What is a Stroke?
Neurosurgery

What is a Stroke?

    A stroke, also known as a cerebral infarction or brain attack, is a medical condition that occurs when the blood flow to a specific part of the brain is suddenly interrupted or when blood vessels in the brain rupture. The brain relies on a continuous supply of oxygen and nutrients carried by the blood in order to control and coordinate bodily functions. Stroke results from the sudden interruption or restriction of this blood flow, leading to the death or damage of brain cells.

    The treatment of stroke requires immediate medical intervention. It is crucial to seek emergency care to quickly establish a diagnosis and initiate appropriate treatment. In the case of ischemic strokes, medications or endovascular procedures may be used to restore blood flow by dissolving blood clots. Hemorrhagic strokes, on the other hand, may require surgical intervention to control bleeding.

    Types of Stroke: Differences Between Ischemic and Hemorrhagic Stroke

    Stroke is generally classified into two main types: ischemic stroke and hemorrhagic stroke. Here are the differences between these two types of stroke:

    Ischemic Stroke

    Ischemic stroke occurs when the blood vessels in the brain become blocked. The blockage is typically caused by a blood clot or plaque. These clots or plaques can originate from the brain's own blood vessels or travel from another part of the body to reach the brain's blood vessels.

    • • Prevalence: Ischemic strokes account for approximately 80-85% of stroke cases, making it the most common type of stroke.
    • • Brain Damage: Ischemic stroke results in the death of brain cells by cutting off the supply of oxygen and nutrients to the brain tissue. The region of the brain supplied by the blocked vessel gets damaged.

    • Post-Stroke Treatment: In the aftermath of an ischemic stroke, the treatment primarily focuses on resolving the blockage and restoring blood flow. Attempts are made to dissolve the obstruction using thrombolytic drugs or endovascular procedures.

    Hemorrhagic Stroke

    Hemorrhagic stroke occurs when the blood vessels in the brain rupture or leak. This condition is usually associated with vascular diseases such as high blood pressure, aneurysm, or arteriovenous malformation (AVM).

    • • Prevalence: Hemorrhagic strokes account for approximately 15-20% of stroke cases.
    • • Brain Damage: In hemorrhagic stroke, the bursting of blood vessels leads to the accumulation of blood around the brain tissue, causing pressure. This pressure can damage the brain tissue and result in injury.
    • • Post-Stroke Treatment: The treatment following a hemorrhagic stroke focuses on controlling the bleeding and reducing blood pressure. Surgical intervention can be employed to repair the bleeding vessel, and medications may be used to lower blood pressure.

    The treatment and management approaches differ between ischemic and hemorrhagic stroke, so it is crucial to determine the correct diagnosis and type. When stroke symptoms are recognized, seeking immediate medical assistance and promptly receiving professional evaluation and treatment are important.

    Stroke Symptoms: How is Stroke Detected in Advance?

    Certain warning signs prior to a stroke provide individuals with information about their stroke risk and indicate the need for immediate medical assistance. These warning signs can be remembered using a mnemonic called "BE FAST":

    1. Balance: Sudden loss of balance, difficulty walking, or coordination loss. The person may exhibit sudden stumbling or a tendency to fall.
    2. Eyes: Sudden loss of vision or vision problems. The person may experience blurry vision, double vision, or disruptions in their field of vision in one or both eyes.
    3. Face: Facial asymmetry. The person may have a facial expression with one side drooping, a drooping corner of the mouth, or a drooping eyelid. When trying to show their teeth, one side may not move properly.
    4. Arm: Weakness, numbness, or paralysis in one arm or leg. The person may exhibit symptoms such as one side of their body being unable to be lifted or controlled when attempting to move an arm.
    5. Speech: Unclear speech, difficulty speaking, or speech disturbance. The person may speak in an unclear or garbled manner, have difficulty finding words, or use nonsensical words or sentences.
    6. Time: It is important to note how long these symptoms have been present. When you notice warning signs, it is crucial to seek immediate medical assistance without delay. Time is emphasized because early intervention can have a positive impact on stroke outcomes.

    Additionally, stroke symptoms can also include:

    1. Sudden dizziness or loss of balance.
    2. Sudden severe headache.
    3. Vision problems, double vision, or vision loss.

    Recognizing pre-stroke warning signs and seeking immediate medical assistance is vital. These warning signs present an opportunity to detect stroke risk early and receive prompt treatment. Stroke symptoms can occur suddenly or develop rapidly, so being vigilant and using the BE FAST mnemonic is of vital importance.

    Stroke Treatment

    Stroke requires immediate medical intervention. Swift diagnosis and initiation of treatment are crucial in the event of a stroke. The goal of stroke treatment is to minimize brain damage and prevent complications. Treatment typically involves the following methods:

    Ischemic Stroke Treatment

    • Thrombolytic Therapy: One of the most effective methods for treating ischemic stroke is thrombolytic therapy. This treatment involves administering medication into the blood vessels to dissolve blood clots. It requires early intervention and is preferably administered within 4.5 hours from the onset of symptoms.

    • • Endovascular Treatment: In some cases, endovascular treatment may be used for patients who are not suitable for thrombolytic therapy or require advanced treatment. This treatment method involves opening the blocked vessel or removing the clot through a catheter inserted into the blood vessel. The most common endovascular treatment method is mechanical thrombectomy.
    • • Blood Pressure Control: In ischemic stroke treatment, controlling blood pressure is important. High blood pressure can increase the risk of stroke, so medications may be necessary to regulate blood pressure.
    • • Blood Sugar Control: It is important to maintain controlled blood sugar levels in ischemic stroke patients. Elevated blood sugar levels can cause more damage to brain tissue.

    • Antiplatelet and Anticoagulant Medications: Following an ischemic stroke, antiplatelet or anticoagulant medications may be prescribed to prevent blood clotting. These medications can reduce the risk of recurrent stroke.

    Hemorrhagic Stroke Treatment

    • Surgical Intervention: Some cases of hemorrhagic stroke may require surgical intervention. The goal of surgical intervention is to address the cause of bleeding or stop the bleeding itself. For example, if a specific cause such as an aneurysm or arteriovenous malformation is identified, surgical correction may be necessary.

    • • Blood Pressure Control: In hemorrhagic stroke treatment, controlling blood pressure is crucial. High blood pressure can worsen bleeding and increase brain damage. Medications are used to regulate blood pressure and bring it to target levels.
    • • Fluid and Electrolyte Balance: After a hemorrhagic stroke, maintaining fluid and electrolyte balance in the body is important. Adequate hydration should be ensured, and electrolyte levels should be monitored.
    • • Anticoagulant Reversal: If the patient is taking anticoagulant medications that may be contributing to the bleeding, these medications may be stopped or reversed to control the bleeding.

    • Stroke Unit Care: Hemorrhagic stroke patients are typically monitored and treated in intensive care units. In these units, the patient's vital functions are closely monitored, respiratory support can be provided, and other supportive treatments can be administered.

    Rehabilitation

    Post-stroke rehabilitation is important in helping patients regain their functions. Various rehabilitation methods such as physiotherapy, speech therapy, occupational therapy, and psychological support are employed. These treatments aim to improve motor skills, speech, swallowing function, and daily life activities.

    Stroke is a serious medical emergency where better outcomes can be achieved with prompt intervention. Therefore, it is crucial to seek immediate medical assistance when stroke symptoms are recognized.

    Stroke Risk Factors: Factors that Increase the Risk of Stroke

    Stroke risk factors are various factors that increase a person's likelihood of experiencing a stroke. Some risk factors may be associated with lifestyle, while others may be genetic or medical conditions. Here are some of the stroke risk factors:

    1. High Blood Pressure: High blood pressure (hypertension) is one of the most significant risk factors that significantly increases the risk of stroke. High blood pressure can damage artery walls, leading to plaque buildup in the arteries and the formation of blood clots.
    2. Smoking: Smoking is a significant risk factor that increases the risk of stroke. Smoking narrows the arteries, increases blood clotting, and raises blood pressure, all of which contribute to an increased risk of stroke.
    3. Obesity: Being overweight or obese can increase the risk of stroke. Obesity can also trigger other risk factors such as high blood pressure, diabetes, and high cholesterol.
    4. Physical Inactivity: Not engaging in regular exercise or being physically inactive increases the risk of stroke. Physical activity can help lower blood pressure, regulate cholesterol levels, and prevent obesity.
    5. High Cholesterol: High cholesterol levels contribute to plaque buildup in the arteries, increasing the risk of stroke. High levels of low-density lipoprotein (LDL) cholesterol and low levels of high-density lipoprotein (HDL) cholesterol are also factors that increase the risk of stroke.
    6. Diabetes: Diabetes is a condition characterized by high blood sugar levels. Diabetes can cause damage to artery walls, plaque buildup in the arteries, and an increased risk of stroke.
    7. Family History: Individuals with a family history of stroke may have an increased risk of stroke. Genetic factors can make some people more susceptible to stroke.
    8. Age: The risk of stroke increases with advancing age. Advanced age is a significant factor in the increased risk of stroke.
    9. Gender: There are differences in stroke risk between women and men. Factors such as pregnancy, the use of birth control pills, and the menopausal period can affect stroke risk in women.

    Other factors such as alcohol misuse, drug use, heart disease, heart rhythm disorders, sleep apnea, stress, a high-stress lifestyle, and certain blood disorders can also increase the risk of stroke. While these risk factors may increase the risk of stroke, many of them are modifiable or controllable. Maintaining a healthy lifestyle can help reduce the risk of stroke.

    Stroke Emergency: Why is Rapid Intervention Important?

    Stroke is a medical emergency, and rapid intervention is crucially important. Here are some reasons why quick intervention is important in a stroke emergency:

    1. Reducing Brain Damage: Stroke causes damage to the brain tissue. In the case of an ischemic stroke, when blood flow to a brain region is not quickly restored, the brain cells are deprived of oxygen and die. In the case of a hemorrhagic stroke, the accumulation of blood and increased pressure leads to brain tissue damage. Rapid intervention can minimize brain damage and improve post-stroke outcomes.
    2. Time-Sensitive Stroke Treatment: In the case of an ischemic stroke, thrombolytic medications can be used to dissolve blood clots, but this treatment option has a specific time window. Thrombolytic therapy needs to be administered within a certain time frame after the onset of stroke symptoms (typically up to 4.5 hours). Therefore, seeking immediate medical attention is vital to not miss the time window for treatment.
    3. Preventing Complications: Stroke can lead to various complications, including brain swelling, recurrent strokes, infections, and long-term neurological issues. Rapid intervention can reduce the risk of these complications and achieve better outcomes with early treatment.
    4. Saving Lives: Stroke is a serious medical emergency and can be life-threatening in some cases. Rapid intervention increases the chances of saving a person's life. It is crucial to quickly reach the emergency department or the nearest medical assistance center in the event of a stroke to receive urgent treatment.

    A stroke emergency is a race against time, and rapid intervention is important to minimize brain damage, take advantage of treatment options, prevent complications, and save lives. When stroke symptoms are noticed, seeking immediate medical assistance is essential.

    Stroke Rehabilitation: The Process of Relearning and Recovery

    The primary goal of stroke rehabilitation is to regain lost skills and help the patient perform daily life activities independently. This process requires a multidisciplinary approach and is typically carried out by a rehabilitation team. This team may include physiotherapists, occupational therapists, speech therapists, rehabilitation psychologists, and other specialists.

    Some key methods used in stroke rehabilitation include:

    1. Physiotherapy: Physiotherapists use exercise programs and physical manipulations to improve movement ability and balance. They may also recommend supportive devices and prosthetics to cope with walking and mobility impairments.
    2. Occupational therapy: Occupational therapists work with patients to improve their skills in performing daily life activities. These activities may include dressing, eating, household chores, and tasks in the workplace. Occupational therapists use specific exercises and adaptive devices to enhance motor skills and hand functions.
    3. Speech therapy: Speech therapists work to address speech and swallowing disorders that occur as a result of a stroke. Language and speech exercises are used to improve voice production, vocabulary, and communication skills. They also teach techniques to regain swallowing function.
    4. Rehabilitation psychology: Post-stroke patients often face emotional and psychological challenges. Rehabilitation psychologists apply individual or group therapies to support the patient's mental well-being, cope with stress, increase motivation, and improve overall quality of life.
    5. Supportive treatments: In stroke rehabilitation, supportive treatment methods such as electrical stimulation, magnetic stimulation, robotic devices, and virtual reality can also be used. These methods aim to promote nerve recovery, increase muscle strength, and enhance motor skills.

    Stroke rehabilitation is typically individually tailored, and the duration of treatment can vary depending on the patient's condition. The effectiveness of treatment depends on factors such as patient motivation, early initiation of treatment, and adherence to regular exercises. Stroke rehabilitation plays a significant role in regaining post-stroke functions and improving the patient's quality of life.

    Stroke and Aging: Stroke Risk and Prevention in the Elderly

    The risk of stroke increases during the aging process. In older individuals, stroke can occur more frequently due to age-related health issues, chronic diseases, and natural changes associated with aging. Stroke can significantly impact the quality of life in the elderly and increase the risk of death. However, it is possible to reduce the risk of stroke through certain preventive measures. Here are important ways to decrease stroke risk in the elderly:

    1. Controlling Hypertension: High blood pressure (hypertension) is a significant factor that increases the risk of stroke. The prevalence of hypertension is high among older individuals. To control hypertension, it is important to regularly monitor blood pressure, limit salt and sodium intake, adopt a healthy diet, engage in regular exercise, and take prescribed medications if necessary.
    2. Quitting Smoking: Smoking is a significant risk factor that increases the risk of stroke. Smoking can contribute to vascular stiffness and raise the risk of stroke. It is important for elderly individuals who smoke to quit smoking and avoid environments where smoking occurs.
    3. Engaging in Regular Exercise: Regular physical activity plays a crucial role in reducing stroke risk in the elderly. Exercise improves circulation, enhances vascular health, and helps control hypertension. Older individuals can create an appropriate exercise program by consulting with their doctors.
    4. Maintaining a Healthy Diet: A balanced and healthy diet is essential in reducing the risk of stroke. Older individuals should adopt a diet that includes fiber-rich foods, fresh fruits and vegetables, whole grains, lean proteins, and healthy fats. Additionally, reducing salt intake and limiting trans fats and saturated fats are important.
    5. Limiting Alcohol Consumption: Excessive alcohol consumption can increase the risk of stroke. Elderly individuals should consume alcohol within the limits recommended by their doctors. Generally, women should limit alcohol intake to one standard drink per day, and men should limit it to a maximum of two standard drinks per day.
    6. Taking Medications Regularly: If older individuals have a chronic health condition or high-risk factors, it is important for them to take prescribed medications regularly. Regular medication use can help control blood pressure, cholesterol levels, and other risk factors, thus reducing the risk of stroke.

    Regular visits to the doctor are important for older individuals. Health check-ups enable the monitoring of risk factors, such as blood pressure and cholesterol levels, and allow for necessary medication adjustments.

    Adopting these preventive measures is important in reducing stroke risk in the elderly. However, since each elderly individual's condition may vary, it is crucial to create an individualized plan with a doctor, considering their health status and risk factors.

    Stroke and Stress Relationship: Effects of Stress on Stroke

    Numerous studies have been conducted on the effects of stress on stroke, and it has been shown that stress can increase the risk of stroke. Here are some important points regarding the effects of stress on stroke:

    1. Hypertension and Cardiovascular Effects: Stress can elevate blood pressure and harm the cardiovascular system. Chronic stress is associated with consistently high blood pressure (hypertension), which is a significant factor that increases the risk of stroke. Stress can also affect heart rate and rhythm, increasing susceptibility to cardiovascular diseases.
    2. Stress as a Stroke Trigger: Stress can act as a short-term or long-term trigger for stroke. Intense moments of emotional stress can lead to sudden increases in blood pressure, increased arterial stiffness, and clot formation, which can raise the risk of stroke. Particularly in individuals experiencing sudden and intense stress, the risk of stroke may temporarily increase.
    3. Behavioral Effects: In individuals under stress, behavioral factors can also contribute to an increased risk of stroke. Harmful habits such as smoking, excessive alcohol consumption, unhealthy eating, and lack of physical activity are more commonly observed in stressful situations. These factors are also known to increase the risk of stroke.
    4. Effects on Post-Stroke Recovery: Stress can influence the process of post-stroke recovery. Stress can lead to psychological and emotional issues, which can negatively affect the rehabilitation process after a stroke. Individuals experiencing stress are more prone to lack of motivation, non-compliance with treatment, depression, and anxiety, all of which can impact the success of rehabilitation.
    5. Stress Management and Reducing Stroke Risk: Stress management plays a significant role in reducing the risk of stroke. To reduce stress, it is important to engage in regular exercise, practice deep breathing, meditation, and relaxation techniques, utilize social support networks, and effectively manage stressful situations. Stress management techniques are crucial steps in reducing the risk of stroke and supporting the post-stroke recovery process.

    In conclusion, it is known that stress has negative effects on stroke. Stress can trigger hypertension, impact cardiovascular health, act as a stroke trigger, and affect the post-stroke recovery process. To mitigate the effects of stress, it is important to employ stress management techniques, adopt healthy lifestyle habits, and seek professional support when necessary.

    The content of the page is for informational purposes only, please consult your doctor for diagnosis and treatment.

    GülşahBADEMCİ
    Neurosurgery

    Prof. M.D.

    Gülşah BADEMCİ

    Koru Ankara Hospital

    Güner MENEKŞE
    Neurosurgery

    Prof. M.D.

    Güner MENEKŞE

    Koru Ankara Hospital