Stroke

A stroke, what’s that?

A stroke, also known as an apoplectic stroke or apoplexy, is a circulatory disorder of the brain. This lack of blood in the brain and the concomitant undersupply of the brain with oxygen results in damage to the brain tissue. Dependent on the region of the brain affected, several symptoms may appear because the brain controls all the functions of the body centrally. Therefore, continuous and sufficient circulation is very important.

As more and more substances are deposited in the arteries when we become older, the peak age is 50+ years. With approx. 6 percent, the stroke is one of the most frequent causes of death worldwide¹.

Cause of a stroke

We normally distinguish between two main types:

• Ischaemic stroke
• Haemorrhagic stroke

In most cases, with approx. 80%, the stroke is caused by an ischaemia (undersupply) due to arteriosclerosis (narrowing of the arteries). For example, they can be located in the area of the carotid arteries or brain arteries. This means that the brain is no longer sufficiently supplied with blood. In this case, we speak of an “ischaemic stroke”.

The risk factors for such a narrowing of the arteries include:

• Hypertension (high blood pressure)
• Lack of exercise
• Poor diet → Hyperlipidaemia (increased blood lipid levels, primarily the so-called “bad” cholesterol LDL and VLDL)
• Nicotine (smoking) → Harmful substances are deposited in the arteries
• Diabetes mellitus → Glucose constricts the arteries
• Chronic stress → Constantly increased cholesterol level/blood glucose level and hypertension
• Cardiac arrhythmias (e.g. atrial fibrillation) → fosters the formation of thrombi
• Endocarditis (endocarditis lenta)
• Cardiac valvular defect → fosters the formation of thrombi

In rare cases (20%)², a haemorrhage / an injury (e.g. a tear) of an artery in the brain region is responsible for a stroke. The haemorrhage increases pressure in the brain and brain structures are damaged. Furthermore, the brain areas which are located behind the lesion in the region supplied, are supplied insufficiently. In this case, we speak of a “haemorrhagic stroke”.

Symptoms of a stroke

Typical stroke symptoms include the sudden occurrence of:

• Vision disorders (scotoma)
• Speech disorders
• Vertigo up to loss of consciousness
• Semi-paralysis (hemiplegia or hemiparesis)
  → e.g. facial nerve paresis, corner of the mouth droops, etc.)
• Severe headache

Important note: A stroke can also be experienced without pain!

However, depending on where the stroke develops in the brain, a wide variety of symptoms may be incurred. If someone shows signs of a stroke, it is important to call the emergency doctor immediately, because fast treatment of the results of the stroke can reduce its effects and rescue lives.

Phases of a stroke

• TIA (Transitory Ischaemic Attack): short circulatory disorder in the brain, mostly only lasting some minutes to a few hours. TIA symptoms always recede in-full and normally within minutes up to an hour. In the vernacular, also often referred to as “mini strokes”.

• PRIND (Prolonged Ischaemic Neurological Deficit): Longer circulatory disorder, generally lasting several days. Symptoms form more slowly and can last for up to several days. Also in case of PRIND, the symptoms remain reversible.

• Manifest stroke
  If the TIA and PRIND symptoms are recognised correctly and timely action is taken, the stage of the actual stroke (manifest) which is accompanied by irreversible damages, can often be avoided.

Diagnosis of a stroke

The longer the circulatory disorder remains, the worse the resulting damages can be.

If a stroke is suspected, the so-called FAST test can be carried-out:

In order to be diagnosed safely, specialist teams are available in the clinics, the so-called “stroke units”. Which have specialised in the treatment of patients with a stroke or suspected stroke. Here, imaging procedures such as CT or MRI of the head are used. They enable determination of the cause and localisation.

In order to recognise failure symptoms, additional neurological tests may be made.

It is important to find out what has caused the stroke. This is the only means to ensure future prevention and the correct therapy.

Treatment of a stroke

As a stroke is always an emergency case, it requires immediate treatment. Every minute during which the brain is not provided with oxygen can lead to the dying off of brain cells.

Acute therapy for an ischaemic stroke (narrowing of the arteries) consists in the dispersal of the blood clot (thrombus) which constricts the brain vessels. Often, lysis therapy has this effect. Here, a given added enzyme specifically destroys and decomposes the structure of the clot in a targeted manner. The thrombus can also be removed via thrombectomy. Here, the physician uses a special catheter to remove the clot. Following acute therapy, it is important to reduce the risk of the stroke recurring. This is achieved by avoiding the triggering factor. Precise cause analysis is therefore all the more important. Taking the medication prescribed by the physician, such as anti-coagulants may help to avoid an ischaemic stroke as they restrict blood clotting (thrombosis formation).

Acute therapy for a haemorrhagic stroke (bleeding, for example resulting from an arteria tear) consists of stopping the internal bleeding and reducing the resulting brain pressure. Depending on the degree of severity, the stroke unit decides upon the best measure in acute cases. Also in case of an ischaemic stroke, it is important to minimise the risk of recurrence following treatment. The patients should also pay attention to their blood pressure because blood pressure which is too high can damage the vessels in the long-term. Equally, activities which involve increased brain pressure, such as pressing or athletic sports, should be avoided.

In order to re-establish lost capabilities or so-called apraxia (e.g. walking, speaking) physiotherapy, speech therapy and ergotherapy are often prescribed following therapy. This is intended to enable the person concerned faster re-integration into everyday life.

How can strokes be prevented?

To reduce the risk of a stroke, for example the risk factors named above which facilitate it, should be avoided. According to a study published in The Lancet1 in 2010, smoking and blood pressure which is too high are viewed as the primary triggers.

Generally speaking, healthy nutrition as well as regular exercise are viewed as recommendable for reducing the risk of a stroke.

As a preventive measure, e.g. in case of family background or the existence of several risk factors, the physician can recognise any possibly already constricted arteries and therefore work against the development of a stroke in good time.

Therapy options with orthopaedic aids in case of neurological damages arising from a stroke.

Unilateral signs of paralysis (hemiparesis or hemiplegia) may arise as a consequence of a stroke. Here, both the upper extremities and the lower extremities can be paralysed.

If the shoulders are paralysed, the person affected can no longer compensate the weight force of the arm due to the loss of muscle. The arm is pulled downwards in an uncontrolled manner with its own weight. This results in partial withdrawal of the humeral head out of the joint socket of the shoulder joint (subluxation). Muscles, tendons, ligaments and nerves are stretched abnormally. Often, this results in severe pain.

Furthermore, the arm experiences an uncontrolled swinging movement due to the paralysis, which can lead to involuntary injury. Often, a pathological internal rotation movement of the upper arm/wrist and unnatural posture can be recognised.

When prescribed by the treating physician, a “shoulder joint brace with a definable movement restriction” such as the BORT OmoControl Shoulder Brace can counteract these symptoms. Further information regarding the mode of action of the BORT OmoControl is explained in the respective BORT FAQ’s .

In case of paralysis in the lower arm and hand region, it may be the case that the extension capability in the wrist no longer exists. The wrist and fingers can then no longer be stretched. A malposition in the area affected may result.

In order to counteract these symptoms, special braces such as the BORT Paresis Splint exist. It enables the gentle correction of the malposition via anatomically correct positioning of the wrist and finger on the brace.

In case of paralysis in the region of the lower extremity, for example paralysis of the peroneus nerve may exist. This nerve is responsible for enabling raising the foot or the toe. If this is no longer possible or only in-part, we speak of a dorsiflexion of the foot or peroneus paresis. In practise, this means that the person affected can remain caught on the ground when moving with the dropfoot resulting from the foot. This results in a higher risk of falling.

With special braces such as the BORT Tibialis Anterior Muscle Brace or the BORT Peroneus Splint, the dropfoot can be held in a physiology-proximate position when walking. The gait becomes more secure as a result and the risk of falling can be reduced.

The medical aid with which in the respective indication case help should be provided depends on several factors (e.g. degree of severity 0-4) and is therefore decided upon by the treating physician or therapist.