Lucanar Stroke Source: HealthLine.com

Complete Definition at Wikipedia

What is a lacunar stroke?
Key points

1. Lacunar stroke is a type of ischemic stroke that occurs within the deepest structures of the brain.
2. Having a lacunar stroke can increase your risk of subsequent strokes.
3. As with all types of strokes, quick diagnosis and treatment is key to minimizing damage to the brain.

A stroke occurs when blood flow to the brain is interrupted or blocked. Strokes that are caused by blockages in blood vessels within the brain are called ischemic strokes.
Lacunar stroke is a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked.
According to the National Institutes of Health (NIH), lacunar stroke represents about one-fifth of all strokes.
Any type of stroke is dangerous because brain cells are deprived of oxygen and begin to die within minutes.

What are the symptoms of lacunar stroke?
Symptoms of stroke usually come on suddenly and without warning.
Signs of lacunar stroke can include:

• slurred speech
• inability to raise one arm
• one side of the face appearing droopy
• numbness, often on only one side of the body
• difficulty walking or moving the arms
• confusion
• memory problems
• struggle to speak or understand spoken language
• headache
• loss of consciousness or coma

As brains cells die, functions controlled by that area of the brain are affected.
These symptoms can vary depending on the location of the stroke.

What causes lacunar stroke?
Lacunar stroke is caused by lack of blood flow in smaller arteries that supply deep brain structures.
The most important risk factor for the development of lacunar stroke is chronic high blood pressure.
The condition can cause the arteries to narrow. This makes it easier for cholesterol plaques or blood clots to block blood flow to the deep brain tissues.

Who is at risk for lacunar stroke?
Risk of lacunar stroke increases with age. Those at risk include people with chronic high blood pressure, heart disorders, or diabetes.
African-Americans, Hispanics, and people with a family history of stroke are also at a higher risk than other groups.
Other factors that increase the likelihood of lacunar stroke include:

• smoking or exposure to secondhand smoke
• alcohol
• drug abuse
• pregnancy
• use of birth control pills
• sedentary lifestyle
• poor diet
• high cholesterol
• obstructive sleep apnea

Annual physical examinations are important to screen for various health issues, including high cholesterol and obstructive sleep apnea.

How is lacunar stroke diagnosed?
Emergency treatment is necessary for any type of stroke, so diagnosis is urgent.
Your doctor may take your blood pressure and ask about your symptoms.
A detailed neurological exam will be used to see if there is any damage to the nerve pathways throughout the body.
If your symptoms are consistent with stroke, immediate diagnostic testing will likely include a CT scan or a MRI scan to take detailed images of your brain.
A Doppler ultrasound may also be used. This will measure the amount of blood flowing through your arteries and veins.
Heart function tests, such as electrocardiogram and echocardiogram may be ordered. Kidney and liver function testing and various blood tests may also be administered.

What is the treatment for lacunar stroke?
If you have a lacunar stroke, early treatment increases your chance of survival and may prevent further damage.
Once you arrive at the emergency room, you'll likely be given aspirin. This reduces the risk of having another stroke.
Supportive measures may be needed to assist your breathing and heart function.
You may receive oral or intravenous clot-busting drugs. In extreme circumstances a doctor can deliver medications directly into the brain.

Lacunar stroke can result in some brain damage. Depending how badly the underlying structures are damaged, you may not be able to care for yourself following a stroke.
Recovery varies for each person and depends on the severity of the stroke.
Some lacunar stroke patients transition from the hospital to a rehabilitation center or nursing home, at least for a short period of time.
Because of brain damage, stroke patients often have to re-learn skills and regain their strength. This can take weeks, months, or years.
Most stroke patients require long-term treatment. This can include medication to treat high blood pressure, diabetes, or high cholesterol.
After a lacunar stroke, some patients also require:

• physical therapy to restore function
• occupational therapy to improve skills needed for everyday living
• speech therapy to improve language skills

What is the long-term outlook?
Quality of life after lacunar stroke depends on many factors, including age and how quickly treatment began after symptoms started.
For some patients, disabilities are permanent. These can include:

• paralysis,
• numbness
• loss of muscle control on one side of the body
• tingling sensation in affected limb

Even after rehabilitation and stroke recovery, some stroke survivors have problems with short-term memory.
Some may also have difficulty with thinking and reasoning. Controlling your emotions can also be an issue.
Some stroke survivors also deal with depression.
Having a lacunar stroke increases your risk of subsequent strokes, so regular medical care is very important.
According to the American Stroke Association, although incidence of stroke is higher in men, women represent more than half of stroke deaths across all age groups.

Lower your risk
Lacunar stroke is a life-threatening emergency. Some risk factors such as aging and family history are beyond your control, but certain lifestyle behaviors can influence risk.
Maintain a healthy diet. Exercise regularly for at least 30 minutes most days of the week.
Together these habits can help lower your risk of having a lacunar stroke.
If you have high blood pressure, heart disease, or diabetes, see your doctor regularly.
Strive to keep under control any of these conditions that you may have. Don’t smoke.
And most importantly, seek medical attention at the first sign of stroke – every second matters.

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Feeding Tube Placement For Stroke Recovery Patients
Source: VeryWell.com

What is a feeding tube?
A feeding tube is a device used to deliver nutrition directly into the stomach of a person who can't swallow food on his or her own.
When are feeding tubes necessary?
Some common reasons why people might need a feeding tube are:

• Trouble swallowing after a neurological illness, such as a stroke
• A head or neck cancer that prevents swallowing
• Being in a coma or in a vegetative state
• Chronic loss of appetite due to a severe illness

What kinds of feeding tubes are there?
The three main kinds of feeding tubes are:

• Nasogastric: Also known as an NG tube, this feeding tube is less invasive than G or J tubes (see below) and is only used temporarily.
  Nasogastric tubes are thin, and can be easily passed down from the nose, through the esophagus, and into the stomach, and can be pulled out just as easily.
  
  Because these tubes are thin, they often become clogged, requiring replacement with a new tube every few days.
  Also, long term use of NG tubes has been associated with sinusitis and other infections.
  In spite of this, they are the easiest and most reliable way for patients who have swallowing difficulties to receive adequate nutrition while in the hospital.
• Gastric Tubes: Also known as G tube or PEG tube, the gastric tube is a permanent (but reversible) type of feeding tube.
  G tube placement requires a small surgery in which the G tube is advanced from the abdominal skin directly into the stomach.
  The tube is kept inside the stomach by a coiled wire, commonly called a “pigtail,” or by a small air-inflated balloon.
  The surgery is safe, but in a small percent of cases, it can lead to complications, such as bleeding and infection.
• Jejunostomy Tubes: Also known as a J tube or PEJ tube, a jejunostomy tube is similar to a G-tube, but its tip lies inside the small intestine, thus bypassing the stomach.
  It is mainly reserved for people whose stomach has an impaired ability to move food down into the rest of the intestine due to poor motility.
  It is also commonly used in people who suffer from severe gastro-esophageal reflux disease (GERD), and in those who are excessively obese.

When is the use of a feeding tube clearly beneficial?
Feeding tubes are especially helpful for people who are unable to feed themselves as a result of an acute illness, or surgery, but who otherwise have a reasonable chance to recover.
They are also helpful in patients who are unable to swallow temporarily, or permanently, but who otherwise have normal or near-normal function. In such instances, feeding tubes might serve as the only way to provide much-needed nutrients, and/or medications.

Are feeding tubes helpful in stroke?
Yes, they are. Studies have shown that up to 50% of all patients admitted to the hospital with a stroke are significantly malnourished by the time they are discharged.
More importantly, complementary studies suggest that preventing malnutrition by feeding patients through a feeding tube in the early phase of an acute stroke improves their recovery by comparison with patients who do not receive early feeding.
In fact, people who are severely underweight have a higher chance of death after a stroke.
The preferred type of feeding tube used within the first 30 days after a stroke is the NG

Controversial uses for G and J feeding tubes
In some instances, a feeding tube is controversial.
These situations include:

• Placing a permanent feeding tube in a person who is comatose due to a progressive and fatal disease (such as metastatic cancer) that will soon end his/her life. Find out more about understanding brain death here.
• Placing a permanent feeding tube in a person who is unable to express his wishes due to his disease, but who had previously stated to his loved ones that he would never want to be fed through a feeding tube.
• Placing a permanent feeding tube in a comatose patient who has extensive and irreversible brain damage and no meaningful chance to recover, but who could be kept alive indefinitely with artificial feedings.
• Placing a feeding tube in a person who has signed a living will which specifies that he/she would never want to be fed through a feeding tube.

Questions to ask your doctor
Important questions to ask doctors about feeding tube placement in a loved one include:

• Does placing a feeding tube improve the chance that my loved one will recover?
• What are the risks and benefits of G/J-tube placement?
• How should the surgery site look like after surgery?
• Does the G/J tube require maintenance?
• Should feeding through the tube be given continuously or intermittently?
• If I were to have any problems with the feeding tube, who should I call?

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Managing Swallowing Problems After A Stroke
Source: VeryWell.com

Your ability to swallow can be weakened after a stroke. This problem is called dysphagia.
While it may sound like a bothersome problem, swallowing trouble is actually more dangerous than it is annoying.
Most stroke survivors who have problems with swallowing impairment do not notice that it is difficult to swallow food and drinks, but instead experience problems such as choking and coughing up food.
Swallowing problems cause the risk of a serious side effect, which is aspiration.

What is Aspiration?
Aspiration means that food, drinks or even saliva can go down the wrong pipe towards the lungs instead of towards the stomach, potentially causing trouble breathing or a lung infection called pneumonia.
Aspiration occurs when the misrouted liquid or bits of food block air from getting into the lungs.
This can cause a bout of coughing, which is a reflex that occurs to try to dislodge the droplets of liquid or food particles from irritating the throat and obstructing air.
When aspiration is severe, excessive material in the lungs may irritate the lungs and cause pneumonia, which is a type of lung infection.

How Does Aspiration Occur?
Your mouth directs food to the esophagus, which leads to the stomach. Your nose and mouth also direct air to the lungs.
After food or air enters the mouth, a small passageway (the pharynx) takes in air and food and then divides to send food down a food pipe (the esophagus) to the stomach or air down a windpipe (the larynx) to the lungs.
Under normal circumstances, a small structure called the epiglottis closes off the windpipe when we swallow to prevent food from going down the wrong pipe.
Aspiration occurs when food, liquids or even saliva enter the windpipe instead of the food pipe.
This can happen during swallowing, or the material may even come back up after going down the correct tube, and enter into the wrong tube.

Why Does a Stroke Cause Aspiration?
Swallowing, which we often take for granted, requires perfect coordination of a number of different muscles controlled by the brain.
A stroke affects the muscles involved in swallowing, often preventing proper chewing and swallowing so that food enters the wrong tube.
Sometimes, after a stroke, food that has begun to go down the correct tube may return back up and enter the wrong tube.

A stroke may even cause the swallowing muscles to weaken in such a way that saliva may leak down into the wrong pipe, even if you aren’t actively eating.
Normally, our bodies produce saliva, and we reflexively swallow to decrease the buildup in our mouths.
One recent clinical research study used a video recording to evaluate stroke patients and demonstrated that the esophagus remains open for a longer period of time with swallowing, possibly allowing material an excessive opportunity to go down the wrong pipe.
Another research study found that stroke survivors who have larger strokes and strokes that affect the right side of the brain (the non-dominant side) experience more serious swallowing problems.

What Can You Do?
Managing swallowing problems on your own is not recommended, as swallowing is a complex skill.
A speech and swallow evaluation is necessary after a stroke, even if you have not noticed obvious problems with swallowing.
Your speech and swallow therapist will recommend foods and liquids of a safe consistency and will also provide you with exercises and a plan to help you advance to other foods.

Some safety recommendations include sitting up at a 90 degree angle during and after meals, pacing yourself as you eat and drink, cutting the food into small pieces and avoiding other activities such as talking while eating.
Some people with severe swallowing problems may sleep in a non-flat position to avoid aspiration.
Swallowing problems are not usually the most obvious handicap after a stroke. But, like bladder problems that may occur after a stroke, swallowing difficulties can interfere with your quality of life and can even cause serious health consequences.
Taking good care of yourself after a stroke includes getting attention for the subtle effects of your stroke.

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The Stroke "Recovery Window" Myth
Source: StrokeSmart

"They told me the window for my recovery had closed."

Stroke survivors who exhaust traditional methods of care are routinely told by medical professionals, "there’s nothing else that can be done." The doctors and therapists move on to the next patient and survivors face the devastating prospect of spending the rest of their lives unable to walk.
In truth, study after study shows that the so-called "window of recovery" does not exist. It is time for the medical community to raise their expectations and their standard of care for stroke patients.
Stroke is the number one cause of disability in the United States and our healthcare system is leaving millions behind.
For National Stroke Awareness Month, we want to shout this news far and wide: it’s never too late to recover from a stroke.

Researchers across the world have demonstrated with a variety of interventions that it is possible for the brain and the body to be retrained and learn how to function again even decades after a stroke. We live in a golden age of stroke care where new options become available every year to break through plateaus and help survivors continue to recover mobility. Unfortunately, stroke survivors often aren’t aware of these breakthroughs.

Significant progress has been made on the drug front to reverse the effects of a stroke. Using injections of an anti-inflammatory drug, Dr. Edward Tobinick in Fort Lauderdale has shown phenomenal improvements are possible in mobility and brain function.
By injecting the drug into the spinal cord of stroke survivors, 80 percent of Dr. Tobinick’s stroke patients showed improvements in their ability to walk.

New physical therapy programs are being developed to improve recovery for stroke survivors. Dr. George Hornby and colleagues at the Rehabilitation Institute of Chicago have started to treat stroke survivors less as patients and more as athletes.
The exercises more resemble football practice than the everyday coping mechanisms such as transferring from a wheelchair to a toilet that are often the focus of post-stroke care.
The results at RIC have been very strong: Senator Mark Kirk triumphantly climbed three dozen flights of stairs at the Willis Tower stair climb less than nine months after a severely debilitating stroke.

A new device called the Kickstart Walking System is showing equally inspiring results. Stroke survivors who are five, ten, and even twenty years post-stroke who have exhausted the traditional medical options try Kickstart and leave their wheelchairs behind.
Quickly they meet small but important milestones such as being able to walk into a favorite restaurant or being able to shop for groceries without a wheelchair for the first time in years.
Kickstart users are achieving independence as they rediscover the activities they used to enjoy before their strokes - hiking, ballroom dancing, and even fly fishing.
Being able to walk independently unlocks limitless possibilities for enjoyable and meaningful lives.

For National Stroke Awareness Month, we want to reiterate that:

1. recovery is never impossible
2. the brain is extremely adaptable
3. independent lifestyles are achievable and possible with the right combination of attitude, hard work, therapy and technology

It is time to bring these new therapies and technologies to the forefront of stroke care, because life is worth walking.