What is a stroke? – Definition and prevention

Definition: A stroke, also known as a brain stroke, cerebral stroke, apoplexy, cerebrovascular accident, or brain infarction, refers to a sudden onset of inadequate supply of oxygen and nutrients to the brain due to an intracerebral hemorrhage or thrombotic occlusion.

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Stroke causes

In about 80% of cases, the cause is a thrombotic occlusion – a blocked blood vessel. This form of stroke is also called an ischemic (white) stroke. It can be caused, for example, by vascular calcification (atherosclerosis) or a blood clot (embolus). A stroke due to an intracerebral hemorrhage, that is, a brain hemorrhage, occurs less frequently and is referred to as a hemorrhagic (red) stroke.

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In the case of a stroke, the brain is no longer adequately supplied with oxygen and other nutrients. With this massive dysfunction of the brain, brain tissue can begin to die due to lack of oxygen in as little as ten to fifteen minutes.

If this condition persists for an extended period (more than 24 hours), the gray cells in a specific area of the brain do not receive sufficient oxygen or nutrients and thus die due to lack of supply.

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

If these stroke symptoms disappear within 24 hours, it is called a transient ischemic attack (TIA) or a “mini-stroke.” It is important to immediately call emergency services 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 adequately reduced and no medical treatment is followed, the TIA can recur and ultimately progress to a stroke.

Signs and Symptoms of Stroke

The symptoms of a stroke are diverse. Often there is hemiparesis (incomplete paralysis of one side of the body) as well as monoparesis (paralysis of a single limb).

Affected individuals often experience apraxia (impairment of actions or movement sequences) and transient visual disturbances as well as aphasia (central language disorder).

The signs of a stroke can last from a few minutes to 24 hours. When these symptoms occur, whether it is due to a TIA or a “major” stroke, hospital admission is necessary in any case.

One can distinguish between three types of symptoms: physical, psychological, and neurological.

Physical symptoms

  • Hemiplegia (complete paralysis of the body)
  • Hemiparesis (incomplete paralysis of one side of the body)
  • Monoparesis (paralysis of a single limb)
  • Balance and support reactions are disturbed.
  • the person concerned can neither sit upright nor stand
  • an eyelid is hanging
  • the face appears asymmetric due to facial nerve paralysis
  • one-sided drooping corner of the mouth
  • acute circulatory failure
  • Tongue muscles are paralyzed.
  • Swallowing disorders or paralysis
  • the person has extreme, sudden headaches
  • no control over urine and stool
  • irregular breathing
  • Vision impairment

Mental symptoms

  • aggressive behavior
  • Memory disturbances
  • Fear/Panic
  • Impairment of consciousness/unconsciousness
  • Confusion
  • Instability
  • Inability to recognize one’s own illness or
  • functional impairments.

Neurological symptoms

  • Saliva flow from the corner of the mouth on the paralyzed side.
  • Dizziness
  • elevated blood sugar levels
  • heart rhythm disturbances
  • Sweating
  • frequent yawning

With the help of the "FAST" test, a stroke can be quickly recognized.

  • Face (facial expression, drooping corner of the mouth)
  • Arm (arm or leg cannot be moved)
  • Speech (slurred, indistinct speech)
  • Time (call emergency doctor)

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 being treated too late.

"FAST" - Test

Diagnosis and treatment

Since every stroke is an emergency, immediate treatment is always necessary. The paramedic first checks the patient’s vital functions and, if the person is responsive, asks about the symptoms that have occurred. Upon arrival at the hospital, the attending neurologist will assess the stroke patient’s coordination, vision, touch, and speech abilities, as well as their sensation of touch.

Afterwards, a robust diagnosis is made using imaging techniques such as a computed tomography of the head (also called cranial CT) or a magnetic resonance imaging (MRI). The images obtained by the CT of the skull provide information on whether the stroke was caused by a brain hemorrhage or by a vessel occlusion.

A CT scan is usually complemented by measuring blood flow (CT perfusion) and visualizing the blood vessels (CT angiography).

Furthermore, the functional or performance capacity of the heart must also be comprehensively examined. This is done through an
electrocardiography – an EKG.

Finally, the following blood tests are also carried out: electrolyte balance, kidney values, blood sugar levels, blood clotting, and blood count to confirm the stroke.

It is important that every stroke is treated as quickly as possible to minimize the extent of possible long-term damage. Ideally, the affected person will be treated by personnel with expertise in the field of strokes in so-called Stroke Units – a specialized department for strokes.

The two types of stroke require different treatment methods.

In the treatment of a hemorrhagic stroke caused by a brain hemorrhage, the size of the brain hemorrhage is initially evaluated. For smaller brain hemorrhages, it may be sufficient to avoid activities that increase pressure in the head.

Larger brain hemorrhages need to be surgically treated. During the surgery, the skull is opened to remove the hematoma (the bruise) and stop the bleeding.

In the treatment of an ischemic stroke, there are two possible treatment methods. The most important treatment is the so-called lyse therapy (also called thrombolysis), in which the vessel blockage is resolved by clot-dissolving medications and the number of dead nerve cells should be kept as small as possible. The medications are usually administered through an infusion.

The blood clot is nowadays also removed additionally by a mechanical intervention. In thrombectomy, a catheter is guided through an artery and under X-ray monitoring to the clot, and with the help of the finest instruments, it is then removed.

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 a stroke.

In the treatment of an ischemic stroke caused by a vessel occlusion, blood-thinning medications are usually prescribed.

Stroke consequences

The consequences of a stroke can be as varied as its symptoms. However, approximately 50 percent of those affected usually suffer permanent damage.

The type and extent of the resulting damage depend largely on the area of the brain where the damage occurs. Below is a list of the resulting damages that significantly impact daily 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: impaired perception of warmth or cold.
  • Swallowing and speech disorders (dysphagia): about 70% of stroke patients are affected by disorders in swallowing, eating, drinking, speaking, and chewing.
  • Epilepsy: If the stroke 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?

  • advanced age
  • Atherosclerosis (deposition of fat, thrombi, connective tissue, and calcium in the blood vessels)
  • Smoking
  • the “pill” in women
  • dehydrationmental stress
  • Hypertension (high blood pressure)
  • Metabolic diseases such as diabetes mellitus.
  • Obesity (overweight)
  • lack of movement or bedriddenness
  • Hyperlipidemia (elevation of blood lipid levels)
  • blood clotting disorders
  • Heart diseases (especially atrial fibrillation and
  • heart rhythm disorders)
  • recent infusions or transfusions
  • The more of the listed risk factors occur, the higher the likelihood of having a stroke.

Precaution

What can be done proactively to minimize the risks of having a stroke?

Stop smoking.

The risk of having a stroke is twice as high for smokers as for non-smokers. Quit smoking to reduce your risk of stroke, as the nicotine in cigarettes not only increases your blood pressure but also narrows your blood vessels.

Avoid high blood pressure

Have your blood pressure regularly measured by your family doctor and if the values are elevated, have them treated. Since high blood pressure initially does not cause any symptoms, a diagnosis often goes unnoticed 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 overweight

You can quickly calculate whether you are overweight through a simple calculation.

Values up to 24.9 are considered normal weight according to the BMI (Body Mass Index), and only values above 25 are considered overweight. Calculate your BMI as follows:

Weight (in kilograms) divided by your height (in meters) squared.
Example calculation You are 1.65 meters tall and weigh 63 kilograms.

Then you calculate:
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 also depends on age and gender, according to other information.

Eat healthy.

Use fish instead of meat and sausage more often, swap butter for olive oil, eat more fruits, vegetables, and nuts!

Vermeiden Sie einen erhöhten Cholesterinspiegel

The higher the cholesterol levels, the higher the risk of deposits in the blood vessels. There is a distinction between LDL cholesterol levels and HDL cholesterol levels. LDL cholesterol is particularly harmful, while HDL cholesterol is considered positive and provides a certain level of protection.

With sufficient exercise, healthy diet, and a generally healthy lifestyle, it is possible to beneficially influence cholesterol levels and other blood lipid levels.

Stay in motion

By getting enough exercise, you improve your high blood pressure, your blood lipid levels, reduce any excess weight, and keep your blood vessels elastic.

Consume alcohol only in moderation

You can safely drink a glass of wine now and then, but here the quantity matters! Regular and excessive alcohol consumption significantly increases the risk of stroke.

Avoid stress

Permanently enduring stress leads to high blood pressure. Find a hobby that relaxes you and look for relaxation exercises that you enjoy. Exercise contributes significantly to stress prevention.

Talk to your primary care physician about heart rhythm disorders.

Disturbances such as atrial fibrillation or other heart rhythm disorders increase the risk of a stroke. At the first signs, you should consult your primary care physician and seek treatment.

Manage your diabetes well.

Diabetics suffer a stroke almost twice as often as non-diabetics.

Especially type 2 diabetics usually already suffer from high blood pressure and elevated blood lipid levels, and if an elevated blood sugar level is added, the risk of a stroke increases significantly, as an elevated blood sugar level damages the blood vessels and promotes the deposition of plaque.

Numbers and Facts

According to the German Stroke Aid Foundation, around 270,000 people in Germany alone suffer a stroke annually, with about 70,000 of them experiencing a recurrent stroke.

More than 80 percent of those affected are over 60 years old, and approximately 300 children suffer a stroke each year.

Within the first year, up to 40 percent of all stroke victims die, and after one year, around 64 percent of surviving patients require care – about 15 percent of them even need to be cared for in a nursing facility.

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

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