It is one of the leading causes of disability and death worldwide: stroke. According to the World Health Organization (WHO), each year, nearly 15 million people worldwide are affected by this brain injury. The latter is linked to an occlusion of a cerebral artery or a cerebral hemorrhage. “Obstruction is the most common cause. A blood clot moves an artery, that is to say a vessel which supplies blood to the brain. The irrigated territory therefore no longer receives blood or oxygen”, explains Dr. Camille Heitz.
Initially, this area suffers and if the blockage persists, the neurons in this area may die. “In the case of hemorrhage, it involves a vessel bursting in the head and causing bleeding. Likewise, this bleeding can lead to the death of the neurons concerned.”, adds the neurologist.
Stroke: what are the symptoms?
It is very important to know the symptoms of stroke in order to react as quickly as possible. Support as early as possible is indeed crucial. “The signs are sudden and occur from one second to the next without warning. This may include paralysis or loss of feeling in an arm or leg, difficulty speaking, loss of vision on one side, or severe dizziness.”, explains Dr. Heitz. In the event of hemorrhage there may also be very violent headaches and vomiting, or even loss of consciousness.
Can you have a stroke while sleeping?
“Yes, it even happens frequently, because in most cases, the stroke is not painful..”, confirms the neurologist. If the stroke occurs at night, the person does not notice it until they wake up. “When we discover the stroke upon waking up, we always try to carefully question the person or their partner to find out their bedtime and whether the person got up during the night (to go to the toilet for example). We try to estimate the time the person was last seen without a stroke”, explains Dr. Heitz.
What is the treatment in the case of a stroke during sleep?
“We have a period of 6 hours after the onset of symptoms to carry out a very effective treatment, called thrombolysis. A powerful product is injected to unblock the artery. But if this treatment is done too late when the neurons are already dead, there is a risk of bleeding and therefore worsening the situation.explains the neurologist.
When the stroke occurs at night, it is therefore essential to try to have as much information as possible on the last moment when the person was seen “normal”. The doctor orders a brain MRI, certain sequences of which make it possible to estimate the time frame for the stroke. “If the stroke does not yet appear on certain sequences, this means that it is probably less than 6 hours old. There is a benefit-risk balance to be assessed, because it is an estimate, not a certainty. Neurologists are used to taking all this data into account to judge whether thrombolysis is risky or not. recalls Dr. Heitz. The latter specifies that the person and their family are always informed of the risks, so that they can make the decision whether or not to carry out the treatment. “
“In certain cases (if the clot is very large) we can do a thrombectomy, that is to say we go directly to look for the clot with a catheter. This procedure causes less bleeding and can be an alternative if the risk of thrombolysis is too great.”, concludes the neurologist.
Thanks to Dr Camille Heitz, neurologist (ICT, Trocadéro Brain Institute, Paris)