How to detect a stroke early?

Symptoms of stroke are usually very easy to identify in reality for those who have read little about stroke. Early recognition of this condition is of great value for early treatment.

Stroke = cerebral infarction, ictus, stroke.

The sooner the diagnosis is confirmed by computed tomography and therapy is started in hospital, the less permanent consequences. The time window from the onset of symptoms to the start of treatment or surgery is crucial.

Equally important is knowledge of the risk factors that cause stroke. Their recognition and early elimination prevent stroke.

Interesting:
Stroke is the most common cause of permanent disability in developed countries.

How does stroke manifest itself?

Stroke is a cerebrovascular disease (cerebrovascular). It is the damage to a blood vessel. As a result of the damage, the blood vessel becomes blocked (embolus, thrombus, atherosclerotic plaque) or ruptures at the point of weakening (cerebral aneurysm - bulging of a cerebral blood vessel).

Either the obstructed or the ruptured vessel causes subsequent damage to the brain parenchyma. Thus, stroke is caused by two very different causes. Nevertheless, the symptomatology is almost identical. The difference is more related to the speed of onset of symptoms, their intensity, duration, speed of development and progression of the condition.

It arises either from ischaemia or haemorrhage. Ischaemia means that, from some pathological cause, some part of the brain is inadequately supplied with blood. It may be a blockage of a blood vessel by a thrombus or its narrowing by an atherosclerotic plaque. Cerebral haemorrhage means haemorrhage resulting from the rupture of a cerebral blood vessel.

The similarity of the manifestations of haemorrhagic and ischaemic stroke tends to be problematic with regard to definitive treatment. Detailed diagnosis by computed tomography or magnetic resonance imaging is necessary. Despite the same symptomatology, these are two fundamentally different conditions with completely different management.

According to the cause, stroke is divided into two types:

• Ischemic stroke.
• Haemorrhagic stroke

Strokes preceding stroke - transient ischaemic attacks

A transient ischaemic attack can also be called a minor stroke. It is a transient condition that usually signals the arrival of a full-blown stroke. In many cases, a transient ischaemic attack indicates a pre-existing ischaemic deposit in the brain or narrowing of the carotid arteries.

It could be said that it is an attack (alarm, signal) that warns the patient of the occurrence of a real stroke. Therefore, it has an important informational value and should never be underestimated. Patients who have overcome a transient ischaemic attack have up to a 15-fold increased risk of stroke in the following 5 years.

A transient ischaemic attack is caused by cerebral ischaemia, never by bleeding, and is therefore a precursor to an ischaemic stroke. Cerebral ischaemia is caused not only by blockage of cerebral blood vessels, but also by obstruction of the carotid arteries that supply blood to the brain - carotid artery stenosis.

Outwardly, it manifests itself in the same way as an actual stroke, but its symptoms spontaneously resolve within a few hours. Up to 90% of the symptoms of a stroke disappear within 6 hours. Most of the time, the resolution occurs within 1 hour. The maximum resolution for the definition of a transient ischaemic attack is within one day.

Interesting:
The manifestations of transient ischaemic attack and stroke are almost identical. The difference is that the symptoms of transient ischaemic attack disappear within 24 hours, whereas in stroke there is no spontaneous resolution of the symptoms. In neurological practice, the term reversible ischaemic deficit is also known. This is the so-called prolonged transient ischaemic attack. It is a condition that manifests itself in the same way as transient ischaemic attack, but the symptoms disappear within two to three weeks.

Table with symptoms, course and treatment of transient ischaemic attack:

Symptoms of stroke from insufficient blood supply to the brain

Ischaemic stroke manifests itself in the same way as a transient ischaemic attack. The difference is that the symptoms do not disappear after 24 hours. They are usually more intense, but this is not the rule. There is no spontaneous resolution of the condition, but rather its progression. If the patient does not seek medical attention and treatment is not started, the condition will not correct itself.

The most common cause of ischaemic strokes is, in most cases, atherosclerosis, i.e. damage to the cerebral arteries by the atherosclerotic process. Together with arterial hypertension (high blood pressure), it forms the perfect basis for stroke. Less commonly, inflammatory and other causes may also be involved.

Symptomatology is dominated by sudden onset of nausea, tingling to paralysis of half the body. Headache, dizziness or disorientation may be present. The patient is pale, sweaty and gives the impression of being ill. In some cases, the primary manifestation is sudden onset of impaired consciousness, but this is more commonly seen in haemorrhagic icts.

Interesting:
Up to 80% of all strokes are due to ischaemia. Approximately 20% are caused by carotid artery stenosis (narrowing of the carotid arteries).

Table showing the manifestations and course of ischaemic stroke:

Symptoms of stroke on the basis of cerebral haemorrhage

Cerebral haemorrhage arises from a variety of causes. Most commonly, it is an aneurysm (bulging of a cerebral blood vessel) combined with high blood pressure. Ultimately, the cerebral blood vessel ruptures because of its previous weakening and usually high blood pressure at the time.

Some patients themselves describe how the condition is preceded by severe pain or a feeling as if something has burst in their head. The condition develops very quickly, the symptoms are intense and the consequences are often fatal. It also very often affects younger age groups and the incidence of cerebral haemorrhages is increasing.

The initial onset is dominated by a sudden onset of intense headache, nausea, massive vomiting and weakness of half of the body. Increasing pressure in the closed skull skeleton causes damage to the brain and its swelling. This is manifested by stiffness of the neck, the patient is unable to bring the chin to the chest and the pain progresses to the neck. The localization of the pain is in the back of the head and neck.

Swelling of the brain also manifests itself externally as varying degrees of disturbances of consciousness, convulsions and fasciculations (spasms of the facial muscles - twitching). Depending on the size of the vessel and the rate of bleeding, disturbances of consciousness and death set in.

Interesting:
Haemorrhagic strokes, i.e. spontaneous (non-accidental) cerebral haemorrhages, account for approximately 20% of all strokes. However, they are much more serious. They have a rapid and unexpected onset, more intense symptoms, a relatively short and dramatic course. In many cases, they end in death or severe brain damage with permanent sequelae, sometimes requiring artificial pulmonary ventilation.

Table with symptoms of hemorrhagic stroke:

Common symptoms of all types of stroke

The symptoms of transient ischaemic attack and ischaemic or even haemorrhagic stroke are almost identical. It could be said that 99% of these conditions are common to all of them.

They differ in the speed of onset of symptoms, their intensity, duration and prognosis. Haemorrhagic strokes are the most dangerous, while transient ischaemic attacks are the least dangerous.

Given this similarity in symptoms and, conversely, the differences in treatment, differentiation of the specific type of stroke is necessary. Only then can the correct treatment be applied, and in the case of haemorrhage, urgent surgery.

Vegetative symptoms occur in all types of stroke

Vegetative symptoms are observed in transient ischaemic attack, but also in both types of stroke. These are manifestations of the autonomic nervous system.

This symptomatology is not only seen in stroke patients. It is also common in other diseases such as myocardial infarction, pulmonary embolism or heart failure.

They are also a concomitant of psychiatric diagnoses and psychological conditions (fright, fear, anxiety).

Vegetative symptomatology:

• Pallor in the face, possibly flushing
• sudden onset of nausea, heaviness or discomfort in the stomach
• massive, repeated vomiting of stomach contents
• diarrhoea (usually one at the beginning - underfeeding, bedwetting)
• excessive sweating, beads of cold sweat on the forehead
• general weakness, malaise
• dizziness, feeling faint, collapse
• palpitations, tachycardia
• hypotension (ischaemia), life-threatening hypertension (haemorrhage)

Neurological symptoms typical of a stroke

The common neurological symptomatology is headache and dizziness. They occur simultaneously with autonomic symptoms. In transient ischaemic attack and ischaemic stroke they tend to be of moderate intensity. In haemorrhagic stroke the pain tends to be very intense, associated with meningeal irritation (stiffness and neck opposition).

Visual disturbances are more typical of a complete stroke and are not common in transient ischaemic attacks. However, there are some exceptions. Visual disturbances include blurred or double vision. However, unilateral visual disturbances are more typical.

Ischaemic or haemorrhagic stroke affects either the right, left or another part of the brain (e.g. the brain stem). Due to the lack of blood supply or pressure in part of the brain, paresthesias (tingling), partial to complete paralysis of the opposite half of the body are present. Patients have difficulty standing and walking. They drag their leg behind them, are inclined to the paralysed side, fall in the direction of paralysis and sit up. They have no feeling in the affected upper limb and cannot hold objects.

Half of the body is also paralysed and the head is affected. Facial asymmetry is visible, manifested by ptosis (drooping of the eyelid) and drooping of the corner of the mouth (drooling or leaking of saliva or fluids from the mouth when trying to drink).

The tongue and palate are also affected. Their paralysis causes a speech disorder, also known as dysarthria (unintelligible speech). In dysarthria, the patient understands what is being asked. He tries to answer, but finds it very difficult to understand. This is because the paralysed tongue muscles tend to pull to one side. However, the answers retain their logical structure.

The second speech disorder is aphasia. It occurs when the speech area of the dominant cerebral hemisphere, frontoparietotemporally, is affected. We know motor or sensory aphasia. In motor aphasia, the patient understands questions but has difficulty pronouncing some words. He is angry with himself for not being able to do so. In sensory aphasia, the patient does not understand questions, speaks poorly, without logical structure (so-called word salad).

Neurological symptomatology:

• headache (moderate and severe intensity, with tangential hemorrhage)
• meningeal symptoms (stiffness and pain in the neck)
• dizziness (markedly worse in hemorrhage when lying down)
• collapse (progresses to unconsciousness in haemorrhage)
• visual disturbances (blurred, double, blur in one field of vision)
• speech disorders (dysarthria, aphasia, stuttering, inability to pronounce certain words)
• paresthesia, tingling of half of the body, face
• paralysis of half of the body (partial, complete)
• disorientation, confusion, sometimes aggressiveness
• psychomotor restlessness (pronounced in cerebral haemorrhage)
• disturbance of consciousness to unconsciousness

Which factors pose a risk in stroke?

The risk factors for stroke have already been partially outlined in the previous paragraphs. Prevention and treatment of these underlying conditions significantly reduces the occurrence of strokes and haemorrhages themselves. This substantially reduces disability and mortality.

In most cases, the unhealthy life of the individual is behind the development of this disease of civilisation. Poor diet, addictions and lack of exercise contribute to the development of diseases that ultimately lead to stroke.

Oh, our addictions!

Smoking, alcohol and drugs, a trinity that has taken many lives. As with other causes of morbidity and mortality, these addictions are important in stroke. They multiply their incidence, worsen their course and their treatment options.

Smoking alone substantially multiplies the risk of stroke. Smokers have up to twice the risk of cerebral haemorrhage and up to four times the risk of subarachnoid haemorrhage. The incidence of ischaemic strokes is even trebled in people with this condition.

There is a higher incidence of hemorrhage in alcoholics compared to ischemia. In chronic alcoholism, the number of hemorrhages (with subarachnoid hemorrhage at the forefront) is almost four times as high. If a chronic drinker begins to have excruciating headaches, the likes of which he has never had before, he is very likely to suffer from a head hemorrhage.

Tip: Do you know how alcoholism affects health?

Damage to the blood vessel wall is the biggest threat of stroke

The blood vessel is most often damaged by excessive intake of sugars. Subsequent or simultaneous excessive intake of fats causes an atherosclerotic plaque to form in the already damaged blood vessel.

Blood vessels damaged by the atherosclerotic process are narrowed, so that flow through the brain is impaired. They are also more susceptible to the attachment of a thrombus (blood clot) or embolus, causing them to become completely blocked.

Atherosclerosis of the blood vessels is also the most common cause of ischaemic stroke. It affects the cerebral arteries, but also other blood vessels. An example is the carotid arteries, whose narrowing causes up to 20% of cerebral strokes.

Tip: Sugar, our sweetest enemy

High blood pressure poses a risk of stroke

High blood pressure increases the risk of both ischaemic and haemorrhagic strokes. It is one of the most common factors. However, given the development of treatment for arterial hypertension, it is also one of the most influential factors.

The systolic (upper) pressure plays a major role in the development of stroke. Long-term elevated and untreated pressure values cause permanent pressure on the vessel wall. In the place of its weakening, over time they form a bulge (aneurysm).

The aneurysm very often ruptures and is also another cause of cerebral haemorrhage. Abnormally high systolic and diastolic pressures pose a threat due to the rupture of the vessel wall, especially at the site of the bulge and subsequent haemorrhage.

Tip: Aneurysms

You should be careful and take any manifestation seriously

In diabetics, the risk of stroke is double. It is mostly ischemic events that put this category of patients at risk. Rarely, hemorrhages also occur, but where blood pressure plays a greater role.

It has already been mentioned above how sugar affects the blood vessels, and what it subsequently causes. In people with diabetes, blood sugar levels are consistently elevated. In better cases, glycaemia is kept just above normal.

Up to 75% of stroke survivors had diabetes or another disorder of carbohydrate metabolism. Older people should be aware that they have elevated fasting glycaemia even if they have not been diagnosed with diabetes mellitus.

Tip.

Are you being treated for cardiac arrhythmia?

Heart rhythm disturbances indirectly cause thromboembolic stroke. Almost every patient with ischemic stroke also has arrhythmia-like changes on the ECG. The most common arrhythmia we see in a stroke patient is atrial fibrillation.

Atrial fibrillation means that the heart contractions are faster, irregular and chaotic. This causes excessive blood to build up in the heart, forming blood clots and subsequently 'shooting' a thrombus up into the cerebral arteries.

In the blood vessels of the brain, the clot causes an obstruction, narrowing or clogging its diameter. A part of the brain is not nourished and sufficiently oxygenated, resulting in its death - a cerebral infarction.