Stroke
What is a stroke?
Stroke is defined as a severe condition where there’s an abrupt interruption in the brain’s blood supply, leading to organ tissue damage. Neurologists are responsible for the diagnosis and treatment of this condition. It’s an acute cerebrovascular disorder that results in tissue death and compromises nervous system functionality. The brain typically receives adequate nutrients and oxygen to function, but a brief cessation of blood flow can cause significant damage, as neurons lack the metabolic reserves. The severity of a stroke can range from minor brain function impairment to extensive tissue destruction, potentially resulting in a vegetative state. Initial symptoms often include muscle weakness, difficulty speaking, and facial asymmetry.
Regarded as one of the most critical neurological conditions, strokes primarily affect individuals over 50, although risk factors can be present at any age. Immediate medical attention is crucial at the onset of stroke symptoms, as brain damage can become irreversible within hours. Medical interventions aim to restore blood flow and stabilize the patient, followed by treatment of the underlying cause and prescribed rehabilitation.
Stroke symptoms
The manifestations of stroke depend on the form of the disease and the duration of the disruption of blood flow in the brain. The patient has signs of cerebral dysfunction, consisting in a disorder of consciousness and impaired mobility. Lesion of large arteries leads to more severe consequences.
Symptoms and signs:
- Speech problems. The patient cannot pronounce words. Speech comprehension is also impaired;
- Facial numbness and facial expression disorders. Most often the patient has unilateral numbness of facial muscles, manifested by a crooked smile and closing of the eyelid of one eye;
- Mobility impairment of the upper and lower extremities. With asymmetric paralysis, the patient cannot raise both arms at the same level. The affected limb is flaccid or immobile;
- Gait and orientation in space disorders;
- A feeling of “fog in the head” or loss of consciousness with the development of coma;
- Sudden severe headache accompanied by dizziness and weakness;
- Hearing and vision impairment.
Additional symptoms depend on the affected part of the brain.
Causes of stroke
Neurologists know two main mechanisms of stroke. It can be a blockage of an artery feeding the brain tissue (ischemic stroke) or a rupture of a vessel with hemorrhage (hemorrhagic stroke). As a rule, with hemorrhage, symptoms appear suddenly, and irreversible changes in the organ develop in a short time. The occurrence of stroke is primarily associated with the activity of the cardiovascular system, since a constant increase in blood pressure, atherosclerosis and other diseases are risk factors for cerebral circulatory disorders. To other risk factors for the disease, doctors include diabetes mellitus, bad habits and improper nutrition.
Causes of impaired blood supply to the brain:
- Arterial thrombosis due to abnormal blood clotting, atherosclerosis, or prolonged lying down. Blood clots from the vessels of the lower extremities can travel to the brain and cause blockages;
- Blockage of a vessel by a foreign substance not normally present in the bloodstream. This may be a drop of fat that has entered the bloodstream during a severe trauma, a gas bubble, pus or other substance;
- Abnormal dilation of a vessel with subsequent rupture of its wall. In an aneurysm, a thinned section of the vessel wall forms a pathologic “pocket” that gradually fills with blood;
- Craniocerebral trauma accompanied by hemorrhage in the brain membranes or tissues.
Determining the cause of the stroke is important for emergency treatment.
Stroke diagnosis
When symptoms of cerebral circulatory disorders occur, the patient is hospitalized in the emergency department for emergency diagnosis. First of all, the neurologist examines the patient’s condition, assesses the activity of the central nervous system by the severity of reflexes and checks the cardiovascular parameters. At this stage, it is important to exclude other diseases with similar symptoms, such as brain injury or myocardial infarction. Instrumental and laboratory tests are then performed to clarify the form of stroke and assess the severity of the condition.
Methods of stroke diagnosis:
- Blood test. Venous blood is taken and a general and biochemical analysis is quickly performed. The neurologist evaluates the rate of blood clotting, glucose level and other important indicators;
- Computed tomography is a method of obtaining images of the brain in different projections. The patient is placed on the CT scanner table. A special machine performs layer-by-layer radiographic scanning to obtain accurate images. The results of the study make it possible to detect the area of the brain lesion. To identify the affected vessel, CT-angiography is prescribed: the method of examination is similar to conventional tomography, but before obtaining the image, the doctor injects a contrast agent into the patient’s vessels to better display the arteries on the images;
- Magnetic resonance imaging is a highly informative examination that provides more accurate layer-by-layer images of the brain without the use of X-rays. The method of performing the procedure is similar to CT, but the MRI machine uses nuclear magnetic resonance technology to obtain images of organs. If necessary, the doctor also injects a contrast agent into the patient’s blood vessels to perform MRI angiography. This is a safer study;
- Ultrasound examination of the carotid arteries. The doctor uses high-frequency sound wave technology to evaluate blood flow in the carotid arteries in real time (on a monitor). A special gel is applied to the skin of the patient’s neck area and then a sensor is used to form an image. The doctor can detect a blood clot in the vessel that provoked the stroke. This is a safe and reliable method of diagnosis;
- An ECG is a method of assessing the performance of the heart. A cardiologist attaches special sensors to the patient’s body, connected to an ECG machine. After a few minutes, the doctor receives a cardiogram that allows him or her to detect severe heart disease.
All necessary tests are performed in the laboratory of our clinic in emergency mode. The neurologist quickly receives the diagnostic results and starts treatment. A cardiologist is consulted.
Therapeutic treatment for stroke
The neurologist quickly conducts diagnostic tests and prescribes the necessary treatment methods. Before specifying the cause of the stroke, the restoration of vital functions is carried out. During the initial therapy of the disease, the patient is in the intensive care unit. Further treatment is carried out in the intensive care unit. Cardiologists and neurologists of our clinic monitor all aspects of therapy and constantly conduct studies to correct prescriptions.
Stroke treatment methods:
- Intravenous injection of tissue plasminogen activator. An injection of this drug is given as soon as possible when an ischemic stroke is confirmed. The drug destroys the blood clot in the artery and restores cerebral blood flow;
- Medication treatment of cerebral hemorrhage. If the patient is taking blood thinners, the doctor performs hemotransfusion to administer blood clotting components. Medications to reduce intracranial pressure are also administered intravenously. To prevent cerebral edema, the doctor uses diuretics and corticosteroids. Oxygen therapy is carried out;
- Symptomatic therapy. The neurologist uses anti-inflammatory drugs, anticonvulsants, sedatives and neuroprotective agents. Additional medications are selected according to the results of diagnosis.
Special sensors monitor the patient’s breathing, heartbeat and other vital signs. Cardiologists and neurologists provide therapy as soon as possible to improve prognosis.
Surgical methods
Surgical treatment of stroke is a critical intervention aimed at minimizing brain damage and improving outcomes in certain types of stroke. It’s important to understand that not all strokes are amenable to surgery; the decision depends on the stroke’s type, severity, and underlying cause. The most frequently performed procedures are:
- Emergency endovascular procedures. To restore blood supply, the doctor inserts a long, narrow tube (catheter) into the femoral artery and releases drugs to break up the clot directly in the area of the blocked vessel. Thrombolysis is a more effective and reliable method of restoring blood flow in ischemic stroke. If the injected drugs do not break up the clot, the doctor uses a catheter to place a stent retriever into the affected vessel and mechanically destroy the foreign body;
- Craniotomy. This operation is done to relieve pressure in the brain. This involves removing a part of the skull to access the brain and alleviate pressure caused by swelling, bleeding, or pooled blood (hematoma).
All these surgical procedures are performed in more than 800 hospitals worldwide (https://doctor.global/results/diseases/stroke). For example, carotid and intracerebral thrombolysis can be done in 17 clinics across Turkey for approximate price of $15.0 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/carotid-and-intracerebral-thrombolysis).
Stroke prevention
Taking care of your cardiovascular health is the number one way to prevent stroke.
Methods of disease prevention :
- Proper nutrition. From the diet it is necessary to exclude too fatty and salty food;
- Sufficient physical activity;
- Timely treatment of cardiovascular disease;
- Examination by a neurologist when stroke risk factors are detected.
Cardiologists and neurologists at our clinic provide consultations to identify predisposition to stroke and prescribe prophylactically.