ACUTE STROKE (PARALLEL)

Strokes are divided into two groups. Hemorrhagic strokes, also known as brain hemorrhages, occur as a result of rupture or bursting of blood vessels in the brain. This type of stroke can occur as a result of a cerebral aneurysm or a cerebral arteriovenous malformation (cerebral arteriovenous malformation) or as a result of capillary rupture due to high blood pressure. The other type of stroke, the more common ischemic stroke, occurs due to a cerebral artery occlusion. Because insufficient blood flow to the brain occurs, approximately two million brain cells die every minute, resulting in permanent brain damage that can lead to disability or death. Prompt recognition of symptoms and initiation of medical treatment are lifesaving and can prevent disability.

What is the incidence of stroke?

There are 17 million strokes annually worldwide. Stroke is the most common cause of disability among adults. It is the second leading cause of death after heart disease. Every 40 seconds, someone in the population has a stroke, and every 3 minutes, someone dies from a stroke.

What are the symptoms of stroke?

• Sudden onset of weakness or numbness in the face, arms, or legs

• Sudden confusion or difficulty speaking or understanding

• Sudden onset of vision loss in one or both eyes

• Sudden onset of loss of balance, inability to walk

• Sudden onset severe headache

Risk factors for stroke

Male

Over 55 years old

diabetes

Hypertension

Hyperlipidemia (high amounts of fat in the blood)

Cigarette

Atrial fibrillation (abnormal and irregular heart rhythm)

Family history of stroke

How is stroke diagnosed?

Patients presenting to the hospital with suspected stroke are first subjected to a brain CT scan. A brain CT scan distinguishes between ischemic and hemorrhagic strokes. The absence of bleeding on the CT scan suggests an ischemic stroke due to cerebral vascular occlusion, and computed tomographic angiography (brain CT angiography) is performed to identify the occlusion. Additionally, a perfusion CT scan can assess the condition of the brain tissue affected by the occlusion for reduced blood flow and blood volume, and can identify irreversibly damaged brain tissue and areas of tissue at risk that can be salvaged. Some centers also utilize magnetic resonance imaging (MRI) in addition to computed tomography.

How is stroke treated?

Time is the key to stroke treatment. The earlier treatment is initiated, the greater the chance of recovery. Therefore, it is crucial to transport patients with suspected stroke to stroke centers equipped and experienced enough to fully diagnose and treat stroke. These centers can perform detailed brain and cerebral vascular imaging, as well as necessary medical and interventional treatments. If the patient can be transported to these centers within the first 4.5 hours and there are no medical conditions that preclude the administration of clot-dissolving medication (tPA), the neurologist or emergency specialist will administer the clot-dissolving medication intravenously. These medications have limited effectiveness in large-vessel occlusions, and if the patient is brought to these centers within the first 12 hours, interventional neuroradiologists will perform an angiographic (endovascular) procedure to remove the clot from the brain vessel (thrombectomy). This procedure is usually performed under general anesthesia, using a needle inserted into the groin or wrist artery, and then plastic tubes called catheters are used to access the neck and brain vessels, respectively. The clot is removed from the blocked artery using an aspiration catheter (clot-absorbing catheter) or a stent. This procedure has a success rate of approximately 90%, resulting in significant improvement in cerebral blood flow. The resolution of stroke symptoms and clinical improvement in a patient depends on how quickly the clot is removed, the severity of stroke symptoms, and the patient's underlying medical conditions prior to the stroke. Significant improvement and recovery are achieved in approximately 60% of patients.