A cerebrovascular accident (CVA), commonly referred to as Stroke, is a neurological disease that results from the interruption of blood supply to a specific part of the brain. This blockage alters the correct functioning of the brain and results in cell damage, ultimately leading to the death of the brain tissue itself. The interruption can originate from two distinct situations and for this reason two types of stroke are distinguished:
Sometimes, “mini strokes” can occur, the so-called Transient Ischemic Attack (TIA), in which there is a small momentary interruption of the blood supply to a certain part of the brain, which is quickly restored. Although in these episodes the brain tissue does not die due to the lack of blood supply and the brain function is quickly restored, they should be seen as a warning sign as they may indicate that an Ischemic Stroke may be imminent.
It is amongst the older community that strokes are more common, affecting women more than men, with women representing almost 60% of stroke deaths.
Every year, 15 million people suffer a stroke, of which 6 million do not survive the episode. In Portugal strokes are the leading cause of death, with the country having the highest mortality rate in all of Western Europe. The incidence of the disease is about 25,000 people per year, of which about 10% result in death and about 35% result in high disability. Once the blood supply is shut off to a certain part of the brain, the brain cells responsible for specific functions can become damaged and unable to fulfill their function, thus causing long-term disability.
Even though the incidence of stroke is decreasing, possibly a reflection of the increased awareness of the population regarding the control of arterial hypertension and the high levels of cholesterol, we can further reduce the number of incidences and fatalities, with a focus on prevention and rapid diagnosis and treatment, which result in effective recovery from the stroke and the resumption of cognitive and motor functions.
The symptoms of a stroke can vary greatly depending on the type of stroke suffered (ischemic or hemorrhagic) and the part of the brain affected, however, as episodes usually occur suddenly, their effects are usually immediate. Since the extent of damage caused by a stroke is closely linked to the length of medical practice, it is essential that the population knows its most typical symptoms:
These are generally the symptoms most associated with stroke and that we need to look out for.
In case any of these symptoms is revealed, the person should be immediately directed to nearest hospital or medical center. Don’t wait for the symptom to go away.
Strokes may also be accompanied by other symptoms that also deserve the same degree of urgency in their observation:
However, strokes can happen without revealing any visible symptoms. Only after carrying out routine exams or for any other reason, it is noticed that the person has suffered a stroke. For this reason, people that present some of the risk factors should have regular consultations with their doctor.
The main causes for a stroke are largely related with the risk factors, factors which can be corrected through changes in lifestyle habits or by taking medication. The most prevalent risk factors are:
There are still other risk factors that we are unable to respond to, such as age, sex and genetic inheritance (the latter not only due to the influence of the family’s health history but also the genetic characteristics of each ethnic group).
The diagnosis for a stroke is suggested by the combination of the symptoms observed and the results of a physical examination performed by a physician. However, in order to be able to understand exactly whether a stroke occurred and whether it was ischemic or hemorrhagic, several medical exams must be carried out:
There are other imaging tests, such as CT angiography or diffusion-weighted MRI that also allow you to assess the extent of damage caused by the stroke.
The doctor should always look for the cause of the stroke, and should therefore order several additional tests, such as:
Based on these tests the physician is able to assess the degree of urgency of the intervention and what type of intervention should be performed, what is the need and degree of rehabilitation to be carried out, as well as instructing the patient on ways to reduce the chances of new a stroke.
After diagnosis, doctors are able to determine the severity and type of stroke and how it should be responded to. The entire process must be carried out as quick as possible, since for every 15 minutes of delay in treatment the risk of fatality increases by 4%. For this reason, early hospitalization is essential. Once the patient is admitted, there is a critical time window of action that will allow for effective treatment and decrease the risk of complications and recurrence.
If the patient is diagnosed with an Ischemic Stroke, the most common, the treatment may include:
If the patient is diagnosed with Hemorrhagic Stroke, the treatment will be different from the previous one and may include:
The patient’s rehabilitation program should start soon after admission, thus reducing stroke sequels.
As with any other diseases, prevention is always preferable to treatment. In the case of strokes, this maxim is no exception, so we must be alert and vigilant to the modifiable risk factors that increase the likelihood of a stroke.
Therefore, we must all seek to implement improvements in our lifestyle and control illnesses and health problems that may aggravate stroke risks:
People suffering from diseases such as diabetes, high blood pressure and heart disease should take extra care in monitoring their health condition, having regular medical examinations, ideally every year.
After the occurrence of a stroke, it is extremely important to take measures that reduce the chances of a new episode. Cardiac exams and brain imaging exams should be performed, as well as clinical analyzes with variable frequency. The patient must also be monitored in a clinical environment in order to monitor associated risk factors.
A large number of patients after a stroke need to take preventive medication, usually for life. The aforementioned lifestyle changes for prevention should also be adopted.
As already mentioned, the degree of severity and duration of the sequelae resulting from a stroke episode are closely linked to the time that elapses until its treatment. The faster the patient is treated, the less severe the sequels and the better the chances of recovery.
The severity and duration of the sequels are also and to a certain extent dependent on the type of stroke suffered (ischemic or hemorrhagic), as well as the area of ​​the brain that was affected.
Generally speaking, a small Hemorrhagic Stroke episode without great intracranial pressure can be less aggressive than a similar episode but with Ischemic Stroke, this because the inflow of blood in an area of ​​the brain causes less damage to the brain tissue when compared to the inhibition of oxygen to that area.
If the stroke affects a highly important area of ​​the brain, such as areas that affect speech or motor functions, recovery can be particularly difficult and time-consuming. In situations where the brain is affected in the areas responsible for the motor functions, a high degree of dependence on others to perform simple tasks such as eating, dressing or walking can develop. These situations can also be responsible for the development of depression. Depression can and must be treated.
Recovery time varies from patient to patient and also due to the specific characteristics of each episode.
In order to reduce the impact of stroke sequels, the rehabilitation process should be started right after admission, usually one or two days after arrival. Physical therapy exercises to improve movement, speech therapy sessions to improve communication and occupational therapy sessions should be started. With these practices, it is intended that the patient recovers as much as possible his abilities to perform daily tasks and activities, that he maintains his physical shape and that his quality of life improves, while also intending that the body and brain are re-educated, relearning old skills and possibly learning some new ones.
The effectiveness of these processes and sessions depend a lot on the patient’s willpower and perseverance, as they do not end when leaving the hospital. This should be an ongoing process that goes through sessions in a rehabilitation center, physiotherapy and occupational therapy centers, as well as the practice of exercises at home and in everyday life.
It is important to recognize that currently people who suffer from a stroke have a greater chance of recovery and a decrease in the severity and duration of the sequels due to the greater ease and speed of response, treatment and follow-up in emergency situations in the so-called stroke units of hospitals.
Centers for Disease Control and Prevention
Viver após um Acidente Vascular Cerebral – Recomendado aos Prestadores de Cuidados Informais, Direcção-Geral da Saúde, Lisboa, 2000
Sociedade Portuguesa de Cardiologia
Sociedade Portuguesa do Acidente Vascular Cerebral