A cerebral infarction is often preceded by a transient ischemic attack (TIA, temporary lack of blood). This means that the brain is not supplied with sufficient blood. As a result, the brain cells lack oxygen and nutrients and there is a risk that affected areas of the brain will die. Depending on how long the failure lasts, this region of the brain will later be more or less functional.
The patient shows symptoms typical of a stroke for several hours and requires immediate emergency medical assistance. The faster the patient receives medical help, the better the prognosis.
Anyone who suffers a cerebral infarction themselves should - if still possible - inform the fire department immediately. There is an acute danger to life in the event of a stroke.
Most people who suffer a stroke are older than 60.
The main causes of a stroke are
- the blockage of a blood vessel (ischemic or white apoplexy) or
- a hemorrhage in the brain (hemorrhagic or red stroke).
An ischemic cerebral infarction is caused by a blood clot that blocks an important blood vessel in the brain. This prevents the supply of blood to the subsequent regions of the brain.
A narrowing of the vessel due to arteriosclerosis(hardening of the arteries) is also possible. In this disease, cholesterol deposits build up on the inside of the affected blood vessels. This reduces the diameter of the vessel. With advanced arteriosclerosis, there is a risk of the vessel becoming completely blocked and the blood flow drying up.
In the less common hemorrhagic stroke, a blood vessel in the brain bursts. The leaking blood seeps into the neighboring brain tissue. The subsequent areas of the brain no longer receive enough oxygen. The leaking blood increases the pressure in the brain and, in extreme cases, even impairs breathing and heartbeat.
A special form of red stroke is subarachnoid hemorrhage(SAH). The subarachnoid space is located between the thin skin covering the surface of the brain and the skull. It contains cerebrospinal fluid (CSF) and blood vessels.
The risk here comes from an aneurysm (a small pouch-like bulge) in one of these vessels: If the aneurysm bursts, the outflowing blood presses on the surrounding brain tissue.
The patient suddenly experiences extreme headaches and requires urgent emergency medical care.

A stroke can be triggered by vascular calcification © Alex Mit | AdobeStock
The following risk factors favor the occurrence of a stroke:
- High blood pressure,
- unhealthy lifestyle (smoking, alcohol),
- obesity,
- unhealthy diet,
- too little physical activity,
- diabetes,
- high cholesterol levels,
- certain heart diseases(atrial fibrillation, heart valve defects),
- certain types of migraine.
If a patient has several of these risk factors, they are particularly at risk of suffering a stroke.
The symptoms of a stroke depend on the area of the brain affected
- the area of the brain affected and
- the extent of the lack of blood flow
depends.
The most common signs include
- Problems with speech (slurred speech, artificial pauses, repetition of words) to complete loss of speech,
- limited understanding of speech,
- unilateral facial paralysis with a drooping corner of the mouth,
- paralysis of one side of the body,
- Numbness on one side of the body,
- Visual disturbances up to (temporary) blindness (double vision, blurred vision),
- severe dizziness,
- Nausea & vomiting,
- severe headaches,
- Swallowing disorders,
- Disorientation and even confusion,
- gait disturbances,
- shortness of breath,
- joint pain,
- unconsciousness.
In the event of a stroke, it is important to recognize and treat it quickly. The earlier the treatment is successful, the greater the patient's chances of suffering little or no damage to their health.
If help is provided too late, there is a risk of paraplegia or even death.
If a stroke is suspected, call for help immediately (fire department, emergency doctor, rescue service). The first aid measures consist of calming the patient and placing them in the supine position. Raise their upper body with a pillow.
Unconscious patients and stroke patients who are vomiting should be placed in the recovery position.
Check their pulse and breathing at regular intervals. If they can no longer be felt, carefully lay the patient on their back on the floor and perform resuscitation.
The ambulance service will then take the patient to a nearby clinic or hospital stroke unit. A stroke unit is the specialized stroke department of certain hospitals. It specializes in stroke treatment.
Blood is first taken from the patient admitted to the hospital. The doctors check
- Blood lipids,
- blood sugar and
- blood clotting factors.
Imaging procedures such as computer tomography (CT) and magnetic resonance imaging(MRI) can show where the stroke has occurred. This also allows the doctor to determine whether the stroke is ischemic or hemorrhagic.
With the help of CT angiography, the neurology specialist can visualize any blockage in the blood vessels. To do this, he injects the patient with a contrast agent beforehand. Using Doppler sonography (special ultrasound), the doctor can see how advanced the arteriosclerosis of the brain already is.
The electrocardiogram (ECG) is used to find out whether the patient is suffering from a cardiac arrhythmia. An ultrasound image of the chest region shows any existing heart disease.
Ischemic strokes are treated with injections of a blood clot-dissolving drug (systemic thrombolysis). However, it is only successful if the injection is given no later than four and a half hours after the cerebral infarction.
If successful, the blood can flow again and the risk of permanent late effects is minimized. However, systemic thrombolysis is not suitable for patients with certain pre-existing conditions.
During mechanical thrombectomy, the physician inserts a thin catheter into the blocked blood vessel. He removes the stuck clot and sucks it out. This procedure is only suitable for embolisms in the large cerebral vessels. It is only promising within a maximum of eight hours after the first stroke symptoms appear. It is also only used in special stroke centers.
In the case of a hemorrhagic stroke , the doctors must stop the cerebral hemorrhage and reduce the excessive intracranial pressure. This sometimes even involves opening the skull bone. Leaking cerebral vessels with aneurysms can sometimes even be closed using special surgical techniques.
In the case of hemorrhagic strokes caused by high blood pressure, antihypertensive medication is administered.
The emergency doctor must be called as soon as the first symptoms of a stroke appear. Every minute counts when it comes to treatment. However, the family doctor is responsible for basic care, as they know the patient best.
Specialist doctors or hospital departments carry outspecial examinations and bundle the results together with the GP. Radiologists, for example, use imaging techniques to examine the blood vessels.
Depending on the results, neurologists and vascular surgeons then also look after the patient. If the stroke was caused by a blood clot in the heart, the cardiologist is the right person to contact.
In some cases, early rehabilitation still takes place in the hospital's stroke unit. Depending on the damage caused by the stroke, the patient receives physiotherapy and/or occupational therapy rehabilitation.
Physiotherapy is used to
- the disturbed movement sequences,
- the sense of balance and
- and other impaired functions of the patient.
slowly restored. It also improves poor posture and paralysis so that the patient becomes more mobile again. If this is not completely successful, rehabilitation should at least help to maintain the remaining bodily functions and abilities.
With the help of occupational therapy, the patient learns how to handle certain objects and carry out the necessary activities of daily living. The aim of occupational therapy is to prepare the patient to lead as independent a life as possible.
If the stroke has caused a speech disorder and/or swallowing difficulties, speech therapy rehabilitation is required.
In addition to the standard rehabilitation measures, there are also special methods, such as
- neuro-psychological training, which may be indicated for hemiplegia, and
- accompanying psychotherapy. This helps patients suffering from depression as a result of the stroke to work through their psychological problems.