Stroke represents the third cause of death in Italy, after cardiovascular disease and cancer. Thanks to Dr. Simona Marcheselli, Head of Emergency Neurology and Stroke Unit at Humanitas, we attempt to clarify a pathology that affects at least two hundred thousand people every year, but on which there is still much confusion.


Ischemic stroke and hemorrhagic stroke

There are two types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke is the most frequent and occurs as a result of the formation – within an artery in the brain – of a thrombus, a blood clot that narrows the diameter of the vessel. This event interrupts or limits the blood circulation in that area, resulting in ischemia of the nerve cells, which stop functioning.

Hemorrhagic stroke occurs more rarely, but it is a more serious event and may be fatal. The rupture of a blood vessel causes blood to escape into the surrounding brain areas. This makes it difficult to speak and understand the words of others, double or blurred vision may occur, and it would be impossible to move one side of the body.


With what symptoms does it manifest itself?

The most frequent signs of a stroke include the following:

  • Sudden numbness or weakness in the face, arm or leg on one side of the body
  • Sudden feeling of confusion
  • Difficulties in speaking and understanding what is said by others
  • Sudden visual impairment on one eye
  • Difficulties walking, often associated with dizziness and coordination difficulties
  • Strong lightning headache, for no known or apparent cause
  • Nausea and vomiting


Who is at risk for a stroke?

Although stroke most commonly affects people over 65 years of age, one case in 100,000 affects patients under 45 years of age. The risk factors, which are increasingly common also in the younger age group include: being overweight and obesity, poor nutrition and smoking. Therefore, lifestyle plays a fundamental role and it is therefore important to ensure that children have a healthy diet, with little salt, few animal fats and rich in fruit, vegetables and vegetable proteins. Smoking and constant physical activity should neither be used to promote circulation nor to combat overweight.

The protective effect of estrogens (female hormones) on the cardiovascular system has long led to the conclusion that stroke mainly affects men. However, the incidence of an incorrect lifestyle also affects women and 43% of stroke cases are female.


How to intervene in the case of ischemic stroke?

In the case of ischemic stroke, thrombolytic or fibrinolytic drugs are used intravenously, which can dissolve the thrombus causing obstruction of the artery, thus restoring normal blood flow. It is important to recognize the symptoms as soon as possible because the treatment must be timely: medications must be administered within 4 hours from the onset of symptoms.

It is then possible to intervene with mechanical thrombectomy, aspiration or removal of the thrombus from the artery through small instruments. On the other hand, for hemorrhagic stroke it is necessary to control the pressure with pharmacological therapy and in more serious cases surgery is necessary.


Is complete recovery possible?

The progress the patient can make depends on several factors: the size and location of the affected area, the extent of the damage, age and health conditions. It is essential that the patient follow the rehabilitation path with perseverance and commitment, even if not everyone is able to return to pre-stroke activities. The rehabilitation process begins in hospital, with the support of physiatrists, physiotherapists, speech therapists, and continues at home, where the patient must perform the prescribed exercises.