Cerebrovascular accident (stroke)
Stroke refers to a sudden cerebral circulation disorder, which alters the function of a specific area of the brain. Stroke features occur abruptly, with higher incidence in elderly people, over 60 years of age, although it can occur in young people, which is generally the result of the confluence of a number of risk factors.
Strokes are classified as:
- Ischaemic, which are the most common (up to 85% of the total) and produced by a significant decrease in blood flow to part of the brain producing what is called a cerebral infarction, which leads to the death of neurons from lack of oxygen and nutrients that go into the blood.
- Haemorrhagic, occur less frequently than previous although mortality is considerably higher; however, long-term recovery from the effects is usually better. They are due to haemorrhage that is caused by the rupture of a cerebral blood vessel.
At present, the major risk factors for stroke are well identified. Age, sex, belonging to a certain race (e.g., African Americans) or family history of stroke are some of the non-modifiable risk factors. Nevertheless, there are fortunately many other modifiable factors including, high blood pressure, heart disease (angina, ischaemic heart disease or arrhythmias), tobacco consumption, high fat levels in the blood, suffering diabetes mellitus, obesity or a sedentary life.
A stroke is a medical emergency and, at present, it has been demonstrated that the effects are lesser the earlier you go to the hospital. That is why early identification of warning signs is important in order to activate Code Stroke. The warning signs are:
- Sudden loss of strength of the face, arm and/or leg on one side of the body.
- Sudden sensory disorders, feeling of "numbness or tingling" of the face, arm and/or leg on one side of the body.
- Sudden loss of vision, partial or total, in one or both eyes.
- Sudden slurred speech, difficulty in speaking, language that is difficult to articulate and be understood.
- Sudden abnormal intense headache without apparent cause.
- Intense feeling of dizziness, unsteadiness, disequilibrium or sudden unexplained falls, if they are accompanied by any of the symptoms described above.
The effects of a stroke will depend on the location of the injury and its extent. A stroke in the right hemisphere often causes paralysis of the left side of the body (left hemiplegia). In addition, problems may occur in the perception of space, or hemispatial neglect, which objects and persons in the patient's left side are ignored. Another consequence of the right hemispheric stroke is ignorance or non-recognition of the effects. A stroke in the left hemisphere, usually causes paralysis of the right side of the body (right hemiplegia) and various alterations of language, generically called aphasia. When the stroke is located in the area of the cerebellum, it will cause problems of coordination, imbalance, dizziness, nausea and vomiting.
Strokes that are located in the brainstem may become more serious. This area controls all involuntary functions such as breathing, heartbeat, blood pressure etc. Moreover, it controls functions such as swallowing, speech, hearing or eye movements. It also has the pathways that carry information from the brain hemispheres through the brainstem to the extremities, so that its injury also causes paralysis of one or two hemibodies.
As demonstrated by scientific studies, it seems clear that in any of the above cases, the earlier the appropriate neurorehabilitation therapy is initiated by an expert multidisciplinary team, the better the long-term functional results.
References about Stroke
Rehabilitación del ictus: modelo asistencial. Recomendaciones de la Sociedad Española de Rehabilitación y Medicina Física, 2009. E. Duartea,, B. Alonsoa, M.J. Fernández, J.M. Fernández, M. Flóreza, I. García-Montes,
J. Gentil, L. Hernández, F.J. Juan, B. Palomino, J. Vidal, E. Viosca, J.J. Aguilar, M. Bernabeu, I. Bori, F. Carrión, A. Déniz, I. Díaz, E. Fernández, P. Forastero, V. Iñigo, J. Junyent, N. Lizarraga, L. López de Munaín, I. Máñez, X. Miguéns,
I. Sánchez y A. Soler.