On average, stroke occurs later in life. In both men and women. And, above all, it is always better treated in most cases, with less severe results. As long as you come quickly to the observation of the doctors.
For the forme ischemichein the last twenty years the long-term outcomes of the lack of oxygen to the brain tend to be less severe, both because people are better informed about the symptoms and therefore seek treatment first and because the therapies have profoundly improved, particularly in terms of opportunity to restore blood to the suffering brain areas.
There is still a lot to do, however, for the hemorrhagic forms, which represent approximately 15-20% of the total. On this front, mortality rates and long-term outcomes have not improved as significantly, particularly with regard to injuries related to subarachnoid haemorrhage.
To offer this encouraging news, recalling how “Time is Brain” or the time factor is the key to safeguarding brain tissue and therefore functioning after stroke, is an original Japanese study published in JAMA Neurologycoordinated by Kazunori Toyodaof National Cerebral and Cardiovascolar Center Japanese.
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The research began with information from the Japan Stroke database, relating to just over 183,000 people hospitalized between 2000 and 2019, therefore in the pre-Covid era. The analysis showed that, as expected, most of the patients (over 135,000) had an ischemic stroke (in four out of ten cases they were women), about 36,000 had a hemorrhagic stroke while 11,800 had a ‘subarachnoid haemorrhage, with a clear prevalence of the female population (more or less two out of three cases involving women).
Studying the data, it was firstly seen that the median age of onset of stroke has significantly increased in recent years (we are around 74 years for ischemic forms, around 70 for haemorrhagic ones and 64 years for haemorrhages subarachnoid), but above all that in the last twenty years there has been a marked improvement in prognosis, as evidenced by evaluations through specific scales such as Stroke Scale dell’NIH (National Institute of Health) of the USA. The improvements in terms of outcomes were particularly encouraging, in both genders, with a decrease in adverse outcomes and in hospital deaths.
But these results depend very much on the type of stroke: while there have been less severe consequences for ischemic forms, the advantages have decreased in haemorrhagic strokes: in particular, in the case of subarachnoid hemorrhage, the same positive trend has not been observed in both sexes.
The good news, in any case, is not lacking. As the Japanese experts write, “stroke has become milder in severity over the past 20 years regardless of gender or stroke type, although the age at onset of stroke has aged in the national stroke registry in Japan.” But there is still a long way to go. If it is true that the therapies for reperfusion, that is, aimed at “reopening” the blocked vessels in the event of ischemia, rapidly returning blood and oxygen to the suffering neurons, have clearly improved, it is necessary to find new solutions to deal with hemorrhagic forms, much more complex than deal with.
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It will be said. These data refer to Japan, but what is the situation with us? “There are two elements to consider: first of all, for ischemic stroke people arrive first to treatment and we have more weapons available to treat the disease, limiting the disabling outcomes in the vast majority of cases – he reports Massimo Del Sette, Director of Neurology of the San Martino Polyclinic in Genoa. We have more and more effective treatments, starting from thrombolytic therapy with drugs (it aims to “dissolve” the blood clot that inhibits the passage of blood and therefore oxygen to the neurons inside the artery) up to thrombectomy mechanical, which involves the insertion of a special instrument, called a stent retriever, which reaches the occluded cerebral artery and restores its patency, removing the residues of material that had obstructed it. For hemorrhagic forms, the improvements are more limited “.
Regarding the age of onset, the feeling is that even in Italy stroke arrives at an increasingly advanced age, probably also because people are increasingly controlling cardiovascular risk factors such as hypertension, high cholesterol and diabetes, in addition to avoid smoking. “In the world we are witnessing a curious phenomenon: strokes in absolute terms are decreasing, in some countries juvenile strokes are increasing, but, for stroke in old age, there is certainly a progressive increase in the age of onset of these injuries – concludes the expert “.
Final warning: remember to arrive early in case of symptoms such as loss of strength, mouth that suddenly becomes crooked, difficulty speaking. In this way, neurologists can better cope with the situation, reducing the risk of disabling outcomes.
Strokes are not all the same
But above all, even when reading the data, we keep in mind that strokes are not all the same. The injury can in fact be caused in the first place by the closure of an arterial vessel and in this case we speak of ischemic strokeBrain lesions have more or less this origin in four out of five cases. Both the large arteries, such as the carotids, as well as the small ducts that run inside the skull and supply specific areas of the brain, can be involved. This phenomenon can be caused by thrombi present on the wall of the vessels or emboli carried by the bloodstream.
L’hemorrhagic stroke, on the other hand, it occurs in about 15 percent of cases and is linked to the rupture of the walls of an artery which then loses blood and compresses the brain tissue. The causes may include a drastic increase in pressure, which leads the vessels to rupture, or the rupture of an aneurysm, that is, a pathological dilation of the arterial wall that is often not perceptible.
There are also cases in which the so-called are created subarachnoid hemorrhages, with blood accumulating between the brain and its outer covering. In these cases, almost always related to the rupture of an aneurysm, there are quite typical signs such as discomfort in the light, a very strong headache with vomiting, in many patients even loss of consciousness. And these are the most difficult forms to deal with.
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