Ischemic and hemorrhagic stroke: what it is, causes and sequelae

What is stroke

Stroke, better known by the acronym stroke, is a serious medical condition that happens when the blood supply to the brain is disrupted. This is because, like all organs, the brain, in order to function properly, needs oxygen and certain nutrients that come from the blood. Therefore, when there is a disruption in the blood flow, the brain cells begin to die, causing various brain problems, and may even reach death.

Because it is one of the most deadly diseases in the world, stroke is a medical emergency and needs immediate treatment, because the sooner what is happening is diagnosed, the less damage the patient will suffer. In Brazil, stroke is the main cause of death from disability: 130 thousand people die from the disease. In addition, it is estimated that in 2030, the worldwide number of deaths may be 7.8 million.

Stroke types

Stroke can be classified in two ways: ischemic or hemorrhagic. See below what characterizes each of them.

Source: redebrasilavc.org.br

Ischemic stroke

Most common type of stroke – affects about 80% of patients – Ischemic stroke is due to the lack of blood flow to the brain. This can happen for 3 reasons:

  • Arterial obstruction, through a thrombus or an embolus;
  • Drop in blood perfusion pressure, as in cases of shock;
  • Obstruction in the drainage of venous blood – as in venous thrombosis -, which makes it difficult for arterial blood to enter the brain.

It is important to note that, in the first moments when the stroke occurs, there is no death of the brain tissue, but, due to the lack of blood supply, it degenerates very quickly. However, there is a region around the accident that has a reduced blood flow and that remains alive for a while. It is called penumbra, and it is precisely in this that therapeutic efforts are concentrated at the time of treatment.

Within the Ischemic Stroke there is also a subtype, called Transient Ischemic Attack (AIT). AIT is characterized by a temporary blockage in one of the blood vessels, but it does not actually cause brain damage. In other words, it is a momentary blood deficit that is reversed in a few minutes or up to 24 hours, without leaving any sequelae. If the 24-hour time exceeds and the AIT has not yet been reversed, it changes to the name of Ischemic Stroke by Definition.

Hemorrhagic stroke

This type of stroke is the least common to occur, but it is still serious. It happens when there is a rupture of a blood vessel located inside the patient’s skull, causing an irritating action due to the contact of the blood with the nervous parenchyma (brain tissue with greater function). In addition, this inflammation, together with the pressure that the clot puts on nerve tissue, damages and degenerates the brain, as well as its function.

Intracranial hemorrhage occurs for one of two reasons:

  • Rupture of Charcot-Bouchard aneurysms – small pockets of the cerebral arteries that are formed by uncontrolled or untreated arterial hypertension;
  • Bleeding from brain aneurysms in the CSF or subarachnoid space (brain-forming parts) – probably have a congenital origin.

Causes of Ischemic Stroke

As this type of stroke happens due to the lack of blood in the brain, some factors can be extremely dangerous for it to affect a person – even more if they are a little older. Among these factors are:

  • Tobacco;
  • Arterial hypertension;
  • Obesity;
  • High cholesterol level;
  • Family history of heart disease or diabetes;
  • Abuse of alcoholic beverages.

Apart from these factors that can cause Ischemic Stroke, another possible cause is having an irregular heartbeat rhythm, which can generate blood clots in the brain. This irregular heartbeat may be a consequence of:

  • Hypertension;
  • Coronary artery disease;
  • Mitral valve disease;
  • Pericarditis;
  • Hyperthyroidism;
  • Abuse of alcoholic beverages;
  • Intake of too much caffeine – contained in teas, coffees and energy drinks.

Causes of Hemorrhagic Stroke

The main cause of hemorrhagic stroke is arterial hypertension, a condition that ends up weakening the arteries of the brain, making them more prone to rupture.

There are several factors that can increase your blood pressure:

  • Being overweight or being obese;
  • Excessively drinking alcohol;
  • To smoke;
  • Do not exercise;
  • Stress.

In addition to hypertension, another common cause of hemorrhagic stroke is a trauma to the head. In most cases, the cause is obvious. However, there are some who do not show any sign of trauma in the skull region, especially in elderly people.

Risk factors

In addition to the factors that end up speeding up the event of the causes of stroke, there are also several others that can be classified as follows:

Gender

Stroke cases are more common in men than in women, unless it is the elderly, because there the problem affects women more than men. This is assumed to be due to the fact that women live longer than men and stroke is more common in older people.

In addition, pregnancy and the use of birth control pills can further increase the risk of stroke in women.

Breed

The people listed below are more likely to have a stroke than whites – however, these chances decrease as age advances:

  • Native Americans;
  • Hispanics;
  • Asians;
  • African-Americans.

Lifestyle

Some factors of your lifestyle can directly influence the occurrence of a stroke:

  • To smoke;
  • Diet;
  • Lack of physical exercise;
  • Excess of alcohol;
  • Too many drugs.

Medicines and diseases

As already mentioned, birth control pills can increase the chance of stroke. However, in addition to them, some medical conditions can also increase your chance of having a stroke at some point in your life. Look:

  • Vascular and heart problems;
  • Diabetes;
  • History of stroke or mini-stroke;
  • High cholesterol;
  • Arterial hypertension;
  • Obesity;
  • Metabolic syndrome;
  • Migraine;
  • Sickle cell disease;
  • Conditions that cause hypercoagulability;
  • Conditions that cause excessive bleeding, such as a lack of platelets or hemophilia;
  • Treatment with drugs that are thrombolytic;
  • History of aneurysm or vascular abnormalities in the brain;
  • Polycystic ovary syndrome;
  • Tumors in the brain, especially malignant ones.

Age

Adults over 65 are at a higher risk of having a stroke, especially if they are:

  • Hypertensive;
  • Diabetics;
  • Sedentary;
  • Overweight;
  • Smokers.

Symptoms of Ischemic Stroke

  • Sudden loss of muscle strength and / or vision;
  • Sensation of numbness in the face, arms or legs;
  • Difficulty communicating and understanding;
  • Slurred speech;
  • Dizziness;
  • Tingling on one side of the body;
  • Memory changes.

Hemorrhagic stroke symptoms

  • Sudden headache;
  • Brain edema;
  • Increased intracranial pressure;
  • Nausea and vomiting;
  • Neurological deficits very similar to those of ischemic stroke.

Diagnosis

If you suspect that you, or someone you know, is having a stroke, a home diagnosis can be done on the spot to see if the case is stroke or not. This diagnosis is called FAST (from English: face), arms (arms), speech (speech) and time (time) and is an effective test, as 9 out of 10 stroke cases can be identified only with this test.

  • Face: Ask the person to smile. Is one side of the face “toppled”?
  • Arms: Ask the person to raise both arms. Does one arm insist on getting lower or is it unable to get up?
  • Speech: Ask the person to say a very simple sentence. Is she speaking in a strange or slurred way?
  • Time: If you notice any of these signs, call an ambulance immediately and wait for medical attention. Remember: time, in this case, is essential.

After arriving at the hospital, the doctor – who may be an emergency doctor (general practitioner), a neurologist or a neurosurgeon – will perform a battery of tests on you in order to find out exactly what caused the stroke. The performance of this procedure is very important, because only then can the most effective treatment be indicated.

Among the exams are:

Clinical examination

This first stage can be subdivided into three others:

  1. In the first, the doctor will ask questions about the symptoms the patient has been having, when they started and what was being done when the symptoms appeared. After that, he will check if these symptoms still remain.
  2. Next, the doctor will want to know about the medications the patient is taking, as well as the family history of heart disease, TIA and stroke.
  3. Finally, the doctor will examine some signs such as blood pressure and heart rate. In addition, he may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of the patient’s eyes.

Blood test

A clinical examination alone will not give the doctor an accurate diagnosis. Therefore, additional tests are required. One of them is the blood test, which can identify the blood’s clotting time, as well as the level of sugar present in it and whether the chemicals critical to the blood are out of balance.

In addition, a blood test can also identify whether you have any type of infection.

Computed tomography

Through a series of x-rays, computed tomography aims to create a detailed image of your brain. Among several factors, it can show a hemorrhage, a tumor or, in this case, a stroke.

MRI

In MRI, the doctor can check if your nervous tissue is damaged by a stroke or brain hemorrhage using radio waves and magnets.

Ultrasound of the carotid artery

With this test, sound waves create images of the interior of the carotid arteries located in the neck. Through it, it is possible to check if there is accumulation of fatty plaques and also if the blood flow is normal or not.

Brain angiography

In angiography, the doctor inserts a catheter through a small incision (usually located in the groin) and moves it between your main arteries, as well as in the carotid or vertebral artery. With this procedure, it is possible to see the arteries of the brain and neck in detail and see if there are any changes.

Echocardiogram

Through sound waves, the doctor can see detailed images of your heart. Because of this, the electrocardiogram shows if there is any source of clot in the organ and that may have eventually moved to the brain, thus causing a stroke.

Treatment for Ischemic Stroke

To treat this type of stroke, doctors need to quickly restore blood flow to the patient’s brain.

Emergency drug treatment

This procedure, if done quickly, can not only increase your chance of survival, but also reduce any complications. Doctors can use:

  • Aspirin : reduces the likelihood of another stroke occurring;
  • Intravenous injection of tissue plasminogen activator: restores blood flow by dissolving the clot.

Emergency procedures

Sometimes, the doctor may resort to emergency procedures other than the aforementioned medications. These procedures can be:

  • Medicines injected directly into the brain;
  • Mechanical clot removal.

Important: Recent studies say that these two procedures are not beneficial for most stroke patients. Doctors need to check in detail whether the use of these procedures can be done or not.

Other procedures

To decrease the chances of the patient suffering from another stroke, doctors may recommend a procedure that will open an artery that is narrowed due to the accumulation of fats. See what they are:

  • Carotid endarterctomy: This procedure aims at removing the plaques that are preventing the blood from having its normal flow within the arteries located in the neck. It must be emphasized that endarterctomy also has certain risks, especially in people who have heart disease or other medical conditions.
  • Angioplasty and stents: Through the use of a balloon, the narrowed arteries are expanded. Then, a stent – a small, expandable, mesh-shaped tube – is inserted to support the open artery.

Hemorrhagic Stroke Treatment

In the case of a Hemorrhagic Stroke, doctors work to control the bleeding inside your brain and also to reduce the pressure exerted on it.

Emergency measures

If you use medications to prevent blood clots, such as warfarin or Clopidogrel, blood transfusions can be done to combat the effects of blood thinners. In addition, you can also be treated with medications that will lower intracranial pressure, blood pressure and also to prevent vasospasm and seizures .

Surgery to repair blood vessels

The surgical procedure can be used to repair anomalies that are present in the blood vessels as a result of a stroke. The indicated procedure can be one of the following:

  • Surgical clipping: With the aid of a small cuff, the doctor places it at the base of the aneurysm, to stop the flow of blood that is going towards it.
  • Endovascular embolization: Using X-ray images, the doctor inserts small detachable coils into the aneurysm. These coils block the flow of blood and cause it to clot.
  • Surgical removal of the aneurysm: If the aneurysm is in an accessible location in the brain, the doctor may choose to remove it and thus prevent the stroke from getting worse.
  • Intracranial bypass : In some cases, the diversion of certain blood vessels can be an option to improve blood circulation in the brain region.
  • Stereotactic radiosurgery: through multiple beams of radiation, this radiosurgery is a treatment used to repair any vascular malformations.

Medicines commonly used to treat stroke

The use of these drugs is usually to prevent future complications. Among them are:

  • Simvastatin ;
  • Aradois ;
  • Aspirina Prevent;
  • Atorvastatin Calcium ;
  • Cebralat ;
  • Cilostazol;
  • Clopidogrel;
  • Marevan;
  • Warfarin ;
  • Xarelto;
  • Eliquis .

Attention! 

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Natural treatment

A Finnish study, published in 2012, found that eating tomatoes significantly reduces a person’s lifetime risk of having a stroke. This is because the food is rich in lycopene, a powerful antioxidant.

Complications and Sequelae

A stroke case can often bring some temporary or permanent complications – this will depend a lot on the intensity of the accident and how long the brain has been without oxygen. It is worth noting that some of these complications can be reversed with recovery and rehabilitation programs.

Paralysis or loss of muscle movement

One side of your body may be completely immobile after a stroke – usually the muscles most affected are those of the face and arms.

As a curiosity: If the paralyzed side is the left, the side of the brain damaged by the stroke was the right. In contrast, if the paralysis occurs on the right side of the body, damage to the brain has occurred on the left side.

Difficulty talking or swallowing

A stroke can cause damage to the muscles around your mouth and throat, which ends up making it difficult to talk and also to swallow what you eat.

In addition, there may also be language difficulties, whether spoken, read or written.

Loss of memory or difficulty thinking

Many people who have suffered a stroke end up losing part of their memories. Others, in turn, have difficulty thinking and reasoning.

Emotional problems

People who have had a stroke have a harder time controlling their emotions. Sometimes they end up developing depression too.

Central pain syndrome

In some cases, stroke patients experience pain, numbness or other strange sensations in the parts affected by the accident.

In addition, these patients may become more sensitive to climate change, especially in the cold.

Changes in the capacity for behavior and self-care

Some stroke victims may become more withdrawn and antisocial. They may need help preparing simple daily tasks, such as drinking a glass of water.

Hydrocephalus

About 10% of people who have had a stroke will also develop a case of hydrocephalus , a condition that occurs when there is excess cerebrospinal fluid in the brain cavities. This liquid is produced by the brain to protect itself and also the spinal cord.

The hydrocephalus can be characterized by the following symptoms:

  • Headache;
  • Nausea and vomiting;
  • Loss of balance.

Deep Venous Thrombosis (DVT)

It is estimated that 5% of people who have suffered from a stroke will also suffer from a thrombosis in the near future. This condition is due to the fact that a blood clot forms in your leg and mostly affects people who have lost the movements of that limb.

Among the symptoms of thrombosis are;

  • Swelling;
  • Ache;
  • Warm skin;
  • Muscle sensitivity;
  • Redness, especially in the calf.

Recovery and Rehabilitation

People who, fortunately, survived a stroke, need support and auxiliary treatments in the long term:

  • Physiotherapy – to restore lost movement;
  • Occupational therapy – to relearn how to perform daily tasks, such as those involving personal hygiene;
  • Speech therapy – to improve the ability to speak and communicate;
  • Psychologist – to help deal with feelings of anxiety or depression.

Prevention

Following some tips can be extremely important to keep your health up to date and, thus, prevent a stroke from affecting you:

  • Find out if you have any disease that could trigger a stroke (such as diabetes, hypertension or high cholesterol);
  • Be active and exercise regularly;
  • Have a healthy diet in your daily life, rich in vegetables and low in salt;
  • Control your alcohol consumption;
  • Avoid smoking – if you do, try to stop as soon as possible;
  • Learn to recognize the first symptoms of a stroke (FAST test).

With these tips and the other information in this text, controlling your risk factors, as well as knowing how to identify the first signs of a stroke, will be much easier.

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