In the cause of death statistics, strokes are in third place in the Western industrial nations after heart disease and malignant tumors. About one in ten inhabitants of a western country dies from a sudden stroke, whereby the risk of disease increases significantly with age. In the seventh decade of life, stroke is the second leading cause of death. Men and women are affected about equally frequently.
Transient ischemic attack and PRIND
Depending on the extent and duration of the acute circulatory disorders in the brain, a variety of symptoms may occur, with smooth transitions between transient, transitory symptoms and life-long persistent neurological deficits:
- In the case of only short-lasting symptoms as a result of a circulatory disorder in the brain, it is called a transient ischemic attack (TIA), which may be a harbinger of a "major" stroke.
- The next higher level in terms of intensity and duration of the complaints would be given by the so-called PRIND (prolonged reversible ischemic neurological deficit), in which the failures can last for hours or sometimes even days, but then completely regress.
- In the case of irreparable damage to the brain substance, the neurological damage usually persists for the rest of life.
Signs of a stroke
Due to the complex structure and function of the brain, the most diverse combinations of symptoms can occur in acute circulatory disorders, depending on the affected area.
For the understanding of the respective deficiency symptoms, it is important that the supplying and discharging nerve fibers, which establish the connection between brain and "periphery", cross in the lower part of the brain, the brainstem. Accordingly, the left hemisphere of the brain is responsible for the right half of the body and vice versa. A sudden paralysis of the right side of the body as one of the possible symptoms, for example, indicates an acute circulatory disorder in the left hemisphere.
Even more complex symptoms arise in acute circulatory disorders at the brainstem level, since numerous fibers are also adjacent to both halves of the body and control centers and can also be affected at the same time.
Typical symptoms of involvement of the brainstem in the stroke process are:
- Head pain
- double vision
- Twitching of the eyeballs
- Feelings of the hands or fingers
- Gait uncertainties and speech disorders
Symptoms depending on the closure area
From the knowledge of brain anatomy and organizational structure, the experienced physician can draw conclusions from the symptom picture of a patient with an acute stroke to the affected brain area, but not to the actually triggering cause. Basically, not all conceivable symptoms and symptom combinations in strokes can be represented by far in this short review article.
Here are just a few typical symptoms of obstruction of an important vessel in individual regions of the brain:
- Vessel occlusion of the middle cerebral artery, middle cerebral artery (about 80 percent of vascular strokes): paralysis and discomfort on the opposite side of the body, most pronounced on the fingers of the hand and face; partly loss of vision in the opposite half of the face
- Vascular occlusion of the posterior cerebral artery, posterior cerebral artery (approximately 10 percent of vascular strokes): loss of vision in the opposite field of vision, disturbance of consciousness, sensory disturbances on the opposite side of the body
- Anterior cerebral artery occlusion, anterior cerebral artery (approximately 5 percent of vascular strokes): Hemiplegia on the opposite side, which affects the leg more than the arm
- Vascular occlusion of one of the numerous brain stem vessels (20 percent of all vascular strokes, up to 50 percent in the case of microvascular damage): visual disturbances, motor disorders, emotional disorders that may affect both halves of the body in different ways; In addition, back pain, double images, twitching of the eyeballs, gait uncertainties, speech disorders and in severe severity also consciousness clouding
Diagnosis of a stroke
The diagnosis of stroke results from the typical picture of suddenly reoccurring neurological deficits. If the symptoms are minor, such as new-onset emotional disorders or sudden double vision, other syndromes must also be included as possible causes.
The ultimate evidence of a circulatory disorder in the brain can be provided by computed tomography or magnetic resonance imaging of the skull. In addition, this examination procedure can be used to clarify the cause and location of the damage in the brain.
Additional diagnostic information after a stroke is provided by the ultrasound examination of the cerebral vessels, possibly a representation of the entire cerebral circulation by contrast medium injection, a detailed examination of the heart for possible embolic sources and the blood test for possible coagulation disorders.
After expired stroke with newly occurring neurological deficits, the degree of spontaneous regression of the lesions is, of course, of utmost interest. Although complete cures are conceivable in individual cases, in the majority of cases of large strokes must be expected with more or less pronounced, persisting defects.
Since numerous individual factors play a major role in the further course of the disease, forecasts in individual cases are very difficult to make. In principle, however, it can be said that the acutely occurring functional failures, even in the case of large strokes, can partially recede over the course of several weeks or months. In such a stroke, it is of vital importance to what extent other brain areas that are still intact can intervene and take over the function of the submerged brain tissue.