Stroke

What is a stroke?

A stroke is defined as the sudden onset of neurological deficits – for example, paralysis of one side of the body – that last at least 24 hours. In about five out of six cases, a stroke is caused by a disturbance in circulation (ischaemic stroke), and in the remaining cases by bleeding in the brain (haemorrhagic stroke).

CAUSES OF BLOOD CLOTS

An ischemic stroke occurs when an artery supplying a specific area of the brain becomes permanently blocked by a blood clot. After about 10 seconds, the affected area of the brain becomes divided into two zones with different prognoses: the region in the centre receives the least blood and contains irreversibly damaged nerve tissue. The area surrounding the core is the slightly better-perfused penumbra. Like the core zone, it is functionally inactive but not damaged irreversibly.

FULL EXAMINATION WITHIN MINUTES

Immediately after admission, a blood sample is taken, infusions are placed, ECG measurements are taken and monitoring set up, and an oxygen meter placed on the stroke patient’s finger. Afterwards, the doctor collects the patient’s medical history and examines the patient. Finally, the brain is investigated using nuclear magnetic resonance (MR) and the cerebral arteries with MR angiography to determine if the cause of the stroke is a blood clot or bleeding. This is significant in the determination of further treatment.

Patients rushed to hospital with a suspected stroke are pre-registered with the Mediclinic City Hospital Stroke Unit by the emergency services. The initial inquiries and referral for imaging are completed within a matter of minutes.

Initial examinations and the arrival of a neurologist the Stroke Unit also take place swiftly for patients who come directly to the emergency department of Mediclinic City Hospital.

TREATMENT

Dissolution of the clot with medication

A stroke should be treated as quickly as possible to keep nerve tissue damage to a minimum. The most important question for every stroke patient is therefore whether an intravenous thrombolysis can be performed to dissolve the causal clots. If this is the case, the clot-dissolving drug is administered into a vein. Intravenous thrombolysis is effective only within the first four and a half hours after the onset of symptoms.

Through a catheter to the site

In approximately 20% of stroke patients with a brain artery occlusion from a blood clot longer than 8 mm, intravenous thrombolysis removes the clot satisfactorily in only 10% to 30% of cases. Endovascular thrombolysis with a catheter is faster and much more successful at reopening the blockages. A catheter, which is taken through the femoral artery to the affected cerebral artery, removes the clot from the site. The treatment is performed in the centre which is specially designed for neuroradiological diagnostics and endovascular therapies.

Operative interventions

If a minimally invasive surgical procedure is indicated, the appropriate specialist will either be called directly to the emergency room or will arrive within the next 24 hours. The interdisciplinary team comprises neurosurgeons, cardiologists, vascular surgeons and neuroradiologists. 

Transfer to the intensive care unit (ICU)

Following the neurological, internal medicine and neuroradiological evaluation and treatment, the patient is transferred to the intensive care unit or a ward with specially trained nursing staff. A patient with an intravenous thrombolysis is monitored 24 hours a day in the ICU.

Immediate start of neurorehabilitation

The neurorehabilitation, which begins on the day after admission, is an integral and essential part of treatment. Most stroke patients are discharged after an average of seven to 10 days of treatment, either to go home to continue outpatient physical, occupational and logotherapy or to an inpatient neurorehabilitation centre for a stay of four to six weeks