There are three kinds of veins in our body: Superficial veins: those that lie close to the skin; Deep veins: those that lie in groups of muscles; and Perforating veins: those that connect them. Deep vein thrombosis is a blood clot in one of the deep veins. Usually it occurs in the pelvis, thigh or calf, but it can also occur less commonly in arms, chest, or other locations. Although a stroke is usually not caused by deep vein thrombosis, if someone has had a stroke, he or she may be at a greater risk for developing DVT.
Quite often, there are no symptoms at all. There may be pain or tenderness in the leg, or raised skin temperature around the compromised area. The first sign may be a sudden swelling in one leg. Occasionally, some of the surface veins become more visible through the skin. DVT is most commonly detected nowadays by the use of ultrasound, which has been proven effective even on the smallest of clots. This allows the physician to measure the speed of blood flow and to see the structure of the veins, and sometimes even the clots themselves. Another method using x ray allows the physician to see the anatomy of the veins and sometimes the clots within them.
How dangerous is it? DVT itself is not life threatening, but the clots are sometimes associated with complications which can be fatal. The most common serious complication is a pulmonary embolism if the clots break off and reach the lung, which causes severe breathing difficulties. If untreated, up to one in ten people who suffer a pulmonary embolism will die as a result.
There is even risk of a second stroke. In some rare cases, a part of the clot may also stay in other organs including the brain, where it will lead to a stroke.
But let us not worry too much. Physicians can usually treat DVT with medications or minimal gentle procedures. Rarely, surgery many be required. Physicians may prescribe an anticoagulant drug called heparin, which helps to prevent the blood from clotting easily and keeps clots the patient already has from growing larger. After 5-7 days of injection of heparin, usually patients will be given an anticoagulant pill called Warfarin, for 6 months. During the time patients are receiving medication, blood tests will be performed in order to make sure that the anticoagulation level is suitable to prevent further clots, but not too high as to cause excessive bleeding.
If the physician wants to dissolve the clot, a thrombolysis is recommended, which means a direct injection of clot-dissolving medicine into the clot. Since thrombolysis presents a high risk of stroke, it will only be performed in life-threaten situations.
Can DVT be prevented? Taking drugs as aspirin is one way to cut the risk of developing a clot. Moreover, a number of physical methods might reduce the formation of DVT after stroke: graded compression stockings, pneumatic compression devices and electrical stimulation of leg muscles. In any case, keeping mobile is vital. Please consult your physical therapist in order to develop the most adequate movements to prevent DVT.
Sources:
BCC News
VascularWeb
]]>
Stroke patients may lose the ability to feel touch, pain, temperature, or position. Sensory deficits may also hinder the ability to recognize objects that patients are holding and can even be severe enough to cause loss of recognition of one’s own limb.
Recent studies have provided evidence of the widespread incidence of sensory dysfunction following stroke. The incidence of sensory deficits in stroke is high ranging from 50% to 74%. The importance of these findings lies in the association between sensory loss post-stroke and poorer outcomes in motor capacity, functional abilities, length of inpatient stay, and quality of life.
QST systems are separable into devices that generate specific physical vibratory or thermal stimuli and those that deliver electrical impulses at specific frequencies. The objective is to test the sensory threshold as follows for instance: a thermode (thermal stimuli surface) contacts the skin and the subject is asked to report sensation of temperature change or heat pain. An alternative stimulation modality utilizes electrical stimuli of variable frequency and intensity to determine sensory thresholds. QST could contribute and has the potential to further contribute to research of sensory dysfunction.
Apart from the loss of abilities, there’s another consequence that could not be ignored which seems to be quite on the contrary, however comes from the same origin. Some stroke patients experience pain, numbness or odd sensations of tingling or prickling in paralysed or weakened limbs, a condition known as paresthesia, a neurological skin disease.
Stroke survivors frequently have a variety of chronic pain syndromes resulting from stroke-induced damage to the nervous system (neuropathic pain). Patients who have a seriously weakened or paralysed arm commonly experience moderate to severe pain that radiates outward from the shoulder. Most often, the pain results from a joint becoming immobilized due to lack of movement and the tendons and ligaments around the joint become fixed in one position. This is commonly called a “frozen” joint; “passive” movement at the joint in a paralysed limb is essential to prevent painful “freezing” and to allow easy movement if and when voluntary motor strength returns. In some stroke patients, pathways for sensation in the brain are damaged, causing the transmission of false signals that result in the sensation of pain in a limb or side of the body that has the sensory deficit.
The loss of urinary continence is fairly common immediately after a stroke and often results from a combination of sensory and motor deficits. Stroke survivors may lose the ability to sense the need to urinate or the ability to control muscles of the bladder. Some may lack enough mobility to reach a toilet in time. Loss of bowel control or constipation may also occur. Permanent incontinence after a stroke is uncommon. But even a temporary loss of bowel or bladder control can be emotionally difficult for stroke survivors.
Moreover, sensory disturbance means loss of sight, hearing or the ability to communicate clearly; the results can be the same: a sense of isolation and loss. This section lists organisations working to help people deal with these feelings and find practical ways to carry on with their lives, in spite of their disabilities.
Sources:
Stroke Rehabilitation journal
American Academy of Neurology
A number of studies have shown that TIAs carry a significant short-term risk of stroke, especially in the first few days. A 6-point score, based on age, blood pressure, clinical features and duration (ABCD) was shown to effectively stratify the short-term risk of stroke after a TIA. One can calculate the ABCD score like this:
| Risk Factor | Category | Score | |
| A | Age | Age ≥ 60 Age < 60 |
1 0 |
| B | Blood pressure at assessment | SBP > 140 or DBP ≥ 90 other |
1 0 |
| C | Clinical Features | Unilateral weakness Speech Disturbance (no weakness) other |
2 1 0 |
| D | Duration | ≥ 60 minutes 10-59 minutes < 10 minutes |
2 1 0 |
| Total | 6 |
Don’t wait for the symptoms to go away, because nobody can tell whether it is a stroke or a TIA. The goal of TIAs management is to prevent a future stroke. The treatment used depends on the exact cause of the TIAs. In addition to lifestyle changes such as diet and exercise, doctors may recommend drugs to treat high blood pressure, high cholesterol or heart disease. These changes may reduce the risk of further Stroke.
Sources:
Stroke Journal
Stroke Org Uk
Journal Watch
Apart from the common stroke symptoms like body paralysis or loss of sensation, there are others including decline in “cognitive” mental functions of memory, speech, language, thinking, organization, reasoning or judgment. If these symptoms severely affect the patient’s life, it is called vascular dementia as it is stroke related.
The prevalence rate of dementia is 9 times higher in patients who had a stroke than in people who didn’t. One year after a stroke, 25% of patients develop new-onset dementia. Within 4 years following a stroke, the relative risk of incident dementia is 5.5%.
Onset can be gradual or dramatic. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability.
Prevention
The underlying vascular disease has to be recognized and treated at early stage. The immediate cause of vascular dementia is stroke-interruptions in blood flow to the brain. So the best way to prevent it is to lower the risk of stroke, being high blood pressure or hypertension the single most important one. Other important risk factors are cigarette smoking, untreated diabetes, high cholesterol, a family history of heart problems, disease in arteries elsewhere in the body, and heart rhythm abnormalities.
Hence, not smoking, avoiding an excessive alcohol intake, a healthy diet and regular exercise will all lessen the risk of stroke.
Treatment
If the patient has been diagnosed with vascular dementia, the most important thing to do would be to minimize the likelihood of additional strokes occurring, causing the dementia to worsen.
Doctors may prescribe aspirin, warfarin, or other drugs to prevent clots in small blood vessels. Medications also can help relieve restlessness or depression or to sleep better, thus alleviating symptoms.
Very rarely, a surgery can be useful if there is a significant narrowing in the carotid artery. Vascular dementia, unlike Alzhemier’s disease, does not always mean a permanent and unavoidable decline.
Sources:
Memory Loss & the brain Website
Alzheimer Scotland – Action on Dementia
North West Dementia Centre