Anyone can be deprived by illness of the opportunity to pursue their cherished life habits, work and other. We have all become accustomed to this thought. But disturbed well-being, changed daily rhythm, the compulsion to bed rest, taking medications, perhaps a hospital stay or even an upcoming operation do not usually take away the will and confidence of the ill person to take a turn for the better, to regain health. The situation is somewhat different in the case of a stroke, which – as its popular name suggests – comes as a surprise, even as an attack, often out of the blue.
Causes of stroke
In the vast majority of all sick people who suffer a so-called stroke with hemiplegia or speech disorders, it is a sudden occlusion of a small artery in the brain. Very often, the patients and their relatives are of the opinion that all medical skills cannot change the course of the disease. Is this assessment still correct today? In recent years, geriatric medicine has also been involved in further research into stroke (apoplexy) and has tried to find new ways of treating this disease. The success of their efforts today gives us the right to answer in the negative the question just raised. Here, too, knowledge of the causes and processes has given us the means for extensive prevention and successful treatment. As is well known, cerebral stroke or apoplexy occurs mainly in the 7th and 8th decade of life. Medical statistics show that about 17% of men and 29% of women aged 80 and over are still surprised by it. Until a few years ago, it was thought that sudden onset of hemiplegia of the extremities was always due to hemorrhage in the brain. Today we know that this is true only in a relatively small proportion of patients. In the vast majority of patients who suffer a so-called stroke with hemiplegia or speech disorders, the cause is a sudden occlusion of a small cerebral artery, either by a blood clot or other phenomena obstructing the blood flow. Such an occlusion prevents the supply of oxygen and other nutrients, especially glucose, which is extremely important for the metabolism of brain cells. The brain cell, which is highly susceptible to disruption, can only survive this interruption of its metabolism if it lasts only a short time (which is why the first thing to do when resuscitating unconscious people is always to secure the blood supply to the brain by artificial respiration). If it lasts longer, the nerve cells and their accompanying cells die in the affected supply region of the brain area, and local tissue death occurs there, which is called localized brain softening. The metabolism of this cell area cannot then be restored, so the damage cannot be “repaired,” that is, it is irreparable.
Course
The process of development of brain softening just described can also proceed in slow motion, so to speak, because arteriosclerosis does not stop at the cerebral arteries; it leads to constrictions of the current pathway occurring in stretches. This is associated with a reduction and slowing of the blood flow, which, depending on where the constriction is located, in a main vessel or one of the many smaller branches, in a larger or smaller section of the brain, results in a restriction of the supply of oxygen and glucose to the brain cells. If the functioning of the heart is now also weakened, so that the necessary pressure is lacking to pump the blood through the narrowed pathway, brain metabolism enters a critical stage. Such localized deficiency of blood flow can also occur, for example, when the whole organism is running “on the back burner,” as in sleep, or when the body promotes blood flow to the digestive organs to the detriment of that to the brain after a meal. If blood flow to the brain is reduced by 15 to 20 percent of normal, paralysis may occur. It only passes again if the cerebral arterial circulatory distress does not last very long. This explains the so-called mild strokes, whose paralysis symptoms can partially resolve themselves and more or less completely, depending on the circulation.Depending on the location and the destruction of brain tissue, cerebral softening or cerebral hemorrhage that disables the regulatory mechanism of larger sections of the brain often results in unilateral paralysis of individual parts of the body, whereby the patient’s ability to speak may be affected to a very different extent and speech comprehension may be completely lost. The consciousness of the affected person is either completely preserved at first and can then be lost in the further course, or the process runs just the other way round: a total unconsciousness sets in immediately, which passes again in the following hours or days. All of these phenomena can occur individually, but can also be combined with each other in whole or in part. The reason for the different clinical picture is not only the location and size of the affected area, but local accompanying symptoms in the brain, such as edema (fluid accumulation) of neighboring areas, which can be treated. Stroke is thus a disease whose symptoms are due to a temporary or permanent loss of function in one or more districts of the brain.
Treatment
Obviously, someone who has suffered a stroke should receive medical treatment as soon as possible. The doctor will undertake urgent therapy with the aim of immediately restoring the disturbed cerebral blood flow and cellular metabolism. In the past, when the cause was always seen in a hemorrhage, it was believed that the patient must have 4 to 6 weeks of absolute bed rest after a cerebral stroke to avoid a recurrence of the hemorrhage and to allow the ruptured vessel to heal. This is outdated today, we know better the cause of stroke and that this long period of waiting has a damaging effect on the patient. It can become the cause of blood clots (thrombosis) in the legs with the lack of movement and cause complications such as lying through, the formation of muscle contractures, muscle atrophy, the decline of mental potencies and others. Since in such a pathological process in the brain important centrally controlled functions can be disturbed, the person concerned must be hospitalized immediately. Only here it is possible to make a diagnosis, to localize the seat of the damage exactly and to carry out the necessary intensive emergency treatment to the full extent. Some people will assume that immediate transport could harm the patient. But this is not true. It has been proven that immediate transport of a person who has just suffered a stroke does not cause any additional stress. That such treatment can be successful and often the paralysis disappears, we can see in many patients who, after long years of their stroke, still enjoy their life in mental health. All this proves that research and treatment, even for such elderly diseases, is not useless. It is wrong to believe that stroke patients should be left alone to “fall asleep” because they will no longer enjoy life. Such views – easily expressed by young, i.e. unaffected people – are no longer justifiable today. However, this does not mean that diseases affecting the brain can be taken lightly. They often require a long and complicated treatment, and it is not always possible to avert a serious fate by medical measures. To have led to the recovery of several, and to have made possible the improvement and preservation of life in many, is a beautiful initial success for the mastery of the process of life, even in old age. The joyful and often expressed gratitude of those who can still experience how life on earth becomes more beautiful from year to year is a constant incentive for us physicians to learn to control the causes and consequences of disease better and better, and thus to take away people’s fear of the end of life.
