What is a stroke and how is it treated?

Stroke is an acute disorder of cerebral (brain) circulation due to blockage or rupture of blood vessels. After a vascular accident, neurological symptoms develop within a few minutes or hours, which progress, sometimes leading to death. Recently, cases of stroke have become more frequent at a young age, up to 30 years.

Short information about stroke

Kinds of strokes

The main classification of strokes takes into account the cause and mechanism of stroke.

- Ischemic stroke is characterized by the cessation of blood flow to the brain tissue. The reason is impaired blood flow, clogging or narrowing of an artery with a thrombus and/or an atherosclerotic plaque (atherothrombotic), vasospasm, and a decrease in pressure. It develops more often at the age of 50-69 years. The incidence is 64-75% among all types of stroke.
- Hemorrhagic stroke is a hemorrhage into the substance of the brain or under the arachnoid membrane due to rupture of a vessel as a result of high blood pressure, atherosclerosis, vasculitis, aneurysms, or coagulation disorders. The high-risk group includes patients aged 50-69 years. At 39-49 years old it is less common. The incidence is 15-20% among all types of stroke.

There are classifications in which types of stroke are distinguished, taking into account other signs:

1. By severity:
- Minor, including a microstroke (transient ischemic attack) - a passing disorder of cerebral circulation with complete disappearance of neurological symptoms within 1 day to 3 weeks;
- Moderate;
- Severe, extensive cerebral stroke - lesion of a large area with pronounced neurological symptoms and severe condition, sometimes with falling into a deep coma.
2. By location - left or right hemisphere. Each side of the brain is responsible for different functions, so the symptoms will be different. For example, if the left half is affected, the movements of the right side of the body suffer, speech and memory are impaired. The person loses the ability to read and write. With the damage to the right hemisphere, the movement of the left side of the body is disturbed, the perception of oneself, one's body, the surrounding space, mental disorders develop.
3. In terms of quantity - primary stroke (first) and repeated strokes (second, third, fourth). Repeated strokes are more severe because the lesion focus increases each time.
4. By age - in children, starting from the prenatal period, young, elderly. The severity of clinical manifestations and prognosis depend on the age of the patient, the cause of concomitant pathology, and the timeliness of diagnosis. The most difficult prognosis for late detection of a stroke, a large size of the focus, a weakened body due to concomitant diseases, bad habits, vitamin deficiency.
5. By localization:
- In the vertebrobasilar basin with damage to the occipital lobe of the brain, cerebellum and trunk - visual impairments develop, gait changes;
- Frontal lobes - speech, swallowing suffers;
- Temporal lobes - memory, writing, speech deteriorates;
- Parietal lobe - speech and speech understanding suffers.

Development and risk groups

A sharp increase in blood pressure, physical exertion, and emotional overstrain can lead to the development of a stroke. In such situations, a vessel ruptures with subsequent hemorrhage or spasm with ischemia. Predisposing factors are diabetes mellitus, high cholesterol levels, diseases of the heart, blood vessels and blood, excess weight. Vessels in these diseases lose their elasticity, their wall stretches. People who or their close relatives have had a stroke or heart attack should be especially careful.

There are scales by which the degree of risk of developing a stroke is determined: the Framingham scale for assessing the individual risk of developing a stroke, the questionnaire of the London School of Hygiene on cardiovascular diseases by J. Rose.

Having passed such testing, you can identify the degree of risk, undergo an examination and a course of treatment in a timely manner, while your health has not suffered.

Stroke risk groups

- By age and gender - the likelihood of stroke increases after 30 years. Ischemic stroke occurs more often in men aged 50-69 years. The incidence of hemorrhagic stroke before 60 years in men and women is the same, then it is higher in women;
- By lifestyle - an unfavorable factor is inactivity/sedentary lifestyle, bad habits, stress, hard physical labor. These factors worsen health, provoke chronic diseases of the heart and blood vessels.

First signs and symptoms

Before a stroke, drowsiness, headache, numbness of the limbs, fatigue, flies before the eyes, nausea, dizziness, body temperature and blood pressure fluctuates. These are the harbingers or first signs of a stroke that appear several hours or days before the disaster. Most often, these symptoms are ignored, or they are attributed to fatigue and overwork.

Symptoms of a stroke itself are divided into cerebral and focal. They can be of varying severity depending on the prevalence of the pathological process.

- General cerebral symptoms: headache, impaired consciousness up to loss of consciousness, deafness, agitation or weakness, disorientation in space and time, sweating, feeling of heat, convulsions, drowsiness, sometimes chills.
- Focal disorders in stroke depend on which area of the brain is affected. They can be unilateral or bilateral. This group includes disorders of speech, vision (visual hallucinations), gait, movements (up to paralysis), and sensitivity.

Symptoms of ischemic cerebral stroke develop gradually, with focal symptoms prevailing.

With hemorrhagic stroke, the onset is rapid, with a predominance of cerebral symptoms.

There are several stages in the development of a stroke: an acute period (from the moment of impact to 3 weeks on average), a recovery period - from 2 weeks to 24 months.

What to do with a stroke?

There are techniques that allow you to identify the signs of a stroke on your own. For example, they can be applied if someone on the street becomes ill and you suspect a stroke. You need to ask the person to smile, speak, raise both hands. If the victim cannot fulfill your request or there is an asymmetry, you should immediately call for help and list all the symptoms.At the same time, first aid must be provided: lay the victim, placing a small support under their head, free them of clothes that interfere with breathing. They should not eat and drink, make sudden movements. If a person vomits, turn their head to the side.

Further treatment is carried out in a hospital. First, diagnostics are carried out to clarify the diagnosis, computed and magnetic resonance imaging, lumbar puncture and EEG (echoencephalography), angiography are appointed. Then conservative (basic therapy, treatment of neurological complications) or surgical treatment is appointed.

The medicines for stroke include:

- Drugs to normalize blood tension (especially in hemorrhagic stroke and less commonly for ischemic);
- Drugs to improve the permeability of the blood vessels walls,
- Medicines to promote blood coagulation (hemorrhagic stroke) and blood thinners in ischemic stroke;
- Drugs improving blood properties (blood viscosity, plasma viscosity, etc.);

Painful spasms and movement disorders are the most frequent aggravations of a stroke and they also require the use of certain medicines. For instance, in paresis, i.e. a paralysis or painful constant spasm of limb muscles, muscle relaxers such as Tizanidine are used.

After the end of the acute period, rehabilitation is prescribed: massage, physiotherapy exercises and other activities, depending on the degree and type of violation. The patient is observed by a neurologist, physiotherapist, speech therapist, and psychotherapist.

The brain is neuroplastic: with the right approach, a person can recover from a stroke, restore brain function, and prevent the complications of stroke. The key factor is the timely start of treatment, competent rehabilitation and regular exercise.

According to the WHO, about 60% of patients by the end of the first year do not need outside help, and 30% of patients of working age can return to work.

Prevention of stroke

- Primary prevention consists of proper nutrition, exercise, elimination of bad habits and stress, adequate sleep and rest, regular medical examinations.
- Secondary prevention of stroke includes the elimination of risk factors - treatment of comorbidities, regular observation by the attending physician, elimination of risk factors. This approach will help not only prevent stroke, but also improve overall health. According to WHO estimates, the creation of an adequate system of care for patients with stroke will allow in the coming years to reduce mortality during the first month of the disease by 20% and ensure independence in everyday life 3 months after its onset in at least 70% of patients.

Frequently asked questions

What is the difference between a stroke and a heart attack?

A cerebral infarction is one of the types of stroke and it is ischemic in nature, i.e. accompanied by the cessation of blood flow to the brain. A characteristic feature is the gradual development of the clinical picture and the predominance of focal symptoms: disorders of speech, vision, gait, movements up to paralysis, sensitivity.

Can stroke and infarction (heart attack) happen at the same time?

If we consider only the brain, there is a mixed stroke, when both hemorrhage and ischemia appear in the causes of the development of a stroke. They can occur simultaneously when a vessel ruptures in one area and blood flow stops in another. Also, ischemia can develop at the site of subarachnoid hemorrhage after a while.

If we consider a heart attack as a heart disease, then these conditions can also be diagnosed simultaneously. Moreover, a stroke can develop as a result of a heart attack: the functioning of the heart suffers, the blood enters the brain in insufficient quantities. This is how we get a stroke.

Does a stroke only happen to the brain?

Stroke (Latin insultus "swoop, attack, blow") is an acute disturbance of the blood supply to the brain due to ischemia (infarction, heart attack) or hemorrhage. If ischemia occurs in other organs, it is also called a ischemia/infarction. For example, myocardial infarction, intestinal infarction, kidney, etc. It is characterized by severe pain, dysfunction of the affected organ and other symptoms.

Is there a stroke at normal or low blood pressure?

Arterial hypertension is one of the main, but not the only, causes of stroke. A risk factor is also thrombosis, atherosclerosis, diabetes mellitus, in which the pressure is normal and even reduced. In addition, at low pressure, the brain is not adequately supplied with oxygen, which is a prerequisite for the development of ischemic stroke.

Can children have a stroke?

Stroke is also diagnosed in children. It can develop even in the perinatal period. Causes: abnormalities in the coagulation system, pathology of the cardiovascular system, including vascular malformations, bad habits in the mother during pregnancy, oxygen starvation during childbirth, trauma.
In the perinatal period and up to a year, the disease is accompanied by anxiety, frequent crying, impaired appetite, impaired reflexes of the neonatal period, strabismus, convulsions. The diagnosis is made on the basis of examination by a pediatric neurologist, ultrasound of the brain, and tomography results. At an older age, symptoms are similar to those of stroke in adults.

The child's body is more plastic and amenable to therapy faster. The main thing is to diagnose a stroke on time and start treatment.

Can a stroke go away on its own?

There is such a condition - a transient stroke. It is accompanied by a short-term impairment of blood circulation, while there are no irreversible changes in the brain tissue. The external manifestations of such a stroke are the same as in a normal stroke, but less pronounced: headache, dizziness, darkening in the eyes, changes in sensitivity in various parts of the body. And they pass within 24 hours. Nevertheless, the condition requires qualified treatment and rehabilitation, elimination of risk factors, because in the future there is the likelihood of a secondary stroke.

At what pressure can there be a stroke?

A stroke can develop at any pressure. Arterial hypertension (high blood pressure) is the cause of hemorrhagic stroke, hypotension (low blood pressure) of ischemic.

Do pine cones help prevent stroke?

Pine cones lower blood pressure, so they should not be consumed for hypotension. The effect is due to the tannins found in the buds. The composition also contains vitamins C and P - they strengthen the walls of blood vessels and improve blood circulation. The expediency of using herbal products is taken by the attending physician after a detailed examination. In general, pine cones or any other natural remedies for stroke can only be used as a complementary method.

Post by: John Avery, General Practitioner, Manchester, United Kingdom