnormal visual fields

How does Intraocular pressure occur in Glaucoma?
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An increased IOP reading indicates a problem with the amount of aqueous humor (fluid) in the eye:
either the eye is producing too much fluid, or
it's not draining properly.

The drainage area is the angle formed between the cornea and the iris, which is why you see the word "angle" in the different glaucoma names.

Narrow-angle glaucoma occurs in less than 10% of glaucoma patients. In this form of the disease, aqueous humor cannot drain out of the eye due to very narrow drainage angles that are usually blocked by the iris. This condition can occur slowly and progressively, or very quickly.

Rapid closing of the angles, or acute angle-closure glaucoma, is a medical emergency. Optic nerve damage and vision loss will occur within hours if the angles are not opened to drain fluid and lower IOP.

Congenital glaucoma is a rare form of the disease affecting babies.
These children are born with narrow angles or some other defect in the drainage system of the eye.

Pigmentary glaucoma is caused by pigment from the iris clogging the draining angles, preventing aqueous humor from leaving the eye.

Secondary glaucoma develops after trauma to the eye that affects the drainage system. Injury, infection, inflammation, tumor or an enlarged cataract can precipitate secondary glaucoma.

What is the aim of treatment for Glaucoma?
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Glaucoma is a lifelong disease.

Any damage to the optic that is discovered at diagnosis is irreversible.

The aim of treatment is thus to prevent further damage and vision loss.

This is done by lowering the intraocular pressure to a safe level.

How is Glaucoma treated?
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1. pressure lowering eye drops

You may be prescribed eye drops to lower the intraocular pressure.
Examples are prostaglandin eye drops, which will allow better flow of fluid within the eye or beta blocker eye drops which reduces the pressure in the eye.
These has to be applied diligently in order to work well.

The majority of glaucoma patients can be well controlled with one or more of these eye drops

2. laser treatment

You may need laser treatment to help lower the pressure or to manage acute angle closure Glaucoma.

3. surgery

Surgery is used only:
when eye drops and/or laser treatment fails
if you develop side effects with the eyedrops
if you need other eye surgery(eg cataract)

How is Glaucoma monitored?

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You should go for regular follow up with your doctor.
He will check whether treatment is effective by:

measuring your intraocular pressure

examining the optic nerve for further damage

analysing your visual fields.

With proper monitoring and treatment most patients will be less
at risk of blindness.


Added 4th October 2008
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Glaucoma
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The best painkiller for glaucoma pain is Tegretol which relieve the pain in the nerves.

Acupuncture has been used to reduce the pressure in the eye as an alternative method of treatment.