Stroke affects 130,000 people a year in Spain

Stroke affects about 130,000 people in Spain every year. In fact, it causes death in 30% of the cases and severe disability in 40% of the cases, being the first cause of disability in adults. It affects mostly men, with an incidence of 160 cases per 100,000 inhabitants. On the occasion of World Stroke Day, we wanted to consult Dr. Eugenio Lecanda, specialist in Neurology and member of Top Doctors, about this violent brain pathology.

How the brain works and when stroke occurs

The brain requires glucose to function normally, consuming 75mg per minute. For this to take place correctly, the cerebral circulation has a self-regulating mechanism in which biogenic, biochemical and neurogenic factors intervene and ensure a constant flow, as long as the arterial pressure is between 50 and 160 mm of mercury.

Stroke is caused by an abrupt alteration in the blood flow to the brain, in the form of arterial obstruction, which may be caused by a clot that prevents the passage of blood to a part of the brain (ischemic stroke) or by a hemorrhage caused by a rupture of a cerebral vessel (hemorrhagic stroke). These episodes do not usually last more than 24 hours, so the reaction time and patient care are essential to ensure that the symptoms are as short as possible for the patient.

Risk factors for stroke

There are certain important risk factors for stroke or cerebral vascular disease:

– Arterial hypertension – Diabetes mellitus – Hyperlipidemia – Smoking (triples the risk) – Alcohol consumption – Cardiac diseases, the most important of which are: atrial fibrillation, mitral stenosis and dilated cardiomyopathy – Stress – Obesity – Sedentary lifestyle – Increased blood viscosity – Alcoholism

Symptoms that warn of a possible stroke

Stroke symptoms depend on the infarcted arteries and territories. Thus, we find:

– Middle cerebral artery infarction: it manifests with left brachio-crural hemiparesis (decreased motor strength or paralysis), if the infarction is right, and right hemiparesis, if the infarction is left. If the infarction is left it also involves aphasia or language disorder. These symptoms also occur when the stroke is in the parietal lobe or thalamus.

– Infarction in the territory that irrigates the basilar arterial trunk and the posterior cerebral artery It manifests with ocular alterations, such as diplopia and conjugated gaze palsy. It is also accompanied by an alteration of the cortico-spinal pathway, producing tetraparesis, dysarthria, dysphagia, impaired level of consciousness… Specifically, in posterior cerebral artery infarction, choreoathetosis, tremor, contralateral hemiparesis, vertical gaze palsy, hallucinations and even visual illusions or cortical blindness occur if the infarction is bilateral. In general, and quickly, stroke can be detected in oneself or in another person if present:

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– Sudden loss of mobility or sensation in half a part of the body such as the face, an arm or a leg.

– Loss of the ability to speak, not being able to articulate words.

– Sudden and intense headache.

– Sensation of dizziness, vertigo or imbalance.

– Total or partial loss of vision, which may affect one or both eyes.

How to treat stroke: the importance of acting quickly

Stroke treatment will also depend on the area where the stroke has occurred. However, during treatment, cardiac monitoring, hypoglycemia control, blood pressure monitoring, urinary control, PCO2 and PO2 control, coagulation tests and radiological tests such as brain CT and MRI will be essential. Also, the assessment of the level of consciousness, the existence of comic crises, fever and a correct position at 30º in supine decubitus (stretched face up), maintaining electrolyte balance, airway, possible cerebral edema or infections.

The treatment will not be the same if what has produced the stroke is a clot or a hemorrhage but, in any case, rapid action will be essential, within 3 or 4 hours from the onset of symptoms. Thus, if the stroke is hemorrhagic, the ideal treatment will be embolization with intravenous drugs to tamponade the wound. On the other hand, if the stroke is ischemic, an intravenous drug will be needed to break up the blood clot that is blocking the cerebral artery. Sometimes, in these cases, surgery is also required to dilate the artery (angioplasty).

What to do after a stroke

First and foremost, time and patience are of the essence. Sometimes the stroke leaves sequelae in speech or movement, so a considerable period of time is necessary for recovery. First of all, it is necessary for both the patient and family members to be patient, since the brain, not the patient, sets the time. Even if the patient wants to walk or recover quickly, sometimes it will not be possible at such an accelerated time. Also, it should be noted that the brain works by repeating things back to you, so it is important to do the actions as many times as necessary for successful recovery to be effective.