Stroke

A stroke or cerebrovascular accident (CVA) is an acute medical condition characterised by a sudden disruption of blood flow to the brain.

Strokes can be divided into cerebral infarctions and brain haemorrhages.

In Belgium, an average of 52 people suffer a stroke every day.

In the case of a stroke, one or more of the following symptoms occur suddenly:

• Sensory impairments or paralysis on one side of the body or face
• Speech and language disorders: difficulty in articulating, finding or understanding words
• Loss of vision in one or both eyes
• Half-sided visual field loss in both eyes
• Loss of balance
• Issues with coordination
• A very severe headache: the so-called 'thunderclap headache’, the worst imaginable headache that comes on very suddenly (a fraction of seconds)

When these symptoms resolve quickly on their own (after minutes or hours), it is referred to as a TIA (transient ischemic attack).

With signs of stroke, patients should come to A&E as soon as possible. 'Time is brain'. The sooner you are in hospital, the better the treatment options.

After questioning and a clinical exam of the patient, a brain scan will be performed as soon as possible if a stroke is suspected. Then, we will know whether it is a brain haemorrhage or a cerebral infarction. Next, the neurologist, in consultation with the radiologist, will discuss the diagnosis and treatment options with the patient or his or her representative.

When a cerebral infarction occurs, supportive measures are always taken and preventive treatment is also initiated to avoid new infarctions. In certain cases, and provided the patient arrives at the A&E very quickly, more specialised treatments may be possible. The timing and speed of these specific treatments are crucial for the patient’s chances of recovery.

• Thrombolysis: a clot-dissolving drug is administered via IV to try to reduce or dissolve the clot.

• Thrombectomy: a catheter is inserted into the groin and advanced to the blood vessels in the brain, where efforts are made to trap and remove the clot by withdrawing the catheter. In all of Flanders, only a few hospitals are authorised to perform this procedure. Within the E17 Hospital Network, there is a team of specialised radiologists who can perform this procedure. If this treatment is indicated, any patient of a hospital in the E17 Hospital Network can access this procedure.

In the event of a brain haemorrhage, the primary focus is to take measures to prevent additional damage to the brain

• lower the blood pressure
• improve clotting
• avoid increased pressure in the brain

For certain types of bleeding caused by abnormally formed blood vessels (e.g. aneurysms), the problem is identified and treated by an interventional radiologist or neurosurgeon. In the case of a brain (or meningeal) haemorrhage, there is also a consult with a neurosurgeon to assess whether surgical intervention is necessary to stop the bleeding or to reduce the pressure on the brain.

After acute care in the A&E, the patient is admitted for specialist care on the Stroke Unit. Here, patients receive continuous neurological and cardiac rhythm monitoring. Patients may be admitted to the Intensive Care Department when more intensive treatment e.g. ventilation) is needed.

On the Stroke Unit, patients are cared for by specifically trained nurses and there is the possibility of continuous monitoring of the brain, heart and lung functions. A multidisciplinary team initiates treatment and rehabilitation immediately. There is smooth cooperation between the neurologists and the radiology and cardiology departments as well as with the rehabilitation physician. Patients can often leave this specialised department after 48 hours. Sometimes, patients have recovered enough to go home, while in other cases, further admission to the Neurology Department or later to the Rehabilitation Department may be necessary.

Strokes are a leading cause of death and also a major cause of disability. The symptoms that occur and their degree of recovery depend on the type of stroke, the part of the brain that is damaged, and the size of the affected area.

Some of the possible symptoms include:

• paralysis, often affecting one side of the body
• spasticity = stiffness
• vision issues: loss of one of the visual fields or double vision
• memory disturbances, concentration issues, cognitive impairments
• speech and comprehension problems
• difficulty chewing/swallowing
• behavioural changes
• depression, lack of initiative, loss of interest
• dizziness, impaired balance
• urinary problems, incontinence
• epileptic seizures
• fatigue

These impairments can be permanent and have a significant impact on daily functioning and quality of life. After a stroke, the patient is also subject to a legal driving ban for at least six months.

Information sessions for patients and family members are regularly organised within the E17 Hospital Network at the different hospitals. At these free information sessions, you'll learn about what a stroke is, the potential risk factors and the treatment options. We want to address the many questions you may have. These information sessions are for patients and their informal carers or close relatives, as well as interested parties. These sessions are regularly repeated. You can choose for yourself which information session(s) you wish to attend. Registration is required.

More information

• Brain Damage League
• Belgian Stroke Council

Latest publication date: 25/10/2024
Supervising author: Dr Aers Isabelle