The cause of around every fifth stroke is unknown

The cause of around every fifth stroke is unknown

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Every fifth stroke remains puzzling

Every year, more than a quarter of a million people in Germany suffer a stroke. A large part of the brain infarctions is due to diseases of the vessels or the cardiovascular system. But with every fifth stroke the cause remains unknown.

One of the most common causes of death in Germany

According to health experts, around 270,000 German citizens suffer a stroke every year. This represents one of the most common causes of death in Germany. A large part of the so-called brain infarctions is due to diseases of the vessels or the cardiovascular system such as high blood pressure, atrial fibrillation or deposits in the carotid arteries. But in about 20 to 30 percent of brain infarctions, the cause remains in the dark. Doctors then speak of a "cryptogenic stroke", reports the German Heart Foundation in a current message.

Take cryptogenic strokes no less seriously

Cryptogenic strokes tend to be less severe and leave less permanent damage than those where the cause can be quickly determined.

"Overall, cryptogenic strokes have a better prognosis than strokes with a known cause," explains Prof. Dr. med. Thomas Meinertz from the Scientific Advisory Board of the German Heart Foundation in the current issue of the heart foundation magazine HERZ HEUTE.

But they should not be taken any less seriously, because here too, the deficiency of a brain area due to a constricted or closed brain-supplying blood vessel leads to permanent brain damage, as the cardiologist from Hamburg emphasizes.

"Therefore, for every stroke with the emergency number 112, the emergency doctor should be called to take the person concerned to a clinic with a stroke unit," said Meinertz.

"Whether it is a preliminary stage of the stroke in the form of a transient ischemic attack, TIA for short, or a stroke of cryptogenic cause can only be clarified by the subsequent diagnosis."

Heart defects as possible causes

As the Heart Foundation explains, there are different causes for a cryptogenic stroke depending on age.

Younger patients between the ages of 16 and 30 are often congenital heart defects - especially the open or persistent oval foramen, or PFO for short.

In this heart defect, the septum between the right and left atria is not properly closed (hole in the heart).

This favors the formation of blood clots that get into the brain and can trigger a stroke there.

"About half of the patients diagnosed with cryptogenic stroke who are under the age of 60 have a PFO," explains Meinertz.

Between the ages of 31 and 60, acquired heart diseases play a larger role as the cause of the cryptogenic stroke. These can be, for example, heart valve defects or cardiomyopathies, i.e. cardiac muscle diseases.

Atrial fibrillation is often not recognized

Atrial fibrillation is a common cause of cryptogenic stroke in older stroke patients over 60 years of age.

However, if the arrhythmia occurs only sporadically, it is difficult to diagnose and is often not recognized as the cause.

"In elderly patients with a stroke of a supposedly unknown cause, attacks of atrial fibrillation should always be searched systematically," said Meinertz.

However, the proof is often only possible with complex diagnostics such as repeated long-term ECGs or the use of "event recorders" that enable continuous monitoring of the heart rate.

With atrial fibrillation, blood clots can easily form in the atria of the heart. If these get into the brain and block an artery there is a stroke.

Many patients with an irregular heartbeat therefore take anticoagulant medication to prevent a stroke.
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Recognize stroke warning signs in good time and dial 112

Not only cardiac patients should recognize the symptoms and possible harbingers of a stroke in good time.

Individual symptoms often appear days or weeks before, but disappear after a few minutes.

The German Heart Foundation explains which warning signs indicate a stroke or can announce it:

  • Paralysis in one arm, leg, or half of the face
  • Difficulty speaking
  • Sudden visual disturbances
  • Sudden severe headache

Those who notice any of these symptoms shouldn't hesitate, but act quickly and call 112.

Important rules to avoid a stroke

Prevention is at least as important as quick action in an emergency. Health experts have summarized the most important rules for this:

Existing hypertension must be treated. Other risk factors such as type 2 diabetes, atrial fibrillation, fat metabolism disorders and high cholesterol must also be prevented.

Overweight as well as stress should be avoided. Regular exercise and a healthy, balanced diet are recommended.

Alcohol should only be consumed rarely and in small quantities. Smoking is not recommended.

Existing cardiac arrhythmias should be treated medically if necessary. (ad)

Author and source information

Video: Atrial Fibrillation and Stroke Prevention Miguel A. Valderrábano, MD (October 2022).