Article written by Dr. Alexandra Dumitru, cardiologist at Enayati Medical City
What is a stroke and how would you define the medical context of a Romanian patient suffering from such a condition?
Stroke is the result of disruption or reduction of blood flow to a brain area, so that area no longer receives oxygen and nutrients. The brain tissue is very sensitive and in a few minutes it dies if it is not irrigated.
Stroke (stroke) is a medical emergency, and prompt diagnosis and treatment are crucial for the patient’s progress. In recent years, due to patient information programs and the evolution of treatments, mortality due to this pathology has decreased.
There are many risk factors for stroke. Some are related to lifestyle, associated pathologies, but it is usually a combination of potentiating factors. There are many examples of patients at risk of stroke. From an overweight smoker, possibly with untreated or inadequately treated hypertension or an inactive woman with a family history of stroke and taking contraceptives, to young people who have been infected with SARS-VOC 2. Generally, when we list the factors people tend to think that they need to have them all to get sick or tend to be lenient when they think of them. Sometimes I ask a patient if he smokes and he says no, then he explains to me how he smokes 5-10 cigarettes a day for 15-20 years, but he doesn’t consider himself a smoker. The Romanian patient is a patient who refuses to believe that he may be at risk of something terrible, does not care about pathologies with a high incidence in the population and tends to associate what he has with a positive example – „a friend’s grandmother had high blood pressure and died at the age of 93 „. The difference is that he is 45 years old and has high blood pressure and maybe that lady was 90 years old.
In Romania, most patients with stroke are undiagnosed or diagnosed hypertensive patients, but not compliant with treatment, overweight, dyslipidemic, diabetic, smokers, alcohol users or with pre-existing cardiovascular pathologies.
There are several types of stroke. What are these and how can they be distinguished by the patient in question?
Depending on the mechanism by which there are 2 types of strokes: ischemic and hemorrhagic.
Ischemic stroke is the most common and occurs when a cerebral vessel serving a certain area has a narrowed or occluded lumen resulting in a severe reduction in blood flow. Stenosis or occlusion of a cerebral vessel is due to the deposition of cholesterol in the intima of the vessel or the presence of a thrombus (either formed in situ by rupture of an atheroma plaque or embolized, most commonly from the left atrium in patients with atrial fibrillation).
Hemorrhagic stroke occurs when a brain ruptures. This type of stroke occurs when the vessel is under stress – high blood pressure, trauma, anticoagulant overdose or when the vascular wall has a fragile structure – the cerebral aneurysm encountered in patients with collagen diseases, protein deposits in the vascular wall – amyloid-induced angiopathy). A ruptured blood vessel causes severe intracranial haemorrhage that affects the surrounding tissues, and the risk of death is very high.
Often, before an ischemic stroke, the patient may have a transient stroke. It manifests as an ischemic stroke, but the duration of symptoms is less than 24 hours and recovery is complete. It is caused by a temporary decrease in blood flow and can last for several minutes.
Stroke symptoms can occur in different combinations, depending on the person and the severity of the accident. Signs of a stroke include:
- Sudden and very severe headache
- Loss of consciousness
- Imbalance, gait and coordination disorders
- Speech problems – a person who has a stroke can say meaningless, intelligible and confusing words. There are cases when she can’t talk at all.
- Confusion – a blank „confused” look.
- Deformation of the face – part of the face seems to have fallen, and the patient cannot move his mouth.
- Paralysis – the patient can no longer move the right or left half of his body.
- Weakness and numbness – if paralysis has not occurred, it is possible for the patient to fall to his feet, usually on one side. The limbs on that side become weak and move heavily.
- Vision disorders – double vision, blurred vision, distorted vision or even vision loss.
A person with a stroke has a high risk of death.
What is the first aid procedure in case of a stroke?
First of all, the diagnosis of stroke must be made quickly, so if there is a suspicion that someone has a stroke, you must act quickly – FAST – each letter is a sign and if that person has one of them then the suspicion is high for stroke.
F – Face – Ask the person to smile. Does your face look asymmetrical or does your mouth fall to one side?
A – Arms – Ask the person to raise both arms above their head at the same time. Does one of them remain inert or lower than the other?
S – Speech – Ask the person to repeat a simple phrase (for example, “The sky is blue”). Can’t you tell what he says or says strangely?
T – Time – If you notice any of these signs, call 112 IMMEDIATELY! In order for the person to be transported to the hospital as soon as possible, tell the operator that you suspect that they have suffered a stroke and tell them the time when the first symptoms appeared.
In case of a major stroke then some gestures are needed that can save the affected person. First of all, seek medical attention immediately (112), try to keep the airways clear, perform respiratory resuscitation maneuvers, if necessary. The victim sits on the weakened side, so that the secretions can drain from the mouth and try to maintain the thermal comfort of the victim (positioning in the shade, covering in case of cold). An important role is also played by encouraging and calming the affected person. A common mistake in the desire to help is when the victim is given fluids or food, as he or she may vomit and drown.
What is the treatment for this condition?
The treatment of a stroke depends on its type. In an emergency, treatment for an ischemic stroke aims to dissolve the clots and restore blood flow to the brain with the help of drugs. Also, a large blood clot may need to be drawn. This is possible through the procedure of mechanical thrombectomy (endovascular) followed by angioplasty. Catheters and stents inserted through the blood vessels are used after a puncture of the skin. The purpose of the stent is to dilate the atheroma plaque and fix it to the walls of the artery, thus eliminating the risk of rupture and migration to another area.
In the case of a bleeding stroke, it is very important that the bleeding is stopped. Therefore, surgery may be needed or in some cases, stopping the bleeding is possible with an interventional method performed by vascular approach, by catheterization technique and involves the implantation of a device called a „coil”.
It is important that treatment be performed within the first few hours after the onset of the stroke.
After the stroke, the patient must follow a drug treatment that ensures optimal blood circulation and must periodically go for a medical check-up. This also applies to those who have had a transient stroke in order to prevent ischemic stroke.
How long does it take to recover from a stroke? To what extent can the patient regain medical status prior to this event?
Medical recovery helps patients who have had a stroke regain their lost skills and develop methods to compensate for irreversible brain damage due to the phenomenon of neuroplasticity (the brain’s ability to change structure and function by making new connections). These skills include language and motor function. Rehabilitation can also begin in the acute and / or subacute phases of the disease when the general condition of the patient allows it. The precocity of initiating rehabilitation is correlated with its results. For this reason, we try to recover the patient from the first 24-48 hours after the onset of the disease.
A patient who has suffered a stroke needs a team in the recovery process and the sooner this is understood and the therapy is initiated the faster the results will be and the more efficient the recovery. The team includes a neurologist for background therapy, specialist in medical rehabilitation, occupational therapy (OT), occupational therapist, physiotherapist, speech therapist, psychologist, social worker, nurse.
The rehabilitation program that the patient must follow is complex and must be customized and adapted to the individual needs of each patient. It may include: physiotherapy (adaptation of the effort is made to the current functional capacity because there is a deconditioning), hydrokinetotherapy, stimulation of the patient to perform daily activities (such as personal care, various household and occupational therapy), therapeutic massage, orthosis, robotic therapy (the upper limb is trained for grasping by supporting, initiating and assisting movements, the lower limb presents walking assistance and movement in space).
There are many situations in which the patient does not recover and remains disabled. They may be instructed to replace lost positions in order to carry out their day-to-day activities. For example, a patient with post-stroke sequelae learns to wash his coat with one hand or to communicate despite speech disorders.
The main problem caused by stroke is that of disability – over 40% of survivors are left with a functional condition. Recovery treatment aims to limit the impact of stroke on quality of life.
How can we prevent such a condition?
Stroke prevention is divided into primary prevention related to the treatment of individuals without a medical history of stroke and secondary prevention related to the treatment of patients who have already suffered a stroke or transient ischemic attack (TIA).
Both primary and secondary prevention include:
-maintaining BP below 140 / 90mmHg both by changing lifestyle and individualized drug therapy.
-strict control of blood sugar through diet, sports and individualized drug therapy. Diabetic patients, blood pressure should be below 130/80 mmHg.
– treatment of hypercholesterolemia (LDL> 150 mg / dl) by lifestyle modification and statin treatment.
– smoking cessation.
– discouraging chronic alcohol consumption in large quantities. Red wine can be chosen as a type of alcohol to be consumed, being the least dangerous for the body, if it is drunk in small quantities. Red wine contains resveratrol, an antioxidant that protects the heart and brain.
– Regular physical activity is recommended. Weight loss is recommended for people with a high body mass index (BMI). An increased body mass index (BMI> 25) is associated with an increased risk of stroke in men and women, and abdominal fat is a risk factor for stroke in men, but not in women.