What is it about ?
A stroke is a condition that affects the blood supply to part of the brain. Part of the brain therefore no longer receives oxygen for a longer or shorter time. This causes sudden loss of certain functions of the body.
Stroke is a collective term for different problems that occur in the brain:
- cerebral infarction: a blood clot blocks a blood vessel in the brain.
- cerebral hemorrhage : a blood vessel in the brain bursts.
A cerebral infarction is usually caused by a blood clot that clogs an artery in the head or neck (thrombosis). In this case, the clot forms on the spot, in the artery, usually when the latter is calcified (arteriosclerosis). A clot can also form elsewhere, for example in the heart, be carried into the bloodstream and eventually get stuck in an artery in the neck or brain (embolism). Congenital bleeding disorders can also be the basis of blood clots.
People tend to use the term “thrombosis” to refer to a stroke. But stroke can correspond to a thrombosis as well as an embolism. This term actually refers to a sudden event affecting a blood vessel in the brain.
When a blood vessel in the brain is blocked for a short time, it is calledtransient ischemic attack (TIA). The functional problems are then short-lived. The risk of stroke is, however, considerably increased during the period following a TIA.
What is their frequency?
According to the 2018 national health survey, the frequency of strokes in Belgium has been relatively stable since 1997. Each year, around 7 people in 1,000 have a stroke. Men are more often victims of it than women.
The percentage of people who have had a stroke varies greatly with age. From 0.1% below the age of 45, this percentage gradually increases to reach 2.4% after the age of 75.
How to recognize them?
The characteristic symptoms of a cerebral infarction are sudden functional deficits: certain functions stop suddenly. They may be motor functions and / or sensory functions. Loss of motor functions results in muscle paralysis. In the event of a deficit of sensory functions, the loss of sensation is predominant.
A cerebral infarction usually results in paralysis on one side of the body (hemiplegia). One half of the body has flaccid paralysis: one arm, one leg and one half of the face. Your mouth is crooked, you have difficulty speaking, and you have trouble seeing. These signs may be accompanied by changes in sensation (feeling of heaviness, deafness, tingling to total numbness). You may also not feel half of your body at all or even forget it.
Vomiting and dizziness are also possible. Later, flaccid paralysis can progress to spasticity. The joints contract in an unnatural position due to shortening of muscles and tendons.
How is the diagnosis made?
The symptoms and the clinical neurological examination allow the doctor to know if you are at risk of having a cerebral infarction. In this context, it assesses the strength of your arms and legs, your sensations, your senses, your balance, your gait, your reflexes, your memory and your capacity for reasoning.
In the event of a cerebral infarction, you will always be referred urgently to the hospital for additional examinations of the brain and heart. An ultrasound of the vessels of the neck, a CT scan and / or an MRI of the brain, as well as an electrocardiogram (ECG) and an ultrasound of the heart (echocardiography) will be performed there. It will also be checked if you have any underlying diseases or risk factors such as high blood pressure, diabetes, high cholesterol, etc.
What can you do ?
A cerebral infarction can be fatal and should be treated as soon as possible. Every minute counts! Pay attention to warning signs: sudden loss of strength or sensory disturbances in the face, arm or leg, difficulty walking, dizziness and difficulty in balance, difficulty speaking or understanding others, blindness or blurred vision in one or both eyes and very severe headache. If you have these symptoms, call 112 immediately or go to the nearest emergency room.
As a preventive measure, you can limit the risk factors as much as possible. There isn’t much you can do about your age, gender, and hereditary burden, however. But there are a lot of risk factors that you can influence, such as smoking, heavy drinking, being overweight, unhealthy eating habits, and lack of exercise. Proper monitoring of treatment for pre-existing conditions or risk factors such as high blood pressure, high cholesterol, diabetes and heart rhythm disturbances is also essential.
What can your doctor do?
First aid should preferably be given in a hospital with a service specializing in the treatment of strokes (a “stroke unit”). In the acute phase, treatment mainly targets 2 objectives:
- the first objective is to stabilize the condition, if necessary by supporting the function of the heart and breathing.
- the second objective is to limit the damage. If possible, the clot that is blocking the blood vessel will be removed:
- by thrombolysis (dilution of the clot with drugs) or
- by thrombectomy (the clot is removed surgically).
Then you receive a long-term treatment with anticoagulants, usually low-dose acetylsalicylic acid (aspirin) and cholesterol-lowering drugs (to lower cholesterol). Of course, underlying conditions and / or risk factors such as high blood pressure, cardiac arrhythmias and diabetes are also taken care of.
At the same time, rehabilitation is started as quickly as possible by a multidisciplinary team made up of a physiotherapist, an occupational therapist and, if necessary, a speech therapist. The revalidation then continues at home. The physiotherapist tries to restore the lost functions through exercise. The occupational therapist mainly teaches you how to manage disabilities so that you can continue to function as independently as possible at home. Finally, the speech therapist helps you improve speech disorders. The majority of progress is recorded during the first 6 months, after which the improvements are usually very limited.
Your driving ability should also be assessed. This assessment is carried out by your doctor, in collaboration with the Vias Institute (ex-IBSR) and the Center for Driving Aptitude and Vehicle Adaptation (CARA). You are unfit to drive until the disease has completely stabilized. The specialist can then declare you fit again. However, he may attach certain restrictions to it, such as a ban on driving at night. It may also require you to have the car adapted according to your possibilities.
Want to know more?
CARA (Vias): https://www.vias.be/fr/particuliers/cara/
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