Cerebral strokes: what it is, how to cope, what are the treatments

By Cristiano Antonino On Nov 1, 2022

Cerebral stroke is a consequence of the failure of an artery to supply an area of the brain with blood, either because the artery itself ruptures (haemorrhagic stroke) or because it is occluded by a thrombus (thrombotic stroke)

Cerebral stroke: death of neurons

Neurons, deprived of the necessary blood-borne oxygen supply, die within minutes; consequently, all parts of the body that are under the control of these neurons cease to function.

In fact, the brain is a so-called noble organ, i.e. it suffers very quickly and noticeably from a reduced blood supply.

Cerebral stroke and prevention

In the case of cerebral stroke, prevention is compulsory because a cure is impossible: unlike other tissues, brain tissue does not have the capacity to regenerate, i.e. to repair an injury by replacing dead neurons with new ones.

This is why it is very important to identify heart problems in time that can cause damage to brain cells that is very difficult to recover from.

Thrombotic cerebral stroke can be caused by a cerebral embolism or cerebral thrombosis

Cerebral embolism. Cerebral embolism is caused by the migration of very small clots that, generally formed in the heart or carotid arteries, take the route of the large arteries and stop in a cerebral artery, obstructing the passage of blood and oxygen. The most frequent cause of cerebral embolism is atrial fibrillation.
Cerebral Thrombosis. Cerebral thrombosis is certainly the most frequent type of cerebral stroke. It is caused by the formation of a thrombus on a cerebral artery injured by atherosclerotic plaques (growths that form on the walls of the arteries due to an excess of fat in the blood, cigarette smoke or excessively high blood pressure) and occurs mainly at night or in the early hours of the morning.

Risk factors for stroke

People most at risk of having a stroke are those who have already had TIAs (Transient Ischaemic Attacks) or other ischaemic artery diseases; those who suffer from diabetes, high blood pressure or have an excess of cholesterol in the blood; and those who have had a family member suffer a stroke at a relatively young age (less than 60 years).

Other important risk factors are cigarette smoking, obesity, sedentary lifestyle and stress.

It has recently been established that too high levels of homocysteine (an amino acid that can cause irritation of artery walls if present in excess) in the blood increase the risk of having a stroke.

Early signs of stroke: the alarm bells

Atrial fibrillation. Atrial fibrillation is an alteration in the heartbeat whereby the cardiac limbs pump blood into the ventricles with insufficient force and at irregular intervals; this causes the blood to stagnate in the atria of the heart and promotes clotting. The patient may feel a sensation of heart palpitation and, on taking his pulse, notice an absolute irregularity of beats. The most serious complication of atrial fibrillation is arterial embolism in the brain.
Transient ischaemic attacks (TIAs). Transient ischaemic attacks are a temporary impairment of a brain function (loss of speech, decrease in the strength of a limb), usually due to the transient obstruction of a cerebral artery by small emboli or thrombi from atherosclerotic plaques in the arteries of the neck that carry blood to the brain. Symptoms last a few minutes, although occasionally they may last a few hours (no more than 24 hours) and regress completely, unlike in cerebral stroke. They are, however, very similar to those typical of stroke:
weakness and/or difficulty moving a limb or side of the body;
blurring or loss of vision in one eye;
speech problems, such as faulty pronunciation (dysarthria) or difficulty finding the right words (aphasia);
more rarely, dizziness or double vision (diplopia).

Transient ischaemic attacks are important premonitory signs, useful in predicting the risk of stroke in each patient.

In fact, the risk of stroke for a person who has had at least one TIA is about ten times higher than for another person with the same characteristics who has never suffered a TIA.

Relationship between vascular surgery and stroke

The vascular surgeon can correct an important risk factor for cerebral stroke: carotid artery stenosis, a narrowing due to the presence of atherosclerotic plaques on the walls of the carotid arteries.

Stenosis of the carotid arteries is detected by ultrasound of the supra-aortic trunks, an examination that does not require injections or pain: by passing a probe over the patient’s neck, the flow in the carotid arteries is observed and any hardening or narrowing of the arteries is looked for.

Cerebral strokes: treatments

In order to set up an appropriate treatment, it is essential to establish, thanks to CT (Computed Axial Tomography) and MRI (Magnetic Resonance Imaging), whether the stroke is ischemic (as in most cases) or haemorrhagic.

For example, if the stroke is ischemic in nature, i.e. due to thrombosis or embolism, the patient can be administered a substance that dissolves the clot (thrombolysis); administering the same substance in the case of a stroke of a haemorrhagic nature means worsening the haemorrhage.

In some cases, however, it is better to keep the patient under observation, waiting for the evolution of the symptoms to lead to a more certain diagnosis and indicate whether a targeted therapy, anticoagulant or anti-platelet, can be administered.