Stroke – causes, symptoms, treatment [WE EXPLAIN]

Proven content

One of the obstacles to improving stroke is the perception, both within and outside the medical community, that stroke is a disease of the elderly, a fate that can only be opposed to a small extent.

Stroke – definition

Stroke is it a group of neurological symptoms resulting from sudden stoppage of blood supply to the brain. It occurs when a large artery that supplies blood to the brain, or a small intracerebral artery, becomes closed, narrowed or ruptured, and fails to deliver oxygen and nutrients to a specific area of ​​the brain.

If the artery is closed or severely constricted, it results in an ischemic stroke, otherwise known as cerebral infarction (similar to a heart attack when the coronary arteries of the heart are closed).

In the latter case, an arteriole may rupture and the blood will spread over a certain area of ​​the brain. It then leads to a hemorrhagic stroke, i.e. a cerebral haemorrhage, commonly referred to by patients as a “stroke”.

The World Health Organization (WHO) specifies that a stroke is a clinical syndrome characterized by a sudden onset of focal symptoms or generalized brain dysfunction that persists – if not fatal beforehand – for more than 24 hours and has no non-vascular cause.

Also read: What is a childhood stroke?

Stroke – statistical data

In 2017, approximately 6,2 million people worldwide died from stroke (including 2,7 million due to ischemic stroke). Stroke is the second leading cause of death, right after heart disease. In 2013, stroke was the cause of nearly 12% of all deaths worldwide (American Heart Association, 2017), and in 2017, 13% of all deaths. In Poland, it is estimated that stroke affects nearly 80-90 thousand people annually. people, of which 30 thousand. dies. Every 8 minutes someone in Poland has a stroke. Stroke is the main cause of permanent disability in Poles over 40.

See: What are the different types of disability?

Stroke – risk factors

Stroke risk factors are any disease or individual feature that may increase the risk of the disease in question. There are modifiable risk factors (those that we have influence and can change) and non-modifiable risk factors (they are not subject to change and we have no influence on them). Modifiable risk factors are factors that we can change ourselves (e.g. lifestyle changes) or through medical measures.

The non-modifiable risk factors are:

1. age over 65,
2. sex (men are more likely to have a stroke),
3. ethnic conditions (statistically, the most common stroke affects black people and Latin Americans),
4. genetic factors (a positive parental history of stroke is a strong, independent risk factor in the offspring),
5. previous stroke or transient ischemic attack (TIA)
6. hereditary syndromes: (Cadasil, hemoglobinopathies (sickle cell anemia), coagulopathies (protein C and S deficiency, factor V Leiden mutation), vasculopathies (moyamoya, fibromuscular dysplasia), connective tissue disorders (Marfan syndrome), metabolic disorders ( hyperhomocysteinemia, Fabry disease) These conditions are characterized by the occurrence of stroke at an earlier age.

The modifiable risk factors are:

1. arterial hypertension – it is one of the main and most dangerous risk factors for stroke. It has been determined that the higher the blood pressure, the higher the risk of a stroke. It is estimated that high blood pressure quadruples the risk of stroke. It is recommended to keep blood pressure below 140/90 mm Hg, and in people with diabetes and kidney diseases up to 130/80 mm Hg,
2. cardiovascular diseases – atherosclerosis of extra-cerebral vessels (previous myocardial infarction, peripheral arteriosclerosis, ischemic heart disease), atherosclerotic stenosis of peripheral arteries, atrial fibrillation, heart defects (cardiomyopathy, endocarditis, valve abnormalities),

Atrial fibrillation or AFib (disturbance of the heart rhythm) increases the risk of stroke five times. This is because it causes the heart’s atria to function abnormally, which can cause blood to build up and develop a clot. A clot can travel to the brain and cause a stroke. In addition, sleep apnea may be associated with AFib and is associated with an increased risk of stroke.

1. diabetes – diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high cholesterol and are overweight – increasing the risk even further. Although diabetes is a controllable disease, its presence still increases the risk of stroke.
2. high cholesterol – large amounts of cholesterol in the blood can build up and cause blood clots – leading to a stroke. There was also a tendency to increase the frequency of ischemic stroke along with a decrease in HDL cholesterol and an increase in triglycerides,
3. smoking – nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system and pave the way for a stroke. Moreover, the use of the contraceptive pill in conjunction with smoking can significantly increase the risk of stroke,
4. incorrect diet – a diet high in saturated fat, trans fat and cholesterol can raise blood levels of this cholesterol. Conversely, a diet high in sodium (salt) may increase blood pressure. High-calorie diets can lead to obesity. In contrast, a diet containing five or more servings of fruit and vegetables a day may reduce the risk of stroke.
5. obesity – people struggling with obesity very often struggle with hypertension, heart disease, high cholesterol and diabetes. All of these conditions can increase your risk of stroke. Moreover, based on the results obtained from clinical trials, it has been shown that being overweight increases the risk of stroke by 30% in both men and women. This is especially true of the abdominal type of obesity, when adipose tissue accumulates mainly in the abdominal cavity,
6. lack of physical activity – every healthy person should engage in physical activity to maintain proper health condition. It is recommended to perform approx. 150 minutes of moderate physical activity at least a week,
7. alcohol abuse – drinking too much alcohol increases the risk of stroke by a factor of three. Long-term alcohol consumption causes high blood pressure, an increase in triglycerides and heart disease, which increases the risk of stroke,
8. psychosocial factors – stress, negative life events and depression, increase the risk of stroke by up to 72%,
9. apoliprotein B to A1 ratio – Due to the close relationship of apolipoprotein and serum lipid levels, apolipoprotein levels are considered important in predicting the risk of cardiovascular disease. High levels of apoliproteins B and low levels of apoliproteins A1 are associated with the risk of myocardial infarction and stroke,
10. migraine,
11. gout
12. artery injury,
13. hypothyroidism,
14. infections
15. blood coagulation disorders,
16. lipid disorders,
17. use of amphetamines, cocaine.

Also read: Taking amphetamines can damage the aorta

Stroke – types and causes

There are ischemic and hemorrhagic stroke. Ischemic stroke is one of the most common forms of stroke. It is estimated to occur in 70-80% of all cases. The main causes of ischemic stroke include:

1. arterial clot
2. damage to small arterioles,
3. stroke as a result of an embolism originating in the heart.

Haemorrhagic stroke may be caused by:

1. intracerebral hemorrhage – arises as a result of rupture of the cerebral arteriole. Most often, a vessel that breaks is previously damaged as a result of untreated or ineffective treatment of high blood pressure or diabetes. Intracerebral haemorrhage usually occurs with high blood pressure (pressure spike),
2. subarachnoid hemorrhage – means that blood is being poured out into the space surrounding the brain. It arises as a result of rupture of a predominantly congenital arterial dilatation, the so-called aneurysm. Subarachnoid haemorrhage accounts for 5% of all strokes and is the most dangerous type of stroke.

See also: Mental decline associated with higher risk of stroke

Stroke – main and warning symptoms

In some cases, warning symptoms appear before the neurological symptoms of a stroke develop. This is called small stroke, also known as transient ischemic attack (TIA). Symptoms of a minor stroke usually last 15-60 minutes, at most 24 hours, and disappear completely on their own. One of the main warning signs is:

1. contortion of the face on one side, it is characteristic to drop the corner of the mouth,
2. sudden disturbance of sensation on one side of the body or its numbness,
3. sudden speech disorder (slurred, hard-to-understand speech)
4. sudden weakness in the limbs on one side of the body (paresis),
5. sudden dizziness accompanied by problems with balancing,
6. sudden visual disturbance – visual impairment in one eye or half of the visual field is not visible.

The main symptoms of a stroke include:

1. motor symptoms – weakness or inability of one limb, both limbs on the same side of the body, three limbs, all limbs,
2. speech disorders / language disorders – difficulties in understanding speech – sensory aphasia, difficulties in choosing words – motor aphasia, difficulties in articulating words – dysarthria, difficulties in reading / writing / counting,
3. sensory disturbances – disturbance / loss of sensation in one or more limbs (analogous to movement disorders)
4. behavioral disorders – difficulties in performing daily activities (washing, eating, dressing), time-space disorientation, memory disturbances (mainly fresh memory),
5. balance disorders – difficulties in moving and maintaining an upright posture.

Read: What is aphasia and how to treat it?

Stroke – FAST test

The abbreviation FAST in development means: FACE – face, ARM – arms, SPEECH – speech, TIME – time. If you suspect that someone around you may be having a stroke, just ask them to do three simple steps as part of the FAST test:

1. F – face: ask the person to smile. Pay attention to whether one side of his face will fall,
2. A – arms: ask the person to raise both arms. Pay attention to whether one arm goes down,
3. S – speech: Ask the person to repeat a simple phrase. Pay attention to whether the speech is slurred or strange,
4. T – Time: If you see any of these signs call 911 immediately.

Can a stroke be prevented?

The best ways to prevent stroke are to eat a healthy, balanced diet, exercise regularly, and avoid smoking and drinking too much alcohol.

These lifestyle changes can reduce the risk of problems such as:

1. clogging of arteries with fatty substances (atherosclerosis),
2. high blood pressure,
3. high cholesterol.

If you have had a stroke, making these changes may reduce your risk of having another stroke in the future.

Diet – An unhealthy diet can increase your risk of stroke as it can lead to high blood pressure and high cholesterol levels. For people with a likelihood of having a stroke, a diet low in fat and high in fiber is usually recommended, including plenty of fresh fruit and vegetables (5 times a day) and whole grains.

Exercise – Combining a healthy diet with regular exercise is the best way to maintain a healthy weight. Regular exercise can also help lower cholesterol and maintain normal blood pressure. It is also worth spending a moment practicing manual skills. Order the Set of 3 4FIZJO finger training rubbers, which can also be used for post-stroke rehabilitation.

Most people recommend that you spend at least 150 minutes (2 hours 30 minutes) a week on moderate-intensity aerobic exercise, such as cycling or brisk walking.

Quit smoking – Smoking significantly increases the risk of stroke. This is because the substances in a cigarette narrow the arteries and increase the likelihood of blood clotting.

Not smoking will also improve your overall health and reduce your risk of developing other serious conditions such as lung cancer and heart disease.

Limit alcohol – Excessive alcohol consumption can lead to high blood pressure and cause an irregular heartbeat (atrial fibrillation). Since alcoholic beverages are high in calories, they also cause weight gain. Drinking plenty of alcohol increases the risk of stroke more than 3 times.

The best way to prevent a stroke is regular checkups with a doctor (periodic check-ups) and a healthy lifestyle!

Management and treatment of the acute phase of stroke

In stroke, the best treatment effect can be achieved in the first hours after the onset of symptoms, so it is necessary to take appropriate measures immediately, including:

1. recognition of symptoms suggesting a stroke by the patient himself or those around him,
2. calling an ambulance and taking the patient to a previously notified stroke unit / sub-unit,
3. determine the type of stroke and receive appropriate treatment as soon as possible.

The following should be implemented as soon as possible:

1. pharmacological treatment (general and specific),
2. specific endovascular treatment (if there are absolute indications),
3. prevention and treatment of neurological (secondary bleeding, brain edema, epileptic seizures) and systemic complications (e.g. aspiration pneumonia, infections, pressure ulcers, deep vein thrombosis, pulmonary embolism),
4. early rehabilitation,
5. early secondary prophylaxis of stroke.

Specific treatment for ischemic stroke consists of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA, alteplase). Intravenous rt-PA thrombolysis is the recommended treatment for acute ischemic stroke and can be used up to 4,5 hours after the onset of symptoms. The drug should be given as soon as possible, as the greatest benefit is obtained for the patient if thrombolytic therapy is initiated within the first hour after the onset of stroke symptoms.