Stroke

Stroke and its treatment

A stroke results from a sudden disturbance of the blood flow to the brain. As a result, the nerve cells in the brain receive too little oxygen and nutrients and perish. Other terms for a stroke are apoplexy, cerebral insult, or cerebral infarction. A stroke is always an emergency, which means action must be taken immediately, without hesitation or waiting. By acting quickly, consequential damage can be minimized in many cases. Every minute counts. You should call the emergency services immediately if stroke symptoms occur.

Stroke is not a unique disease; the generic term “stroke” is rather used for a multitude of different diseases that require different causes and, thus also, different therapies. The term was coined when it was not yet possible to determine the different forms and causes of this disease as reliably as it is today due to modern medical technology. Depending on the cause, doctors, therefore, nowadays speak more precisely of a “cerebral infarction”, for example, if the stroke was caused by a lack of blood supply to the brain, or of a “cerebral hemorrhage”, if the stroke was caused by blood leaking into the brain tissue.

According to the latest estimates, approximately 270.000 first-time strokes occur annually in Germany. Strokes are the third most common cause of death in Germany after cancer and heart disease. In addition, it is the most frequent cause of the need for long-term care: about 30 percent of stroke victims remain permanently dependent on nursing support. Qualified neurological rehabilitation is the prerequisite for avoiding the need for care as far as possible and enabling each patient individually to exploit his or her development potential.

Symptoms

The consequences of a stroke are manifold and can affect different functions of our body. Paralysis, sensory disturbances, swallowing and speech disorders are just a few examples that affect the lives of those affected.

The human brain is divided into different regions that control different processes in our body. For example, one area is responsible for the production of our speech, another for speech comprehension. The consequences after a stroke depend on the region in which the circulatory disturbance occurred. Therefore, the impairments for the patient are very different. No stroke patient is like another – an individual treatment programme is the prerequisite for successful neurological rehabilitation.

• Paralysis: A common symptom of stroke is paralysis of one half of the body or a specific area.
• Spasticity: After a stroke, the basic tension of the muscle may be disturbed. Due to increased tension in the muscle, it can no longer be moved and pain occurs.
• Sensory disturbances: The restriction of the ability to feel is another consequence of the stroke. This can manifest itself in the form of tingling and numbness, the loss of sensitivity to heat or cold in the skin but also feelings of heaviness.
• Speech: Usually, the speech centre is located in the left hemisphere of the brain in right-handed people and in the right hemisphere in left-handed people. If the speech centre is affected, a so-called aphasia can develop. Aphasia means a loss of speech or a speech disorder.
• Swallowing: The process of swallowing can be disturbed after a stroke. This is called dysphagia. The swallowing disorder can manifest itself in occasional swallowing, but can also make it completely impossible to take in food.
• Cognitive abilities: A person’s cognitive abilities include, for example, attention, memory, learning, creativity, planning, orientation, and some other abilities that can be impaired after a stroke.

Causes

Ischaemic stroke

Ischaemic stroke is the cause of about 80 percent of all strokes. It is triggered by two different mechanisms: Either the blood vessels in the brain close or narrow due to vascular calcification (arteriosclerosis) or they are clogged by blood clots (cerebral embolism). In both forms of stroke, the area of the brain that is normally supplied by the blocked vessel is suddenly cut off from the blood supply. As a result, the brain cells no longer receive enough oxygen and nutrients and die.

The most important risk factors for arteriosclerosis and thus also for a stroke are:

• High blood pressure (hypertension)
• Diabetes mellitus (diabetes)
• Smoking
• Overweight
• High blood fat levels (cholesterol and triglycerides)
• Excessive alcohol consumption

Triggers for cerebral embolism include:

• Absolute arrhythmia in atrial fibrillation
• Other cardiac arrhythmias
• Heart attacks
• Heart valve defects

Causes of a cerebral haemorrhage

Risk factors for a stroke caused by a cerebral haemorrhage are:

• Elevated blood pressure (arterial hypertension).
• Diseases of the haematopoietic system and coagulation disorders (e.g. thrombocyte disorders, von Willebrand-Jürgens disease, haemophilic diseases such as haemophilia A and B)
• Use of blood-thinning medication (e.g. heparin, Marcumar)
• Advanced liver diseases such as cirrhosis of the liver
• Vascular malformations such as abnormal bulges of blood vessels (aneurysms) or tumour-like neoplasms of blood vessels (angiomas)
• Changes in the blood vessels caused by deposits of abnormally changed proteins (amyloidosis) or vascular inflammation (vasculitis)

Rare causes

Very rare causes of cerebral infarctions include inflammation of the brain vessels.

Therapy

The sooner treatment is started after a stroke, the greater the chances of the person affected that only a little damage will remain or that the impairments will even completely disappear over time. Optimal treatment with monitoring of the important functional data of the circulation, heart and brain is offered by hospitals that have a special stroke unit.

A stroke is always an emergency. This results from the experience that all measures for improvement have their best effect within the first 3 hours (preferably in the first hour).

If the examination of the patient has shown that the stroke was caused by a blood clot in an artery of the brain, the blood clot must be dissolved as quickly as possible. Blood-thinning drugs (anticoagulants) are used to inhibit blood clotting. They prevent the enlargement of existing clots and the formation of new ones.

If a brain haemorrhage is the cause of a stroke, the additional blood volume leads to an increase in pressure inside the skull. The result is additional damage to nerve tissue. The patient may then need surgery to remove the blood that has leaked into the brain from the ruptured vessel.

Therapy outcome

Closely linked to the acute therapy is the rehabilitation, which should be carried out in a specialised facility. The stay in a rehabilitation clinic can last for different lengths of time, depending on the individual condition of the patient and the extent of the functional disorders.

In rehabilitation, lost abilities can be either completely or partially regained. Intact areas of the brain take over the function of the damaged areas, and the damaged areas of the brain partially regenerate.

A prerequisite for successful rehabilitation is the close cooperation of doctors from different disciplines, physiotherapists, occupational therapists, speech therapists, social workers, and others with the patient and his or her relatives.

An important task of rehabilitation is not only to restore lost functions, but also to support those affected in living with permanent impairments and to cope with them in everyday life. The importance of the patient’s motivation should not be underestimated. The more actively the patient participates in the exercises, the greater the success of the rehabilitation.

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