What is a Brain stroke?
Brain cells need a constant supply of oxygen in the blood to stay alive.
If the blood flow to the brain is interrupted for even a few seconds, the brain cells begin to die.
The extent of the damage caused by a stroke depends on where in the brain it occurs and how much of the brain is deprived of oxygen.
 Types of Stroke:
There are two types of stroke:
- Ischaemic stroke:
This is the most common type of stroke: 85% of strokes are ischaemic.
Ischemic stroke occurs when an artery becomes blocked, preventing blood flow to part of the brain and preventing it from functioning properly.
In short, it is caused by a blood clot that blocks the flow of blood to the brain.
Note: when the artery becomes blocked for a short period of time (usually less than an hour), it is called a transient ischemic attack (TIA).
It can be a warning sign of a stroke in the days that follow. Any symptom, even a transient one, should therefore be urgently investigated.
- Hemorrhagic stroke:
This accounts for 15% of strokes and occurs when a cerebral artery ruptures, creating a hematoma that compresses the brain.
It may be a cerebral hemorrhage or a subarachnoid hemorrhage.
Subarachnoid hemorrhage is most often caused by a ruptured aneurysm (rupture of an arterial aneurysm).
 What are the causes?
“There are more than 150 causes of stroke, but four main causes,” says the neurologist:
- Ischemic stroke occurs when the arteries supplying oxygen to the brain constrict or clog, lowering or stopping blood flow to the brain.
- A blood clot or tissue debris carried by the circulation typically causes ischemic strokes.
- Uncontrolled high blood pressure (hypertension), anticoagulants, and/or weak areas in the blood vessel walls can all induce hemorrhagic stroke (aneurysms).
- Stroke is due to a combination of lifestyle variables (weight, diet, physical activity, smoking, and alcohol intake, for example) .
- Medical problems (high cholesterol, high blood pressure, diabetes, smoking, etc).
 What are the signs of a stroke?
About 9 out of 10 people have at least one of the following symptoms of a stroke.
- Curved mouth: the corner of the mouth suddenly hangs downwards.
- Confused speech: the person suddenly speaks in a confused manner or has difficulty pronouncing words.
- Paralyzed arm: sudden loss of strength or paralysis of one arm
Other signs of a stroke:
There are other symptoms that can occur with a stroke. You can read about them below.
Paralysis or reduced strength:
A paralysed arm is a common sign. What also happens: paralysis or reduced strength in a leg a feeling of numbness on one side of the body.
Loss of vision:
You see less well on one side: sudden blindness in one eye, sudden vision in half of what you normally see sudden double vision.
sudden and severe dizziness, problems with coordination and balance
In case of brain hemorrhage: severe headaches or seizures
In the case of a brain hemorrhage, a very severe headache may suddenly occur.
The pain is so severe that it is obvious that medical help is urgently needed. You may also have an epileptic seizure (convulsion).
You may also feel nauseous or speechless.
Finally, an unusual, extremely sudden headache, usually very severe, may signal a stroke. “What characterizes the symptoms of a stroke is their sudden onset,” says Professor Amarenco.
 What are the risk factors?
The risk factors are common to both types of stroke and to vascular pathologies in general. They include the following risk factors:
- Non-preventable: age, gender (men are more at risk), heredity (more risk of having a stroke if a family member has had one before the age of 65), previous stroke.
- Preventable: high blood pressure, diabetes, high cholesterol, overweight, sedentary lifestyle, smoking and cannabis, excessive alcohol consumption. “Stroke prevention is essential,” says the neurologist.
 How to treat a stroke? How to react?
A stroke should be treated as soon as possible. Call 15 or go to the nearest hospital.
An MRI or CT scan is performed to make the diagnosis and to see if it is a cerebral infarction or a cerebral hemorrhage.
“The revascularisation treatment must be carried out within 3 hours ideally, at the latest within 6 hours following the stroke”, informs Professor Pierre Amarenco.
This treatment by intravenous thrombolysis aims to unblock the artery blocked by a clot.
“If this is not enough, we can carry out a thrombectomy treatment,” explains the neurologist.
This consists of introducing a catheter into the femoral artery under imaging control and then moving it up into the carotid artery and then into the cerebral artery to remove the clot.
“Management in a neurovascular unit makes it possible to reduce mortality by 30%, thanks in particular to the interest in swallowing disorders (responsible for pneumonia) and to ensure that 60% more patients return home,” says Professor Amarenco.
A check-up is carried out to find the cause and/or risk factors and treat them (e.g. diabetes, hypercholesterolemia, tobacco or cannabis intoxication, high blood pressure, etc.).
 Rehabilitation after a stroke: how does it work?
Some people have to go to a rehabilitation center a few weeks or even months after a stroke.
“They receive motor and language rehabilitation. Invisible handicaps such as memory problems, concentration problems, and changes in character must also be dealt with by stroke specialists,” explains Professor Pierre Amarenco.
What is the prognosis and life expectancy after a stroke?
150,000 people suffer a stroke in France every year, of which more than 110,000 are hospitalized, and 30,000 dies.
“It is the leading cause of death in women,” warns Professor Amarenco. However, it should be noted that the mortality rate has fallen considerably.
More than 500 000 French people are living with the after-effects of a stroke. This pathology is the leading national cause of acquired disability in adults.
Globally, the risk of recurrence of a stroke is between 1 and 8% per year depending on the cause,” says the neurologist, “but this risk is reduced by 80% with the treatment of the cause”, he reassures.
 Stroke: how to avoid it?
Primary prevention (if you have not had a stroke) can prevent most strokes.
It is based first of all on a healthy lifestyle: a balanced diet, regular physical activity, while avoiding excess weight, no smoking, no use of cannabis, and no alcohol.
It is also important to control blood pressure and cholesterol levels and to treat high blood pressure or high cholesterol if necessary.
Note: this healthy lifestyle also helps if you are still suffering from a stroke.
“People who have had a stroke and were physically active have a 50% lower risk of disability,” says Professor Amarenco.
“We can reduce this risk of stroke by 80% with simple measures,” says the neurologist whose Association Vaincre l’AVC aims to reduce strokes by 80% by 2030.
Secondary prevention (if you have already had a stroke) is also essential. It includes the same rules as primary prevention.
“Physical activity is a major point,” says Professor Pierre Amarenco, who asks his patients to do 30 minutes of exercise every morning before showering.
In addition to hygiene rules, good compliance with treatment is essential.
 What are the chances of survival?
“Haemorrhagic accidents are more serious than cerebral infarctions. One year after a cerebral hemorrhage, only 50% of people survive and half of them have a significant disability. Only a quarter of them are doing well and can maintain their independence,” note the neurologists at Inserm.
Millions of undetected strokes:
Presented at the 2001 annual meeting of the American Stroke Association, the results of Professor Adams’ team are a landmark. According to their work, “silent” strokes are extremely frequent, affecting nearly 4% of the American population.
These silent lesions would therefore constitute clusters of necrotic cells in the brain but whose location would not lead to the appearance of symptoms specific to strokes.
However, the authors specify that the term silent is only moderately appropriate because the accumulation of such phenomena can lead in the more or less long term to memory loss, behavioral problems, coordination, and balance difficulties.
They are also thought to be precursors of full-blown strokes.
These estimates are based on two surveys of brain scans of nearly 5,500 Americans.
The prevalence of these brain lesions would be lower before the age of 30 but would double every 10 years thereafter.
By the age of 70, one in three people would be affected each year. If these results are correct, they mean that only 3% of strokes were diagnosed in the US in 1998.
Until then, scans for such lesions were not systematically performed. Should this type of screening be generalized? In what type of population?
Should treatment be introduced to prevent the occurrence of fewer silent accidents?
These are all questions that seem difficult to answer today, even if, given the stakes, researchers are now pointing out that only the top of the iceberg is currently being taken into account.
In 2011, researchers from Columbia University conducted a study on these “silent” strokes.
According to their findings, published in the scientific journal Neurology, they also have an impact on memory and could contribute to the symptoms of Alzheimer’s disease.
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