The stroke

Stroke is a clinical syndrome due to brain damage as a result of an ischemic or hemorrhagic vascular event. Globally, the disease is one of the leading causes of mortality and morbidity. Current studies indicate an increase in pathology from one year to another with a high probability of placing the disease at the top of the leading causes of death in the future.

In developed countries, stroke is the main factor in the onset of long-term disabilities and promotes the development of epileptic syndromes and cognitive decline (dementia), especially among the elderly. The morbidity and mortality of ischemic strokes or ischemic strokes (due to a thrombotic or embolic process) are higher than those of hemorrhagic strokes (due to rupture of the vascular wall).

Causes of stroke

Cerebral haemorrhages
They occur most frequently subarachnoid in people suffering from chronic hypertension, but situations have also been described in which the event is due to spontaneous rupture of cerebral microaneurysms or craniocerebral trauma. Secondary to a hemorrhagic stroke, there is a hematoma that increases the local intraparenchymal pressure with the rupture of other vessels in the vicinity. This favours the maintenance and aggravation of the initial injury. Irreversible brain damage occurs because of neuronal death due to coagulation necrosis and apoptosis (programmed cell death).

Cerebral ischemia

Occurs when the blood vessel is obstructed to varying degrees by the presence of a thrombus, a cracked atheroma plaque, or an embolism with a cardiac starting point (due to atrial fibrillation, valvular disease, or birth defects).

Because the amount of oxygen and glucose stored in the brain is very small compared to neural metabolic needs, stopping blood flow has immediate consequences on brain activity: loss of consciousness after a few seconds of ischemia and irreversible damage within minutes of hypoperfusion.

Transient ischemic stroke

Develops in conditions similar to the ischemic accident, the major difference being given by the short period of interruption of the blood flow, followed by the restoration of the cerebral perfusion with complete recovery of the deficits.

What are the symptoms of a stroke?

The symptoms of hemorrhagic stroke vary depending on the area where the event occurred, with clinical manifestations of paralysis in different segments of the body, cognitive deficits, speech loss, vision loss to coma and death (depending on the severity and extent of brain damage).

The clinical picture of transient ischemic episodes is generally represented by headache, dizziness, transient decrease in visual acuity (single or bilateral) and unexplained confusion. Complete ischemic strokes are accompanied by severe changes in neuronal metabolism, including loss of consciousness, disorders of the respiratory and cardiac nerve centres, coma, permanent motor deficits and in severe cases death.

Self-assessment

Manifestations such as tingling or numbness in the upper limbs, paralysis with asymmetry of the facial muscles, decreased visual acuity (single or bilateral), aphasia (difficulty expressing and perceiving), confusion, sudden/violent headaches, balance disorders or motor coordination are some frequently reported changes by patients who have suffered a stroke.

Treatment in case of a stroke

There is a close connection between how a stroke occurs and the therapeutic adopted manoeuvres. The doctor will adopt with the patient the optimal method of treatment (drug or surgical) specific to each case. It is vital to stop bleeding with the need for surgery in certain situations (for hemostasis and drainage). In the event of an accident due to ischemia, it is necessary to restore the blood flow as soon as possible with the optimal reperfusion of the cerebral arteries affected by drug thrombolysis or mechanical thrombectomy followed by angioplasty.