Stroke is the second leading cause of death worldwide and the leading cause of disability. In Brazil, according to data from the information technology service of the Ministry of Health (DataSUS), more than 100,000 deaths caused by stroke were recorded in 2019.
The recognition of warning signs together with prompt urgent treatment are key factors in saving lives and reducing the risk of sequelae. That’s what happened about two months ago when the parliamentary advisor, Antônio Pinheiro, 36, arrived at the Santa Rosa Hospital emergency room with paralysis on the left side of his body and severe headaches. Antônio had an ischemic stroke and the agility in helping and providing care ensured that he could return to his home without sequelae.
“It was a Monday, August 2nd, after a weekend with the family at Manso, I had to return to our farm to get a medicine that my wife had forgotten there. I was with a friend and when we turned onto the dirt road I started to feel severe pains in my head and in a matter of minutes my left side froze. At the time, I asked her to tell my family and drive to me. When we arrived at the farm, my wife had already got in touch with my doctor and he advised them to run with me to Santa Rosa, as the symptoms were typical of a stroke. That’s what saved me. If I had been alone in the car, I would have died”, recalls Antônio.
With less than an hour of symptoms, Antônio was admitted to the hospital and started the stroke protocol in the emergency unit. “The service started on the sidewalk, even before I got out of the car”, emphasizes the parliamentary advisor.
According to Ariely Teotonio Borges, a medical neurologist, specialist in movement disorders and current coordinator of the Hospital Santa Rosa neurology service, the speed in recognizing symptoms and providing assistance in a short time were crucial to saving Antônio’s life. “Time is essential in stroke cases. Thanks to the care protocol for patients with stroke, our multi-professional team acted in a coordinated manner and in less than 1h30 all the necessary procedures were performed on the patient, saving his life and avoiding sequelae”, explains the doctor.
At 1:30 am, Antônio Pinheiro underwent a clinical evaluation, underwent laboratory and imaging tests —cranial tomography, angiotomography of the arteries of the neck and brain — and was referred to a highly complex procedure, called thromboectomy, to release the thrombus that it was causing the ischemic ACV in his brain.
“Mechanical thrombectomy is the introduction of a catheter that goes to the occlusion point responsible for the stroke. In the case of Antônio, it was performed via the femoral artery and at the tip of this catheter there is a device called a “stent retriever” (ie, a stent that is removed), capable of adhering to the thrombus and rescuing it, unblocking the affected vessel. In the operating room, after the procedure, we started to see the patient’s improvement”, explains the neurosurgeon and interventional neuroradiologist physician Wilson Novais, responsible for the surgery.
What is the AVC Protocol
Hospital Santa Rosa was the first private unit in Cuiabá to institute an emergency and specialized care protocol for patients with suspected stroke.
“The CVA protocol is a systematization of patient care in the acute phase, which consists of a line of treatment, within pre-established procedures. At Santa Rosa, the medical team is composed of neurologists, neuroradiologists and hemodynamicists, specialized and constantly trained. We work 24 hours a day and, in addition to the medical staff, we have modern equipment and adequate infrastructure, from the Emergency Room to areas such as Radiology, ICU and Hemodynamics to provide total, fast and safe care to patients”, summarizes the neurology coordinator, Ariely Teotonio Borges .
A cerebrovascular accident (CVA) occurs when vessels that carry blood to the brain clog or rupture, causing paralysis of the brain area that has been left without blood circulation. There are two subtypes of stroke, ischemic and hemorrhagic.
According to Ariely, it is a disease that affects more elderly patients, but there are also cases in young people. “As was the case with patient Antônio Pinheiro. His stroke occurred due to a heart disease called the patent foramen oval (FOP – acronym in Portuguese). The foramen ovale is a small hole located in the middle of the muscle wall that divides the two atria (cavities) in our heart. Under normal conditions, this orifice usually closes at birth or in the first few months of life. However, it may not close, leaving a small communication between the cardiac atria. And the passage of blood from one side to the other leads to the formation of thrombi, which end up in the cerebral circulation.
Antônio explains that he only learned that he had FOP after the stroke. “The neurology team did an investigation and discovered the disease, as my health history never indicated it. I even have regular exams every six months, I don’t have high blood pressure problems, I practice physical activity and I never imagined I could suffer a stroke”, he says. After a month of recovery, Antônio underwent surgery to correct the heart problem.
Ariely also points out that there are several factors that increase the likelihood of a stroke, whether hemorrhagic or ischemic. The main ones are: hypertension, type 2 diabetes, high cholesterol, obesity, smoking, physical inactivity, excessive alcohol use and family history.
Changing lifestyle habits and learning to recognize the warning signs of stroke help prevent death and the sequelae of the disease. Know how to identify the main symptoms:
- Weakness or tingling in the face, arm or leg, especially on one side of the body;
- Mental confusion;
- Alteration of speech or comprehension;
- Change in vision;
- Change in balance, coordination, dizziness;
- Sudden, severe headache with no apparent cause.