In this episode we continue to talk about stroke, seeing together what are the symptoms that should alarm us and how we can also intervene on a preventive level.
Briefly, I remind you that stroke is caused by a sudden lack of blood in a more or less large area of the brain; this blood deficit can be caused by the rupture of a cerebral blood vessel or the presence of a plug - therefore of an embolus or a thrombus - which occludes it. In the first case, that of the rupture, we speak of a hemorrhagic stroke; in the second case, where the obstruction by a thrombus or an embolus is involved, we speak instead of ischemic stroke. Whatever the cause, if they are deprived of the necessary supply of oxygen and nutrients, the brain cells (called neurons) die and the parts of the body that are under their control stop working. For this reason, recognize the typical warning signs of stroke are fundamental. There are, in fact, specific treatments that allow to limit serious and permanent consequences, if not fatal; however, for these drugs to be effective, they must necessarily be administered rati shortly after the onset of symptoms
The symptoms of stroke vary according to the location and extent of the damaged brain area. One of their characteristics, which differentiates them from the symptoms of other neurological disorders, is that they arise abruptly and without warning. The most frequent manifestation is the sudden onset of difficulty in moving an arm, leg or side of the face. Usually, the disorder affects only one side of the body, on the opposite side of the brain injury. Often, this sign is associated with a difficulty in finding words or understanding what others are saying. In other words, the functions of language and the ability to communicate are compromised. In addition, sudden visual disturbances in one or both eyes, excruciating headache, confusion, loss of sensation, dizziness, walking or coordination problems may occur during a stroke. The effects of stroke can be limited to the initial symptoms or intensify and become more severe over the course of a few hours or days. For example, if a person first feels numbness in one hand, he may then feel the extension of numbness in the arm and shoulder. In severe cases, the affected person may even lose consciousness. This occurs more often in hemorrhagic strokes, where blood can collect in the brain and exert pressure on neighboring vessels, affecting a larger area. If you recognize one or more of the symptoms listed, you should go to the emergency room as quickly as possible.
First of all, it is essential to establish whether it is an ischemic or hemorrhagic stroke to set up an adequate treatment. During the acute phase, therefore, specific investigations are used, such as CT and magnetic resonance imaging (MRI). The brain CT scan, in particular, is performed urgently, after arriving in the emergency room. In addition to allowing to distinguish between ischemic stroke and hemorrhagic stroke, this examination allows to detect any signs of ischemic suffering. The CT scan, in general, is then repeated 48 hours later. For proper evaluation, it is also very important to perform an echocardiogram, to highlight the presence of a cardiac embolism. Other tests that may be required to understand the causes of stroke are cerebral angiography and carotid Doppler ultrasound. If the stroke is of an ischemic nature, there is a drug therapy that - provided it is administered in the first hours after the event - allows to limit the damage caused by the stroke. This therapy, called thrombolysis, involves the intravenous administration of a thrombolytic drug, which has the ability to dissolve the thrombus and thus restore blood flow to the affected area. The drug in question is the tissue plasminogen activator of recombinant origin.As mentioned, this treatment must be carried out as early as possible: the longer the hours pass, the less brain cells are saved and the greater the risk of complications. Thrombolytics are most effective if administered within 3 hours of the onset of symptoms, preferably no later than 4-5 hours; after 6 hours these drugs become completely ineffective. As an alternative to drugs, in certain circumstances doctors may resort to mechanical removal of the thrombus that caused the stroke, by introducing a special catheter into the cerebral artery. Other times, if the carotid, that is the large artery in the neck that carries blood to the brain, has severe atherosclerosis, an intervention aimed at "cleaning" the arterial vessel of atherosclerotic plaques is required. Alternatively, it is also possible to proceed with an angioplasty with placement of a stent, which allows the artery to reopen.
As for hemorrhagic stroke, thrombolysis is not effective. However, even in this case, it is essential to act as soon as possible to control bleeding and reduce intracranial pressure. In case of haemorrhage it is possible to administer intravenously mannitol or glycerol, substances capable of facilitating the reabsorption of fluids from the affected tissues. In the case of major bleeding, however, the neurosurgeon can intervene surgically to stop blood loss and promote drainage. Once the acute phase of stroke has been managed with emergency therapies, treatment is aimed at recovering damaged brain functions as much as possible. Particular attention will be paid to drug therapy. A first type of therapy involves antiplatelet drugs, such as aspirin or clopidogrel. These prevent platelets from aggregating, therefore they serve to keep blood circulation fluid and prevent the formation of any thrombus. In other cases, however, a treatment is indicated. anticoagulant therapy, usually with warfarin. Anticoagulants such as coumadin slow down the normal activity of blood clotting, preventing the formation of clots. This therapeutic regimen is used especially for patients who have had an embolism originating from the heart. At discharge, it is planned to be discharged. there is also rehabilitation therapy, which includes physiotherapy, speech therapy and occupational therapy programs. Unfortunately, in some cases, strokes are known to be fatal or leave permanent disabilities.
It is possible to try to prevent stroke by keeping some risk factors under control. First of all, in the presence of specific diseases, such as diabetes, hypercholesterolemia, atrial fibrillation, arterial hypertension and some heart diseases, it is essential to follow the doctor's instructions and undergo periodic checks. Attention to lifestyle is also fundamental. The first tip is to quit smoking. As we have mentioned, smoking is an enemy of blood circulation, facilitates the formation of plaques within the arteries, damages the walls of the vessels and facilitates platelet aggregation. It is also very important for the prevention of stroke that the diet is balanced and healthy. The generally recommended diet is based on simple and low-fat foods, preferring whole grains, fish, fruit and vegetables and, as a condiment, extra virgin olive oil. It is necessary to avoid excess salt and limit the consumption of alcohol and sweets. Particular attention should also be paid to physical activity, which plays a protective role against stroke, as long as it is carried out regularly. In fact, it has been shown that a sedentary lifestyle favors many other cardiovascular risk factors, as well as worsening circulation.
