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World Stroke Day aims to raise awareness of stroke prevention and treatment. The condition is a "modern pandemic" that threatens not only survival but also the quality of life of people.

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The need for public awareness is demonstrated by recent research data showing that strokes are the second most common cause of death in people over 60 years of age and the most common cause of disability. It is striking that, after a stroke, every minute that passes around 2 million cells die. Therefore, public awareness is vital to ensure that treatment is carried out as quickly as possible and that the damage is minimised.

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What is a stroke?

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Vascular Stroke (VTE) is defined as damage to the brain parenchyma when the blood supply to an area of the brain stops. This deprives brain cells of oxygen, resulting in a temporary or permanent cessation of function. Some patients recover completely, others get permanent damage, and some end up with permanent damage.

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Stroke is divided into ischaemic (80%) and haemorrhagic (20%). Ischaemic strokes - which are the most common - involve the interruption of blood flow to an area of the brain due to a narrowing or blockage of an artery (thrombosis or embolism). Haemorrhagic strokes are rare and involve the rupture of a vessel or aneurysm, resulting in intracerebral haemorrhage.

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What is transient ischaemic attack?

A transient ischaemic attack has exactly the same symptoms as a typical stroke, except that they usually pass in a few minutes on their own, without any treatment. It is like a "warning" stroke that, while not causing any permanent damage, requires investigation.

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What are the risk factors?

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There are some risk factors that have been linked to stroke. In particular:

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Age over 55 years old
Male sex
Smoking
Treatment with estrogen / contraceptives
Consumption of large amounts of alcohol
Atrial fibrillation
Obesity and poor physical fitness
Diabetes mellitus
High cholesterol
Increased blood pressure
Previous stroke
Stress and depression
Diseases related to blood clotting
Use of euphorigenic substances

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What are the symptoms?

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Depending on the area of the brain affected, the patient may lose certain brain function. Recognising the symptoms of stroke is vital so that the patient can be taken to hospital as soon as possible. These symptoms are:

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Numbness or weakness in the face, arm, leg - especially on one side of the body
Confusion or impaired speech or perception
Visual impairment in one or both eyes
Gait disturbance, vertigo, instability
Acute headache
Smell of burning
Dropping of the corner of the mouth (crooked mouth)

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What are the complications of a vascular stroke?

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The patient's outcome after a stroke depends on the area of the brain and the extent of the stroke. Some of the complications are:

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Weakness that causes difficulty in walking and daily movements
Difficulty in speaking
Difficulty in swallowing; risk of aspiration pneumonia
Disorders in higher brain functions, such as memory, judgment
Epileptic seizures
Lethargy or coma, endangering the patient's life

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How is the diagnosis made?

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Once the patient arrives at the hospital, an emergency CT or MRI scan is performed to confirm the condition and proceed with treatment immediately. This is immediately followed by an evaluation that will provide information about the cause.

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The evaluation includes:

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Physical Examination
Neurological examination
Brain imaging tests (CT scan, MRI)
Blood tests
Brain vessel imaging
Carotid and heart triplex
Cardiac function tests
Electrocardiogram (ECG)
Ultrasound
Heart rate recording

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What is the treatment?

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The first step is immediate transport to the hospital and urgent diagnosis with CT or MRI.

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If it is an ischemic episode, the clot must be dissolved. This can be achieved with specific thrombolytic treatment. Treatment options also include mechanical thrombectomy, as well as invasive devices (stents). Decompressive craniectomy is a last resort.

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In vascular bleeding episodes, the treatment approach includes medication to reduce blood pressure and swelling in the brain. Surgery may be needed to drain the blood or relieve intracerebral pressure.

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Intubation and mechanical ventilation in the intensive care unit is necessary when the person has fallen into a coma and their life is threatened.
Once a stroke has been treated, the neurologist will look for its causes through a series of tests. At the same time, once the patient is stabilized, complications are treated and rehabilitation begins.

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Vascular Stroke Rehabilitation

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Many patients achieve full recovery soon after a stroke. However, there are cases in which the damage is such that it will significantly affect the patient's quality of life. For these individuals, an appropriate rehabilitation plan is set up to help them recover psychologically and socially, with training in self-care.

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Rehabilitation is a demanding process that requires the assistance of a number of specialists: a neurologist, a pathologist, a physiatrist, a physiotherapist, an occupational therapist, a speech and language therapist and a psychologist. The best place to coordinate all the procedures is a specialised rehabilitation centre. After rehabilitation is complete, the patient is put on chronic follow-up with a neurologist.

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