Stroke

Stroke

A stroke is caused by either a blood clot in the brain or a cerebral haemorrhage. A stroke often occurs quickly and unexpectedly, and causes symptoms such as sudden numbness, weakness or paralysis in one half of the body. The risk factors for having a stroke are largely the same as for other cardiovascular diseases.

What is a stroke?

Strokes are caused by changes in the blood circulation to the brain which means that parts of the brain do not receive enough blood supply. The brain cells thus receive too little oxygen and nutrition, and the brain cells in the part of the brain that is affected die. This causes sudden changes in body functions, such as paralysis and/or speech difficulties.

In recent years, there has been a decrease in mortality from stroke and more people are living longer after a stroke.

Causes of stroke

Strokes are in most cases caused by a blood clot in the blood vessels of the brain (cerebral infarction), but can also be caused by bleeding in one of the blood vessels of the brain or meninges.

Blood clot

A stroke caused by a blood clot means that a blood vessel becomes blocked. The blood clot can either arise in one of the brain's own blood vessels (thrombosis) or be formed somewhere else, for example in the heart or in the arteries, and then be transported with the blood flow to the brain (embolism).

Cerebral hemorrhage

A stroke caused by cerebral haemorrhage means that a blood vessel in the brain bursts. The brain cells closest to the bleeding area are exposed to too much pressure and die as a result.

Risk factors for stroke

• High blood pressure is the most important risk factor for cerebral haemorrhage

• If you have previously had a stroke

• Heart disease such as atrial fibrillation and plaque in the blood vessels (atherosclerosis)

• Diabetes

• Hereditary predisposition to cardiovascular disease

• The risk increases with increasing age. 90% of all strokes occur in people over the age of 60

• Strokes affect men more often than women until the age of 75, after which the differences even out

• Smoking

• Overweight

• High alcohol consumption

Symptoms of stroke

The symptoms of a stroke often appear quickly, and which symptoms you get depend on where in the brain the damage is and how large a part of the brain is affected. The most common symptoms are:

• Paralysis or weakness in one half of the body, often both face, arm and leg

• Speech difficulties

• Visual disturbances (loss of vision in one eye)

• Sudden severe headache

• Unconsciousness

In some cases, the symptoms disappear within a day (often within an hour). Such attacks can be a warning sign of a stroke and are called "trip" or TIA. If you have had a "drip", you have an approximately 30-40% increased risk of having a stroke within 5 years. It is therefore important that you contact a doctor to receive preventive treatment.

Preventive advice against stroke

• Avoid smoking (smoking cessation)

• Ensure regular exercise adapted to your own condition

• Weight reduction is recommended if you are overweight

• Eat "heart-healthy" food with little saturated fat, sugar and salt

• See your doctor regularly to check your blood pressure, cholesterol and blood sugar

Treatment of stroke

The treatment aims to limit the brain damage and functional disorders, as well as to reduce the risk of new strokes. This means treating the cause of the stroke and other diseases, such as high blood pressure and heart disease, which increase the risk of new strokes. Rehabilitation of lost functions is also an important part of the treatment.

Emergency treatment

Anyone with a stroke must quickly go to hospital for emergency treatment. Important parts of the treatment are fluid and oxygen supply. The treatment is different depending on whether the cause is a blood clot or a brain haemorrhage. In the event of a stroke caused by a blood clot, some people receive blood clot-dissolving drugs (thrombolytic treatment). The treatment must be started shortly after the stroke and research is being done on how long after the stroke it has an effect.

If the stroke is caused by a brain haemorrhage, surgery may be necessary.

Blood sugar-lowering medications and antipyretics may be necessary as high blood sugar and fever can worsen the stroke.

Treatment after the acute phase

Treatment with medication always starts in hospital. There are no medicines for the damage to the brain, but there are medicines that can help prevent new strokes.

In the event of a stroke caused by a blood clot, blood-thinning medication is recommended. Blood-thinning medications will prevent new events. There are several types and groups of blood thinners. Acetylsalicylic acid (Albyl-E) is often used to prevent platelets from sticking together. Other anti-platelet medicines are Asasantin Retard, Persantin and Plavix. Marevan (warfarin) is another blood-thinning medicine that is also used for stroke caused by a blood clot. Marevan prevents the blood from coagulating (thickening) by reducing the amount of vitamin K and other clotting factors in the blood.

Blood pressure-lowering medications and cholesterol-lowering medications may also be relevant after a stroke.

Rehabilitation

Many of the lost functions can be retrained. 90% of recoveries occur within three months of the stroke, and it is therefore important to get started quickly with rehabilitation. Recent research shows that a week after the stroke, as many as 2 out of 3 stroke victims are self-reliant. The vast majority of people notice the effect of the training during the first months, but rehabilitation after a stroke is a long-term process.

Sources: Patient handbook, Helse Bergen, Norwegian electronic medical handbook, Norwegian drug handbook for healthcare personnel, National Association for Public Health, Medical dictionary,