Diagnosis
A stroke is an emergency, so if there is the slightest suspicion of a stroke, a doctor should always be consulted. An early diagnosis and immediate start of therapy can improve the prognosis and positively influence the course of the disease. In order to make a diagnosis, it is first necessary to take a detailed anamnesis, i.e. a detailed interview with the affected person or relative about underlying diseases, such as arterial hypertension or cardiac arrhythmia, as well as about current symptoms.
This is followed by a physical examination of the affected person, whereby particular attention is paid to the neurological deficits described by the affected person, such as weakness or paralysis of a single limb, one half of the face or the entire half of the body, as well as sensitivity disorders of a limb or the entire half of the body, visual disorders and speech disorders. The cause of a stroke is usually a blockage of a blood vessel, which is called an ischemic stroke. In some cases, however, a cerebral hemorrhage is the cause of the stroke, which is then called a hemorrhagic stroke.
Since the treatment of an ischemic stroke differs from that of a hemorrhagic stroke, it is necessary to first investigate what form of stroke it is. Imaging techniques, in particular computer tomography (CT), are used for this purpose. With the help of CT, a cerebral hemorrhage can be quickly ruled out and appropriate therapeutic steps can be initiated.
In some cases a further examination, a CT angiography, is necessary. With a CT angiography, blood vessels in the brain can be visualized and a possible occlusion of a blood vessel can be localized exactly. Additional examinations, which usually take place during the course of the procedure and serve to find the cause, include blood tests, an electrocardiogram (ECG), a cardiac ultrasound (TEE or TTE), and an ultrasound examination of the cervical vessels.
In the event of a stroke, a circulatory disorder of blood vessels in the brain results in a reduced supply of blood and oxygen to downstream areas of the brain. It is an emergency that requires immediate therapy in order to keep the damage to brain tissue as low as possible. Depending on the cause of the stroke, different therapy concepts can be considered.
The more frequent form of stroke, the ischemic stroke, is caused by a blood vessel being blocked by a blood clot. The therapy aims to dissolve the blood clot and thus open the blood vessel and restore blood flow. This is done with the help of a so-called lysis therapy.
Lysis involves the use of drugs from the fibrinolytic group, such as rtPA or alteplase, which dissolve the blood clot and restore blood flow to the brain tissue. In addition, after a careful risk-benefit assessment, a thrombectomy can be performed, in which the blood clot is surgically removed. If the stroke is caused by a cerebral hemorrhage, lysis therapy must not be used under any circumstances, as this would increase the bleeding.
Instead, special attention should be paid to lowering the blood pressure. In some cases, surgery is necessary to stop the source of bleeding. For both forms of stroke, monitoring on a special ward, the so-called stroke unit, is recommended. Here, continuous monitoring of the cardiovascular function is guaranteed.Rehabilitation measures are also started early on at the stroke unit in order to avoid complications of a stroke, such as disability and the need for care. The rehabilitation should be continued in a suitable clinic after the stay in hospital.
