What types of stroke are there?

1. Brain Stroke of the Ischemic Type

1.1. Cerebral ischemic insult

A cerebral ischemic insult is caused by the presence of a thrombus in blood vessel in the brain. Usually, the thrombus is formed in patients who exhibit arterial disorders, often in patients with damages caused by cerebral atherosclerosis.

Large white atheroma plaques are formed in the vicinity of vascular bifurcations (when blood vessels split in a V shape).

These are usually encountered in ages above 50 in all of the blood vessels in the body.

The formation of thrombuses depends on conditions such as

• a lowering of arterial tension
• sudden exposure to either cold or warm temperatures
• vascular infections or malignant hemopathies

Symptoms

In a majority of cases the disease develops in patients at an advanced age. It most often sets on while the patient is asleep. The patient observes a motor deficit when they wake up in the morning (they can’t move, or their arm or leg is asleep).

It may have occurred that a few days prior to this, they have felt

• weakness in the hand or leg
• a feeling of heaviness or numbness
• vertigo
• whooshing noise in the ear
• and overall fatigue

At times, patients exhibit these symptoms, 2-3 weeks or 2-3 months in advance.

Symptoms develop within a few hours or 2-3 days. In a majority of cases, the patient does not fall into a coma, instead their consciousness is clouded.

In rare cases, when the area where the infarction occurred is wise, the patient may fall into a comatose state. During examination of the patient, they exhibit flaccid sensitive motor hemiplegia, accompanied by lack of reflexes and clouded consciousness. When the hemiplegia is not complete, prognosis tends to be more favorable.

1.2 Cerebral embolic insult

Mitral stenosis (as well as atrial fibrillation) is one of the most common causes of cerebral embolism.

An embolism can also be caused by a case of sub acute bacterial endocarditis. The infected emboluses released from the lungs may also cause cerebral abcesses. The area that becomes damaged mainly depends on the localization and dimensions of the embolus.

The changes that occur in the brain following an embolism are similar to those that occur during a cerebral infarction. Fat embolisms can come as a consequence of fracturing long bones, which can then reach the brain via circulatory pathways.

Symptoms

The onset of a cerebral embolism is immediate and sudden, faster than the onset of a cerebral hemorrhage, it is not always accompanied with loss of consciousness, but a clouding of consciousness and confusion are common.

It is also accompanied by very severe headaches. Usually, cerebral embolisms have favorable prognoses, with the exception of cases when the embolus obstructs major blood vessels, which may lead to death.

2. Brain Stroke due to Hemorrhage(Cerebral Hemorrhage)

1. Subarachnoid Hemorrhage
2. Hemorrhage due to Arterial Hypertension due to Arterial Hypertension, among which one distinguishes:
   • Capsular Hemorrhages
   • Hemorrhage of the Centrum Semiovale
   • Hemorrhage of the Brain Stem
   • Ventricular Hemorrhages
3. Hemorrhages caused by Vascular Raptures or Malformations

2.1. Subarachnoid Hemorrhage

The most common cause of a subarachnoid hemorrhage is the rupture of an aneurism. More rarely one may encounter this type of hemorrhage in cases of acute meningitis.

Subarachnoid hemorrhages are divided into primary and secondary hemorrhages. When the anterior cerebral artery is affected, the hemorrhage occurs in the frontal region.

• In hemorrhages originating from the branches of the medial cerebral artery, the frontal-tempo-parietal region is affected instead.
• In hemorrhages originating from posterior cerebral arteries, the occipital region is affected.

Symptoms

The clinical aspects of these hemorrhages are different. At times, a comatose may develop unexpectedly.

The condition usually exhibits a prodromal stage characterized by

• headaches
• vertigo
• tinnitus
• seeing bright flashes of light
• and nausea

It is however, possible that the condition may develop

• without a prodromal stage
• with immediate vomiting
• eyes rolling to the side
• aphasia
• excitation
• convulsions
• delirium
• lack of attention
• All of these symptoms appearing suddenly and subsiding quickly.

Usually subarachnoid hemorrhages exhibit severe headaches in the occipital and parietal region.

The patient exhibits

• hyperemia in the face (excessively flushed)
• the pulse is at times slowed
• and body temperature may reach 38 degrees celcius

In the best cases, the condition of the patient improves upon beginning mediation, whereas in unfavorable cases, the condition worsens and the patient suffers a slow death.

2.2 Hemorrhages due to Arterial Hypertension

In these cases, a cerebral angiography is most helpful, as well as an electroencephalography (EEG), in determining the diagnosis.

The prognosis of this type of hemorrhage depends

• on the size and localization of the aneurysm
• the general condition of the cardiovascular system
• arterial hypertension
• and the age of the patient

Approximately a third of patients suffer from fatal first attacks, and nearly half may suffer from recidivism, which occurs during the first month of the attack.

The development of a comatose state, heart rate and breathing disruptions as well as a high fever are all signs indicating an unfavorable prognosis.

Cerebral hemorrhages occur

• as a consequence of the rupture of intra cerebral arteries
• or due to a vascular anomaly
• or due to a congenital arterial malformation
• or due to arterial atheroma (with or without arteral hypertension)
• or due to an infectious arthritis

Hemorrhages occurring due to arterial malformation are mostly encountered among young patients, whereas atheromatosis is usually a disease most common among patients older than 50.

2.2.1. Capsular Hemorrhages

It occurs due to the rupture of the lenticulostriate artery. It is one of the most severe and common cases of hemorrhage.

This condition is most common in patients over 50 years of age and patients suffering from hypertension and atherosclerosis. It can lead to death, or leave patients with severe consequences.

Symptoms

The onset of the disease is sudden:

• during exertion, the patient may fall unconscious and within a few minutes fall into a coma.

The patient exhibits hemiplegia and in more moderate cases, they may remain conscious, they complain of a headache that is accompanied by hemiparesis.

Patients who fall into a coma do not react to extrinsic stimuli, at times they appear

• agitated
• exhibit short breaths
• Cheyne-Stokes breathing
• slow heart rate
• head turned to the side
• eyes deviating to the area of damage
• anisocoric pupils
• high arterial tension
• and their temperature may reach 40 degrees.

Recovering from the disease

At times, the patient begins to improve within 2-3 days, and they come out of the coma, sometimes even after 7-10 days.

With the passage of time, the hemiplegia may improve. Movement can be regained in the lower extremities first.

In patients with aphasia, the patients may begin to articulate a few words, but they are not in a condition where they can conduct a full conversation.

2.2.2. Hemorrhage of the Centrum Semiovale

This type of hemorrhage is usually located in the frontal, temporal or occipital region. This type of hemorrhage is not usually accompanied with loss of consciousness, develops more gradually.

The patient complains of a headache, vomiting and then hemiplegia develops. The hemiplegia first begins in the hand but then spreads to half of the body in a few minutes.

In a few cases, the condition may deteriorate, but in the majority of cases, patient recover;

• the hemiplegia becomes spastic and the motor deficit that remains is lesser than that of the case of a capsular hemorrhage.

2.2.3. Hemorrhage of the Brain Stem

This hemorrhage is located in parts of the brain that are called the mesencephalon, pons and medulla oblongata (these three make up the brain stem). Even though the hemorrhages that may occur in these parts may be minor, they cause a variety of symptoms.

This part of the brain hosts the vasomotor centers of breathing, swallowing and where ascending and descending pathways pass.

Often these hemorrhages are accompanied by clouding of the consciousness, subcoma and coma. The onset is sudden and immediate.

These symptoms are observed when the hemorrhage is small, when massive hemorrhage occurs, death is immediate.

2.2.4. Ventricular Hemorrhages

Ventricular hemorrhages are in general, fatal.
Ventricular hemorrhages are massive hemorrhages, where three variants may be distinguished:

• Hemorrhage of the lateral ventricles
• Hemorrhage of the third ventricle
• Hemorrhage of the fourth ventricle

 

The onset of ventricular hemorrhage is usually immediate. The majority of patients are brought to the hospital in an unconscious state.

Usually occurs often during the workday and is often linked to physical exertion or emotional excitation or stimuli.

Clinically, the patient exhibits severe symptoms:

• They may immediately fall into a coma
• They exhibit meningeal symptoms
• Vomiting
• Breathing disturbances
• Slower heart rate, which quickly transforms into tachycardia
• Hyperemia of the face
• Hyperhidrosis (profuse sweating)
• Miosis (excessive constriction of the pupil)
• High fever
• Disruptions of sphincters (involuntary defecation)
• Development of pulmonary edema
• Gradual lowering of arterial tension, which at the onset of the coma is high. The patient may leave three to five additional days.

3. Hemorrhages due to the rupture of blood vessels or due to vascular malformations

These types of hemorrhages occur rarely, usually observed in younger patients, which do not suffer from either cerebral atherosclerosis and arterial hypertension.

These patients exhibit congenital malformations usually in the form of an aneurysm or an angioma, which are usually of small, limited dimensions.

The rupture (bursting) of an aneurysm is usually accompanied by hemorrhage, which leads to the formation of a hematoma within the first 10-15 days.

A cerebral angioma may develop on the surface of the cortex or deep within the brain. The development of the insult occurs gradually.

Patients suffering from these conditions often have also previously suffered from migraines or epilepsy attacks.

Causes of the hemorrhages include

• experiencing extreme emotions
• physical exertions

And usually these hemorrhages are small and do not pose substantial risk to the patient.
When they are massive, however, they may lead to death.

This is why it is important that these cases receive immediate medical attention and are surgically treated.