Acute cerebrovascular accident. Causes, signs, diagnosis and treatment of ischemic type cancer Consequences of acute cerebrovascular accident

Disturbances in trophism (nutrition) of cerebral structures are represented by a large group of pathological processes.

If we exclude variants with a chronic course, we can distinguish only two acute varieties, according to the classification:

• The first is a classic stroke. Acute malnutrition of the brain with parallel development of necrosis of neuronal clusters. This is the most dangerous type of violation.

Not heterogeneous (homogeneous) in nature, has several subspecies. Hemorrhagic (bleeding in the brain as a result of a ruptured vessel) and ischemic (tissue death due to insufficient blood supply).

It can also be primary, secondary, or localized in different parts of the brain.

They also differ in the extent and area of ​​affected tissue. This disease alone deserves many scientific works.

• The second is a micro-stroke. There is no such diagnosis in the international classifier. We are talking about a transient or transient ischemic attack.

That is, a sharp significant decrease in the quality of brain nutrition but with no necrosis.

Therefore, this form is considered less dangerous: there is no tissue death, spontaneous regression of the disorder is observed even without medical assistance.

Thus, acute cerebrovascular accident, abbreviated as ACVA, is a disorder of insufficient speed and poor quality of blood flow in cerebral structures, provoking focal neurological symptoms and a reduction in certain functions of the central nervous system. There is a possibility of death.

Acute circulatory disorders in the brain develop in several ways. Among the key ones, three can be named.

The first is atherosclerosis. The essence of the disorder is the narrowing or blockage of an artery located in the brain. In 95% of cases, the culprit is a cholesterol plaque.

Slightly less common is a blood clot that has broken away from the site of its own formation (usually the legs or arms, sometimes the heart).

Blocking the lumen leads to the inability of blood to move further or to a decrease in the efficiency of fluid tissue circulation. For the most part, this ends with a decrease in the quality of trophism (nutrition) of nerve fibers.

In the case of predominant blockage, especially if there are problems with the vessels, a rupture with the formation of a hematoma and massive bleeding cannot be avoided.

A stroke in itself is much more dangerous, because everything is exactly the opposite. Symptoms of acute cerebrovascular accident are divided into general and focal.

Common stroke symptoms

The first are represented by nonspecific manifestations:

• Headache. Strong, unbearable. It is localized in the occipital region, crown, temples, and can cover the entire skull, spreading diffusely and radiating to the eyes and neck.
• Vertigo. Inability to navigate. The world is literally spinning, it’s impossible to even walk normally. Often a person takes a forced lying position.
• Nausea, vomiting. Short-term symptoms. Indomitable reflex gastric emptying almost never occurs. There is no relief after the act, because a false defense mechanism is triggered.
• Weakness, lethargy, drowsiness. Asthenic moments.

Focal signs

More specific and informative. Multiple areas of the brain may be affected.

Frontal lobe

Responsible for cognition. Creativity, thinking, behavior, everything is localized here.

Typical symptoms include:

• Marked decrease in intelligence, inhibition and decline in thinking productivity.
• Goofiness, inappropriate emotional reactions. Behavioral disorders may not be noticeable at first, because the patient is unable to demonstrate personal qualities. He is apathetic, mostly lies down and is silent.
• Regression. Induced infancy. Complete immaturity. Again, this refers to a behavioral disorder.
• Epileptic seizures. Heavy. Tonic-clonic. They can be repeated repeatedly, developing not into an attack, but into a status (a long course of paroxysms continuously or one after another for 30 minutes or more).
• Paralysis of the muscles opposite the localization of the lesion to the side.
• Aphasia. Inability to speak clearly.

Parietal lobe

Responsible for intellectual activity (partially), processing of tactile information (sensory component of human activity), and also the perception of smells.

• Inability to read, write, or perform simple arithmetic operations.
• Physical hallucinations. It seems to a person that someone is touching him, something is moving under the skin.
• There may be a lack of holistic perception of one's own body.
• There is agnosia, the inability to recognize an object, even the simplest one, known to everyone, by touch with eyes closed.
• There are complex complex hallucinations of the type of oneiric clouding of consciousness.

Temporal lobes

Responsible for auditory analysis, memory, verbal abilities.

• Deafness or hearing loss.
• Inability to understand speech in one's native language.
• Lack of speech, telegraph type of process. The patient expresses himself in abrupt words with formal logic intact.
• Epileptic seizures. This time they rarely turn into a full-fledged status with a continuous long-term course of the episode. Otherwise, the clinic corresponds to people’s ideas about a similar condition (seizure).
• Memory impairment. Anterograde, retrograde. Global and partial amnesia.

Occipital lobe

Responsible for visual analysis. Hence the corresponding symptoms: the simplest hallucinations such as luminous points and geometric figures, loss of areas of visibility, blindness (temporary) and other moments.

Limbic system and cerebellum

When it is affected, there is no sense of smell. Against the background of destruction of extrapyramidal structures (cerebellum), the inability to navigate in space, muscle weakness, lack of normal coordination of movements develops, and nystagmus is provoked (rapid spontaneous movement of the eyeballs to the left and right).

If the brain stem is involved in the pathological process, catastrophic consequences are possible: disturbances in heart rhythm and breathing, up to stopping one or the other, critical jumps in body temperature. Even against the backdrop of a transient attack.

There is no fundamental difference between the individual forms of the disorder.

Deviation of the ischemic type is somewhat easier, because there is no additional negative factor. Namely, a blood clot, a hematoma, which compresses the tissue.

Hemorrhagic type lesions are more lethal, for comparison, the ratio of deaths in the first and second forms of stroke is 20 versus 43% for the small-focal type and 70/98% against the background of extensive destruction of nerve tissue.

First aid

It turns out immediately, at the pre-medical stage. The main thing to do is call an ambulance.

Then the algorithm is:

• Calm and reassure the patient. Fussiness will not lead to anything good.
• Place the victim on his back in a half-sitting position so that his head and torso are slightly elevated. A cushion made from scrap materials or several pillows will do.
• Provide fresh air flow. Open the window, window. This is important because it is necessary to correct hypoxia (oxygen starvation), which inevitably manifests itself during a stroke and even a transient ischemic attack.
• Loosen the collar and remove body jewelry. If there are any.
• Closely monitor the patient's condition. Assess the heart rate (based on the pulse on the carotid artery), pressure level, and the number of respiratory movements per minute.
• If you lose consciousness, turn your head to the side to prevent choking on vomit.

• If necessary, carry out resuscitation measures: cardiac massage (palm on the other, both on the middle of the sternum, do 80-100 energetic and rhythmic passes pressing the area 5-6 cm until the heart activity is restored).

Artificial respiration is done only if you have the skill, every 10-20 massage movements. If you don't have one, it's a waste of time.

Attention:

In no case should you put your head below the level of your body, give any medications, allow the patient to move, especially walk, take a bath, shower, eat or drink a lot.

Diagnostics

It is carried out after the condition has stabilized. Acute cerebral circulatory disorders require minimal examination: measuring blood pressure, heart rate, respiratory movements, and identifying the integrity of reflexes. Next they provide assistance.

Only after recovery does it make sense to evaluate the situation more carefully and look for the reasons.

The list of events is quite long:

• Oral questioning of the patient and collection of anamnesis.
• Daily monitoring using a programmable Holter device. It measures blood pressure and heart rate levels. Provides information about indicators over a 24-hour period.
• Electro- and echocardiography. To exclude a cardiac etiology of the problem.
• MRI of the brain. To identify the consequences of a violation.
• General blood test, biochemical (especially with detailing the lipid spectrum), for thyroid, pituitary, and adrenal hormones.

Other methods are also possible. The diagnosis of stroke is specified and established. Then it is important to carry out regular preventive examinations, as part of prevention and rehabilitation.

Treatment

Conservative (medicinal) predominantly. Upon arrival at the hospital, the first stage begins. The following medications are mandatory:

• Thrombolytics. Streptokinase and others. To dissolve blood clots and normalize the flow of liquid tissue.
• Statins. Eliminate cholesterol deposits on the walls of blood vessels.
• Diuretics. Furosemide or more powerful osmotic ones. As part of the prevention of cerebral edema.
• Antiplatelet agents. Restores the rheological properties of blood. Fluidity. Aspirin Cardio, Heparin.
• When there is a critical drop in blood pressure, Epinephrine and Dopamine are used.
• Increased blood pressure levels are controlled by antihypertensive drugs. There are many options, so it makes no sense to give specific names.

• Cerebrovascular. Normalizes brain nutrition and blood flow.
• Nootropics. Glycine. To restore metabolic processes in nerve fibers.

It is possible to use other means, such as protectors that prevent the destruction of blood vessels (Anavenol) and others. At the discretion of specialists.

Operations are performed according to indications if the cause is a vascular anomaly (for example, an aneurysm), severe atherosclerosis, which cannot be corrected with drugs.

Lifestyle changes are a must: refusal of smoking, alcohol, drugs, unauthorized use of medications, full sleep (at least 7 hours per night), physical activity within the limits of what is reasonable and allowed (walking in the fresh air at a slow pace), limiting the amount of salt (7 grams per day or less), correction of the diet (refusal of animal fat, fried foods, fortification, treatment table No. 10 is suitable).

Rehabilitation

It is carried out immediately after stabilization of the condition. It consists of systematically taking medications (already named), activity (physical therapy, exercises), massage, kinesitherapy (the same exercise therapy, but more variable, includes passive methods when movements are made with the help of another person). Also psychotherapy, restoration of emotional background.

Rehabilitation lasts from 6 months to a year. In some cases, even more. A transient attack does not require recovery for the most part.

Read about treatment after a stroke, and the rehabilitation process is described.

Possible complications

The consequences of stroke are obvious - the death of the patient or severe disability due to neurological deficit.

Hence other options: bedsores in long-term immobilized patients, congestive pneumonia, muscle atrophy, blood poisoning and others.

For an example of the consequences after a right-sided stroke, read. The left side is no different.

Forecast

In case of transient ischemic attack - positive. But there is a risk of developing necrosis in the future (about 40-60% and increasing every year).

Small-focal ischemic stroke provokes death in 20% of situations or less. With the involvement of a large area, the mortality rate is 60-70%. The forecast is described.

Hemorrhage with a small amount of destroyed tissue takes the lives of patients in 40% of situations or so. Otherwise - already 95%.

Finally

Acute cerebrovascular accident is one of the most dangerous neurological disorders. It is fatal in many cases.

Complications after an acute stroke may not be fatal, but they will put an end to life and lead to an existence without the possibility of recovery.

To minimize risks, you need to treat all diseases in a timely manner, lead a correct lifestyle and undergo regular examinations.

Primary and secondary prevention of stroke have been described.

Cerebrovascular accidents usually develop against the background of vascular diseases, mainly atherosclerosis and high blood pressure.

Atherosclerotic cerebrovascular accidents

Symptoms The clinical picture of atherosclerotic disorders is expressed by decreased performance, headaches, sleep disturbances, dizziness, noise in the head, irritability, paradoxical emotions (“joy with tears in the eyes”), hearing impairment, decreased memory, unpleasant sensations (“crawling goosebumps”) skin, decreased attention. Asthenodepressive or asthenohypochondriacal syndrome may also develop.

Cerebrovascular accident in hypertension

Symptoms With hypertension, stagnant foci of excitation may appear in the cerebral cortex, which spread to the hypothalamic region, which leads to disruption of the regulation of vascular tone (hypogalamic-endocrine system of the kidney or hypogalamic-pituitary-adrenal system).

Next, compensatory reserves are depleted, the electrolyte balance is disrupted, the release of aldosterone increases, the activity of the sympathoadrenal system and the renin-angiotensin system increases, which leads to vascular hyperreactivity and an increase in blood pressure. The development of the disease leads to a change in the type of blood circulation: cardiac output decreases and peripheral vascular resistance increases.

Against the background of the above-described changes in the vessels, cerebrovascular accident develops. One of the clinical forms of cerebrovascular accident is the initial manifestations of insufficiency of blood supply to the brain. The diagnosis is made taking into account complaints of headache, dizziness, noise in the head, decreased memory and performance, and sleep disturbances. The combination of two or more of these complaints provides an opportunity and basis for making a diagnosis, especially when these complaints are often repeated and persist for a long time. There are no organic lesions of the nervous system. It is necessary to carry out treatment of the underlying vascular disease, rational employment, work and rest regime, nutrition, sanatorium treatment, especially aimed at increasing the physiological defenses of the body.

Acute cerebrovascular accident

This term combines all types of acute cerebrovascular accidents, which are accompanied by transient or persistent neurological symptoms.

Symptoms Acute cerebrovascular accident is characterized by the appearance of clinical symptoms from the nervous system against the background of existing vascular changes. The disease is characterized by an acute onset and is characterized by significant dynamics of general cerebral and local symptoms of brain damage. There are transient disorders of cerebral circulation, which are characterized by regression of neurological signs within 24 hours after their onset, and acute disorders with more persistent, sometimes irreversible neurological symptoms - strokes.

Strokes are divided into ischemic (cerebral infarction) and hemorrhagic - blood leaking into the surrounding tissues and soaking them. Conventionally, small strokes are distinguished, in which the disease is mild and neurological symptoms (motor, speech, etc.) disappear within 3 weeks.

Transient cerebrovascular accidents

Transient cerebrovascular accidents are most often observed with hypertension or atherosclerosis of cerebral vessels.

In hypertensive cerebral crises, the autoregulation of cerebral vessels is disrupted with phenomena of cerebral tissue edema and vascular spasms. In atherosclerotic transient ischemic attacks - transient ischemia - in the zone of an atheroscleretically altered vessel as a result of the influence of extracerebral factors and a decrease in blood pressure, the trigger is most often a weakening of cardiac activity, an unfavorable redistribution of blood, an impulse from a pathologically altered carotid sinus. Often transient disorders of cerebral circulation develop as a result of microembolism of cerebral vessels, which is typical for patients with myocardial infarction in the post-infarction period, atherosclerotic cardiosclerosis, heart defects, sclerotic lesions of the aorta and great vessels of the head, as well as changes in the physicochemical properties of blood (increased viscosity and coagulation) .

Stressful situations can provoke cerebrovascular accidents. The materials for embolism and thrombosis are cholesterol crystals, masses of disintegrating atherosclerotic plaques, pieces of blood clots, and platelet conglomerates.

General cerebral symptoms. The clinical picture of transient cerebrovascular accidents can manifest as both general cerebral and focal symptoms. General cerebral symptoms include headache, dizziness, pain in the eyeballs, which increases with eye movement, nausea, vomiting, noise and congestion in the ears. Changes in consciousness are possible: stupor, psychomotor agitation, loss of consciousness, and there may be a short-term loss of consciousness. Convulsive phenomena are observed less frequently.

General cerebral symptoms are especially characteristic of hypertensive cerebral crises. An increase in blood pressure is observed in combination with autonomic disorders (feelings of chills or heat, polyuria). Meningeal phenomena - tension in the neck muscles - may be observed. In hypotensive cerebral crises, blood pressure is reduced, the pulse is weakened, and cerebral symptoms are less pronounced.

Focal symptoms. Focal neurological symptoms may appear depending on their location. If there is a circulatory disorder in the cerebral hemispheres, then most often the sensitive area is disrupted in the form of paresthesia - numbness, tingling, often localized, involving individual areas of the skin, limbs or face. Areas of decreased pain sensitivity - hyposthesia - may be detected.

Along with sensory disorders, movement disorders—paralysis or paresis, often limited (of the hand, fingers, foot)—may occur; paresis of the lower part of the facial muscles and tongue muscles is also noted. The examination reveals changes in tendon and skin reflexes, and pathological reflexes (Babinsky reflex) can be caused. Transient speech disturbances, disturbances in body diagram, loss of visual fields, etc. may also develop.

Damage to the brain stem is characterized by dizziness, unsteadiness of gait, lack of coordination, double vision, twitching of the eyeballs when looking to the side, sensory disturbances in the face, tongue, fingertips, weakness in the limbs, and swallowing disorders may also occur.

Treatment. Treatment of transient cerebrovascular accidents of atherosclerotic origin, which are assumed to be based on cerebrovascular insufficiency, must be very careful. It is impossible to say in advance whether this violation will be transient or persistent.

The patient must be provided with mental and physical rest.

When cardiac activity is weakened, cardiotonic drugs are used (sulfocamphocaine, subcutaneous cordiamine, 0.25-1 ml of 0.06% corglycon solution). In case of a sharp drop in blood pressure, administer 1-2 ml of a 1% solution of mezatone subcutaneously or intramuscularly, caffeine subcutaneously, ephedrine 0.025 g three times a day orally.

To improve blood supply to the brain, in conditions of normal or high blood pressure, a solution of aminophylline is prescribed intravenously or intramuscularly (10 ml of a 2.4% solution of aminophylline per 10 ml of isotonic sodium chloride solution intravenously or 1-2 ml of a 24% solution of aminophylline intramuscularly).

Vasodilators are prescribed mainly for transient disorders of cerebral circulation, which is accompanied by an increase in blood pressure, use a 2% solution of papaverine - 1-2 ml intravenously, or no-shpu - 1-2 ml (administer slowly!)

It is advisable to prescribe intravenous drip administration of Cavinton (preferably in a hospital setting) 10-20 mg (1-2 ampoules) in 500 ml of isotonic sodium chloride solution, after which they switch to taking the tablet drug 0.005 three times a day.

Ischemic stroke

Symptoms Ischemic stroke, or, as it is also called, cerebral infarction, develops when cerebral blood flow is disrupted (decreased). The most common cause of cerebral infarction is atherosclerosis. It is preceded by physical or mental stress. Ischemic stroke is most often observed in people over 50 years of age, but nowadays it has become “younger”.

As a result of blockage of a vessel (thrombosis, embolism, spasm), cerebrovascular insufficiency occurs, which leads to disruption of the nutrition of brain tissue - a heart attack.

Ischemic stroke is most characterized by a gradual increase in neurological symptoms - from several hours to 2-3 days. Their degree of expression can “flicker”, then decreasing, then increasing again. Characteristic of a cerebral infarction is the prevalence of focal symptoms (numbness of the face, speech impairment, weakness in the limbs, dysfunction), but there may be no headache, nausea, or vomiting. Blood pressure is either normal or low. As a rule, the temperature is not elevated, the face is pale, the lips and nasolabial triangle are slightly cyanotic. The pulse is rapid, weak, and decreased in volume. Most often, such patients experienced heart pain, which indicates angina pectoris, or these patients suffered a myocardial infarction, were observed by a cardiologist with symptoms of coronary artery sclerosis and coronary heart disease. Heart rhythm disturbances are recorded.

Hemorrhagic stroke

Symptoms Hemorrhagic stroke is hemorrhage into the substance of the brain or under the arachnoid membrane of the brain, which can also be of a mixed nature (subarachnoid-parenchymal).

Hemorrhages into the brain substance are most often observed in people with hypertension and occur in the cerebral hemispheres, less often in the cerebellum and brain stem.

Cerebral hemorrhage usually develops suddenly, at a time of physical and emotional stress. The patient falls and loses consciousness, or his consciousness becomes confused. In the initial period of hemorrhagic stroke, psychomotor agitation and automated gestures in healthy limbs and vomiting may be observed. A severe headache occurs, and there may be meningeal symptoms, but their severity is moderate. Very typical for cerebral hemorrhage is the early appearance of pronounced autonomic disorders - redness or pallor of the face, sweating, increased body temperature. Blood pressure is most often elevated, the pulse is tense, breathing is impaired (can be hoarse, periodic, rapid, rare, of varying amplitudes). Along with general cerebral and autonomic disorders, cerebral hemorrhage causes severe focal symptoms, the peculiarity of which is determined by the localization of the lesion.

With hemispheric hemorrhages, hemiparesis or hemiplegia, hemigynesthesia (decreased pain sensitivity), and gaze paresis towards the paralyzed limbs occur.

If a cerebral hemorrhage is accompanied by a breakthrough of blood into the ventricles of the brain, then there is a threat of death in 70% of cases, since vital functions are disrupted. The patient is unconscious, muscles are tense, body temperature is elevated, cold sweat and trembling are characteristic. With such symptoms, the prognosis is disappointing; patients die in the first two days after a stroke.

All strokes must be treated in a hospital setting. If an acute cerebrovascular accident is suspected, the patient should be urgently hospitalized by ambulance to a neurological hospital.

Prevention. It is advisable to carry out for persons with manifestations of atherosclerosis, hypertension, as well as in old age. Antiplatelet agents are prescribed in maintenance doses: acetylsalicylic acid in small doses - 0.001 7 weight in the morning; prodexin or kuralenil; indirect anticoagulants (pelentin - 0.1-0.3 g 2-3 times a day or fimilin - 0.03, twice a day, simkupar 0.004 g 3 times a day). All these drugs must be prescribed with blood monitoring, and contraindications to their use must also be strictly taken into account (liver and kidney diseases, gastric and duodenal ulcers, hemorrhoidal and uterine bleeding, increased bleeding, etc.).

These drugs are discontinued gradually, reducing the dose and increasing the interval between doses.

ACUTE CEREBRAL CIRCULATION DISORDER

Acute cerebrovascular accident may be transient or persistent, with focal brain damage ( cerebral stroke).

Transient acute cerebrovascular accident

Symptoms transient vascular cerebral disorders are observed within a few minutes, hours or recorded within a day.

Reason These disorders may include hypertensive crisis, cerebral vasospasm, atherosclerosis of cerebral vessels, heart failure, arrhythmias, collapse.

General cerebral symptoms when transient cerebrovascular accidents occur, headaches, dizziness, nausea, vomiting, stupor, disorientation, and sometimes short-term loss of consciousness occur.

Focal symptoms is expressed in the occurrence of transient paresthesia, paresis, aphasic disorders, visual disturbances, paresis of individual cranial nerves, and impaired coordination of movements.

Intensive therapy transient vascular cerebral disorders consists of stopping a hypertensive crisis, arrhythmia, if they were the cause of a secondary ischemic state of the brain.

It is possible to use drugs that improve cerebral arterial blood flow (aminophylline, trental, nootropil, etc.). Hospitalization of patients with transient cerebrovascular accidents is recommended in cases of threat of cerebral stroke, i.e. in the event that focal symptoms last more than 24 hours and the treatment measures taken are ineffective.

Intensive therapy in these cases is as follows:

Decreased blood pressure; Injections of magnesium 25% 10 ml IM or IV, papaverine 2% 2 ml, dibazol 1% 3.0 IV or IM, no-shpa 2% 2 ml IM are prescribed. The drugs of choice are clonidine 0.01% 1 ml IM or IV, droperidol 2 ml, Lasix 1% 4 ml;

Improvement of cerebral blood flow, microcirculation. For this purpose, rheopolyglucin is used intravenously;

Reducing increased blood clotting and red blood cell disaggregation. Aspirin and other anticoagulants are used;

Improvement of metabolism in the brain is carried out with the drugs Cerebrolysin, piracetam, and B vitamins.

Indications for surgical treatment is the failure of therapy in the presence of stenosis of the carotid artery or its blockage, compression of the vertebral artery, etc.

If such a condition occurs in a patient during a dental appointment, hospitalization in the therapeutic or neurological department of a multidisciplinary hospital is indicated.

Cerebral stroke or persistent acute cerebrovascular accident

Cerebral stroke is an acute cerebrovascular accident with focal brain damage. Clinically manifested severe focal and cerebral symptoms, often to the point of cerebral coma.

There are hemorrhagic and ischemic strokes.

Hemorrhagic stroke - this is a hemorrhage into the substance of the brain (apoplexy), usually develops suddenly, more often during the day, during physical and emotional stress.

Symptoms usually spicy. The patient loses consciousness and develops cerebral coma. The face is red, the eyes are averted, the head is turned towards the source of hemorrhage. On the side opposite to the hemorrhage, hemiplegia is determined and pathological reflexes are evoked. With brainstem hemorrhages, profound disturbances in breathing and the function of the cardiovascular system occur, and blood pressure is often elevated.

Ischemic stroke - this is an acute, relatively long-term or permanent cessation of blood supply to a region of the brain due to persistent spasm or thrombosis of the supply artery.

Symptoms less acute than with a hemorrhagic stroke, develop gradually, neurological symptoms depend on the location and volume of the lesion. The clinical picture of coma is the same as for hemorrhagic stroke.

Intensive therapy. Pre-hospital treatment:

In case of gross violations, mechanical ventilation is performed;

Take measures to normalize high blood pressure;

Hospitalization is indicated for all patients with cerebral stroke.

At the prehospital stage, emergency care for stroke is provided regardless of its nature.

First of all, the fight against violations of the vital functions of the body is carried out:

If breathing is impaired, for mechanical ventilation, tracheal intubation is performed or a tracheostomy is applied;

For cardiovascular disorders, selective therapy is carried out depending on the clinical manifestations. For example, when collapse develops, caffeine 10% 1 ml, prednisolone 60-90 mg, glucose 40% 20-40 ml are administered;

For elevated blood pressure, see therapy for transient cerebrovascular accident;

The fight against cerebral edema is carried out by administering Lasix 40-80 ml IV or IM, prednisolone 60-90 mg, mannitol, saline, ascorbic acid;

Elimination of hyperthermia is carried out by injection of a lytic mixture (seduxen, diphenhydramine, analgin), ice packs are placed on the area of ​​​​large vessels and to the head.

A feature of the treatment of hemorrhagic stroke is the introduction hemostatic agents: dicinone 2 ml IV or IM, aminocaproic acid 5% 100 IV. Trasylol or contrical 20,000-30,000 units IV. The patient is placed on a bed with the head end elevated, creating an elevated position for the head.

For ischemic stroke. on the contrary, all measures are aimed at improving blood supply to the brain. Reopolyglucin 400 ml IV, heparin 5,000 units 4 times a day, Cavinton, cinnarizine are prescribed. Hyperbaric oxygen therapy is prescribed.

A poor prognostic sign for strokes is a profound degree of impairment of consciousness, especially the early development of coma.

If, due to paralysis of the limbs or speech impairment, the patient needs outside help, then disability group 1 is established.

Prevention of complications when performing dental interventions in patients with impaired cerebral vascular function (post-stroke, atherosclerotic, etc.) is to control blood pressure and pulse before, during and after dental intervention. Such patients are indicated for premedication with the mandatory inclusion of a tranquilizer, analgesic and antispasmodic.

In this category of patients, increased secretion of endogenous adrenaline as a result of stress poses a risk. Therefore, to perform local anesthesia, it is necessary to use an anesthetic with a minimum content of a vasoconstrictor.

If after the intervention the patient’s general condition is complicated by hypertension or an increase in neurological symptoms, the patient must be hospitalized in a therapeutic or neurological hospital.

For patients with subcompensated or decompensated forms of cerebral circulatory insufficiency, dental interventions are performed for health reasons in a specialized hospital of a multidisciplinary hospital.

Disorders of arterial circulation of the brain: forms, signs, treatment

In recent years, the percentage of mortality from pathological lesions of cerebral vessels, which were previously associated with the aging of the body and were diagnosed only in elderly people (after 60 years), has increased significantly. Today, the symptoms of cerebrovascular accident have become younger. And people under 40 often die from strokes. Therefore, it is important to know the causes and mechanism of their development in order to prevent them. diagnostic and therapeutic measures gave the most effective results.

What are cerebrovascular accidents (CVA)

The vessels of the brain have a unique, perfect structure that ideally regulates blood flow, ensuring the stability of blood circulation. They are designed in such a way that while the flow of blood into the coronary vessels increases approximately 10 times during physical activity, the amount of circulating blood in the brain, with an increase in mental activity, remains at the same level. That is, a redistribution of blood flow occurs. Some of the blood from parts of the brain with less load is redirected to areas with increased brain activity.

However, this perfect circulatory process is disrupted if the amount of blood entering the brain does not satisfy its need for it. It should be noted that its redistribution across brain regions is necessary not only for its normal functionality. It also occurs when various pathologies occur, for example, stenosis of the lumen of the vessel (narrowing) or obstruction (closure). As a result of impaired self-regulation, the speed of blood flow slows down in certain areas of the brain and ischemicity occurs.

Types of MC violations

There are the following categories of blood flow disorders in the brain:

1. Acute (stroke), which occurs suddenly with a long course, and transient, the main symptoms of which (visual impairment, loss of speech, etc.) last no more than a day.
2. Chronic, caused by discirculatory encephalopathies. They are divided into two types: hypertensive in origin and caused by atherosclerosis.

Acute disorders

Acute cerebrovascular accident causes persistent disorders of brain activity. It comes in two types: hemorrhagic (bleeding) and ischemic (also called cerebral infarction).

Hemorrhagic

Hemorrhage (hemorrhagic disturbance of blood flow) can be caused by various arterial hypertension and vascular aneurysms. congenital angiomas, etc.

As a result of an increase in blood pressure, plasma and the proteins contained in it are released, which leads to plasma saturation of the walls of blood vessels, causing their destruction. A peculiar hyaline-like specific substance (a protein whose structure resembles cartilage) is deposited on the vascular walls, which leads to the development of hyalinosis. The vessels resemble glass tubes and lose their elasticity and ability to hold blood pressure. In addition, the permeability of the vascular wall increases and blood can freely pass through it, soaking the nerve fibers (diapedetic bleeding). The result of such transformations can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. Thus, hemorrhage occurs as a result of:

• Plasmic impregnation of the walls of blood vessels of the white medulla or visual thalamus;
• Diapedetic bleeding;
• Microaneurysm formations.

Hemorrhage in the acute period is characterized by the development of hematomas due to wedging and deformation of the brain stem into the tentorial foramen. In this case, the brain swells and extensive edema develops. Secondary hemorrhages occur, smaller ones.

Clinical manifestations

Usually occurs during the day, during physical activity. Suddenly your head starts to hurt and you feel nauseous. Consciousness is confused, the person breathes quickly and whistlingly, and tachycardia occurs. accompanied by hemiplegia (unilateral paralysis of the limbs) or hemiparesis (weakening of motor functions). Basic reflexes are lost. The gaze becomes motionless (paresis), anisocoria (pupils of different sizes) or divergent strabismus occurs.

Treatment of cerebrovascular accidents of this type includes intensive therapy, the main goal of which is to reduce blood pressure, restore vital (automatic perception of the outside world) functions, stop bleeding and eliminate cerebral edema. The following medications are used:

1. Blood pressure-lowering drugs - ganlioblockers ( Arfonad, Benzohexanium. Pentamin).
2. To reduce the permeability of vascular walls and increase blood clotting - Dicynone. vitamin C, Vikasol. Calcium gluconate .
3. To increase blood rheology (fluidity) - Trental, Vinkaton, Cavinton, Eufillin, Cinnarizin.
4. Inhibiting fibrinolytic activity - ACC (aminocaproic acid).
5. Decongestant - Lasix .
6. Sedatives.
7. To reduce intracranial pressure, a spinal puncture is prescribed.
8. All drugs are administered by injection.

Ischemic

ischemic cerebrovascular accident due to atherosclerotic plaque

Ischemic circulatory disorders are most often caused by atherosclerosis. Its development can be provoked by severe anxiety (stress, etc.) or excessive physical activity. May occur during night sleep or immediately upon awakening. Often accompanies a pre-infarction condition or myocardial infarction.

They may appear suddenly or grow gradually. They manifest themselves in the form of headaches, hemiparesis on the side opposite to the lesion. Impaired motor coordination, as well as visual and speech disorders.

Pathogenesis

An ischemic disorder occurs when insufficient blood flows to a particular area of ​​the brain. In this case, a focus of hypoxia arises, in which necrotic formations develop. This process is accompanied by disruption of basic brain functions.

Treatment uses injections of medications to restore normal functioning of the cardiovascular system. These include: Korglykon, Strophanthin, Sulphocamphocaine, Reopoliklyukin, Cardiamin. Intracranial pressure decreases Mannitol or Lasix .

Video: causes of different types of strokes

Transient cerebrovascular accident

Transient cerebrovascular accident (TCI) occurs against the background of arterial hypertension or atherosclerosis. Sometimes the reason for its development is their combination. The main symptoms of PNMK are as follows:

• If the focus of the pathology is located in the basin of the carotid vessels, the patient’s half of the body (on the side opposite to the focus) and part of the face around the lips become numb; paralysis or short-term paresis of the limbs is possible. Speech is impaired and an epileptic seizure may occur.
• If the blood circulation in the vertebrobasilar area is impaired, the patient's legs and arms become weak, he becomes dizzy, it is difficult for him to swallow and pronounce sounds, photopsia occurs (the appearance of luminous points, sparks, etc. in the eyes) or diplopia (doubling of visible objects). He becomes disorientated and has memory lapses.
• Signs of cerebrovascular accident due to hypertension are manifested in the following: the head and eyeballs begin to hurt very much, the person experiences drowsiness, he or she experiences stuffiness in the ears (like on an airplane during takeoff or landing) and nausea. The face turns red and sweating increases. Unlike strokes, all these symptoms disappear within 24 hours. For this they received the name “transient attacks”.

Treatment of PNMK is carried out with antihypertensive, tonic and cardiotonic drugs. Antispasmodics are used to improve blood flow in the brain. and calcium channel blockers. The following medications are prescribed:

Dibazol, Trental, Clonidine, Vincamine, Euphyllin, Cinnarizine, Cavinton, Furasemide. beta blockers. Alcohol tinctures of ginseng and Schisandra chinensis are used as tonics.

Chronic cerebrovascular accidents

Chronic cerebrovascular accident (CVA), unlike acute forms, develops gradually. There are three stages of the disease:

1. At the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person gets tired quickly, his sleep is disturbed, he often hurts and feels dizzy. He becomes hot-tempered and absent-minded. His mood often changes. He forgets some minor points.
2. At the second stage, chronic cerebrovascular accident is accompanied by significant memory impairment. Minor impairments in motor functions develop, causing unsteadiness in gait. There is a constant noise in my head. A person perceives information poorly, having difficulty concentrating his attention on it. He is gradually deteriorating as a person. Becomes irritable and unconfident, loses intelligence, reacts inadequately to criticism, and often becomes depressed. He constantly feels dizzy and has a headache. He always wants to sleep. Performance is reduced. He adapts poorly socially.
3. In the third stage, all symptoms intensify. Personality degradation turns into dementia. memory suffers. Having left home alone, such a person will never find his way back. Motor functions are impaired. This manifests itself in hand tremors and stiffness of movements. Speech impairment and uncoordinated movements are noticeable.

The last stage of chronic cerebral obstruction is brain atrophy and neuron death, the development of dementia

Cerebrovascular accident is dangerous because if treatment is not carried out in the early stages, neurons die - the main units of the brain structure, which cannot be resurrected. Therefore, diagnosing the disease in the early stages is so important. It includes:

• Identification of vascular diseases that contribute to the development of cerebrovascular accidents.
• Making a diagnosis based on patient complaints.
• Conducting a neuropsychological examination using the MMSE scale. It allows you to detect cognitive impairment by testing. The absence of violations is indicated by 30 points scored by the patient.
• Duplex scanning to detect damage to cerebral vessels due to atherosclerosis and other diseases.
• Magnetic resonance imaging, which allows identifying small hypodense (with pathological changes) foci in the brain.
• Clinical blood tests: complete blood count, lipid profile, coagulogram, glucose.

Etiology

The main causes of cerebrovascular accident are as follows:

1. Age. They mainly occur in people who have entered their fifth decade.
2. Genetic predisposition.
3. Traumatic brain injuries.
4. Overweight. Obese people often suffer from hypercholesterolemia.
5. Physical inactivity and increased emotionality (stress, etc.).
6. Bad habits.
7. Diseases: diabetes mellitus (insulin-dependent) and atherosclerosis.
8. Hypertension. High blood pressure is the most common cause of strokes.
9. In old age, problems with blood flow in the brain can result from:
   • atrial fibrillation,
   • various diseases of the hematopoietic organs and blood,
   • chronic thrombophlebitis,
   • heart defects.

Treatment

For chronic disorders of blood flow in the brain all therapeutic measures are aimed at protecting brain neurons from death as a result of hypoxia, stimulate metabolism at the neuronal level, normalize blood flow in brain tissue. Medicines for each patient are selected individually. They should be taken in a strictly prescribed dosage, constantly monitoring blood pressure.

In addition, for cerebral circulatory disorders accompanied by neurological manifestations, antioxidants, venotonics, vasodilators, neuroprotectors, drugs that increase blood microcirculation, sedatives and multivitamins are used.

Chronic cerebrovascular accident can also be treated using traditional medicine, using various herbal teas and herbal teas. Particularly useful is an infusion of hawthorn flowers and a collection that includes chamomile, cudweed and motherwort. But they should be used as an additional treatment course that enhances the main drug therapy.

People with increased weight who are at risk for developing atherosclerosis due to high cholesterol need to pay attention to nutrition. There are special diets for them, which you can learn about from a nutritionist who monitors the organization of nutrition for patients undergoing treatment in an inpatient department of any hospital. Dietary products include everything of plant origin, seafood and fish. But milk products, on the contrary, should be low in fat.

If cholesterolemia is significant and the diet does not give the necessary results, medications included in the statin group are prescribed: Liprimar. Atorvakar, Vabarin, Torvacard, Simvatin. With a large degree of narrowing of the lumen between the walls of the carotid arteries (more than 70%), a carotid endarterectomy (surgical operation) is required, which is performed only in specialized clinics. For stenosis less than 60%, conservative treatment is sufficient.

Rehabilitation after acute cerebrovascular accident

Drug therapy can stop the progression of the disease. But she is unable to regain the ability to move. Only special gymnastic exercises can help with this. You need to be prepared for the fact that this process is quite long and be patient. The patient’s relatives must learn to perform massage and therapeutic exercises, since they will have to do them for him for six months or more.

Kinesiotherapy is indicated as the basis for early rehabilitation after dynamic cerebrovascular accident in order to fully restore motor functions. It is especially necessary in the restoration of motor skills, as it contributes to the creation of a new model of the hierarchy of the nervous system for the physiological control of the motor functions of the body. The following techniques are used in kinesitherapy:

1. Gymnastics “Balance”, aimed at restoring coordination of movements;
2. Feldenkrais reflex exercise system.
3. The Voight system, aimed at restoring motor activity by stimulating reflexes;
4. Microkenisotherapy.

Passive gymnastics “Balance” is prescribed to every patient with cerebrovascular accidents as soon as consciousness returns to him. Usually, relatives help the patient perform it. It includes kneading the fingers and toes, flexing and straightening the limbs. Exercises begin to be performed from the lower extremities, gradually moving upward. The complex also includes kneading the head and cervical regions. Before starting the exercises and finishing the gymnastics, you should use light massaging movements. It is imperative to monitor the patient's condition. Gymnastics should not cause him to become overtired. The patient can independently perform eye exercises (squinting, rotating, fixing the gaze at one point, and some others). Gradually, with the improvement of the patient's general condition, the load is increased. An individual recovery method is selected for each patient, taking into account the characteristics of the course of the disease.

Photo: basic passive gymnastics exercises

Feldenkrais Method is a therapy that has a gentle effect on the human nervous system. It promotes the complete restoration of mental abilities, motor activity and sensuality. It includes exercises that require smooth movement when performed. The patient must focus on their coordination, making each movement meaningfully (consciously). This technique forces one to divert attention from the existing health problem and concentrate it on new achievements. As a result, the brain begins to “remember” previous stereotypes and returns to them. The patient constantly studies his body and its capabilities. This allows you to find quick ways to get him moving.

The technique is based on three principles:

• All exercises should be easy to learn and remember.
• Each exercise must be performed smoothly, without overstraining the muscles.
• While performing the exercise, the sick person should enjoy the movement.

But most importantly, you should never divide your achievements into high and low.

Additional rehabilitation measures

Breathing exercises are widely practiced, which not only normalizes blood circulation, but also relieves muscle tension that occurs under the influence of gymnastic and massage loads. In addition, it regulates the respiratory process after performing therapeutic exercises and gives a relaxing effect.

In case of cerebrovascular accidents, the patient is prescribed bed rest for a long time. This can lead to various complications, for example, disruption of natural ventilation of the lungs, the appearance of bedsores and contractures (mobility in the joint is limited). Prevention of bedsores involves frequent changes of position of the patient. It is recommended to turn him over on his stomach. At the same time, the feet hang down, the shins are located on soft pillows, and under the knees there are cotton wool discs covered with gauze.

1. Place the patient's body in a special position. In the first days, he is transferred from one position to another by his relatives caring for him. This is done every two or three hours. After stabilizing blood pressure and improving the general condition of the patient, they are taught to do this on their own. Getting the patient into bed early (if well-being allows) will prevent contractures from developing.
2. Perform the massage necessary to maintain normal muscle tone. The first days it includes light stroking (if muscle tone is increased) or kneading (if muscle tone is decreased) and lasts only a few minutes. Subsequently, the massage movements intensify. Rubbing is allowed. The duration of massage procedures also increases. By the end of the first half of the year, they can be completed within an hour.
3. Perform physical therapy exercises, which, among other things, effectively combat synkinesis (involuntary muscle contractions).
4. Vibration stimulation of paralyzed parts of the body with an oscillation frequency of 10 to 100 Hz gives a good effect. Depending on the patient’s condition, the duration of this procedure can vary from 2 to 10 minutes. It is recommended to carry out no more than 15 procedures.

For cerebrovascular accidents, alternative treatment methods are also used:

• Reflexology, including:
  1. Treatment with odors (aromatherapy);
  2. classic version of acupuncture;
  3. acupuncture at reflex points located on the ears (auricolotherapy);
  4. acupuncture of biologically active points on the hands (su-Jack);
• Treatment with leeches (hirudotherapy);
• Pine baths with the addition of sea salt;
• Oxygen baths.

Video: stroke prevention and rehabilitation

Read more about comprehensive rehabilitation after strokes and ischemic attacks by following the link.

Consequences of NMC

Acute cerebrovascular accident has serious consequences. In 30 cases out of a hundred, people who have suffered this disease become completely helpless.

1. He cannot eat, perform hygiene procedures, dress, etc. on his own. Such people have a completely impaired ability to think. They lose track of time and have absolutely no orientation in space.
2. Some people retain the ability to move. But there are many people who, after a cerebrovascular accident, remain bedridden forever. Many of them maintain a clear mind, understand what is happening around them, but are speechless and cannot express their desires and feelings in words.

connection between areas of brain damage and vital functions

Disability is a sad result of acute and in many cases chronic cerebrovascular accident. About 20% of acute cerebrovascular accidents are fatal.

But it is possible to protect yourself from this serious disease, regardless of what category of classification it belongs to. Although many people neglect it. This is an attentive attitude to your health and all the changes occurring in the body.

• Agree that a healthy person should not have headaches. And if you suddenly feel dizzy, it means that some kind of deviation has arisen in the functioning of the systems responsible for this organ.
• An increase in temperature is evidence of problems in the body. But many people go to work when it is 37°C, considering it normal.
• Do you experience short-term numbness in your limbs? Most people rub them without asking the question: why is this happening?

Meanwhile, these are the companions of the first minor changes in the blood flow system. Often an acute cerebrovascular accident is preceded by a transient one. But since its symptoms disappear within 24 hours, not every person rushes to see a doctor to undergo an examination and receive the necessary drug treatment.

Today, doctors have effective drugs - thrombolytics. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one “but”. To achieve maximum effect, they must be administered to the patient within three hours after the first symptoms of a stroke appear. Unfortunately, in most cases, seeking medical help is too late, when the disease has reached a severe stage and the use of thrombolytics is no longer useful.

Elderly people are familiar with this disease, the name of which is ACVA - acute cerebrovascular accident or simply a stroke. Almost every older person has experienced this illness. It is very important to understand the causes of stroke and proper treatment of the disease.

What it is?

Stroke is a clinical symptom manifested by sudden disruptions in the normal functioning of the existing brain options of the head, the duration of which is more than one day.

The main symptoms of stroke are:

1. Inability of the patient's body to move normally;
2. Disorders of the organs responsible for sensitivity;
3. Violations of the proper functioning of the speech apparatus;
4. The patient's inability to swallow;
5. Frequent headache;
6. Loss of consciousness.

An unexpected disturbance in the speech apparatus, loss of body sensitivity and problems with coordination of movement disappear over the next 24 hours. Then they talk about transistor ischemic attack. This is not as dangerous a disease as stroke, but also refers to stroke.

If the disease relates to disturbances in the functioning of the circulatory system, it is characterized as “CVA of the ischemia type.” In the case when a specialist confirms bleeding, the disease is characterized as “CVA of the hemorrhagic type.”

A stroke that ends in a stroke is a stage when the flow of blood to some part of the brain stops. This phenomenon is caused by a decrease in the tone of the walls of the arteries of the brain and is accompanied by a disorder of the neurological system, which is a consequence of the destruction of part of the nerve tissue.

ONMK - code according to ICD-10

In the tenth international classification of diseases, stroke has several codes that differ from each other according to the disorders that caused the disease.

Prevention and treatment of this disease are considered at the state level, since stroke is fatal in a third of cases. Sixty percent of patients who have suffered from the disease turn out to be disabled people who cannot do without social assistance.

Causes of stroke

ACVA, related to the ischemic type, develops as a result of existing pathologies in the patient’s body.

Such diseases include:

ACVA occurs not only in the adult population, but also in children. This is due to the fact that the vessels of the children’s brain have some anomalies in their development. A high risk of developing stroke is observed in children who have congenital heart disease.

When acute stroke occurs, only 30% of children recover completely. About fifty percent have incurable disorders of the neurological system. Twenty percent of cases of acute cerebrovascular accident in children are fatal.

In what cases can one suspect stroke?

The diagnosis of stroke is made if the patient has the following disturbances in the functioning of the body:

1. A sharp lack of sensitivity in the limbs;
2. Loss of vision up to blindness;
3. Inability to recognize the opponent's speech;
4. Loss of balance, problems with coordination;
5. Very severe headaches;
6. Confusion of consciousness.

An accurate diagnosis can only be made after diagnostics.

Stages of cerebral infarction

ACVA has several stages of development. Let's look at each of them in more detail.

Stage number	Stage symptoms
First stage	A lack of oxygen occurs, which leads to disruptions in the permeability of flat cells located on the surface of blood vessels. As a result, fluid and protein from the blood cells enter the brain tissue. Edema formation occurs;
Second stage	At the capillary level, blood pressure continues to fall, which leads to disruption of the cell membrane. Nerve receptors and electrolyte channels also stop functioning properly. At this stage, the disease is preventable;
Third stage	Disturbances in cell metabolism occur, and lactic acid accumulates in tissues. Energy synthesis occurs, in which oxygen molecules do not participate. The anaerobic regime does not allow the tissues of neurons and astrocytes to maintain a normal level of vital activity. These cells increase in volume, causing malfunctions in the structure. The clinical picture represents focal signs of a neurological nature.

Ischemic stroke

This type of stroke is accompanied by a complete cessation of blood flow to specific areas of the brain tissue, which is accompanied by the destruction of brain cells and the cessation of its basic functions.

Causes of ischemic stroke

This type of stroke is caused by obstruction of blood flow to any brain cell. As a result, normal brain activity stops. A plaque consisting of cholesterol can also become an obstacle to the normal flow of blood. This causes more than 80% of all diseases.

Risk group

ACVA most often manifests itself in the population that has the following pathologies:

• Vascular disorders of an atherosclerotic nature;
• A sharp increase in blood pressure;
• Previous extensive myocardial infarction;
• Stretching of the artery;
• Heart defects that are acquired or congenital in nature;
• Increased blood thickness caused by diabetes:
• Reduced blood flow rate, which is a consequence of cardiac failure;
• Excess body weight;
• Transistor ischemic attacks previously suffered by the patient;
• Excessive consumption of alcohol and tobacco products;
• Reaching the age of sixty;
• The use of oral contraceptives, which contribute to the occurrence of blood clots.

Symptoms of the disease

Neurologists distinguish several periods of development of ischemic stroke according to the severity of the disease:

1. The sharpest. Lasts up to five days;
2. Spicy. The duration is 21 days;
3. Early recovery. From the moment of elimination of acute symptoms it takes six months;
4. Late recovery. The rehabilitation period lasts for two years;
5. Eliminating traces. More than two years.

In addition to general symptoms, ischemic stroke of the brain is characterized by local symptoms. It depends on the area where the disease occurred.

And so, if you are amazed , then the following symptoms appear:

• Disorder of the visual system in the side where the blockage of the vessel occurred;
• The sensitivity of the limbs disappears on the opposite side of the lesion;
• Paralysis of muscle tissue occurs in the same area;
• There are disorders in the functioning of the speech apparatus;
• Lack of ability to understand your illness;
• Problems with body orientation;
• Loss of field of vision.

When the spinal artery is narrowed, other symptoms are noticeable:

• Hearing loss;
• Twitching of the pupils when moving in the opposite direction;
• Objects appear double.

If defeat happened on area of ​​combination with an unpaired blood vessel, then the symptoms manifest themselves in a more severe form:

In case of defeat anterior cerebral artery:

• Loss of sensation in the opposite side, usually in the leg area;
• Slowness in movement;
• Increased tone of muscle-flexor tissue;
• Lack of speech;
• The patient cannot stand or walk.

If failures prevent normal patency of the middle cerebral artery:

• The consequence of complete blockage of the main trunk is a state of severe coma;
• There is a loss of sensitivity in half the body;
• The motor system fails;
• Inability to fix your gaze on an object;
• Fields of vision disappear;
• There is a failure of the speech apparatus;
• The patient is unable to distinguish the right limb from the opposite one.

In case of violation patency of the posterior cerebral artery The following clinical picture is observed:

Obstruction of the optic geniculate artery accompanied by the following symptoms:

• Lack of tactile sensations on the opposite side of the face and body;
• If you touch the patient’s skin, he experiences severe pain;
• Incorrect perception of light and knocking;
• The forearms and shoulder joints are bent. The fingers are also bent at the base.

Defeat on the site thalamus characterized by the following symptoms:

• The patient's movements have a wide range;
• There is a strong tremor;
• Loss of coordination occurs;
• Half the body loses sensation;
• Characterized by severe sweating;
• Bedsores occur.

The most severe case of stroke is the process of breakthrough of an intracerebral hematoma. Hemorrhage occurs in the cerebrospinal fluid pathways, filling the cerebral stomachs with blood. This disease is called “ventricular tamponade”.

This case of stroke is the most severe and in almost all cases ends in death. The explanation for this is the unimpeded flow of blood to the patient's brain.

Treatment of stroke of ischemic type

The above symptoms may appear unexpectedly in a loved one. It is very important to provide first aid to the patient.

After calling an ambulance, it is necessary to alleviate the patient’s condition using the following techniques:

1. Place the patient on the side so that vomit leaves the victim’s mouth without hindrance;
2. The head should be slightly raised;
3. If you have a tonometer, you need to measure your blood pressure. If a sharp increase in pressure to critical values ​​is noticed, then a drug should be placed under the patient’s tongue to reduce it;
4. Provide the patient with the necessary amount of fresh air;
5. Free the patient's neck from any constricting objects.

Treatment in hospital

After arriving at a medical facility, the victim is placed in the intensive care unit. Next, the patient is prescribed a special diet, which focuses on the balance of all necessary microelements. Nutrition adjustments are made so that the diet does not contain fatty, spicy, salty foods.

Mayonnaise and other seasonings should also be excluded. Vegetables and fruits are limited only during the acute stage of the disease. If the patient is unconscious, then food is supplied through a medical tube no earlier than two days later.

After confirmation of stroke, inpatient treatment continues for a month. The consequences of suffering from this disease are extremely severe.

Severe decrease in strength in muscle tissue on the opposite side of the brain, the area of ​​which was damaged. Some patients practically learn to walk and perform normal movements again;

. The decrease in strength occurs only in the area of ​​the mouth, cheeks and lips. The patient cannot eat or drink fluids properly;

Disturbed functioning of the speech apparatus is quite common.. This is caused by damage to the speech center in the human brain. The patient either completely loses speech or does not perceive the words of another person;

Movement coordination disorder It is caused by damage to the parts of the central nervous system that are responsible for the normal functioning of the human motor system. In severe cases, disturbances may persist for several months;

Malfunctions of the visual system They are of different nature and depend on the size and location of the stroke lesion. Usually they are expressed in loss of visual fields;

Sensory impairment is expressed in the loss of pain, sensations of heat and cold.

Rehabilitation

A very important stage on the path to recovery after stroke.

Quality therapy includes the following treatment categories:

1. Physiotherapy. It is necessary to return the patient to normal movement of the limbs. The set of exercises is selected by the attending physician;
2. Visit to a speech therapist. Prescribed if the patient has problems with speech and swallowing;
3. Physiotherapy. The most accessible type of therapy, which is located in every clinic;
4. Medication therapy. The main stage in the recovery process. The drugs mitigate complications after the disease and prevent the risk of relapses;
5. Training for the mind. It is advisable for the patient to read as much literature as possible, memorize poems or excerpts from works.

stroke of hemorrhagic type

Components that have a nutritional effect, which includes oxygen, enter the brain through the carotid arteries. Located in the skull box, they form a network of vessels, which is the root of the blood supply to the central nerve system. When arterial tissue is destroyed, blood flows into the brain.

Causes

A stroke of the hemorrhagic type occurs in the case of hemorrhage into the brain from a vessel whose integrity has been compromised. As a result, a hematoma occurs in the patient’s brain, which is limited to brain tissue. Also, blood from a burst vessel can enter the area surrounding the brain.

Risk group

Particular attention should be paid to the health status of the following categories of citizens:

• Suffering from congenital dilatation of blood vessels;
• Having anomalies in the development of arteries and veins;
• Suffering from inflammatory diseases of the walls of blood vessels;
• With connective tissue pathologies of a systemic nature;
• Having lesions of blood vessels, accompanied by disturbances in protein metabolism;
• Abuse of drugs that stimulate the nervous system.

Symptoms

1. Acute headache;
2. Constant vomiting;
3. Frequent loss of consciousness for a long period;
4. In almost all cases, there is an increase in blood pressure;
5. Increasing sensations of weakness in the limbs;
6. Disorder in the functioning of organs responsible for sensitivity or complete loss of sensitivity;
7. Disturbance in the functioning of the motor system;
8. Visual system disorder;
9. Strong nervous excitement;
10. When analyzed, a small amount of blood is observed in the cerebrospinal fluid;

Treatment of stroke of hemorrhagic type

Drug therapy consists of the use of drugs whose action is aimed at stopping bleeding, reducing the size of cerebral edema, and calming the nervous system. Antibiotics and beta blockers are used.

Medicines can cause relapse of stroke, so it is advisable to eliminate the problem through surgery. First of all, the neurosurgeon removes the lesion, and then eliminates the malfunction in the vessel.

Reversibility of pathology

During diagnostic studies, it is essential whether the symptoms of stroke are reversible. When the stage is reversible, brain cells exist in the paralysis phase, but their integrity and full-fledged work are not impaired.

If the stage is irreversible, then the brain cells are dead and cannot be restored in any way. This area is called the “ischemic zone”. But therapeutic treatment in this case is possible.

Its purpose is to provide neurons with all nutritional components in the ischemic zone. With proper treatment, cell functions can be partially restored.

It was revealed that a person does not use all the resources of his body in the process of his life, including not all brain cells are involved. Cells that are not involved in work can replace dead cells and ensure their full functioning. The process is quite slow, so complete rehabilitation continues for three years.

Transistor ischemic attack (TIA)

This disease is also a stroke, but unlike ischemic and hemorrhagic stroke, it is temporary. Over a period of time, there is a sharp disruption of blood flow in the large vessels of the brain, as a result of which its cells suffer from a lack of oxygen and nutrients. Symptoms of TIA - transistor ischemic attack last for 24 hours and are similar to the symptoms of a stroke.

If more than 24 hours have passed, but the disease has not subsided, then most likely an ischemic or hemorrhagic stroke has occurred.

Symptoms

Consider the symptoms of transistor ischemic attack:

• There is a decrease in sensitivity in one side of the face, body, lower or upper extremities;
• Weakness in the body that is mild or moderate in nature;
• Disturbances in the functioning of the speech apparatus, up to a complete absence of speech or problems with understanding the opponent’s words;
• Dizziness and loss of coordination;
• Sudden noise in the ears and head;
• Headache and heaviness.

These symptoms appear abruptly and disappear within 3-4 hours. The deadline that distinguishes a transistor ischemic attack from a stroke is no more than a day.

What diseases can cause TIA?

TIA can be caused by the following diseases:

1. Persistent increase in blood pressure, which is chronic;
2. Chronic cerebrovascular disease;
3. Changes in blood cell clotting;
4. Sudden decrease in blood pressure;
5. Impossibility of normal blood flow through the artery caused by a mechanical obstruction;
6. Pathologies of the structure of cerebral vessels.

Transistor ischemic attack can and should be treated! Despite the fact that its symptoms pass rather quickly, this disease already signals a malfunction of the body and, in case of relapse, can result in a stroke!

Risk group

Transistorized ischemic attack is no less dangerous than a stroke. Up to 8% of TIA patients suffer a future stroke within a month of the attack. In 12% of patients, a stroke occurs within a year and in 29% within the next five years.

Treatment of transistor ischemic attack

It is carried out in a hospital.

Diagnostic studies include the following procedures:

1. Visiting a cardiologist, angiologist and ophthalmologist. The patient is prescribed a consultation with a medical psychologist;
2. To conduct a laboratory analysis, the patient must undergo a general blood and urine test, as well as blood for biochemical analysis;
3. Electrocardiography;
4. Computed tomography of the brain;
5. X-rays of light;
6. Constantly checking your blood pressure.

The victim is allowed to go home only if a recurrence of TIA is excluded or the patient has the opportunity to be immediately hospitalized in the event of a repeat attack.

Treatment for transient ischemic attack involves taking the following oral medications:

• The action of which is aimed at thinning the blood;
• Vasodilators;
• Reducing blood cholesterol levels;
• Aimed at normalizing blood pressure.

It is good to combine drug therapy with balneotherapy and physiotherapy.

Prevention

To avoid the occurrence and recurrence of transistor ischemic attack, a set of preventive measures should be followed:

1. Play sports, having previously drawn up an exercise plan together with your specialist;
2. Adjust your diet by reducing the amount of fatty, salty and spicy foods;
3. Reduce the consumption of alcohol and tobacco products;
4. Monitor your body weight.

Examination algorithm

ACVA can be diagnosed by characteristic symptoms, but in order to determine the extent of the disease and what type of ACVA it belongs to,

It is necessary to undergo a series of diagnostic tests.

Examination by a specialist immediately after the patient’s admission to a medical facility;

Taking blood for laboratory analysis, in order to assess the state of glucose levels, coagulation, enzymes;

CT scan in this case, it allows you to obtain more complete information about the disease. In the first 24 hours after an ischemic disorder, it is not possible to determine the location of the affected area.

This problem can be solved by performing magnetic resonance imaging;

Angiography of cerebral vessels helps to determine with reliable accuracy the area where the lesion occurred or the level of narrowness of the artery. With this study, it is possible to diagnose an aneurysm and a pathological connection between the veins and arteries of the brain.

But the results obtained do not allow us to correctly assess the amount of nerve tissue destruction. The solution to this problem is to combine vascular angiography with other diagnostic methods;

Cerebrospinal fluid collection for laboratory tests poses a threat to the patient’s life, but this study allows us to determine what type of stroke it is.

This diagnostic method is used mainly in medical institutions that do not have more advanced equipment.

Forecast

A favorable outcome after the disease has a category of citizens who have experienced a small form of acute stroke. With minor restrictions, these patients can normalize their activities.

Statistics show that 40% of deaths occur within the first month after illness. 70% show signs of disability in the first month. Over the next 6 months, 40% become disabled. After two years, signs of disability are noticeable in 30% of patients.

Video: ONMK. Signs of a stroke.

Cerebrovascular accident is the most pressing medical and social problem of the present time, which is a group of diseases manifested by chronic or acute hemodynamic disturbances in the vessels of the brain, leading to a decrease in cerebral blood supply.

Due to the progressive general aging of the population, i.e. With the increase in the number of elderly people in the population, the total number of patients with acute or chronic cerebrovascular accidents is increasing from year to year.

One of the most informative among modern neuroimaging methods is the MRI diagnostic method.

Only thanks to modern programs used in MRI diagnostics, it became possible to recognize signs of cerebral circulatory disorders within the first 24 hours.

According to the modern classification, cerebrovascular disorders are divided into:

• Acute cerebrovascular accidents: ischemic stroke, hemorrhagic stroke, transient cerebrovascular accidents.
• Chronic disorders of cerebral circulation (dyscirculatory encephalopathy of hypertensive and atherosclerotic origin.

1. Acute cerebrovascular accidents

Transient cerebrovascular accidents are acutely occurring cerebral circulatory disorders, manifested by general cerebral or focal symptoms lasting no more than 24 hours. They are also called transient ischemic attacks (TIA) due to the fact that they are based on transient ischemia in the basin of one or more cerebral vessels.

The first hours of ONMK. Changes in the area of ​​the right insula are demonstrated only by the DW insult program.

In contrast to transient disorders of cerebral circulation, strokes are characterized by persistent impairment of brain functions of varying degrees of severity.
Based on the nature of the pathological process, strokes are divided into ischemic and hemorrhagic.

Ischemic stroke.

In the list of diseases leading to the formation of ischemic stroke, atherosclerosis is in first place, often against the background of diabetes mellitus. In addition, hypertension, also in combination with atherosclerosis, is a common cause.

Meanwhile, there are many diseases that can be complicated by a stroke, of which valvular heart defects with embolism, hematological diseases (leukemia, erythremia), and vasculitis with collagenosis should be mentioned.

The etiopathogenetic factor that directly leads to a decrease in blood flow through the vessels is stenosis and occlusion of cerebral vessels. In some cases, a role is played by vascular malfomations and (rather rarely) cervical osteochondrosis with pathology of the intervertebral discs - with strokes in the vertebrobasilar region.

The trigger factor in the development of stroke is often mental and physical stress (stress, overwork, overheating, hypothermia).

The main pathogenetic condition for the development of stroke is a deficiency of blood flow to a certain area of ​​the brain with the formation of a zone of hypoxia and further necrosis. The size of the area of ​​ischemic stroke depends on the degree of development of collateral circulation.

Clinically, ischemic stroke is characterized by the predominance of focal symptoms over cerebral symptoms, as well as the close connection of focal symptoms with the blood supply of a specific cerebral vessel.

Symptoms increase gradually, over several hours and sometimes days. It is possible that the increase in symptoms will alternate with their weakening (flickering of symptoms in the initial stages of a stroke).

Ischemic stroke most often develops in the carotid region. In the vertebrobasilar - somewhat less frequently.

With lesions of large (main) arteries, extensive, territorial strokes develop according to the area of ​​blood supply to the affected vessel. Due to damage to small arteries, lacunar strokes with small lesions are formed.

The blood supply basin of the left superior cerebellar artery, acute stage of cerebrovascular accident.

Zone of subacute ischemic cerebrovascular accident, in the basin of the right middle cerebral artery. In T1 mode, the “veiling” symptom is visualized - the isointensity of the MR signal.

Subacute stage of ischemic cerebrovascular accident. With intravenous contrast, the accumulation of CV in the grooves at the level of the ischemic zone is determined (gyral type of enhancement).

Zone of chronic ischemic cerebrovascular accident, in the basin of the left posterior cerebral artery.

Ischemic stroke, brainstem (subacute period)

One of the advantages of MRI in assessing the consequences of stroke is the ability to visualize descending Wallerian axonal degeneration in the brainstem and corticospinal tract on the affected side.

Cortical ischemic cerebrovascular accident

Lacunar ischemic stroke against the background of chronic vascular insufficiency.

Some heart attacks with dyscirculatory encephalopathy are asymptomatic. These are “silent” heart attacks, which, as a rule, are localized in the deep parts of the brain and are diagnosed only with MRI. This case shows the possibility of identifying a focus of limited ischemic stroke of the basal ganglia on the left against the background of chronic ischemia.

Severe vascular encephalopathy with the presence of multiple foci of chronic ischemia and lacunar post-ischemic cysts. The DWI program clearly shows the focus of acute stroke in the basal ganglia on the right against the background of leukodystrophy.

Ischemic stroke in the basin of the left middle cerebral artery. Absence of the phenomenon of void flow at the level of the intracranial section of the left ICA (signs of slowing blood flow).

Ischemic stroke in the VBB on the left. Absence of the phenomenon of void flow at the level of the extracranial section of the left vertebral artery (signs of slowing blood flow).

Postischemic lacunar cyst with perifocal gliosis (middle third of corona radiata on the right)

Hemorrhagic stroke.

The development of hemorrhagic stroke is most often caused by hypertension against the background of atherosclerosis. In some cases, the cause of hemorrhages may be vascular pathology (congenital angiomas, vascular aneurysms), as well as other causes of arterial hypertension (pheochromacytoma, kidney disease, SLE, pituitary adenoma, etc.).

the blood plasma impregnates the vessel wall with a violation of its trophism and subsequent destruction, the formation of microaneurysms, ruptures of blood vessels and the release of free blood into the substance of the brain, i.e. development of stroke as a hematoma. In addition, it is possible to form a stroke of the type of hemorrhagic impregnation, which is based on the mechanism of diapedesis.

In cases of cerebral hemorrhage caused by a ruptured vessel, blood often breaks through into the ventricles of the brain or subarachnoid space.
Often, a major hemorrhagic stroke is accompanied by severe edema, which leads to displacement of the midline structures of the brain, various types of herniation, deformations of the brain stem with the subsequent development of secondary small hemorrhages.

The development of hemorrhagic stroke usually occurs during the day, during vigorous physical activity. The appearance of both general cerebral and focal symptoms is characteristic. Sudden sharp headache, disturbance of consciousness, tachycardia, rapid loud breathing, development of hemiparesis or hemiplegia are typical initial symptoms of hemorrhage. Impaired consciousness varies from stupor to deep coma with loss of all reflexes, disturbance of breathing rhythm, significant increase in blood pressure, hyperemia of the skin, sweating, and intense pulse. Anisokaria, divergent strabismus, gaze paresis, hemiplegia are sometimes observed, and rarely, meningeal symptoms.

Intracerebral hematoma (the border between the acute and early subacute stages - 3 days), complicated by intraventricular hemorrhage.

Intracerebral hematoma, late subacute period (14-21 days) with perifocal edema around the hematoma.

Intracerebral hematoma of the right parietal lobe. The border between the late subacute and early chronic stages. T2-weighted image shows a hemosiderin rim (arrow).

I would like to emphasize the possibility of MRI in identifying the consequences of a hemorrhagic lesion - there remains a well-differentiated T2 rim of hemosiderin, which is inaccessible for visualization with other neuroimaging methods.

The arrows show a rim of hemosiderin along the periphery of the postischemic cyst.

2. Chronic cerebrovascular accidents

Chronic cerebrovascular accidents are a progressive form of cerebrovascular pathology, characterized by multifocal or diffuse ischemic brain damage with the gradual development of neurological and psychological disorders.

The main causes of chronic cerebrovascular accident are arterial hypertension, cerebral atherosclerosis, and heart disease accompanied by heart failure.
Clinically, chronic disorders of cerebral circulation are manifested by disorders in the emotional sphere, impaired balance, walking, deterioration of memory and other cognitive functions, pseudobulbar disorders, neurogenic urination disorders, leading over time to maladjustment of patients.
A characteristic manifestation of DEP on MRI scans is the presence of multiple foci of gliosis.

In the white matter of the left frontal and both parietal lobes, mainly subcortically, multiple small foci of chronic ischemia were identified (most of them localized in the territory of the right middle cerebral artery).

A manifestation of chronic ischemia is also the development of pronounced dystrophic changes in the white matter of paraventricular localization - leukoaraiosis.

Severe dystrophic changes in the white matter of paraventricular localization - leukoaraiosis.

Combination of multifocal focal changes with diffuse cortical cerebral atrophy.

An ischemic stroke is an acute disorder of cerebral circulation due to the cessation of blood flow to the brain. This disease is widespread among people of all ages, although it is most often experienced by the elderly. Only 20% of patients who have suffered this type of stroke return to a full life. Therefore, timely provision of medical care for such patients is extremely important.

Kinds

Insufficient blood flow caused by a stroke leads to impairment of many neurological functions. This usually results from blockage of cerebral vessels by blood clots or emboli, which leads to the death of certain areas of the brain. Affected cells cease to function, and all tasks they perform cease to be performed.

According to the ICD, ischemic has code I63. Neurology studies and treats it. Doctors distinguish several types of stroke of this type. The main classification takes into account the mechanism of disease development and the overall severity of the stroke.

According to development mechanisms, five types are distinguished:

• atherothromboembolic - development is associated with atherosclerosis of large arteries in the brain;
• cardioembolic – associated with the appearance of emboli due to the development of arrhythmia, heart defects, endocarditis or other diseases;
• lacunar - develops when small vessels in the brain overlap, causing the formation of a cavity or softening of the gray matter;
• ischemic stroke of a different etiology - occurs with other rare causes, including cerebral artery dissection, migraine and vascular disease;
• unknown etiology - caused by one of several possible factors; it is not possible to establish the exact one.

Based on severity, ischemic stroke is classified into three types:

• mild – symptoms are mild, disappear completely within a few weeks, in some cases they may be completely unnoticeable;
• average - all symptoms are limited to neurological manifestations, thinking is adequate, the brain is functioning normally;
• severe – symptoms of brain damage appear, thinking is impaired, the patient urgently needs help.

The exact type of stroke can only be determined after undergoing diagnostics. It is very important to do this, since the prognosis and medications prescribed by the doctor will depend on the type of disease.

Of all cases of strokes, the share of ischemic strokes is about 75%, and the remaining 25% are hemorrhagic.

Causes

Acute ischemic cerebrovascular accidents can occur even in healthy people. Men aged 30 to 80 years are more likely to experience this disease. After 80 years, on the contrary, women usually suffer from such disorders. Even a child can experience a stroke, although the disease is most common among people over 50 years of age. Sometimes heredity or regular stress is enough to cause this type of circulatory disorder.

Main causes of stroke:

• atherosclerosis;
• arterial hypertension;
• diabetes;
• cervical osteochondrosis;
• bad habits;
• being overweight;
• passive lifestyle.

Most often, the disease is provoked by atherosclerosis. According to doctors' observations, approximately 90% of stroke cases are caused by this particular pathology. It has a direct impact on blood supply as it is associated with arterial disease. The risk of its occurrence increases in those who have had a heart attack or suffer from heart disease.

Symptoms

With stroke of this type, symptoms are divided into main and focal. The first is manifested almost completely in the majority of stroke victims. The second occurs only when there are disorders in specific areas of the brain and damage to certain vessels. In some cases, signs of stroke of ischemic type may be non-standard. For example, a lacunar stroke causes seizures without many other symptoms.

Main symptoms:

• disturbances of consciousness, sometimes coma is possible;
• severe headaches, dizziness;
• nausea, vomiting;
• discomfort in the heart area;
• vision problems, double vision, nystagmus;
• paralysis of part or all of the body;
• slurred speech, aphasia;
• loss of coordination of movements;
• facial distortion.

Focal symptoms are sometimes more severe. It is impossible to determine the exact location of the affected area from it, despite the special manifestations. In some cases, symptoms may be mixed, causing them to be inaccurate. For example, if one artery is damaged, symptoms from the second and third will appear, although they are healthy. Much depends on the individual characteristics of the patient and the nature of the stroke.

Foci and features of symptoms:

• anterior cerebral artery – paralysis of the leg, which is located on the side opposite to the affected hemisphere, uncontrolled urination;
• middle cerebral artery – inability to perform desired movements, speech and perception disorders;
• posterior cerebral artery – inconsistency of muscle work, lack of sensitivity of the body on the left or right, problems with memory and speech;
• internal carotid artery – paralysis of half the body or one limb, problems with speech;
• anterior villous artery – severe weakness and loss of sensation in half of the body, speech and vision disturbances;
• basilar and vertebral arteries - paralysis of the left or right limbs, loss of sensitivity, visual impairment, damage to the facial nerve;
• posterior cerebellar arteries – loss of facial sensation, speech problems, lack of perception of temperature and pain.

Ischemic stroke appears suddenly. Most often this happens in the morning or at night. It is very important that at this moment there is someone next to the person who can call an ambulance.

Differences from hemorrhagic type

If the subtypes of ischemic stroke are very similar, then the hemorrhagic type will differ radically from each of them. The main feature of this type of stroke is that it is not just a circulatory disorder, but a hemorrhage in the brain.

Typically, a hemorrhagic stroke develops extremely quickly. Sometimes everything can happen in a matter of minutes. If medical assistance is not provided in a short time, it will not be possible to save a person’s life. But even with a quick arrival of doctors, there is a high risk of complications. One of the most severe is swelling of brain tissue.

According to clinical signs, hemorrhagic stroke also has its own distinctive features:

• loss of consciousness;
• sudden drowsiness or agitation;
• headache with dizziness;
• nausea developing into vomiting;
• feeling of heat, sweating;
• rapid heartbeat, rhythm disturbances.

Focal symptoms may also develop. They depend on which hemisphere of the brain is damaged. The patient may experience impaired motor functions, paralysis of the entire body, and he/she ceases to control urination and defecation. If the patient’s left hemisphere is affected, then muscle problems will arise on the right. If the right is damaged, the left is damaged. The affected left side of the brain leads to impaired speech and thinking. The right one causes problems with orientation in space, perception and imagination. Complete memory loss is also possible.

The most dangerous thing is damage to the medulla oblongata, as this can lead to complete cessation of breathing. Without urgent medical intervention, the probability of death is almost 100%. The overall mortality rate in acute stroke that occurs of the hemorrhagic type exceeds 30%.

First aid

Determining a stroke at home is not so difficult. If a person begins to behave strangely, then you need to ask him to answer some question, smile or bare his teeth, and also raise his hands 90° for 5 seconds. His speech will be unintelligible, his face will be distorted, and one limb will not be able to hold on and will simply fall. In this case, you should immediately call an ambulance.

First self-aid is limited to simple actions:

1. Place the person in a horizontal position.
2. Elevate his head with a pillow or soft cloth.
3. Unfasten the collar, bra and belt.

When vomiting, the patient should be turned to the side, remove the tongue from the mouth and press it so that it cannot stick back. Under no circumstances should you rub your ears or other parts of the body according to popular advice - such actions can make a person feel even worse. It is also strictly forbidden to give medications to the victim.

Immediately after arrival, emergency doctors will conduct a quick examination of the patient, assess his condition and check for the possibility of a stroke. To this end, they will talk to him, observe his breathing, measure his blood pressure and pulse, and also listen to his lungs. If possible, doctors will immediately do an ECG. On the way to the neurological department of the hospital, it may be necessary to lower blood pressure, stop seizures, prevent cerebral edema and perform other actions aimed at preserving the patient’s life.

While the person is conscious and can speak, it is worth finding out whether he has chronic diseases and whether he is taking medications.

Diagnostics

The first part of the diagnosis, when the patient is admitted to a medical facility, is the examination and study of symptoms by the attending physician. He will record everything he observes and, based on this, make a preliminary diagnosis. And after this, the patient will be sent for a full diagnosis to confirm the condition.

Basic examinations:

• blood test - checking for clots;
• – search for affected areas in the brain and determine their dimensions;
• Ultrasound of arteries - study of the patency of arteries outside the skull;
• TCD – study of cerebral artery patency;
• MR angiography – additional check of the patency of arteries in the brain;
• ECG – assessment of normal heart rhythm;
• Cardiac ultrasound – examination of the heart for the presence of blood clots.

Usually only part of the methods are prescribed. Sometimes just a couple of them are enough to make a diagnosis. Only the attending physician can determine which ones to use. If necessary, they can be supplemented with other diagnostic tools.

Treatment

The primary goal in the treatment of ischemic stroke is to restore blood flow to the brain and minimize the consequences. This is achieved through drug therapy, but sometimes additional surgery may be required.

What goals do doctors set:

• body temperature control;
• elimination of headaches;
• getting rid of convulsive seizures;
• normalization of water and electrolyte balance;
• correction of blood pressure and heart function;
• saturating the body with oxygen;
• glucose level tracking.

One of the most important categories of drugs for the treatment of stroke of ischemic type are thrombolytic agents. They help dissolve the blood clot formed in the arteries. Such medications show maximum effectiveness in the first hours after the patient has suffered a stroke. They may be incompatible with some chronic diseases, which is why it is not always possible to prescribe them.

Neuroprotectors are considered the second important means. They stimulate the brain, which helps shrink the area affected by the stroke. The effectiveness of such drugs is questionable, but most doctors are confident in it. Later, in addition to these two types of drugs, drugs against blood pressure and arrhythmia are prescribed. If necessary, oxygen therapy is given to increase the level of oxygen in the blood. It is needed in cases where this figure drops to 92% and below. If such therapy does not have an effect, then the patient is prescribed artificial ventilation.

Along with drug treatment, a group of doctors consisting of a cardiologist, neurologist, psychologist and speech therapist will normalize the condition and relieve symptoms using a non-drug method. The effectiveness of their actions depends on how severe the stroke occurred in the patient.

In the most difficult situations, surgery may be required. It is usually prescribed in the absence of results from drug therapy, since there is a chance of removing a blood clot with the help of drugs only in the first hours after the blockage. During the operation, a special device is inserted into the vessel. It engages the clot and gently removes it. After this, it remains to restore the patient’s condition and eliminate all the consequences of stroke that may arise in the form of complications.

Recovery

During the recovery stage, it is very important to avoid congestive pneumonia, thrombophlebitis and bedsores. Therefore, a bedridden patient must be carefully monitored and cared for. Periodically it should be turned over on different sides. In this case, you need to make sure that the sheet does not bunch up.

The recovery process after a circulatory disorder must be systemic and consistent. When a person begins to feel a little better, he will need passive gymnastics with massage. To do this, it is recommended to hire a specialist who can ensure high-quality implementation of all rehabilitation measures. Later, the recovering person will have to study independently. To do this, he will be sent to physical therapy. Training on special simulators shows high efficiency. At the same time, doctors will prescribe useful medications that will help you quickly return to normal.

An important component of recovery is working with a psychiatrist and speech therapist. They will help normalize thought processes, restore memory and logic, and also correct speech functions. After some time, the person will again be able to fully communicate with others and even work.

Nutrition

Recovery after stroke has requirements for the quality of nutrition. A special diet will help avoid some health problems and also speed up the return to normal life.

It is necessary to build a diet from the following products:

• healthy cereals;
• lean fish, seafood;
• white or red meat;
• berries, fruits;
• dairy products.

Meat and fish should only be served boiled. When cooking, it is allowed to use vegetable oil - after an acute stroke it will be useful. It is recommended not to add salt, as it can negatively affect your overall health and reduce the effectiveness of some medications.

You should completely avoid the following foods:

• fried and smoked foods;
• fatty foods;
• dishes with a high amount of spices;
• bakery products.

Bad habits are subject to an even stricter ban. It is strictly forbidden to drink alcoholic beverages, even if they are low-alcohol. You can't smoke either. The ban applies not only to the recovery period - drinking and smoking are prohibited forever, as this can cause repeated circulatory problems in the future.

Forecast

The mortality rate from strokes is very high. According to statistics, more than 30% of patients die in the first month after a circulatory disorder, even with proper treatment. Of those who remain alive, only 20% are able to return to a full life and fully restore body functions. Those who have experienced lacunar stroke have the greatest chance of a favorable outcome. This type of stroke is considered one of the least dangerous.

The forecast depends on several factors:

• speed of medical care;
• degree of brain damage;
• individual characteristics of the patient;
• quality of implementation of recommendations for restoration.

The consequences of stroke can manifest themselves to varying degrees. If one patient has problems with speech, then the other is not able to fully think at all. Quite a lot of problems may remain after treatment. The most difficult of them can arise directly during therapy. It consists of severe bleeding from the effects of thrombolytic drugs. The risk of death in this case increases sharply.

Most often, after recovery, patients have to deal with motor disorders, speech problems and disorders of cognitive or emotional-volitional functions.