Nearly 200 people in HSK die from strokes every year

October 29 is World Stroke Day. It was launched in 2006 to increase public interest in the disease and to provide information on prevention and treatment options. The corona pandemic also poses difficult tasks for people affected by a stroke, their relatives and caregivers. “Above all, a stroke is not a question of age,” says Dr. Interview with Rüdiger Buschfort from Olsberg. Since 2014 he has been chief physician and medical director of the Aatalklinik in Bad Wünnenberg. In 2018, 174 people died from a stroke in HSK alone.

Characteristics and symptoms

Are there any features, symptoms that make me suspicious and should be a reason for an urgent visit to the doctor?

Yes, symptoms include blurred vision or double vision and speech or language disorders. The words cannot be found or understood, the person concerned speaks in a telegraphic tone, confused, indistinct. Other typical symptoms are paralysis and numbness, as well as a corner of the mouth hanging to one side. Dizziness or a staggering gait may also occur. Sometimes a fall preceded him. Cerebral hemorrhage as a special form of stroke can manifest itself as a severe headache. Under no circumstances should these symptoms be confused with a migraine attack. But less specific symptoms like dizziness or acute confusion can also indicate the presence of a stroke. When a stroke occurs, every minute counts. “Time is Brain” is the motto. And: it is an emergency, quick action is indicated!

In March, an exhibition with the motto “My way” was set up in the Aatalklinik in Bad Wünnenberg, in which patients described their personal journey. how to deal with stroke. The presentation with photos and images was very moving. The fate of the young people was particularly touching. Is stroke just something that affects the elderly?

No, there is no age group that cannot also be affected by a stroke. Older people aged 60 and over are the most affected in terms of numbers. Here, in particular, vascular risk factors play the main role alongside cardiac arrhythmias. In younger people, however, a genetic predisposition or blood clotting disorder is more likely. Lifestyle and the use of certain medications, such as birth control pills, may also play a role.

Chance of healing

What about the chances of recovery?

Treatment of acute stroke has developed rapidly and positively, so much so that today the chances of relieving symptoms have increased significantly. This has something to do with specialized racing units and at the same time with improved and specialized rescue services. On the other hand, the therapeutic options have also increased significantly. The prerequisite is always: the stroke is recognized early and action is taken quickly. This cannot be stressed enough, because stroke leads to the death of nerve cells, which can only be stopped with special therapies. The sooner a patient with stroke symptoms reaches the special clinic, the greater the chances of a “mild” course. The less damage to the nerve cells, the lower the functional losses, which can also be a decisive advantage for subsequent rehabilitation. This patient has more “resources”, which is usually reflected in a better rehabilitation outcome.

What can be done preventively to at least minimize the chance of having a stroke?

If you know your risk factors for a stroke, you can work to reduce or optimize them. Risk factors include cardiac arrhythmias, high blood pressure, blood sugar disturbances, but also diet, stress and your lifestyle. It is up to us to change something if necessary to reduce personal risk. Even small changes in our behavior can make a big difference, starting with very simple things: getting enough exercise, keeping an eye on your weight, quitting smoking, or drinking only small amounts of alcohol.

New forms of treatment

What happened over the years to treat the aftermath of a stroke? Are there new / different approaches to treatment?

Much has happened in the case of strokes, which are linked to an insufficient supply of blood and oxygen. In addition to drug therapy (lysis therapy) that dissolves blood clots, which has been the preferred method of treatment for many years, a new therapeutic method, thrombectomy, has been increasingly used in recent years in suitable cases. A catheter is used to locate the damaging blood clot in the brain vessel, capture it, and then remove it. This procedure shows surprisingly good results in some ship sections, so great progress can be seen here too.

Corona Keyword: Have you had stroke patients who also suffered from Corona? And how did the virus affect the nervous system?

Corona is currently playing everywhere and in our everyday life. With COVID-19, however, in rehabilitation we have to distinguish two different aspects with which we are dealing. On the one hand, we see seriously ill patients who are more likely to be affected internally (lungs, liver, kidneys). The result is intensive medical treatment, often with long-term ventilation. This results in severe damage to the muscles and nervous system, resulting in a high degree of inability to move and instability of the autonomic nervous system. These patients must first be weaned from ventilation and relearn how to “breathe”. Basic skills such as swallowing, moving and stabilizing the autonomic nervous system must be relearned from scratch during rehabilitation. This is a huge task, and not just for patients.

Crown and stroke

And what is the second aspect?

On the other hand, COVID-19 is also a virus that specifically affects the nervous system. Under the influence of COVID-19, one’s immune system is directed against the body’s nerve cells and damages them. Impairment of smell and taste was already known. However, recent studies indicate a much wider range of neurological symptoms. This includes the increased occurrence of strokes and other vascular complications with all their consequences. But inflammatory muscle and nerve diseases also occur with symptoms of paralysis, psychiatric symptoms and much more.

Corona again: how important is contact with relatives for the progress of the patient’s recovery? And what effects do the distance rules have on therapeutic options?

We now have six months of rehabilitation experience treating COVID-19 patients, and we have found that even young people are sometimes severely affected. As with elderly patients, they usually damage various organ systems. And these are often associated with psychiatric symptoms such as depression or psychosis. In their impotence, patients depend more than ever on the accompaniment and support of their relatives to maintain the necessary motivation and perspective during the lengthy rehabilitation treatment. Relatives act as an “emotional anchor” and give confidence and self-confidence and after a long time in the hospital they reflect something everyday and normal. This helps against fear.

No visits and recovery process

But didn’t the bans on visiting clinics make it possible?

Yes, as you know, we too have had to ban visits from time to time, many patients have been out of contact with relatives for weeks, which particularly affected severely affected patients. We have tried to establish constant contact with relatives using technical solutions with videoconferencing and the like, but nothing can replace personal contact. I therefore hope that we will be spared another ‘blockade’ and that we will not have to resort to similar measures again. COVID-19 means working to the limit in difficult conditions in every respect. But as long as everyone is on board, I am very optimistic that we and our patients will also be able to master this task. A special thanks from me goes to the nurses, not just in my hospital, who carry the burden of overtime due to COVID-19 and also the greater risk. They do more than a great job and, in my opinion, it will largely depend on them how we handle this crisis and how stable our healthcare system will prove to be.

Do you see a threat to the healthcare system from Corona – or more precisely: is there a risk that there could be changes in services to the detriment of stroke patients?

It is very difficult to answer this question. It can be seen that older people in particular are increasingly shy about leaving their homes to report to a doctor or hospital. Specialized societies have already emphasized this point and see a problem in the early diagnosis and adequate treatment of stroke. It is currently difficult to assess to what extent the resources actually earmarked for the special treatment of stroke patients are being used by COVID-19 patients. Hope this doesn’t happen. I don’t think so either, since stroke is an emergency and obviously needs to be treated this way.