Stroke, also known as a cerebral hemorrhage, embolism, thrombosis, or cerebrovascular accident (CVA), refers to the sudden interruption of blood flow to a part of the brain. The lack of blood and oxygen can cause brain cells (neurons) to die, leading to permanent brain damage. The severity of the consequences depends on how long the blood flow is reduced and which area of the brain is affected.

Stroke is the second leading cause of death in Spain, the leading cause of death in women, and the main cause of disability in adults. It is also one of the main causes of dementia. One in six people will suffer a stroke during their lifetime, and about 50% of them will either die or be left with disabling sequelae.

causascausasCauses

Causes

There are two main types of stroke:

1. Ischemic Stroke (Cerebral Infarction)

Caused by the obstruction of a blood vessel, mainly due to:

  • Atherosclerosis, which promotes clot (thrombus) formation in the vessel wall.
  • Cardioembolic causes, when heart valve disease or heart rhythm disorders (such as atrial fibrillation) lead to clot formation in the heart that travels to the brain.

Ischemic strokes account for approximately 85% of all strokes.

2. Hemorrhagic Stroke (Cerebral Hemorrhage)

Occurs when an artery ruptures, causing bleeding in the brain. It accounts for about 15% of strokes.

Risk Factors

  • High blood pressure (most important risk factor; increases risk fivefold)
  • High cholesterol
  • Diabetes mellitus
  • Smoking
  • Excessive alcohol consumption
  • Heart disease (e.g., atrial fibrillation, valve disorders)
  • Obesity
  • Sedentary lifestyle
sintomassintomasSymptoms

Symptoms

Each area of the brain controls different functions, so symptoms vary depending on the affected region. A stroke should be suspected if any of the following appear suddenly:

  • Loss of strength or sensation on one side of the body
  • Difficulty speaking or understanding speech
  • Loss of vision in one or both eyes, or double vision
  • Loss of balance or difficulty walking
  • Sudden, severe headache unlike previous headaches
DiagnosticoDiagnosticoDiagnosis

Diagnosis

Neuroimaging tests differentiate between ischemic and hemorrhagic stroke:

  • CT scan (brain CT)
  • MRI (brain MRI)
  • CT angiography or MR angiography, which provide detailed images of blood vessels

Once stroke is confirmed, additional tests (blood tests, cardiac evaluation, Doppler ultrasound of supra-aortic trunks) are performed to determine the cause.

tratamientostratamientosTreatment

Prevention

Up to 80% of strokes can be prevented by controlling vascular risk factors through:

  • Quitting smoking
  • Limiting alcohol intake
  • Healthy diet (rich in fruits and vegetables, low in saturated fats)
  • Regular physical activity (e.g., moderate walking or swimming 30 minutes daily)
  • Regular monitoring of blood pressure, heart rhythm, glucose, and cholesterol
  • Proper adherence to prescribed medications

Treatment

Treatment of Ischemic Stroke

It has two phases:

1. Revascularization Treatment

Aimed at reopening the blocked vessel. It must be administered within the first hours after symptom onset.

  • Intravenous thrombolysis: Administration of tissue plasminogen activator (tPA) to dissolve the clot.
  • Mechanical thrombectomy: A catheter is inserted through the groin artery and guided to the blocked vessel to remove the clot. Used when thrombolysis fails or in large vessel occlusions.

2. Secondary Prevention

Medications are used to prevent new clots:

  • Antiplatelet agents or anticoagulants
  • Blood pressure medications
  • Diabetes medications
  • Cholesterol-lowering drugs

Treatment of Hemorrhagic Stroke

Treatment depends on the location of the bleeding:

  • In subarachnoid hemorrhage due to aneurysm rupture, catheterization through the femoral artery allows sealing of the aneurysm using coils.
  • If not suitable for catheter treatment, surgical intervention may be necessary.
  • In cases of intracerebral hemorrhage, surgery may be considered to evacuate the hematoma.

Rehabilitation

After a stroke:

  • One-third of patients recover satisfactorily.
  • One-third have severe disabilities.
  • One-third do not survive.

Sequelae may include:

  • Mobility problems
  • Speech difficulties
  • Vision impairment
  • Swallowing problems
  • Mood changes
  • Cognitive impairment

Rehabilitation aims to achieve maximum independence and social reintegration. It should begin as early as possible during hospitalization, as early treatment improves outcomes.

Rehabilitation is intensive and multidisciplinary, involving physicians, nurses, physiotherapists, occupational therapists, neuropsychologists, and social workers.

Most recovery occurs within the first three months, although improvement may continue more slowly for up to a year.

Specialties:
  • Neurology