Stroke

Early recognition of the signs of stroke is essential to reduce brain damage and improve the chances of recovery. Symptoms vary depending on the area of the brain affected, but certain warning signs are common:

Sudden facial paralysis may occur, often affecting only one side of the face. Similarly, weakness or numbness in the arm or leg, usually on one side of the body, is common. The person may have difficulty raising both arms or may have drooping on one side of the face when trying to smile.

Speech disorders, such as difficulty speaking or understanding what others are saying, should be cause for concern. Visual disturbances, ranging from double vision to sudden loss of vision, may also be present. Finally, an intense and unusual headache, often accompanied by vomiting or severe dizziness, may indicate a hemorrhagic stroke.

It is imperative to act immediately when these signs appear, even if they seem to be fading: the prognosis depends on the speed of intervention.

Ischemic stroke results from a blood clot blocking a cerebral artery. This blockage can be caused by local thrombosis (clot formation directly in the cerebral artery) or by embolism (migration of a clot from another part of the body, often the heart). Clots can form from fatty deposits in the arteries (atherosclerosis) or be linked to heart conditions such as atrial fibrillation. In some cases, no specific cause can be identified, even after thorough investigation. Hemorrhagic stroke, on the other hand, is caused by the rupture of a cerebral vessel. This rupture can be caused by uncontrolled high blood pressure, an aneurysm, head trauma, or a congenital vascular abnormality (arteriovenous malformation, or AVM).
In young adults, certain specific causes must be considered, such as coagulation disorders, use of oral contraceptives, autoimmune diseases, or complications of pregnancy.

Stroke is frequently associated with modifiable risk factors, i.e., factors that can be targeted to reduce the likelihood of a cerebrovascular event.
One of the most common is high blood pressure. It is described as the most common modifiable risk factor. Next are diabetes, smoking, hyperlipidemia, being overweight, an unbalanced diet, a sedentary lifestyle, and excessive alcohol consumption.
Certain heart conditions, such as atrial fibrillation, also create conditions conducive to the formation of emboli that can migrate to the cerebral arteries.
Non-modifiable factors also come into play. Age is a determining factor: after 55, the risk of stroke increases significantly. Gender also plays a role, with women at increased risk of disabling sequelae. A family history of stroke, as well as certain genetic predispositions, also influence individual risk.

The diagnosis of stroke is based on a rapid and structured clinical approach. The aim is to identify the type of stroke, locate the affected area of the brain, and determine the underlying causes.
The process begins with an assessment of neurological signs. A detailed medical history is taken to establish the exact time of onset of symptoms, which is an essential criterion for eligibility for certain therapies. A physical examination completes this approach by assessing consciousness, motor functions, speech, and reflexes.
A brain scan without injection is routinely performed. This allows ischemic stroke, characterized by arterial obstruction, to be differentiated from hemorrhagic stroke, caused by a ruptured blood vessel. In some cases, magnetic resonance imaging (MRI) may be used to refine the diagnosis, particularly in subtle forms or brainstem infarcts.
Additional tests are often necessary, including blood tests, electrocardiogram, echocardiography, and Doppler ultrasound of the cervical and intracranial arteries. The aim is to identify contributing factors such as heart disease, coagulation abnormalities, or carotid stenosis.

The therapeutic management of stroke depends on its nature, how early it is detected, and the patient's profile. In all cases, it is based on the urgency of the intervention.

• In the case of ischemic stroke, treatment can be initiated within the first few hours after the onset of symptoms. Depending on certain criteria, this time frame can be extended to 24 hours. Treatment may involve intravenous thrombolysis or mechanical thrombectomy, particularly in the case of occlusion of a large cerebral vessel. A specialized emergency assessment is necessary to determine the best treatment strategy
• For hemorrhagic strokes, the priority is to stabilize the patient. This involves controlling blood pressure, correcting any coagulation disorders, and assessing the need for surgery in the event of a compressive hematoma.

In all cases, hospital care includes maintaining vital functions, preventing complications (lung infections, thrombosis, bedsores), and planning appropriate rehabilitation. Early treatment in a specialized neurovascular unit significantly improves the functional prognosis and reduces mortality.

Stroke has immediate consequences, but it can also lead to progressive complications that profoundly alter quality of life. Approximately two-thirds of stroke survivors suffer from lasting physical, cognitive, or psychological sequelae.
Common complications include motor disorders such as hemiplegia, muscle spasticity, or chronic weakness on one side of the body. Cognitively, patients may experience memory problems, attention disorders, or language disorders (aphasia). Mood disorders are also common, particularly post-stroke depression, which can sometimes be difficult to diagnose. Another significant risk is recurrence. The risk of another stroke is estimated at around 20% within five years, particularly in patients whose risk factors have not been adequately managed. Finally, secondary medical complications may occur in the acute phase: respiratory infections, bedsores, swallowing disorders, deep vein thrombosis, or epileptic seizures

Stroke prevention is mainly based on reducing modifiable risk factors. It is estimated that nearly 80% of strokes could be prevented through a healthy lifestyle and appropriate medical care.
Prevention involves strict control of blood pressure, diabetes, and cholesterol. Atrial fibrillation, a heart rhythm disorder with a high risk of embolism, must be diagnosed and treated quickly. Smoking cessation and reduced alcohol consumption are also recommended.
Adopting a healthy lifestyle is an important lever: a balanced diet, regular physical activity, adequate hydration, stress reduction, and maintaining a healthy weight are measures that everyone can take.

A stroke is an absolute emergency. If symptoms suggestive of a stroke occur, even if they are temporary, emergency services should be called immediately.
It is essential to recognize the warning signs quickly: drooping on one side of the face, weakness in an arm or leg, sudden difficulty speaking or understanding, visual disturbances, or loss of balance.
The acronym FAST (“Face, Arm, Speech, Time”) can be used as a simple guide: Face (the face is distorted, paralysis on one side), Arm (one arm drops or is difficult to move), Speech (speech is slurred, difficulty articulating), Time (every minute counts; if one or more of these signs are present, call emergency services).
Even if the signs disappear quickly, emergency consultation is necessary, as this may correspond to a transient ischemic attack (TIA), a precursor to a major stroke. Only a thorough medical evaluation can determine the cause and implement effective secondary prevention

At Hôpital de La Tour, stroke care is based on close coordination between the emergency, internal medicine, intensive care, and neurology departments. As a private acute care facility open 24/7, the hospital ensures a rapid and structured response as soon as the patient arrives.

Can a stroke occur without any identifiable risk factors?

Yes, although rare, some strokes occur in the absence of any known factors. These are referred to as cryptogenic strokes. A thorough evaluation can sometimes identify an underlying cause that was not initially obvious.

What is the optimal time frame for action in the event of a stroke?

The sooner the better. The therapeutic window for thrombolysis is 4.5 hours after the onset of symptoms, and up to 6-24 hours for thrombectomy, depending on the case.

What is a transient ischemic attack (TIA)?

It is a brief episode, lasting less than 24 hours (often a few minutes), caused by a temporary interruption of blood flow to the brain. It does not cause any lasting damage, but must be taken very seriously, as it indicates an increased risk of stroke.

Is a stroke always painful?

No. Many strokes are not accompanied by any pain, which can delay awareness. However, hemorrhagic strokes can cause severe headaches.

Is it possible to make a full recovery after a stroke?

Yes, but this depends on many factors: the severity of the stroke, the time taken to receive treatment, the location of the stroke, the patient's age, and their overall health. Only 10% of patients regain all their abilities.

Do strokes affect young people?

Yes, approximately 3-4% of strokes occur in people aged 15-45. The causes often differ from those seen in older people.

What tests can confirm a stroke?

A brain scan without contrast is the initial test of choice. MRI is used in some cases. Other tests are performed depending on the clinical context (ECG, Doppler, blood tests, etc.).

Can someone who has had a stroke drive again?

It depends on their functional recovery. A medical evaluation is mandatory before resuming driving. In the event of persistent cognitive or motor disorders, driving may be contraindicated.