Stroke

Stroke is a collective name for brain damage caused by a blood clot or bleeding in the brain. A stroke leads to a lack of oxygen in the brain which causes you to suddenly lose various functions such as speech, movement, feeling, and vision. It can be life-threatening and therefore immediate hospital care is required.

Most people who get a stroke are over 65, but even younger ones can get it. The risk of stroke increases if, for example, you have high blood pressure, atrial fibrillation, high blood fats,  diabetes or if you smoke. Stroke is sometimes also called a stroke.

If there is a stroke in the family, in biological parents or siblings, you yourself have an increased risk of having a stroke. Part of the risk increase is because, for example, high blood pressure and high blood fats can be hereditary.

It is common to have trouble after a stroke, but it varies from person to person. With the help of care and rehabilitation, many can get better or find new ways of doing things. 

Symptoms of Stroke

During a stroke, several functions in the body suddenly stop working properly. The symptoms depend on which part of the brain is damaged, but it is common to

  • get numbness or paralysis on the face, arms, and legs, usually in one half of the body
  • have difficulty speaking and understanding
  • get confused
  • get visual disturbances on one eye or both eyes
  • get dizzy and get scams
  • get worse balance and get difficult to walk
  • get severe headaches without a clear cause.

TIA – a warning signal

TIA, a transient ischemic attack, is a disorder of the blood circulation of the brain that goes over. This means that you get symptoms that are similar to those you get during the stroke, but that disappear completely within a day. Often the symptoms at TIA last only a few minutes.

TIA is due to a small blood clot for a short time clogging the blood circulation in a small vessel in the brain. The blood circulation usually becomes as it should again and therefore no lasting damage can occur. But if you get a TIA there is a risk that you will get a new or larger blood clot within the next few days. You should, therefore, seek care immediately even if the problems have gone away.

Bleeding in blood vessels on the surface of the brain

If you have a severe and sudden headache, it may be due to a blood vessel bleeding on the brain surface, below the innermost meninges. It is usually called a subarachnoid hemorrhage. Often you also feel sick and vomit. You may lose consciousness if you get major bleeding.

The bleeding is usually due to a pulmonary artery rupture in the brain. A pulmonary vein is an enlargement of a pulmonary vein, which is usually due to the wall of the blood vessel weakening.

Blood clotting or bleeding inside the brain

The symptoms of a blood clot in the brain and bleeding inside the brain are often similar. Headaches, nausea, and vomiting often result in major bleeding in the brain. You can sometimes find it difficult to stay awake or even lose consciousness.

When should I seek care?

Seek care as soon as possible, even if the symptoms have passed. Never drive a car yourself to the hospital if you have symptoms suggestive of a stroke.

Acute Test

The ACUT test is a simple method that you can use to check if a person has suffered a stroke. The letters in the word AKUT stand for this:

  • A – Face – which is aimed at asking the person to smile and show their teeth. 
  • K – Body part – aimed at asking the person to raise their arms and hold for 10 seconds.
  • U – Pronunciation – refers to asking the person to say a simple sentence, for example, “The sun is shining today”. 
  • T – Time – indicates that the sooner the person receives treatment, the less the injuries.

How can I reduce the risk of having a stroke?

You can do a lot yourself to reduce the risk of a stroke. It is especially important to consider if you have heredity, such as that many in the family had high blood pressure or had a stroke.

The risk of stroke is significantly reduced if you stop smoking.

If you are over 50, it may be good to check your blood pressure for high blood pressure to be detected and treated.

It is good that if you exercise regularly, eat healthy and varied and lose weight if you are overweight. You should avoid sitting still too much.

If you find yourself having an irregular heartbeat, consult a doctor.

Investigations

When you have symptoms of stroke and come to the hospital, you are examined if you have had a blood clot or bleeding, exactly where the injury is located and what functions are affected.

The doctor is also investigating whether it may be another illness that causes similar symptoms such as epilepsy, meningitis or migraine. The doctor then assesses whether it is possible to start treatment with blood clot-releasing medication at once.

You may undergo various investigations

At the hospital, the doctor does a survey of past illnesses and you yourself and often a close relative are interviewed about what has happened. The doctor also usually does a body examination when the heart, blood pressure, and nervous system, in particular, are examined.

You usually have blood tests to check blood levels, platelets, blood sugar, and blood fats.

In addition, you may have the following common investigations:

  • ECG to check if it may be a disorder of the heart rhythm, heart attack or any blood disease that may be behind.
  • Computer tomography of the brain to see if the cause is a blood clot or bleeding.
  • Ultrasound examination of the neck vessels to detect any constrictions.

Sometimes more examinations may be needed, such as heart ultrasound examination, coronary x-ray, spinal fluid or special blood tests.

Investigation of suspected brain hemorrhage

If the doctor suspects that there is bleeding on the surface of the brain, you need to undergo a computer tomography examination as soon as possible. Then the doctor can usually see the bleeding, but not always. If no bleeding is seen, but the doctor still suspects a brain hemorrhage, the spinal fluid is examined by leaving a spinal fluid test.

If you have a cerebral hemorrhage, you are usually investigated at a neurosurgical clinic.

Examination of various functions

The first investigations are done to investigate the cause of a stroke and to be able to start treatment. Thereafter, it is investigated how the injury affects various bodily functions. Then you test, for example, how you walk and balance, the ability to swallow and talk. Your intellectual ability may also need to be tested sometimes.

The surveys are done by staff from the stroke team, for example, occupational therapist, nurse, physiotherapist and speech therapist. The staff will test what abilities you have and if any functions have been damaged.

Treatment of Stroke

The treatment you receive depends on what causes you to have a stroke. If the investigation shows that the cause is a blood clot, you will receive medication that prevents new blood clots.  If you have problems that increase the risk of getting a blood clot, such as atrial fibrillation, you also receive medicines that prevent it.

In order to limit the damage to the brain, the nutritional and oxygen supply needs to be as good as possible. Therefore, the doctor carefully monitors blood pressure, brain functions, breathing, and any diabetes. You will receive treatment if needed.

It is very important to get to the hospital quickly when you get symptoms of a stroke because you need to get a blood clot-releasing medication right in the blood with a drop. It is a treatment that you must receive within four to five hours after the first symptoms began. Treatment with plug-in medicine can increase the risk of brain bleeding. The risks of treatment are usually too great if, for example, you have had a brain hemorrhage before, if you have very mild symptoms or if the injury is very severe.

Sometimes, in the case of a more severe blood clot, it can be removed by means of a tube that is inserted into the pulmonary vein of the groin and reaches the brain. This treatment must be done within the next few hours after you become ill.

Treatment of bleeding in the brain

Bleeding under the innermost meninges is often due to a small pulmonary artery rupture on the surface of the brain. The doctor can then by a special method enter the pulmonary vein and prevent new bleeding.

Sometimes, but it is unusual, you may need surgery even if the bleeding has occurred inside the brain tissue. But this only applies if you quickly deteriorate and the bleeding is superficial.

Operation of constriction on the carotid artery

If you have a more severe constriction on the carotid artery you are usually operated on. Then the constriction is removed and it prevents new blood clots from forming. You usually need such surgery within two weeks of the blood clot.

The operation takes about half an hour and you are either anesthetized or have local anesthesia. Through the skin on the neck, the surgeon opens the carotid artery and clears the constriction from the vessel. It is common for you to stay in the hospital for a few days after the operation.

Medicines can reduce the risk of new stroke

You are often treated with medicines so that you do not get a new stroke. It is, for example     

  • medicines for high blood pressure
  • blood thinners 
  • medicines for high blood fats

Long-term follow-up after a stroke

After you have had a stroke, you may go on regular visits to a doctor, usually at a medical center. At the same time, you usually get rehabilitation from a physiotherapist, occupational therapist and sometimes speech therapist.

At the doctor’s visits, you check, among other things, whether you have had new symptoms or if you have had any complications.

Other things that the doctor checks are for example

  • blood pressure
  • how the medication works and if you have any side effects
  • if any new risk factors have been added, such as diabetes
  • how to handle your daily chores, such as eating, dressing, washing, and moving 

It is also common for the doctor to want to know how the workout is going. They also usually ask whether the collaboration between care and rehabilitation within the municipality and county councils works well or if there is something that needs to be addressed.

The doctor also wants to get a picture of how everyday life works and that you get the information about the disease you need. You will also be told about how the relationship with close relatives works. If you agree, they may participate in the doctor’s visits. Your relatives have the right to receive the information they need from the healthcare staff in order to help and understand. If you have underage children, they also have the right to receive information and support.

What is the cause of a stroke?

The most common cause of stroke is that a blood clot clogs blood circulation in an area of ​​the brain. It is also called brain infarction.

A blood clot can form in a narrow blood vessel in the brain and is then called thrombosis. Often, there is a smaller blood vessel in the brain in the deep parts of the brain that has become clogged, so-called small-vessel disease.

A blood clot can also occur in a constriction in a carotid artery or heart and accompany the blood to the brain. Such a plug is called an embolism.

A blood clot from the heart is usually due to a disturbance of the heart rhythm, so-called atrial fibrillation. Other causes of a blood clot leaving the heart may be, for example, a heart attack or an implanted flap in the heart. If you have had a myocardial infarction, the risk of the blood rising and forming new clots in the heart increases, which then continues to the brain. 

What happens in the body during the stroke?

Here are some common injuries you may suffer from stroke:

Injuries in the right hemisphere

Injury to the right hemisphere often causes paralysis or loss of sensation in the left half of the body. This is because the right hemisphere controls movements in the left half of the body. It is also the right brain that controls the ability to analyze and assess distance, size, and speed.

You can also have problems with the senses of the mind and to orient yourself in the room. For example, you may find it difficult to pick up items, snap buttons or tie shoes. It can be a problem to communicate because you find it difficult to interpret emotions and attitudes in tone and mimicry. Personality changes are also common. For example, your mood can change, and your pace.

Neglect

It is common for you to get something called nails if you get a stroke. This means that you have trouble perceiving things that are on one side of the body. You may also have difficulty perceiving your own body half or one part of the field of view. For example, neglect can mean that you only eat the food on one side of the plate or just shave half your face. The word neglect comes from English neglect, which means neglect, ignored.

Most often it is information from the left side that you do not perceive as it is most common with neglect in the right hemisphere.

Damage in the left hemisphere

In most people who are right-handed are the centers that govern the language in the left hemisphere. Damage in the left hemisphere can, therefore, make you, for example, difficult to speak, understand spoken language, read, write or count. As with damage to the other half of the brain, you can become paralyzed and feel degraded in the opposite half of the body.

Aphasia – language difficulties

You may have difficulty talking and expressing yourself after you have had a stroke. It’s called aphasia. The linguistic difficulties you get, and how big they are, depending on which part of the brain is damaged.

Often, speech and language difficulties are already improved after a few days or weeks after a stroke, but it is common for you to continue to have problems with the language for a long time.

Damage to the cerebellum

If you get a clot or bleeding in the cerebellum, you may experience symptoms such as dizziness, difficulty in coordinating movements, balance problems or involuntary eye movements.

Damage to the brain stem

Damage to the brain stem can affect consciousness. You can also become paralyzed in one half of the body, face or feel worse. Other problems may be that it becomes difficult to swallow due to paralysis in the throat or difficult to speak due to paralysis in the tongue.

Complications

In addition to the direct consequences of brain damage, such as paralysis and speech difficulties, you may also have other complications following a stroke in the short or long term. It could be, for example

  • brain edema, swelling in and around the brain injury
  • blood clots in the legs or lungs
  • pneumonia
  • epileptic seizures
  • depression and difficulty controlling their emotions
  • injuries that can occur if you fall, such as fractures
  • problems with the urinary tract
  • pressure sores if you have become bedridden
  • constipation
  • pain from joints and other body parts.

If especially sensitive parts, or large parts, of the brain are damaged, stroke can lead to dementia. This is especially true if you have had a stroke several times.

Cerebral edema

Brain edema means that fluid has accumulated in the brain so that the brain swells. The pressure can then increase inside the skull and the blood circulation to the brain can decrease. Cerebral edema is serious and there is no medication that can effectively prevent you from getting cerebral edema during the stroke, but sometimes you can get surgery. The greatest risk of getting edema is two to four days after a stroke.

A blood clot in the legs

Stroke and other diseases that cause you to lie still for a long time increase the risk of getting blood clots in your legs. A plugin the leg can loosen and get off to the lungs, which is life-threatening. The risk can be reduced by early training to walk and stand and avoid lying to bed. Blood-thinning medicine is mainly used if you have such a severe stroke that you cannot walk or stand due to leg paralysis.

Pneumonia

Pneumonia may be due to the fact that you have swallowed wrongly and received food and drink in the trachea, or that you cannot cough as usual. You are treated with antibiotics and antidepressants, as fever can aggravate the brain damage you get in a stroke. A physiotherapist can help with breathing gymnastics.

Epileptic seizures

Some may have epileptic seizures in connection with a stroke, but the risk of having permanent epilepsy is small. Epileptic seizures can sometimes come a long time after you have had a stroke, sometimes after several years.

Depression

Some become depressed after a stroke. Treatment with drugs and psychological support from health care professionals and relatives can then help.

It is common for you to have an increased psychological sensitivity after a stroke. You will then have difficulty controlling your emotions and crying easily. Medicines for depression can help.

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