Stroke and Preventive Treatments

What is a Stroke?

Cerebrovascular diseases are clinical conditions that occur due to blockage or bleeding in the blood vessels of the brain, causing temporary or permanent impairment of the functions of a region of the brain. They are among the leading causes of both death and disability worldwide. However, the fact that cerebrovascular diseases are largely preventable and their onset can be prevented with appropriate preventive treatments has led to a significant increase in efforts to raise public awareness about these diseases in all countries.

Cerebrovascular diseases may present with transient symptoms. Cases that resolve without leaving permanent damage, where the underlying cause is temporary vascular occlusion, are called transient ischemic attacks. Although these patients show improvement, depending on the underlying cause, they carry the risk of recurrent attacks and the emergence of permanent disability. Vascular diseases with permanent symptoms are generally referred to as stroke. Approximately 85-90% of strokes are caused by permanent blockage of the brain's blood vessels and are called ischemic strokes. Approximately 10-15% are caused by bleeding in the brain's blood vessels and are called hemorrhagic strokes.

What Are the Risk Factors for Stroke?

Risk factors are factors that facilitate the onset of stroke. Although they vary across populations, the most common ones, and more importantly, those that can be controlled to significantly reduce stroke risk, are modifiable risk factors closely related to lifestyle, such as hypertension, diabetes, obesity, hypercholesterolemia, smoking, excessive alcohol consumption, and physical inactivity.

What Are the Causes of Stroke?

Stroke can occur for many reasons. Hemorrhagic stroke is mostly related to hypertension. Pathologies developing in the vessel walls with aging increase the risk of bleeding in the brain vessels. Various vascular pathologies, medications, brain tumors, and blood disorders are among the other less common causes of brain hemorrhage.

The most common causes of ischemic stroke include brain embolisms associated with heart disease and atherosclerosis, a condition known as hardening of the arteries, which develops in the artery walls as a result of the risk factors mentioned above. Many systemic diseases (hematological, rheumatological diseases, infections, malignant diseases), vascular wall tears (dissection) resulting from trauma or developing spontaneously, and genetic diseases can also lead to stroke.

What are the symptoms of stroke?

The clinical signs and symptoms that appear in patients with stroke are very diverse. Damage to the blood vessels supplying different areas of the brain leads to impairment of the functions associated with that area.

• Weakness (paralysis) or loss of sensation in the arms and legs,
• Speech impairment (inability to speak, understand speech, or pronounce words correctly),
• Facial drooping, visual impairment (blurred vision, double vision, visual field defects),
• Dizziness,
• Imbalance,
• Difficulty walking are the most common symptoms caused by stroke. Depending on the location and extent of the disease, many different symptoms such as headache, forgetfulness, and behavioral changes may also be seen.

Stroke and Preventive Treatments

In order to prevent stroke, it is very important to investigate the risk factors that may lead to stroke in each patient through detailed examinations. The goal should be to identify existing risk factors before a stroke occurs, control them, modify them, and prevent a stroke. This is called primary prevention. Any preventive approach taken to prevent recurrence in patients who have had a stroke before is called secondary prevention. First, brain imaging (cranial CT and/or cranial MRI) and vascular imaging (CT angiography, MR angiography, cerebral angiogram) should be performed in patients with clinical signs and symptoms suggestive of stroke. Depending on the patient's characteristics, blood tests, cardiac tests, tests for systemic diseases, and genetic tests, if necessary, are performed to investigate risk factors. Based on the results of these tests, planned treatments may enable patients to continue their lives without ever having a stroke or without a recurrence of stroke.

Patients who have had an ischemic stroke need to take anticoagulant drugs, which have different mechanisms of action. These drugs significantly reduce the risk of recurrence, but patients must be carefully evaluated and monitored for any undesirable effects these drugs may cause. Controlling patients' risk factors, regular use of anticoagulant drugs, and performing vascular treatments in patients who require them significantly reduce the incidence of severe sequelae. Vascular treatments performed in advanced centers (carotid endarterectomy or angioplasty/stenting) are very important in reducing the risk of stroke recurrence.

Both cerebral hemorrhages and cerebral vascular occlusions require urgent intervention as soon as they occur. In hospitals where emergency treatment is available, treatments that reduce vital risks and minimize sequelae are administered first. It is recommended that patients be monitored in intensive care units during the acute phase.

Treatment plans for patients presenting with hemorrhagic stroke are based on the location and size of the hemorrhage and the underlying cause. Some patients require surgical intervention, while others only require treatment and monitoring of vital signs.

Patients presenting with ischemic stroke may receive thrombolytic therapy (to dissolve blood clots in the brain vessels), thrombectomy (to remove blood clots from the vessels), or both, depending on the time of onset and the patient's clinical characteristics.

Despite significant advances in the treatment and prevention of cerebrovascular diseases in recent years, some patients may experience significant functional losses due to stroke. In these patients, it is possible to achieve encouraging results with physical therapy and rehabilitation programs that begin as early as possible. After experiencing a stroke, patients should be regularly monitored in the outpatient clinic, and regular check-ups and treatment plans should be made according to the risk of recurrence. It should not be forgotten that stroke is a preventable disease. Preventive measures are much easier than treatments administered after the disease has developed.