Stroke

introduction

At a Stroke (Synonyms: stroke, Insult, apoplexy) it occurs because of a Circulatory disorder of blood vessels in the brain to an insufficient supply of downstream areas of the brain with blood and oxygen.

The circulatory disturbance leads to different depending on the localization neurological failures, such as to a Hemiplegia or one Hemiplegia, a weakness or even paralysis of an individual extremity, weakness or paralysis Half of the face, to Sensory disturbances one extremity or the entire half of the body (for example Numbness), to Visual disturbances or to Speech disorders.

Typically, the symptoms appear suddenly. A stroke lies in 80%of the cases Occlusion of a blood vessel, a so-called Ischemia underlying (ischemic stroke).

In approximately 20% of the falls is one Cerebral hemorrhage the cause of the circulatory disorder (hemorrhagic stroke). Since the affected brain area dies without the supply of blood and oxygen, the diagnosis must be made quickly and therapy initiated immediately. Depending on the genesis of the stroke, different therapy concepts can be considered.

root cause

A stroke leads to a circulatory disorder in the brain and, as a result, to an undersupply of brain tissue with blood and oxygen.

In over 80% of cases, the circulatory disorder is based on an acute occlusion of a blood vessel. This is known as an ischemic stroke. Often the reason for the occlusion of a blood vessel is pronounced calcification (arteriosclerosis), in which so-called plaques massively narrow the lumen of a blood vessel. If these plaques tear open over time, blood clots, so-called thrombi, can be deposited and the blood vessel narrowed further or even closed completely. If the thrombus has formed outside of the brain and has been washed into a cerebral vessel via the bloodstream, it is called an embolism.

Other less common causes of a cerebral vessel obstruction are, for example, inflammatory changes in blood vessels in the brain, so-called Vasculitis.

In about 20% of cases, the stroke is caused by a cerebral hemorrhage. A stroke due to a hemorrhage in the brain is called a hemorrhagic stroke designated. The most common cause of hemorrhagic stroke is the arterial hypertension (arterial high blood pressure), which leads to long-term damage to the small vessels and makes them porous. One of the common causes is the so-called. Aneurysm, a bulging of a blood vessel which, when torn, leads to massive bleeding into the brain.

Read more on this topic: Brain artery aneurysm, what are the consequences of a cerebral hemorrhage

Furthermore, taking blood-thinning medication, such as Marcumar® from the group of Anticoagulants, Be the cause of a brain hemorrhage.

In rarer cases, congenital coagulation disorders, vascular malformations or brain tumors are the cause of a hemorrhagic stroke.

In addition to arterial hypertension, important risk factors for a stroke are obesity (overweight), diabetes mellitus (high blood sugar), stimulants such as nicotine and alcohol, stress and previous illnesses such as a heart attack or cardiac arrhythmias, especially atrial fibrillation.

Read more about this under: Causes of a stroke

Symptoms

In the event of a stroke, a circulatory disorder of blood vessels in the brain leads to an insufficient supply of downstream brain tissue with blood and oxygen. Since each section of the brain is responsible for a specific function of the body, depending on the localization of the circulatory disorder, the affected person can experience a wide variety of symptoms with different degrees, so-called neurological deficits.

The characteristic symptoms of a stroke include hemiplegia (Hemiparesis) or hemiplegia (Hemiplegia), weakness up to paralysis of a single extremity, weakness or paralysis of one half of the face (Facial palsy), Sensitivity disorders of one extremity or the entire half of the body (for example numbness of one extremity), visual disorders (for example visual field defects or reduced vision) and speech disorders (slurred, slurred speech).

Typically, the symptoms mentioned appear all of a sudden "in one fell swoop". In some cases, only unspecific complaints, such as dizziness, unsteadiness to walk and stand (Ataxia), Headache, confusion, drowsiness or loss of consciousness, which makes it much more difficult to recognize the stroke.

The symptoms vary depending on where in the brain the stroke occurs. A stroke in the cerebellum, for example, shows quite different symptoms. Read about this: Cerebellar infarction

You can also find out more at:

• Which symptoms can be used to recognize circulatory disorders in the brain?
• Impaired vision after a stroke

Signs and harbingers

A short-term appearance of the characteristic symptoms, such as weakness or paralysis of a single extremity, half of the face or the entire half of the body, as well as sensory disturbances of one extremity or the entire half of the body, visual disturbances and speech disturbances is considered to be a harbinger of a stroke and, depending on the duration of the symptoms, becomes transitory ischemic Attack (TIA) or known as a minor stroke. Both forms are characterized by the fact that the symptoms completely recede after a certain time. By definition, it is a TIA if the neurological deficits have completely regressed within an hour, in the case of a minor stroke, those affected are symptom-free again within seven days.

Signs of a TIA or a minor stroke should still be taken seriously, as the risk of suffering a stroke after a TIA or a minor stroke is increased by almost 20%. A TIA or a minor stroke should definitely be treated, as appropriate therapy can significantly reduce the risk. The therapy of a TIA or a minor stroke corresponds to that of an ischemic stroke.

Read more on the subject at: Signs of stroke, transient ischemic attack

diagnosis

A stroke is one emergencyTherefore, if you have the slightest suspicion of a stroke, you should definitely consult a doctor. An early diagnosis and an immediate one Start of therapy can improve the prognosis and positively influence the course of the disease.

In order to make a diagnosis, a detailed anamnesis is required, which means a detailed questioning of the person affected or relatives about underlying diseases, for example arterial hypertension or Cardiac arrhythmias, as well as current complaints. This is followed by a physical examination of the person concerned, paying particular attention to the neurological failures described by the person concerned, such as weakness or paralysis a single limb, half of the face or the entire half of the body, as well as sensory disturbances of one extremity or the entire body half, visual disturbances and speech disturbances are taken into account.

The cause of a stroke is usually a blockage of a blood vessel, which is known as ischemic stroke designated. However, in some cases Cerebral hemorrhage Reason for the stroke, one then speaks of hemorrhagic stroke.

Since the therapy of an ischemic stroke differs from that of a hemorrhagic stroke, it must first be investigated what type of stroke it is. Imaging methods are used for this, especially the Computed Tomography (CT) for use. With the help of CT, cerebral hemorrhage can quickly be ruled out and suitable therapeutic steps initiated. In some cases, another investigation is one CT angiography required. With a CT angiography blood vessels in the brain can be displayed and a possible occlusion of a blood vessel can be precisely localized. Additional examinations, which are usually carried out during the course of the disease and are used to find the cause, are Blood tests, a electrocardiogram (EKG), a Cardiac ultrasound (TEE or TTE), as well as one Ultrasound examination of the neck vessels.

therapy

In the event of a stroke, a circulatory disorder of blood vessels in the brain leads to an insufficient supply of downstream areas of the brain with blood and oxygen. It is an emergency that requires immediate therapy to keep the damage to the brain tissue as low as possible. Depending on the cause of the stroke, different therapy concepts can be considered.

The more common form of stroke, ischemic stroke, is based on the occlusion of a blood vessel with a blood clot. The therapy aims to dissolve the blood clot and thus open up the blood vessel and restore blood flow. This is done using a so-called Lysis therapy. During a lysis, drugs from the group of Fibrinolytics, for example rtPA or alteplase, which dissolve the blood clot and restore blood flow to the brain tissue. In addition, after a careful risk-benefit assessment, a Thrombectomy in which the blood clot is surgically removed.

If the stroke is caused by cerebral haemorrhage, under no circumstances should lysis therapy be used, as this would increase the bleeding. Instead, special attention should be paid to lowering blood pressure. In some cases, surgery is required to stop the source of the bleeding.

With both forms of stroke, monitoring is required on a special ward, the so-called Stroke Unit recommended. Continuous monitoring of the cardiovascular function is guaranteed here. The Stroke Unit Rehabilitation measures started early to avoid stroke complications, such as disability and the need for care. Rehabilitation should be continued in a suitable clinic after the hospital stay.

Read more on the topic:

• Stroke therapy
• Stroke measures

forecast

The prognosis of a stroke is very variable and depends on the location and the extent of the brain damage. Often the symptoms from the stroke are completely reduced, but there can also be a strong need for care. In some cases, a stroke can be fatal. An early diagnosis and a quick start of therapy, as well as preventive measures if a stroke has already occurred, the prognosis can be significantly improved and the course of the disease can be positively influenced.

Read more on the topic: What are the chances of recovery after a cerebral hemorrhage? and healing after a stroke

Complications and consequences

The most common and most important consequences of a stroke are lifelong handicap, need for care, bed restraint, disability and incapacity for work, which leads to a massive impairment of quality of life, especially for young people. Some people also develop depression due to the loss of body functions. Due to the early use of rehabilitation measures such as physiotherapy and speech therapy measures still on the Stroke Unit attempts are made to prevent the complications of disability, need for care, bed restraint, disability and incapacity for work.

The restriction of mobility after a stroke can also lead to leg vein thrombosis and, as a result, to a life-threatening pulmonary embolism, which is why bedridden patients should always be treated with heparin.

In some cases, a stroke can result in difficulty swallowing. In the case of swallowing disorders, food or liquids can be swallowed into the airways, which is known as aspiration. Aspiration of food components can lead to pneumonia and even suffocation. In some cases, feeding a tube may be necessary.

The brain damage can also lead to epileptic seizures after a stroke, which should be treated with medication.

Find out more about this topic at: These are the consequences of a stroke!

Death from stroke

About 10% of all strokes are fatal. The brain tissue damaged by the stroke can swell very strongly, which leads to increased intracranial pressure, which can ultimately lead to death by pinching brain tissue.

Read more on this topic: What happens when you die?

prophylaxis

To prevent a stroke, risk factors for a stroke, such as arterial hypertension, Obesity, Diabetes mellitus, Luxury foods like nicotine and alcohol and stress, be avoided.

That means, Blood pressure and Blood sugar should be optimally adjusted and excess weight should be reduced. Nicotine and alcohol should be avoided and one should pay attention to a conscious diet and exercise regularly.

If you have already had a stroke and you want to prevent another stroke, you should take Acetylsalicylic acid (ASS), a so-called Antiplatelet drugs and from one Statin, which one Cholesterol levels lowers, recommended. These drugs improve the flow properties of the blood and have been shown to reduce the risk of having another stroke.

Depending on the cause of the stroke, further measures such as a therapy With Anticoagulants or operative interventions be useful.