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

Cerebral infarction (stroke) is currently one of the leading causes of death in Thailand. For those who survive, there is a significant risk of disability, which can hinder self-reliance and necessitate close caregiving.

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Causes of Cerebrovascular Disease (Stroke)

Cerebrovascular disease, commonly referred to as stroke, occurs due to abnormalities in the blood vessels supplying the brain. There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Both types can cause sudden brain dysfunction due to either insufficient blood flow or bleeding into brain tissue.

Ischemic Stroke

Approximately 70% of stroke cases are ischemic, caused by an inadequate blood supply to the brain. The primary causes include:

1. Blockage of Blood Vessels
This is the most common cause of ischemic stroke. It is often associated with risk factors such as advanced age, hypertension, diabetes, smoking, and high cholesterol. Patients may have one or more of these risk factors.

2. Blood Clots
Blood clots may form in the heart or blood vessels and travel to the brain, causing arterial blockage. Individuals with irregular heart rhythms—particularly atrial fibrillation (AF)—are at higher risk. The irregular heartbeat can lead to blood pooling in the heart, increasing the risk of clot formation. These clots may then enter the bloodstream and block vessels in the brain.

3. Severe Drop in Blood Pressure
Although rare (less than 1% of cases), a significant drop in blood pressure can also lead to stroke. Contributing factors include:

Heart failure, resulting in poor cerebral perfusion
Septicemia causing a sudden decrease in blood pressure
Overdosage of antihypertensive medications
Sudden changes in posture, especially in elderly patients or those with long-standing diabetes

Hemorrhagic Stroke

The remaining 30% of strokes result from the rupture of brain blood vessels. These are classified into:

1. Intracerebral Hemorrhage (ICH)
This occurs when small blood vessels rupture, often due to weakened vessel walls from aging or chronic conditions. Symptoms may include sudden paralysis, severe headache, vomiting, or loss of consciousness. Common risk factors include older age, high blood pressure, diabetes, excessive alcohol use, and high stress.

2. Subarachnoid Hemorrhage (SAH)
This occurs when a large artery at the base of the brain ruptures, allowing blood to leak into the space surrounding the brain. Symptoms typically include a sudden, severe headache and nausea. In severe cases, it can lead to loss of consciousness or death. Common causes include ruptured cerebral aneurysms or arteriovenous malformations (AVMs).

Symptoms of Cerebrovascular Disease (Stroke)

Different brain regions control different functions. When blood supply is blocked or disrupted, the resulting symptoms vary depending on the affected area:

Cerebrum:

Frontal Lobe: Controls voluntary movement and speech. Damage may cause weakness on the opposite side of the body and difficulty speaking.
Parietal Lobe: Handles sensory input. Damage can result in sensory loss or numbness on the opposite side.
Temporal Lobe: Involved in memory and language comprehension. Damage may impair understanding of sounds and speech.
Occipital Lobe: Processes visual information. Damage may lead to partial or total vision loss.
Insular Lobe: Regulates autonomic functions. While less commonly affected, it can be involved in stroke cases.

Brain Stem:
Connects the brain to the spinal cord and controls vital functions via cranial nerves. Damage can cause limb or facial weakness, double vision, slurred speech, unsteady gait, and difficulty swallowing.

Cerebellum:
Coordinates movement. Damage here may lead to dizziness and unsteadiness without muscle weakness.

Key Symptoms of Cerebral Infarction (Stroke):

Drooping or weakness of the face
Weakness in the arms or legs (especially on one side)
Slurred speech or difficulty speaking

Patients may experience one or more of these symptoms. Severe symptoms typically indicate involvement of major brain arteries. Prompt medical attention is crucial for effective stroke treatment and prevention of long-term disability.