Ischaemia: what it is and why it causes a stroke
Stroke is a cerebrovascular disease that causes permanent neurological damage
Most strokes develop from ischaemia.
What is stroke
A stroke is a cerebro-vascular lesion that causes a sudden impairment of brain function and develops as a result of a suspension of the normal blood flow to the brain due to the rupture or obstruction (thrombosis) of one of the arteries supplying it.
Because of this sudden rupture or occlusion, the neurons, suddenly deprived of oxygen and all the other substances that keep them alive, die.
From the data we have available, stroke is the first cause of disability, the second of dementia and the third of death.
In 75% of cases it affects individuals over 65 years of age, while the remaining cases involve younger people, even those under 40.
We recognise two types of stroke, the haemorrhagic stroke, which occurs as a result of a ruptured artery, and the ischaemic stroke (ischaemia), which is caused by a thrombus, i.e. a blood clot that obstructs the artery and compromises normal blood circulation.
The causes of stroke: ischaemia and haemorrhage
Most strokes (about 80 per cent) develop from ischaemia.
The underlying blood clot is often caused by atherosclerosis, i.e. the accumulation of fat, fibrotic material and cells on the inner walls of the arteries, which are thickened, resulting in a decrease in blood flow.
In arteries subject to atherosclerosis, a thrombus (i.e., as we have specified, a blood clot) can be created, which blocks the blood circulation in a certain area of the brain and, therefore, the nutritional supply to the neurons.
Ischaemia can also be caused by an embolus, i.e. a blood clot which from the heart or other areas of the body enters the bloodstream until it reaches a cerebral artery with a diameter smaller than its size and causes its occlusion, causing an interruption in the blood supply to the neurons.
Ischaemic stroke particularly affects older patients and its risk factors include diabetes, hypertension and high cholesterol and blood sugar levels.
Haemorrhagic stroke: Watch out for high blood pressure
A haemorrhagic stroke, on the other hand, develops as a result of a rupture in a blood vessel whose walls may be weakened and causes blood to leak into the surrounding tissue, resulting in compression of the brain tissue.
Cerebral vessels can rupture due to an aneurysm, i.e. a dilatation of the vessel walls caused by alterations or trauma, or due to arteriovenous malformations, i.e. congenital abnormalities whereby arteries flow directly into the outflow veins without the capillary beds that reduce blood pressure.
The pressure, therefore, is higher in this circuit and can cause a haemorrhage
Haemorrhagic stroke affects 15% of stroke patients, but is the most severe form.
Its risk factors include high blood pressure, which also affects young patients, as well as alterations in blood clotting, e.g. following treatment with anticoagulant drugs.
In any case, as regards both ischemic and haemorrhagic stroke, in terms of prevention it is essential to have a balanced and active lifestyle, characterised by regular physical activity, the absence of cigarette smoking and a healthy diet, low in animal fats, salt and alcohol and rich in vegetables, legumes and fruit.
Stroke: what symptoms should not be underestimated
There are certain signs that, if recognised in time, can help the patient or those close to a person suffering a stroke to seek help promptly.
Indeed, the manifestations that indicate the onset of stroke tend to be recognisable because they are conditions that deviate from the norm.
For example, we are talking about events such as a sudden difficulty in movement or a persistent tingling in the limbs unrelated to any other cause.
Other symptoms are related to the sphere of vision, such as a narrowing of the visual field, which then makes vision appear narrower at the edges, or to the sphere of speech: stroke victims often have difficulty both speaking and remembering individual words.
Finally, another alarm bell is a headache that is very intense, sudden and different from what one is used to experiencing.
What to do in case of a stroke: the importance of early intervention
When a stroke occurs, it is crucial to act in a timely manner.
What to do, then, once you have recognised the symptoms of a stroke on yourself or someone close to you?
First, you must immediately call the emergency services on 112, so that the person suffering a stroke is received as soon as possible in an emergency room equipped with a Stroke Unit.
Treating a stroke requires a multidisciplinary team of specialists capable of dealing with the emergency.
Stroke Units are fundamental and, in recent years, thanks to them it has been possible to reduce the disability and mortality incidence of stroke patients, regardless of the intensity of the event and the age of the patient.
What, however, should absolutely be avoided in case of a suspected stroke?
First of all, one should not waste time calling the doctor or general practitioner, as they would not be able to intervene and it would only be an intermediate step before alerting 112, which would only waste precious time.
Waiting for symptoms to pass should also be avoided: if there is any doubt that a symptom can be attributed to a stroke, the only way to resolve it is immediate hospital intervention.
When a stroke occurs, in fact, it is necessary to intervene within six hours in order to be certain that the treatments are decisive and not, on the contrary, counterproductive.
Moreover, the sooner action is taken, the sooner the progress of the stroke is halted and the fewer areas of the patient’s brain will be compromised.
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