The need for stroke awareness: a medical emergency

According to the World Health Organization, every year, between 15 and 17 million people suffer a stroke and 6 million die from it, making it the second leading cause of death worldwide. During a stroke, 2 million neurons are destroyed every minute. Everyone can be affected: 31% of victims are under 65 years old and even children are affected. The French Neurovascular Society estimates that stroke is one of the 10 main causes of death in children. On the occasion of the World Stroke Day, a day dedicated to stroke awareness, the Alcimed Healthcare team took an interest in this real public health problem, qualified as a pandemic by the WHO.

What are the two categories of stroke?

When a stroke occurs, the lack of oxygen and nutrients essential to the functioning of nerve cells causes their death. In reality, there are 2 categories of stroke:

Ischemic stroke or cerebral infarction

Ischemic stroke represents 80% of the cases and occurs when a cerebral artery or cerebral blood vessels are blocked, either by a blood clot that has formed in the rest of the body and then moved to the brain, – this is called an embolic stroke -, or by the formation of a clot in the brain directly, – this is called a thrombotic stroke -.

The cerebral lesions can then be temporary, it is a transient ischemic attack, or permanent, leading to the destruction of part of the cerebral tissue for the cerebral infarction.

Hemorrhagic stroke

Hemorrhagic stroke occurs in the 20% of complementary cases during the rupture of a blood vessel that irrigates the brain. If the resulting bleeding occurs in the brain, it is called cerebral hemorrhage. If the bleeding occurs between the brain and the meninges (membranes surrounding the central nervous system), it is called a meningeal hemorrhage.

The prognosis of a hemorrhagic stroke depends on the size of the hematoma, the age of the patient, and the patient’s previous general condition. It can cause consciousness problems or even coma and rehabilitation, often prolonged, is necessary.

Stokes: the causes and risk factors

• Atrial fibrillation, a heart rhythm disorder that causes the heart to beat rapidly and irregularly, is a major risk factor for stroke, accounting for 50% of ischemic strokes.
• High cholesterol and diabetes can also cause stroke. Both can contribute to the formation of blood clots that block blood flow to the brain.
• High blood pressure is also a risk factor. The pressure on the blood vessels makes them prone to blockage or even rupture.
• Excessive alcohol consumption, which promotes hypertension, is also a risk factor.
• Smoking doubles the risk of stroke. Indeed, carbon monoxide takes the place of oxygen by fixing itself on the red globules. The organs are then less oxygenated, the heart rate and blood pressure will increase, which can cause a blockage of the blood system.
• Finally, the lack of physical activity contributes to the development of cardiovascular diseases such as stroke.

Why is stroke awareness so important : the consequences of stroke

The consequences of stroke are major for the victim. In one out of four cases, a stroke results in death.

It can have other serious consequences:

• Causing a loss of learning ability
• Affecting language, thought and emotions
• Or even causing aphasia or hemiplegia. Aphasia is the total or partial loss of the ability to speak or understand. Hemiplegia is the paralysis of one or more parts of the body in a lateralized manner. If the hemiplegia is total, the lower and upper limbs, the trunk and half the face are affected.

Stroke also has serious consequences for the victims’ relatives. Indeed, in case of after-effects, it is necessary to accept that the person the victim was is no longer the same. They also have to learn to live with the way others look at their sick loved one.

Stroke management is evolving

Today, the most common solution is the administration of TPA – tissue plasminogen activator – which breaks down the blood clots that caused the stroke. This treatment is effective in treating ischemic stroke if administered within 4.5 hours of the first symptoms.

Since 2004, mechanical thrombectomy, which physically removes a blood clot, has been a major advance in the management of ischemic stroke. However, this technique faces some barriers: still too few trained surgeons and a very expensive investment in equipment for hospitals, even if it continues to gain popularity.

For hemorrhagic stroke, treatment may be surgical to empty the blood bag that is compressing part of the brain, and long-term treatments, such as anti-coagulants, may be prescribed to prevent relapse.

However, new treatments for hemorrhagic stroke are becoming available to surgeons, such as surgical clipping (this involves placing a clip at the base of the bleeding area to stop the flow and prevent the area from bleeding again), coiling (this involves guiding a wire through the groin to the brain while inserting small coils to fill in areas of weakness and bleeding) or surgical removal (the surgeon can move a small portion of the damaged area, but this type of operation is a last resort because it is considered very high-risk and cannot be performed on many areas of the brain).

Stroke awareness to save lives: recognizing stroke symptoms

Stroke awareness is important because recognizing the symptoms of a stroke allows you to react quickly and can therefore reduce brain damage and improve the chances of survival and recovery.

There are three main symptoms that should raise the alarm:

• The first is a sudden paralysis of the face or sometimes loss of sensitivity of the face.
• The second may be numbness, weakness or sudden paralysis of an arm or leg.
• The last is a sudden loss of speech, such as difficulty speaking, articulating or even understanding what is being said.

In the case of an ischemic stroke, it is important to note that symptoms that occur may disappear within 24 hours. However, these symptoms may be a warning sign of a more serious stroke. The consequences of a stroke depend on how quickly it is managed. For this reason, it is important to improve stroke awareness and public education about stroke detection.

Stroke is a major cause of death worldwide and the leading cause of acquired disability in adults. The speed of medical management is key: as soon as one or more symptoms of stroke appear, it is essential to consult medical services in order to limit the serious consequences of stroke as much as possible. Finally, prevention of risk factors, most of which can be controlled, remains a priority.

About the author, 

Amaury, Consultant in Alcimed’s Healthcare team in France