Does the brain fog ever go away
stroke (Stroke, cerebral infarction, apoplexy): Sudden circulatory disorder in a part of the brain, which is typically associated with severe neurological deficits such as speech disorders or paralysis. The main cause of these circulatory disorders are arteriosclerotic changes in the cerebral vessels. Around 270,000 strokes occur in Germany every year. Most people over 70 are affected, but strokes can also occur in younger people, e. B. as a result of untreated high blood pressure.
Stroke is the third leading cause of death in Germany. One in five patients died within four weeks, and one in two survivors remains in need of permanent care. Stroke is therefore also the most common cause of permanent disability in adulthood.
In order to improve the chances of survival and to save as much brain tissue as possible, intensive therapy should be initiated as soon as possible in the event of a stroke, combined with lysis therapy or the removal of a thrombus (thrombectomy) by a neuroradiologist, depending on the cause. After surviving a stroke, patients usually receive long-term therapy with a blood thinner or a platelet aggregation inhibitor to prevent further events.
Depending on which brain region is affected, the following occurs:
- Paralysis on one half of the body (e.g. the right arm, leg and / or the right half of the face e.g. in the form of a drooping corner of the mouth)
- Sensory disturbances on one side of the body, such as tingling or numbness or not feeling touch
- Visual disturbances (e.g. double vision, blurred vision, one-sided vision loss)
- Balance disorders (e.g. dizziness, "falling over" when trying to sit, unsteady walking "like drunk")
- Difficult or unclear speaking (e.g. twisted syllables, "word salad") or even inability to speak
- Difficulty understanding what is being said
- Loss of bladder and / or bowel control
- Failure to recognize and ignore parts of the body, e.g. B. the paralyzed arm
- Impaired consciousness, e.g. B. confusion or agitation, but also drowsiness or loss of consciousness
- Symptoms often start early in the morning, e.g. B. after getting up
- Mostly sudden onset of failures, rarely progressing over hours.
When to the doctor
Immediately to the family doctor or internist, if
- the symptoms listed occur even if they have disappeared after a few minutes.
- Note: the stroke is an emergency! Treatment within the first few hours is essential for a long-term prognosis.
If the cerebral blood flow is impaired, the function of the sensitive nerve cells is disturbed after just a few minutes. If only a very small area of the brain is affected, it can go unnoticed. As a rule, however, failures such as B. paralysis or speech disorders.
If the blood circulation returns to normal quickly, the nerve cells recover and the failures recede completely. If the circulatory disturbance lasts longer, however, the nerve cells die. Long-term effects then almost always persist.
Two common causes
The "stroke" is initially a collective term for all sudden circulatory disorders of the brain that lead to prolonged failures. Many causes and diseases can be concealed behind these serious circulatory disorders, which can be divided into two groups: the stroke due to a vascular occlusion and the stroke due to a cerebral haemorrhage.
A Vascular occlusion is the cause of a stroke in about 85% of cases. The brain tissue "behind" the blocked vessel does not receive any blood and thus no more oxygen and dies. One then speaks of one stroke (Brain ischemia, ischemic stroke).
- The most common cause of such a vascular occlusion is vascular calcification (arteriosclerosis). The arteriosclerotic deposits narrow a carotid artery or a vessel within the brain more and more until a tiny clot is sufficient to cause a complete occlusion. But even if the deposits do not completely close the vessel, there is a risk of a stroke: Detached particles can get into smaller brain vessels with the blood and eventually block them (cerebral embolism).
- The second most common cause is blood clots in the heart, such as: B. as a result of atrial fibrillation, parts of which are carried away with the bloodstream and obstruct a cerebral vessel.
- Rare causes are e.g. B. vascular inflammation or an increased tendency of the blood to clot, so that the blood clumps without any particular cause. These causes play a role especially in younger people.
- In about 20–25% of ischemic strokes, the cause remains unclear despite extensive diagnostics.
In the remaining 15% of stroke patients, bleeding into the brain is the cause of the stroke. This is called Cerebral hemorrhage (intracerebral hemorrhage, cerebral mass hemorrhage). The bleeding compresses and damages the brain. Such bleeding often occurs when a vessel that has previously been damaged by high blood pressure bursts (hypertonic mass bleeding); more rarely, a congenital weakness of the vascular wall is the cause.
Possible triggers for a stroke. Most of the time, constrictions or occlusions of the arteries supplying the brain or blood clots emanating from the heart are the cause of a stroke.
Georg Thieme Verlag, Stuttgart
Warning: TIA (Transient Ischemic Attack)
A short-term Circulatory disorder of the brain (without Evidence of a complete cerebral infarction) with temporary The doctors call neurological failures TIA, also known colloquially as "mallets". It comes z. B. paralysis that lasts too briefly, sensory disturbances (e.g. one arm) or visual disturbances. Usually these symptoms only last a few minutes and then go away. Despite the spontaneous improvement, the TIA is often a harbinger of a stroke, and the risk is particularly high in the first few days afterwards. Therefore, the cause should be clarified as quickly as possible, ideally on the same day, in order to avert the impending stroke in good time.
High blood pressure increases the risk of a stroke by 4–5 times, and atrial fibrillation up to 15 times. Other important risk factors are
- Diabetes, lipid metabolism disorders
- Smoking, alcohol abuse, and cocaine abuse
- Sedentary lifestyle
- Stress and depression
- Clotting disorders
- Pregnancy, taking the "pill", hormone replacement therapy.
Time is Brain - time is brain. Since the brain cells are very sensitive, they die after a short time without an oxygen supply. Therefore, if a stroke is suspected, it is important to advance the diagnosis as quickly as possible. Ideally, it starts on the way to the hospital. The patient is connected to a monitoring monitor to check breathing and circulation and an EKG is used to determine cardiac arrhythmias.
In the clinic, blood samples are taken to assess the metabolic status and to rule out other causes (see below, differential diagnoses). Experienced neurologists carry out a focused examination for a wide variety of neurological failures and abnormalities. The examination of facial motor skills (baring teeth, puffing up cheeks, smiling, frowning), arm and leg motor skills and testing language comprehension and speaking are suitable for a quick, orientating assessment.
Computed tomography or, alternatively, magnetic resonance imaging of the skull is performed as soon as possible, but no later than 25 minutes after admitting the patient. If cerebral haemorrhage is excluded as the cause, doctors immediately start treatment (see below).
Left: An X-ray of the cervical arteries of a 57-year-old patient with hemiplegia shows a severe narrowing of the left internal cervical artery (arrow). Right: The finding is even more pronounced in a 72-year-old patient with TIAs: This shows two severe vascular constrictions, the first (arrow below) at the branch of the cervical and arm arteries on the right, the second (arrow above) in the left cervical artery.
Georg Thieme Verlag, Stuttgart
Differential diagnoses. In up to 30% of all suspected stroke cases, the sudden neurological failures are due to other causes. The most important of these are low blood sugar (hypoglycaemia), alcohol intoxication, nerve damage, migraines with aura, epileptic seizures and sepsis.
Immediate intensive care therapy
The faster the cerebral blood flow is normalized, the greater the chances of survival. The same applies to the regression of neurological deficits, even with pronounced symptoms. The time window for possible treatments is small, however, it closes 4.5 hours after the onset of the complaint.
The cornerstone of medical treatment is optimal adjustment of the cardiovascular situation, respiratory function and metabolism. Sufficient blood pressure and the additional supply of oxygen via a nasal tube can mean the difference between survival or destruction for damaged but not yet dead nerve cells and the difference between independence and the need for help in everyday life for the patient. High blood sugar and fever are unfavorable and require treatment. The fluid balance is regulated by means of infusions.
Restoration of blood flow during a cerebral infarction
If a cerebral haemorrhage and other contraindications are excluded, the doctors try to restore the blood flow in the areas of the brain with less blood flow. There are currently two procedures for this
- Thrombolysis Therapy (Lysis Therapy)
- Mechanical thrombectomy.
In the Lysis therapy one tries to dissolve the blood clot with the help of medication. For this purpose, fibrinolytics such as Alteplase (e.g. Actilyse®) are administered via an infusion. Such a therapy is only promising within the first 4.5 hours after the onset of the complaint; it is only used later in individual cases. Lysis is also fraught with risks, especially the risk of cerebral haemorrhage. In addition, it must not be performed in a number of situations, such as: B. with increased risk of bleeding (fresh gastric ulcer, esophageal varicose veins), pregnancy, after previous major operations, with uncontrollable high blood pressure or impaired blood clotting. For this reason, even with early hospital admission, lysis is only used in around 20% of stroke patients.
If one of the large vessels supplying the brain is blocked by a thrombus, doctors consider one Thrombectomy. To do this, they first push a thin guide wire over the large femoral artery up to the vascular occlusion and use a contrast agent to radiographically depict the vessels and constrictions. A special small catheter is then inserted to remove the thrombus. The procedure entails a number of risks: for example, vessels can be damaged and bleeding can be triggered, clots can be carried over or vascular spasms can be caused. There is also a time window for this therapy, typically up to 6 hours after the onset of the symptoms, in individual cases longer. Because of this time window and the above-mentioned contraindications, only about 5-10% of stroke patients are suitable for thrombectomy.
For patients for whom neither a lysis nor a thrombectomy is an option, only intensive medical, symptomatic care remains in order to stabilize the condition and avoid complications. In addition, these, as well as all other stroke patients, start early rehabilitation as early as possible (see below).
Therapy for cerebral hemorrhage
In the case of a cerebral hemorrhage, no special treatments are usually possible. Surgical removal of the blood from the brain sounds logical, but has only proven beneficial for certain types of bleeding (e.g. acute subdural hematoma). It is currently being investigated whether drugs that promote coagulation can stop the bleeding quickly. As with cerebral infarction, the cornerstones of therapy are therefore intensive medical stabilization and monitoring of the patient, the avoidance or treatment of complications and, if possible, early rehabilitation.
Special text: Stroke Unit - the best for the first few days of treatment.
Treatment of complications
If complications arise, they should be treated as early as possible. In the first few days, the brain tissue can swell a lot. The resulting increase in intracranial pressure also damages the brain and must therefore be treated immediately, e.g. B. by cerebral pressure lowering drugs, drainage of the cerebral fluid via a drainage to the outside or surgical removal of the skull cover so that the brain has the opportunity to expand.
In the case of bladder dysfunction, an indwelling urinary catheter is first placed; swallowing or impaired consciousness make tube feeding necessary.
It is also crucial for the prognosis to counteract the risks arising from being bedridden. These include drug-based thrombosis prophylaxis as well as precautions against bedsores and pneumonia.
Early rehabilitative treatment
Rehabilitation measures are already used during acute therapy in order to maintain existing skills and reduce consequential damage. In addition to physiotherapy or occupational therapy and speech therapy, this also includes the Bobath concept. This was specially developed for patients with impaired function, movement and posture control due to damage to the central nervous system.
How long a patient stays in a stroke unit or in a hospital varies. The acute therapy is usually followed by 4–6 weeks of rehabilitation in specially equipped clinics.
Secondary prophylaxis against recurrence
People who have had a TIA or a stroke are at high risk of developing circulatory disorders again. Depending on the underlying disease, what is known as secondary prophylaxis by inhibiting blood clotting is therefore necessary.
- Patient With Atrial fibrillation receives therapeutic anticoagulation with coumarins (e.g. Marcumar®) or direct oral anticoagulants (DOAC), such as. B. Dabigatran (e.g. Pradaxa®) or Apixaban (Eliquis®).
- Patient without Atrial fibrillation is given a drug that inhibits the clumping of blood platelets and thus the formation of clots, usually acetylsalicylic acid (e.g. Aspirin 100®), temporarily combined with clopidogrel (e.g. Plavix®) if the risk is high.
In addition, increased blood lipid and blood sugar levels as well as high blood pressure are treated with medication. It is also important to consider other risk factors such as B. To fight overweight sustainably.
In the event of a stroke, the prognosis depends crucially on which area of the brain is affected, how severe the damage is and how quickly blood circulation can be restored. In the long term, it is just as important how well the rehabilitation is tailored to the individual needs of the patient and how well he works.
In general, young patients with minor deficiency symptoms have a greater chance that the deficiency symptoms will regress again.
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Prevention and aftercare
Switching off or minimizing risk factors is crucial for prevention, both for people who are (still) healthy and for people who have already had a stroke or TIA. The most important measures include:
- Optimize blood pressure. High blood pressure is a major risk factor for the development of vascular calcifications - and not only in the brain! Regular physical activity can have a positive effect on blood pressure. If this is not enough, discuss the problem with your doctor. If you already have high blood pressure, take your medication as directed.
- Control blood sugar. Diabetes also leads to various vascular changes, so increased blood sugar should be lowered and anti-diabetic therapy should be strictly adhered to. Another important step is a balanced and healthy diet.
- Quit smoking. Smoking not only damages the lungs, but also the blood vessels. Try to limit nicotine consumption step by step until you quit smoking completely. Nicotine replacement therapy or medication can help you quit smoking. You can find tips on smoking cessation in the article Nicotine addiction.
- Optimizing blood lipids: The main component of vascular plaques are fats.Blood lipids (especially LDL cholesterol) should be improved to prevent further growth (up to and including vascular occlusion). Again, eating a healthy diet and exercising is the most important step. Your family doctor recommends drug therapy if necessary.
- Maintain or reduce weight. Obesity is another risk factor that damages blood vessels. Regular exercise and sport contribute to weight loss and effectively lower the risk of stroke. You can find helpful tips and information about losing weight in the article Overweight and obesity in adults.
- To go for a walk. A study has shown that in women over 45 years of age, regular walks totaling at least two hours per week reduce the risk of stroke by 30 percent.
- Drink less alcohol. If you want to protect your vessels, you don't have to do without alcohol completely. There is nothing wrong with moderate alcohol consumption - but it is less than most would assume. Men should not consume more than approx. 20 g of alcohol per day (this corresponds to approx. 0.5 l of beer or 0.2 l of wine), women not more than approx 0.1 l wine).
Drugs for prevention
Medicines are used to help prevent stroke Healthy not recommended. It is different for people with pre-existing cardiovascular diseases. For patients with coronary artery disease, the use of a statin is recommended, which, in addition to its lipid-lowering effect, appears to have a beneficial effect on the blood vessels. Low-dose acetylsalicylic acid (e.g. Aspirin 100®) is also recommended - it prevents blood platelets from clumping together and thus the formation of clots in blood vessels. In the case of atrial fibrillation, bulges in the heart wall (aneurysms) or certain valve defects, anticoagulant medication (e.g. with Eliquis®) prevents clots from forming in the heart and thus a stroke.
A preventive operation or dilatation of narrowing of the carotid artery only makes sense if these are severe, progressing rapidly or have already led to a TIA. With slight or moderate constrictions and no symptoms, the risk of intervention is higher than the risk of stroke.
AuthorsDr. med. Nicole Menche in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 12:14
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