Stroke Treatment
Stroke is a neurological condition that occurs due to the sudden blockage of the brain’s blood vessels and poses a life-threatening risk. It usually develops as a result of blockage in the neck or intracranial arteries caused by atherosclerosis (hardening of the arteries) or blood clot formation.
An Overview
Stroke is a neurological emergency caused by the sudden occlusion of cerebral vessels, posing a life-threatening risk. It typically occurs due to atherosclerosis or clot formation in the neck or intracranial vessels. Sometimes, a clot formed elsewhere in the body can travel through the bloodstream to the cerebral arteries, causing a sudden blockage.
Such occlusions halt blood flow to the corresponding area of the brain, leading to the rapid loss of function in the nerve cells of that region. Without intervention, it can result in severe, permanent neurological damage or death.
Stroke is considered a preventable disease, as it can be managed by addressing modifiable risk factors such as hypertension, diabetes, smoking, and high cholesterol.
Types of Stroke
Stroke is a neurological condition that occurs when a part of the brain is deprived of blood and oxygen due to a blockage or hemorrhage in the cerebral vessels. Based on clinical and imaging findings, stroke is fundamentally classified into two main groups:
Ischemic Stroke (Stroke due to Vessel Occlusion)
This is the most common type of stroke, accounting for approximately 85% of all cases. Atherosclerosis leads to the narrowing and occlusion of vessels as the vessel wall loses elasticity and its inner surface deteriorates. In this process, blood clots or fatty deposits can block vessels, stopping blood flow to the brain. Ischemic stroke usually occurs suddenly and can cause permanent damage if not intervened.
Hemorrhagic Stroke (Stroke due to Brain Hemorrhage)
Although less frequent, it has a higher mortality rate. Hemorrhagic stroke is caused by bleeding resulting from the rupture or tearing of a brain vessel. This condition typically occurs due to high blood pressure, an aneurysm, or vascular malformations. Although it constitutes a small portion of all strokes, it is responsible for approximately 30% of stroke-related deaths.
Both types of stroke require emergency intervention. Early recognition of symptoms and rapid transition to the most appropriate treatment method following an accurate diagnosis are life-saving.
Causes of Stroke
Stroke is largely a preventable disease. However, being aware of and controlling risk factors plays a critical role in preventing its occurrence. These factors are divided into two main groups: modifiable and non-modifiable risk factors.
Causes of Ischemic Stroke
Atherosclerosis: The development of plaques composed of cholesterol and fatty deposits on the walls of brain vessels. These plaques can narrow the vessel, restricting blood flow, or a clot (embolus) breaking off from them can block a brain artery. Stenosis in the neck carotid arteries or major intracranial vessels forms this way. Treatment approaches include angiography with stenting, anticoagulant/antiplatelet medications, and control of risk factors.
Small Vessel Disease: The damage and occlusion of small vessels deep within the brain due to risk factors like hypertension.
Embolism: A blood clot formed in the heart chambers (especially in arrhythmias like atrial fibrillation) or elsewhere in the body breaks off and travels via the bloodstream to block a cerebral artery.
Cervical/Cerebral Artery Dissection: A tear in the wall of an artery supplying the brain can reduce blood flow or cause clot formation. This can occur due to physical trauma, some connective tissue diseases, or sometimes unknown reasons. It is a significant cause, especially in young stroke patients. With early diagnosis, it can be treated medically or with stenting if necessary.
Cerebral Venous Thrombosis: A rare cause of stroke. It is characterized by clot formation in the cerebral veins. Pregnancy, certain medications, or clotting disorders increase the risk. The primary treatment is anticoagulants; in rarely worsening cases, angiographic mechanical thrombectomy may be required.
Causes of Hemorrhagic Stroke
Hypertension: Uncontrolled high blood pressure can weaken cerebral vessel walls over time, leading to their rupture.
Aneurysm Rupture: The rupture of a weak, balloon-like point in an artery wall.
Arteriovenous Malformation (AVM): The rupture of an abnormal, fragile tangle of vessels between an artery and a vein.
Alongside these causes, cerebral amyloid angiopathy, use of medications that increase bleeding risk (e.g., anticoagulants), liver diseases, and head trauma can also lead to brain hemorrhage.
Modifiable Risk Factors
Risks that can be controlled based on an individual’s lifestyle and medical management:
Hypertension
Diabetes
High Cholesterol
Cardiac Arrhythmias (especially Atrial Fibrillation)
Smoking
Sedentary Lifestyle
Unhealthy Dietary Habits
The risk of stroke can be significantly reduced by managing these factors.
Non-Modifiable Risk Factors
Uncontrollable but important genetic and demographic characteristics:
Age: Stroke risk increases with age. 75% of cases are over 60 years old. After age 60, the risk approximately doubles every 10 years.
Gender: Men over 55 have a higher stroke risk. However, the risk also increases in women with advancing age.
Previous Stroke History: Individuals who have had a previous ischemic stroke have a significantly increased risk of a new stroke.
Genetic Predisposition: A family history of early-onset vascular diseases or stroke increases individual risk.
Early diagnosis and regular monitoring of risk factors are the most effective steps in preventing stroke. With regular check-ups, healthy lifestyle habits, and professional risk assessment, stroke can be largely prevented.
How is Stroke Diagnosed?
Diagnostic Methods:
Physical and Neurological Examination: Assessment of brain functions such as level of consciousness, strength, sensation, balance, coordination, speech, and vision.
Imaging Tests:
Computed Tomography (CT): Used to rapidly screen for brain hemorrhage upon initial presentation.
Magnetic Resonance Imaging (MRI): Shows early damage to brain tissue and the precise cause of the stroke in more detail than CT.
Angiography (CTA, MRA, or DSA): Provides detailed imaging of cerebral vessels. Used to detect problems such as stenosis, aneurysm, AVM, or dissections. DSA (Digital Subtraction Angiography) is an invasive procedure performed via femoral artery access and is considered the “gold standard.”
Carotid/Vertebral Doppler Ultrasound: Uses sound waves to assess stenosis or plaques in the neck vessels.
Other Tests:
Blood Tests: Check blood sugar, cholesterol, clotting parameters, and blood cell counts.
ECG (Electrocardiogram) and Echocardiogram: Performed to investigate cardiac arrhythmias (e.g., atrial fibrillation) or clots in the heart chambers that could be the source of the stroke.
What are the Symptoms of Stroke?
Stroke is a neurological condition with sudden onset that requires emergency intervention. If not recognized early and treated quickly, it can lead to permanent disability or loss of life.
The following symptoms may be warning signs of a stroke:
Sudden loss of consciousness or fainting
Weakness in the arms and legs (especially on one side)
Difficulty walking, balance, and coordination disorders
Impaired speech or inability to speak
Sudden confusion, clouding of consciousness
Sudden onset, unexplained severe headache
Difficulty understanding
Drooping of the mouth corner (especially on one side)
Unilateral numbness or loss of sensation (in arms and legs)
Vision loss or double vision
What to Do During a Stroke Suspected Event
If you notice sudden facial drooping, arm/leg weakness, or speech difficulties in yourself or someone else, please call 112 immediately without wasting any time. Remember, in stroke treatment, time is brain.
Thanks to early and rapid intervention, stroke is now a treatable disease. Timely treatments performed at the right center can minimize damage to brain tissue, prevent the risk of permanent disability, and symptoms can largely resolve.
Speed saves lives. Even if stroke symptoms are transient (Transient Ischemic Attack), this could be a warning sign of a major impending stroke. Therefore, do not wait for symptoms to resolve on their own; seek immediate medical help.
Actions to Take During a Stroke: Act F.A.S.T.
H – Face: Ask the person to smile. Does one side of the face droop?
A – Arms: Ask the person to raise both arms. Does one arm drift downward?
S – Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T – Time: If you observe any of these signs, call emergency services immediately.
Until Emergency Help Arrives:
Lay the person on their side in a safe place, if possible.
Keep their head slightly elevated.
Loosen tight clothing.
Do not give them anything to eat or drink (swallowing difficulty can cause choking).
If they are vomiting, turn their head to the side to prevent aspiration.
Prepare the patient’s medical information (medications, allergies, significant medical history).
Stroke Treatment
Stroke treatment varies depending on the type of stroke (ischemic/hemorrhagic) and the patient’s condition. The primary goals are to minimize brain damage and prevent secondary strokes.
Ischemic Stroke Treatment (Vessel Occlusion):
Intravenous Thrombolytic Therapy (clot-busting drug): The “tissue plasminogen activator (tPA)” drug, which can be administered within the first 4.5 hours after symptom onset, helps dissolve the clot and reopen the vessel. It is the gold standard medical therapy.
Mechanical Thrombectomy (Interventional Procedure): A procedure where access is gained via the femoral artery, and the large clot causing the stroke is removed under angiography guidance using special devices. It is most effective within the first 6 hours from symptom onset but can be applied in selected patients up to 24 hours. This method, available 24/7 in comprehensive stroke centers, is life-saving for large vessel occlusions.
Hemorrhagic Stroke Treatment (Brain Hemorrhage):
Treatment focuses on controlling the bleeding, correcting the cause of the bleeding, and reducing intracranial pressure.
Medications that increase bleeding risk are stopped, and blood pressure is tightly controlled.
Surgical or Interventional Treatments: For large or life-threatening hemorrhages, surgical intervention (craniotomy) may be necessary to repair the bleeding point or evacuate the clot. For aneurysms or AVMs, intervention can be performed via angiographic (endovascular) methods using coils, stents, or adhesive materials.
Post-Stroke Recovery and Rehabilitation
Post-stroke rehabilitation is vital for regaining lost functions and helping the patient achieve the highest possible level of independence. This process begins within the first 24-48 hours after the stroke in the hospital setting and can continue for months or even years.
Rehabilitation is a multidisciplinary team effort involving:
Neurologist and Physiatrist: Management of the treatment and rehabilitation plan.
Physiotherapist: Regaining walking, balance, and movement skills.
Occupational Therapist: Achieving independence in daily living activities (eating, dressing).
Speech and Swallowing Therapist: Treatment of speech, language, and swallowing problems.
Rehabilitation Nurse, Psychologist, Social Worker.
Rehabilitation can continue in the hospital, specialized rehabilitation centers, outpatient clinics, or at home. Significant improvement is possible with patience, determination, and consistent therapy.