Neurovascular Pathology: Stroke

Stroke: definition and clinical manifestations

Stroke is a cerebrovascular disease that can cause serious consequences such as death, disability or dementia in adults. It is important to know the types of stroke and its symptoms in order to be able to intervene quickly and effectively to reduce the risk of neurological sequelae.

Types of stroke

There are two main types of stroke: ischaemic stroke and cerebral haemorrhage. Ischaemic stroke occurs when an artery in the brain becomes blocked and not enough blood reaches the relevant area of the brain, causing injury to nerve tissue. Cerebral haemorrhage, on the other hand, is the result of a ruptured cerebral artery, which causes bleeding in the brain.

Ischaemic Stroke

The ischaemic stroke is the most common type of stroke, accounting for 85 % of cases. It can be caused by the formation of a clot in an artery in the brain or by partial or total blockage of an artery due to atherosclerosis, a build-up of plaque in the walls of blood vessels.

Cerebral Haemorrhage

The cerebral haemorrhage occurs when a blood vessel in the brain ruptures, causing intracranial bleeding that damages brain tissue. This type of stroke accounts for 15 % of cases.

Stroke symptoms

The symptoms of a stroke can appear suddenly and without warning. It is important to be aware of them so that you can identify a possible stroke and act quickly. Symptoms can vary depending on the area of the brain affected, but some of the most common symptoms are: loss of strength and sensation in the face, arms or legs (usually on only one side of the body), difficulty speaking or understanding, loss of vision, severe headache, dizziness, problems with balance and coordination, among others.

Clinical Manifestations of Ischaemic Stroke

The symptoms of ischaemic stroke can be classified into three categories: focal symptoms, non-focal symptoms and symptoms of brainstem disorders. Focal symptoms usually appear suddenly and affect only one part of the body, such as weakness in one part of the body or slurred speech. 

Non-focal symptoms are less obvious and may be more difficult to detect, such as headache, dizziness or nausea. Finally, the symptoms of brainstem disorders are characterised by the fact that they affect vital functions such as breathing or the maintenance of consciousness.

Clinical Manifestations of Cerebral Haemorrhage

The symptoms of cerebral haemorrhage can also vary depending on the area of the brain affected. Common symptoms include: severe headache, vomiting, loss of consciousness, muscle weakness, convulsions or epileptic seizuresamong others.

Risk Factors and Stroke Prevention

There are some risk factors that increase the likelihood of suffering a stroke, such as smoking, high blood pressure, diabetes, high cholesterol, a sedentary lifestyle, obesity or excessive alcohol consumption, among others. It is important to lead a healthy lifestyle to prevent the risk of stroke.

The stroke prevention The key is to control these risk factors and eat a balanced diet, take regular physical exercise, avoid smoking and excessive alcohol, and follow medical advice if you have a chronic disease.

Stroke treatment

The stroke is a medical emergencyand treatment must be prompt to avoid irreparable damage to the brain. Therefore, the therapeutic approach is essential to reduce mortality and improve the quality of life of patients. This section describes the different treatments available for stroke and how they are applied depending on the stage of the patient.

Treatment of the acute phase

The acute phase of stroke refers to the time at which the cerebrovascular injury occurs, and the main goal is to restore cerebral blood flow and limit brain damage. In order to do this, it is essential to make the correct assessment and diagnosis as quickly as possible so that the right treatment can be applied.

Correct assessment and diagnosis of stroke

In order to make the correct diagnosis, symptoms and signs must be identified and diagnostic tests, such as the computed tomography or magnetic resonance imagingimmediately. Identifying the type of stroke is crucial to determine the appropriate treatment.

Fibrinolytic therapy

The fibrinolytic therapy aims to dissolve the clot blocking an artery in the brain and restore cerebral blood flow. To do this, a drug called 'alteplase' is administered to dissolve the clot. 

It is a very effective treatment that can reduce disability and mortality in patients with ischaemic stroke, but its safety must be carefully assessed before administration.

Mechanical thrombectomy and intra-arterial thrombolysis

Mechanical thrombectomy and intra-arterial thrombolysis are surgical techniques used to remove the clot blocking a cerebral artery. The mechanical thrombectomy is performed manually, while intra-arterial thrombolysis is performed in an image-guided manner. 

These techniques have made it possible to treat patients who have a clot that cannot be dissolved by intravenous fibrinolytic therapy.

Long-term therapeutic treatment

Once the patient is beyond the acute phase, it is important to initiate long-term treatment to prevent recurrences and maximise recovery. Doing so accurately requires a precise diagnosis of the mechanism by which the stroke has occurred.

Treatment of cerebrovascular disease

The treatment of cerebrovascular disease aims to prevent recurrence of stroke and prevent the onset of other vascular diseases. It is based on the modification of vascular risk factors, such as hypertension, diabetes and dyslipidaemia, and the administration of antithrombotic or antiplatelet drugs, as appropriate.

Rehabilitative therapy

The rehabilitation therapy aims to maximise the patient's functional recovery, and focuses on physical and neuropsychological rehabilitation. The physical rehabilitation focuses on strength and balance training, while neuropsychological training focuses on cognitive and emotional rehabilitation.

Prevention of vascular events in stroke patients

The prevention of vascular events in stroke patients focuses on educating patients and their caregivers about the disease, the importance of adherence to treatment and the adoption of a healthy lifestyle. In addition, it will focus on long-term monitoring and control of vascular risk factors.

Neurovascular pathology: Research and medical care

The neurovascular pathology requires individualised assessment and treatment. Multidisciplinary units specialised in the management of stroke patients offer a rigorous assessment and rapid vascular analysis that allows early identification of the causative mechanism, so that immediate and appropriate treatment can be initiated. In this section, we will address the stroke units and the medical services available in Spain for research and medical care in neurovascular pathologies.

3.2. Health professionals

The treatment of neurovascular pathologies The treatment of stroke requires a multidisciplinary medical team, made up of health professionals who are highly trained and specialised in the treatment of this pathology. Among the health professionals involved in the treatment of stroke are stroke treatment are neurologists, whose role is fundamental in the follow-up and treatment of the patient. Neurologists are responsible for coordinating and supervising the process of diagnosis and treatment of stroke patients.

3.3. New research and training

Recent technological advances are allowing for the development of new techniques in the diagnosis and treatment of neurovascular pathologiessuch as stroke. Medical services dedicated to research in neurovascular pathologies are working on the integration of these innovations into clinical practice. In addition, specific training programmes for the diagnosis and treatment of neurovascular pathologies are offered in Spain, with the aim of improving the knowledge and training of health professionals who treat these pathologies. Dr. De la Cruz is the director of the most relevant university degree programme in our country focused on this pathology.