Cerebral strokes: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 23, 2023

Stroke is estimated to affect more males than females, although it has a higher mortality rate in females

There is no age at which a stroke can occur; it can affect young and old alike.

Nevertheless, almost all cases are recorded in patients aged 55 years or older.

Cerebral stroke: what is it?

Cerebral stroke is the most frequent neurological disease and occurs when a sudden occlusion or rupture of a cerebral vessel occurs.

As a result of this rupture or occlusion, brain cells are either damaged due to the lack of oxygen and nutrients brought in by the blood or by the compression caused by the leakage of the blood.

Cerebral stroke: what causes it

A cerebral stroke – the damage or death of part of the brain tissue – occurs because the blood supply to a certain area of the brain is cut off.

This can be caused by the occlusion of a cerebral vessel or a rupture of the same.

Depending on the underlying cause, two types of stroke can be distinguished: ischaemic stroke and haemorrhagic stroke.

Then there is a third condition, mainly of occlusive origin, called TIA (transient ischaemic attack).

Ischaemic stroke

Ischaemic stroke occurs when a cerebral artery becomes occluded.

Brain cells, which were previously nourished by the blood circulating in that artery, no longer receive nourishment, suffer an infarction and die.

An ischaemic stroke – which accounts for the majority of stroke cases – can occur for two main reasons: thrombosis or embolism.

One speaks of cerebral thrombosis when a blood clot forms in the artery and completely occludes the lumen of the artery, preventing the blood from circulating normally.

On the other hand, a cerebral embolism occurs when the cerebral artery is occluded by clots of a different nature that have formed in another area of the body, usually in the heart or by atheromatous plaques in the arteries that carry blood to the brain.

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Haemorrhagic stroke

Much rarer, it occurs when an artery – usually due to excessively high blood pressure – cannot withstand the pressure of blood flow and ruptures.

The artery that undergoes the rupture usually already has malformations (such as aneurysms or atherosclerotic plaques) that make its wall even more fragile and prone to rupture.

Transient ischaemic attack

Transient ischaemic attack (Tia) consists of a momentary occlusion of a cerebral blood vessel and the consequent, momentary failure to supply the brain cells with nutrients.

This, unlike ischaemic stroke, is only transient and resolves within a limited period of time (from a few minutes to several hours) leaving no after-effects.

The symptoms are the same as in ischaemic stroke and – for this reason – the transient ischaemic attack may be an alarm bell preceding the actual ischaemic stroke.

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Cerebral stroke: how to recognise it

It is not always easy and immediate to recognise the occurrence of a cerebral stroke.

The most frequently reported symptoms are:

Paralysis;
Weakness of a muscle district;
Tingling of different body areas (face, arms, legs,…);
Diminished or blurred vision;
speech difficulties;
difficulty understanding even simple sentences;
loss of balance;
vertigo;
lack of coordination.

These symptoms are present in many other pathologies and, for this reason, can be misunderstood or underestimated, leading to a rapid worsening of the patient’s clinical picture.

These phenomena should be taken as a wake-up call.

It will be necessary to intervene promptly in order to carry out the necessary investigations and possible treatment.

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Ischaemic stroke: risk factors and prevention

As already mentioned, stroke is not a predictable condition and can affect any person regardless of gender, age or ethnicity.

These are the non-modifiable risk factors.

Nevertheless, there are some modifiable risk factors, which can be acted upon preventively to avoid the onset of a possible stroke, especially if the age is advanced and if there is a familiarity with this disease.

The risk factors that can be acted upon are:

Arterial hypertension;
Hypercholesterolaemia;
Organic heart disease;
Heartbeat conduction disorders (atrial fibrillation,…);
Smoking;
Drugs;
Alcohol;
Obesity;

A correct lifestyle, a healthy diet and regular practice of low-impact physical activity are the best possible prevention factors, especially when combined with regular medical check-ups.

The onset of cerebral stroke in childhood and youth is mainly attributable to the occurrence of a dissection of the carotid and vertebral arteries that carry blood to the brain.

This clinical condition is not caused by endogenous factors, but by repeated trauma or microtrauma to the neck caused by sports injuries, traffic accidents or incorrect chiropractic manoeuvres.

Abuse of smoking, alcohol, drugs combined with a sedentary lifestyle can be the cause of stroke – as well as cardiovascular disease – even at a young age.

Women, up to the onset of menopause, are less likely to develop a stroke due to the protective action of the oestrogen hormones naturally produced by their bodies.

The use of hormonal contraceptives during childbearing age does not increase, if only slightly, the chance of stroke occurrence.

On the other hand, an increased risk percentage occurs if the woman taking hormonal contraceptives is over 35 years of age, is a smoker and has high blood pressure.

Taking hormone replacement therapy once the menopause has been reached does not produce the same beneficial and preventive effect of oestrogen on the body, which is why these therapies should only be taken by patients in an appropriate state of health.

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Cerebral stroke: treatment and possible consequences

Stroke treatment must take place in a timely manner and at specialised centres, called stroke units or stroke units.

Here – after carrying out blood tests and instrumental tests – only patients with an ischaemic stroke that has occurred within a certain time frame – usually three hours – can be treated, after which any therapy administered would be futile.

The therapy that patients undergo includes thrombolysis, through the use of appropriate drugs, and/or mechanical thrombectomy, the physical removal of the thrombus that is occluding the cerebral artery, causing the stroke.

Subsequently, the specialists working in these operating units will proceed to the neurological and clinical stabilisation of the patient using continuous monitoring systems.

With these systems, the patient’s cardiorespiratory parameters are constantly monitored, so that any worsening of the clinical picture can be detected at an early stage and, if necessary, action can be taken in good time.

Depending on the hemisphere involved and damaged, the after-effects of the stroke may be different and present themselves with different intensity.

Damage to the right hemisphere of the brain may result in paralysis or loss of sensation in the left side of the body, loss of spatial perception (resulting in an inability to judge distance and size) or loss of vision in the temporal hemicampus of the right eye and nasal hemicampus of the left eye.

Damage to the left hemisphere of the brain can cause paralysis or loss of sensation of the right side of the body, speech or swallowing difficulties, slowed reaction speed, loss of vision in the temporal hemicamp of the left eye and nasal of the right eye.

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