Dr. Ioan Dogariu, primary care physician in neurology and doctor of medical sciences, Neurology Department of the Târgu Jiu County Emergency Hospital produced an informative material on the topic of stroke.
Neurological pathology is complex both due to the large number of diseases and their severity, the most frequent and with the greatest burden being cerebrovascular accidents. Stroke is a pathology of major importance for public health, with serious social and economic consequences.
It is the second leading cause of mortality globally after ischemic heart disease and has a very high morbidity, which translates into the fact that approximately 50% of stroke survivors will be left with a major disability. Stroke is a medical emergency, so it is very important that at the first signs and symptoms the patient goes to the doctor because prompt treatment is crucial, it can reduce the destruction of brain tissue and other complications.
Definition of stroke
Stroke is defined as the sudden onset of a neurological deficit as a consequence of interruption of blood flow to a cerebral vessel (cerebral infarction) or rupture of a blood vessel (intracerebral hemorrhage). Cerebral infarction is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than cerebral hemorrhage whose main cause is hypertension.
2. Signs and symptoms of a stroke
The main signs and symptoms of a stroke are:
motor deficit (decreased muscle strength) in the limbs of the same side, facial asymmetry or paresthesias (tingling) in the face, upper and lower limbs; difficulties speaking or understanding the language of others; visual disturbances in one or both eyes, diplopia (double vision); difficulty walking or balance disorders; headache accompanied by vomiting, dizziness, altered state of consciousness;
If the signs and symptoms are short-lived (minutes to hours) and completely remit, we are talking about a transient ischemic attack (TIA) that can foretell a complete ischemic stroke, which is why it is extremely important to see a neurologist at the first symptoms. There is no pathognomonic clinical sign that differentiates ischemic from hemorrhagic stroke, but the combination of nausea, vomiting, headache, and sudden alteration of consciousness are more common and argue for hemorrhagic stroke.
Risk factors involved in the occurrence of a stroke
Strokes are a consequence of the interaction between environmental factors and genetic predisposition. Risk factors can be divided into 2 broad categories: modifiable (which can be controlled) and non-modifiable. Modifiable risk factors are: hypertension, diabetes, dyslipidemia, smoking and sedentary lifestyle. The non-modifiable risk factors are: age, especially advanced age, although in recent years vascular accidents are more common in young people, gender with a higher risk in men compared to women.
Arterial hypertension is a major risk factor for both cerebral ischemia and intracerebral hemorrhage, being the most important condition involved in the pathogenesis of intracerebral hemorrhage.
Atrial fibrillation is the most common cause of cardioembolic ischemic stroke. Vascular accidents caused by atrial fibrillation are usually large, have a sudden onset and have a worse prognosis, so anticoagulant treatment is very important for the prevention of cardio-embolic events when necessary.
Hyperlipidemia is an important risk factor for cerebral atherosclerotic vascular disease. The relationship between serum cholesterol concentration and stroke is complex. Studies have shown that elevated levels of total cholesterol and LDL (low-density lipoprotein) cholesterol are found in ischemic stroke, particularly in large-vessel cerebral disease, and there is an inverse association between cholesterol levels and hemorrhagic stroke.
Diabetes mellitus causes a two-fold increase in the risk of developing ischemic stroke compared to the non-diabetic population. Smoking is associated with an increased risk of developing both types of stroke, with the relationship between smoking and stroke being dose-dependent for both ischemia and cerebral hemorrhage. It should be noted that observational studies have shown that the increased risk of developing stroke disappears 5 years after stopping smoking.
The risk of developing stroke is particularly increased in patients with two or more risk factors.
Diagnostic methods for cerebral infarction
Clinical neurological examination and imaging investigations are essential for the correct diagnosis and type of stroke and will guide the neurologist on therapeutic management. The anamnesis and personal history of the patient also bring additional information and will outline the diagnosis. Most of the time, the neurological examination together with the anamnesis can point to the accidental vascular localization at the cerebral level, there being a certain correlation between the neurological signs and symptoms and their representation at the level of the nervous system.
The biological balance in the patient with stroke – what does it include?
Brain imaging and a complete neurovascular evaluation should be performed in all patients who have had a stroke, transient ischemic attack, or have risk factors that may lead to a stroke. In the evaluation of the acute stroke patient, imaging studies such as cerebral computed tomography (CT) or magnetic resonance imaging (MRI) are necessary to differentiate ischemic or hemorrhagic strokes and provide valuable information about their location and size. The neurovascular evaluation is carried out by Doppler ultrasound, which is a non-invasive investigation that provides information on the permeability of the cervico-cerebral vessels and detects possible atheroma plaques that can determine the vascular obstruction responsible for causing a stroke. Cerebral angiography (through various techniques: MRI, CT, classic angiography) is a high-accuracy imaging investigation that confirms vascular changes suspected by ultrasound or detects aneurysms, arterio-venous malformations or other vascular anomalies.
A complete cardiological assessment is also very important where a cardiac cause of the cerebral event is suspected.
Ischemic stroke treatment
In the acute phase of an ischemic stroke, if the patient is eligible, intravenous thrombolysis is performed, after which the patient may have a chance of recovery with remission of neurological deficits. This is administered in the so-called therapeutic window of a maximum of 3-4.5 hours from the onset of symptoms, therefore it is very important that the population recognize the signs of a vascular accident and present themselves to the emergency service as quickly as possible. Hence the well-known expression in neurology “time is brain”.
Targu-Jiu County Emergency Hospital has been performing this treatment since 2019, at that time being the first center in Oltenia to start this procedure.
After carrying out the investigations and establishing the cause of the stroke, it is necessary for the patient to follow the treatment recommended by the neurologist, for the secondary prevention of stroke.
2023-09-19 13:32:16
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