Stroke, paralysis, paralysis must be prevented at the cause.

Currently, cerebral infarction (stroke) is one of the leading causes of death in Thailand. Even for those who survive, there is a high chance of disability, which makes it difficult for them to be self-reliant and requires close caregivers.

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Causes of cerebral vascular disease (stroke)

Cerebral vascular disease, also known as stroke, is a condition that occurs due to abnormalities in the blood vessels that supply the brain. There are two types of strokes: ischemic stroke and hemorrhagic stroke. These conditions cause the brain to suddenly stop functioning either due to a lack of blood supply or bleeding into the brain tissue.

70% of cerebral vascular disease cases are caused by insufficient blood supply to the brain, with three main contributing factors:

1.Blockage of blood vessels from the narrowing or hardening of the arteries:

This is the most common cause of ischemic stroke. It occurs when individuals have risk factors such as advanced age, high blood pressure, diabetes, smoking, or high blood cholesterol levels. Some patients may have one or multiple risk factors.

2.Blood clots from the heart or blood clots that form in the blood vessels and travel to block the arteries in the brain.

Causes of blood clots that escape from the heart and enter the brain’s blood vessels often occur in people with irregular heartbeats, specifically atrial fibrillation (AF).

The irregular beating of the heart chambers causes blood to stagnate in the heart chambers. Blood can form large or small blood clots on the day of the incident. These blood clots can escape into the left lower heart chamber and then enter the main artery leading to the brain, causing blockages in smaller blood vessels. This leads to insufficient blood supply to the brain. Additionally, blood clots located on the surface of plaques in the large neck blood vessels can detach and enter the brain due to the force of blood flow being faster than normal at the narrowed section of the neck blood vessels, leading to blockages in brain blood vessels as well.

3. Severe decrease in blood pressure that fails to adequately supply the brain.

This is a less common cause, accounting for less than 1% of all cases of cerebral blood vessel disease. Causes of decreased blood pressure include:

• Heart failure resulting in inadequate blood supply to the brain, also known as a heart attack. When cardiopulmonary resuscitation is performed after the heart has stopped beating for an extended period, the brain can suffer from insufficient blood supply when the heart starts beating again but the brain has been deprived of blood for too long.
• A significant drop in blood pressure in patients with septicemia entering a state of shock.
• Excessive dosage of blood pressure-lowering medication, causing blood pressure to drop to an insufficient level to supply the brain.
• Low blood pressure due to rapid changes in posture, such as transitioning from lying down or sitting to standing. This is commonly observed in elderly individuals who are taking medication to reduce obesity or in patients with long-standing diabetes accompanied by peripheral neuropathy

Another 30% is caused by ruptured brain blood vessels, which can be divided into two types:

1. Bleeding within the brain tissue (Intracerebral hemorrhage or ICH):

This occurs when very small blood vessels, as thin as a hair strand or smaller, burst due to weakened vessel walls from aging or other factors. This results in bleeding within the brain tissue, which can be the size of a pea or even as large as an orange.

Patients with this condition may experience sudden paralysis, severe headache, vomiting, or loss of consciousness in cases where the blood clot is large. Common risk factors include advanced age, long-standing hypertension, diabetes, excessive alcohol consumption, and high levels of stress.

• Elderly patients with fragile blood vessels (amyloid angiopathy)
• Patients with congenital abnormal blood vessels, where there are numerous and larger blood vessels than normal (arteriovenous malformation or AVM)

2. Bleeding on the surface of the brain (Subarachnoid hemorrhage or SAH):

This occurs when a large blood vessel at the base of the brain, ranging in size from a smooth ballpoint pen tip to that of a small coffee straw, experiences gradual swelling and eventually bursts, causing blood to leak and spread throughout the surface of the brain. Patients with this condition often experience severe headaches and nausea. In severe cases, loss of consciousness or death can occur. Common causes include ruptured cerebral aneurysms.

•  The patient has a weak wall of the major blood vessels at the base of the brain, along with long-standing high blood pressure. The high blood pressure gradually pushes the blood vessel wall to become weak and causes it to grow thinner over time. Eventually, the blood vessel wall will rupture.
• Arteriovenous malformation (AVM) is a congenital condition where there is an abnormality in the blood vessels of the brain’s surface. It occurs from birth and can progressively increase in size and eventually rupture.

Symptoms of cerebrovascular disease (stroke)

Each part of the brain has its own functions. If a particular part of the brain is deprived of blood supply due to blockage of the blood vessels or bleeding inside the brain, it will cease to function, resulting in symptoms specific to the affected area. The important parts of the brain are as follows:

1.Cerebrum

Located at the top and is the largest part of the brain, divided into 5 regions:

• Frontal lobe: Responsible for controlling body movements. The right hemisphere controls the left side of the body, while the left hemisphere controls the right side. If this part of the brain or the connecting nerves are damaged, the patient will experience weakness on the opposite side of the body, including facial drooping. In severe cases, there may be complete paralysis. This condition is called hemiplegia. Additionally, the lower part of the left frontal lobe (Broca’s area) controls speech. If this area is damaged, the patient may be unable to speak or only able to speak a few words without forming sentences.
• Parietal lobe: Responsible for sensory perception, including temperature and pain sensations from the opposite side of the body. Abnormalities in this region may cause sensory disturbances on the opposite side.
• Temporal lobe: Important for memory, as well as a specific area responsible for interpreting sounds heard into language. It is usually located in the dominant hemisphere (often the left hemisphere) for language. If this part of the brain is damaged, the patient may not understand the meaning of the sounds they hear, even if it is in their native language.
• Occipital lobe: Plays a crucial role in receiving visual information from the eyes. If this part of the brain is damaged, the patient may have visual field loss on one side of each eye. If tested by closing one eye and then the other simultaneously, the patient will not be able to see the opposite side corresponding to the affected brain.
• Insular lobe: Involved in controlling the autonomic nervous system, which is not significant in relation to cerebrovascular disease.

2. Brain stem

It is the part of the brain connecting the upper brain to the spinal cord, responsible for controlling the functions of the 12 pairs of cranial nerves. It also coordinates posture with the cerebellum. Abnormalities in this region can cause weakness in the limbs, facial weakness, double vision, slurred speech, unsteady gait, difficulty swallowing, and head spinning. In severe cases, loss of consciousness may occur.

3.Cerebellum

Located at the back of the brain, it coordinates the functions of different brain regions, particularly related to movement. If this part of the brain is damaged, the patient may experience dizziness, unsteady gait, slurred speech, but without weakness.

Patients with cerebrovascular disease may exhibit one or several of these symptoms. For example, some may have only weakness or hemiplegia, while others may have a combination of weakness, slurred speech, difficulty swallowing, and unsteady gait.

Severe symptoms often occur due to blockage or bleeding in larger blood vessels in the brain. Patients with bleeding on the brain’s surface

Important symptoms of cerebral infarction (stroke):

1. Facial drooping or facial weakness.
2. Weakness in the arms and legs.
3. Slurred speech, difficulty speaking, or inability to speak.

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