Stroke

A stroke is a life-threatening condition that has to be treated immediately. It occurs when the blood supply to part of the brain is cut off. The brain tissue is deprived of the oxygen it needs, and the brain cells die. A stroke may result in problems with speech, behavior, memory, and might lead to permanent brain damage, disability or death. Therefore if a stroke occurs, prompt treatment is crucial. The earlier the affected person is treated, the less damage is likely to happen.


Symptoms of stroke

If these warning signs occur in a person, emergency should be called immediately (even if the symptoms disappear again):

  • One side of the face droops or is numb: When the affected person smiles, the smile is uneven.
  • One arm is weak or numb: If the person raises both arms, one arm drifts downward.
  • Slurred speech: The person is not able to speak or difficult to understand.

It’s important to remember the time when the first signs of the stroke appeared.

Other symptoms may also appear suddenly:

  • Confusion
  • Trouble with understanding
  • Trouble with seeing in one or both eyes 
  • Walking difficulties
  • Dizziness
  • Coordination problems
  • Severe headache without a known cause

Causes and origin of stroke

A stroke occurs when the blood supply to the brain is interrupted or reduced. This deprives the brain of oxygen and nutrients, and the brain cells start to die. A stroke might be the result of a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). A few patients experience only a temporary disruption of blood flow to the brain (transient ischemic attack – TIA), also known as a ministroke.


Risk factors

There are certain risk factors that may increase the risk of getting a stroke. The following factors are treatable, e.g.:

  • Lifestyle risk factors
    • Excess body weight
    • Obesity
    • No sports
    • Heavy drinking
    • Smoking
    • Taking illicit drugs 
  • Medical risk factors
    • High blood pressure – the risk of stroke begins to increase at blood pressure higher than 120/80 millimeters of mercury
    • High cholesterol
    • Diabetes
    • Obstructive sleep apnea 
    • Cardiovascular disease

However, there are also other risk factors that cannot be influenced, e.g.:

  • Family history of stroke, heart attack or transient ischemic attack
  • Age 55 or older
  • Men are more likely to get a stroke than women
  • Women are normally older when they have a stroke
  • Women die more often from a stroke than men
  • Women who take certain birth control pills or have hormone therapies with estrogen and those who gave birth to a child, might also be more at risk.

Consequences of stroke

A stroke may sometimes lead to temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part of the brain was affected.
Complications might include:

  • Paralysis on one side of the body
  • Losing control of certain muscles, e.g. on one side of the face or one arm
  • Less control over muscle movement in the mouth and throat which might result in dysarthria (difficulties to talk clearly), dysphagia (difficulties to swallow or eat), aphasia (difficulties with language)
  • Memory loss
  • Thinking difficulties
  • Difficulties to control emotions
  • Depression
  • Pain in body parts that are affected by the stroke
  • Central pain syndrome (sensitive to temperature changes, particularly extreme cold)
  • Changes in behavior
  • Changes in self-care ability
  • Death

Prevention and therapy of stroke

Physiotherapy after stroke
Physiotherapy after stroke

Emergency treatment when a stroke occurs

In case of a stroke, it’s important to get medical help right away. Immediate treatment might reduce the long-term effects to a minimum and prevent death.
Treatment depends on the type of stroke: hemorrhagic or ischemic. An ischemic stroke results from an obstruction within a blood vessel supplying blood to the brain. A person gets a hemorrhagic stroke when a weakened blood vessel ruptures and spills blood into brain tissue. The most common cause for the rupture is uncontrolled high blood pressure. In addition, there are two other types of weakened blood vessels that also lead to hemorrhagic stroke: aneurysms and arteriovenous malformations.

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to the patient’s brain. Therapy with clot-busting drugs has to start within three hours if they are given into the vein. Quick treatment reduces problems and improves chances of survival. Aspirin e.g. may prevent new blood clots and another stroke. Some patients receive a potent clot-busting drug: an injection of a recombinant tissue plasminogen activator (TPA) or “alteplase” that is given through a vein in the arm within 4.5 hours after stroke symptoms start.
There are also other procedures that must be performed as soon as possible: medications delivered directly to the brain and mechanical clot removal. However, experts found out recently that for quite a few people, delivering medication directly to the brain or using a device to remove clots might not be beneficial. 
To prevent a stroke, physicians sometimes suggest the following procedures: carotid endarterectomy (a surgeon removes plaques from arteries that run along each side of the neck to the brain), angioplasty and stents.

Hemorrhagic stroke

Emergency treatment aims to control the bleeding and reduce pressure in the brain. Surgery often follows to diminish future risk. If the patient takes warfarin or anti-platelet drugs to prevent blood clots, he/she might be given drugs or transfusions of blood products to counteract the effects of the blood thinners. In addition, the patient may receive drugs to lower pressure in the brain. After the bleeding has stopped, the affected person gets supportive medical care. If the area of bleeding is large, the surgeon might remove the blood to relieve pressure on the brain.
If surgery has to be performed to repair blood vessel abnormalities associated with hemorrhagic strokes, the doctor might suggest one of the following procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation resulted in hemorrhagic stroke: surgical clipping, coiling (endovascular embolization), surgical AVM removal, intracranial bypass, stereotactic radiosurgery.


Recovery

After emergency treatment, stroke care focuses on helping the patient regain his/her strength, and recover as much function as possible in order to return to a “normal”, independent living. Most patients are treated in a rehabilitation program after they had the stroke. The doctor may recommend the most rigorous therapy program the affected person can handle depending on age, overall health and degree of disability caused by the stroke.


Preventive measures

1. Diet

  • Low-fat, high-fibre
  • Plenty of fresh fruit and vegetables (five portions a day)
  • Whole grains
  • Balance in diet
  • Not too much salty foods 
  • Not too much processed foods
  • No more than a teaspoonful of salt (6g, 0,2oz) per day

2. Execise

  • Sports on a regular basis
  • Goals: healthy weight, lower cholesterol level, blood pressure at a healthy level
  • Exercises: at least 150 minutes of cycling, fast walking and other moderate activities every week
  • Patients who just had a stroke should talk to the doctor about exercising (it might not be possible in the first months)

3. Quitting smoking

Smoking narrows the arteries and raises the risk of unwanted blood clots. If somebody quits smoking, he/she may reduce the risk of having a stroke. In addition, the general health improves.

4. Cutting down on alcohol

Since excessive alcohol consumption may result in high blood pressure, irregular heartbeat, weight gain – all risk factors for getting a stroke, it’s important to reduce the alcohol intake. Heavy drinking multiplies the risk of having a stroke by more than three times. If a patient has not fully recovered from a stroke, it might be possible that he/she is especially sensitive to alcohol and has to be even more careful regarding the amounts of alcohol he/she is drinking.

5. Managing underlying diseases and conditions

If somebody suffers from a condition that increases the risk of stroke, it has to be controlled regularly to help prevent a stroke. Among the conditions that can trigger a stroke are: high blood pressure, high cholesterol, atrial fibrillation, diabetes or a transient ischaemic attack (TIA).


12.10.2016 15:12:01