Prognosis and course

The prognosis depends crucially on how extensive the loss of brain tissue is. 20% of patients who are hospitalized for a stroke die in the clinic as a result of cerebral underuse. A 1/3 rule can be formulated for the surviving stroke patients: 1/3 of the patients remain in need of long-term care after a stroke, 1/3 of the patients can take care of themselves again after the stroke and appropriate rehabilitation measures and 1/3 of the patients experience an almost to complete regression of the symptoms.

The consequences of a stroke depend very much on the severity and location of the circulatory disorder, but also on the time window between the event and the therapy or care in a hospital.Ultimately permanent damage can include all kinds of neurological deficits, such as speech or vision disorders, paralysis and sensory disturbances in certain regions of the body. It is important to start a rehabilitation program early after a stroke. This includes physiotherapy and, depending on the damage, also occupational therapy and speech therapy.

The aim is to actively restore the connections between the brain cells damaged by the stroke. If rehabilitation is not started early enough, these connections can be destroyed permanently. In this case, certain abilities or bodily functions cannot be regained. Therefore, a lot of attention should be paid to early rehabilitation.

Symptoms

A stroke suddenly causes severe physical limitations, depending on the location of the vessel occlusion in the brain. The following symptoms can be a sign of a stroke and should therefore be clarified immediately by a doctor: The patient has difficulty speaking or has a slurred speech. In most cases, a stroke affects one half of the body, which is why the patient cannot move or feel the affected half of the body.

Sensitivity, the sense of feeling and motor functions are restricted or switched off. The patient can therefore no longer walk safely. Often the corner of the mouth hangs limp, which can make it difficult to eat.

Chewing and swallowing disorders can also occur. Further signs of a stroke can be incontinence (= unintentional loss of urine) or the altered perception of one half of the body. and stroke of the speech center.

A classic harbinger of stroke is the so-called transitory ischemic attack (TIA). In very simple terms, TIA is a “stroke light” in which no brain tissue is destroyed and all symptoms disappear completely within one hour (earlier definition: complete recovery of symptoms after 24 hours). TIA is considered to be closely related to a stroke, and is a typical precursor to the later occurrence of a stroke.

Classical symptoms of TIA are, as with stroke, hemiplegia with a reduction in strength on the affected side. Strokes are usually strictly one-sided. This is because one side of the brain is usually affected in isolation.

If the right side of the brain is less well supplied, the paralysis appears on the left side of the body, because the nerve tracts of the brain hemispheres cross after leaving the skull. The symptoms of TIA are similar to those of a stroke, with the difference that they regress. Other signs include slurred speech – patients are often fatally mistaken for drunk.

In addition, they may also experience confusion and gait and balance problems (see foot lifter paresis). A weakened handshake is also typical in comparison: the patient shakes and presses the hand on the affected side much less than on the healthy side. A classic sign is also the paralysis of the mimic muscles of one half of the face.

The face looks flabby and clumsy there, while the healthy half of the face still functions without any problems. When sticking out the tongue, a deviation towards the affected side is often observed. The uvula in the mouth also follows this phenomenon.

Visual field failures are also among the typical signs of a stroke. Although a visual field failure can be caused by many different neurological symptoms, a sudden occurrence in combination with other stroke-typical symptoms is indicative. Visual field failures manifest themselves by the patient no longer seeing anything on one side of the visual field.

The patient is not necessarily aware of the loss. Usually, it is only discovered when the patient is conspicuously often “stuck” on corners or furniture because he or she has miscalculated the distance. Detecting a stroke is not always that easy.

Depending on the location of the circulatory disorder in the brain, different symptoms can occur. Occasionally these are so little pronounced that the stroke as such is not recognized at all. A proven scheme that has led to early detection of some strokes is the so-called “FAST”.

This scheme from the English-speaking world serves as a memorizing aid for quick recognition and correct action.The “F” stands for face and means that in the case of an acute stroke, the face is often paralyzed on one side. If you ask the person to smile, this can be seen very easily. The “A” stands for Arms.

You ask the person to stretch out their arms straight. If an arm cannot be held upright by itself, this also indicates paralysis. The “S” stands for Speech and can be checked by speaking a simple sentence: if the language is difficult to understand it is an acute speech disorder.

The “T” stands for Time: if the first three letters are positive, the emergency call should be dialed quickly. The arteries have certain supply areas of the brain and therefore associated functional areas of the body. Based on the pattern of symptoms of a stroke, the affected vessel or undersupplied area can be identified.

The front part of the brain is supplied by the arteria carotis interna and arteria cerebri media. Occlusion of the internal carotid artery has the following effects: The rear part of the brain is supplied by the two basilar arteries. Possible symptoms of a partial or complete vascular occlusion are the following: In a stroke, the following two vessels are most frequently affected by a constriction or occlusion:

The patient is impressed by paralysis of one side of the body, which mainly affects the arms and face. The affected half of the body also shows loss of sensitivity, i.e. sensory disturbances. An initially flaccid paralysis with reduced muscle tone can develop into a spastic paralysis.
Speech disorders are possible if the speech-controlling side of the brain is less well supplied (for most right-handed people, the left hemisphere of the brain is the place of speech control; in this case, the handiness does not necessarily determine the seat of the dominant hemisphere).
Temporary visual complaints are possible symptoms of embolic vascular occlusion in the area of the internal carotid artery, more precisely the opthalmic artery, which originates from the former.
Dizziness is a symptom that may indicate a stroke.
The patient may complain about swallowing disorders.
The occurrence of ringing in the ears, deterioration of hearing (hearing loss) or double vision (=diplopia) should be examined for the presence of a stroke.
So-called “drop attacks” are typical for restrictions of the vascular supply in the area of the basilar artery: sudden falling of the patient, which occurs without notice.
If both supplying arteries are blocked, the symptoms are drastic and can lead to loss of consciousness (= coma).
Arteria carotis interna (about 50% of cases)
Arteria vertevralis (about 15% of cases)
Arteria cerebri media (about 25% of cases)