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Stroke signs and therapy
Most people are affected who are older than sixty years. However, this life-threatening disease can affect younger people, even children and newborns.
contents
- How a stroke develops
- causes
- risk factors
- symptoms
- Stroke - right hemiparesis
- Warning signals
- diagnosis
- Stroke symptoms suggest
- Stroke with its consequences
- Stroke Unit Special Department
- therapy
How a stroke develops
In most cases, brain ischemia (depleted blood supply) is the underlying cause, which then causes the poorly-supplied tissue to deteriorate and diminish or fail to deliver.
causes
The main cause, in approximately eighty-five percent, is a misplaced vessel, which results in less blood flow and the subsequent tissue can not be properly cared for. This area dies and can no longer fulfill its tasks. The reason for a relocation is usually an underlying arteriosclerosis (arteriosclerosis), which means that there are deposits of fat, connective tissue, thrombi and lime in the vessels. These become more and more confluent, forming a graft in the worst case, which clogs a vessel in the brain in a stroke.
Blood clots in the brain lead to a stroke. Image: www.fotolia.com © psdesign1 Blood clots, for example, from the carotid artery, can break loose, reach the brain via the bloodstream, lay a vessel there and thus trigger an apoplex. An embolus (vascular graft) from the heart, for example, caused by atrial fibrillation (arrhythmia of the heart with uncoordinated atrial events), can lead to the transfer of a cerebral vein.
Less commonly, approximately fifteen percent of strokes are due to intracerebral haemorrhage.
risk factors
Different risks can promote cerebral infarction, with a distinction between "white insult" and "red insult". The "white insult" clogs a cerebral artery, causing the affected area is no longer sufficiently supplied and then dies. The risk factors for this are hypertension (hypertension), smoking, diabetes mellitus, lipid metabolism disorders and the intake of the pill. The main risk of a "red insult," that is, brain hemorrhage, is hypertension.
Obesity is also associated with an increase in the risk of stroke. In addition, a higher age is to be evaluated as a risk factor.
symptoms
The symptoms are very varied and depend on the affected area and its extent. Typical is the sudden loss of various brain functions, depending on which cerebral artery is affected. Sudden onset of symptoms such as drooping corners of the mouth, vision or speech problems, walking difficulties, paralysis or massive headache, dizziness, hiccups, shortness of breath, nausea and vomiting are among the signs. These symptoms do not necessarily lead to a stroke, but can act as a harbinger. However, an emergency doctor should definitely be called.
The most common form is the Cerebri Media Infarction. This results in incomplete hemiparesis or even complete hemiparesis, but this is rarely the case. However, it can happen that the affected patient wakes up in the morning and can not get up. Hemiplegia is usually obstructed, associated with facial paralysis (paralysis of the facial nerve, which supplies parts of the face). From the initially flaccid develops over weeks a spastic paralysis. Although those affected usually suffer from incomplete hemiplegia, they are often referred to as hemiplegics (hemiplegic).
Sensitivity disorders associated with an apoplexy include, for example, numbness, "running ants" and tingling in the limbs. If the insult closes the left cerebral artery, aphasia occurs. These include disorders of speech understanding and / or speech. An apraxia is mentioned when the affected persons can no longer perform certain actions, such as combing, although there is no paralysis and also a normal perception. See also:
- Aphasia symptoms
- Aphasia speech disorders
- Aphasia treatments
Urinary incontinence or urinary behavior can occur, as well as a clouding of consciousness up to day-long unconsciousness. Confusion associated with disorientation is also one of the possible symptoms.
As the descending pyramidal tract and also the ascending sensory pathways intersect, the left side of the body and vice versa are affected in case of an attack of the right artery. For example, a right-sided stroke leads to a left-sided hemiplegia and the associated sensitive disorders, also the left side.
If the circulation of the affected tissue is disturbed so long that the area completely dies, the neurological damage is irreversible.
Stroke - right hemiparesis
In a stroke with right hemiparesis the following symptoms may occur. Those affected suffer from facial paralysis. This creates a drooping corner of the mouth, and often the mouth can not be properly closed and therefore drinking is difficult. The frown on the affected side does not work or only partially. Likewise, the eyelid closure is obstructed. There are also symptoms such as an inwardly drawn shoulder, an inwardly rotated arm and an elbow in flexion posture. Likewise, the fingers are bent and the thumb pulled up. When walking, the leg is led forward in a semicircle. Depending on the extent and severity of the symptoms mentioned occur more or less pronounced.
Warning signals
So-called TIAs or PRINDs are warning signals. The most important harbinger of brain infarction is the TIA - Transient Ischemic Attack. These are neurological deficits that last only a few minutes, or have completely receded within 24 hours. A PRIND - a Prolonged Ischemic Neurological Deficit is also a warning signal that, however, develops more slowly compared to TIA and also takes longer - between 24 hours and three weeks - to completely regress.
Visual disturbances in one eye, lasting only a few minutes, or short-term paralysis are examples of so-called TIA. Unfortunately, this is often not seen as a warning, but dismissed as a triviality. However, if this is taken seriously, it can be prevented by appropriate treatment, possibly by surgery, a cerebral infarction.
diagnosis
If suspected, every minute counts. The patient must go to a clinic immediately. The success of the treatment largely depends on a quick and correct diagnosis followed by treatment.
After a detailed history of the patient, often in conjunction with the relatives, and checking the reflexes further investigation is needed. With the help of computed tomography, the brain can be displayed in layers. A contrast agent allows the representation of the blood vessels. Thus, the location of the incident is shown, but also the cause such as bleeding or a vascular occlusion can be seen in this way. In some clinics, MRI is preferred. This method works without X-rays, which makes more frequent use possible. However, patients who have metal parts or a pacemaker in the body can not be examined by MRI.
Special ultrasound examinations, such as duplex sonography, are used to create images of the brain and thereby measure blood flow. Especially with circulatory disorders, this is a suitable examination method. A normal ECG or long-term ECG can show any irregularities such as atrial fibrillation. It is not uncommon for them to be the triggers. But other diseases of the heart, such as valve defects, can be discovered here.
Of course, a detailed blood test is part of the portfolio of a stroke diagnosis.
Stroke symptoms suggest
If suspicion must be acted quickly. Through simple tests, even laymen can quickly assess the situation correctly and assign the symptoms more easily. Symptoms everyone can recognize include a sudden corner of the mouth, slurred speech or the inability to speak. In addition, those affected complain of numbness, difficulty swallowing, problems seeing or a disturbed motor function of hands or feet, the suspicion is close.
Affected people should be encouraged to smile. This is usually not possible with a half-sided palsy and the patient has problems with his facial expressions and makes a face. Also, raising one's arms with the palms turned upwards would not work properly on paralysis caused by the stroke of the brain. The affected arm would turn inward again and sink down. When the person is asked to speak a very simple sentence, this is often associated with problems. Affected may speak very slowly, halting, washed out or twisting the words. This does not necessarily occur, but is often found in acute stroke. These tests are abbreviated to the letters FAST (face, arms, speech, time - face - arms - language - time). If the sufferer has trouble completing one of these simple exercises, the time counts. The faster the emergency physician is informed, the better the chances of recovery. It is also important to communicate on the phone the suspicion of a stroke.
Stroke with its consequences
A stroke does not have to be mandatory, but it can have consequences for your future life. Cerebral stroke is the most common cause of long-term care. The consequences are very individual. These include hemiparesis (hemiplegia), associated with sensory disturbances, speech disorders (aphasia), dyslexia (dysarthria), dysphagia, incontinence, difficulty concentrating and blurred vision. Under Neglect the physician understands attention disorders that affect one side of the body and half of the environment. For example, those affected only eat half their plates, shave only one half of their faces, and do not perceive their surroundings on the affected side.
Timely checkups can prevent a stroke. (Image: Henrie / fotolia) Stroke Unit Special Department
A stroke unit is a special department for stroke patients. It is an acute care unit in a hospital where comprehensive equipment monitoring is ensured. Special diagnostic and therapeutic procedures adapted to patients with an apoplexy are included, which gives patients a better prognosis for recovery than treatment on a normal ward. Unfortunately, not every hospital has such a stroke unit.
therapy
It starts with stabilizing vital signs and parameters such as blood pressure, heart rate, blood sugar, oxygen saturation, electrolyte content and body temperature. Rapid diagnostic procedures, such as CT or MRI, determine where and to what extent the stroke occurs. In order to preserve the underserved area and to eliminate the resulting occlusion, a so-called intravenous lysis therapy is initiated. The faster the diagnosis is made, the sooner such treatment will succeed. Affected areas of the brain are penetrated by means of catheters in order to enable local dissolution of the blood clot there. However, this therapy is only possible in special centers. Brain hemorrhage does not use lysis therapy. Here is often treated surgically. An intracranial pressure relief is important here. (Sw)