✔ Medically Reviewed
Last reviewed on March 26, 2025.
Stroke (apoplexy) is a common term for both blood clots and hemorrhages in and around the brain. Since both conditions cause largely similar symptoms and the treatment is roughly the same, these conditions are described together. It is also the leading cause of chronic disability. Therefore, prevention is of utmost importance. Half of the patients are over 70 years old.
Cerebral vascular stroke is a collective term for injuries affecting the brain’s cells through disruptions in circulation.
In cases of arteriosclerosis or excessively high blood pressure, blood vessels in the cerebrum may rupture, causing bleeding. The most common cause of cerebral stroke in older individuals is thrombosis in a calcified vessel.
It is therefore not entirely correct to call the condition a brain hemorrhage.
Types of stroke and causes
Blood clots in the brain account for 85% of all stroke cases. Ten percent are caused by brain hemorrhages within the brain tissue, while the remaining 5% are due to bleeding from a blood vessel between the two innermost brain membranes (subarachnoid hemorrhage). Regardless of the cause, brain cells can survive only a few minutes without oxygen before they begin to die.
Transient ischemic attack – TIA
If the blood clot is so small that the symptoms disappear completely within 24 hours, the condition is called TIA (transient ischemic attack). For example, a sudden loss of vision in one eye may occur and last for half an hour. TIA is a warning that one is at risk of a larger blood clot and should therefore adopt a healthier lifestyle.
Brain hemorrhage
In a brain hemorrhage (cerebral hemorrhage), bleeding occurs when a blood vessel ruptures. The cause is often high blood pressure or a congenital malformation in the blood vessel. Alcoholism, conditions with increased bleeding risk, and blood-thinning medications also increase the risk.
Stroke in one side of the brain
A stroke on one side of the brain typically causes symptoms on the opposite side of the body because nerve pathways cross over to the other side of the body.
Blood clot in the brain
A blood clot in the brain often occurs as a complication of atherosclerosis in the brain’s own arteries or the large artery in the neck. The condition is essentially the same as atherosclerosis in other parts of the body, such as the heart. Stroke may also result from a blood clot formed in the heart’s atrium due to atrial fibrillation, which is carried by the blood to the brain. The blood clot lodges in a blood vessel and blocks blood supply to an area of the brain. If blood flow is not quickly restored, brain cells start to die within a few minutes.
Subarachnoid hemorrhage
In a subarachnoid hemorrhage, a ruptured aneurysm in an artery on the brain’s surface or a congenital vascular malformation causes blood to leak between the two innermost brain membranes. It feels like a sudden “explosion in the head,” followed by severe headache and possibly unconsciousness. This condition often occurs during physical activity.
Risk factors
High blood pressure, smoking, excessive fat and cholesterol in the blood, obesity, heart valve disease, heart rhythm disorders, and diabetes increase the risk. Regular exercise and a healthy diet reduce the risk.
What are the symptoms?
The symptoms of cerebral vascular stroke are similar regardless of the underlying cause of the condition. However, the extent of the injury determines how severe and widespread the symptoms will be.
The onset is usually acute and may be preceded by headaches, nausea, and vomiting. With a large and widespread brain injury, the patient may lose consciousness.
The injuries often occur in vessels leading to the motor centers and language function centers. In the first case, paralysis of one side of the body, hemiplegia, occurs.
If the injury is in the right cerebral hemisphere, the left side of the body becomes paralyzed since nerve pathways cross as they travel from the cerebral cortex to the skeletal muscles. An injury in the left hemisphere results in right-side paralysis. Since the language center for right-handed individuals is located in the left hemisphere, the injury can lead to difficulties in understanding or speaking the language, often combined with difficulties in reading and writing, aphasia.
Stroke symptoms depend on which part of the brain is affected. A stroke in the right hemisphere generally causes symptoms on the left side of the body, and vice versa. Typical stroke symptoms occur suddenly and may include the following:
- Paralysis in an arm, leg, or face.
- Numbness on one side of the body.
- Difficulty speaking or understanding speech.
- Blindness in one eye.
- Severe headache that appears like a thunderclap.
Treatment of a stroke
In many cases, the doctor cannot determine solely based on clinical symptoms whether it is a brain hemorrhage, a blood clot in the brain, or a subarachnoid hemorrhage. To diagnose, CT scans or MRI (magnetic resonance imaging) of the brain are required.
Treatment during the first hours and days is crucial to minimizing damage caused by a blood clot or bleeding in the brain. The main goals are to limit the damage and prevent life-threatening complications that may occur after a stroke.
Blood pressure is only reduced if it is extremely high, as it must not become too low. If the symptoms are caused by a blood clot, clot-dissolving medications may be used if they can be administered within a few hours after the stroke. To protect brain cells from oxygen deprivation, the brain may be cooled while the patient is on a ventilator.
High blood sugar levels are reduced with insulin to avoid the formation of lactic acid.
The patient should be mobilized as quickly as possible, and it is essential to begin physiotherapy, occupational therapy, and speech therapy to support rehabilitation so the patient can regain as much function and speech as possible. This is best done in specialized stroke units in hospitals with experts in various rehabilitation fields.
The greatest improvements occur during the first three months, after which progress slows significantly.
Approximately 15% of all stroke cases result in death within a short period, 45% become dependent on assistance with daily living, and 40% manage on their own. It is a good sign if symptoms disappear or improve within the first few days. In the mildest cases, the person may be discharged after just a few days or weeks. In severe cases, hospitalization may last several months.
To prevent recurrence, aspirin, blood pressure medication, and cholesterol-lowering drugs may be prescribed. If there is a significant narrowing in the carotid artery, the atherosclerotic segment can be removed in a procedure called endarterectomy. If there are aneurysms in the brain’s blood vessels, it may be necessary to repair them to prevent a subarachnoid hemorrhage.
Care for a patient after stroke
Acute care aims to maintain normal bodily functions and prevent complications. Post-care focuses on rehabilitating the patient.
The bed positioning must prevent misalignments, pressure sores, and other complications from prolonged bedrest. A thin pillow is placed under the head to avoid the head and neck bending forward. The head should be turned towards the healthy side to prevent the patient from collapsing towards the paralyzed side. The paralyzed hand and forearm should rest higher than the upper arm.
- When making the bed for a patient with one-sided paralysis, a nurse or assistant should assist. A physical therapist typically provides instructions on proper patient positioning.
- Observations regarding consciousness, motor skills, and speech must be made during acute care. Additionally, pulse, blood pressure, breathing, and clear airways must be monitored.
- Fluid and nutrient intake is usually provided via infusion during the first days and then via a feeding tube as long as needed. If the patient has difficulty swallowing, the risk of aspiration must be considered.
Rehabilitation
Rehabilitation is crucial for the patient to regain mobility and independence. Every day of delay reduces the chances of recovery. Rehabilitation should include:
- ADL (Activities of Daily Living) training, involving the entire care team according to their expertise.
- Mobilization under the guidance of a physiotherapist, who starts with passive exercises and later progresses to active movements.
The patient should leave the bed as soon as possible and gradually extend the time spent out of bed. Physiotherapists often conduct walking exercises with the patient, and care staff should assist in these exercises as instructed.
Rehabilitation may extend over a very long period.
Speech and language training
Most patients cannot initiate speech and language training on their own, so this must be conducted with the help of those around them, ideally under the guidance of a speech therapist.
The patient must understand that their participation is crucial and that improvement relies on their own effort. Care staff can support the patient with language training. Here are some simple rules:
- Speak words slowly and clearly. Remember, the patient’s hearing is not impaired, and they can comprehend what is being said. Their thought process is normal.
- Allow the patient time and avoid interruptions. Effective word stimulation can include singing songs with familiar lyrics.
- Demonstrate what you want the patient to say, such as saying “clap” while clapping your hands.
- Identify the patient’s personal interests and encourage conversations about these topics.
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