World Stroke Day | Correctly understand stroke, and sudden death is no longer "unpredictable"

Author: Wang Huiping, Wan Shan, Wang Yanhua, School of Basic Medical Sciences, Three Gorges University

Illustration: Wang Huiping, School of Basic Medical Sciences, Three Gorges University

Reviewer: Huang Yiling, Associate Professor, School of Basic Medical Sciences, Three Gorges University

Stroke, commonly known as "stroke", has the characteristics of "five highs": high incidence, high mortality, high disability rate, high recurrence rate and high economic burden, and is known as the "number one killer of human health." According to statistics from the "China Stroke Prevention and Treatment Report 2020", the population-standardized prevalence of stroke in people aged 40 and above in my country was 2.58% in 2019, and the number of people currently suffering from or having suffered from stroke was about 17.04 million, showing an increasing trend year by year. What kind of disease is stroke? What are its risk factors? How should we identify it early? And how should we prevent it?

1. What is stroke?

Stroke is an acute cerebrovascular disease. It is a group of diseases caused by sudden rupture or blockage of cerebral blood vessels, leading to brain tissue damage. It can be divided into ischemic stroke and hemorrhagic stroke.

Ischemic stroke, also known as "cerebral infarction", refers to brain tissue necrosis caused by insufficient blood supply to the brain due to stenosis or occlusion of the blood supply arteries to the brain. It includes two situations: ① Thrombotic cerebral infarction, that is, when the patient has cerebral artery atherosclerosis, the atherosclerotic plaques will accumulate and thicken, hindering blood circulation, and then leading to brain tissue ischemia; ② Embolic cerebral infarction, that is, when the embolus breaks off and runs along the blood flow, blocking the cerebral artery, causing ischemia of brain tissue in the corresponding area.

Hemorrhagic stroke is also known as "intracranial hemorrhage", which is commonly referred to as cerebral hemorrhage or cerebral hemorrhage. Hemorrhagic stroke is mostly caused by hypertension, intracranial aneurysm or rupture of vascular malformation. Its incidence is lower than that of ischemic stroke, but its mortality and disability rates are higher than those of ischemic stroke.

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2. What are the risk factors for stroke?

The risk factors for stroke are divided into non-interventional risk factors and interventional risk factors. Non-interventional risk factors include age, gender, family history and genetic background; interventional risk factors include high blood pressure, high blood lipids, high blood sugar, exercise status, eating habits, etc. In today's society, many people have bad eating habits and lack of exercise, which can easily cause obesity and lead to the "three highs" (high blood pressure, high blood sugar, and high blood lipids). Among all the risk factors for stroke, high blood pressure is the culprit. Patients with high blood pressure have a 4 to 6 times higher risk of stroke than those without high blood pressure.

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3. How to identify stroke early?

As we all know, the situation after a stroke is often not optimistic. Even if the patient's life can be saved by timely thrombolysis and surgery, the damage to the body is still objective. The typical clinical manifestation of a stroke is transient ischemic attack, which manifests as weakness of one side of the limbs, sensory impairment, and may be accompanied by aphasia and hemianopsia. Transient ischemia of the vertebral and basilar systems manifests as vertigo, and may also cause diplopia, homonymous hemianopsia and other manifestations.

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In fact, stroke is a preventable and controllable disease. Early identification and early intervention are crucial to improving the prognosis of stroke patients. "Stroke 120" is a formula summarized by Chinese scholars to quickly identify the precursors of stroke. The evaluation content is: check whether there is asymmetry in the face and crooked corners of the mouth; check whether there is unilateral weakness when the two arms are raised in parallel; listen to whether the patient has unclear speech and difficulty in expression. If any of the above symptoms are found, please remember the time of onset and call 120 immediately!

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4. How to prevent stroke?

Prevention of stroke includes primary prevention and secondary prevention. Primary prevention is etiological prevention. Patients have not had a stroke but have risk factors for stroke. They need to control risk factors, change unhealthy lifestyles, and prevent the occurrence of stroke. The focus is on maintaining a healthy lifestyle, regular physical examinations, controlling blood pressure, blood lipids, and blood sugar, quitting smoking, limiting alcohol, exercising moderately, and maintaining a good attitude. Secondary prevention is rehabilitation training and health education. For patients who have already had a stroke, they should take medications in a standardized manner and receive active treatment to prevent the disease from recurring. They should also go to the hospital for regular checkups to keep abreast of the recovery of the disease. In addition, secondary prevention also requires intervention in lifestyle, including a low-salt, low-fat diet, maintaining a good mood, and engaging in reasonable physical exercise and rehabilitation training. Through standardized prevention, the mortality rate, disability rate, and recurrence rate can be reduced.

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References

【1】《China Stroke Prevention and Treatment Report》 Editorial Group. Summary of 《China Stroke Prevention and Treatment Report 2020》[J]. Chinese Journal of Cerebrovascular Diseases, 2022, 19(2): 136-144.

【2】Teng Gaojun, Wang Wei. Interventional Radiology[M]. 5th edition. Beijing: People's Medical Publishing House, 2022.

【3】Huang Jiayan, Zhan Jiayin, Wang Zheng, et al. Qualitative study on community residents’ cognition of “Stroke 120”[J]. Chinese General Practice, 2021, 24(27): 3501-3505.

[4] Deng Caiping, Qian Tao, Yang Fenghua. Application effect of "Stroke 120" rapid assessment combined with stroke green channel time node control table in patients with acute ischemic stroke [J]. Integrated Traditional Chinese and Western Medicine Nursing (Chinese and English), 2022, 8(7): 157-159.