Stroke: Act fast to save the brain, at any age

Just imagine: You get up one morning and your arm refuses to move, your mouth is lopsided or you have difficulty speaking. Every minute counts. You are perhaps having a stroke. Which is not rare: World data (GBD/WHO, 2018) indicate that one in four persons aged over 25 will suffer a stroke at some time in their life.

A stroke occurs when part of the brain no longer receives oxygen and the nutrients it needs. There are two principal kinds of stroke:2  

• Ischaemic stroke (85 % of cases): a clot blocks an artery preventing the blood from reaching certain areas of the brain.    
• Hemorrhagic stroke (15 %): an artery ruptures and causes bleeding in the brain.   

The symptoms are the same, whether it is an ischaemic or hemorrhagic stroke: difficulty in speaking, weakness in an arm or leg, lost or blurred vision. Only a scan or MRI can differentiate between the two.    

The TIA: A warning signal 

A TIA, or transient ischaemic attack, is similar to a stroke but is soon over, often in less than an hour. Although the symptoms soon pass, it is a warning sign: There is a high risk of a major stroke within the coming days. You must act immediately.   

The golden rule: F.A.S.T 

• Face: sagging on one side of the face 
• Arm: weakness in an arm or leg 
• Speech: speech or language disorders 
• Time: every minute counts, call 112 immediately 

Any sudden neurological deficit — blurred vision, dizziness, numbness in a limb — must be taken seriously and you should go immediately to the hospital emergency department. 

“Even if the symptoms seem to be ceasing, they often signal an imminent risk of a more serious stroke. So you must go to hospital emergencies immediately. Every minute counts to protect the brain,” stresses Dr. Noémie Ligot, Head of the Neurovascular Clinic at Brussels University Hospital.   

In the rest of this article we will speak mainly of ischaemic strokes. These are the most common strokes and for which there is now specific treatment in the acute phase. 

For young stroke victims a specific diagnostic approach is needed: specialised brain MRI, heart ultrasound, cerebral artery Doppler and extended blood test. The aim is to understand the precise cause so as to adapt the treatment and prevent a recurrence. In some cases, no cause is found despite an exhaustive search. This does not mean that there is no solution, and the right monitoring and preventive measures can nevertheless greatly reduce the risk of another stroke.

Dr. Noémie Ligot stresses that: “Even in a young adult with no conventional risk factor, a stroke can occur. It is essential to never underestimate the importance of the symptoms.”

You will now have understood: When suffering a stroke, time is a key factor. The quicker the patient gets to hospital the greater the chances of limiting the after-effects.  At the Brussels University Hospital, the care respects the strictest international standards with a pathway designed to be ultra fast, precise and effective.    

1. The acute phase: Act fast to save the brain 

On arrival at the emergency room the patient benefits from:   

• A brain scan that serves above all to rule out a haemorrhage but also to assess the first ischaemic brain lesions, and an angio scan to precisely locate the clot and assess the condition of the arteries.   
• A perfusion scan to detect those areas of the brain that can still be salvaged and those irremediably affected.   

This information guides the treatment: 

• Thrombolysis that consists of injecting medication into the veins to dissolve the blood clot. It must be administered as rapidly as possible to be fully effective. It is generally carried out within the first 4 or 5 hours but, thanks to perfusion imaging, some patients can still benefit from this up to 9 hours after the onset of symptoms.  
• A thrombectomy that is an endovascular procedure to remove the blood clot directly from the artery. This is reserved for blockages in the brain’s biggest arteries. It must be carried out as quickly as possible: the sooner it is carried out the more effective it is. It is usually carried out within the first 6 hours but, thanks to perfusion imaging, some patients can still benefit from it up to 24 hours after the onset of symptoms. This procedure is carried out 24 hours a day, 7 days a week by a specialist team ready to intervene immediately, including at night or during the weekend.   

2. Follow-up and the search for the cause 

Once the stroke has been stabilised, the diagnosis is exhaustive, with : 

• Detailed imaging to detect dissections, vascular anomalies or a silent heart attack. 
• A cardiac assessment to detect any atrial fibrillation or permeable foramen ovale. 
• Blood tests to detect any coagulation problems or inflammatory factors. 

“The aim is to understand precisely the cause of the stroke so as to adapt the treatment and prevent any further strokes as much as possible. Even if the cause is not found in 100% of cases, the team can determine the best prevention strategy for the individual patient,”   explains Dr. Ligot. 

3. Rehabilitation and global support 

Recovery does not stop at the hospital: 

• Patients benefit from adapted rehabilitation (physiotherapy, speech therapy, occupational therapy, neuropsychology)  from the very start. 
• Psychological  support is proposed to help overcome stress, anxiety and depression associated with the stroke. 
• Education for the patient and patient’s family on the  risk factors and prevention is essential : high blood pressure, smoking, cholesterol, physical activity, balanced diet.   

4. A unique reference centre 

The H.U.B. has a reference Stroke Unit, with: 

• 10 monitored beds dedicated to stroke patient surveillance. 
• Trained interventional vascular neurologists and neuroradiologists who are ready to supervise patients after each procedure. 
• A multidisciplinary team (radiologists, accident and emergency doctors and specialised nurses, physiotherapists, speech therapists, etc.) who receive continuous training in the latest techniques. 
• More than 120 thrombectomy procedures a year and regular follow-up of patients following a stroke. 

Since 2018, the H.U.B. has been recognised by the European Stroke Organisation (ESO) as Belgium’s first certified Stroke Centre, a guarantee of quality and compliance with international standards.  This organisation also permits comprehensive, rapid and precise care that is adapted to the needs of the individual patient, whether a young adult or an elderly person.   

5. Prevention: Acting before the stroke 

Prevention remains the central pillar: 

• Check cardiovascular factors: blood pressure, cholesterol, weight. 
• Stop smoking and limit alcohol consumption. 
• Take regular physical exercise, limit stress and adopt a balanced diet. 

Source: Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. 

New England Journal of Medicine. 2018;379(25):2429-2437.  doi: 10.1056/NEJMoa1804492