Stroke – Current Scientific Data, Expert Advice, and Perspectives from Leading Specialists

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 A stroke is a sudden brain injury caused by an interruption of blood flow (ischemic stroke) or by bleeding in the brain (hemorrhagic stroke). It is one of the most serious acute neurological conditions, often resulting in permanent disability or death, and remains a leading cause of long-term disability and secondary mortality both globally and in the United States. The modern clinical motto is: “Every minute counts – time is brain”—meaning that every moment without treatment leads to the loss of millions of brain cells.

Causes and Risk Factors Stroke is a complex condition with two primary types:

• Ischemic stroke – caused by a blockage in a blood vessel (approximately 87% of all cases), most commonly due to thrombosis, embolism, or atherosclerosis.

• Hemorrhagic stroke – results from the rupture of a blood vessel and bleeding into the brain.

Modifiable Risk Factors:

• High blood pressure – the most significant risk factor.

• Diabetes and blood sugar disorders

• High cholesterol, obesity, smoking

• Atrial fibrillation – increases the risk up to five times; proper control is critical.

• Physical inactivity and unhealthy diet

Non-modifiable Risk Factors:

• Age – risk increases with advancing age

• Genetics, sex, ethnicity – women experience strokes more often, and the severity and resulting disability are typically greater in women

• Socioeconomic status – individuals from lower-income groups are more frequently and severely affected

Important: Recent research increasingly highlights differences in stroke risk, progression, and outcomes based on gender, race, and social factors.

Key Symptoms Stroke is characterized by sudden onset of neurological disturbances, such as:

• Sudden weakness or numbness in the face, arm, or leg (especially on one side of the body)

• Difficulty speaking or understanding speech

• Sudden loss of vision or double vision

• Sudden and unexplained severe headache

• Balance issues, coordination problems, or trouble walking

The FAST campaign helps the public recognize stroke symptoms:

• F – Face drooping

• A – Arm weakness

• S – Speech difficulty

• T – Time to call emergency services

Transient Ischemic Attacks (TIAs, or "mini-strokes") show the same symptoms but resolve within 24 hours. A TIA is a warning sign of a high risk for a full-blown stroke.

Diagnosis (Expert Opinions) Timely and accurate diagnosis is crucial. The diagnostic process includes:

• Clinical assessment – a rapid neurological evaluation, often using standardized tools like the NIH Stroke Scale (NIHSS)

• Imaging tests – CT scan to rule out hemorrhage; MRI (especially DWI sequences) for more detailed assessment of ischemia

• Vascular studies – CT/MR angiography to locate vessel blockages or ruptures

• Laboratory and cardiac tests – especially in suspected embolic stroke

Experts emphasize the importance of rapid diagnostics and precise interpretation of imaging studies, particularly to determine eligibility for reperfusion therapies.

Treatment and Official Guidelines In the U.S. and other developed countries, treatment follows strict evidence-based protocols:

Acute Ischemic Stroke:

• Thrombolysis with tissue plasminogen activator (tPA) – administered within 4.5 hours of symptom onset

• Endovascular thrombectomy – for large vessel occlusions, up to 6 hours after onset, and in selected cases (based on imaging) up to 24 hours

• Supportive care – blood pressure control, blood sugar regulation, and oxygen therapy

Hemorrhagic Stroke:

• Blood pressure control, discontinuation of anticoagulants, supportive therapy, and neurosurgical intervention when necessary

Secondary Prevention and Long-Term Care:

• Management of high blood pressure, diabetes, and cholesterol

• Use of statins, antiplatelet drugs (aspirin, clopidogrel), and anticoagulants in patients with atrial fibrillation

• Rehabilitation and social reintegration

• Education and lifestyle changes (physical activity, healthy diet, smoking cessation)

Institutions such as the American Heart Association (AHA), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) regularly issue strict, evidence-based clinical guidelines.

Latest Research and Scientific Advances

New Medications:

• Tenecteplase – a newer thrombolytic agent with easier administration and a potentially better safety profile

• Sovateltide – a new class of molecules under clinical trials for neuroprotection and recovery

Integrated Models of Care:

• Telemedicine and mobile stroke units significantly reduce time to treatment, especially in remote areas

Advances in Imaging:

• Perfusion studies and advanced MRI/CT techniques allow for precise identification of patients eligible for reperfusion, extending the treatment window

Cellular and Genetic Therapies:

• Development of regenerative strategies – including stem cell and molecular therapies aimed at neural regeneration after stroke

Secondary Prevention:

• Use of dual antiplatelet therapy and new oral anticoagulants (DOACs) in high-risk patients

Expert Consensus

Leading neurologists, cardiologists, and vascular medicine specialists agree:

• Early recognition, rapid diagnosis, and timely treatment drastically reduce disability and death

• An integrated, multidisciplinary approach – involving emergency care, stroke centers, and rehabilitation – yields the best outcomes

• Prevention through blood pressure, diabetes, and lipid control, along with lifestyle changes, remains essential: up to 90% of strokes are preventable

• The future lies in personalized medicine, novel reperfusion strategies, and integrated digital health solutions for patient care

Sources and Scientific References

Ischemic Stroke. Steven K. Feske. The American Journal of Medicine (2021) – https://doi.org/10.1016/j.amjmed.2021.07.027

Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Diji Kuriakose, Zhicheng Xiao. Int J Mol Sci (2020) – https://doi.org/10.3390/ijms21207609

Treatments in Ischemic Stroke: Current and Future. Maria Giulia Mosconi, Maurizio Paciaroni. European Neurology (2022) – https://doi.org/10.1159/000525822

The Impact of Sex and Gender on Stroke. Kathryn M. Rexrode et al. Circulation Research (2022) – https://doi.org/10.1161/circresaha.121.319915

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory. Tanya N. Turan et al. Neurology (2022) – https://doi.org/10.1212/wnl.0000000000200030

Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020. David J. Gladstone et al. Can J Neurol Sci (2022) – https://doi.org/10.1017/cjn.2021.127

Stroke mimics: incidence, aetiology, clinical features and treatment. Brian H. Buck et al. Annals of Medicine (2021) – https://doi.org/10.1080/07853890.2021.1890205

Management of acute ischemic stroke. Michael S. Phipps, Carolyn A. Cronin. BMJ (2020) – https://doi.org/10.1136/bmj.l6983

Acute Ischemic Stroke. William J. Powers. NEJM (2020) – https://doi.org/10.1056/nejmcp1917030

Assess the Safety and Efficacy of Sovateltide in Patients With Acute Cerebral Ischemic Stroke. (2024, Clinical Trial) – https://clinicaltrials.gov/study/NCT04046484

Integrated care for optimizing the management of stroke and associated heart disease. Gregory Y.H. Lip et al. European Heart Journal (2022) – https://doi.org/10.1093/eurheartj/ehac245

A systematic review and synthesis of global stroke guidelines. Gillian E Mead et al. Int J Stroke (2023) – https://doi.org/10.1177/17474930231156753