Expert interview on stroke

PD Dr. Med. Philippe Lyrer is a senior physician at the Neurological University Clinic Basel, Switzerland. He studied at the Faculty of Medicine of the University of Basel and continued his education in clinical neurology at the Department of Neurology at the University of Basel. A study visit led him in 1992 to London / Ontario, Canada. In 1983 he acquired the specialist title FMH for neurology and he was promoted to clinical senior physician of the Neurological Clinic.

Stroke Unit

Since autumn 1994 he has additionally been the technical director of the department for cerebral ultrasound diagnostics. In 1997 he was appointed senior physician. Accompanying the clinical activity, he co-developed the co-ordinated decision-making and treatment concept for stroke, the so-called "stroke unit". His research and publications deal with cerebrovascular diseases. It is a member of several national and international professional societies, including the Cerebrovascular Working Group of Switzerland (secretary - chair).

Stroke - what is it?

Dr. Lyric: According to the World Health Organization, a stroke or stroke is a localized disorder in the brain. The cause is insufficient or completely missing blood circulation. Characteristic of a stroke are symptoms that indicate the loss of certain brain functions and that last longer than 24 hours. Even a sudden onset of death without any indication of other reasons speaks for a stroke.

In some - albeit rare - cases, there is a total loss of all brain functions. This happens, for example, in patients with coma or in patients with bleeding in the so-called spider tissue of the brain (subarachnoid space).

Which risk factors for the stroke can you turn off yourself?

Changes in personal lifestyle can protect against a stroke. For example, you can change harmful habits or improve your overall health. High blood pressure is one of the common risk factors. About 70 percent of all victims of a stroke suffer from it. Diabetes or too much cholesterol are other risk factors.

In addition, all types of heart disease, such as atrial fibrillation, infarction, artificial heart valves or other heart defects increase the risk. Another reason may be arteriosclerosis: If the carotid artery, which supplies the brain with blood, hardened by arteriosclerosis, this is a high risk.

How can one concretely protect oneself against a stroke?

You can, as already said, try to limit all known risk factors. In other words, anyone who suffers from high blood pressure, heart disease, diabetes or other illnesses should be treated with it. Strokes often occur as a result of already existing, other diseases. Low-fat diet and moderate exercise are also recommended for prevention. And who smokes, should restrict this habit as possible or give up completely.

Does a stroke occur frequently in certain age groups or sexually?

Now we talk about those risk factors that you can not turn off. One can not influence the age or the sex. But strokes occur at twenty or thirty years old. Why? For example, strokes accumulate within certain families. Such cases with family members are already a risk factor on their own. In metabolic disorders or other existing diseases, it can also come at a young age to a stroke.

Belonging to certain ethnic groups also increases the risk: In the USA, for example, there are demonstrably fewer white stroke patients than blacks or Hispanics.

Another risk is already suffered seizures. Who already had a stroke, more likely to suffer another, as someone who had not yet. As far as gender is concerned, men under the age of eight have a higher risk than women. However, after the age of eighty there are more female than male stroke patients. But maybe that's because there are just more women in this age group.

How to recognize a stroke?

The most common symptoms are paralysis or numbness on the arm or leg of the same body side. Often also speech or writing difficulties occur. Or the patient is confused and does not know where he is or what he is doing. The vision of an eye may be limited or double sighted. Another typical symptom is the simultaneous paralysis of both arms and legs. Anyone who suspects a stroke is best addressed to a doctor in the wide variety of possible symptoms. He can then make a reliable diagnosis thanks to his experience.

Should I take a stroke patient to the hospital?

Yes, as fast as possible. In concrete terms, this means first calling an ambulance, then the family doctor and asking him for advice. If the ambulance arrives first, but you should not wait for the family doctor. A stroke can progress. It can also occur within a few hours, another attack. That's why in any case as soon as possible to the hospital.

How many patients die during transport?

A serious stroke can be deadly. But deaths on the transport are rather rare. The biggest problem with a stroke is the sudden dependence. Stroke patients can not continue their normal life. You become invalid. Of all the stroke patients admitted to our hospital, only seven percent die in the first fourteen days.

The death rate in the first year after a first stroke is twenty to thirty percent. But many of these patients succumb to other diseases, such as heart disease. As already said, a stroke is often the consequence of another underlying condition. A stroke only dies when it is extremely heavy.

What is the probability of having another stroke after a first one?

That depends on the personal circumstances. In general, the risk of suffering a second stroke within one year is around twelve percent. After five years, the risk increases to thirty percent. Those who suffer from narrowing of the carotid arteries and do not surgically remove the deposits in the vessels will increase their risk of a second seizure to eighteen percent within the next thirty months. Strokes are quite common.

How is the life of a stroke patient changing?

Strokes, as already mentioned, require long-term care. Those who are at home need help with their daily work. Or the patient may even be disabled enough to require admission to a nursing home. Permanent speech disorders cause great communication problems. Walking is possibly completely lost. Especially climbing stairs is difficult even with partial paralysis. Those who can no longer move their hands without problems are subjectively somewhat less subjectively compared to the paralysis of the legs.

Forgetfulness, orientation problems or blurred vision also hinder stroke patients. Yet here, about sixty percent of stroke patients return home, about twenty percent are enrolled in intensive care units, and between twenty-five and thirty percent are transferred to rehabilitation centers or nursing homes.

How to Treat a Stroke?

At the moment, the most effective therapy after a stroke is the individual and coordinated care of patients in a special stroke department called the stroke unit.

What happens in this special department?

The Stroke Department is quite systematic. First, a comprehensive diagnosis is made. That's especially important. Then you try to avoid any conceivable complication whenever possible. At the same time, the prevention of another seizure, which is most effective for the individual patient, begins as quickly as possible.

Each patient also receives individual physiotherapy, occupational therapy and language training. The Stroke Unit treats each person exactly according to their needs. As a result, fewer people die and fewer nursing cases occur. The clear goal is to get as many patients home as possible.

In the treatment of strokes much of the so-called tissue plasminogen activators (tPA) is mentioned. What are these drugs doing?

We have been using tPA routinely for three years now. This medicine should only be applied to clinics that already have experience in patient monitoring and good aftercare. For this purpose, the clinic should carry out controlled comparative studies. As in the US, the use of tPA in Switzerland is only allowed within the first three hours after the seizure. We administer the drug intravenously after middle and heavy strokes. In light cases, we do not use it. We receive about two and a half percent of all patients admitted with tPA.

What are the side effects of this treatment?

The most important and dreaded side effect is the risk of cerebral hemorrhage. On average, six to eight percent of all patients run the risk of cerebral hemorrhage. If one clarifies the danger of bleeding exactly and excludes the endangered patients from the tPA treatment, such cerebral hemorrhages are rare. Some of these bleeding also remain without symptoms. Another potential side effects are rare allergies to tPA.

What other treatment options will emerge in the future?

Ultrasound treatment is a much discussed option in the medical media. Ultrasound at a relatively low frequency can dissolve or even dissolve blood clots. This can reopen the carotid artery. I think that until five years the success of this method will be proved. In the ultrasound treatment, I put some hope.

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