What is it?

A stroke is damage to a region of the brain caused by alteration in blood flow, the symptoms of which last at least 24 hours or result in death. Stroke is the most frequent neurological disease: every year 150 people out of every 100,000 are victims of it, and about 1 out of 4 people will suffer during his or her lifetime. Stroke is the second leading cause of death worldwide after acute myocardial infarction, and the third leading cause of disability after heart attack and neonatal complications. The risk of having a stroke increases significantly after 45 years of age (in fact, only 8% of strokes occur in people younger than that age).

There are two major categories of stroke: ischemic (due to failure of blood supply) and hemorrhagic (due to bleeding at a cerebral vessel). Ischemic stroke is due to a brain vessel that becomes occluded. This event may depend either on alterations in the vessels themselves caused by the same risk factors as heart attack (high cholesterol, diabetes, hypertension), or by bodies called emboli that get stuck in vessels smaller than their size (often formed by coagulated blood, for example that can form in the heart in cases of atrial fibrillation not under anticoagulant therapy) or by individual predisposition to thrombosis. Hemorrhagic forms, on the other hand, in most cases are due to major increases in blood pressure, which causes the rupture of vessels already made fragile by poorly controlled hypertension itself.

Which are the symptoms?

The manifestations of stroke are very varied as they depend on the tasks performed by the affected region of the brain. The most typical symptoms are: weakness in the arm and/or leg on one side of the body, deviation of the mouth, alterations in the production or comprehension of words, disturbances of sensibility, and the ability to hear and feel. Other localizations may cause worsening of balance or visual disturbances. In the most severe cases, coma can occur.

  • weakness in the arm and/or leg on one side   
  • mouth deviation    
  • speech impairment   
  • sensitivity defects   
  • visual disturbances   
  • impaired balance    
  • coma

How is it diagnosed?

The diagnosis of stroke involves two steps.

  • Recognizing the presence of brain damage. This should be done as soon as possible after the onset of symptoms to set up treatment as soon as possible. The following tools are available: computed tomography (CT) of the head, which sees hemorrhages very well but may not reveal very recent ischemic lesions; CT angiography of the neck and intracranial vessels, which highlights the possible occlusion of a large cerebral vessel; and magnetic resonance imaging (MRI) of the brain, which is extremely sensitive to ischemic lesions, even in early stages, but requires time and cooperation from the patient to perform.
  • Identifying the cause of the damage. This phase is as varied as the possible causes of stroke are. Neck and intracranial vessels can be studied by ultrasound or angio-CT/RM exams. Sources of emboli can be detected with an ultrasound of the heart. Finally, the presence of predisposition to thrombosis can be studied with simple blood samples that study the coagulation factors.

How is it treated?

It is possible to treat ischemic stroke in the very first hours (window period) with procedures that unblock the vessels, i.e. mechanical thrombectomy, in which an attempt is made to physically free the vessel from the inside by means of a catheter introduced transfemorally, or with thrombolysis, i.e. the administration of a drug in a vein that dissolves thrombi and emboli of clotted blood. These treatments are all the more effective and safer the earlier they are performed, and can result in the reduction of symptoms (or even their disappearance) as soon as the procedure is completed.
Hemorrhagic forms, on the other hand, often require the use of medications to reduce edema, as free blood irritates surrounding tissues and causes fluid accumulation. In the most voluminous collections of blood, neurosurgical intervention can be indicated to drain them (decompressive surgery).
Once the acute phase is over, the key role is played by prevention. In particular, reducing cardiovascular risk factors and combination with antithrombotic therapy are essential elements to prevent new events (secondary prevention). Rehabilitation, on the other hand, is useful to significantly reduce and/or prevent the aggravation of disorders that have now become established (tertiary prevention) such as physiotherapy for the motor component, or speech therapy for any speech disorders.

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