Ischemic episodes are mostly caused by the atherosclerosis of either the large vessels, such as carotid arteries, or the smaller vessels of the brain. Cardiac causes, such as atrial fibrillation type arrhythmias, as well as various other causes such as vascular inflammations (vasculitis), brain tumors, and blood clotting disorders are also common.

 

In contrast, haemorrhagic episodes are mostly due to increased blood pressure (hypertension), as well as vessel wall lesions (aneurysms).

• Muscular weakness of one or more extremities.
• Disorder of the sensation of one or more extremities or the face
• Visual disorders such as hemianopia, diplopia
• Balance disorders such as acute-onset vertigo
• Speech disorders, dysarthria,
• Dysphagia, etc.

• High blood pressure (Hypertension)
• Diabetes mellitus
• High cholesterol (Hyperlipidemia)
• Arrhythmia, such as atrial fibrillation
• Smoking
• Obesity
• Genetics - Family history

The patient should undergo a complete hematologic and biochemical testing, brain imaging with CT or MRI scans, a complete cardiac testing, as well as an ultrasound of the cervical vessels (carotid arteries and spinal arteries).

Modern treatments for acute vascular ischemic stroke include the various thrombolysis techniques. A prerequisite is for the patient to come to the emergency department of the hospital within less than 4.5 hours of onset of the stroke. In these cases, the chances of rehabilitation are increased. Finally, in the case of cerebral haemorrhages there is a possibility of neurosurgical treatment or treatment with the help of invasive radiologists.

The restoration of neurological functions depends on whether other centers of the brain will have the capacity to undertake them, which is achieved only by applying the appropriate Neurological rehabilitation and with the help of speech therapy, physiotherapy and ergotherapy.

For the treatment of strokes, apart from a neurologist, the collaboration of other specialties (cardiologist, physician, neurosurgeon) is required.

Secondary prevention treatment is determined by the cause of the cerebrovascular accident. There are cases where anticoagulation treatment should be given, as it is usual for patients with atrial fibrillation, etc. In other cases, antiplatelet treatment is usually chosen, while the choice of substance and the dose depends on the cause of the stroke and the history of the patient. Lastly, the section on the modification of the factors responsible for the occurrence of the episode is dealt with.

Perhaps the most important word that should come to our mind when hearing the word “stroke” is prevention, which is made possible by the diagnosis and treatment of various risk factors such as, for example, hypertension, blood sugar, hyperlipidemias, various cardiac arrhythmias and thrombophilia (increased blood clotting tendency).

Stroke is a neurological disease and the patient should always be referred to a neurologist. However, monitoring of a patient with stroke usually requires the co-operation of a variety of specialists (cardiologist, hematologist, radiologist, physician, endocrinologist) whose coordination should be undertaken by the specialist neurologist.