What exactly is a stroke? - Definition and prevention

Causes

In about 80% of cases, the cause is the thrombotic occlusion - a blocked blood vessel. This form of apoplexy is also called ischemic (white) stroke. This can occur, for example, as a result of vascular calcification (atherosclerosis) or an unattached blood clot (embolus). Strokes due to intercerebral hemorrhage, a hemorrhage in the brain, is less likely to occur and is referred to as hemorrhagic (red) stroke.

Course

In case of a stroke, the brain is no longer sufficiently supplied with oxygen and other nutrients. With this massive malfunction of the brain, the brain tissue can die due to the lack of oxygen after ten to fifteen minutes.

If this condition persists for an extended period of time (more than 24 hours), the gray cells in the affected area on the brain will not receive enough oxygen or nutrients and will die as a result of a lack of supply. Whether the affected area in the brain loses its function permanently or only temporarily depends greatly on how long and to what extent the blood supply to the brain is impaired.

If these symptoms disappear within 24 hours, one speaks of a transient (transistoric) ischemic attack (TIA) or a "mini stroke". It is important that, in any case, whether it is a TIA or a stroke, the emergency physician has to be alerted immediately.

After a TIA, the risk of a stroke is significantly increased. If the risk factors are not adequately reduced and no medical treatment is provided, the TIA may reoccur and eventually progress to a stroke.

Symptoms

The symptoms of a stroke are diverse. Hemiparesis (incomplete paralysis of one half of the body) and monoparesis (paralysis of a single limb) are quite common. Those affected often suffer from apraxia (disturbance of actions or movements) and transient visual disturbances as well as aphasia (central speech disorder). The symptoms can last from a few minutes up to 24 hours. When these symptoms occur, whether it is due to a TIA or a "major" stroke, hospitalization is required in any case.

Physical symptoms include:

• Hemiplegia (complete paralysis of the body)
• Hemiparesis (incomplete paralysis of one half of the body)
• Monoparesis (paralysis of a single limb)
• Equilibrium and support reactions are disturbed

-> The affected person can neither sit upright nor stand

• an eyelid hangs
• the face is asymmetric as a result of facial nerve paralysis
• one-sided limp hanging corner of the mouth
• acute circulatory failure
• Tongue musculature is paralyzed
• Dysphagia or paralysis
• the person has extreme, sudden headaches
• no control over urine and stool
• irregular breathing

Mental symptoms:

• depression
• aggressive behavior
• memory problems
• anxiety / panic
• hazy consciousness / unconsciousness
• confusion
• fragility
• inability to recognize one's own illness or functional failures

Neurological symptoms:

• salivation from the corner of the mouth of the paralyzed side
• dizziness
• elevated blood sugar level
• arrhythmia
• sweat
• frequent yawning

With the help of the "FAST" test, a stroke can be detected quickly:

• Face (face, hanging corner of the mouth)
• Arm (arm or leg can not be moved)
• Speech (slured, faded language)
• Time (call ambulance immediately)

Do not hesitate to call the ambulance! The consequences of one or more false alarms are less severe than the consequences of a stroke, that has been treated to late.

Diagnosis and treatment

Since every stroke is an emergency, it always requires immediate treatment. The emergency physician first checks the vital functions of the patient and, if the affected person is responsive, asks for the symptoms that have occurred. Arriving at the hospital, the responsible neurologist will check the stroke patient for the ability to coordinate, the ability to see, touch and speak as well as the sensibility of touch.

This is followed by creating a reliable diagnosis using imaging techniques such as a computed tomography of the head (also called cranial CT) or a magnetic resonance imaging (MRI). The CT images of the inside of the skull provide information on whether the stroke was caused by a cerebral hemorrhage or occlusion of the vessels. CT is usually complemented by blood perfusion (CT perfusion) and vessel imaging (CT angiography).

Furthermore, the function or performance of the heart must be comprehensively examined. This is done by electrocardiography - an ECG. Finally, the following blood tests are carried out additionally: the electrolyte balance, kidney levels, blood glucose levels, blood coagulation and blood count to confirm the apoplexy.

It is important that every stroke is treated as quickly as possible to minimize the extent of potential consequential damage. In the best case, the person concerned will be treated by staff with stroke expertise in what are known as stroke units.

The two types of stroke require different treatment methods.

In the treatment of a hemorrhagic stroke, which has occurred due to a cerebral hemorrhage, is the size of the cerebral hemorrhage evaluated initially. For smaller cerebral hemorrhages, it may be sufficient to avoid activities that increase the pressure in the head. Larger cerebral hemorrhage must be operated on. During surgery, the skull is opened to remove the hematoma (bruise) and to stop the bleeding.

In the treatment of ischemic strokes there are two possible treatments. The most important treatment is the so-called lysis therapy (also called thrombolysis), in which the vascular closure is resolved by clot-dissolving medication. The number of necrotic nerve cells should be kept as small as possible. The drugs are usually administered through infusion.

Typically, the blood clot will also in addition be removed by a mechanical intervention. During the thrombectomy, a catheter is passed through an artery to the clot under x-ray supervision and is then being removed with the help of very fine instruments.

The last part of the treatment is the prevention of a new stroke. Once it has been determined what type of stroke has occurred and what exactly led to the stroke, preventative measures can be taken. In the treatment of ischemic strokes caused by vascular occlusion, blood-thinning medications are usually prescribed. A change in lifestyle also contributes to further stroke prevention.

Consequences

The consequences of a stroke can be as different as its symptoms. As a rule, however, about 50 percent of those affected suffer permanent damage. The type of sequelae and the extent to which they occur depend strongly on the area in the brain where the damage is located.

Below is a list of the consequential damages that significantly affect everyday life:

• Paralysis: paralysis of one side of the body or face
• Memory Disorders: both long and short term memory can be affected
• Disorder of sensory perception: limited sensation of warmth or cold
• Swallowing and speech disorders (dysphagia): About 70% of stroke patients are affected by having difficulties swallowing, eating, drinking, talking and chewing disorders
• Epilepsy: if the brain infarction took place in the right hemisphere, the risk of epilepsy increases. The closer the affected site is to the cerebral cortex, the higher the risk.
• Embolism, pneumonia and thrombosis: a weakened immune system after a stroke increases the risk of embolism, pneumonia and thrombosis and harmless infections can quickly become dangerous.

What are risk factors?

• Old age
• Arteriosclerosis (deposition of fat, thrombi, connective tissue and plaque in the blood vessels)
• Smoking
• The "pill" for women
• Dehydration
• Mental stress
• Hypertension (high blood pressure)
• Metabolic diseases such as diabetes mellitus
• Obesity (overweight)
• Lack of exercise or too much bed rest
• Hyperlipidemia (increase in lipid levels)
• Bleeding disorders
• Heart disease (especially atrial fibrillation and cardiac arrhythmia)
• Recent infusions or transfusions

The more of the risk factors listed here, the higher the likelihood of having a stroke.

Prevention - What can be done as a precaution to minimize the risks of stroke?

Stop smoking!

The risk of suffering a stroke is twice as high for smokers as for nonsmokers. Stopping smoking reduces your risk for suffering a stroke, because the nicotine in cigarettes not only increases your blood pressure but also narrows your blood vessels.

Avoid hypertension!

Have your blood pressure regularly monitored by your GP and if the levels are elevated, you can have them treated. Since high blood pressure initially causes no complaints, a diagnosis often goes unrecognized and people affected often notice the problem rather late. Hypertension, however, is one of the major risk factors for a stroke.

Avoid being overweight!

You can quickly figure out if you are overweight with a simple calculation. Values ​​up to 24.9 are according to the BMI (Body Mass Index) recognized as normal weight and only values ​​from 25 count as overweight. How to calculate your BMI:

Weight (in kilograms) divided by your height (in meters) squared.

Example calculation They are 1.65 meters tall and 63 kilograms heavy. Then calculate:

1.65 x 1.65 = 2.7225

61 / 2.7225 = 22.4

Click here for the online BMI calculator.

This is the BMI classification according to the World Health Organization (WHO):

18.5 - 24.9: normal weight

25 - 29.9: overweight

30 - 34,9: obesity (obesity) grade I

35 - 39,9: obesity grade II

from 40: obesity grade III

The normal weight depends also on other information such as age and sex.

Eat healthy!

Instead of eating meat and sausage, use fish, exchange butter with olive oil, eat more fruits, vegetables and nuts!

Avoid high cholesterol!

The higher the cholesterol levels, the higher the risk of deposits in the blood vessels. A distinction is made between the LDL cholesterol values ​​and the HDL cholesterol values. LDL cholesterol is particularly harmful, but HDL cholesterol is considered positive and even provides some protection. With enough exercise, a healthy diet, and a healthy overall lifestyle, you can make a positive impact on cholesterol and other blood lipid levels.

Stay moving!

By exercising enough, you can improve your blood pressure, your blood lipid levels, reduce overweight and keep your vessels elastic.

Only consume alcohol in moderation!

You can drink a glass of wine from time to time without hesitation, but it always depends on the quantity! Regular and excessive alcohol consumption increases the risk of stroke considerably.

Avoid stress!

Persistent stress leads to hypertension. Find a hobby that will make you relax and try to find relaxation exercises that you enjoy. Sports contribute to avoiding stress to a high degree.

Talk to your family doctor about cardiac arrhythmia!

Disorders such as atrial fibrillation or other cardiac arrhythmias promote strokes. At the first sign you should consult your GP and get treatment.

Adjust your diabetes well!

Diabetics suffer a stroke almost twice as often as non-diabetics. Especially type 2 diabetics usually already suffer from hypertension and elevated blood lipid levels. With elevated blood sugar level, the risk of stroke increases significantly, because elevated blood sugar levels damage the vessels and promote the deposition of plaque.

Facts and figures

In Germany alone, about 270,000 people suffer a stroke each year and approximately 70,000 of them suffer from a recurrent stroke. More than 80 percent of those affected are over 60 years old.

There are, however, around 300 children who suffer a stroke each year. Within the first year, up to 40 percent of all stroke victims die and after one year about 64 percent of the surviving patients remain in need of care - about 15 percent of them need to be cared for in a nursing home.

This makes stroke the most common reason for acquired disability in adulthood.