Introduction
Stroke is a significant medical condition characterized by the sudden onset of neurological deficits due to vascular injury in the central nervous system. It is a leading cause of death and disability worldwide, with various subtypes and underlying mechanisms.
Key Insights
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Definition and Classification of Stroke:
- Stroke is defined as an acute onset of neurological deficits lasting more than 24 hours or resulting in death, caused by a sudden impairment of cerebral circulation .
- It includes both ischemic strokes (caused by infarction) and hemorrhagic strokes (caused by bleeding) .
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Epidemiology and Impact:
- Stroke is the third leading cause of death in developed countries, following heart disease and cancer .
- Annually, an estimated 140,000 people in France are hospitalized for stroke.
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Pathophysiology and Mechanisms:
- Stroke results from a disruption of cerebral blood flow, leading to tissue damage.
- Ischemic strokes, which account for about 85% of all strokes, are primarily caused by small vessel arteriolosclerosis, cardioembolism, and large artery athero-thromboembolism .
- Hemorrhagic strokes, making up about 15% of cases, can be deep (due to hypertensive arteriopathy) or lobar (due to cerebral amyloid angiopathy or arteriolosclerosis) .
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Risk Factors:
- Hypertension is the most significant modifiable risk factor for stroke.
- Other risk factors include cardiovascular diseases, diabetes, smoking, and obesity .
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Clinical Spectrum and Diagnosis:
- Stroke can present with a wide range of symptoms depending on the affected brain region, including sudden weakness, speech difficulties, and vision problems .
- Diagnosis involves clinical evaluation, neuroimaging, and sometimes neuropathological evidence.
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Treatment and Management:
- Acute treatment focuses on restoring cerebral blood flow and minimizing tissue damage, with the concept of an ischemic penumbra being central to treatment strategies.
- Long-term management includes secondary prevention through lifestyle changes and medical interventions to control risk factors .
Conclusion
Stroke is a complex cerebrovascular disorder with significant health impacts globally. It encompasses both ischemic and hemorrhagic types, each with distinct causes and risk factors. Effective management requires timely diagnosis, acute intervention, and ongoing prevention strategies to mitigate risk factors and prevent recurrence.