A stroke (cerebrovascular accident – CVA) is an acute neurological condition that occurs when the blood supply to an area of the brain is disrupted or when bleeding occurs within or around the brain. This disruption can damage brain cells and lead to the sudden onset of neurological symptoms.

A stroke is a medical emergency. Immediate recognition of the symptoms and rapid transfer to a hospital are essential, as certain treatments are most effective when administered as early as possible.

Types of Stroke

Strokes are mainly divided into two categories:

Ischemic stroke: This occurs when a blood vessel supplying the brain becomes blocked, usually by a blood clot. It is the most common type of stroke.

Hemorrhagic stroke: This occurs when a blood vessel ruptures, causing bleeding within the brain or in the spaces surrounding it.

There is also the Transient Ischemic Attack (TIA), in which temporary neurological symptoms develop due to a brief disruption of blood flow to the brain. Even when the symptoms resolve completely, a TIA requires urgent medical assessment, as it may be a warning sign of an increased risk of a future stroke.

Symptoms of Stroke

The symptoms of a stroke usually develop suddenly and depend on the area of the brain affected.

They may include:

• Sudden weakness or numbness of the face, arm, or leg, particularly on one side of the body
• Facial asymmetry or drooping on one side of the face
• Sudden difficulty speaking or understanding speech
• Sudden visual disturbance or loss of vision in one or both eyes
• Difficulty walking
• Sudden dizziness or loss of balance and coordination
• Sudden confusion
• A sudden, extremely severe headache, particularly in certain types of hemorrhagic stroke
• Altered or reduced consciousness in more severe cases

An easy way to recognize some of the most common signs of stroke is FAST: Face drooping, Arm weakness, Speech difficulty, and Time to seek emergency medical help immediately.

Risk Factors for Stroke

The risk of stroke increases with age, although a stroke can also occur in younger people.

Important risk factors include:

• High blood pressure (hypertension)
• Diabetes mellitus
• High cholesterol and other lipid disorders
• Smoking
• Atrial fibrillation
• Coronary artery disease and other cardiovascular conditions
• Obesity
• Physical inactivity
• Sleep apnea
• Excessive alcohol consumption
• Previous stroke or TIA
• Certain blood clotting disorders
• Use of substances such as cocaine and amphetamines
• Family history and genetic factors

High blood pressure is one of the most important modifiable risk factors for stroke.

Diagnosis of Stroke

The diagnosis must be made urgently in order to determine whether the stroke is ischemic or hemorrhagic and to select the appropriate treatment.

The initial assessment may include:

Neurological examination: Muscle strength, sensation, speech, vision, coordination, walking, and level of consciousness are assessed.

Brain Computed Tomography (CT): CT is a key investigation during the acute phase and is particularly important for distinguishing between ischemic and hemorrhagic stroke.

Brain Magnetic Resonance Imaging (MRI): MRI can provide more detailed imaging of certain ischemic and other brain lesions.

Vascular imaging: CT angiography, MR angiography, and other vascular investigations may be used to identify blocked or narrowed blood vessels.

Cardiac and laboratory investigations: An electrocardiogram (ECG), blood tests, and, when appropriate, further cardiac investigations can help identify the underlying cause of the stroke.

 Treatment of Stroke

The treatment of stroke depends on the type of stroke, the time elapsed since the onset of symptoms, the area of the brain affected, and the patient's overall medical condition.

In acute ischemic stroke, selected patients may be eligible for reperfusion treatment, such as intravenous thrombolysis, which aims to dissolve the blood clot and restore blood flow to the affected area of the brain.

In certain cases involving the blockage of a large cerebral artery, mechanical thrombectomy may be performed. This is an endovascular procedure in which the blood clot is mechanically removed from the affected vessel.

The treatment of hemorrhagic stroke is different and may include blood pressure management, reversal of anticoagulant medication when indicated, and, in selected cases, neurosurgical or endovascular treatment.

Treatment during the acute phase takes place in a hospital setting and requires immediate specialist assessment.

Prevention of Another Stroke

Following the acute phase, one of the most important goals is the prevention of another stroke.

The secondary prevention strategy depends on the underlying cause of the initial stroke and may include:

• Antiplatelet therapy when indicated
• Anticoagulant treatment for specific conditions, such as atrial fibrillation
• Blood pressure control
• Cholesterol management
• Appropriate management of diabetes
• Smoking cessation
• Treatment of cardiovascular conditions
• Regular physical activity when safe and appropriate
• A balanced diet and healthy weight management

Identifying the underlying cause of the stroke is therefore particularly important when selecting the appropriate preventive treatment.

Rehabilitation After Stroke

The effects of a stroke vary considerably from one patient to another. Stroke may affect movement, speech, swallowing, memory, attention, behavior, and emotional well-being.

Neurological rehabilitation after stroke may include:

• Physiotherapy to improve mobility, muscle strength, and balance
• Occupational therapy to help regain everyday functional skills
• Speech and language therapy for difficulties with speech, communication, or swallowing
• Cognitive rehabilitation for difficulties with memory, attention, and executive functions
• Management of spasticity, pain, and other neurological complications
• Assessment and treatment of depression, anxiety, or other emotional changes

Rehabilitation should be individualized and should begin as early as possible when the patient's medical condition allows.

Neurological Follow-Up After Stroke

Regular neurological follow-up after a stroke is important for monitoring recovery, managing potential complications, and reducing the risk of another stroke.

Follow-up may include assessment of mobility, speech, cognitive function, and everyday functioning, as well as a review of medication and vascular risk factors.

Early recognition of stroke, immediate treatment during the acute phase, appropriate secondary prevention, and structured rehabilitation are essential for reducing disability, preventing recurrent strokes, and improving overall quality of life.