Stroke: Symptoms, Causes & Treatment
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Stroke: Symptoms, Causes & Treatment | Everything you need to know about stroke

For the majority of people, there are no warning signs of a seizure. However, several risk factors can be monitored.

Strokes have very variable consequences. More than half of people keep the sequelae. About 1 in 10 individuals recover completely.

The severity of the sequelae depends on the region of the brain affected and the functions it controls. The larger the region deprived of oxygen, the greater the risk of sequelae. Following a stroke, some people will experience:

  • difficulty speaking or writing: this is called aphasia ;
  • memory problems;
  • of a more or less significant paralysis of the body.

The different types of stroke

Stroke: emergency care

When nerve cells are deprived of oxygen, even for a few minutes, they die and they will not regenerate. Also, the shorter the time between stroke and medical care, the lower the risk of serious sequelae.

Regardless of the damage caused by oxygen deprivation, the brain has some capacity to adapt. Healthy nerve cells sometimes manage to take over dead cells if they are stimulated by various exercises.

The different types of stroke

There are two types of cerebrovascular accidents.

Ischemic stroke

This is caused by the blockage of a cerebral artery, namely cerebral thrombosis or cerebral embolism. It is the most frequent. It accounts for about 80% of strokes.

hemorrhagic stroke

It is caused by a cerebral hemorrhage.

The different types of stroke

cerebral thrombosis

Cerebral thrombosis accounts for 40 to 50% of cases. It occurs when a blood clot forms in a cerebral artery, on a plaque of lipids called atherosclerosis.

cerebral embolism

Cerebral embolism accounts for approximately 30% of cases. As in the case of thrombosis, a cerebral artery is blocked. 

However, here the clot blocking the artery formed elsewhere and was carried by the bloodstream. It often comes from the heart or from a carotid artery in the neck.

cerebral hemorrhage

Cerebral hemorrhage accounts for about 20% of cases, but it is the most serious form of stroke. Usually caused by long-standing high blood pressure, it can also result from a ruptured artery in the brain where an aneurysm is located. 

In addition to depriving part of the brain of oxygen, the hemorrhage destroys other cells by exerting pressure on the tissues. It can occur in the center or at the periphery of the brain, just below the cranial envelope.

Other, rarer causes of cerebral hemorrhage include:

  • hypertensive crises;
  • a hemorrhage in a brain tumor;
  • blood clotting problems.

It may happen that the obstruction of a cerebral artery is only temporary and that it resolves naturally, without leaving any sequelae. This phenomenon is called a transient ischemic attack or TIA, or mini-stroke.

Diagnosis of a cerebral hemorrhage

The diagnosis is confirmed by an MRI. The symptoms are the same as those of a “real” stroke, but they disappear within an hour. 

A mini-stroke is a warning signal to be taken seriously: it can be followed by a sometimes more serious cerebral attack during the following 48 hours. It is therefore important to consult a doctor as soon as possible.

What are the causes of stroke?

Causes of stroke include:

  • atherosclerosis, ie the formation of fatty plaques on the wall of blood vessels, which is one of the main causes of stroke;
  • high blood pressure is also an important risk factor. Over time, the abnormal pressure exerted by blood on the walls of blood vessels can cause them to rupture;
  • an aneurysm that can facilitate the rupture of an artery in the brain. This corresponds to a swelling of a small section of an artery, due to a weakness in the wall.

It is not always possible to determine the exact cause of a stroke. It is important, however, that doctors look for it by carrying out various examinations in order to reduce the risk of recurrence.

What is the prevalence of stroke?

Thanks to advances in prevention, the prevalence of stroke have decreased significantly over the past decades. Since the 1990s, however, it seems to have stabilized.

In France, 150,000 people are victims of a stroke each year, of which more than 110,000 are hospitalized and 30,000 die. 

In Canada, more than 62,000 people suffer a stroke each year. Although strokes are rarer than heart attacks, they still represent the third leading cause of death in the country and are a major factor in disability.

Three-quarters of strokes occur in people aged 65 and over. In Canada and North America, in general, they affect women more than men. Young children can also suffer from it, but this rarely happens.

Symptoms of stroke are dizziness, loss of balance, numbness, and loss of feeling. How to detect a stroke and how to react? Discover the list of the different symptoms.

What are the symptoms of a stroke?

A stroke can cause paralysis or loss of consciousness. Sometimes it is detected by one or more of the following signs:

  • dizziness;
  • a sudden loss of balance;
  • sudden numbness;
  • loss of sensitivity;
  • paralysis of the face, arm, leg, or side of the body;
  • of confusion;
  • sudden difficulty speaking or understanding;
  • sudden loss of sight;
  • blurred vision in only one eye;
  • a sudden headache of exceptional intensity, sometimes accompanied by vomiting.

In all cases, emergency services should be contacted as soon as possible.

There are two main risk factors for stroke.

What are the risk factors for stroke?

There are two main risk factors for stroke

L’hypertension

Hypertension is the most important risk factor. High blood pressure weakens the walls of blood vessels, including those in the brain.

Hypercholesterolemia

Hypercholesterolemia corresponds to a high level of LDL cholesterol, and low-density lipoprotein cholesterol, known as “bad cholesterol” or triglycerides. It contributes to atherosclerosis and the hardening of the arteries.

Other factors include:

  • obesity;
  • a poor diet ;
  • physical inactivity ;
  • chronic stress;
  • excessive alcohol or hard drugs, such as cocaine;
  • taking oral contraceptives, especially in the case of women who are at risk and who are over 35;
  • hormone replacement therapy administered at the time of menopause which slightly increases the risk;
  • smoking.

The latter contributes to atherosclerosis. In addition, nicotine acts as a cardiac stimulant and increases blood pressure. As for the carbon monoxide present in cigarette smoke, it reduces the quantity of oxygen which reaches the brain, because it binds to the red blood cells in the place of oxygen.

How to prevent cerebrovascular accident (CVA)?

Discover basic preventive measures here, as well as measures to reduce the risk of a recurrence of stroke.

How to prevent stroke?

Can stroke be prevented?

According to the stroke prevention guide published by the American Heart Association, people with healthy lifestyles reduce their risk of suffering a first stroke by 80% compared to those who neglect risk factors.

Basic preventive measures

Adopt healthy lifestyle habits

  • NO SMOKING ;
  • avoid excess alcohol;
  • find ways to integrate physical activities into their daily lives;
  • maintain a healthy weight;
  • learn to cope better with stress;
  • change the contraceptive methods if necessary.

Birth control pills and risk of stroke

Indeed, women over the age of 35 who take birth control pills and who are considered at risk, because they smoke or have high blood pressure, should change to another method of birth control, such as an intrauterine device or a pill that contains only progesterone.

Make good food choices

Diet influences several risk factors for stroke. Researchers have reviewed 375 published studies to identify the type of diet that best helps prevent strokes. According to their analysis:

  • a diet low in salt, i.e. less than 1150 mg per day, and rich in potassium and magnesium lowers blood pressure and, therefore, helps prevent strokes;
  • a diet rich in fruits and vegetables generally provides adequate amounts of potassium;
  • whole grains, nuts, seeds, legumes, and dark green leafy vegetables are good sources of potassium;

Studies show that people who consume about 10 servings of fruits and vegetables a day, who favor whole grain cereals, and who eat 1 to 2 servings of oily fish per week run a lower risk of suffering from a stroke. 

As for diets, the DASH or Dietary Approaches to Stop Hypertension and the Mediterranean diet have been shown to help prevent hypertension effectively.

Submit to medical examinations and treatment

You should consult your doctor at the frequency recommended by him. When a patient is at high risk of having a stroke, the doctor can listen to the sound of their carotid arteries with a stethoscope. 

If he suspects an artery is affected by atherosclerosis, he recommends a carotid Doppler ultrasound. This examination makes it possible to know the degree of narrowing of the artery.

It is also advisable to monitor your blood pressure regularly and, if you suffer from hypertension, treat it, even if it is asymptomatic. This is the most important risk factor to control. The following few measures help to lower blood pressure:

  • a healthy diet ;
  • avoidance of very salty food;
  • the practice of physical exercise;
  • moderate alcohol consumption;
  • stop smoking.

It is also necessary to remember to carry out regular blood lipid check-ups and take the necessary measures to correct any abnormalities. In Canada, routine screening is recommended every 5 years for men over 40 and postmenopausal women or women over. Those at risk should be screened more frequently. These include people who suffer from:

  • diabetes ;
  • hypertension ;
  • smoking;
  • abdominal obesity;
  • family history of cardiovascular diseases, etc.

It is also important to check or have your blood sugar checked regularly in order to prevent diabetes and to properly control your blood sugar if you have diabetes.

How often? At the time of the periodic medical examination, if your doctor deems it necessary, he may order a fasting blood glucose test.

Finally, do not hesitate to consult your doctor without delay in the event of an abnormally fast or irregular heartbeat and to treat any heart disease.

Measures to prevent recurrences

Take blood-thinning medication

It is recommended that people who have had a mini-stroke or a stroke caused by cerebral thrombosis or embolism take daily medication to reduce the risk of a blood clot forming.

It could be :

  • an anticoagulant such as warfarin (Coumadin) or dabigatran (Pradaxa);
  • an antiplatelet such as aspirin or dipyridamole (Aggrenox).

People for whom aspirin is contraindicated can take clopidogrel bisulfate (Plavix) or ticlopidine hydrochloride (Ticlid).

The primary goal of stroke treatment is to minimize brain damage by restoring blood flow in an MRI-diagnosed ischemic stroke or reducing blood loss in a hemorrhagic stroke.

If the stroke is severe, the person will remain under observation in the hospital for a few days. A period of rehabilitation, at home or in a specialized center, is sometimes necessary. It is also necessary to find and treat the cause of the stroke (for example, by correcting high blood pressure or cardiac arrhythmia).

How to treat stroke?

It is important to note that a stroke is a medical emergency and requires immediate treatment, just like a heart attack. Emergency services should be contacted as soon as possible, even if symptoms resolve after a few minutes. The faster treatment is obtained, the lower the risk of sequelae.

Drug treatment in stroke

If an artery is blocked

Only one drug aimed at reducing the risk of irreversible brain damage is approved. It is indicated in the case of strokes caused by thrombosis or embolism. 

It is a tissue plasminogen activator, a blood protein that helps dissolve clots quickly within an hour or two. To be effective, the drug must be injected intravenously within 3 to 4.5 hours after the stroke, which greatly limits its use.

A few hours after a non-hemorrhagic stroke, anticoagulant or antiplatelet medication is often given. This helps to prevent the formation of new blood clots in the arteries. In addition, it prevents the enlargement of clots already formed.

Once the stroke has stabilized, the doctor usually suggests a lighter medication, such as aspirin, to be taken daily for the long term.

During the rehabilitation period, other medications may be helpful. For example, antispasmodic drugs can help relieve muscle spasms.

If there is bleeding

In the hours following this type of stroke, drugs to lower blood pressure are generally administered to limit bleeding and the risk of resumption of bleeding. Sometimes the hemorrhage triggers epileptic seizures. They will then be treated with drugs of the benzodiazepine class.

Surgery

If an artery is blocked

Once the stroke has stabilized, the doctor offers various tests to find out if other arteries are weakened by atherosclerosis. He may suggest any of the following surgeries as a preventive measure.

Carotid endarterectomy

Endarterectomy consists of “cleaning” the carotid wall affected by atherosclerosis. It has been practiced for about forty years and is intended to prevent the recurrence of strokes.

An angioplasty

Angioplasty involves placing a balloon in the artery affected by atherosclerosis to prevent blockage. A small metal rod is also inserted into the artery to prevent it from narrowing. 

This procedure carries more risk than the previous one because, when the atherosclerotic plaque is crushed by the balloon, fragments of the plaque may break free and cause another blockage further down the cerebral artery.

If there is bleeding

Brain surgery may be needed to remove accumulated blood. If the surgeon discovers an aneurysm at the time of surgery, he treats it to prevent it from rupturing and another stroke from occurring. 

Treatment most often involves placing a platinum filament in the aneurysm. A blood clot will then form around it and fill the dilation of the blood vessel.

Note: It may happen that a medical examination reveals the presence of an unruptured aneurysm in the brain. Depending on the context, the doctor will recommend preventive surgery or not. 

If the patient is under, the doctor will usually suggest this preventive surgery. If the patient is older, a choice should be made taking into account the benefits and risks of the operation. 

Indeed, the latter exposes the patient to a risk of neurological sequelae ranging from 1 to 2% and to a risk of mortality of approximately 1%. In addition, more studies are needed to know the real effect of such an intervention on stroke prevention.

rehabilitation

Rehabilitation aims, in particular, to train the nerve cells of an unaffected part of the brain to perform functions that were fulfilled, before the stroke, by other nerve cells. Depending on the needs, the services of various therapists are required:

  • a nurse ;
  • a dietician;
  • a physiotherapist ;
  • a speech therapist;
  • an occupational therapist;
  • a psychologist ;
  • a psychiatrist ;
  • a social worker;
  • etc.

There are different complementary approaches that can prevent and treat stroke naturally.

Complementary approaches in case of stroke

Prevention

In general, measures aimed at reducing risk factors for stroke have an important role to play in preventing it.

Qi Gong

According to a summary of clinical studies, people with hypertension who practice Qi Gong run less risk of suffering from a stroke and dying from it. In addition, Qigong sometimes lowers hypertension and in doing so, it helps to reduce medication aimed at treating hypertension.

In supportive treatment

Acupuncture

Acupuncture has been used for centuries in traditional Chinese medicine, but scientific studies on the subject are only just beginning.

A systematic review of 14 clinical studies looked at the effect of acupuncture on 1,208 stroke patients. The acupuncture sessions started 10 to 30 days after the stroke and lasted for 7 to 10 weeks. 

The results obtained indicate that acupuncture can exert a long-term beneficial effect. One year after their stroke, people who received acupuncture sessions had:

  • lower risk of dying than people in control or placebo groups;
  • less risk of suffering from a loss of autonomy.

A systematic review focused on 9 studies dealing with moxibustion used as adjuvant therapy during rehabilitation. Moxibustion involves stimulating acupuncture points with a heat source. 

Conclusion: some studies have shown benefits on motor functions, while others have not. The authors underlined the deficient methodological quality of the studies, and consequently, the difficulty in deciding on the effectiveness of this method.

Biofeedback

A few studies suggest that biofeedback by electromyography or EMG associated with physiotherapy would increase functional recovery and the quality of the patient’s gait. However, overall, data regarding the benefits of this technique are limited at this time.

Reiki

Reiki may provide support during the rehabilitation of stroke victims. The results of a study conducted among fifty volunteers who had suffered a stroke show some improvement in mood and a boost in energy after ten sessions of 30 minutes each. 

On the other hand, no effect was observed on the development of autonomy and on the relief of depressive states.

Visualization and mental imagery

According to a systematic review, visualization combined with physiotherapy improves the rehabilitation of people who have suffered a stroke. In the opinion of the authors, other studies are necessary in order to specify the contributions of these practices.

In addition, 2 small-scale clinical studies reported an increase in the functional capacity of patients who used mental imagery.

Feldenkrais method

Dr. Andrew Weil recommends the practice of the Feldenkrais method in addition to conventional treatments during the rehabilitation period following a stroke. This approach helps the nervous system find new ways to compensate for neurological damage. For the moment, only case studies indicate that it is useful in the context of rehabilitation.

It would also help to regain a sense of balance and coordination. Although Feldenkrais sessions seem safe in most cases, people who want to use them should discuss it with their doctor first.

relaxation techniques

Deep breathing or any other relaxation technique used regularly helps release stress.

Image Credit: Photo by Alexander Grey on Unsplash

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