In Norderstedt I have already given many lectures on the subject of strokes – “How dangerous are they really?” – at the health fair and other public events.

Recognising the risk of strokes at an early stage is a particular concern of mine, since it makes swift therapeutic treatment possible and holds out the chance that the consequences of a serious stroke will be avoided.

Recognising the risks of strokes at an early stage gives us the chance to do something for the long-term preservation of our health.

I often find, however, that the following view predominates:

Many people believe that the occurrence of a stroke can be neither forecast nor hindered.

Then, however, a stroke suddenly occurs like a bolt from the blue.

For most people this is a major catastrophe, since the symptoms connected with it – such as physical and speech disability – often make the patient either partly or wholly dependent on care and support.

For younger patients, further gainful employment is frequently impossible.

Strokes as an overall diagnosis happen not only – as is often believed – to older people; they can also affect the relatively young.Frequently, mini-

symptoms occur for a few seconds or minutes before the stroke occurs.

They can manifest themselves, for example, in the form of fleeting sight disorders, tingling or other sensibility disturbances or fleeting symptoms of paralysis, and they frequently last no more than a few seconds or minutes.

In the stress of everyday life, these symptoms are not taken seriously enough – after all, everything returned to normal, didn’t it?

The harbingers of a stroke are overlooked.

It is also frequently the case that the danger of a stroke is underestimated. Patients have often said to me: “I had a little shock”.

We call these fleeting symptoms transitory-ischemic attacks. They herald the occurrence of a heavy stroke.

Each year, between 150,000 and 300,000 people in Germany suffer their first stroke.

It is assumed that almost one million people in Germany are affected by the consequences of such a stroke.

20% of the patients die during the first four weeks.

Of those who survive, only about one-third are restored to health in a manner that enables them to resume the lives they led before the stroke.

Another third regains sufficient independence to deal with simple everyday things, but these patients are so disabled by paralyses and other symptoms that they can no longer be gainfully employed.

The final third of the stroke patients remains dependent on care.

The term stroke or apoplectic attack refers generally to the sudden onset of a disorder in brain activity that is caused by vascular-related factors.

This definition, however, does not indicate whether the stroke is a cerebrovascular accident or a cerebral haemorrhage.

Reference must also be made to the fact that strokes can also occur in the spinal cord if large vessels in the spinal cord no longer receive a proper blood supply or if spinal aneurisms collapse.

Our brain consists of the cerebrum, the brain stem and the cerebellum. Together, the brain, the spinal cord and the optic nerves form the central nervous system. It is split into two halves that are the mirror image of each other. Each half contains four large cerebral flaps.

Cerebral perfusion takes place through a highly complicated network of vessels.

One special feature is that many sections of the brain are supplied solely by one artery, without there being sufficient further inflow possibilities through substitute vessels or byways.

We make a distinction between the extracranial vessels that supply the brain and run alongside the throat (main arteries) and can be reached with Doppler ultrasonography and the intracranial cerebral vessels that supply the brain directly in the bony skull and can be diagnosed with transcranial Doppler ultrasonography.

Depending on which vessel inside or outside the brain is diseased, a large number of symptoms can set in.

Stroke symptoms can lead to more than just speech disorders, one-sided vision disorders and impaired consciousness.

A wealth of neuropsychological disorders can set in, for example:

• motorial apraxia, whose sufferers are not capable of raising themselves from a chair;
• dressing apraxia, whose sufferers can no longer put on a shirt or blouse, etc. without help;
• ideomotoric apraxia, a disorder that renders symbolic actions impossible;
• ideatoric apraxia, a disorder that renders complicated sequences of actions involving the concrete use of different objects impossible, e.g. such patients are no longer able to prepare a cup of instant coffee;
• constructive apraxia, which impairs the spatial imagination to such an extent that the patients can no longer draw a bicycle;
• visual agnosia: although the sufferers have normal visual impressions, they are unable to assign any significance to the perceptions and cannot say, for example, what people or things are being seen;
• tactile agnosia, whose sufferers can perceive a painful pinprick on the finger, for example, but cannot recognise what it means – pain is felt and the hand is not withdrawn;
• auditory agnosia has a similar effect, with patients hearing something without being able to record the significance of what they have heard;
• finger agnosia, whose sufferers, although able to name their fingers, cannot move, say, their ring finger when requested;
• stereo agnosis impairs spatial recognition via touching, e.g. the patients can touch an object with their eyes closed but cannot name the object.
• patients suffering from an alexia can write but not read;
• if they suffer from an agraphia they cannot write;
• if they suffer from an acalculia they cannot count;
• a neglect is a disorder in the perception of one side of the body or its environment, which can lead to neglect or inattentiveness in respect of that side of the body;
• a visual neglect, one of the most frequent forms of neglect, means that e.g. one half of a plate is neglected because it is not perceived, or that the patient often bumps into things with one shoulder.

However, other stroke symptoms such as dysphagia, hoarseness, acute dizziness, tingling, manifestations of paralysis and headaches are important, must be taken seriously and require immediate neurological clarification.

Only the neurologist is sufficiently qualified to reach a conclusion about the condition of the cerebral vessels on the basis of directional and transcranial examinations using Doppler ultrasonography.

From a medical point of view, it makes a great deal of sense to carry out an annual examination of the condition of the vessels that lead to and supply the brain using Doppler ultrasonography.

The individual risk of a stroke can also be estimated annually by a neurological specialist.

Examining the vessels using Doppler ultrasonography enables statements to be made about the condition of those vessels and about whether or not an arteriosclerotic process is present as a significant risk factor for strokes.

In addition to that, all factors that represent vessel risks must be monitored annually.

The cost of prophylactic examinations, however, is not borne by the health insurance funds.

They are paid for via IGEL,i.e. by the patient.

But what can the individual patient do to reduce the risk of a stroke?

1. Sporting activity
2. Blood pressure management
3. Put an end to fat and sugar metabolism
4. Renounce nicotine or withdrawal_from_smoking
5. Have himself monitored annually with Doppler ultrasonography

All in all, it can be stated that we in Germany live in one of the most modern countries in the world and have a wonderful democracy at our disposal.

It hardly seems conceivable that using the latest preparations for secondary stroke prophylaxis is often connected with considerable problems for the prescribing doctor.

I personally believe that enlightening the population is one of the most important methods of countering the overall risk of strokes.

For this reason, I regularly hold lectures about strokes in Norderstedt, Hamburg and the surrounding area and train doctors all over the country in the treatment of these afflictions.