Brain stroke

How a brain stroke happens

Prerequisites

Ischemic stroke is extremely heterogeneous for its reasons. The most dangerous cardioembolic stroke develops suddenly and mainly in the most elderly patients, is severe, with rapidly increasing symptoms.

Lacunar stroke is the most favorable in clinical presentation and outcome. With lacunar stroke, there are no signs of damage to the cerebral cortex, and the clinical diagnosis confirms the presence of a history of diabetes mellitus or hypertension.

Risk of early stroke in obesity in adolescence

Scientists from the Hebrew University (Jerusalem), doctors at Ikhilov Hospital, together with their American colleagues, discovered an alarming pattern. According to their observations, obesity in young people 16-20 years old increases the risk of stroke under the age of 50 years. According to scientists, this explains the increase in the number of strokes in young people, which has occurred in recent years, as in Israel and the United States, as well as around the world. The results of the study were published in 2021 in the well-known medical journal Stroke. Read more here.

Smoking

Quitting smoking is one of the most important actions for prevention and treatment and results in a significant reduction in stroke risk regardless of gender, age and race. In moderate smokers (up to 20 cigarettes per day), the risk of stroke normalizes 5 years after refusal. Malicious smokers maintain an increased risk of more than 2 times compared to non-smokers.

"In 2009, before the ¼, all strokes were directly related to smoking, reaching 50% in young patients with a cryptogenic genesis of ischemic stroke. Smoking increases the risk of stroke by 2 times, in intensively smokers - by 3 times. At the same time, the risk increases as the number of cigarettes smoked increases, "said Nikolai Shamalov, professor of the Department of Neurology, Neurosurgery and Medical Genetics of the Medical Faculty of the Russian National Research Medical University named after N. I. Pirogov in October 2021.

Prevention of repeated strokes

Every second stroke turns out to be repeated. Specialists of the Russian National Research Medical University named after N.I. Pirogov told about this in October 2021.

"The basic principles and timing of secondary stroke prevention is the start of all activities within 48 hours. It is also necessary to reduce risk factors, a differentiated approach depending on the pathogenetic version of stroke and the combined nature of therapy, "said Nikolai Shamalov, professor of the Department of Neurology, Neurosurgery and Medical Genetics of the Medical Faculty of the Russian National Research Medical University named after N. I. Pirogova.

The goal of secondary stroke prevention is to reduce the risk of recurrent stroke and other vascular events. With 100% use of medical methods and 20% surgical methods, the frequency of repeated cerebrovascular accident is reduced by 15-20%.

According to the Assistant Director for Regional Development and Federal Projects of the Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Ph.D. Alexander Rozanov, the main provisions of the recommendations for the secondary prevention of stroke include:

• healthy lifestyle, including proper nutrition and motor activity;
• adherence to the low-salt and Mediterranean diet;
• physical rehabilitation under strict medical supervision;
• change in the patient's lifestyle.

"In our country, adherence to a healthy lifestyle is high only in 21.9% of the population, low - in 43.6%. What is the low commitment? More than 50% of the population consume too much salt, 37.5% eat little vegetables and fruits, 22.7% smoke, 19.6% are sedentary and 4.9% drink alcohol excessively, "said Alexander Rozanov.

The specialist recommended that stroke patients follow a diet containing monosaturated fats, vegetable products and fish, with the addition of extra virgin olive oil or nuts, reduced body weight and blood pressure, and control of table salt intake (less than 1.5 g/day).

Patients who have suffered any stroke need to constantly monitor blood pressure, lipid and glucose levels, and use drug prophylaxis. Antithrombotic therapy, including antiplatelet or anticoagulant, is recommended for almost all patients without contraindications.

Mortality

2019

Deaths from stroke in the world over 30 years increased by 1 million cases per year

In 1990, the death rate from ischemic stroke in the world amounted to 2.04 million cases per year, and in 2019 - 3.29 million. At the same time, the incidence of ischemic stroke per 100 thousand people decreased during this period from 66 to 44 cases. Such data in May 2023 led scientists from Tongji University in Shanghai.

This increase in the global number of ischemic stroke deaths along with the projected further increase in the future is worrying. But ischemic strokes can be prevented. Our studies show that it is the combination of lifestyle factors that lead to an increased risk of stroke, "said lead author Lisa Xiong.

Scientists cite smoking, non-compliance with dietary rules, kidney problems and obesity, high blood pressure, high cholesterol and sugar as the reason for the increase in deaths from stroke.

The journal The Lancet Neurology (the leading journal in clinical neurology) published a study that reported 101 million cases of stroke between 1990 and 2019 - a figure the study calls the "prevalence" of the disease. At the same time, in 2019 alone, 12.2 million cases of the disease were registered, 6.55 million people died. Another important indicator is the disability-adjusted patient's years of life (GFID), equivalent to years of "healthy" life, lost to ill health, disability or death. It turned out that in 1990-2019, humanity lost a total of 143 million years of "healthy" life.

Globally in 2019, stroke was the second leading cause of death (11.6% of the total) after coronary heart disease (16.2%) and the third leading cause of death and disability in the aggregate (5.7%) after hereditary impairment (7.3%) and coronary heart disease (7.2%), according to the study^[1]

Ministry of Health: Mortality from stroke in Russia decreased by 37% in 8 years

At the end of October 2020, the Ministry of Health of Russia reported a decrease in mortality from strokes in the country from 2012 to 2019 by 36.8%. Deputy Minister of Health RFOleg Salagai called this result "very serious" and linked its achievement with the implementation of the vascular program and the re-equipment of medical organizations.

A large-scale vascular program was implemented in our country, which made it possible to significantly reduce mortality from vascular diseases. This program has repeatedly deserved high praise, including from the World Health Organization, - said Salagay, whose words are quoted by TASS.

According to him, almost 300 medical organizations in Russia were re-equipped and re-equipped with medical equipment in 2019 (we are talking about thousands of units of medical equipment that began to be used in clinical practice), and the number of such operations as endovascular interventions exceeded 250 thousand, which is 50 thousand operations more than a year earlier.

According to the Ministry of Health of the Russian Federation, in 2019, mortality from heart attacks and strokes in Russia decreased by 5.2% and 3.1%, respectively, compared to 2018. Mortality from myocardial infarction decreased to 36.8 cases per 100 thousand population, and mortality from acute cerebrovascular accident - to 86.2 cases per 100 thousand.

The fight against cardiovascular diseases is one of the priority areas of the national project "Health." The largest number of cardiovascular diseases in Russians can be prevented by reducing the impact of risk factors - alcohol consumption, smoking, irrational nutrition and low physical activity. These measures are provided for by the national project "Demography."^[2]

The number of strokes and deaths from them in the world increased by 70% over 30 years, to 12.2 million cases

In 2019, 12.2 million strokes were registered in the world, which is 70% more than 30 years earlier. The prevalence of such cases of acute disruption of the blood supply to the brain during this time increased by 43%, to 101 million. Mortality increased by 43%, to 6.55 million cases.

These data are presented in the Global Burden of Diseases, Injuries, and Risk Factors Study.

Another important indicator in the report is the disability-adjusted years of life of the patient, equivalent to years of "healthy" life, lost due to poor health, disability or death. It turned out that in 1990-2019, humanity lost a total of 143 million years of "healthy" life (+ 32%). At the same time, low-income, medium-low and upper-middle income states accounted for 86% of all stroke-related deaths and 89% of GFPI.

Although the absolute number of strokes in the world has increased over the past 30 years, the rates standardized by age have decreased: the incidence rate has decreased by 17%, the prevalence rate by 6%, the mortality rate by 36%, and the GFPI has decreased by 36%. However, among people under the age of 70, the prevalence rate, taking into account age, increased by 22%, and the incidence rate, taking into account age, increased by 15%.

In 2019, the age-standardized mortality rate was 3.6 times higher in low-income countries than in high-income countries. Low-, middle-low-income and upper-middle-income states accounted for 86% of all stroke-related deaths and 89% of GFID.

Over 30 years, the level of disability associated with stroke has increased: GFID has decreased slightly in high-income countries and has increased significantly in the rest.^[3]

2017: More than 86 thousand people die from ischemic stroke in Russia annually

According to 2017 data, more than 86 thousand people die from ischemic stroke in Russia annually. ^[4]

History

2024

Telerehabilitation app will help you choose the optimal stroke recovery pattern

The TeleRehab application to support medical decision-making to restore patients after a stroke was developed by employees of the University of MISIS and the Research Institute of Health and Medical Management of the Moscow Department of Health (NIIOSMM DZM). The program based on algorithms and artificial intelligence gives the most suitable recommendations for telerehabilitation for each case. MISIS announced this on October 22, 2024. Read more here.

A carotid artery stent was released and began to be installed. It prevents strokes

In early October 2024, the company InspireMD received permission to study stentings the carotid artery system CGuard Prime 80 cm to prevent embolization of the brain brain and development. stroke More here

NtechLab registers product to diagnose ischemic and hemorrhagic strokes

The company's medical product - NtechMed CT Brain - has received a registration certificate and is ready for implementation in public and private clinics. The company previously announced its entry into the medical technology market. NtechLab (Ntech Lab) announced this on April 26, 2024.

The NtechMed CT Brain product allows physicians to diagnose ischemic and hemorrhagic strokes and promptly initiate patient therapy. Read more here.

SberMedII registered AI-service "Brain CT" in Roszdravnadzor

The company SberMedII registered in Roszdravnadzor AI the service "-brain CT " a system of supporting medical decision-making for the diagnosis of stroke. Algorithm helps the doctor quickly analyze CT images and make the correct diagnosis, which in critical cases allows you to start treating the patient in a timely manner and save his life. This was SberMedII announced on April 17, 2024. More. here

2023

Russia will use AI to rehabilitate stroke survivors

Scientists from MTUSI and the Federal Center for Brain and Neurotechnologies proposed using artificial intelligence and vision technologies to rehabilitate patients after a stroke. According to them, the development is especially relevant for remote areas of Russia, where rehabilitation centers are far from patients. MTUSI announced this on October 23, 2023. Read more here.

Emergency doctors get smart helmet to assess effects of stroke

On October 17, 2023, Dutch researchers from the Academic Medical Center (UMC) in Amsterdam reported on the development of a smart helmet that allows you to assess the severity of a stroke even before the patient enters the hospital. The data obtained with the device make it possible to quickly determine the necessary therapy regimen. Read more here.

Boston Scientific releases heart implant that prevents strokes

On September 6, 2023, Boston Scientific announced the Watchman FLX Pro heart implant, the use of which helps prevent stroke. Read more here.

A woman paralyzed after a stroke was able to speak thanks to chips implanted in the brain and an AI device

On August 23, 2023, researchers from the University of California, San Francisco and the University of California, Berkeley, reported on the development of a new technology that allowed a paralyzed woman to "talk" again. Read more here.

Physical activity provokes strokes with severe narrowing of the carotid arteries

In mid-June 2023, researchers from the Indian Institute of Technology in Kharagpur discovered that an increased pulse could trigger a stroke in patients with severe blockage of the carotid arteries. In contrast, for healthy patients and those with slightly blocked arteries, exercise is beneficial for maintaining healthy blood flow. Read more here.

Brain implant released to help people talk after stroke

On May 18, 2023, the American company Paradromics announced the creation of an innovative implant on the basis of which a high-performance brain-computer interface can be implemented. The product, among other things, will help patients who have lost the opportunity to talk as a result of a stroke to regain contact with the outside world. Read more here.

WHO: Sugar substitutes raise stroke risk by 19%

On May 15, 2023, the World Health Organization (WHO) published the results of a study on the consumption of sugar substitutes. Experts came to the conclusion that artificial sweeteners can harm health, increasing, among other things, the risk of stroke and death. Read more here.

Domestic spinal neuroprosthesis will return the ability to move to patients after a stroke

The spinal neuroprosthesis of the Skolkovo resident is presented, which will return the ability to move to patients after a stroke. This was announced on March 7, 2023 by representatives of the Skolkovo Foundation. Read more here.

ITMO graduate student creates prosthetic simulator for rehabilitation after stroke

A graduate student ITMO has developed artificial limb exercise machine that allows you to restore muscle activity in cerebral palsy and after stroke. Unlike its counterparts, it can be used even at home: it is more compact and convenient to use. The first prototype was created for training the muscles and joints of the hands, but in the future the development can be adapted for other parts of the body. ITMO Corporation announced this on February 3, 2023. More. here

2022

Plaque analysis system released to assess heart attack risks

In mid-October 2022, HeartFlow launched a plaque analysis system to assess heart attack risks based on artificial intelligence. Read more here.

A simulator has been created in Moscow to improve hand motility after a stroke

The Moscow manufacturer in the field of neurotechnologies and robotics "Neurobotics" has developed a simulator for restoring fine hand motility after injuries and strokes. This was announced on September 5, 2022 by the head of the Department of Investment and Industrial Policy of Moscow, which is part of the Complex of Economic Policy and Property and Land Relations of the capital, Vladislav Ovchinsky. Read more here.

Deadly blood clots: Energy drinks constrict blood vessels for 90 minutes

Energy drinks constrict blood vessels for 90 minutes, said cardiologist Oleg Varfolomeev at the end of August 2022. According to him, after drinking such drinks, the inner diameter of blood vessels decreases by an average of 50%. Read more here.

Device released to remove blood vessel blood clots during ischemic stroke

In late July 2022, Rapid Medical developed the Tigertriever 13 device to remove a blood clot from thin blood vessels in the brain during an ischemic stroke. Read more here.

COVID-19 significantly increases the risks of stroke, Alzheimer's and Parkinson's disease

At the end of June 2022, a study conducted in Denmark showed that outpatients with COVID-19 had an increased risk of diagnosing Parkinson's disease, Alzheimer's disease, stroke and cerebral hemorrhage compared to patients with a negative COVID-19 result. Most neurological disorders after coronavirus infection were no more common than after other respiratory infections, according to a study published in the journal Frontiers in Neurology. Read more here.

Vitamin D deficiency directly raises dementia and stroke risks

In mid-June 2022, scientists from the University of South Australia reported a causal relationship between vitamin D and neurodegeneration and found out how many cases of dementia could be prevented with a dietary supplement. The data also show optimal vitamin D levels for the prevention of incurable disease. Read more here.

American medical community recommended taking aspirin every day to prevent stroke

On May 2, 2022, the U.S. Preventive Services Task Force announced the completion of updated guidelines for daily aspirin use for the prevention of heart attack or stroke. Read more here.

2021

Global strokes have fallen by 21.8% since 1990

From 1990 to 2021, a global decrease in age-standardized stroke rates was recorded by 21.8%, prevalence - by 8.5%, mortality - by 39.4%. This is stated in the study, the results of which were published by an international group of specialists in early October 2024.

In 2021, an estimated 93.8 million people around the world suffered a stroke, and the number of deaths associated with this ailment amounted to 7.3 million. Stroke was the third most common cause of death after coronary artery disease and coronavirus infection COVID-19. Ischemic stroke was most often diagnosed: it accounted for 65.3% of all new cases in 2021. This is followed by intracerebral hemorrhage (28.8%) and subarachnoid hemorrhage (5.8%).

The number of strokes is decreasing in the world

The burden of stroke varies widely between regions. So, in Luxembourg in 2021, the lowest incidence was noted - 57.7 cases per 100,000 population, and in the Solomon Islands - the highest, amounting to 355 diagnoses per 100,000 inhabitants. Singapore has the lowest death rate from stroke at 14.2 cases per 100,000 population, while North Macedonia recorded the highest at 277.4 deaths per 100,000 inhabitants. Significant differences are observed between high-income and low-income regions, with Central Asia, East Asia and sub-Saharan Africa facing the highest stroke burden. In contrast, high-income regions such as North America and Australasia showed the lowest levels.

In Russia, the number of new cases of stroke in 2021 amounted to 422 thousand, which is 27% less than in 1990. The number of deaths from stroke decreased over 30 years by 43.9% - to 311 thousand. The prevalence of strokes was 2.45 million cases, falling by 9.5%.^[5]

Announcement of a bracelet warning of a stroke

In mid-November 2021, Alva Health introduced a bracelet that can detect signs of a stroke and promptly notify the owner or medical personnel. The technology is designed for people at high risk of stroke. Read more here.

Highland residents 12-17% less likely to die from strokes

At the end of September 2021, a study was published in the journal Frontiers in Physiology on whether living at high altitude above sea level could affect the likelihood of a stroke. It turned out that residents of the highlands are 12-17% less likely to die from this acute violation of the blood supply to the brain. brain

This is the first study to examine the rate of hospitalization and death from stroke in people living at four different heights in Ecuador, and includes data collected over 17 years on more than 100,000 stroke patients. The study showed that people living at higher altitudes have a lower risk of stroke and death from stroke and that this protective effect is strongest at an altitude of 2 thousand to 3.5 thousand meters.

Stroke is one of the leading causes of death and disability worldwide. A stroke usually occurs due to a blockage, such as a blood clot, one of the arteries supplying blood to the brain. You may be familiar with some of the most common lifestyle and health factors that contribute to stroke risk, including smoking, high blood pressure, high cholesterol, and lack of physical activity. However, there is another overlooked factor that could also affect stroke risk - altitude.

Higher altitude means less oxygen availability, so people living on higher ground have adapted to these conditions. However, how this environment affects the likelihood of developing a stroke remains to be seen. Evidence suggests that short-term exposure to low oxygen may contribute to increased blood clotting and risk of stroke, but the risk among people permanently living at high altitude is unclear. Researchers in Ecuador are in a unique position to study these phenomena, as the presence of the Ecuadorian Andes means that people in the country live at a wide variety of altitudes.

The main motivation for our work was to draw attention to an issue that is very little understood. That is, more than 160 million people live at an altitude of more than 2.5 meters, and there is very little information about epidemiological differences in terms of stroke at an altitude. We wanted to contribute to new knowledge in this population, which is often considered the same as the population living at sea level, and from a physiological point of view we are very different, "explained Professor Esteban Ortiz-Prado from the University of Las Americas in Ecuador, lead author of the study.

Researchers examined hospital records in Ecuador for the period from 2001 to 2017 and estimated the rate of hospitalization and mortality from stroke among people living at four different heights: low (less than 1.5 thousand meters), moderate (1.5-2.5 thousand meters), high (2.5-3.5 thousand meters) and very high (3.5-5.5 thousand meters).

The results showed that people living at higher altitudes (above 2.5 meters) tended to experience stroke later in life compared to those living at lower altitudes. Interestingly, people living at higher altitudes were also less likely to go to hospital or die of a stroke. However, this protective effect was stronger in the range from 2.0 to 3.5 thousand meters and slightly weakened above 3.5 thousand meters.

Perhaps people living at high altitude have adapted to low oxygen conditions and are building up new blood vessels faster to help overcome stroke-induced damage, the researchers clarify. They may also have a more advanced vasculature in the brain that helps them make the most of the oxygen they consume, but it may also protect them from the worst effects of stroke. More research is needed to identify the mechanisms behind the phenomenon, but the findings may provide some comfort to those living on top of the world.^[6]

Stroke rehabilitation implant announcement

At the end of September 2021, an implant for rehabilitation after a stroke entered the market. We are talking about a drug-free rehabilitation system MicroTransponder Vivistim that helps treat motor deficiency of the upper extremities with the stimulation of the vagus nerve. More. here

Sciberia to release diagnostic module for stroke detection

Sciberia, a graduate of the B8 accelerator, a resident of the Yakutia Technopark, Yakutsk IT Park and Skolkovo, will release a diagnostic module for detecting signs of acute cerebrovascular accident - stroke. The Press Center of Yakutia in Moscow announced this on March 31, 2021. Read more here.

Icobrain Announcement - Stroke Impact Analysis Programs

At the end of February 2021, the developer software on the basis AI Icometrix released ON icobrain cva for the analysis of the consequences of ischemic stroke (heart attack) by brain CT photographs. More. here

2020

Stroke diagnostic app announcement

In late October 2020, researchers at the University of Pennsylvania and Houston Methodist Hospital developed an app that helps doctors quickly diagnose stroke. The developers expressed the hope that this AI-based application will be able to speed up the diagnosis of stroke and reduce the number of severe complications that can be avoided with the timely start of treatment. Read more here.

Tigertriever Announcement - Blood Clot Removal Devices

In mid-August 2020, the Israeli company Rapid Medical began selling the Tigertriever XL device to remove large blood clots from intracranial vessels during the first hours of ischemic stroke to prevent further lesions. The company calls its line of devices "strivers," because in appearance and function they are similar to stents, but are designed to remove blood clots from the body. Read more here.

Roszdravnadzor registered a smart glove for rehabilitation after a stroke

On May 20, 2020, it became known that Roszdravnadzor registered the Senso Rehab smart glove created by SensoMed for rehabilitation after a stroke. This simulator helps restore fine motor skills. Read more here.

2019

Bristol-Myers Squibb and Pfizer to use Fitbit technology to detect atrial fibrillation in patients at high risk of stroke

In mid-October 2019, Fitbit and pharmaceutical companies Bristol-Myers Squibb and Pfizer signed a multi-year partnership to improve the detection of atrial fibrillation and thereby reduce the risk of life-threatening conditions such as stroke. Read more here.

"RTM Diagnostics" will develop a sensor to determine the temperature of the brain

On July 30, 2019, the Russian venture capital company announced that the portfolio company RVC Biofund received a Skolkovo Foundation minigraft in the amount of 5 million rubles. for the development of the RTM-Brain microwave sensor. The device will allow visualization of brain temperature for the prevention and treatment of stroke. Read more here.

Medtronic to become distributor of stroke sign imaging software

On July 23, 2019, it became known that Medtronic (Medtronic) enters into a distribution agreement with Viz.ai (Vis.ei-ai), a software developer (software) that allows you to detect signs of stroke, which will make it possible to expand the supply of this technology to hospitals and medical centers. Read more here.

2018

A schoolboy from Yekaterinburg invented a device for the rehabilitation of people after a stroke

As it became known to Zdrav.Expert on December 7, 2018, Daniil Novik, a 17-year-old schoolboy from Yekaterinburg, received a gold medal at the International Exhibition of Young Inventors in Delhi for developing a neural glove for the rehabilitation of people after a stroke, which as of December 2018 has no analogues all over the world. Read more here.

Stent retriever for the treatment of stroke demonstrated at the MKDC Kazan

On November 16, 2018, the Interregional Clinical and Diagnostic Center (Kazan) demonstrated a device for the treatment of acute ischemic stroke, the Solitaire Platinum stent retriever, as part of an educational course for doctors. Read more here.

Notes