Schlaganfall

A stroke happens when part of the brain loses its blood supply. About 85 percent are ischaemic, caused by a clot blocking an artery. The rest are haemorrhagic, caused by a burst vessel bleeding into or around the brain.

Brain cells begin to die within minutes, so stroke is a medical emergency in which speed decides the outcome. A transient ischaemic attack, or mini-stroke, produces the same symptoms which clear within 24 hours, usually within an hour, and is a warning that a full stroke may follow in the next days.

Symptome

• Gesicht hängend auf einer Seite
• Weakness or numbness of an arm or leg, usually on one side
• Slurred speech, or difficulty finding or understanding words
• Plötzlicher Verlust des Sehvermögens auf einem Auge oder auf einer Seite
• Sudden dizziness with unsteadiness or double vision
• Sudden severe headache unlike any before
• Confusion or collapse

Ursachen und Risikofaktoren

Ischaemic strokes arise from atherosclerosis in the neck or brain arteries, clots from the heart (most often due to atrial fibrillation), disease of the small deep arteries from high blood pressure and diabetes, and, in younger people, a tear in a neck artery or a clotting tendency. Haemorrhagic strokes are due mainly to high blood pressure, amyloid change in older vessels, ruptured aneurysms, vascular malformations and anticoagulant treatment. Major risk factors are hypertension, smoking, diabetes, high cholesterol, obesity, inactivity and heavy drinking.

Wie es diagnostiziert wird

• Urgent CT or MRI of the brain: Separates clot from bleed, which determines all treatment.
• CT or MR angiography: Finds a blocked large artery suitable for clot retrieval and shows the neck arteries.
• ECG and prolonged heart rhythm monitoring: Search for atrial fibrillation, which may be intermittent.
• Carotid ultrasound: Measures narrowing of the neck arteries.
• Echocardiography: Looks for clots, valve disease or a patent foramen ovale.
• Blood tests: Glucose, cholesterol, clotting and blood count.

Behandlungsmöglichkeiten

• Thrombolysis: A clot-dissolving drug given in a vein within 4.5 hours of onset in eligible patients.
• Mechanical thrombectomy: Catheter removal of a clot from a large artery, usually within 6 hours and up to 24 hours in selected cases.
• Stroke unit care: Monitoring, swallowing assessment, early mobilisation and prevention of complications improve outcomes for every patient.
• Secondary prevention: Antiplatelets, or anticoagulants for atrial fibrillation, plus intensive blood pressure and cholesterol lowering.
• Carotid endarterectomy or stenting: For a symptomatic narrowing of 50 to 99 percent, ideally within 2 weeks of the event.
• Treatment of bleeds: Blood pressure control, reversal of anticoagulants, and surgery, coiling or clipping for aneurysms when appropriate.
• Rehabilitation: Physiotherapy, occupational therapy, speech therapy and psychological support, started early and continued for months.

Wenn es dringend ist

Use the FAST check: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Do this even if symptoms pass. Note the time symptoms began. Do not drive yourself, do not wait to see if it improves and never consider travelling for acute treatment.

Reisen nach Türkiye zur Behandlung

Acute stroke care must happen at the nearest stroke centre. Once you are medically stable, usually some weeks later, travel may be reasonable for an intensive inpatient rehabilitation programme of several weeks, including robotic gait and hand therapy, or for a planned procedure such as carotid surgery, PFO closure or aneurysm treatment. Check fitness to fly with your doctor, travel with a companion and plan how therapy will continue at home. Stem cell treatments for stroke remain experimental.

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