Recognizing and Assisting Stroke (Apoplexy)

High blood pressure increases the risk of suffering a stroke - medically known as apoplexy. Another term is brain stroke or cerebral stroke - previously also called stroke flow and colloquially often simply referred to as stroke. Stroke is the third leading cause of death in Germany. Most strokes are caused by a blood clot, often resulting from atrial fibrillation. Atrial fibrillation is usually associated with high blood pressure. Although strokes primarily affect older people, children, adolescents, and young adults can also suffer a stroke.

In 2024, a study showed that high blood pressure particularly increases the risk of a severe stroke. A stroke is classified as severe if the affected person can no longer walk or care for themselves afterward or even dies as a result of this event. 74% of those who suffered a severe stroke had high blood pressure. Even those who experienced a mild to moderate brain stroke had a prior diagnosis of hypertension. This risk was also observed, albeit to a lesser extent, in participants with atrial fibrillation or those who were smokers.

What is a Stroke?

A stroke occurs due to a disturbance in blood flow in the brain. This results in the brain cells in the affected area being supplied with too little oxygen and nutrients, leading to cell death. There are two main forms of stroke: ischemic (non-bleeding) stroke and hemorrhagic (bleeding) stroke.

Ischemic (Non-Bleeding) Stroke

This occurs due to an acute reduction in blood flow (ischemia) - often caused by a blood clot. This form accounts for about 80 to 85 percent of all strokes. The severity of the apoplexy depends on which region of the brain is affected by the reduced blood flow.

Hemorrhagic (Bleeding) Stroke

In this form, the disturbance in blood flow is due to a brain hemorrhage. Since the brain is protected from impacts and similar forces by the skull, there is no possibility of forming a bump on the outside in the event of a brain bleed. The blood that escapes presses on the brain, causing reduced blood flow - or this reduced blood flow occurs due to the lack of blood in the downstream region. This accounts for 15 to 20 percent of strokes.

How Do I Recognize a Stroke?

Certain symptoms are often observed in a stroke.

The most well-known symptom is hemiplegia, which can be recognized by the following signs:

drooping mouth corner, drooping eyelid - it is typical, for example, that drinks or saliva flow uncontrollably from the mouth;
one arm feels weak, cannot be lifted, and the palm cannot be turned upwards;
slurred speech and/or difficulty understanding spoken words;
unsteady gait, problems walking, one leg does not cooperate.

Additionally, the affected individuals may experience the following problems:

loss of balance, dizziness;
partial loss of the visual field - certain areas of normal vision can no longer be perceived;
seeing double or blurred vision;
sudden severe headache;
nausea, possibly vomiting (caution: risk of choking!);
confusion, disorientation - questions about name, date of birth, current date, and location may not be answered or only inadequately;
clouding of consciousness up to unconsciousness.

What to Do if You Suspect a Stroke?

If you suspect that you or the person in front of you may have suffered a stroke, please call emergency services immediately at 112! Time is brain!

Follow the FAST scheme:

F Face: Ask the person to smile. If one side of the face does not smile, or if a mouth corner or eyelid droops, paralysis is likely, indicating a stroke.
A Arms: Ask the person to stretch their arms forward and turn their palms up - either one arm first, then the other, or both arms at the same time. If one arm hangs limply, paralysis is likely, indicating a stroke.
S Speech: Ask the person to repeat a sentence. Or ask them a simple question. If you notice slurred speech and/or the person does not remember their name or date of birth, this is a sign of a stroke.
T Time: Do not waste time! If you notice abnormalities in F, A, or S, call emergency services immediately at 112. Time is brain!

Stay with the person, position them with an elevated upper body, and monitor the affected individual. Do not let them eat or drink - the risk of choking due to paralysis is high! If necessary, provide first aid. If the person becomes unconscious but is breathing, place them in the recovery position. Continuously check their breathing. If the affected person stops breathing, start CPR.

If you are affected, if possible, call the nearest reachable person to you. Wake your partner, call the neighbor, inform your children or relatives. Do everything to ensure you are not alone in this situation. Do not eat or drink! Do not exert yourself!

Wait for the emergency services! Do not drive yourself to the hospital! This endangers you and others.

What Else is Important?

Open the door for the arriving emergency services. If necessary, place a shoe or something similar in the door to prevent it from closing. Be prepared for the situation to worsen before the emergency services arrive, so you may not be able to open the door later.

For emergencies such as a stroke, it is helpful to have an up-to-date medication plan and any noted allergies on hand.

Time is brain - time is brain. This means the faster a stroke can be medically treated, the higher the chances of survival and minimizing lasting damage. The best time to initiate a so-called lysis therapy is within up to 4.5 hours after the stroke.

What Happens Next?

The emergency services will take the affected person to the hospital as quickly as possible - preferably to a so-called stroke unit. In more remote areas, the fastest option may require a rescue helicopter. A stroke unit is a specialized department for stroke patients.
In the hospital, a CT (computed tomography) of the head will be performed. This imaging procedure shows whether, where, what type, and how severe the stroke is. Depending on the indication, therapy will be initiated - possibly a lysis, which can dissolve the blood clot that is blocking the vessel.

Smile - Speak - Raise Arms

Cartoonist Ralph Ruthe has created a funny music video on this serious topic. Humor helps to remember the symptoms:
https://www.youtube.com/watch?v=SmZZLGnbWxc

Sources:

This article is from BloodPressureDB the leading app since 2011 that supports hundreds of thousands in blood pressure monitoring every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 12/2024).

Author Sabine Croci is a certified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has been leading the editorial team of BloodPressureDB since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder, and in various therapy and emergency areas, she provides well-founded, practical, and reliably verified information.