Stroke is a brain injury that occurs when there is a lack of blood supply to a specific part of the brain. With a prevalence in Spain of 200 cases for every 100,000 inhabitants, especially those over 70 years of age – although it can also occur in younger people – we are facing a problem that poses a real challenge when it comes to identifying it due, above all , which can have various symptoms.
This is what happened to Azucena Galindo when, at work, her hands began to shake, she was unable to speak and everything was dark. She didn’t know what was happening to her until “it hit me very hard in the temple and I got dizzy,” she explains.
Stroke, a medical emergency that requires immediate attention
Although, fortunately, this is not what happened to Galindo, we are facing “the first cause of death among women and the second cause of death in men and the first cause of disability in adulthood,” says the Doctor. Natalia Barbero, from the Neurology Service of the King Juan Carlos University Hospital, Infanta Elena and General of Villalba.
Why does it affect some people and not others? Although, as we have seen, age has an influence, it is not the only factor that does so. Stroke is the result of the accumulation of a series of risk factors, which make it more likely that a person will have a stroke. As described by the Spanish Society of Neurology (SEN), the blood vessels are the target of these attacks and, after years of suffering continuous damage, they complain outright with a stroke.
“We must raise awareness of the classic risk factors that we repeat over and over again, almost monotonously, but which are essential to take into account: high blood pressurethe fundamental factor; diabetes mellitus; consumption of alcohol, tobacco and other drugs that are appearing; and finally, obesity“, a risk factor that combines many of them,” admits Doctor José Carlos Fernández Ferro, head of the Neurology Service at the Rey Juan Carlos, Infanta Elena and General de Villalba university hospitals.
In the case of Galindo, he says that “he had no cholesterol, no high blood pressure, nothing. My tests were good, but they told me that the artery could be defective from birth, that it had a fold that was what caused the blood to clot there.”
This brain injury requires urgent medical attention because “the longer a part of the brain spends without blood flow, the greater the consequences. Time is the brain, and it is very important for us,” admits Dr. Barbero. By affecting the brain, one or more cognitive, motor or sensory functions may be compromised. That’s why reaction time is so important.
Stroke, the challenge (and importance) of identifying the signs early
But, in order to act urgently, it is necessary to know how to identify the symptoms that put us on the track. As Doctor Fernández Ferro admits, “the challenge with a stroke is that it can take on many different symptoms, although we know that the vast majority contain at least one of the following four.”
The most important are language impairment, either due to problems with understanding or uttering language, as well as slurred or unclear language; deviation of the corner of the mouth; strength or sensitivity problems on one side or the other of the body; and, finally, a sudden, high-intensity headache.
We speak, in general terms, of two main types of stroke: ischemic and hemorrhagic. In the first, a thrombus travels through an artery and blocks circulation. In the second, the wall of a blood vessel is broken and a part of the blood that goes in the vessel is poured into the brain parenchyma. In the event of any of these types of stroke, the speed with which action is taken is essential when it comes to minimizing the effects. “For this purpose, a protocol called the Stroke Code has been created,” says Dr. Barbero.
Stroke Code, the quick response
As we have seen, stroke is a time-dependent disease, with potentially devastating repercussions, so tools such as activating the Stroke Code are key, not only for greater survival, but also for fewer sequelae. “Within a Stroke Code, neurologists and radiologists converge on the scanner table to quickly obtain information about what is happening and be able to make determinations,” says Fernández Ferro.
Stroke Unit, a hospital ecosystem of multidisciplinary care
After the diagnosis, another of the basic needs is to facilitate access to multidisciplinary care such as those offered by the Stroke Unit, which, as Fernández Ferro defines, is an “in-hospital ecosystem formed by a group of professionals who work to obtain the best benefit.” ”.
These units are made up of a multidisciplinary team led by vascular neurologists, including interventional neuro-radiologists, neurorehabilitation specialists and trained nursing staff “who detect up to the minute any changes that may occur in the neurological patient,” admits Carmen Pajuelo, from the Neurology and Neurosurgery Service of the Jiménez Díaz Foundation University Hospital.
It is important to keep in mind that caring for neurological patients is complex because small, very subtle changes can occur, which it is important to know how to detect. Hence, regardless of the type of stroke, a fundamental part of the treatment is admission to a Stroke Unit.
According to an extensive revision Regarding the benefits of these types of units, patients are more likely to survive and be independent if treated in these units. Its benefits equally affect any type or subtype of stroke and patients of any age.
Stroke: adapt treatment to each person
In the first four and a half hours, and with the aim of dissolving the thrombus and restoring cerebral circulation, the pharmacological treatment known as thrombolysis is applied. For larger thrombi we have interventional treatment.
As explained by Doctor Claudio Rodríguez, Interventional Neuroradiology Service of the Fundación Jiménez Díaz, Rey Juan Carlos, Infanta Elena y General de Villalba University Hospital, “mechanical thrombectomy is the technique of choice in most patients with acute ischemic stroke and occlusion. of a large glass.” This technique consists of extracting the clot using thrombus extraction devices and aspiration techniques or with a stent retriever, a type of spring or stent.
After the patient’s stabilization, rehabilitation from the first moment of the stroke is essential because it is the way to “stimulate the neural networks and all the neuroplasticity that is generated in the patient,” admits Doctor Raquel Cutillas, from the Hospital’s Rehabilitation Service. University Jiménez Díaz Foundation. We must keep in mind that the person has to relearn all the functions that they have lost. “It’s like teaching again how to recover those functions that you have lost,” says Cutillas.
Stroke School, special care after hospital admission
But not everything ends when the hospital phase is over. The doubts that arise after such a diagnosis are numerous and the need to find answers to all of them is essential. And one of the priorities is also the Stroke School, an initiative that the aforementioned university hospitals have launched and that begins when the hospital phase ends, where a whole series of concerns have accumulated that must be resolved.
“A stroke is a biographical rupture since, whether there are after-effects or not, patients have a before and after,” says Fernández Ferro. At the Stroke School, patients have a meeting space, also for families, where the same things as during admission are addressed but in a more leisurely manner. Because, after discharge, it is important to maintain a healthy life, with medical check-ups and lifelong treatment.
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