One of the most feared brain phenomena and problems worldwide is the occurrence of a stroke, which is one of the most frequent causes of death worldwide.

The reason for this is the fact that its presence causes the death of part of the brain cells, something that can have different more or less disabling consequences and can even compromise survival depending on the areas that are damaged.

But the truth is that when we talk about stroke we’re actually talking about two major types of stroke: we can be looking at a cerebral hemorrhage or a cerebral ischemia .

It is on this last type that we are going to focus throughout this article, in order to discuss what it is, why it can happen and what type of intervention can be carried out on those who have suffered it.

What is a cerebral ischemia?

One of the great types of stroke that exist is called cerebral ischemia, which is characterized by the appearance of a degeneration or neuronal death in the brain due to the existence of some type of blockage in one of the blood vessels that supply the brain .

This blockage prevents the blood from reaching the nerve cells that the blood vessel is supposed to supply, so that without a sufficient level of oxygen and nutrients the affected cells degenerate and die quickly. Thus, technically we speak of ischemia when for some reason the supply of nutrients and oxygen that the brain cells need to survive is interrupted.

Symptoms

Brain ischemia is a disorder that can generate a wide variety and diversity of symptoms , since the blockage can occur in any of the blood vessels that supply any of the areas of the brain. Thus, the specific symptoms will depend largely on the affected area.

However, there are some symptoms that are common in both ischemia and other strokes: the sudden onset of paralysis or numbness of a part of the face or half of the body, sudden speech disturbances (including aphasias in which the ability to understand and/or produce speech is lost), and sudden hypotonia or lack of muscle tone in a part of the body.

In addition to this, other types of alterations may arise such as dizziness, headaches, hallucinations, personality changes, tremors and/or convulsions , blurred vision or loss of specific sensory abilities.

Between ischemia and cerebral hemorrhage ischemia is much more common, and there are many factors and situations in which a blockage of the cerebral vessels can occur.

Its main types

Within ischemia we can also find different typologies, depending on how and why the blockage in question appears and even to what extent it affects more or less brain regions. Among the different types, the following stand out.

Thrombotic ischemia

This type of ischemia occurs when a blockage appears inside the blood vessels of the brain that prevents the passage of blood . This blockage is called a thrombus, and is usually caused by the presence of cholesterol plaques in the vein or artery or by a clot forming within the brain’s own cerebrovascular system.

2. Embolic ischemia

Embolic ischemia or embolism differs from the above because the element that causes the blockage of the cerebral blood vessel, in this case called an embolus, arises somewhere in the body other than the brain and travels along with the bloodstream throughout the body until it finally reaches the cerebrovascular system, causing a blockage at some point if it encounters a vessel smaller than itself. This is what can happen for example with some blood clots .

3. Transient ischemic attack

The transient ischemic attack is a type of brain ischemia in which, as in the rest, some element suddenly appears that blocks the brain vessels, but which nevertheless the very functioning of the body manages to unblock it by itself quickly (for example because the blood flow manages to push or fragment the embolus or thrombus).

In these cases the symptoms are usually short lived and the subject may recover fully, although the fact that they have appeared means that the subject is at risk for more severe symptoms.

4. Lacunar ictus

This is understood as a type of cerebral ischemia in which the affected blood vessel is an arteriole, that is, one of the small branches of the arteries that go deep into the different areas of the brain .

That ischemia occurs at this level implies that the affected areas will usually be small and its effects less than in other types of stroke, but it can also have serious repercussions and even cause death depending on the region in which it occurs.

5. Focal cerebral ischemia

This is called a type of ischemia in which the interruption of blood flow occurs in a blood vessel that is going to irrigate a particular area of the brain , so that the effect at the neuronal level is specific to the particular area that is damaged or dies.

6. Global cerebral ischemia

In this case, ischemia does not occur in a specific vessel but at a more global level, with all or almost all of the brain not receiving sufficient oxygen or nutrients. In this case the problem is global and has the potential to generate many more repercussions on the subject that suffers it.

7. Hemodynamic ischemia

In this little known type of ischemia there is no blockage as such, but there is an interruption of the arrival of oxygen or nutrients to the brain . The cause of this type of stroke is the absence of a deficit in the level of blood pressure that leads the blood to circulate at the necessary speed to nourish the cells.

Causes

Technically, the presence of an ischemia implies the existence of some type of blockage or difficulty in the arrival of blood with oxygen and nutrients to the cells of the brain. In this sense, the most common causes are blood clots or cholesterol and lipid plaques that clog the arteries . But beyond that there are many possible causes that can lead to this type of stroke.

Among the many risk factors for its appearance are the presence of high blood pressure, diabetes mellitus, cholesterol, previous brain injuries (for example due to scarring from a vascular lesion), heart problems (as in the case of hemodynamic cerebral ischemia), malformations, trauma (which can generate blood clots), lack of sufficient nutrients, tumors, smoking or consumption of certain drugs .

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Affect on the subject’s life

Suffering from a cerebral ischemia usually has a great impact on the life of the patient, who may suffer significant sequelae for a time or even throughout his or her life.

At a direct level, the patient can suffer a great diversity of problems derived from the death of their tissues, which can go from aphasia to paralysis of part of the body, passing through tingling, cognitive difficulties (such as concentration or memory), sensory deficits, sleep, movement, sexuality or eating problems, among others. Unfortunately, these problems cannot always be solved or compensated for, , which can lead to the patient presenting different degrees of disability .

Furthermore, it must be taken into account that at a social and work level the consequences of ischemia can have consequences: for example, if the patient suffers from aphasia derived from ischemia, he or she will find it difficult to communicate effectively, something that can be very frustrating for the subject and generate misunderstandings with the environment.

Finally and beyond the direct consequences of ischemia, we cannot ignore the great emotional impact of suffering from this type of disorder . The subject has lived a situation of great risk for his life and it is not uncommon for problems of an anxious or depressive nature to appear, as well as a great fear of the possibility that it may occur again.

Treatment

In cases of cerebral ischemia, the urgency in going to the medical centre is fundamental and can even save the life of the person suffering from it, as well as reduce the possible effects of cell destruction .

Once the problem has been identified, it is possible on a medical level to inject substances that allow the clot to dissolve or even to use surgery to remove the clot (it can reach the cerebral arteries with procedures such as angioplasty from other parts of the body).

Once the problem has been treated and the blood supply has been restored to normal, and after a period in which the patient is kept under observation and in which it is possible that part of the area affected by the lack of risk (the so-called ischemic penumbra in which an area of the brain has been partly affected but has not died completely, and which in some cases can partially or totally recover functionality), it will be necessary to assess the neuropsychological state of the patient .

To do this, it will be necessary to assess their functionality in the various areas, both at the motor and cognitive levels, in order to identify possible deficits and alterations that have caused the death of nerve cells. Once this has been done, it will be necessary to elaborate an individualized treatment, in which, depending on the case, it may be necessary to use occupational therapy, cognitive stimulation (in which aspects such as memory, executive functions or attention can be worked on), speech therapy and/or physiotherapy.

The aim is to carry out a neuropsychological rehabilitation of the patient, helping him/her to recover or compensate for the affected functions.

Psychological therapy can also be useful to the affected person, given that the sequelae of ischemia can be experienced with panic and suffering and cause (either directly as a consequence of the ischemia or indirectly by deriving from the perception of deficits) emotional alterations, anxiety, cognitive distortions and problems of psychosocial adjustment.

Bibliographic references:

  • Kuźma, Elżbieta; Lourida, Ilianna; Moore, Sarah F.; Levine, Deborah A.; Ukoumunne, Obioha C.; Llewellyn, David J. (2018-08). “Stroke and dementia risk: A systematic review and meta-analysis. Alzheimer’s & Dementia. 0 (0)
  • Lewis. S.L (2008). Medical-Surgical Nursing. Vascular disorder.