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Brain Stroke is a sudden loss of brain function caused by the interruption of blood flow to the brain. A stroke is sometimes called a brain attack. Brain cell function requires a constant delivery of oxygen and glucose from the bloodstream. A brain stroke occurs when blood supply to part of the brain is disrupted, leading to inadequate oxygen supply and causing brain cells to die. Blood flow can be compromised in a variety of ways.

Brain Strokes are the third largest killers in America, after heart disease and cancer. The effects of a stroke depend upon which part of the brain was injured and how much damage has occurred. About 80% of strokes are ischemic and 20% are hemorrhagic.

There are two major types of stroke: ischemic brain stroke and hemorrhagic stroke.

Ischemic stroke
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:
One type of ischemic stroke is a
1.Thrombotic stroke. This is caused by a blood clot (thrombus) in one of the arteries of the head or neck, which severely reduces the blood flow. The thrombus may be a result of a build-up of fatty deposits (plaques) in the blood vessels.Another type of ischemic stroke is an
2.Embolic stroke (or cerebral embolism). Caused when a blood clot that forms elsewhere in the body (for example, the chambers of the heart) travels through the circulatory system to the brain. The traveling clot is called an embolus.



Hemorrhagic stroke
The most severe type of brain stroke is a hemorrhagic stroke. A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

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According to neurologists, if a brain stroke can be immediately recognized and medical attention made available within three hours, it is normally possible to reverse the effects, often completely.
Doctors suggest one other way to know if a person has suffered a stroke – asks the patient to stick out his tongue. If his tongue is not straight or droops or slants to one side rather than coming straight out of his mouth, it is a sign of a stroke.

Symptoms
Symptoms of a stroke happen quickly. A brain stroke may cause:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Weakness or paralysis of eye muscles.
• Sudden confusion or trouble understanding simple statements.
• A sudden, severe headache that is different from past headaches.
• Difficulty walking
• Gets worse when you change positions or when you bend, strain, or cough.
• Confusion or loss of memory.
  

Warning signs

• Worst headache
• Confusion
• Sudden Difficulty speaking, writing or reading
• Unsteadiness or sudden falls
• Changes vision
• Personality, mood, or emotional changes
• Changes in taste
  

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The two main causes of brain strokes are termed ischemic and hemorrhagic and involve blood vessels in the brain. Ischemic strokes comprise about 80% to 85% of all strokes. With an ischemic stroke, a blood vessel in the brain becomes clogged with a clot just like the clogged arteries in the heart. With a hemorrhagic stroke, a blood vessel in the brain actually bursts or leaks. Hemorrhagic strokes tend to be more serious. The distinction between these two types of stroke can be critical in determining the treatment used to help the patient.

Facts can’t control

• Advancing age facts
• Family history of stroke risk
• Men have a higher risk of brain stroke than women who have not reached menopause
  

Facts you can control

• High blood pressure
• Heart disease
• Avoid smoking
• Diabetes
• High cholesterol
• Physically be active
• High alcohol intake
• Reduce stress
• Control your weight
• Taking cocaine and other illegal drugs
  

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A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 1122 or your local emergency number or seek urgent medical care at the first signs of a stroke.

In cases of ischemic stroke, it is common to give aspirin to reduce the risk of death or of a second stroke.If the cause of the stroke was a clot, it is possible that the quick administration of certain clot-dissolving drugs, such as alteplase, may prevent some symptoms such as paralysis. However, this is not a suitable treatment for all strokes, and can increase the risk of hemorrhagic brain stroke, so there are strict guidelines determining the circumstances in which it should be used.

Physicians have several tools available to screen for brain stroke risk and diagnose an active stroke. These include:

• Physical assessment – Blood pressure tests and blood tests to see cholesterol levels, blood sugar levels, and amino acid levels
• Brain surgery – If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels.
• Arteriography – A catheter is inserted into the arteries to inject a dye that can be picked up by X-rays.
• CT and MRI with angiography – Scans that are aided by a dye that is injected into the blood vessels in order to provide clearer and more detailed images.
• Ultrasound – A wand waved over the carotid arteries in the neck can provide a picture that indicates any narrowing or clotting.
  

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After a stroke, home treatment will be an important part of your rehabilitation. Family adjustment and support will be important to your loved one’s recovery. Strong support from the family can greatly enhance recovery.

You may need to use assistive devices to help you:

• Eat. Large-handled silverware can be easier to grab and use if you have a weak hand. If you have trouble swallowing, you may need to change your diet or you may need further tests or an evaluation by a speech therapist.
• Managing vision problems. After a stroke, some people have problems seeing to one side. For example, people with right-sided paralysis may have difficulty seeing to the right.
• Get dressed. Devices called reaches can help you put on socks or stockings if you have weakness in one arm or hand.
• Walk. Canes and walkers can be used to help prevent falls.
  

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• Visit your doctor regularly for blood pressure checks and appropriate medication.
• Avoid smoking.
• Reduce alcohol intake.
• Exercise regularly.
• Eat a healthy diet.
• Control your blood cholesterol.
• Control your diabetes, if you have it.
• Treating diabetes properly.
• Not using drugs.
• Many people recover completely after a brain stroke. For others, it can take many months to recover from a stroke. Physical therapy and other retraining methods are greatly improving rehabilitation and recovery.
  

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What is High Blood Pressure? Blood pressure is a measure of the force that your blood applies to the walls of your arteries as it flows through them. Hypertension, also known as high blood pressure, it is dangerous because it makes the heart work harder to pump blood to the body and contributes to hardening of the arteries, or atherosclerosis, and to the development of heart failure. High blood pressure is often called a ‘silent disease’ because you usually don’t know you have it.

About Blood pressure
Blood pressure is an essential part of the way your body works. When blood pressure is measured, there are two numbers for each reading: for example, “120 over 80″ is written as 120/80. This is because each heartbeat sends a pressure wave through the bloodstream.  Your blood carries oxygen and nutrients around your body and is pumped by your heart. Your blood is under pressure as a result of the pumping action of your heart and the size and flexibility of your arteries, which carry your blood.

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Most people with high blood pressure don’t have any symptoms, so you may only find out you have high blood pressure by having it checked. If you have very high blood pressure, or your blood pressure rises quickly, you may have headaches, problems with your vision, fits or black-outs.

• Fatigue or confusion
• Vision problems
• Chest pain
• Shortness of breath
• Nosebleeds
• Severe headache
• Severe anxiety
• Irregular heartbeat
• Blood in the urine
• Pounding in your chest, neck or ears
  

Symptoms Risk Factors
Although the exact cause of hypertension (high blood pressure) is unknown, there are several factors and conditions that may increase risk. These are:

• Overweight and obesity
• Smoking
• Little or no exercise
• Too much salt in the diet
• Drinking too much alcohol
• Stress
• Ethnic background (black person of African or Caribbean descent or of South Asian descent)
• Family history of high blood
  

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The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development, including:

• Smoking
• Overweight or obese
• High cholesterol
• Lack of physical activity
• Too much salt in the diet
• Too much alcohol
• Stress
• Older age
• Genetics
• Family history of high blood pressure
• Chronic kidney disease
• Adrenal and thyroid disorders
  

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Normal blood pressure can vary somewhat from person to person according to many factors. What’s in the high-normal range for one person may be considered high in a person with diabetes, for example.
However, The National Heart Foundation offers a general guide:

Normal blood pressure	generally less than 120/80 mmHg
Normal-to-high blood pressure	between 120/80 and 140/90 mmHg
High blood pressure	140/90 mmHg or higher
Very high blood pressure	180/110 mmHg or higher

Tests will be ordered to check for causes of high blood pressure and to assess any organ damage from high blood pressure or its treatment. These tests may include the following:

• Blood tests including measurement of electrolytes, blood urea, and creatinine levels (to assess kidney involvement)
• Lipid profile for levels of various kinds of cholesterol
• Special tests for hormones of the adrenal gland or thyroid gland
• Urine tests for electrolytes and hormones
  

A noninvasive, painless eye examination with an ophthalmoscope will look for ocular damage.
Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands.
Any of the following may be performed to detect damage to the heart or blood vessels:

• Electrocardiogram
• Echocardiogram
• A plain chest x-ray
• Doppler ultrasound
  

Medicines
If your blood pressure stays high, your GP may prescribe you one or more of the following antihypertensive medicines:

• ACE inhibitors or angiotensin-II receptor antagonists. It help you to relax and widen the walls of your blood vessels by reducing the production of hormones that cause your blood vessels to tighten
• Calcium-channel blockers. It helps you widen your blood vessels by relaxing the muscles in your blood vessel walls
• Diuretics. It help you to increase the amount of water and salt removed from your blood by your kidneys – lowering the volume of your blood which reduces blood pressure
• Beta-blockers. It reduce the work your heart has to do by reducing your pulse rate and the force of contraction of your heart at rest and when you exercise
• Alpha-blockers. It helps you to widen your blood vessels by relaxing the muscles in the blood vessel walls.
  

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Making lifestyle adjustments is key to maintaining normal blood pressure. Most doctors will suggest lifestyle changes before prescribing medicines.

Self-help:
Your GP, nurse or carer will talk to you about lifestyle changes which might help. For example, they may advise you to:

• stopping smoking
• Eat healthily
• Maintain your diet
• Low-fat and salt
• Eat Fruit and vegetables
• Avoid alcohol
• cutting down on coffee ,high-caffeine drinks, such as cola
• Taking regular exercise
• Losing any excess weight
• It may also help, where possible, to reduce stress in your life to prevent short-term rises in blood pressure – you could try relaxation techniques or meditation.
  

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Your diet, exercise levels and weight have a real effect on your blood pressure. If you have high blood pressure, you can start lowering blood pressure today by eating more healthily and being more active.

• Maintaining a healthy weight.
  

• Eat fruit and vegetables
  

• Getting regular exercise
  

• Reducing salt intake
  

• Avoid drinking alcohol
  

• Reducing stress
  

• Use Potassium
  

• Take Calcium
  

It is important for people to know their blood pressure in mm Hg and the importance of keeping it controlled. The evidence suggests that even a small increase in blood pressure can cause a significant change in life expectancy.

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Diabetes is a condition where people don’t produce enough insulin to meet their body’s needs and/or their cells don’t respond properly to insulin. Insulin is important because it moves glucose, a simple sugar, into the body’s cells from the blood. It is a chronic (long-term) condition characterised by high levels of glucose in the blood (hyperglycaemia).  If not treated it can cause long-term complications such as heart disease, kidney damage, stroke, circulatory problems and damaged vision.

Type of diabetes
Type 1 diabetes
Type 1 diabetes occurs when the pancreas cannot make insulin. Everyone with type 1 diabetes requires insulin injections.This type 1 diabetes is thought to occur as the result of an autoimmune reaction. During an autoimmune reaction the body’s immune system attacks the body’s own healthy cells and tissues.  In Type 1 diabetes, it is thought that the body attacks and destroys the specialised insulin-producing beta cells in the pancreas, making them incapable of producing insulin.

Type 2 Diabetes
Type 2 diabetes used to be called adult-onset diabetes, but with the epidemic of obese and overweight kids, more teenagers are now developing type 2 diabetes. Type 2 diabetes was also called non-insulin-dependent diabetes. People with type 2 diabetes usually have a family history of this condition and are most often overweight. People with type 2 diabetes may eventually need insulin injections. This condition occurs most commonly in people of First Nations descent, Hispanics, and North Americans of African descent.

Gestational Diabetes
Gestational diabetes is a form of diabetes that occurs during the second half of pregnancy. It is often diagnosed in middle or late pregnancy. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby’s growth and development. According to the Canadian Diabetes Association (CDA), about 4% of women, and up to 18% of First Nations women, will develop gestational diabetes. The problem usually clears up after delivery, but women who have had gestational diabetes have a higher risk of developing type 2 diabetes later in life.

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The main symptoms of diabetes include significantly increased thirst, needing to urinate more often than usual and increased hunger. When hyperglycemia occurs, the body tries to get rid of the excess glucose by excreting it in the urine.  This increases urine output and can lead to dehydration.  At the same time the body’s cells are starved of the glucose energy they need The onset of symptoms in Type 1 diabetes is typically quite sudden and symptoms can be severe.  However the symptoms of Type 2 diabetes tend to manifest gradually, so much so that they may go unnoticed.

• Weight loss
  

• Increased urination
  

• Yeast infections
  

• Skin wounds or infections that are slow to heal
  

• Increased thirst
  

• Blurry vision Hunger
  

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There is no common diabetes cause that fits every type of diabetes.The reason there is no defined diabetes cause is because the causes of diabetes vary depending on the individual and the type.  More on what causes diabetes.  

• Family history of gestational diabetes
  

• Bad diet
  

• Chemical toxins within food
  

• Increasing age
  

• Overweight or obese
  

• Trauma or surgery
  

• Environmental factors
  

• Viral or bacterial infection
  

• Some genetic disorders
  

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If this happens to you, make sure your doctor finds the time to discuss or refer you to someone who will be able to answer the questions you may have.

Fasting blood glucose test
A sample of blood is taken to measure the blood glucose levels in the blood after the person has not eaten for several hours.  This is usually performed in the morning, before breakfast.  It is the most common blood test used to assist with diagnosis.

Random blood glucose test
A sample of blood is taken to measure the glucose levels in the blood – regardless of when the person last ate.A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

Urine tests
Urine tests may also be done and will demonstrate high levels of glucose.  They are not used in isolation in the diagnosis of diabetes, as the results can be misleading.

HbA1c test
A blood test called the haemoglobin A1c (HbA1c) assay is often used to indicate a person’s average blood glucose levels over a period of time.  As well as being a diagnostic tool, this test is useful in monitoring the progress of the condition and the effectiveness of treatment.

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A variety of different factors have a role to play in treating diabetes. Successful treatment makes all the difference to long-term health, and achieving balanced diabetes treatment can be the key to living with both type 1 and type 2 diabetes. While diabetes cannot be cured, it can be controlled.  The aim of treatment is to maintain healthy blood glucose levels (ie: between 4.0 mmol/L and 8.0 mmol/L) and to prevent diabetic complications.

This will normally involve balancing lifestyle factors (eg: diet and exercise) and medications.

• Health promotion
  

• Early detection
  

• Knowledge of the condition
  

• Effective monitoring
  

• Control blood glucose levels
  

• Avoid Smoking
  

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Balanced diabetes treatments
Generally it is recommended that foods containing refined sugars be avoided. This includes foods such as,

• Chocolate
  

• Jam
  

• Soft drinks
  

• Sweet biscuits
  

• Cakes
  

• Pastries
  

• Fruit juices
  

• Natural carbohydrates
  

This can be converted to energy, are recommended.  This includes foods such as,

• Fruit Vegetables
  

• Whole meal
  

• Bread Cereals
  

The diet should also be low in fat and high in dietary fiber. Alcohol contains a lot of sugar so intake should be minimized. Having a regular eating pattern is also important as this helps to keep blood glucose levels balanced. In some cases, having snacks between meals may be recommended. Again this helps to balance blood glucose levels.

It is recommended that people with diabetes seek dietary advice from a dietitian and that they follow an individualized food plan.

Exercise Regularly
Regular exercise is important in maintaining balanced blood glucose levels.  Exercise also helps to maintain a healthy body weight and control blood pressure and blood cholesterol levels.  Exercise helps

• Control blood pressure
  

• Control weight
  

• Control cholesterol levels
  

• Reduce the risk heart attacks and strokes
  

It should be remembered however that excessive and/or prolonged exercise can cause the blood glucose levels to drop too low.  It is therefore recommended that any exercise undertaken is regular and moderate.

Other Lifestyle Activities
When the body is stressed, the blood glucose levels are more difficult to control.  It is therefore important that stress is adequately managed. It is recommended that people with diabetes do not smoke.  Smoking plays a part in increasing the risk of developing many diabetic complications. Illness can also make blood glucose levels more difficult to control.  If blood glucose levels become unstable due to illness, it is important to consult a doctor – particularly if vomiting occurs.

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Tablets
People with Type 2 diabetes may not be able to adequately control their blood glucose levels through diet, exercise and lifestyle changes alone.  Therefore, in many cases diabetic tablets are required.  There are a variety of tablets available, which work in different ways.  These include: Tablets to increase insulin output from the pancreas eg:

• Glipizide
  

• Glibenclamide
  

Tablets to reduce insulin resistance eg:

• Metformin
  

Tablets that stop the absorption of carbohydrates from the bowel eg:

• Acarbose
  

Insulin
In people with Type 1 diabetes and in some people with Type 2 diabetes, insulin injections are required.  There are a number of different types of insulin available that vary in the duration of time they are effective. Some are short-acting; meaning they are absorbed quickly by the body and are effective for a short period of time. Others are long-acting; meaning they are absorbed more slowly by the body and are effective for a longer period of time. Often a combination of different types of insulin is required.

Insulin is injected under the skin of the abdomen or thigh and can be administered by using a disposable syringe and needle, or a preloaded insulin “pen”. Insulin can also be administered by a pre-programmed insulin pump. An insulin pump is a small battery powered device into which insulin can be a loaded. The insulin is pumped into the abdomen via a thin plastic tube connected to a very thin plastic needle that is secured under the skin.

It is important that the person is trained in how to correctly administer the insulin.  This training is usually given by a diabetes nurse educator.  The amount of insulin required, and how often it is to be administered will vary according to the needs of the individual and the glucose levels in the blood.

Blood Glucose Testing
To enable blood glucose levels to be tested, a droplet of blood is obtained from a small finger prick test and is measured on a special testing strip.  The results will help to determine how much medication is required, how much exercise can be undertaken and what foods should be eaten.  This simple home test needs to be performed regularly, in some cases up to several times per day.  It is important to follow the guidelines given by the treating doctor as to how often they should be done.

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Knowing how diabetes affects your body can help you look after your body and prevent diabetic complications from developing.

• High cholesterol levels
  

• High blood pressure
  

• Affected on brain
  

• Lower limbs
  

• Affected on heart
  

• Damage the nerves
  

• Affected on Eyes
  

• Kidney failure
  

• Teeth and gum problems
  

Therefore diabetes can affect any part of the body.