Stroke, cerebral infarction, insult, apoplexy
Every year, around 16,000 men and women in Switzerland suffer a stroke (stroke, cerebral infarction, insult or apoplexy). This is always a medical emergency that must be treated as quickly as possible.
There are two different types of stroke: an ischemic stroke, i.e. reduced blood flow to the brain, and a hemorrhagic stroke, i.e. a cerebral hemorrhage. Both forms can lead to impairments throughout the body, depending on the area of the brain in which the stroke has occurred. This is because each brain region controls different bodily functions.
Those affected often feel as if the stroke has come suddenly, as if with a single blow. This is why this dramatic dysfunction in the brain is also known as a stroke. In around 85 percent of cases, it occurs because a blood vessel in the brain is blocked. This means that the blood supply in the underlying part is interrupted and the associated bodily functions are literally paralyzed, resulting in paralysis, speech disorders, dizziness, visual disturbances and other neurological deficits. If the blood vessel is not reopened within a short time, these disorders persist. In about 15 percent of cases, however, it is a hemorrhage in the brain: a vessel has burst, which increases the pressure in this area. Strokes mostly affect older people, around four-fifths of whom are over 60 years old. But younger people can also have a stroke.
Both forms of stroke, the more common ischemic stroke and the hemorrhagic stroke, have different causes.
In an ischemic stroke, a blood vessel in the brain is blocked. As a result, the underlying tissue is more or less cut off from the blood supply, and oxygen and sugar are no longer sufficiently available. If this condition lasts longer, the undersupplied area dies off. In addition to various rare causes, there are two common mechanisms for vascular congestion:
The most common cause of a hemorrhagic stroke is high blood pressure. The blood vessels are permanently overloaded by the high blood pressure and can tear. If this happens in the brain, a cerebral hemorrhage occurs. The escaping blood exerts mechanical pressure on the surrounding area. The surrounding nerve cells are damaged. In addition to high blood pressure, there are rare causes of cerebral hemorrhage, such as vascular malformations in the brain.
There are various factors that significantly increase the risk of a stroke. You cannot influence two of them. These are:
However, there are four times as many other known risk factors for which you can reduce the risk of a stroke yourself with medical support:
Most strokes can be recognized within a few seconds using the FAST symptom check.
There are a number of signs that may indicate a cerebral infarction. They are so different because they depend on which area of the brain is affected by the stroke and which bodily functions are impaired by the resulting deficiency. These are mostly neurological deficits. The most common symptoms are
The symptoms usually occur suddenly. Exception: They wake up in the morning with symptoms (wake-up stroke), i.e. they did not register when they started because they were asleep at the time. But it doesn’t matter whether you notice these symptoms from one minute to the next or only in the morning, whether they are dramatic or mild: You should always call the emergency services (144) immediately or have them call you. Because every minute counts when treating a stroke. A stroke can be life-threatening. And the more time that passes before treatment begins, the greater the risk of permanent damage.
In the event of neurological deficits, the ambulance service usually takes the patient immediately to a specialized center (stroke unit, stroke center). As a stroke center, the USZ offers all the possibilities of modern stroke care at any time of day or night. Specialists from neurology, neuroradiology and neurosurgery work closely together on an interdisciplinary basis. Other hospitals with a stroke unit carry out the necessary diagnostics and transfer patients to the stroke center if necessary. The diagnosis must be made very quickly and consists of a neurological examination to clarify the symptoms in more detail: Computed tomography or MRI. The CT scan helps to determine whether it is ischemia or a cerebral hemorrhage, i.e. whether a blood vessel is blocked or has burst. This distinction is important because the acute treatment of these two forms of stroke is very different.
In the further course, the cause of the stroke must then be clarified with the help of:
The USZ offers all the possibilities of modern stroke care at any time of day or night. Specialists from neurology, neuroradiology and neurosurgery work in three shifts to achieve this. This ensures high-quality care even at night and at weekends. The Stroke Center at the USZ is very active in research, both in the network of all stroke specialists in Switzerland and with its own studies on therapies in acute treatment and rehabilitation. At the USZ, you will find the right specialist for every stroke-related problem in an emergency and long after the acute phase.
The risk of a stroke can be reduced if you control and treat the common risk factors in particular. We can advise and help you with this as part of our specialized stroke consultation hours:
In addition, an ultrasound examination of the blood vessels, such as the carotid artery, can show whether the blood vessels are in good condition or whether the innermost layer of the vessel wall has changed – an important indication of arteriosclerosis. Of course, regular blood pressure checks complement the stroke prevention program.
Ultimately, a stroke can be life-threatening. In industrialized nations such as Switzerland, stroke is the third leading cause of death. It can lead to lifelong disabilities, but also to dementia. This results in enormous costs for the healthcare system (direct healthcare costs alone amount to over CHF 700 million per year).
A stroke is therefore always a medical emergency and treatment should start as soon as possible. Every minute counts. If therapy is started as soon as the first symptoms appear and only a small area of the brain is affected, the stroke can, in the best case scenario, have no consequences.
Unfortunately, sometimes the therapy does not work quite as quickly, and more or less impairing functional disorders remain – such as speech disorders and partial paralysis. However, with the appropriate neurorehabilitation, these can disappear or at least be alleviated over time. The brain develops the ability for intact areas to learn and take over the tasks that were lost with the damaged areas. However, this often requires a lot of time, but also the strength, will and motivation of those affected.
The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.
Depending on whether it is an ischemic stroke or a hemorrhagic stroke, the therapies differ fundamentally.