Stroke Treatment in Germany – Focusing On Prevention

What is a stroke?

A stroke is a medical emergency that can cause sudden and irreversible brain death due to lack of oxygen. Lack of oxygen may be due to artery blockage by blood clots or other factors. This is an ischemic stroke – the more widespread condition, arising in 90% of cases. The second possible cause is a rupture of the brain artery. This is a hemorrhagic stroke, which arises in 10% of cases.

The condition is more often diagnosed in people over 50 years old with a number of other risk factors – uncontrolled arterial hypertension, high level of cholesterol and blood sugar. In younger patients, stroke is often connected with drug abuse (e.g. cocaine, amphetamines) or inherited vascular malformations.

Stroke prevention is more beneficial than even the most innovative treatment, as damaged nervous tissue hardly restores its full function. Excluding risk factors and taking preventive measures are the basis of saving precious brain tissue.

Simple steps can successfully prevent a stroke

Stroke prevention includes lifestyle modifications and management of chronic disorders. Also, the same preventive measures reduce the risk of coronary artery disease and dementia.

Control your blood pressure

Uncontrolled arterial hypertension damages brain vessels and increases stroke risk. Fortunately, appropriate anti-hypertensive therapy brings this risk back to normal.

Check your blood cholesterol level.

High level of “bad” cholesterol (LDL cholesterol) stimulates creation of the lipid plaques in the brain arteries, affecting blood circulation and causing oxygen insufficiency.

Treat diabetes mellitus

Maintaining normal blood sugar level prevents vessels damage.

Treat atrial fibrillation.

Atrial fibrillation contributes to the formation of blood clots that may close brain arteries.

Maintain normal body mass.

Obesity raises your odds of developing diabetes mellitus and arterial hypertension.

Take care about your diet.

Including into your diet fruits and vegetables, fish and whole grains enriches body with “good” cholesterol and polyunsaturated fatty acids.

Be physically active

Regular exercises normalize vessels tone and blood circulation.

Quit smoking

and/or using the tobacco products. Nicotine contributes to the blood clots formation and makes vessels more fragile.

Avoid taking illicit drugs.

Psycho-motor stimulants are connected with the increased risk of both ischemic and hemorrhagic stroke. It is considered that immunologic and hemodynamic mechanisms are involved.

These measures are related to the primary prophylaxis. There is also the secondary prophylaxis. It is performed in people who have already had stroke. The secondary prophylaxis reduces risk of the disease relapse. It includes antiplatelet therapy (aspirin intake).

Is it possible to identify a stroke fast?

Stroke is diagnosed by the clinical picture (symptoms), medical history (presence of atrial fibrillation, deep venous thrombosis etc.), and imaging tests (MRI or the CT scan). Nevertheless, the first disease manifestations can be recognized easily enough. You just need to remember the acronym FAST:

• Face asymmetry – one-sided corner of the mouth drooping.
• Arm weakness – a patient cannot lift arm or clench fist with enough strength.
• Speech difficulty – a patient speaks unclear and slowly, cannot understand speech of the others.
• Time to call 911 – seeing these symptoms, you need to seek emergency medical help.

The final diagnosis will be made after a series of laboratory and instrumental examinations:

• Blood tests, including blood sugar, liver and kidneys functional markers.
• CT scan (or MRI) provides a doctor with the detailed image of the brain. It allows differentiating between the ischemic and hemorrhagic stroke.
• ECG and EchoCG are the additional examinations, as they are aimed at revealing the concomitant cardiologic pathology.

Comprehensive treatment of stroke in Germany

If the primary prophylaxis has failed and the diagnosis of stroke is confirmed, medical help should start as early as possible. The treatment tactics depends on the stroke type, as the ischemic and hemorrhagic conditions have principally different pathophysiological background.

In patients with ischemic stroke all efforts are made for the brain blood supply restoring. Earlier it is done, better the outcome is. In German clinics the following techniques are applied in such clinical situations:

1. Intravenous introduction of tPA – tissue plasminogen activator. Being injected within 3 hour from symptoms arising, this pharmaceutical dissolves the blood clot.
2. Directly removing the blood clot with a stent retriever. A thin catheter is used to reach the blood clot and destroy it.
3. Drug support, including the blood pressure management drugs and neuroprotectors.

In patients with hemorrhagic stroke doctors strive for controlling the bleeding. In German clinics this may be reached with a number of approaches, which are available due to the state-of-art equipment:

1. Surgical clipping of the bleeding vessel. A specially constructed clamp is placed at the target vessel or aneurism, completely stopping the blood flow.
2. Endovascular embolization of the bleeding vessel (coiling). Endovascular catheter is used to deliver the artificial coil into the aneurism or other bleeding source. Blood clot is formed around the coil, preventing the recurrent bleeding.
3. Surgical hemostasis. A surgeon may directly remove the bleeding source (e.g. arteriovenous malformation) during the open intervention on the brain.
4. Stereotactic radiosurgery is coagulating blood vessels with the highly focused radiation beams. The obvious benefit of the technique is its minimal invasiveness – skull opening is not required in this case.
5. Drug support includes antihypertensive drugs, anticonvulsant therapy, and drugs for lowering the intracranial pressure.

Treatment of stroke in Germany combines emergency medical services with qualitative neurological rehabilitation and the secondary prophylaxis (aspirin intake and managing the stroke risk factors). Rehabilitation restores post-insult neurological deficit and makes a patient as independent as possible in performing activities of daily living.

Booking Health will make treatment planning easier

Arranging timely treatment in leading German hospitals may be somewhat complicated, as a patient with stroke requires urgent help. In addition, attention should be paid to the proper transportation before the treatment and rehabilitation after it.

If you do not have enough experience in the organization of treatment abroad, it will be more convenient and efficient to contact Booking Health. Booking Health is the certified medical tourism provider that facilitates receiving medical services for patients from 75 countries. Booking Health accompanies patients from the stage of diagnostics to comprehensive rehabilitation and functional recovery.

Specialists of Booking Health provide assistance in:

• Choosing the best clinic for the stroke treatment.
• Preparing medical program in advance, so that you can estimate its duration and cost.
• Excluding possible additional fees for the foreign patients (saving up to 50%).
• Booking urgent appointments.
• Constant independent monitoring of the medical program.
• Communication with the clinic after treatment completion, organization of any additional procedures, if necessary.
• Organization of neurological rehabilitation, if necessary.
• Control of invoices and timely return of unspent funds.
• Booking accommodation for the accompanying person and plane tickets, transfer organization.
• Services of interpreter, translation of medical reports.

Should you leave the request on the Booking Health website, and our patient case manager or medical adviser will contact you the same day.