Stroke – symptoms, treatment, prevention. Life after a stroke

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A stroke is a life-threatening condition in which parts of the brain die by stopping blood supply to the tissues of the brain. The specific symptoms of a stroke occur suddenly and do not give much time for rescue. What is a stroke? How do you recognize its symptoms and help someone suspected of having a stroke?

Stroke – characteristics and types

A stroke is sometimes also referred to as a cerebrovascular event, and in older literature as apoplexy (from the Greek word apoplexia meaning paralysis, Latin apoplexia cerebri or insultus cerebri – literally “paralysis of the brain”). It is a group of clinical symptoms associated with the sudden onset of damage to parts of the brain caused by stopping the blood supply to the brain tissue.

There are two types of stroke – ischemic stroke and hemorrhagic stroke.

Ischemic stroke of the brain

Ischemic stroke accounts for 4/5 of all cases. It occurs when an artery that supplies the brain with blood is blocked. As a consequence, blood cannot flow through it, or it does not flow enough for cells in the brain to receive enough blood.

Atherosclerosis is considered the most common cause of ischemic stroke. The mechanism of this disease causes the so-called arteries to form. Atherosclerotic plaques are obstacles that block blood flow and build up in the walls of blood vessels, consisting mainly of cholesterol. As the disease progresses, plaque gradually increases, and the lumen of the artery becomes narrower and narrower. Eventually, they are completely blocked – usually by a blood clot forming in such a restriction – to stop blood flow.

Another factor that can block an artery and lead to an ischemic stroke is embolism. This is a blockage of an artery by a clot that can form:

1. in the heart – e.g. in the left ventricle of the heart after a heart attack, on the surface of artificial or damaged heart valves or during atrial fibrillation;
2. in the veins of the limbs – this happens very rarely, but can happen in people who have so-called patent foramen ovale, i.e. a permanent and patent connection between the right and left atrium of the heart.

An embolism may also form when a ruptured atherosclerotic plaque (or its fragments), e.g. from the area of ​​the carotid artery, tears off, and then, along with the blood stream, reaches the cerebral artery and blocks it.

If the artery is spontaneously evacuated before irreversible ischemic changes occur in the brain, it is referred to as a “would-be stroke” or a “mini-stroke”. transient cerebral ischemia.

Also read: Atherosclerotic plaques form late and quickly

Hemorrhagic stroke

Haemorrhagic stroke, accounting for about 1/5 of all cases, is also called a haemorrhage. This name describes the mechanism of such a stroke quite well – it causes a rupture of the wall of the cerebral artery and the outflow of blood outside the vessel.

The blood is then unable to reach the brain tissue in the area that was previously supplied by the ruptured artery. Moreover, blood flowing out of a broken blood vessel damages the surrounding nerve tissue and causes an increase in intracranial pressure. In this way, the work of the entire brain is disturbed, not only the part that is no longer supplied with blood.

Haemorrhagic strokes can be twofold – there is a division into:

1. intracerebral hemorrhages, where the damaged vessels are located inside the brain; their cause is usually high blood pressure, which is not treated or treated in an inappropriate way, which leads to the formation of the so-called micro aneurysms (dilations of small arteries) with walls prone to rupture;
2. subarachnoid hemorrhages, when the damaged vessel is located on the surface of the brain – the blood then accumulates in the space between the brain and the arachnoid, i.e. the brain’s protective membrane; it is usually based on the rupture of a larger aneurysm or hemangioma, which results from a congenital defect in the vessel wall.

A hemorrhagic stroke is much more severe than an ischemic stroke – the treatment options are limited, so it more often ends in death or extensive disability.

In the general population, stroke affects 2 in 1000 people every year, and the frequency increases significantly with age – among people over 65, this rate is as much as 10 in 1000 people.

Also check: You can reduce the risk of stroke associated with atrial fibrillation

Stroke – causes and risk factors

The most common and serious risk factor for stroke is hypertension. Therefore, it is very important that in the event of its occurrence, always start treatment and regularly monitor its effectiveness. If you manage to stabilize the pressure at a level similar to that of the “book” (120/80 mm Hg), the risk of stroke drops by as much as 30-40%. So it is one of the modifiable factors that we have influence on and that we can neutralize through treatment or changing habits.

Other such factors include:

1. other vascular diseases, especially atherosclerosis;
2. heart disease such as atrial fibrillation and congenital heart disease;
3. diabetes;
4. obesity and being overweight;
5. sleep apnea syndrome;
6. problems with the lipid economy;
7. harmful habits: smoking and alcohol abuse.

In addition, in the context of strokes, there is also talk of non-modifiable risk factors – those over which we have no influence. They include:

1. gender (stroke is more common in men);
2. age (the risk of a stroke increases with age, people over 55 are most often affected);
3. genetic predisposition.

Also read: Sleep apnea increases the risk of brain damage

Stroke – symptoms

A stroke can have all sorts of symptoms, depending on which part of the brain has been damaged. An artery blockage prevents blood from reaching the area of ​​the brain that was normally supplied by it. However, if this part of the brain is home to vital vital functions – e.g. breathing and blood circulation in the brainstem – the effects of ischemia can be extensive and very serious.

Za the most common symptoms of a stroke it is recognized:

1. blurred vision – patients may experience double vision or severely restricted field of vision, or even complete loss of vision; usually these changes occur in one eye;
2. problems with balance and coordination of movementswhich cause the patient to stumble, move in a strange way, have trouble dressing, and drop objects;
3. facial muscle weakness, manifested, for example, by drooping corner of the mouth;
4. paresis of the lower or upper limb, or both at the same time (on one side of the body); patients often complain of problems with moving their arms or legs, sometimes they are not able to make the most straightforward movements; this weakness is often accompanied by a feeling of numbness in one half of the body or some specific area of ​​the body;
5. very severe headacheoccurring suddenly and unexpectedly (especially in patients with subarachnoid haemorrhage),
6. paresis of the muscles of the tongue and throat causing difficulties in speaking and swallowing food; the patient may choke while eating, may also develop dysarthria – articulation disorders that make it impossible to understand speech;
7. loss of consciousness – a major stroke makes the patient very sleepy and his speech is illogical; the sick person does not know what is happening to him or he loses consciousness completely.

It’s good to know that the symptoms of a stroke often get worseto give way for several hours later and intensify again. If they resolve spontaneously within 24 hours, the patient is diagnosed with transient cerebral ischemia. Relatively often – in 1/3 of all cases – a stroke occurs while sleepingand you don’t notice symptoms until you wake up.

Stroke – What to Do When You See Symptoms?

Strokes, regardless of the severity of symptoms, are considered a life-threatening condition. Therefore, it is extremely important that the environment reacts quickly, enabling quick hospital treatment in a special ward specializing in the treatment of stroke patients. If not supplied with oxygen, brain cells begin to die very quickly, after just 4 minutes. Such changes in the brain are often irreversible.

So if we notice disturbing symptoms in ourselves or in someone in our environment that may indicate a stroke, call an ambulance as soon as possible and inform the dispatcher about your suspicions. He can then pass the data on to the emergency team, which will take the patient straight to the stroke unit.

In this case, every second counts – quick and efficient transport of the patient to the hospital can save his life and protect him from severe disability. You definitely shouldn’t wait for your symptoms to clear up, and you shouldn’t take any medications on your own, or go to the hospital yourself. If you have a stroke, visiting your GP will not help either.

Stroke – diagnosis

Strokes are diagnosed based on the patient’s symptoms and the results of the imaging test: computed tomography (CT) or magnetic resonance imaging. Computed tomography of the head allows to distinguish the type of stroke we are dealing with – ischemic or hemorrhagic. This is important information that influences the selection of the appropriate treatment method. Such imaging also helps to assess whether the patient has developed brain swelling or other dangerous changes that require special treatment.

In the first 6 hours after the onset of ischemic stroke, the CT scan usually does not show changes typical of ischemic stroke. However, if they are visible, they usually include the blurring of the boundary between the white and gray matter in the brain as well as mild edema.

CT scan on hemorrhagic stroke gives the image of a focus with high absorption (bright area). How much area of ​​the brain has been damaged, however, only becomes apparent after a few days (or weeks) during the next CT scan.

Other studies that are used to look for the causes of stroke include:

1. Carotid ultrasound (non-invasive method, commonly used in the diagnosis of atherosclerosis);
2. arteriography of the cerebral arteries;
3. echocardiography;
4. blood count;
5. transcranial Doppler ultrasound;
6. 24-hour Holter examination of ECG and blood pressure;
7. electroencephalography (EEG);
8. OB;
9. saturation;
10. ionogram evaluation;
11. assessment of the coagulation system;
12. lipidogram;
13. acute phase protein;
14. carbohydrate metabolism research.

Also check: What tests are used to correctly diagnose cardiovascular diseases – the most common cause of death in Poles?

Stroke – treatment

At the beginning of treatment, regardless of the type of stroke, it is necessary to urgently protect the vital functions of the patient. To this end, specialists decide to connect a drip in order to administer medications and replenish the necessary fluids and nutrients. It is often necessary to give the patient an oxygen mask or connect him to a respirator, which supports his breathing.

Tissue plasminogen activator (tPA or alteplase) is often used in patients with less than three hours from the onset of stroke (i.e. from the onset of symptoms)., which dissolves clots that block the artery. However, this type of method may impair blood clotting and increase the risk of bleeding. Therefore, this drug is only used when an ischemic stroke has been confirmed. TPA cannot be used in patients who have had a haemorrhagic stroke or have recently undergone surgery, as it could cause bleeding from the wound.

Conversely, when an artery remains clogged for more than a few hours, brain cells become oxygenated and die as a consequence. Treatment with alteplase then turns out to be pointless. It happens quite often – in 1/3 of patients a stroke occurs while sleeping, so when the patient notices symptoms after waking up, it is too late for treatment with tissue plasminogen activator. It must be more than 3 hours since the patient has been healthy recently.

If alteplase is not given, aspirin (acetylsalicylic acid) or heparin is sometimes recommended. The effectiveness of the so-called However, neuroprotective drugs have not been confirmed in the treatment of stroke, so there are no indications for their use.

In the event of a haemorrhagic stroke, when the hemorrhage has caused a dangerous increase in intracranial pressure, surgery is required. Sometimes it is an endovascular procedure when the cause of the bleeding is a cerebral hemangioma.

After stabilizing the patient’s condition, care should be taken to properly care for him. Proper nutrition, pressure ulcer prevention and intensive rehabilitation turn out to be very important. These actions are very important in reducing the degree of disability of patients after stroke.

In patients who are unconscious or suffering from paralysis of the limbs, rehabilitation in the initial phase focuses on proper positioning of the limbs and regular repositioning of the body to avoid pressure ulcers and contractures. The more the patient’s condition improves, the more the scope of rehabilitation increases. It includes further physical exercises and physiotherapy treatments to improve the patient’s well-being. Over time, patients are prepared to sit on the bed and then walk.

In a group of patients, the result of a stroke is aphasia, which is difficulty speaking and understanding speech. Then they have difficulties in naming certain objects and recalling the names of their relatives. Speech therapy classes can help with such people.

After discharge from the hospital, the patient may continue rehabilitation in a specialized neurological rehabilitation ward. In such departments, occupational therapies are conducted, which teach how to function in everyday life despite certain limitations that are left over from a stroke. The role of the psychotherapist turns out to be very helpful.

Find out more: Stroke rehabilitation – act fast

Life after a stroke

Brain cells that have died completely as a result of a stroke are unable to regenerate and regenerate. However, hypoxia does not always lead to death – it happens that those who managed to survive return to normal work after some time. Moreover, the brain (especially in young patients) is characterized by high plasticity – this means that healthy cells are able to partially take over the tasks that were previously performed by those destroyed by a stroke.

Patients who received an ischemic stroke quickly and quickly received help and took alteplase have a good chance of reversing their neurological disorders. In patients who were not so lucky, properly conducted rehabilitation adapted to their needs helps to reduce neurological ailments, but is not able to completely overcome them.

If the patient’s condition was very severe from the beginning – for example, when an artery that supplies blood to a large part of the brain was blocked – he usually has to deal with a severe disability for the rest of his life.

To reduce the effects of a stroke, it is worth using the Set of 3 4FIZJO finger training bands to support rehabilitation exercises.

In addition to intensive post-stroke rehabilitation, tailored to the individual needs of the patient, other forms of treatment also turn out to be necessary, such as:

1. successful treatment of the diseases that caused the stroke and may lead to its reoccurrence in the future – mainly hypertension, diabetes or hypercholesterolaemia; in addition to medications, a healthy lifestyle plays an important role – proper diet, regular physical activity and avoidance of stimulants;
2. oral intake of anticoagulantsmedicines that inhibit blood clotting (if the cause of a blood clot in the heart has not been resolved) or, if there is no such need – taking medications that inhibit the activity of platelets (aspirin, clopidogrel or ticlopidine) for life;
3. if your stroke was caused by a narrowing of the carotid artery – stenosis widening surgery by inserting a catheter into the artery and implanting the so-called A stent that helps maintain proper blood flow, or cervical endarterectomy.

Stroke – prevention

In the prevention of stroke, it is crucial to avoid diseases that increase the risk of stroke, primarily atherosclerosis, diabetes and arterial hypertension. It is important to undergo regular periodic check-ups to help you find and treat these conditions quickly.

In addition, to lower your risk of stroke, you should:

1. reduce stress;
2. control arterial pressure (it should not exceed the norms appropriate for the age and condition of the patient);
3. quit smoking;
4. play sports regularly;
5. limit alcohol;
6. control blood sugar levels;
7. keep body weight constant;
8. take care of a healthy, balanced diet that provides the body with all the necessary nutrients.

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