Apoplexy is a condition of sudden unconsciousness when an occlusion or rupture of any blood vessel leads to lack of oxygen supply to the brain. Any such cerebrovascular accident leads to uncontrolled bleeding in the brain causing impulsive unconsciousness. It leads to paralysis of various body parts.
Apoplexy is a major cause of concern as it’s the leading factor for disability in the United States. It has also been reported to be the 3rd most common cause of deaths. This condition can prove to be highly fatal leading to irreversible brain damage by affecting the brain cells. Based on the type and severity of stroke and the part of brain that gets affected, the attack can even result in permanent paralysis on one side of the body. It can also affect various human abilities like memory, speech, vision and movement. About one-third of the patients get well completely while the rest of the survivors suffer from various kinds of disabilities.
A venerable term for brain stroke, apoplexy is a term coined by Galen and derived from the Greek work apoplexia which means ‘seizure’ or ‘to strike down’. It is also defined as a sudden loss of any sensation or movement in body parts except for respiration and blood circulation.
Apoplexy is also generally used to refer bleeding in internal organs like pituitary apoplexy or adrenal apoplexy for pituitary glands and adrenal glands respectively. However, when mentioned as simply ‘apoplexy’ it indicates to the uncontrolled bleeding in brain as a result of some cerebrovascular accident also called a stroke.
A cerebrovascular accident can involve either blocking or rupture of an oxygen-carrying blood vessel. This leads to severe reduction in supply of oxygen and other essential nutrients to brain. Without adequate supply of oxygen and nutrients, the brain cells may not survive for more than a few minutes. A very fragile balancing is necessary for the amount of blood supplied to the brain to prevent apoplexy.
Causes of Apoplexy
Now that we know the answer for what is apoplexy, let us look at the various causes that lead to this condition.
The sudden unconsciousness condition of apoplexy occurs due to drastic changes in blood levels of brain. An increase in the levels of blood within brain is due to hemorrhagic stroke. Such a stroke occurs when there is a blood vessel rupture or leak due to various other medical disorders including aneurysm and high blood pressure.
Ischemic stroke is another condition of apoplexy which results due to decrease in the levels of blood in brain. It usually happens due to the blocking of some blood vessel that carries blood to the oxygen. This type of apoplexy leads to the death of certain brain cells that are irreplaceable. This is the most common type of apoplexy with 80% apoplexy cases related to it. These are of various types with embolic and thrombotic strokes being the two most common ones.
A traveling particle in the arterial bloodstream which originates from some other place sometimes blocks the artery. These particles can be anything like fat, cancer cells, bacteria clumps or air. This blockage cuts the blood supply to brain either partially or fully resulting in sudden unconsciousness as the oxygen level decreases.
In thrombotic apoplexy, the artery gets blocked gradually due to the formation of blood clots (thrombus) in the area around atherosclerotic plaques.
A sudden blockage or rupture of a blood vessel or a pituitary tumor linked to the pituitary gland is known as pituitary apoplexy. Though, there are a wide range of diseases and disorders associated with pituitary apoplexy, there is no clear information on the predisposing factors leading to its development.
Pituitary apoplexy can lead to acute visual disorder, meningeal signs, severe headaches, panhypopituitarism, cranial nerve palsies and in some rare cases it even leads to coma. The symptoms of pituitary apoplexy also include headache, nausea, fever and neck stiffness.
A pituitary apoplexy MRI is the best way to diagnose the condition even though CT scan of the gland is also used in most cases.
Also known as encephalorrhagia and hematencephalon, cerebral apoplexy is bleeding into cerebrum substance, mainly involving the internal capsule. It is indicated by rupture of blood vessel in brain leading to high bleeding into the brain tissues.
Cerebral Apoplexy is the 2nd most common type of stroke. It can also be due to various factors like high blood pressure, skull fracture and penetrating head trauma. Children are found to be less affected compared to adults. Other conditions that lead to cerebral apoplexy are smoking, alcohol, menopause and diabetes mellitus.
Since apoplexy causes sudden unconsciousness and is due to abrupt rupture or blocking of the blood vessel, the symptoms for this condition too appear rather swiftly and suddenly.
- The patient complains of severe headache along with stiffness in neck. Pain is also felt in between the eyes.
- Paralysis is a major risk involving apoplexy. One part/side of the body gets numb, weak and immobile.
- The vision of the patient gets affected. The decreased ability results in blurry and double visions.
- There is a loss of coordination between various parts of the body and the balance gets disturbed.
- Speaking or trying to concentrate and understand a subject becomes quite difficult. This condition is known as Aphasia.
- The patient experiences mental effects like confusion.
- The infected person also experiences nausea and vomiting.
- Transient Ischemic Attack (TIA) is a condition similar to apoplexy attack and is a possible indication of an attack that may ensue shortly. It lasts for only a few minutes without any permanent after-effects.
A condition of apoplexy can be diagnosed the best way with a MRI (magnetic resonance imaging) scan of brain. Even a CT (computerized tomography) scan can help in the diagnosis of apoplexy.
- The treatment for apoplexy involves medically stabilizing the patient as the first step.
- The effective treatment requires immediately administrating high-dose corticosteroid to the patient. The fluid and electrolyte levels are to be vigilantly monitored.
- Immediate evaluation of electrolytes, pituitary hormones and glucose is necessary.
- In some cases, bromocriptine or cabergoline are used for treatment of the condition.
- It has to be noted that not much can be done in the state of unconsciousness.
- The cause of this disorder in each individual should be found and treated directly so as to prevent any recurrence.
- A surgery involves opening a window in the body and then working on the rupture or block in the blood vessel. This is known as a transsphenoidal surgery.
- Appropriate endocrinologic replacement therapy also helps in treating apoplexy. This can also be combined with transsphenoidal surgery.
European Journal of Neurology, Blackwell Publishing