May 10 is the “Day against the Stroke”. We think this is an important day, because when a stroke occurs, time is an important factor and the right treatment is necessary. If you have a stroke, you also have to have radiology imaging support and that’s why we at Team Fair Imaging took a close look at the topic and asked what relatives can do and clarified why it is so important even in times of the coronavirus to go to the hospital go.

With Priv.-Doz. Dr. med. We conducted an interview with Eberhard Siebert, senior physician at the Institute of Neuroradiology at Charité, to take a closer look at the topic of stroke.

Priv.-Doz. Dr. med. Eberhard Siebert

Attending, Head of Service

at CCM Institut of Neuroradiology

Charité –Universitätsmedizin Berlin

Please introduce yourself briefly.
As a neuroradiologist, I have specialized in imaging diagnostics and minimally invasive treatment of neurological diseases, a fascinating area. One of my focal points is the treatment of acute stroke. Treatment options in this area have improved tremendously in recent years. Being part of this great progress means a lot to me. As an interventionalist, it is always very nice to see patients recover practically completely on the treatment table after a successful procedure.

What is a stroke?
In the event of a stroke, a blood clot blocks a vein in the brain. The area blocked in this way does not get enough blood and can therefore no longer function normally. It usually dies within hours. The neurological symptoms that arise in this way are therefore still capable of regressing at the beginning if the occlusion is removed in short time. Once the brain part behind the blockade has died, permanent disabilities likely occur.

How can I recognize a stroke?
A stroke usually manifests itself through “sudden”, i.e. suddenly occurring neurological deficits. Typical characters are e.g. a weakness on one side of the body, problems with speaking, not feeling everything, visual disturbances or coordination disorders.

What should be done in this case?
It is of utmost importance to act quickly in this situation. Any hesitation carries the great risk of deterioration. The principle is: Time is brain!, because the brain cannot survive this condition permanently. Calling emergency services at any time of the day or night is therefore urgently required. Patients affected are then brought to a hospital by ambulance, which includes a so-called stroke unit and can treat strokes around the clock.

What is going to be done in the hospital?
First of all, you will undergo an emergency neurological examination and the neurologist will ask you some important questions. Immediately afterwards, a (neuro)radiological imaging of the head is carried out. This can be a CT or an MRI (see Figure 1). These two medical imaging methods can be used to decide on a so-called “revascularization therapy”, that is, a treatment aiming to dissolve or mechanically remove the clot in the brain vessels (Figure 2). In the further course of the hospital stay, the causes of the clot formation are searched for and these are also treated in a targeted manner. The first rehabilitation measures are also being initiated while in the hospital.

Figure 1 Acute stroke can be identified very reliably by means of MRI (arrow). This infarction, which is only as small as a pinhead, lies in the brain supply area of the hand and the patienthad fine motor disorder that suddenly appeared three hours ago with weakness in the left hand.

Figure 2 In the case of severe stroke with large clots that are stuck far down in the vascular tree (left picture, arrow = location of the blockage due to a stuck clot), the clot can be removed with a so-called thrombectomy using a neuroradiological catheter procedure (2nd picture from left: the clot was passed and a so-called stentretriever was released, bridging the clot, recognizable by the punctiform markings). Together with a manual suction on the catheter, the stentretriever with the clot hooked into it was pulled out. The vascular tree is again completely open to all branches (2nd from right, right: catheter and stentretriever with the clot trapped and removed). The patient had sudden and complete paralysis of the left side of the body three hours ago together with feeling weak and having a speech disorder. Minutes after the clot was removed, the patient’s symptoms improved significantly.

Does the new corona virus infection cause strokes?
There is no reliable data on this yet. However, there is increasing evidence that coagulation disorders occur more frequently in people with Covid-19, which then can lead to strokes.

I am very afraid of Corona. Should I avoid hospitals at the moment?
These concerns are quite understandable in the current situation. However, it is of utmost importance that you immediately contact emergency services or the fire department if you suspect a stroke, as this is the only way to obtain the effective therapies described in Figure 2 in the time frame in which the disease can still be treated. Otherwise there is a high risk of permanent severe disabilities that could have been avoided.

We are often asked whether patients should come to the hospital for planned neurological therapies …
Many patients with chronic neurological diseases are permanently followed by neurological consultation services. Our Department of Neurology at Charité has recently started video consultation hours, during which many concerns can be discussed and the medical approach can be defined together with the patients for the next weeks and months. There is also a lot that can be discussed over the phone. For regularly required therapies, e.g. certain infusions, however, a short stay in the hospital is still necessary and recommended in many cases. This is because the current situation is likely to continue for several months and thus treatments should not be delayed.