What is a stroke? - Definition and prevention

Definition: A stroke, also known as cerebral apoplexy, apoplexia cerebri or cerebral infarction, refers to a sudden undersupply of oxygen and nutrients to the brain as a result of an intercerebral hemorrhage or thrombotic occlusion

Contents

Causes of stroke

In around 80% of cases, the cause is a thrombotic occlusion - a blocked blood vessel. This form of apoplexy is also known as an ischemic (white) stroke. This can be caused by vascular calcification (arteriosclerosis) or a blood clot (embolus), for example. A stroke due to an intercerebral hemorrhage, i.e. a cerebral hemorrhage, occurs less frequently and is referred to as a hemorrhagic (red) stroke.

Course

In the event of a stroke, the brain is no longer supplied with sufficient oxygen and other nutrients. This massive malfunction of the brain can lead to the death of brain tissue after just ten to fifteen minutes due to the lack of oxygen.

If this condition persists over a longer period of time (more than 24 hours), the gray cells in a certain area of the brain do not receive sufficient oxygen or nutrients and therefore die due to the undersupply.

Whether the affected area of the brain loses its function permanently or only temporarily depends largely on how long and to what extent the blood supply to the brain is impaired.

If these signs of stroke disappear within 24 hours, this is referred to as a transient ischemic attack (TIA) or a "mini stroke". It is important to call the emergency doctor immediately in any case, whether it is a TIA or a stroke. After a TIA, the risk of a stroke is significantly increased. If the risk factors are not reduced accordingly and no medical treatment follows, the TIA can occur repeatedly and ultimately turn into a stroke.

Signs and symptoms of a stroke

The symptoms of a stroke are varied. Hemiparesis (incomplete paralysis of one half of the body) and monoparesis (paralysis of a single limb) are common. Those affected often suffer apraxia (disruption of actions or movement sequences) and transient visual disturbances as well as aphasia (central speech disorder).

The signs of a stroke can last from a few minutes to 24 hours. If these symptoms occur, whether due to a TIA or a "major" stroke, hospitalization is necessary in any case.

A distinction can be made between three types of symptoms: physical, psychological and neurological.

Physical symptoms

  • Hemiplegia (complete paralysis of the body)
  • Hemiparesis (incomplete paralysis of one half of the body)
  • Monoparesis (paralysis of a single limb)
  • Balance and support reactions are disturbed
  • the affected person can neither sit nor stand upright
  • one eyelid hangs
  • the face appears asymmetrical as a result of facial nerve paralysis
  • One-sided drooping of the corner of the mouth
  • acute circulatory failure
  • Tongue muscles are paralyzed
  • Swallowing disorders or paralysis
  • the affected person has extreme, sudden headaches
  • No control over urine and stool
  • Irregular breathing
  • Visual disturbances

Psychological symptoms

  • aggressive behavior
  • Memory disorders
  • Anxiety/panic
  • Clouding of consciousness/unconsciousness
  • Confusion
  • Lability
  • Inability to recognize your own illness or functional deficits

Neurological symptoms

  • Salivation from the corner of the mouth on the paralyzed side
  • Dizziness
  • Elevated blood sugar level
  • Cardiac arrhythmia
  • Sweating
  • Frequent yawning

A stroke can be detected quickly with the help of the "FAST" test

  • Face (face, drooping corner of the mouth)
  • Arm (arm or leg cannot be moved)
  • Speech (slurred, slurred speech)
  • Time (time to call an ambulance)

Do not hesitate to call the emergency doctor! The consequences of one or more false alarms are less serious than the consequences of a stroke that is treated too late.

"FAST" - Test

Diagnosis and treatment

As every stroke is an emergency, immediate treatment is always required. The emergency doctor first checks the patient's vital functions and, if the patient is responsive, asks about the symptoms that have occurred. Once at the hospital, the neurologist in charge will check the stroke patient's coordination, vision, ability to touch and speak as well as the sensation of touch.

This is followed by a reliable diagnosis using imaging techniques such as a computer tomography of the head (also known as a cranial CT) or magnetic resonance imaging (MRI). The images of the inside of the skull obtained by CT provide information on whether the stroke was caused by a cerebral hemorrhage or a blockage of the blood vessels. A CT scan is usually completed by measuring the blood flow (CT perfusion) and imaging the vessels (CT angiography).

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

It is important that every stroke is treated as quickly as possible in order to minimize the extent of possible consequential damage. In the best case scenario, the affected person is treated by staff with specialist knowledge of strokes in so-called stroke units - a special department for strokes.

The two types of stroke require different treatment methods.

When treating a hemorrhagic stroke that has occurred due to a cerebral hemorrhage, the first step is to evaluate how large the cerebral hemorrhage is. For smaller cerebral hemorrhages, it is sometimes sufficient to avoid activities that increase the pressure in the head. Larger cerebral hemorrhages require surgery. During the operation, the skull is opened to remove the hematoma (bruise) and stop the bleeding.

There are two possible treatment methods for treating an ischemic stroke. The most important treatment is the so-called lysis therapy (also known as thrombolysis), in which the vascular occlusion is repaired with clot-dissolving medication and the number of dead nerve cells is kept as low as possible. The medication is usually administered by infusion.

Nowadays, the blood clot is also removed by a mechanical procedure. During a thrombectomy, a catheter is guided through an artery to the clot under X-ray monitoring and the clot is then removed with the help of extremely fine instruments.

The last point of treatment is the prevention of new strokes. Once it has been determined what type of stroke it is and what exactly led to the stroke, measures can be taken to prevent the recurrence of an apoplexy. In the treatment of an ischemic stroke caused by a vascular occlusion, blood-thinning medication is usually prescribed.

Consequences of a stroke

The consequences of a stroke can be as varied as its symptoms. As a rule, however, around 50 percent of those affected suffer permanent damage. The type of consequential damage and the extent to which it occurs depends greatly on the area of the brain in which the damage is located. Below you will find a list of the consequential damage that has a considerable impact on everyday life:

  • Paralysis: paralysis of one side of the body or the face
  • Memory disorders: Both long-term and short-term memory can be affected
  • Disturbance of sensory perception: limited sensation of heat or cold
  • Swallowing and speech disorders (dysphagia): around 70% of stroke patients are affected by disorders when swallowing, eating, drinking, speaking and chewing
  • Epilepsy: If the cerebral infarction occurred in the right hemisphere of the brain, the risk of epilepsy increases. The closer the area affected by the stroke is to the cerebral cortex, the higher the risk.
  • Embolism, pneumonia and thrombosis: A weakened immune system after a stroke increases the risk of embolisms, pneumonia and thrombosis, and harmless infections can quickly become dangerous.

What are risk factors?

  • old age
  • Arteriosclerosis (deposition of fat, thrombi, connective tissue and calcium in the blood vessels)
  • Smoking
  • the "pill" for women
  • Lack of fluids
  • mental stress
  • Hypertension (high blood pressure)
  • Metabolic diseases such as diabetes mellitus
  • Obesity (overweight)
  • Lack of exercise or bedriddenness
  • Hyperlipidemia (increase in blood lipid levels)
  • Blood clotting disorders
  • Heart disease (especially atrial fibrillation and cardiac arrhythmia)
  • recent infusions or transfusions

The more of the risk factors listed here that occur, the higher the probability of having a stroke

Precaution

But what can you do as a precaution to minimize the risk of suffering a stroke?

Stop smoking

The risk of suffering a stroke is twice as high for smokers as for non-smokers. If you give up smoking, you reduce your risk of stroke, because the nicotine in cigarettes not only increases your blood pressure but also constricts your blood vessels.

Avoid high blood pressure

Have your blood pressure measured regularly by your GP and if the values are elevated, have them treated. As high blood pressure does not initially cause any symptoms, a diagnosis often goes unrecognized and those affected often only notice the problem very late. However, high blood pressure is one of the main risk factors for a stroke.

Avoid being overweight

You can quickly calculate whether you are overweight using a simple calculation. According to the BMI (Body Mass Index), values up to 24.9 are normal weight and only values above 25 are considered overweight. How to calculate your BMI:

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

Example calculation You are 1.65 meters tall and weigh 63 kilograms. Then do the math:

1,65 x 1,65 = 2,7225

61 / 2,7225 = 22,4

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: Adiposity (obesity) grade I

35 - 39.9: Obesity grade II

40+: Obesity grade III

According to other data, normal weight also depends on age and gender.

Eat a healthy diet

Use fish more often instead of meat and sausage, replace butter with olive oil, eat more fruit, vegetables and nuts!

Avoid an elevated cholesterol level

The higher the cholesterol levels, the higher the risk of deposits in the blood vessels. A distinction is made between LDL cholesterol levels and HDL cholesterol levels. LDL cholesterol is particularly harmful, whereas HDL cholesterol is considered positive and offers a certain degree of protection. With sufficient exercise, a healthy diet and a generally healthy lifestyle, cholesterol levels and other blood lipid values can be influenced favorably.

Keep moving

Sufficient exercise improves your high blood pressure and blood lipid levels, reduces any excess weight and keeps your blood vessels elastic.

Read our tips for more activity in everyday life.

Only consume alcohol in moderation

You can drink a glass of wine every now and then without hesitation, but it's the quantity that counts! Regular and excessive alcohol consumption significantly increases the risk of stroke.

Avoid stress

Long-term stress leads to high blood pressure. Find a hobby that allows you to relax and look for relaxation exercises that you enjoy. Sport is a great way to avoid stress.

Talk to your family doctor about cardiac arrhythmias

Disorders such as atrial fibrillation or other cardiac arrhythmias can lead to a stroke. You should consult your family doctor at the first signs and seek treatment.

Adjust your diabetes well

Diabetics suffer a stroke almost twice as often as non-diabetics. Type 2 diabetics in particular usually suffer from high blood pressure and elevated blood lipid levels anyway, and if an elevated blood sugar level is added to this, the risk of a stroke increases considerably, as an elevated blood sugar level damages the blood vessels and promotes the build-up of plaque.

Facts and figures

According to the German Stroke Foundation, around 270,000 people suffer a stroke every year in Germany alone and around 70,000 of these suffer a recurrent stroke. More than 80 percent of those affected are over 60 years old and around 300 children suffer a stroke every year. Up to 40 percent of all stroke victims die within the first year and after a year, around 64 percent of surviving patients remain in need of care - around 15 percent of them even have to be cared for in a nursing home.

This makes stroke the most common cause of acquired disability in adulthood.

See how the TOPRO Step stair climbing aid can help patients during their recovery process.

Espen (35), father of two children, suffered a stroke and now uses the TOPRO Step mechanical stair climbing aid

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