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A stroke is amedical emergencyand can permanently damage theneurological system in rare cases death occur. It occurs when blood flows to part of the brain stops due to blood clots or ruptures of arteries that result brain cannot get blood and oxygen and finally death of brain cells. It is also associated withcerebrovascular accident(CVA),cerebrovascular insult(CVI). Colloquiallybrain attackis the loss ofbrainfunction due to disturbance in theblood supplyto the brain. Stroke is a preventable and treatable disease. A growing body evidence has proved fake perception about the stroke that stroke is simply consequences of aging, over the last two decade. Effective prevention strategies, better reorganization would cause results to be improved. To overcome the disease, need to draw a table of the patients, their ages, life after and before the stroke, consequences, symptoms, mortality, and length of stay in the hospital etc then put this table to practice place that will show then reduction in outcome of patients. Uk,s national sentinel stroke audits have been introduced over the last 10 years. Physician’s recommendation derived from systematic methodology also helpful reduces the consequences. Stroke patients or their families need continuing information and support. Clinician dealing with stroke case need to be fully mindful across the whole process of care by follow the Mental Capacity act 2005[1 & 4]. There are two main types of Stroke has been identified, Ischemic and Haemorrhage Stroke.
These kinds of stroke cause by interruption of the blood flow, result stops the blood supply to the part of the brain reduced that leading to dysfunction of the brain tissue. There would be four different reasons of blood supply stops identified,
- Thrombosis (Blood Vessel obstruction due to a blood clot)
- Embolism (Blockage due to anembolusfrom elsewhere in the body, see below).
- Systemic hypo perfusion (general decrease in blood supply, e.g., inshock)
- Venous thrombosis.
This kind of stroke occur when a blood vessel in part of the brain becomes weak or bursts open that cause blood to spread within the brain. But some people have defects in the blood Vessels of the brain (may include aneurysm and arteriovenous malformation)
Roughly 87% strokes are ischemic, rest caused by haemorrhage.
Symptoms and Reorganization:
Symptoms of Stroke disease typically start suddenly within couple of seconds to minutes without warning. The severity of the attack depend side of the brain been affected. Different kind of stroke caused different symptoms at different level. For example, in case of intracranial haemorrhage, the affected area would affect other structure of the brain. Most kinds of stroke are not associated withheadache (Bleeding in the brain), apart from subarachnoid haemorrhage and cerebral venous thrombosis and occasionally intracerebral haemorrhage. More addition, symptoms may include, sudden change in alertness ( sleeping, coma etc ), problems in hearing, alter in taste, sudden change that affect the ability to feel pain, touch, pressure and different temperature), loss of memory, loss of balance, difficulty in swallowing, loss of coordination, problems with eyesight and trouble in speaking and walking. People who present Stroke disease should need proper and fast clinical assessment and treatment but unfortunately delay in structure procedure may lead to patient’s permanent or temporary disability or some time lead to death. To prevent this structure delay number of tools has been developed to improve the speed of diagnosis before to the arrival of the patients at A&E Department (Special treatment area for Stroke patients with a team of specific doctors and medical consultants). Sudden-onset face weakness, arm drift and abnormal speech test, Los Angeles pre hospital stroke screen (LAPSS), Cincinnati pre hospital stroke screen (CPSS) and Melbourne ambulance stroke screen (MASS). More addition, reorganization of stroke in the emergency room (ROSIER), but this test done on the arrival of the patients and it depends upon the history and physical examination feature. 
There are many of many risk factors have been identified towards Brain Stroke but some of them will be described below with the statistics of patient’s ages, severity and consequences etc
High blood pressure is one of the most common factor almost all kind of disease especially in Brain disease. In the UK, 30% of the adults suffered hypertension that increase with the passage of time as patients get older. Sexual base, men are on more threat than women. 
Obesity also a factor of stroke disease and this is not the result of amputation of an accident. Average of 12 % people is suffered in the UK. A national report from the England health association about the Obesity with different age and sex described as
Some other factors that could affect the brain would be Lipid, Tobacco, Physical Inactivity, Obesity, Blood pressure, Diabetes and Socioeconomic Status.
Global Burden of Disease
Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community. Stroke is uncommon in people under 40 years; when it does occur, the main cause is high blood pressure. Stroke also occurs in about 8% of children with sickle cell disease.
5.5 million People death accounted by the cerebrovascular disease worldwide, and this roughly equal to 9.6% of all deaths. Developing countries people affected two-third of these deaths and 40% subjected less than 70 years old. More addition, cerebrovascular disease is the main leading reason of disability.
National Burden of Disease:
There are approximately 152,000 strokes in the UK every year. That is more than one every five minutes. There are approximately 1.1 million stroke survivors living in the UK. Stroke is a leading cause of adult disability. More than half of all stroke survivors are left dependent on others for everyday activities. High blood pressure is the most important risk factor for stroke, contributing to about 50% of all strokes. One out of five strokes are fatal. Stroke causes about 7% of deaths in men and 10% of deaths in women. In 2010 stroke was the fourth largest cause of death in the UK after cancer, heart disease and respiratory disease, causing almost 50,000 deaths. For every 1,000 patients who receive thrombolytic, a clot busting treatment, 80 will live more independently (stroke.org.uk).
National economic Burden of Disease
In England, stroke is claimed to cost the economy roughly £7 billion per year. This includes £2.8 Billion to the NHS, £2.4 Billion to the informal care and 1.8 billion due to disability. A national strategy was introduced by the DH in 2007 that outline an ambition of the treatment, diagnosis and management about the life care after a stroke attack. 
As mentioned before there are two main subtypes of Brain Stroke (Ischemic and Haemorrhage) and many of many treatment methods are available currently to treat these subtypes of Stroke. So some of them, general treatment method will be described below,
This kind of stroke occurs when there is a blood clot that stopped the blood circulation to the brain, result lead to deprive the brain of oxygen and nutrients essential for brain and initiates a dynamic sequence of phathophysiological events.
Diagnosis of disease
MR and CT scanning usually used to detect the dieses. Water content of affected tissue rapidly increase that detected as increased signal at MR diffusion imaging or reduced attenuation on CT scanning.
This depends on the severity of the attack that varies stage by stage.
- Alteplase: used to break up the blood clots and restore the blood flow towards brain.
- Aspirin and Clopidogrel: used to decreases risk of blood clots after a stroke.
- Warfarin: Used to prevent blood clots forming in case of diagnoses, blood clot coming from heart.
- Sometime other different medicine used to reduces the blood pressure and cholesterol.
This would happened when medication does not affect to remove the blood clots that could cause another type of severe stroke so surgery recommended to remove blood clots and fatty deposits from the carotid artery in the neck
(Carotid endarterectomy). Although, endovascular interventional therapy has not approved , as a standard treatment in ischemic stroke.
Intravenous recombinant Plasmogeon Activator (IV rtPA)
Sources of treatments to ischemic types of Stroke limited, however but intravenous recombinant plasmogeon activator within 4.5 Hours when it has been approved by set of specialist’s doctors is one of the potentially effective treatment systems but also there is several successful protocol of endovascular therapy for Ischemic stroke available where chances of treatment delayed possible (non developed countries). A report was made using 7 patients with multimodal imaging and multimodality methods used by using different period of stroke attack time.
Intra-arterial thrombolysis (is one of the option used when patients arrived after the 3 hours), Multi MERCI trial (Used by using device that used up to 8 hours after arrival patients), the swift trials (Shows clot extraction with the solitaire devise in large vessel including Internal carotid artery, middle cerebral artery part 1, middle cerebral part 2, and basilar artery used to recanalization rate up to 80%. Patients who were not able to treat by (Iv rtPA) or who still need to treat again after (iv rtPA) were evaluated by the stroke neurologist if diffusion of water contents mismatched more than 20 % would be then treated with endovascular treatment.
7 cases aged from 56 to 87 years, national institute of health stroke scale ranged from 9 to 30 and MRI was done 6 of 7 cases. And 2 patients with other remain methods.
The aim of this case study was to determine the perfect method of treatment Ischemic Stroke. Results showed intra-arterial thrombolysis is one of the proffered treatment systems approved based on the proact trial with the patency rate was 66% less than 2 at the 90th day was 40% but unfortunately there were no clot was found in this study, due to limited does of rtPA used possibly.
This kind of disease occur when escape of blood from a ruptured blood vessel. Result lead to brain attack.
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