Strokes and paralysis must be prevented by addressing their underlying causes.

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 Cerebral Vascular Disease (Stroke)

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

Ischemic Stroke

About 70% of cerebral vascular disease cases are caused by insufficient blood supply to the brain, primarily due to the following factors:

1. Blockage of Blood Vessels:

This is the most common cause of ischemic stroke, often resulting from risk factors such as advanced age, high blood pressure, diabetes, smoking, and high cholesterol levels. Patients may have one or multiple risk factors.

1. Blood Clots:

Blood clots can originate from the heart or form in blood vessels, traveling to block arteries in the brain. Individuals with irregular heartbeats, particularly atrial fibrillation (AF), are at higher risk. The irregular beating of the heart can cause blood to stagnate, leading to the formation of clots that may escape into the bloodstream and cause blockages in the brain.

1. Severe Decrease in Blood Pressure:

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

• Heart failure resulting in inadequate blood supply to the brain.
• Significant drops in blood pressure in patients with septicemia.
• Overdosage of blood pressure-lowering medications.
• Sudden changes in posture, especially in elderly patients or those with long-standing diabetes.

Hemorrhagic Stroke

The remaining 30% of strokes are caused by ruptured brain blood vessels, which can be divided into two types:

1. Intracerebral Hemorrhage (ICH):

This occurs when small blood vessels burst, often due to weakened vessel walls from aging or other factors. Symptoms can include sudden paralysis, severe headache, vomiting, or loss of consciousness. Common risk factors include advanced age, hypertension, diabetes, excessive alcohol consumption, and high stress levels.

1. Subarachnoid Hemorrhage (SAH):

This happens when a large blood vessel at the base of the brain swells and eventually bursts, causing blood to leak into the space surrounding the brain. Symptoms often include severe headaches and nausea, and in severe cases, loss of consciousness or death. Common causes include ruptured cerebral aneurysms or arteriovenous malformation (AVM).

Symptoms of Cerebrovascular Disease (Stroke)

Each part of the brain has specific functions. If a part is deprived of blood supply due to blockage or bleeding, it can lead to various symptoms based on the affected area.

1. Cerebrum:

• Frontal Lobe: Controls body movements and speech. Damage can cause weakness on the opposite side of the body and speech difficulties.
• Parietal Lobe: Responsible for sensory perception. Abnormalities may lead to sensory disturbances on the opposite side.
• Temporal Lobe: Important for memory and language comprehension. Damage can impair understanding of sounds.
• Occipital Lobe: Critical for visual processing. Damage can cause visual field loss.
• Insular Lobe: Involved in autonomic functions, less relevant to cerebrovascular disease.

1. Brain Stem:

• Connects the upper brain to the spinal cord, controlling cranial nerve functions. Damage can result in limb weakness, facial weakness, double vision, slurred speech, unsteady gait, and difficulty swallowing.

1. Cerebellum:

• Coordinates movement functions. Damage can lead to dizziness and unsteady gait without weakness.

Important Symptoms of Cerebral Infarction (Stroke):

• Facial drooping or weakness
• Weakness in the arms and legs
• Slurred speech or difficulty speaking

Patients may exhibit one or several of these symptoms, and severe symptoms often occur due to blockage or bleeding in larger blood vessels in the brain. Prompt medical attention is crucial for stroke management and treatment.

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