Stroke Cause Management Prevention and Treatment

what is stroke 

Stroke

A stroke is defined as a sudden onset of non-traumatic
focal neurological defect of a vascular aetiology, that either
causes death or lasts more than 24 hours

or

a stroke or a (cva)occurs when blood supply to part of the brain is disrupted,causing brain cell to die
types there are two types of the stroke
the most common are called ischemic and 2nd is hemorrhagic stroke
Incidence
Third commonest cause of death in Western World (1–2
per 1000 per year).

effect of  Age 

Uncommon under 40 years.

Aetiology

20% of strokes are haemorrhagic and 80% are ischaemic,
of which two-thirds arise from extracranial lesions and
one-third arise from intracranial lesions. Strokes may
also be due to subarachnoid haemorrhage. Risk factors
for stroke can be divided into
Intra- or extra-cranial atherosclerosis: In particular
hypertension, smoking, hyperlipidaemia, family history
of stroke or ischaemic heart disease and diabetes
mellitus.
Heart disease: Valvular heart disease such as mitral
stenosis, infective endocarditis, and any condition
which predisposes to mural thrombus such as atrial
fibrillation or myocardial infarction.
Less common causes: Hyperviscosity or prothrombotic
states, e.g.polycythaemia, oral contraceptive pill;
vasculitis; clotting disorders

Pathophysiology

Haemorrhagic strokes are discussed elsewhere. Ischaemic
strokes are due to the interruption of arterial blood
supply, and the clinical picture depends on the size of
artery and hence extent of territory affected, the area
affected, and whether there is temporary or permanent
ischaemia and hence infarction

Clinical features

Anterior circulation (carotid territory) strokes are the
most common, in particular those involving a branch of
the middle cerebral artery. This causes infarction of the
motor pathways (at the level of the motor cortex or the
internal capsule) and usually results in a contralateral
hemiparesis. This is an upper motor neurone (UMN)
deficit, i.e. increased tone, reduced power and brisk tendon
reflexes, although acutely there may be a flaccid,
areflexic paralysis. The arm tends to be affected more
than the leg (the motor cortex for the leg is supplied by
the anterior cerebral artery).
Other features of an MCA territory infarct include
an ipsilateral UMN lesion of the face (weakness of
the lower facial muscles), hemianopic visual field
loss and if the dominant hemisphere is affected
dysphasia may occur due to infarction of areas governing
speech (Wernicke’s and Broca’s areas).
Posterior circulation (the vertebral, basilar arteries and
their branches) strokes affect the brainstem, cerebellum
and occipital lobes. One characteristic but uncommon
pattern is lateral medullary syndrome which can
be caused by thromboembolism of the posterior inferior
cerebellar artery (PICA) or the vertebral artery. It causes
sudden vertigo and vomiting. On examination there is
ipsilateral ataxia (loss of co-ordination), contralateral
loss of pain and temperature sensation and there may
be nystagmus, diplopia and an ipsilateral Horner’s syndrome

Macroscopy

In the first 24 hours, there is little macroscopic change.
The tissue may look paler and lose differentiation between
white and grey matter.
The normal pattern of tissue change within the
brain following a stroke is liquifactive necrosis. Structural
breakdown takes place, the infarcted tissue becomes
soft and is at risk of reperfusion haemorrhage

Management

Patients who present within 3 hours of onset of symptoms
who have no evidence of haemorrhage or large
infarct on CT head scan should be considered for
thrombolysis.
Acutely, treat any exacerbating factors such as hypotension,
hypoglycaemia, hyperglycaemia, or severe
hypertension (with caution, to prevent sudden loss
of perfusion pressure, particularly in the acute stages,
when the brain is unable to autoregulate BP well).
Prevent and treat any complications such as deep vein
thrombosis due to immobility, aspiration pneumonia
due to disordered swallow, pressure sores and limb
contractures.
Inpatient or outpatient rehabilitation is used to regain
maximal functional improvement, and so reduce
the impact on the patient’s life, including physiotherapy,
speech therapy, and occupational therapy. Patients
who are admitted to a dedicated stroke unit have
been shown to have improved functional outcomeand
reduced mortality.

Prevention of recurrence

Any risk factors present
should be treated. All patients with ischaemic (not
haemorrhagic) stroke should ideally be on an antiplatelet
agent such as aspirin. Cholesterol-lowering
agents (statins) and anti-hypertensive agents have also
been shown to reduce recurrence. Anti-coagulants are
indicated in certain conditions such as atrial fibrillation
and valvular heart disease, but only after approximately
2weeks andwhen blood pressure is controlled,
to reduce the risk of haemorrhage into infarcted
tissue

Prognosis

Overall, 40% of patients die as the result of their stroke
(mainly in the first month), 40% are left significantly
disabled and 30% have reasonable recovery

treatment 

A stroke is medical emergency .immediate treatment can save lives and reduce disability,
so it is very important for people who are having stroke symptoms to get hospital as a quickly
as  possible
treatment depend upon type of stroke .in hospital a ct scan or MRI must be done to see
whether the stoke is from a clot or from bleeding .clot-busting drugs such is
(thrombolytic therapy)
and blood thinner such as heparin are prescribed for treatment

psychoactive drug uses effect Addiction and treatment

what are  psychoactive drug

A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that changes brain function and results in alterations in perception, mood, or consciousness.These substances may be used recreationally, to purposefully alter one's consciousness, or, as entheogens, for ritual, spiritual, or shamanic purposes, as a tool for studying or augmenting the mind. Some categories of psychoactive drugs, which have medical therapeutic value, are prescribed by medical doctors and other healthcare professionals. Examples include anesthetics, analgesics, hormonal preparations, anticonvulsant and antiparkinsonian drugs or drugs used for the treatment of neuropsychiatric  disorders, as hypnotic drugs, anxiolytic and some stimulant medications used in ADHD and some sleep disorders. There are also some psychoactive substances used in the detoxification and rehabilitation programs for psychoactive drug users.

main  psychoactive drug 

cocaine
crack cocaine
methylphenidate (Ritalin)
ephedrine
MDMA (Ecstasy)
mescaline (cactus)
LSD blotter
psilocybin mushroom (Psilocybe cubensis)
Salvia divinorum
diphenhydramine (Benadryl)
Amanita muscaria mushroom
Tylenol 3 (contains codeine)
codeine with muscle relaxant
pipe tobacco
bupropion (Zyban)
cannabis
hashish

Psychoactive substances often bring about subjective (although these may be objectively observed) changes in consciousness and mood that the user may find rewarding and pleasant (e.g. euphoria or a sense of relaxation) or advantageous (e.g. increased alertness) and are thus reinforcing. Substances which are both rewarding and positively reinforcing have the potential to induce a state of addiction – compulsive drug use despite negative consequences – when used consistently in excess.

Purposes

Psychoactive substances are used by humans for a number of different purposes to achieve a specific end. These uses vary widely between cultures. Some substances may have controlled or illegal uses while others may have shamanic purposes, and still others are used medicinally

Psychoactive drugs are divided into different groups according to their pharmacological effects. Commonly used psychoactive drugs and groups:

Anxiolytics

Example: Benzodiazepine

Euphoriants

Example: MDMA (Ecstasy), MDA, 6-APB, Indopan

Stimulants ("uppers"). This category comprises substances that wake one up, stimulate the mind, and may even cause euphoria, but do not affect perception.

Examples: amphetamine, caffeine, cocaine, nicotine

Depressants

 ("downers"), including sedatives, hypnotics, and narcotics. This category includes all of the calmative, sleep-inducing, anxiety-reducing, anesthetizing substances, which sometimes induce perceptual changes, such as dream images, and also often evoke feelings of euphoria.

Examples: ethanol (alcoholic beverages), opioids, barbiturates, benzodiazepines.

Hallucinogens, including psychedelics, dissociatives and deliriants. This category encompasses all those substances that produce distinct alterations in perception, sensation of space and time, and emotional states

Examples: psilocybin, LSD, Salvia divinorum and nitrous oxide.

uses of psychoactive drug 

Anesthesia

General anesthetics are a class of psychoactive drug used on people to block physical pain and other sensations. Most anesthetics induce unconsciousness, allowing the person to undergo medical procedures like surgery without the feelings of physical pain or emotional trauma.

To induce unconsciousness, anesthetics affect the GABA and NMDA systems. For example, halothane is a GABA agonist.and ketamine is an NMDA receptor antagonist

Pain management

Psychoactive drugs are often prescribed to manage pain. The subjective experience of pain is primarily regulated by endogenous opioid peptides. Thus, pain can often be managed using psychoactives that operate on this neurotransmitter system, also known as opioid receptor agonists

Mental disorders

Psychiatric medications are psychoactive drugs prescribed for the management of mental and emotional disorders, or to aid in overcoming challenging behavior.There are six major classes of psychotropic medications

Antidepressants 

treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.

Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.

Antipsychotics, which are used to treat psychotic symptoms, such as those associated with schizophrenia or severe mania.

Mood stabilizers, 

which are used to treat bipolar disorder and schizoaffective disorder.

Anxiolytics, which are used to treat anxiety disorders.

Depressants, which are used as hypnotics, sedatives, and anesthetics, depending upon dosage.

In addition, several psychoactive substances are currently employed to treat various addictions. These include acamprosate or naltrexone in the treatment of alcoholism, or methadone or buprenorphine maintenance therapy in the case of opioid addiction

Effects on human  

Psychoactive drugs operate by temporarily affecting a person's neurochemistry, which in turn causes changes in a person's mood, cognition, perception and behavior. There are many ways in which psychoactive drugs can affect the brain. Each drug has a specific action on one or more neurotransmitter or neuro receptor in the brain.

Drugs that increase activity in particular neurotransmitter systems are called agonists. They act by increasing the synthesis of one or more neurotransmitters, by reducing its reuptake from the synapses, or by mimicking the action by binding directly to the postsynaptic receptor. Drugs that reduce neurotransmitter activity are called antagonists, and operate by interfering with synthesis or blocking postsynaptic receptors so that neurotransmitters cannot bind to them

Addiction and dependence

Psychoactive drugs are often associated with addiction or drug dependence. Dependence can be divided into two types: psychological dependence, by which a user experiences negative psychological or emotional withdrawal symptoms (e.g., depression) and physical dependence, by which a user must use a drug to avoid physically uncomfortable or even medically harmful physical withdrawal symptoms.Drugs that are both rewarding and reinforcing are addictive; these properties of a drug are mediated through activation of the mesolimbic dopamine pathway, particularly the nucleus accumbens. Not all addictive drugs are associated with physical dependence, e.g., amphetamine, and not all drugs that produce physical dependence are addictive drugs, e.g., caffeine.

hypertension Symptoms causes and Treatment

hypertension treatment

Hypertension: Symptoms and Treatment
High blood pressure is a serious disease that can, over time, damage the blood vessel
walls and increase a person's risk of heart attack, stroke and other conditions
Blood pressure is the force of your blood against the blood vessel walls. Having high
blood pressure means that this force is higher than it should be, and could lead to health
problems.

There are two types of blood

pressure measurements:Systolic blood pressure, which is a measure of the force of
the blood when the heart beats, and
diastolic blood
pressure, or the force of the blood between heart beats. A person is considered to have
high blood pressure when their systolic pressure is 140 mmHg or higher most of the time, or
when their diastolic pressure is 90 mmHg or higher most of the time, according to the
National Institutes of Health About one-third of U.S. adults or 70 million people, have high
blood pressure, and only about half have it under control according to a 2013 report
from the Centers for Disease
Control and Prevention.
Adopting healthy lifestyle behaviors can help prevent high blood pressure, also known as hypertension,experts say High blood pressure is really a disease of the Western world
and if we can do our best to work on diet and exercise and stress relief, we could take a huge amount of this burden down

Causes

Most of the time, doctors cannot find a specific cause of hypertension, and this is known as essential hypertension. Certain factors increase the risk of developing
hypertension, including being obese, drinking too much alcohol, eating a lot of salt,smoking and having diabetes Aging also increases the risk of hypertension because blood vessels become stiffer with age, the NIH says. About 65percent of U.S. adults ages 60 and older have high blood
pressure, according to the National Heart, Lung and Blood Institute (NHLBI).Being under stress can also increase your blood pressure temporarily, but stress is not a proven risk factor for
hypertension. Still, some studies have linked mental stress and depression with risk of high blood pressure. A 2003 study published in the Journal Of the American Medical Association found that people who felt pressed for time or were inpatient had higher odds of developing high blood
pressure over a 15-year period, than people who did not feel such time pressure.

Symptoms

People with high blood pressure usually have no symptoms, and so patients can have the condition for years without knowing it
according to NHLBI.
"We call it the 'silent killer,'"
because patients are often
asymptotic, Freeman said. In
rare cases, some people with
high blood pressure
experience headaches.
Although many patients may
not have symptoms at first,
over time, high blood pressure
can lead to "wear and tear" on
the body, Freeman said. For
example, high blood pressure
can stretch and damage blood
vessels, which in turn, can
increase the risk of health
problems, according to the
American Heart Association.
Stretched blood vessels can
have weak spots that are more
likely to rupture, leading to a
hemorrhagic strokes or
aneurysms, AHA says.
Stretching of the blood vessels
can also cause tears and
scars that create places for
cholesterol or blood to build
up.

Diagnosis

High blood pressure is
diagnosed from a blood
pressure test. Typically,
doctors place a blood pressure
cuff on the arm, which has a
gauge that measures pressure
in the blood vessels. Patients
should avoid drinking coffee or
smoking cigarettes for 30
minutes before the test,
because such behaviors can
increase blood pressure
temporarily, the NHLBI says.
Because a person's blood
pressure can vary depending
on a number of factors,
including the time of day, a
doctor will usually check blood
pressure several times and
different appointments before
diagnosing someone with high
blood pressure.
Freeman said that he will often
have patients use a device
called an ambulatory blood
pressure monitor, which
patients wear at home, and
which takes a blood pressure
reading about every 30
minutes. This device can show
whether a person really does
have hypertension, and how
well they are responding to
treatment, he said. If a patient
doesn't want to use an
ambulatory blood pressure
monitor, they can also use a
home blood pressure monitor
to manually check their blood
pressure. "You get a lot better
idea of what's going on," if you
track blood pressure with one
of these devices, Freeman
said.
Doctors may measure blood
pressure in both arms to see if
there is a difference in
readings, the Mayo Clinic
Doctors may also recommend
other tests to look for
indicators of heart disease,
such as high cholesterol,

Treatment & medication

The goal of treatment is for patients to keep their blood pressure in the normal range
below 140/90 mmHg. For Patients who have diabetes or chronic kidney disease,
doctors recommend that they keep their blood pressure under 130/80 mmHg
Lifestyle changes — including
changes in diet and physical
activity — and medications are
recommended for treating high
blood pressure.
People with pre-hypertension
— that is, those with blood
pressure readings higher than
120/80, but lower than 140/90
— are usually treated with
lifestyle changes alone,
according to the National
Institutes of Health.
But many people with true
hypertension will need take
medications, as well as make
lifestyle changes
Lifestyle changes that can help lower blood pressure include eating a healthy diet — such
as a diet that cuts down on salt, and boosts fruit and vegetable intake — increasing
physical activity, reducing weight (if the patient is overweight or obese), and quitting smoking
In addition, stress relief practices, such as meditation or other relaxation techniques,
can also be helpful in lowering blood pressure, especially when combined with other
lifestyle changes
medications include:
Diuretics: These medications remove some salt from the body, which reduces fluid in
the blood vessels and causes blood pressure to go down.Beta-blockers Allow the
heart to beat slower with less force, which results in lower.
blood pressure Angiotensin converting enzyme inhibitors (also called ACE inhibitors):
Blocks the formation of a hormone that narrows blood vessels, allowing blood
vessels to open up Angiotensin II receptor blockers (ARBs):These medications are newer,
but work in a way similar to ACE inhibitors to widen blood vessels Calcium channel
blockers: Stop calcium from entering muscle cells in the heart and blood vessels, which
relaxes the blood vessels Side effects from blood pressure medication tend to be
minor, and can include cough diarrhea, dizziness, feeling tired, headaches, and
unintentional weight loss and skin rash

sorry to say that but we can't explain it briefly due to some problems
note the the above post is just for education only not for treatment