Treatment of stroke abroad
Stroke is an abnormal disruption of the brain (cerebral) blood circulation which is manifested by the death of the brain region.Theischemic stroke caused by blood clot and makes 85% of all cases. 15% of patients experience hemorrhagic stroke (cerebral hemorrhage).
Stroke is one of the most common causes of death in the modern world (10-30% in different countries).
Causes of stroke
Ischemic stroke. The cause is a violation of blood circulation in the brain due to a sharp reduction in the lumen of blood vessels. Brain areas die because of oxygen starvation.
The reasons for this phenomenon are:
- Atherosclerosis which is anarrowing of the vessels lumen with atherosclerotic plaques
- Thrombosis which the formation of thrombi in the area of atherosclerotic plaques
- Cardioembolism which is a circulatory failure due to cardiac causes (atrial fibrillation, myocardial infarction, heart defects)
All the rest of causes are rare, e.g, a stratification of the artery wall, diseases of the hematopoiesis system, non-atherosclerotic vasculopathy.
Hemorrhagic stroke. The cause of this pathological condition is the rupture of blood vessels, resulting in a cerebral hemorrhage.
Possible reasons are:
- Aneurysms (local vasodilatation)
- Cardiovascularization (irregular structure of blood vessels)
- Treatment with anticoagulants (drugs that slow blood coagulation)
- Hypertensive crisis (a sharp rise in blood pressure)
- Amyloid angiopathy
Main risk factors of ischemic and hemorrhagic stroke are:
- Hypertonic disease
- Asymptomatic carotid artery disease
- Acute stress
Symptoms of stroke
Several periods are differentiated in the stroke course:
- Peracute - up to 3 days
- Acute - up to 28 days
- Early recovery - up to six months
- Late recovery - up to 2 years
- Residual effects - after 2 years
According to the severity of neurological disorders, there are:
- Stroke in progress - when the symptoms progress
- Completed stroke - the patient is stable or the neurologic symptoms regress
Progression of symptoms is observed in the acute period of a stroke. The clinical picture depends on the localization of the pathological process.
Possible symptoms are:
- Paresis of limbs and facial muscles
- Speech disturbance or loss of ability to talk
- Defects in the vision
- Disorientation in space
- Loss of sensitivity in certain parts of the body
- Urinary incontinence
- Visual hallucinations
- Symptoms of the cranial nerves damage
Diagnostics of stroke
Ischemic stroke is diagnosed when there is a sudden disruption of cerebral blood flow with the appearance of neurological symptoms and its preservation for 24 hours or more (if the death did not come earlier).
If neurologic symptoms regress within 24 hours, the diagnosis will be different, a transient ischemic attack.
Specialist applies a number of different instrumental diagnostics methods to differentiate stroke from other brain pathologies:
- CT (computed tomography)
These visualization techniques also help to differentiate between ischemic and hemorrhagic strokes. If CT and MRI are unavailable, then lumbar puncture is done to distinguish between these two kinds of this disease.
Blood in the cerebrospinal fluid is a characteristic for the hemorrhagic stroke while it is absent in case of ischemic stroke. Lumbar puncture is contraindicated if a patient is in severe condition since it can cause complications with fatal outcome.
Treatment of stroke abroad
The first 3 hours after an ischemic stroke are called “therapeutic window”. During this time it is possible to introduce the systemic thrombolytic drugs, dissolve thrombus and restore cerebral blood flow. In case of success, the death of brain regions does not occur.
Most patients having stroke should be hospitalized. The main directions of treatment are:
- Maintenance of vital activity in the acute period
- Prevention and elimination of infectious complications
- Neuroprotective therapy (to limit areas of brain necrosis)
Surgical treatment for ischemic stroke is indicated if an increase in intracranial pressure happens. It allows improving cerebral blood flow and reduces the risk of death more than twice.
Surgical treatment for hemorrhagic stroke can be directed at:
- Removal of intracerebral hematoma
- Ventricular drainage to eliminate hydrocephalus
- Prevention of recurrent stroke (resection of an aneurysm or arteriovenous malformation)
In German hospitals it is possible to remove hematomas using stereotactic surgery. Such operations take place without trepanation of the skull and therefore are less traumatic.
Prognosis for the Stroke
If a person had an ischemic stroke then prognosis is unfavorable. 30-35% of patients die within 28 days after the acute brain circulatory disruption. Mortality during the first year exceeds 50%.
Among the survivors of those who had an ischemic stroke there is following statistics:
- Only 8% of patients restore their work capacity
- 30% of patients need constant third-party help
- 20% of patients are unable to walk
- 30% of patients experience a recurrent stroke
Prognosis is also negative in case of hemorrhagic stroke. General mortality is 70%. Mortality after the surgical treatment is a little lower 50%. 65-70% of patients do not restore their work capacity after the hemorrhagic stroke.
Survival rate considerably differs in different countries and regions which is associated with different standards and the quality of the medical care given.