What is a stroke? Do you know its symptoms, risks or treatment?

When vascular brain stroke occurs for various symptoms , which are well recognizable. Cerebrovascular diseases are the third most common cause of death and disability.

Early detection and early treatment is a criterion for a good prognosis.

Vascular cerebral stroke we know well thanks to another name, such as, for example, sudden cerebral stroke, defeat, cerebral infarction, stroke, apoplexy, cerebral stroke, or bleeding into the brain. 

Likewise known are the abbreviations stroke or stroke, thus vascular cerebral stroke and sudden vascular cerebral accident. At the same time, they express the same group of vascular diseases of the brain, professionally also cerebrovascular diseases.

Brain stroke is the third leading cause of death and disability in developed countries, after cardiac and oncological diseases. Mortality due to cerebral stroke, the range in the range of about 100-200 / 100 000 inhabitants in Slovakia.

This disease is economic and social problems and in today's time, when the professional care time available and at a good level.

Stroke is defined as:

Sudden disease caused by rapidly developing focal loss of brain function. The symptoms persist for more than 24 hours or are the result of death. This is when the cause of death was a vascular cause.

The brain is an organ demanding oxygen and sugar

A constant supply of oxygen and sugar is important for the proper functioning of the brain.

Glucose, ie sugar, is the only source of energy for nerve cells and its brain consumes approximately 115 g per day. Consumption is approximately 5.5 mg per 100 grams of brain tissue, which is 75 mg per minute for the whole brain.

Oxygen consumption is approximately 3.5 ml per 100 grams of brain tissue, or 50 ml per minute for the whole brain. This value represents about 15 - 20 percent oxygen demand for the whole organism. Therefore, a constant and sufficient blood flow through the brain is needed. 

It is a 50-60 ml of blood per 100 grams of brain tissue for one minut.

Experimentally it was found, that cerebral ischemia, ie complete consumption of oxygen in the brain occurs approximately after 2-8 seconds . After 12 seconds, there is a disorder of consciousness, collapse, unconsciousness. Electrical activity is not present on the EEG after 30-40 seconds.

Irreversible brain damage occurs after 3-4 minutes. After 9 minutes, survival is not possible due to complete cerebral ischemia.

The only exception is the state of hypothermia, ie hypothermia, when the energy and oxygen intensity of the brain is significantly reduced.

Therefore, in the bearing , but also in the total loss of blood supply or in part, loss of blood supply occurs to a fault function of the central nervous system suddenly. Brain cells are for life now further divide, as in the case of long-term loss of blood supply means irreversible damage, and thus the permanent neurological problems.

We know several types of vascular brain events

The sudden vascular cerebral accident is divided by the, which is the mechanism to form.  

It is divided into two basic types. And thus the ischemic and haemorrhagic. The symptoms of both types are similar. That's how the stroke occurs depends on the site, the extent and length of disorders of blood circulation of the brain tissue.

Ischemic vascular cerebral accident is the cause of loss of blood supply to thrombosis, and thus the atherosclerosis of brain arteries, or emboli released thrombus, ie embolisms from migrating ( blood clot ) from other parts of the body and a clogged blood into the brain arteries. Wherein about 80-83% of cases consisting of ischemic stroke.

Hemorrhagic, thus hemorrhagic cerebral stroke, is a large scale due to high blood pressure or rupture of the damaged blood vessels, for example, the site of the aneurysm. With intracerebral hemorrhage was found about 15% of cases.

Subarachnoid hemorrhage, which is another form of hemorrhagic stroke is represented approximately 5% of all vascular cerebral events.

The table shows the main division of CMP and some causes

The cause of a stroke is a disorder of blood flow and the supply of the necessary oxygen and nutrients to the brain.

The incident can be caused by two mechanisms. The most common is clogging of the blood vessel, cerebral artery and the second variant is bleeding. The result is neurological problems.

Ischemic stroke

Ischemic CMP is the result of partial or complete occlusion of a vessel when the brain tissue is not sufficiently or completely congested. Disorder of the cerebral circulation results in neurological difficulties, or neurological deficits.

The intensity and type of symptoms is directly dependent on the location, extent and total duration of the blood circulation disorder.

Stroke can also take the form of a transient ischemic attack , also referred to as TIA, or transient ischemic attack. Naming transient is because neurological problems go away completely within 24 hours of the onset of symptomatology.

Approximately 1.9 million neurons are damaged in the uncured portion every minute.

Another type is reversible ischemic deficit, the symptoms of which subside within 7 days. It is also referred to as RIND in professional circles.

A serious form is a permanent neurological deficit, ie cerebral infarction - CI. We can also meet the sign LIM.   

Within one year, about 1/3 of people affected by ischemic stroke die.

LIM is short for focal cerebral ischemia. What is the sign for local lack of blood and nutrients. This deficiency is the result of temporary or permanent neuronal damage.

Cerebral infarction is most often caused by atherothrombosis of the large vessels (40-60%), followed by cardioembolic causes (20-30%), lacunar stroke (15-20%) and other or undetected causes.

Another way is to divide the ischemic stroke according to the triggering factor, into:

1. large arterial diseases, for example for atherosclerosis of the large cerebral arteries, where the vessel wall is damaged by atherosclerosis, which prevents blood circulation
2. cardioembolization, in heart disease and cerebral artery embolization (atrial fibrillation, heart attack, valve replacement, endocarditis)
3. small artery disease, as a result of small artery disease, lacunar infarcts with a small extent up to the size of 1 - 1.5 cm, and for example also for untreated hypertensive disease
4. other causes such as vasculitis, vasculopathy, angiopathy, genetic disease

CMP or also stroke = defeat = apoplexy = stroke.

Hemorrhagic stroke

This form of stroke is the result of bleeding.

Cerebral hemorrhage results in brain damage in two ways. The first is the oppression of the surrounding tissue by leaking blood from a damaged vessel. The second is a disorder of blood circulation to a given area of ​​the brain, and thus insufficient oxygenation and nutrient supply. 

We know two types of bleeding strokes.

Intracerebral and subarachnoid hemorrhage. This group does not include bleeding into the skull resulting from the injury. Bleeding events are associated with higher rates of brain damage and mortality than ischemic CMP.

 About one-third of affected people die within one year of a bleeding stroke.

The first type is intracerebral hemorrhage (ICH), ie bleeding into the brain tissue - parenchyma. It occurs to a lesser extent than an ischemic event, in approximately 15 percent of cases. 

However, it has the most serious devastating impact. It is stated that within a year, about half of those affected die as a result. Half of those who survive have severe neurological damage and only 20% of people are self-sufficient. 

The second type of bleeding is subanarchnoid hemorrhage (SAH). It occurs in approximately 5% of cases of CMP. In this case, the bleeding is located between the arachnoid and the pia mater (cerebral membranes) into the cerebrospinal fluid. It is largely caused by a ruptured vascular aneurysm, up to 85%. 

Also read: anarticle with general information about aneurysm at the Medical Center. 

It is characterized by high mortality during its onset (5-10% of cases). Subarachnoid hemorrhage occurs for no apparent reason or after exercise. And it can be physical exertion, but also agitation. It can also occur after coughing, sneezing or stool. 

The table shows the most common causes of stroke

Risk factors that affect the development of CMP

There are risk factors that directly or indirectly influence the formation of cerebral vascular diseases. These are either controllable or unaffected. 

A small group of uncontrollable risk factors consists of:

• age, while the risk is increasing higher age (over 65 years )
• sex, men have a higher tendency to form CMP
• race and geographical differences. You SSI incidence is in Japanese, Swedes and Finns
• dedi virtue

Influenceable risk factors:

• Arteri scoring of hypertension
• atherosclerosis and failure metabolized lipid
• obesity
• cardio - vascular diseases, disorders of cardiac rhythm (atrial fibrillation),valvular defects (flap compensation), endocarditis
• Diabetes mellitus, ie diabetes, hyperglycaemia (high sugar in the blood)
• coagulopathy, a problem with blood clotting, anticoagulant therapy
• smoking tion
• alcoholism
• sleep apnea syndrome
• Autoimmune's disease

The symptoms of a stroke are the result of a disorder of the blood circulation, and thus a disruption of nerve functions. Neurological problems are encountered in both cases, or have it on ischemic or haemorrhagic form. They are similar and may have a different course .

Symptoms of bleeding events usually start very quickly and often from complete health .

When hemorrhage is a higher rate occurs disturbance of consciousness, coma or symptoms of epilepsy. But the sharp pain head emerging in seconds. The warning is the first pain head in life, or the sudden appearance of other neurological disorders for the first time .

However, in some cases, they are difficult conversely less intense. Therefore it is not possible to clearly determine whether the incident ischemic, or hemorrhagic. The exact diagnosis is determined on the basis of a professional examination by a neurologist and after a CT examination .

When CMP is can occur any neurological problems. And as is apparent, it depends from the site, extent, and last but not least, the length of duration. The neurologist determines the location according to the symptoms also in the basin of an individual artery ( vessel ).

Of course, the symptoms are dependent also on that in what part of the vessel, the problem occurred .

Example of CMP distribution in individual artery involvement :

• ophtalmica - causes blindness
• cerebri media - often embolic cause, where there is failure mobility or speech
• cerebri anterior - disorder of speech, defect mobility
• cerebri posterior - failure spatial perception, impaired vision
• bazilaris - the highest threat to life, disorder of consciousness, coma
• internal carotid artery - visual disturbances
• carotis communis

Probably the most well-known symptoms are a movement or speech disorder. The anatomy of the nervous system is arranged so that the hemispheres cross. The problem in the left half of the brain (the left hemisphere ) will show you how difficult the momentum right leg .

A person may be paralyzed by a limb. She does n't feel it, she ca n't move with it. We know this feeling, for example, even when the hand lies down for a long time in sleep.  

Paralysis can be partial, as weakening. Man knows the upper limbs to move, but in the hands hold cup, or it ever grasps. The strength of the other limb is maintained at a normal level.  

Can not move one lower limb, it holds are the legs and falls. Or when walking behind him one leg pulled. It does not have to feel one side of the face, lips (such as at the dentist for Deliver numbing medicine, ie local anesthetic ).

Ocher may also mimic muscles, ie muscles of the face. What is apparent decline in the mouth corner .

It 's similar with speech. According to the site of damage will occur different symptoms. An example is dysarthria, when a person has impaired articulation and mispronounces some letters, such as "r". And so far he has not had a problem with that. Another form of speech disorder is aphasia.

In aphasia, a person with a disability can understand what you are telling him, but he can not answer you, only happily, he cannot speak words. Disrupted the formation of speech. Also referred to as expressive aphasia. Another type is sensory aphasia, which is a disorder of speech comprehension .

One does not understand at all, but the ability to form words is preserved .

We also know amnestic ( anomic ) aphasia, which is characterized by an inability to recall a certain concept. However, he can describe it differently. Occurs is the global ( utter ) aphasia, in which it is not concerned capable of communication, it is a complete loss of communication skills.  

When vascular brain stroke is can experience symptoms, such as for example :

• sore head
• dizziness
• problem with maintaining balance, coordination of movement
• feeling the sick and vomiting
• increased sensitivity to light and noise
• visual impairment (blindness, color blindness, visual field loss, double vision)
• speech disorder (dysarthria, aphasia, etc.)
• swallowing disorder
• whistling in the ears, or other noises ( tinnitus )
• sensitivity disorders, twitching of a part of the body
• movement disorder, mobility
  • paresis, partial paralysis, weakening of the limb
  • plegia is complete paralysis
  • one limb ( monoparesis )
  • half body ( hemi - paresis / plegia )
• disorder of consciousness
  • short-term loss of consciousness, ie collapse
  • qualitative disorder of consciousness (disorientation, dementia, confusion, aggression, psychomotor restlessness)
  • quantitative disorder of consciousness (drowsiness - somnolence, sopor to coma)
• body cramps, as in an epileptic seizure

Even a person without a medical education can evaluate consciousness or breathing. Of course, the natural presence of stress in serious situations. In the context of a stroke, it is important to recognize the problems early, as this has a direct impact on human health or life, and early diagnosis and treatment.

It is important to recognize :

• sudden loss of ability to move limbs or noticeable weakness, especially if one cannot move one side of the body
• gait disorder, pulling one limb in a row
• sensory disturbance, numbness or tingling of half of the body, face
• sudden onset of disorientation, confusion, aggression
• speech disorder
• failure of vision, double vision
• suddenly caused dizziness, loss of balance and coordination of movements, falling
• intense pain in the head, especially if you are experienced for the first time in life, with no known cause or after physical exertion
• collapse and impaired consciousness

In this case, it is necessary to provide first aid and call the emergency number of the emergency medical service, ie number 155. When calling, the emergency medical service operator assesses the need and urgency of sending an emergency medical service ambulance .

Questions from the emergency room operator that are important and need to be answered :

• address, exact place of the event, indicative description?
• name, especially important for the address in the apartment building
• age
• state of consciousness, reacting, talking, just looking, looking at one place ?
• breathes or does not breathe, breathes fast, catching, growling, whistling ?
• responds adequately, is it oriented, disoriented ?
• speech is impaired, does not understand, does not speak, silly ?
• moves the limbs, does it perform a simple action ?
• what is he doing now, what is his position in ?
• where is the pain where is the pain?
• does he have a headache, is the headache long-term or for the first time?
• how long do the difficulties last ?
• Cures were on diabetes, nip your insulin ?
• occurred was with him convulsions of the body ?
• not after the injury ?
• had a CMP in the past ?
• other long-term diseases

The symptoms of a stroke are well recognizable. Such as is mentioned in the section above, it is important to notice consciousness, contact person, speech, mobility, sensitivity and muscle strength. Associated pain in the head, dizziness and vomiting can lead to suspicion for vascular brain incident.

It's about what kind of vascular brain events it is not in the field important. The main thing is to notice the difficulty of transporting the affected person to a professional examination in time and quickly. That's how long difficulties insist has an impact on the outcome of treatment.

In the case of an ischemic event, the therapeutic window and the best result are within 3 hours of the onset of the first difficulties.

Important is the medical history and clinical picture, the value of physiological functions, such as blood pressure, pulse. In a diabetic,  it is important to measure blood glucose so that CMP is not confused with hypoglycemia. And then transport to the destination medical facility. Where CT and neurological examination are performed.

Among other diagnostic methods it is classified and MRI, therefore,  magnetic resonance and ultrasound. CMP can have a cardiac origin, and therefore an ECG, ECHO, is performed. And especially when detected malfunction of the heart rhythm. Doing is the laboratory examination of blood. In the case of neurological disorders,  it is important to distinguish between other diagnoses. Such as, for example,  hypoglycemia, dehydration (especially in the case of small children and the elderly).

And these problems can occur for complete health and for no known reason.

It can be immediately after physical exertion, agitation, after the toilet - stool or after sexual intercourse. However, sometimes in peace.

In case of bleeding events, short-term loss of consciousness, collapse, is frequent. But also a disorder of consciousness, drowsiness, the inability to wake a person to address, except for pain or coma.

Symptoms of CMP include sudden disorientation, confusion, aggression, and psychomotor restlessness. Of course, depending on the extent, the course may be milder and the difficulties develop a little longer. 

In ischemia, i.e., bloodlessness, there is also a sudden onset of symptoms such as muscle weakness, paralysis, or speech impairment.

Patients may describe numbness of the side of the body or only half of the face, lips. When the facial muscles are paralyzed, one corner of the mouth drops. Or there is a sudden visual disturbance, double vision, or loss of field of vision.

Noticeable is the fall to one side and the inability to walk in people who did not have a problem with mobility.

TIP: An important question and warning signs for headaches are covered in an article in Pregnancy Headache magazine.

The diversity of symptoms and the course of the disease cannot be summarized in one standardized example. Therefore, any neurological difficulties cannot be neglected.

If they occur, an immediate examination is recommended. Especially with the rapid onset of difficulties that did not occur in a given person in life.