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Poles die of stroke much more often than the rest of Europe. Among those who survive it, as many as 70%, i.e. almost a quarter more than in other countries – become disabled.
It is better to prevent than to cure – this old adage is especially true in medicine. Many chronic diseases can be avoided by using conscious prophylaxis. This also applies to stroke, a serious disease considered to be the third leading cause of death in the world. In Poland, on average, someone experiences a stroke every eight minutes. Every year there are approximately 70 cases of this disease and approximately 000 deaths caused by it. In order to change these unfavorable statistics, medical education is needed and the resignation from the previous harmful habits is needed.
What is a stroke
This disease has not appeared in the present day, it has been known since the times of Hippocrates as apoplexy and consists in a sudden reduction in oxygen supply to the brain. There are two types of stroke: ischemic stroke and hemorrhagic stroke. The most common is ischemic stroke (70-80 percent of all cases). It is caused by the obstruction or narrowing of the intracerebral or extra-cerebral vessels that carry blood to the brain, or a slowdown in cerebral flow of various haemodynamic causes. As a result, the brain’s nerve cells are cut off from oxygen and other nutrients, and they die. The ischemic area depends on the size of the blocked vessel.
There are three main causes of ischemic strokes: 1. A clot of a large artery – in this case, the stroke is mainly caused by atherosclerosis. Atherosclerosis is a chronic inflammatory process of the walls of arteries, which causes the deposition of characteristic atherosclerotic plaques within the walls. Over time, the vessel narrows and closes, resulting in tissue ischemia and hypoxia. The development of atherosclerosis is favored by: age (over 45 years for men and over 55 years for women) and genetic predisposition to early atherosclerosis (under 55 in men and under 65 in women). These are factors beyond our control and cannot be modified. We can influence other risk factors. The most important of them are: improper diet, smoking, low physical activity, high blood pressure, lipid disorders (low HDL – good cholesterol – high LDL – bad cholesterol and high triglycerides), glucose metabolism disorders, obesity.
2. Small artery disease – is one of the most common causes of ischemic strokes. In this case, we are not dealing with atherosclerosis, but with the sclerosis of small vessels in the brain. Their walls become thick and hard, and the vessel’s lumen becomes narrower. Hardened vessels contract very poorly, therefore only the force of contraction of the heart muscle becomes responsible for blood circulation. Many diseases, including high blood pressure and diabetes, can damage the small arteries in the brain and cause small strokes. If the blood pressure and glucose levels are not regulated, more and more ischemic outbreaks may develop.
3. Heart embolism – there are many links between heart disease and cerebrovascular disease. Certain heart diseases can cause clots to form inside the heart. Part of the thrombus can break off, flow down the bloodstream to various organs and become the cause of an embolism, i.e. blockage of a blood vessel, most often the brain. Blood clots in the heart can be caused by arrhythmias and atrial fibrillation. Also, a heart attack, a defect in the valves, or the presence of artificial heart valves can form a thrombus.
Atrial fibrillation affects one in four people over the age of 40. It is the most common heart rhythm disorder found in adults worldwide. Atrial fibrillation is a special risk of stroke. Every year, 3 million people develop a stroke as a result of atrial fibrillation. Due to abnormal atrial contraction, blood collects outside the main flow stream. The parts of this residual blood stick together and form clots. Sometimes the clots break off, travel with the bloodstream and block in a blood vessel, blocking the blood flow. If it is a cerebral vessel, then cerebral hypoxia and stroke occur. Therefore, atrial fibrillation, even if it does not cause troublesome symptoms, needs to be treated. There are different treatments for people with atrial fibrillation. Your doctor may recommend medications to lower the heart rate – they restore the heart rhythm to normal and also prevent dizziness. Another method of treatment is cardioversion, which uses an electrical pulse or special anti-arrhythmic drugs to restore the heart’s normal rhythm. On the other hand, anticoagulants work by thinning the blood and preventing blood clots, reducing the risk of having a stroke. Anticoagulants are the cornerstone of the treatment of atrial fibrillation.
Stroke – hemorrhagic stroke
This type of stroke is less common than ischemic, and accounts for 10-20 percent of the cerebral vascular disease. As a result of a cerebral haemorrhage, the most common is an intracerebral haemorrhage, which is a consequence of a vessel rupture. The main causes of intracerebral haemorrhage are hypertension, old age, smoking, alcohol abuse, but also vascular deformation, brain tumors, the use of drugs that stimulate the central nervous system and overdose of drugs that dissolve clots (anticoagulants and thrombolytic drugs).
Another form of hemorrhagic stroke is subarachnoid haemorrhage. In this case, blood is poured into the subarachnoid space, which is located between the spider and soft dura. Generally, the cause is an aneurysm rupture, most often located in the major vessels of the brain or their branches. Aneurysm, i.e. dilated lumen of the artery, is formed in places where the vessel wall is defective. The tendency to form aneurysms can be familial.
Medicine also distinguishes mini-strokes, or transient ischemic attacks, the symptoms of which disappear fairly quickly, but which can be a harbinger of a major stroke. Therefore, it is worth informing your doctor about them.
How to recognize a stroke
It appears unexpectedly, and its most common symptoms are:
– sudden numbness or weakness of the muscles in the face and limbs, usually on one side (hemiplegia);
– sudden puckering of the mouth
– sudden changes in consciousness or feeling confused
– sudden difficulty speaking or understanding speech
– sudden trouble with uni- or binocular vision
– sudden loss of balance (problems with walking, coordination of movements, dizziness)
– sudden severe headache, nausea and vomiting.
The symptoms of a stroke may not all occur at the same time. If we observe any of the above-mentioned symptoms in a person around us, we should immediately call an ambulance. Every minute counts with a stroke, just like with a heart attack. The sooner a patient is admitted to hospital, the more likely he or she is to receive treatment that will reduce the effects of a stroke.
Diagnosis and treatment
After conducting an interview with the patient (if his condition allows it) or with witnesses of the incident, the doctor determines the time from the appearance of the symptoms until the patient is brought to the hospital. The choice of treatment method depends on it. The patient must undergo a neurological examination, and also tests of cardiac function, blood pressure, carotid flow and respiratory system are performed. If the doctor suspects a stroke, he or she orders a computer examination or MRI of the head. These tests can help you identify a stroke and find out what’s behind it. It is very important to make a diagnosis as soon as possible and implement appropriate treatment to restore blood flow in the ischemic area. In the case of an ischemic stroke, this is the administration of thrombolytic drugs (that dissolve the clot), and in the case of a hemorrhagic stroke, surgery may be necessary. However, thrombolysis can only be used up to 4,5 hours after the onset of the first symptoms of a stroke. That is why it is so important to call an ambulance quickly.
In addition to administering drugs and surgical treatment, rehabilitation is extremely important. It should be started as soon as possible, already on the first day of a stroke. Early initiation of rehabilitation reduces the risk of non-cerebral complications related to the patient’s immobilization. Rehabilitation stimulates the phenomenon of brain plasticity and reduces symptoms of motor deficit, improves efficiency, muscle strength, everyday functioning, prevents muscle contractures and depression. Speech rehabilitation and talking to a psychologist play an important role. Recovery is favored by proper care (helping the sick person, but not relieving them) and the support of their relatives.
The effects of a stroke
Rehabilitation is about reversing or reducing the effects of a stroke, which can vary depending on the cause of the stroke. Most often it is motor disability, inability to make a deliberate gesture and impaired body balance. It is caused by paresis or paralysis on one or both sides, increased muscle tension, disturbance of deep sensation (this is the sense of the position in which a given part of the body is located, also with eyes closed). Another effect of a stroke may be a hemifacial disturbance of surface sensation, which manifests itself as a disturbance in the sensitivity and different perception of certain stimuli, e.g. pain or temperature. A common consequence of a stroke is aphasia, which is a disorder in the understanding of speech, the inability to say words and sentences, or a combination of both. Other consequences of a stroke include:
– visual disturbance (hemianopia, double vision)
– apraxia (a neurological disorder involving, among others, the inability to perform precise, previously performed movements)
– amnesia (disturbances in the ability to remember new information)
Behavioral disturbances (e.g., failure to cope with daily activities, spatio-temporal disorientation or memory impairment)
– mental disorders (depressive syndrome and others)
– tiredness and mood swings.
All these effects of a stroke interfere with the normal functioning of the body and therefore can cause depression, sudden outbursts of anger and a decrease in self-esteem.
Prevention of cerebral hemorrhages
Stroke is the most common cause of permanent disability in people over 40. The incidence of stroke in Poland remains at the average European level. On the other hand, mortality rates in patients with stroke are unfavorable (106 / 100 men and 000 / 79 women) and are among the highest in Europe). The issue of disability in stroke survivors is even worse, as it affects as many as 100 percent of patients (000 percent in developed countries). Thanks to the dynamically developing network of Stroke Units in Poland, the situation of patients after a stroke has improved significantly. However, only medical education and prevention of this disease can contribute to the decline in stroke incidence.
By following these recommendations, you will greatly reduce your risk of stroke:
– control blood pressure and keep them normal (120/80 mmHg). Reducing the systolic blood pressure by 20 mm Hg and diastolic blood pressure by 10 mm Hg reduces the risk of stroke by more than 40 percent
— if you feel palpitations, check the EKG. Irregular heartbeat can be a symptom of atrial fibrillation. The incidence of this disease increases with age – it occurs in 10 percent of people over the age of 80
– maintain a healthy body weight
– eat healthily
Based on many studies and observations, nutritionists considered the so-called Mediterranean diet. Its basic assumptions are: the elimination of animal fats in favor of vegetable ones, limiting animal protein and, at the same time, increasing the amount of fish, vegetables and fruits. A recent study published in Sweden found that eating red meat (pork and beef) significantly increases the risk of stroke.
– be physically active
Already in the XNUMXth century, the court physician of Stefan Batory, Wojciech Oczko, said: “Movement is able to replace almost any drug, but all drugs taken together will not replace exercise.” This maxim has not lost its relevance. The beneficial effects of moderate exercise on health have been proven in many studies.
– control sugar levels
– do not abuse alcohol
There is ample clinical evidence showing an increased risk of stroke in heavy drinkers.
– do not smoke
Numerous scientific studies have proven that stroke (especially ischemic) in smokers is much more common than in non-smokers. A reduction in the risk of this disease was observed as early as 2 years after smoking cessation.
– reduce stress
Stress promotes a stroke in many ways. Chronic or too strong stress causes arteries to contract, raises the level of sugar and fats in the blood, accelerates the process of atherosclerosis, as a result of which the vessels are increasingly damaged. In addition, stress raises blood pressure, but sometimes it also lowers it very much. Both situations can contribute to a stroke occurrence. Summing up, we can say that we prevent stroke by leading a healthy lifestyle that includes proper nutrition, daily physical activity, not smoking and not consuming alcohol, and coping well with stress. A similar prophylaxis should be implemented after a stroke, to prevent another stroke.
On May 10, for the first time in Poland, we will celebrate the European Day of Stroke Prevention.
Find information on the websites: www.stopudarom.pl
www.fum.info.pl