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Stroke: symptoms

, medical expert
Last reviewed: 20.11.2021
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Stroke is a broad term that includes a number of conditions characterized by a sudden breakdown in brain function due to impaired cerebral circulation. To describe the condition that occurs after the occlusion of the cerebral vessel, it is advisable to use the term "cerebral ischemia". Vein thrombosis can also lead to ischemia, but is less common than occlusion of the artery. In this article, intracranial hemorrhages (including subarachnoid and intracerebral hemorrhage) are not considered, which are also considered varieties of stroke.

Stroke is characterized by a significant loss of neurological functions, which develops within a few minutes or hours. Sometimes the symptomatic of a stroke progresses in a staggered manner over a longer period of time, sometimes several days. Over time, there may be an expansion of the ischemia zone in the brain, as a result initially mild neurological symptoms may build up during the subsequent hours or days.

A key symptom that allows diagnosing cerebral ischemia is an acute neurological deficit associated with loss of function of a region of the brain that is supplied with blood by a certain cerebral artery. Although the diagnosis of the etiology of stroke and the identification of risk factors are important, the affected vessel should first be identified.

Usually, with ischemic damage, neurologic symptoms are most pronounced soon after the onset of the disease (if there is no tendency to progress), and in the subsequent there is a restoration of the impaired function. The fastest recovery is observed in the first few days after a stroke and can sometimes lead to an almost complete recovery of the function. Although the recovery slows after the first week, it can still be significant and lasts for several months (sometimes years) after a stroke. Although patients and their relatives are often frightened by the loss of the ability to move, talk, limb movements, it is important to inform them that, in the course of time, there is usually an improvement, and to be encouraged by the prospect of a possible gradual recovery.

In many patients a few hours or days after the stroke there is a complete recovery, since arterial occlusion is often only temporary. If neurologic symptoms persist for less than 24 hours, the episode qualifies as a transient ischemic attack (TIA). If the symptoms persist longer, but subsequently completely regress, "reversible ischemic neurological deficit" is diagnosed. These terms are widely used to classify patients in scientific research. The risk of recurrence is the same for both temporary and persistent arterial occlusion, since the main pathological process that leads to arterial occlusion is crucial.

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Initial symptoms of stroke

Most patients with ischemic stroke develop loss of motor or sensory functions, which is often limited to only one side of the body. Movement disorders can be characterized by true weakness (paresis) or loss of coordination (ataxia). Often patients characterize motor symptoms as "awkwardness" or "heaviness". Although any sensory system may suffer during a stroke, somatosensory and visual functions are most often affected, whereas taste, smell and hearing usually remain intact.

While acute focal symptoms are a characteristic manifestation of ischemic stroke, cerebral symptoms of the common are not characteristic of focal ischemia. In this regard, in order to diagnose a stroke in a patient who makes unspecified complaints of general weakness, fatigue, dizziness, weakness in the extremities, migrating sensory disorders involving both sides of the body, one must strive to identify clear focal symptoms. Diagnosis of stroke is impossible without specific specific complaints.

The transient loss of vision in one eye - amaurosis fugax - deserves special mention, as it often occurs when the proximal part of the carotid artery is affected. The eye artery, the blood supply to the retina, is the first branch of the internal carotid artery. Since the pathology of the carotid artery is shown to be a surgical intervention, in this situation, urgent investigation of the carotid arteries is necessary.

In cerebral ischemia, cognitive functions are sometimes impaired. The loss of function can be obvious (for example, with aphasia, when the patient loses the ability to speak or understand the speech addressed to him) or more hidden (for example, with isolated damage to the associative zones of the cerebral cortex). In the latter case, the patient may develop hallucinations or confusion. Sometimes a patient with a speech disorder that does not have obvious impairments in motor function or sensitivity is mistakenly diagnosed with a psychiatric illness. However, cognitive impairment rarely occurs in the absence of more typical focal motor or sensory disorders, which usually help in diagnosing cerebral ischemia.

Acute dizziness is an especially difficult symptom for evaluation, as it can occur as a result of loss of function of the brain (cerebral trunk and cerebellum) or peripheral vestibular apparatus (semicircular canals or the eighth cranial nerve). The analysis is also hampered by the fact that the vestibular apparatus is partially supplied with the same blood vessel that supplies blood and brain stem. Thus, ischemia of the inner ear can be caused by the same mechanisms as brain ischemia.

Pain as such, including pain in the limbs, is usually not a manifestation of cerebral ischemia. An exception to this rule is a headache, which is often noted in stroke. Nevertheless, the presence, intensity or localization of pain usually does not help in diagnosing a stroke.

In the onset of a stroke, there may be epileptic seizures or a passing loss of consciousness, but the fact that they develop against the background of a newly emergent resistant focal neurologic defect is a weighty proof that this episode is not just an epileptic fit or fainting but a manifestation of a stroke. Epileptic seizures and loss of consciousness are more often noted with intracranial hemorrhages, but they are also possible with occlusion of the artery. Although they are more often observed with cardiogenic embolism of cerebral vessels, this pattern is not so absolute that, based on them, one can draw a conclusion about the mechanism of stroke development.

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