PD Philippe Lyrer, MD, is a senior physician at the Neurological University Hospital in Basel, Switzerland. He studied at the University of Basel Medical School and trained in clinical neurology at the Neurological University Hospital Basel from 1987. A study visit took him to London/Ontario, Canada in 1992. In 1983, he obtained the FMH specialist title in neurology and he was promoted to clinical senior physician at the Neurological Clinic.
Stroke Unit
Since the fall of 1994, he has also had under him the professional management of the Department of Cerebral Ultrasound Diagnostics, and in 1997 he was appointed senior physician. Accompanying his clinical activities, he has been instrumental in developing the coordinated assessment and treatment concept for stroke, the so-called “Stroke Unit.” His research work and publications deal with cerebrovascular diseases. It is a member of several national and international professional societies, including the Cerebrovascular Working Group of Switzerland (Secretary – Chair).
Stroke – what is it actually?
Dr. Lyrer: According to the World Health Organization definition, a stroke or cerebrovascular accident is a localized disorder in the brain. The cause is insufficient or a complete lack of blood flow. Characteristic of a stroke are symptoms that indicate loss of certain brain functions and that last longer than 24 hours. Sudden death with no indication of other causes is also indicative of a stroke. In some – albeit rare – cases, there is a total loss of all brain functions. This happens, for example, in patients in a coma or in patients with hemorrhage in the so-called spinal tissue of the brain (subarachnoid space).
What risk factors for stroke can you eliminate yourself?
Changes in personal lifestyle can protect against brain stroke. For example, one can change harmful habits or improve overall health. High blood pressure is one of the common risk factors. About 70 percent of all stroke victims suffer from it. Diabetes or too much cholesterol are other risk factors. In addition, all types of heart disease, such as atrial fibrillation, infarctions, artificial heart valves or other heart defects also increase the risk. Another reason can be arteriosclerosis: If the carotid artery, which supplies blood to the brain, is hardened by arteriosclerosis, this causes a high risk.
How specifically can you protect yourself from stroke?
You can try to limit all known risk factors, as already mentioned. That is, those who suffer from high blood pressure, heart disease, diabetes or other conditions should definitely have them treated. Strokes often occur as a result of pre-existing, other conditions. Low-fat diets and moderate exercise are also recommended for prevention. And those who smoke should limit this habit if possible or give it up altogether.
Does stroke occur more frequently in certain age groups or according to gender?
Now we are talking about those risk factors that cannot be eliminated. After all, you can’t influence age or gender. But strokes do occur in people as young as twenty or thirty. Why? For example, strokes occur more frequently in certain families. Such cases in family members are a risk factor in themselves. Metabolic disorders or other existing diseases can also cause strokes at a young age. Belonging to certain ethnic groups also increases the risk: in the USA, for example, there are demonstrably fewer white stroke patients than blacks or Hispanics. Another risk is posed by strokes that have already been suffered. Those who have already had a stroke are more likely to suffer another than those who have not. As for gender, men under eighty have a higher risk than women. After age eighty, on the other hand, there are more female stroke patients than male. But that may be because there are simply more women in that age group.
How do you recognize a stroke?
The most common symptoms are paralysis or numbness in the arm or leg on the same side of the body. Often, speech or writing difficulties also occur. Or the patient may react in a confused manner and no longer know where he or she is or what he or she is doing.The vision of one eye may be impaired, or double vision may occur. Another typical symptom is simultaneous paralysis of both arms and legs. Anyone who suspects a stroke is best advised to consult a doctor, given the wide variety of possible symptoms. He or she can then make a definite diagnosis thanks to his or her experience.
Should you take a stroke patient to the hospital?
Yes, as soon as possible. In concrete terms, this means: first call an ambulance, then the family doctor and ask him for advice. If the ambulance arrives first, however, don’t wait for the primary care physician. A stroke can progress. Another attack can occur within a few hours. Therefore, in any case, go to the hospital as soon as possible.
How many patients die during transport?
A severe stroke can be fatal. But deaths in transport are rare. The biggest problem with a stroke is the sudden dependency that develops. Stroke patients cannot continue their normal lives. They become invalids. Of all stroke patients admitted to our hospital, only seven percent die in the first fourteen days. The death rate in the first year after a first stroke is twenty to thirty percent. But many of these patients succumb to other conditions, such as heart disease. As stated earlier, a stroke is often the consequence of another underlying condition. You only die from a stroke if it is extremely severe.
What is the likelihood of having another stroke after a first one?
That depends on your personal circumstances. In general, the risk of having a second stroke within a year is about twelve percent. After five years, the risk rises to thirty percent. Those who suffer from narrowing of the carotid arteries and do not have the deposits in the vessels surgically removed increase their risk of a second stroke within the next thirty months to eighteen percent. Strokes, therefore, do occur more than once.
How does a stroke patient’s life change?
Strokes, as stated earlier, cause need for care. Those who are at home need help with daily activities. Or the patient may even remain so severely disabled that nursing home admission becomes necessary. Permanent speech disorders cause major communication problems. The ability to walk may be completely lost. Climbing stairs in particular causes difficulties even with partial paralysis. Those who can no longer move their hands without problems may be subjectively somewhat less restricted compared to paralysis of the legs. Forgetfulness, orientation problems or visual disturbances also hinder stroke patients. Here at our hospital, nevertheless, about sixty percent of stroke patients go home again, about twenty percent we have to admit to intensive care units, and between twenty-five and thirty percent we transfer to rehabilitation centers or nursing homes.
How do you treat a stroke?
Right now, the most effective therapy after a stroke is individualized and coordinated care for patients in a specialized stroke unit.
What happens in this special unit?
In the stroke unit, the approach is quite systematic. First, a comprehensive diagnosis is made. This is particularly important. After that, one tries to avoid every conceivable complication whenever possible. At the same time, the most effective prevention of another stroke for the individual patient is started as soon as possible. Each patient also receives individual physiotherapy, occupational therapy and speech training. The stroke unit treats each affected person exactly according to his or her needs. As a result, fewer people die and fewer nursing cases arise. The clear goal is to discharge as many patients as possible back home.
There is a lot of talk about so-called tissue plasminogen activators (tPA) in the treatment of strokes. What do these drugs do?
We have been using tPA routinely here for three years. This drug should only be used by clinics that have experience with it, in patient monitoring and good follow-up. To do this, the clinic should conduct controlled comparative studies. As in the USA, the use of tPA in Switzerland is only allowed within the first three hours after the seizure.We administer the drug intravenously after moderate and severe strokes. We do not use it for mild cases. In our hospital, about two and a half percent of all admitted patients receive tPA.
What are the side effects of this treatment?
The most important and feared side effect is the risk of brain hemorrhage. On average, six to eight percent of all patients run the risk of brain hemorrhage. However, if the risk of bleeding is carefully assessed and patients at risk are excluded from tPA treatment, such brain hemorrhages are rare. Some of these hemorrhages also remain asymptomatic. Another possible side effect is rare allergies to tPA.
What other treatment options are emerging in the future?
Treatment with ultrasound is currently a much-discussed option in the professional media. Ultrasound at a relatively low frequency can dissolve or even dissolve blood clots. That can reopen the carotid artery. I think that by five years from now the success of this method will be proven. I have some hope in ultrasound treatment.
