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What is Stroke ?

A stroke is a brain attack. It happens when the blood supply to part of your brain is cut off. Blood carries essential nutrients and oxygen to your brain. Without blood your brain cells can be damaged or die. This damage can have different effects, depending on where it happens in your brain. Therefore, a stroke can affect the way your body works as well as how you think, feel and communicate.

2 types of Strokes: the ischemic stroke and the hemorrhagic stroke.

  • The ischemic stroke is the most common type of stroke in Europe and happens when an artery in the brain is blocked. A blockage can be caused by a blood clot forming in an artery leading to the brain or within one of the small vessels deep inside the brain (cerebral thrombosis). Blockages in the brain can also be caused by a blood clot or other matter (such as an air bubble) moving through the blood stream from another part of the body( cerebral embolism).
  • The hemorrhagic stroke happens when a blood vessels in the brain burst and spills blood into the brain. High blood pressure and aneurysm can make bloods vessels enough to burst.

Key facts and figures

Stroke affects approximately 6 million people of all ages and ethnic backgroung in the EU, with 1.1 million new cases every year.At least one in four stroke survivous will experience another stroke and recurrent stroke often have a higher rate of death disability.

Despite spontaneous recovery, more than 50% of stroke patients have residual impairment, causing a huge burden on the patients, their relatives, and society. The total cost of disorders of the brain was estimated at €798 billion in 2010. Of that, €64.1 billion is attributed to stroke alone, mainly due to the high costs of long-term special care and rehabilitation. The socio-economic burden of stroke is expected to increase due to aging of the population and the sharp rise in diabetes and obesity, which are reaching an epidemic level. Thus, effective interventions to alleviate residual impairment are urgently needed to help stroke patients

Treatments

Current treatment options for stroke are limited to intravenous (IV) thrombolysis by Alteplase within 4.5h, thrombectomy, aspirin within 48h, decompressive craniectomy for large strokes, and management in stroke care units for intensive care and rehabilitation.

Preventive approaches are effective in reducing stroke mortality and incidence. However, while thrombolysis together with improved acute care has led to decreased mortality, the surviving patients are left with sensorimotor and cognitive disabilities, resulting in significant additional burden to rehabilitative care. Thus, effective treatments beyond prevention and acute care are urgently needed. This requires a sophisticated understanding of stroke pathophysiology. It is well-known that stroke effects are not limited to neurons but involve glial and endothelial cells and the surrounding extracellular matrix in a “glio-neurovascular niche” that interacts with the peripheral immune system. For these reasons, new therapies should target all these systems rather than narrowly targeting an individual deleterious process, perhaps avoiding the failures of past clinical translational attempts to develop specific protective drugs

  •  Ischaemic stroke: If the ischaemic stroke is caused by a blood clot, you may be treated with a clot-busting medicine, known as thrombolysis/thrombectomy that can break down and disperse a clot that is preventing blood from reaching your brain. However, for it to have the best effects, it needs to be given within four and a half hours of your stroke symptoms starting.Most people who have an ischaemic stroke will be given anti-platelet medication, which helps to prevent your blood from clotting.
  • Hemorrhagic stroke To stop the bleeding, remove blood or relieve any pressure that has built up around your brain the patient may need surgery. If the stroke was caused by a burst aneurysm, an operation may be needed to seal it and stop it bleeding again. To lower the blood pressure or if your the bleed was caused by anticoagulant medication, the patient may be given medication  you will usually be given another drug to reverse the effects as soon as possible.

After a stroke, therapies are focused on helping the brain’s undamaged areas to re-learn lost skills such as walking or talking (termed neurorehabilitation). This involves a wide range of professionals, including neurologists, speech therapists, nurses and physiotherapists. In some cases, healthy areas of the brain can learn to take over from those areas that were damaged by the stroke. Unfortunately, severely damaged parts of the brain cannot recover because the body cannot replace the lost brain cells. This is where scientists hope that stem cells may play a role, helping us to find ways to boost the body’s repair systems.

Risk Factors and preventing strokes

Risk factors and prevention:

  • High blood pressure: High blood pressure (>120/80mmHg) is the most important and prevalent modifiable risk factor for stroke.There is a  significant reduction of stroke incidence with a decrease in Blood Pressure. Antihypertensive drugs reduce stroke recurrence risk.
  • High Cholesterol: High blood cholesterol (e.g. LDL>150mg/dl [3,9mMol/l]) should be managed with lifestyle modification
  • Diabetes:Diabetes narrows the arteries. Elevated blood glucose in the early phase of stroke is associated with death and poor recovery.
  • Smoking :Smoking damages the arteries and makes the blood more likely to clot. Smokers are also more likely to develop high blood pressure, which is a major risk factor for stroke. A smoker has a 2-3 fold increased risk compared to non-smokers. The risk decreases by half by 2 years after stopping smoking.
  • Heavy alcohol use: A heavy alcohol consumption (>60g/day) increases risks for both ischaemic and haemorrhagic stroke. Light alcohol consumption (<12g/day) is associated with reduced stroke. Red wine consumption carries the lowest risk.
  • Physical inactivity: Regular exercise (at least 3x30min/week) is associated with a decreased risk of stroke or death. This is mediated, in part, through beneficial effects on body weight, blood pressure, serum cholesterol, and glucose tolerance.
  • Obesity: High body mass index (BMI ≥25) increases risk of stroke in men and women. A diet low in salt and saturated fat, high in fruit and vegetables and rich in fibre is recommended.
  • Hearth disease

Do you think that someone is having a stroke?

Use the FAST technic and as the stroke is a medical emergency, you need to call 999 immediately.

The quicker your stroke is diagnosed and treated, the better your recovery will be. A stroke is usually diagnosed using a brain scan: either a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan.

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