Types of disorders

Types of disorders | Stroke

A cerebrovascular accident (CVA) is the medical term for stroke. Strokes are roughly classified into bleedings and infarcts. A bleeding occurs when a blood vessel bursts in the brain. With an infarct, there is a blockage of a blood vessel in the brain. Because of the blockage of an artery, the dependent part of the brain is deprived of sugar (glucose) and oxygen. A prolonged obstruction can cause irreversible damage. A temporary minor stroke is also called a TIA: Transient Ischaemic Attack. This is a temporary circulatory disturbance in the brain. A TIA is like a stroke, but will soon pass, usually within half an hour. TIAs can be a harbinger of a real stroke.

By far the most important risk factor for getting a stroke is age. The older, the greater the risk of stroke. Other important risk factors are: hypertension, impaired glucose tolerance, smoking and excessive alcohol consumption.

How to recognize a stroke?

During the acute phase the symptoms of a stroke may vary greatly. This depends on the location of the damage in the brains and the size of the area where the blood flow is impaired. Common effects of stroke are: paralysis (usually contra lateral to the involved brain site), loss of vision, difficulty speaking (aphasia), disturbances in thinking, impairment in memory, difficulty swallowing and incontinence.

Using the FAST test (Face Arm Speech Test) the symptoms of a stroke can be recognized. Face: ask the person to smile or show teeth. If the mouth is crooked or hanging down, this may indicate a stroke. Arm: ask the person to use both arms to lift and to stretch with the inside of the hand upward. If an arm is sliding or wobbling around, this may indicate a stroke. Ask the person to close his or her eyes, this avoids the visual (eye) correction if one arm starts to sink. Speech: ask the person or bystanders if a change in speech has occurred. If the person began to speak unclear or could not pronounce the correct words, this may indicate a stroke. You can also ask the person to count to ten. When he/she repeats, incorrectly pronounces or is unable to name one or more numbers, this may be the result of a stroke.

Cerebral ischemia or circulatory disorders of the brain

Cerebral ischemia or cerebral circulatory disorders are a complete or partial obstruction of the blood flow in the brain. One distinguishes here an acute form (stroke, infarct or CVA (cerebrovascular accident)) and a more chronic form of circulatory disorders (hypoperfusion).

In patients with hypoperfusion, part of the brain receives not enough blood, but just enough so that the brain does not die. As a result, there is a less well functioning of the brain. If the blood flow is even more critical (for example, with exertion or low blood pressure) a permanent damage to the brain in the form of a stroke may happen.

A cerebral hypoperfusion is usually caused by a blockage of one or several main arteries to the head for example due to vascular calcification (atherosclerosis) or narrowing of the arteries. The symptoms that may occur are transient blindness in one eye, hemiplegia, a crooked face, difficulty speaking and feeling light-headed.

The diagnosis is often made through a combination of cerebral angiography, CT and/or MRI in which the blood flow to the brain is examined by a contrast.

Cerebral circulatory disorders can occur at any age, but most frequently in patients older than 50 years, both in men and women. The risk is greater if you smoke, have diabetes and/or general affected blood vessels.

Treatment consists primarily of taking medication such as blood thinners (aspirin), so that the platelets are less likely to clot. Sometimes, a single constriction of the main artery of the neck is the cause. This can be treated with a stent placement or a surgical procedure. Also very localized narrowing in the head can be opened with a stent. A stent is an open metal mesh tube that is inserted through the artery by the interventional neuroradiologist. In some cases there may still be residual symptoms of circulation problems and then a cerebral bypass (override) can be considered. This bypass is performed under general anesthesia through an operation. The aim of treatment is to improve the blood circulation in the brain through a surgical vascular connection between arteries from outside to inside of the skull. In most cases, a superficial temporal artery, is used for this procedure. This artery is connected to one of the brain arteries located on the surface of the brain through a small hole in the skull.