Stroke or stroke

It is a non-convulsive focal cerebral affectation of 24 hours of evolution with visible lesion by head CT or brain MRI (definition of the WHO). It represents the third cause of mortality in developed countries. The incidence is approximately 200 cases / 100,000 inhabitants / year, and is higher after 55 years. It is especially serious in women.

How it is produced

Cerebrovascular accidents (CVA) are produced by an alteration, transitory or not, in the functioning of one or more areas of the brain due to a circulatory disorder. This can be due to an arterial occlusion (ischemic) or due to an arterial rupture (hemorrhagic).

When neurological dysfunction produces symptoms of less than 1 hour and there is no evidence of injury on neuroimaging tests, it is defined as a transient ischemic stroke (TIA). It is a situation that requires immediate attention as it is a precursor injury to non-transitory cerebrovascular accidents (stroke). This risk increases mainly during the first week, especially in the first 48 hours.

There are risk factors associated with cerebrovascular disease, distinguishing between modifiable and non-modifiable factors.

Non-modifiable risk factors:

• Age: The risk of stroke doubles every decade after the age of 55
• Race: higher incidence in African Americans and Hispanics.
• Sex: increased in males, but more disabling and fatal in females.
• Genetic factors

Modifiable risk factors:

• : it is the main risk factor in both ischemic and hemorrhagic accidents. Better control of HT in recent years has contributed to a decrease in stroke.
• : due to an increase in vascular risk factors (hypertension, dyslipidemia (alteration in lipids), obesity.
• smoking: double risk of ischemic stroke; associated with HT, the risk increases up to 20 times.
• Dyslipidemia
• Obesity: especially abdominal and more in women
• Alcoholism: increased risk of hemorrhagic stroke
• Drugs: cocaine, amphetamines, increased risk up to 7 times more
• Coagulation disorders
• Cardiac disorders: Chronic atrial fibrillation, increasing the formation of cardiac emboli that break off and cause cerebral infarcts.
• Carotid stenosis (total or partial occlusion)

Symptoms

It will depend on the location of the cerebral infarction that one or the other symptoms occur. Symptoms appear that will affect the mobility of the upper and lower extremities, the sensitivity of these territories, walking, language disorders, of or of their own body, visual disturbances, etc. Many symptoms can appear, and very often associated with each other.

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Diagnosis

It is very important to take a complete cynical history as detailed as possible. Ask about the time of onset of the symptoms, the form of onset, the duration, the evolution, the triggers followed by a precise neurological and cardiovascular examination.

Complementary examinations initially include a glucose, a, blood oxygen saturation, axillary temperature, and an urgent cranial CT scan.

Cranial CT is the technique of choice in all patients with an acute onset neurological deficit. It allows ruling out hemorrhagic strokes, as well as non-vascular brain injuries such as tumors or bruises. Other tests to perform depending on the patient's symptoms are:

• Doppler ultrasound of the supra-aortic trunks: suspected carotid artery occlusion
• Transcranial Doppler Ultrasound
• Brain MRI
• Angioresonance or conventional angiography
• Transthoracic echocardiogram
• Holter study

Treatment

In the acute phase of ischemic stroke, fibrinolysis (rt-PA) is available, the objective of which is to restore vascular flow, limit brain damage and avoid complications of stroke, by pharmacological rupture of the thrombus that has caused vascular occlusion.

The indications for treatment with fibrinolysis are: age over 18 years, onset of symptoms less than 3-4.5 h prior to treatment, clinical diagnosis of cerebral ischemic infarction and symptoms present for at least 30 minutes that do not improve before starting the treatment.

Subsequent treatment will include the use of antiplatelet agents (aspirin) or oral anticoagulants (sintrom). The latter in those cases of ischemic strokes of cardioembolic cause as well as for the prevention of the appearance of medical complications.

Correcting modifiable risk factors is vitally important:

• Control of blood pressure figures
• Control of cholesterol levels
• Control of blood glucose levels
• Tobacco cessation
• Carrying out regular physical exercise.
• Avoid being overweight and.

Dra. Laura Cristel Ferrer Family and Community Medicine Specialist