Nihal U. Siddiqui, MD, PA

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Overview:

our brain requires a continuous supply of oxygen. Disruption of blood circulation or blockage of an artery to the brain occurs inactive oxygen supply or cut off brain cells which begin to die may result in a stroke. A stroke is a very serious condition.

Symptoms:

Many patients do not seek medical attention until it gets serious health issue. Symptoms of stroke is commonly subside or go away. For betterment immediate need to seek medical attention as soon as the warning signs appear. There are some symptoms:

  • Balance: sudden loss of balance, dizziness or trouble in walking
  • Eyes: sudden loss of vision or become blurred in one or both eyes
  • Face: noticeable unevenness or droopiness in the face
  • Arm: sudden weakness or numbness in to the arm and the legs, especially on one side of the body
  • Speech: sudden confusion, troubling speaking or understanding
  • Headache: sudden severe headache with no known cause

Causes:

There are some causes which can refer to a stroke.

  • High blood pressure: Hypertension is the biggest cause of stroke. When the blood pressure goes beyond 140/90 then it’s an indication for stroke.
  • Tobacco: nicotine makes blood pressure rise up high. cigarette causes a fatty build up in the neck artery which thickens blood cot and also secondary smoke can affect badly.
  • Heart disease: Stroke can appear more likely at an elderly age who have heart disease. Defective heart valves and atrial fibrillation or irregular heartbeat causes stroke.
  • Diabetes: diabetes damages blood vessels which is the main cause for stroke. When the blood sugar level is high, stroke directly effect into the brain, the impact will be very high.
  • Family history: if any close relative like parent, grandparent, brother or sister had a stroke then the risk is higher.

Types:

Stroke can happen in two main types, one when something blocks the flow of blood or something causes the bleeding in the brain.

  • Ischemia stroke: it occurs as a result of a hindrance within a blood vessel supplying blood to the brain or poor blood supply from an irregular heartbeat from a blood clot.
  • Hemorrhagic stroke: its less than ischemia stroke but the impact can be serious. It occurs when a weakened blood vessel ruptures. There are two types of weakened blood vessels that cause hemorrhagic stroke.one is aneurysms and arteriovenous malformations(AVMs). But the most common cause of hemorrhagic stroke is hypertension or high blood pressure.
  • TIA (transient ischemia attack): it is called “mini stroke”. It caused by a temporary clot or blockage, it doesn’t causes permanent damage but still the impact can be dangerous.

Diagnosis:

Strokes are diagnosed by some physical test or studying images of the brain through some test. There are some test that can help to confirm the diagnosis and determine the cause of a stroke before the actual treatment can start. There are some test which can help doctor to determine the stroke stage and reason behind it.

  • Brain computed tomography: This test done to the patient who arrives at the hospital as a suspected stroke case, it will distinguish between whether it is serious stroke or minor stroke. The test involves the use of low dose X-Rays to visualize the brain.
  • Magnetic resonance imaging(MRI): Generally it is use in the patient who are in more serious condition where the extent or damage location is unknown. An MRI uses strong magnetic field and radio waves to produce a detailed picture of the inner part of the body.
  • Magnetic resonance angiography(MRA): MRA uses noninvasive technology for imaging the central blood vessel.
  • CT scan: CT scan usually use like an X-Ray. It is uses to produce multiple images so the doctor get the three dimensional pictures of a brain to identify the problem area. It’s generally more quicker than MRI.
  • Transcranial doppler(TCD): It’s a portable test which can be performed frequently at the patients bedside to follow the progress of medical treatment of a stroke.
  • Carotid duplex scanning: It’s a study to diagnose blockage in the carotid arteries.
  • Radionuclide SPECT scanning: This test provides data with no relative blood flow using the radionuclide technitum99.
  • Cerebral angiogram: This methods uses through the injection of a contrast dye area through the major artery for assessment of blood flow to the brain. This procedure takes 2-3 hour to complete and minimum 6 hour bed rest requires after the procedure.
  • Ultrasound: It’s a test given to the patient which help to identify movement, size and shape of blood vessel with the usage of high frequency waves of sound.
  • Echocardiography: It’s a painless test that uses sound waves to create a picture of heart.
  • Blood test: Low blood glucose level may cause stroke. This test measure the amount of glucose in the blood.

Treatments:

The treatments depends on the types of strokes.

  • Ischemic stroke treatment: this type of stroke treatments goal is to remove the clot. Ischemia strokes can be treated using injections of a medication called alteplase which dissolve blood cells and restore blood flow to the brain. This medication known as Thrombolysis. Thrombectomy remove blood clots and helps restore blood flow to the brain. The procedure involves using catheter into an artery. A small device go through the catheter into the artery of the brain. Generally most people prescribed a regular dose of aspirin, which reduces the chances of another clot forming. Some people offered anticoagulant which help to reduce further developing blood clots. For high cholesterol Statin advised to take as a medicine, as it is helps to reduce the risk of strokes. Some ischemia strokes caused by narrowing of an artery in the neck side known as carotid artery, surgery is offered to unblock the artery.
  • Hemorrhagic stroke treatment: this type of stroke treatments goal is to stop the bleeding. In some cases surgery may need to remove blood from the brain and repair any damage blood vessels. After the bleeding has been stopped an artificial metal plate replaced in the skull and remove the piece of bone from skull. Hydrocephalus treated by surgically place an artificial tube called a shunt into the brain to allow the fluid to drain properly
  • Specialized stroke rehabilitation also helps to reduce strokes.