Ischemic Stroke - Information Overview

Ischemic stroke is a pathological condition that is not a separate and special disease, but an episode developing within the framework of progressive general or local vascular damage in various diseases of the cardiovascular system. Patients with ischemic stroke usually have a general vascular disease: atherosclerosis, arterial hypertension, heart disease (ischemic heart disease, rheumatic heart disease, rhythm disturbances), diabetes mellitus and other forms of pathology with vascular damage.

Strokes include acute cerebrovascular accidents characterized by sudden (within minutes, rarely hours) appearance of focal neurological and/or general cerebral symptoms that persist for more than 24 hours or lead to death of the patient in a shorter period of time due to a cause of cerebrovascular origin. In ischemic stroke, the cause of the development of the pathological condition is acute focal cerebral ischemia. If the neurological symptoms regress within the first 24 hours, the pathological condition is defined as a transient ischemic attack and is not classified as an ischemic stroke, but together with the latter, it is classified as a group of acute cerebrovascular accidents of the ischemic type.

ICD-10 codes:

• 163.0. Cerebral infarction due to thrombosis of precerebral arteries.
• 163.1. Cerebral infarction due to embolism of precerebral arteries.
• 163.2. Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries.
• 163.3. Cerebral infarction due to thrombosis of cerebral arteries.
• 163.4. Cerebral infarction due to embolism of cerebral vessels.
• 163.5. Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries.
• 163.6. Cerebral infarction due to thrombosis of cerebral veins, nonpyogenic.
• 163.8. Other cerebral infarction.
• 163.9. Cerebral infarction, unspecified.
• 164. Stroke, not specified as hemorrhage or infarction.

Epidemiology

A distinction is made between primary (development in a given patient for the first time in life) and secondary (development in a patient who has previously suffered an ischemic stroke) cases of stroke. A distinction is also made between fatal and non-fatal ischemic stroke. The acute period of stroke is currently accepted as the time interval for such assessments - 28 days from the onset of neurological symptoms (previously it was 21 days). Repeated deterioration and death during the specified period of time are considered as a primary case and fatal ischemic stroke. If the patient has survived the acute period (more than 28 days), the stroke is considered non-fatal, and if ischemic stroke develops again, the latter is defined as repeated.

Cerebrovascular diseases are the second leading cause of death worldwide and are the leading cause of disability in adults. According to WHO, about 5.5 million people died from stroke in 2002.

The incidence of stroke varies significantly in different regions - from 1 to 5 cases per 1000 population per year. Low incidence is observed in the countries of Northern and Central Europe (0.38-0.47 per 1000 population), high - in Eastern Europe. The incidence of stroke among people over 25 years old was 3.48±0.21, mortality from stroke - 1.17±0.06 per 1000 population per year. In the USA, the incidence of stroke among residents of the Caucasian race is 1.38-1.67 per 1000 population.

Over the past decade, stroke incidence and mortality have decreased in many Western European countries, but the number of stroke patients is expected to increase due to demographic ageing of the population and insufficient control of the main risk factors.

Research conducted in European countries shows a clear link between the quality of organization and provision of medical care to patients with stroke and mortality and disability rates.

The share of acute cerebrovascular accidents in the structure of overall mortality is 21.4%. Mortality from stroke among people of working age has increased over the past 10 years by more than 30% (41 per 100,000 population). Early 30-day mortality after stroke is 34.6%, and approximately 50% of patients die within a year, that is, every second patient.

Stroke is the leading cause of disability in the population (3.2 per 1000 population). According to stroke research, 31% of stroke patients require outside help to care for themselves, 20% cannot walk independently. Only 8% of surviving patients can return to their previous job.

The National Stroke Registry (2001-2005) showed that stroke mortality significantly correlates with morbidity (r = 0.85; p <0.00001), but while the stroke incidence rate between regions of the country differs by a maximum of 5.3 times, the differences in mortality are 20.5 times. This indicates different quality of medical care in different regions, which is confirmed by differences in hospital mortality rates between regions of more than 6 times.

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Causes ischemic stroke

An ischemic stroke occurs when, for some reason, the blood supply to a certain part of the brain is interrupted, which can lead to damage to brain tissue. Causes may include the following:

1. Atherosclerosis: The accumulation of cholesterol and other fatty substances in the walls of blood vessels can lead to plaque formation and narrowing of the vessels. This can lead to blockage of blood vessels in the brain.
2. Embolism: An embolism is the breakaway of blood clots (emboli) or other material that can block blood vessels in the brain. Embolism can result from abnormal heart rhythms (such as atrial fibrillation) or other heart problems.
3. Carotid artery stenosis: Narrowing of the carotid arteries, which supply blood to the brain, can increase the risk of stroke.
4. Thrombosis: The formation of thrombi (blood clots) directly inside the blood vessels of the brain can lead to ischemic stroke.
5. Hypertension (high blood pressure): High blood pressure can damage the walls of blood vessels and increase the risk of blood clots.
6. Diabetes: Diabetes can increase the risk of blood vessel damage and plaque buildup.
7. Hypercholesterolemia: Elevated levels of cholesterol in the blood can contribute to plaque formation in the arteries.
8. Smoking: Smoking increases the risk of developing atherosclerosis and stroke.
9. Hereditary factors: Certain genetic mutations and inherited syndromes may increase susceptibility to strokes.
10. Migraine with auras: Some people who suffer from migraines with auras may experience a stroke, which is called "migraine with auras and cerebral infarction."

Read also: Ischemic stroke - Causes and pathogenesis

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Pathogenesis

Ischemic stroke develops as a result of disruption of the blood supply to the brain due to blockage of an artery, which leads to insufficient supply of oxygen and nutrients to the brain tissue. The pathogenesis of ischemic stroke includes the following stages:

1. Blocked artery: The most common cause of ischemic stroke is the formation of a thrombus (clot) or embolus (inclusion) in an artery that supplies blood to an area of the brain. This can occur due to atherosclerosis (the deposition of cholesterol and other substances on the walls of arteries), thrombosis (the formation of a clot directly in an artery), or an embolus breaking off from another part of the body, such as the heart.
2. Ischemia (hypoxia): Blockage of an artery results in a reduction or cessation of oxygen and nutrient supply to the brain tissue, causing hypoxia (lack of oxygen) and ischemia (lack of blood supply) in the affected area.
3. Biochemical Cascade: When an ischemic stroke occurs, a biochemical cascade begins, including activation of inflammatory processes, accumulation of metabolites that cause damage to brain cells, and activation of microglia (brain macrophages), which can increase inflammation and tissue damage.
4. Apoptosis and Necrosis: As a result of ischemia, brain cells begin to undergo apoptosis (programmed cell death) or necrosis (cell death), resulting in loss of tissue viability.
5. Brain swelling: Ischemic stroke can cause brain swelling because the accumulation of fluid in the brain tissue increases pressure in the skull and impairs blood supply.
6. Infarction Formation: Ischemia and hypoxia can lead to infarction (dead tissue) formation in the brain, which becomes a source of long-term consequences and irreparable damage.
7. Complications: Complications can occur after a stroke, such as swelling of the brain, infections, seizures, and even recurrent strokes.

Symptoms ischemic stroke

Ischemic stroke causes a variety of symptoms, which can vary depending on which part of the brain is affected and how severely. Some of the common symptoms of ischemic stroke include:

1. Loss of strength or paralysis: Usually one side of the body becomes weak or paralyzed. This may manifest as weakness in an arm, leg, or facial muscles.
2. Difficulty speaking: Patients may have difficulty speaking, understanding speech, or losing the ability to talk.
3. Difficulty swallowing: Ischemic stroke can cause problems swallowing food and liquids.
4. Loss of sensation: Patients may experience loss of sensation in one or more parts of the body. This may manifest as tingling, numbness, or decreased sensation.
5. Mixed symptoms: Often, stroke symptoms are combined. For example, a patient may experience weakness and difficulty speaking at the same time.
6. Headache: Headache, often severe, can be one of the symptoms of a stroke.
7. Loss of coordination and balance: Patients may experience difficulty with balance and coordination of movements.
8. Vision loss: A stroke can cause vision loss in one or both eyes or changes in the visual fields.
9. Changes in consciousness: Patients may experience changes in consciousness, including loss of consciousness or drowsiness.
10. Disorientation in space and time: Patients may have difficulty determining location and time.

Read also: Ischemic Stroke - Symptoms

Diagnostics ischemic stroke

The standard test for detecting a stroke is the FAST (Face, Arms, Speech, Time) test, which helps to quickly identify symptoms. If a person has problems with their face, arms or speech, they should call 112 or an equivalent ambulance service immediately.

The FAST (Face, Arms, Speech, Time) test is a simple and effective way to detect stroke that can help quickly identify symptoms. Here's how it works:

1. Face: Ask the person to smile. If they have problems with one side of their face or cannot smile, this may be a sign of paralysis or loss of sensation in the facial muscles, which may indicate a stroke.
2. Arms: Ask the person to raise both arms in front of them and keep them parallel to the floor. If one arm does not rise or begins to droop, this may be a sign of weakness or paralysis in one arm, which may also indicate a stroke.
3. Speech: Ask the person to repeat a simple sentence. Notice their ability to pronounce words correctly and form an understandable sentence. If they have trouble pronouncing words or cannot string words together to form a sentence, this may be a sign of a speech disorder, which may also indicate a stroke.
4. Time: If you notice any of the above symptoms (facial, hand, speech problems), call 911 immediately. It is important to act quickly, as stroke treatment is most effective when started as early as possible.

Read also: Ischemic stroke - Diagnosis

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Treatment ischemic stroke

Treatment of ischemic stroke requires a quick and comprehensive approach. The effectiveness of treatment depends on the time that has passed since the onset of symptoms, so it is important to immediately call an ambulance if a stroke is suspected. Here are the main methods of treating ischemic stroke:

1. Medicines to dissolve a clot (thrombolytic therapy): If you have an ischemic stroke caused by a blockage in your blood vessels by a clot (blood clot), a medicine called a thrombolytic (such as alteplase) may be used. This medicine helps dissolve the clot and restore blood flow to the brain.
2. Antiplatelet agents: Medicines such as aspirin and dipyridamole may be used to reduce blood clotting and prevent new clots from forming.
3. Anticoagulants: In some cases, anticoagulants such as warfarin may be prescribed to prevent blood clots.
4. Maintenance treatment: Patients may require treatment to manage coexisting medical problems such as hypertension (high blood pressure), diabetes, etc.
5. Physical therapy and rehabilitation: After a stroke, physical therapy and rehabilitation are important to restore function to weakened muscles and restore daily living skills.
6. Risk factor control: Patients may be advised to make lifestyle changes, such as eating a healthy diet, being physically active, stopping smoking, and managing stress, to control stroke risk factors.

Stroke treatment should be individualized and supervised by doctors. It is important to support the patient and provide long-term management of their condition to prevent recurrence and improve quality of life.

Read also: Ischemic stroke - Treatment

Prevention

Prevention of ischemic stroke is important because many risk factors can be controlled and the likelihood of stroke can be reduced. Here are some recommendations for preventing ischemic stroke:

1. Blood pressure control: High blood pressure (hypertension) is one of the main risk factors for stroke. Have your blood pressure checked regularly and, if it is elevated, follow your doctor’s recommendations for controlling it.
2. Smoking: Smoking is a major risk factor for stroke. The best strategy is to stop smoking completely.
3. Diabetes Control: If you have diabetes, manage your blood sugar levels as directed by your doctor.
4. Healthy eating: Eat a balanced diet rich in vegetables, fruits, whole grains, lean meats and fish. Limit your intake of salt, sugar and saturated fats.
5. Physical activity: Regular physical activity helps maintain cardiovascular health. Aim for at least 150 minutes of physical activity per week.
6. Weight control: Maintain a healthy weight, as obesity can increase your risk of stroke.
7. Moderate Alcohol Consumption: If you drink alcohol, do so in moderation. Recommendations for consumption levels may vary from person to person.
8. Preventive medications: In some cases, your doctor may prescribe antiplatelet drugs or anticoagulants to prevent blood clots, especially if you have a high risk of stroke.
9. Managing risk factors: Get regular medical checkups and monitor your health. If you have other risk factors, such as atrial fibrillation, high cholesterol, or a family history, follow your doctor’s recommendations.
10. Lifestyle: Avoid stress, get enough sleep, and manage mental health factors, as stress can increase your risk of stroke.

Following these steps will help reduce your risk of developing ischemic stroke and keep your cardiovascular system in good condition.

Read also: Ischemic stroke - How to prevent?

Forecast

The prognosis depends on many factors, primarily on the volume and localization of the brain lesion, the severity of the associated pathology, and the patient's age. Mortality in ischemic stroke is 15-20%. The greatest severity of the condition is noted in the first 3-5 days, which is due to the increase in cerebral edema in the area of the lesion. Then follows a period of stabilization or improvement with a gradual restoration of impaired functions.