Stroke has come to mean a variety of things but in general the term refers to sudden brain damage caused by a hermorrhage of a blood vessel in the brain, a thrombosis or clot formed by hardening of the vessel walls. A clot that gets into the blood stream from other diseased or injured part and blocks a brain artery. The brain area affected stops functioning and cause the symptons related to this loss of function.
Stroke affects not only older people a high percentage of the death and disability it cause hits people between the ages of 30 and 64.
In ancient times, victims of a stroke though to have been struck down by God. Today, an eminent scientist says that the fiction is often only a stroke of a bad luck. If treated successfully during the acute stage, the patient may live a useful life for many year perhaps one term stroke persists because the illness it cause is so dramatic in its abruptness.
Estimates are that more then 1,800 people in India have been crippled by strokes caused by the blood vessels supplying the rain alone strokes take more than 70,000 lives a year. Hardening of the arteries in the brain which is related to stroke is the around leading cause of first admissions to mental hospitals.
The seriousness of brains damage from strokes can be realized by comparing-strokes in the brain with those in other parts of the body. For example if a small clot lodges in the lung, the lung is not severely handicapped because all parts perform the same functions and can if necessary to make up for the injured portion. In the brain, a small closure in an artery relates to such a specialized function or movement of limbs can destroy that particular function. Victims of heart attack often survive because blood vessels quickly appear to send life-giving blood to the injured part. However extensive research has been able to show the recovery capacity of brains, which is our most delicated and our most prized possession.
RESEARCH INTO STROKE
The dimmest view has been taken of brain hemorrhage which because of its abruptness, may cause death in a short time. But experts feel that if a patient can be treated quickly, he may survive and enjoy a long, useful life. In studies made, 80 percent of stroke victims had high blood pressure. Thought often claimed in recent years, no real cure for high blood pressure had been found. However, several new drugs do lower blood pressure and much has been learned about how a calm way of life will lessen both tension and hypertension. Recently it has been shown to be of great value for people with a family record of hypertension and cerebral hemorrhage to take precautionary measures long before their blood pressure climbs to the danger mark.
Among such precaution should be regular medical supervision, diet and weight control, carefully considered activities, and moderation in all phases of living.
The other fairly common cause of massive brain hemorrhage is a ruptured aneurysm or break in the wall of an artery which was not properly formed before birth. In a study or 143 ruptured aneursyms, the ages of the patient ranged from 18 to 89, but almost half were between 40 to 59 years. Only one third diet within the first 48 hours after their strokes.
Since none of the breaks occurred in persons under 10 years of age and their number rises with age, these doctors suspect that it often takes hypertension and arteriosclerosis to batter down the weakened vessel. Otherwise, the accident would have occurred much earlier. With modern x-ray techniques giving knowledge of blood vessels and lymphatic, the aneurysms can now be detected when they first cause trouble, and measures can be taken to prevent their recurrence.
Once a hemorrhage has occurred, it presents a problem similar to that of any foreign body and can sometimes be treated surgically. Since certain heart, lung, and other conditions are known to throw off clots that may lodge in the brain. They can often be anticipated and prepared for.
A thrombosis of closing of cerebral artery by a clot caused by arteriosclerosis comes comparatively over a period of a day or two, in contrast to the instant striking of a hemorrhage.
Little strokes may have occured when people over 38 have mental or nervous symptoms that seem too severe for the slight abdominal discomfort they feel, when nervous symptoms occur suddenly with no background of instability, or when there are changes in character and performance after a fall or dizzy spell. Since these small episodes may start at an early age, they often progressively incapacitate the victim for 20 or 30 years.
The stroke problem is almost overwhelming because of its many facets and its conflict with our modern, urban way of life. Only a beginning had been made in the recognition of types of cerebral disease in treatment, and in application of rehabilitation measures. But with the great strides that have been made with coronary disease- which in some ways is similar-the full weight of scientific effort and knowledge is behind the research against one of mans oldest and most feared afflictions.
An often unsuspected cause of mental and physical incapacity is a series of little stokes. These may start when the person is in the 30 or 40 striking silently at night or passing almost unnoticed as a sudden dizzy spell, a momentary blackout, or just a few moments of confusion. The stroke itself is not severe enough to compel the patients to seek medical aid.
A formaly kind, gentle person may suddenly become highly impatient and irritable with little cause. His judgement is often impatient and a strong man may become weak and be prone to tears. Suspiciousness is common. A person who has had a tendencey toward emotional instablility held in check heretofore by will power, may suddenly develop a psychosis. some become sloppy in dress and be fuddled in thought others lose their moral sense and become involved in sexual indiscretions. Sometimes the victim merely loses interest in his family and friends and friends and lives secretively, constantly hiding thing that through forgetfalness be cannot later find.
When, symptoms are mild as they often are, the person may get along very well, provided he does not live in a city. Surveys show that a sufferer of cerebral vascular disease can get along better in the slower-going farm and small-town areas. Fast living with its dashing cars, hustling activities and tight time schedules, serves only to confuse a tired slowed-up mind and body.
The most popular experimental approach is that of finding ways to prevent strokes. Tentative results show that scientists may be on the right track in recognizing early symptoms and treating them so that disastrous effects can be avoided for many years.
EFFECTS OF BRAIN DAMAGE
When a strokes patient first returns to his home after hospitalization, he may appear to be extremely happy and unconcerned about his condition. It is difficult for both the patient and his family to recognize immediately the numerous deficiencies that have resulted from damages to the nervous system.
Once the patient begins to recognize his own physical, emotional and communication deficiencies, he may begin to show despair. At this point, the family must be careful not to be discouraged. Professional guidance to hasten their understanding of the patients most often result in his refusal to try, accompanied by a complete rejection of the household. The growth of his anxieties drastically interferse with retraining.
It is necessary for the family to carefully regulate conversations with the patient. Abstract ideas may be extremenly difficult to talk about because of the patients reduced ability to express and understand spoken language. A simple vocabulary must be used, along with frequent reference to the topic being discussed. A short memory complicates the patients language abilities.
The patients persistence in frequently repeating the same conversation is involuntary and should not be interpreted as purposeful nagging. He may, for example, be concerned with the fact that fuel for heating the home is extremenly low and repeatedly instruct the household members to order more fuel. Even though he may have heard repeated explanations that fuel had been ordered the day before, it is possible that with in a matter of two or three hours he may again make the same request. Many times such patients eventually come to understand their own memory inadequacies where the family had the patience to accept such behaviour.
It is important to keep in mind that the patient may be disgusted with himself as he begins to recognize his memory failures. Certainly, he condemns himself enough without having his frustrations increased through unkind comments from those about him. When he is repeatedly blamed for his unavoidable forgetfulness, he has no choice but to develop deep and morbid depressions. The family may need professional counseling to assist them to accept unusal behaviour in an unruffled manner, thus providing an opportunity for the patient to improve his insight into his own behaviour.
Disrupting factors in our daily lives bring on feelings of helplessness, hopelessness, and exhaustion even in normal persons. The stroke patients as may be readily understood, freequently develops such feelings. This is apt to occur as he acquires longer memory spans for they may tend to increased his consciousness of his failures in physical and social activies.
Many of our basic attitudes toward our husbands or wives depend upon our ability to express maximum affection toward them. The reestablishment of a stable relationship between a stroke victim and his husband or wife may depend upon their achieving an adequate sexual relationship. A short memory span may handicap the patient in doing this A vast number of patients, both male and female, have described difficulties in concentrating upon even this basic drive. Such failures can create marked emotional problems for both partners.
Unless the normal sex partner has a good understanding of the recovery that is likely to come, it is possible that he will develop a frigid attitude toward such relationships. This reaction can have a severe effect upon the patients total recovery.
Many stroke patients object to visits by friends and relatives. They often withdraw inmediately from the living room upon the arrival of visitors. This reaction may be due to their inability to control emotional outbursts, toilet problems, or conversation. If at all possible, friends and relatives should have careful guidance concerning their conversation. They should especially be warned to avoid negative comments about the patient condition and welfare. often they will begin a conversation with the patient and then find that his responses are unrelated to the topic being discussed. When this occurs, visitors should then direct their conversation toward other family members.
If at all possible, the family should prepare their friends and relatives for contact with the patients. They must advise them to allow the patient time to respond, to avoid topics that may upset him, and to do their utmost to allow the patient to take part in the conversation. The better the visitors understand the situation, the less will they fear the patient. As a result, they will assist in improving the patients social relationships and in building his self confidence. Everyone should treat the patient with as much courtesy and consideration as they would have before his illness.
The well members of the immediate family must be aware of be patient reactions to what he may hear and see regarding himself. The family must keep in mind that the patients needs frequent periods of emotional Ventilation. Such outbursts are often his chief means of gaining emotional relief. If the patients has no one to listen to him, his only alternative may be to withdraw completely from all activities. Doing so will, in the long run, greatly reduce degree of his recovery
THE STROKE VICTIM
In carefully considering all aspects of the disrupted living pattern among stroke victims, it becomes obvious that the entire household can be affected. The time sequence for recovery may be long and laborious for each member of the family group. All of a sudden the patient has an extremely short memory and marked difficulty in understanding and expressing both oral and written languages, combined with a degree of paralysis. when we consider these facts, it seems reasonable to assume that there will be some drastic difficulties in adjustment. when such patients are subjected to a whole series of unreasonable demands, they may have no choice but to voluntarily withdraw from contact with other people.