Acute cerebrovascular accidents. Oncology - what it is, treatment, symptoms and consequences Condition after oncology

Symptoms of ischemic stroke vary depending on the vascular system in which the blood flow is disrupted. There are two vascular basins.

• Vertebrobasilar:
  • formed by two vertebral arteries;
  • supplies blood to the brain stem (responsible for vital functions, such as breathing, blood circulation).

• Carotid:
  • formed by two internal carotid arteries;
  • supplies blood to the hemispheres of the brain (responsible for motor activity, sensitivity, higher nervous activity, for example, writing, memory, counting, etc.).

vertebrobasilar area The following symptoms are possible:

• systemic vertigo: the patient feels as if the world around him is spinning around him, which makes him try to grab onto surrounding objects in order to maintain balance (even in a sitting and lying position);
• unsteadiness of gait: the patient sways from side to side when standing;
• lack of coordination of movements: movements are sweeping, imprecise;
• tremor: trembling of the limbs when performing active movements;
• impaired ability to move in the limbs or throughout the body (paralysis);
• disturbance of sensitivity in the entire body or in one half of it (the border dividing the body into the right and left halves is formed by a line drawn through the tip of the nose and the navel);
• nystagmus: oscillatory movements of the eyeballs to the sides;
• breathing disorders: irregular breathing, long pauses between breaths;
• sudden loss of consciousness.

In case of circulatory problems in carotid basin The following symptoms are possible.

• Impaired ability to move in the limbs (usually in the limbs on one side - for example, only in the right arm and leg, although it can be isolated in one limb) or in the entire body (paralysis).
• Paralysis of one half of the face: its signs can be noticed if you ask a person to smile (the asymmetrical raising of the upper lip is visible) or raise the eyebrows (the forehead wrinkles asymmetrically on both sides).
• Impaired sensitivity in the entire body or in one half of it (the border dividing the body into the right and left halves is formed by a line drawn through the tip of the nose and the navel).
• Speech disorders:
  • dysarthria: unclear, slurred speech;
  • sensory aphasia: lack of ability to understand overheard speech. At the same time, the patient looks disoriented and frightened, since the speech of people coming into contact with him seems incomprehensible to him. The patient himself can actively speak, but his speech consists of words and phrases that are not related to each other in meaning, so this phenomenon is sometimes called “verbal hash”;
  • motor aphasia: lack of ability to pronounce words correctly. At the same time, the patient hears a defect in his speech, so he is laconic and tries to remain silent more;
  • mutism: complete absence of speech.

• Visual impairment:
  • violation of the movement of the eyeballs: restriction of the movement of one or both eyes to the sides, up to complete immobility of the eyes or the formation of strabismus;
  • partial or complete blindness in one or both eyes;
  • freezing of gaze directed to the right or left.

• Impaired intellectual abilities (cognitive impairment): the patient has difficulty counting, difficulty naming where he is, what time it is, etc.
• Disorders of higher nervous activity:
  • impaired ability to read (it seems to a person that all the letters in the text are mixed up);
  • impaired ability to write (a person confuses letters and syllables in a written text).

Forms

The following forms of ischemic stroke are distinguished based on the vascular basin in which the circulation was disrupted.

• Ischemic stroke in the vertebrobasilar region:
  • in the basilar artery system;
  • in the posterior cerebral artery system.

• Ischemic stroke in the carotid region:
  • in the anterior cerebral artery system;
  • in the middle cerebral artery system.

According to the side on which the circulatory disturbance occurred, the following forms of ischemic stroke are distinguished:

• right-sided ischemic stroke;
• left-sided ischemic stroke.

Due to the reason that caused the disturbance of blood circulation in the brain, the following types of ischemic stroke are distinguished:

• atherothrombotic: circulatory disorders are caused by atherosclerosis of the arteries supplying blood to the brain. At the same time, various fractions of cholesterol are deposited in the walls of blood vessels, which causes the appearance of so-called “atherosclerotic plaques.” If they are large in size, it is possible to block the lumen of the artery, which impairs blood circulation to the brain. Damage to the plaque is also possible with the release of atherosclerotic masses (cholesterol) into the blood, which clog the vessel, disrupting the blood supply to the brain;
• cardioembolic: in this option, the lumen of the vessel supplying blood to the brain is blocked by thrombotic masses (an accumulation of blood cells glued together) that came here from the heart or veins of the lower extremities;
• hemodynamic: develops when the amount of blood flowing to the brain decreases. More often the cause of this is a decrease in arterial (blood) pressure;
• lacunar: occurs when a small vessel supplying blood to the brain is blocked;
• hemorheological: occurs when local blood thickens directly in the arteries of the brain.

Causes

• Atherosclerosis of the brain: deposition of cholesterol fractions in the walls of arteries. At the same time, the lumen of the vessel narrows, which causes a decrease in blood supply to the brain, and there is also a risk of damage to the atherosclerotic plaque with the release of cholesterol and blockage (thrombosis) of the arteries of the brain.
• Heart rhythm disturbance (atrial fibrillation): in this case, blood clots form in the cavities of the heart (usually in the atria), which can fragment (split into pieces) at any second, enter the arteries of the brain with the bloodstream and cause disturbances in blood flow there.
• The presence of blood clots in the veins of the lower extremities: they can fragment (split into pieces), enter the arteries of the brain with the bloodstream (if there is an open foramen ovale in the heart - a situation in which there is a direct connection between the right and left parts of the heart) and cause disruption of blood flow there .
• Compression of the arteries supplying blood to the brain: for example, during sudden turns of the head, during operations on the carotid arteries.
• A sharp decrease in arterial (blood) pressure.
• Blood thickening: for example, when the number of blood cells in the blood increases.

Diagnostics

• Analysis of complaints and medical history:
  • how long ago the complaints appeared: blurred vision, unsteadiness of gait, sensory disturbances, etc.;
  • how much time has passed since the first complaints appeared;
  • whether there have been previous episodes of similar complaints;
  • whether complaints appeared at rest or during active physical activity;
  • whether the patient had previously been diagnosed with cerebral atherosclerosis, heart rhythm disturbances, or the presence of blood clots in the veins of the lower extremities.

• Neurological examination: search for signs of neurological pathology (partial or complete loss of vision, loss of sensation in half of the body, inability to move the limbs (paralysis), etc.).
• Blood test: may reveal signs of blood thickening.
• CT (computed tomography) and MRI (magnetic resonance imaging) of the head: allows you to study the structure of the brain layer by layer to detect the area of ​​brain damage (cerebral infarction, that is, the death of its area), assess its location and size.
• ECG (electrocardiography): detects signs of abnormal heart rhythm.
• Echo-CG (ultrasound of the heart): allows you to detect blood clots in the cavities of the heart.
• Ultrasound of extracranial arteries: using a special sensor, the patency of the arteries supplying blood to the brain, which are located outside the skull (on the neck), is examined.
• TCD (transcranial dopplerography): the method allows you to evaluate blood flow through the arteries located in the cranial cavity. To do this, the ultrasonic sensor is applied directly to the skull (in the temporal areas).
• MRA (magnetic resonance imaging): the method allows you to evaluate the patency of the arteries in the cranial cavity.
• Consultation is also possible.

Treatment of ischemic stroke

• Hospitalization in the neurological department for treatment and rehabilitation with the participation of neurologists, speech therapist (correction of speech disorders), psychologist (correction of mental disorders), cardiologist (correction of blood pressure, rhythm disturbances).
• Drug treatment:
  • thrombolytic therapy: injection into the bloodstream of a drug that can dissolve a blood clot that has blocked the lumen of a brain artery. The method has a lot of contraindications (including the time from the onset of the first symptoms to more than 3 hours). Carrying out thrombolytic therapy is associated with the risk of intracerebral or gastrointestinal bleeding (the activity of the coagulation system is sharply reduced);
  • drugs that lower arterial (blood) pressure (on the next day of the disease, on the first day the pressure cannot be reduced, as this will reduce the blood supply to the brain);
  • neuroprotectors (drugs that improve brain nutrition and accelerate its recovery);
  • antiarrhythmic drugs (to restore heart rhythm).

• Surgical treatment is the removal of a blood clot through a vessel: for this, a special device resembling an umbrella is inserted into the arteries of the brain, with the help of which the blood clot is captured and removed.

Complications and consequences

• Persistent neurological defect: paralysis (impossibility of movement in the limbs), dysarthria (slurred speech), cognitive (mental) impairment (decreased memory, cognitive abilities).
• Risk of death.

Prevention of ischemic stroke

• A nutritious diet with limited consumption of fatty, fried foods.
• Medication methods:
  • elimination of rhythm disturbances: taking antiarrhythmic drugs. If it is impossible to restore the rhythm, take drugs that inhibit coagulation (anticoagulants) to prevent thrombosis;
  • control of arterial (blood) pressure: taking antihypertensive (pressure-lowering) drugs;
  • taking statins (drugs that improve cholesterol metabolism and reduce the activity of the atherosclerotic process in blood vessels);
  • taking antiplatelet agents (drugs that reduce blood clotting).

• Surgical correction of narrowing of the arteries supplying blood to the brain:
  • carotid endarterectomy (removal of the inner lining of the carotid arteries along with atherosclerotic plaque): for narrowing of arteries located outside the skull;
  • extra-intracranial microanastomosis (forming a connection between vessels located outside the skull and vessels in the cranial cavity): when narrowing the arteries located in the skull.

The classic abbreviated name for the pathology in acute cerebrovascular accident is “ischemic stroke.” If hemorrhage is confirmed, then it is considered hemorrhagic.

In ICD-10, ACME codes may vary, depending on the type of violation:

• G45 is an established designation for transient cerebral attacks;
• I63 - recommended for statistical registration of cerebral infarction;
• I64 - an option used for unknown differences between cerebral infarction and hemorrhage, used when a patient is admitted in an extremely serious condition, unsuccessful treatment and imminent death.

The frequency of ischemic strokes exceeds hemorrhagic strokes by 4 times and is more associated with general human diseases. The problem of prevention and treatment is considered in programs at the state level, because 1/3 of patients who have suffered the disease die in the first month and 60% remain permanently disabled requiring social assistance.

Why does a lack of blood supply to the brain occur?

Acute ischemic cerebrovascular accident is often a secondary pathology and occurs against the background of existing diseases:

• arterial hypertension;
• widespread atherosclerotic vascular lesions (up to 55% of cases develop due to pronounced atherosclerotic changes or thromboembolism from plaques located in the aortic arch, brachiocephalic trunk or intracranial arteries);
• previous myocardial infarction;
• endocarditis;
• heart rhythm disturbances;
• changes in the valvular apparatus of the heart;
• vasculitis and angiopathy;
• vascular aneurysms and developmental anomalies;
• blood diseases;
• diabetes mellitus

Up to 90% of patients have changes in the heart and main arteries of the neck. The combination of these reasons sharply increases the risk of ischemia.

Possible compression of the vertebral artery by the processes of the vertebrae

Transient attacks are most often caused by:

• spasm of the arterial brain stems or short-term compression of the carotid and vertebral arteries;
• embolization of small branches.

The following risk factors can provoke the disease:

• elderly and senile age;
• excess weight;
• the effect of nicotine on blood vessels (smoking);
• experienced stress.

The basis of the influencing factors is the narrowing of the lumen of the vessels through which blood flows to the brain cells. However, the consequences of such a malnutrition may vary according to:

The combination of factors determines the form of the disease and clinical symptoms.

Pathogenesis of various forms of acute cerebral ischemia

Transient ischemic attack was previously called transient cerebrovascular accident. It is identified as a separate form because it is characterized by reversible disorders; the heart attack does not have time to form. Usually the diagnosis is made retrospectively (after the disappearance of the main symptoms), within a day. Before this, the patient is treated as if he had a stroke.

The main role in the development of hypertensive cerebral crises belongs to the increased level of venous and intracranial pressure with damage to the walls of blood vessels and the release of fluid and protein into the intercellular space.

Swelling of brain tissue in this case is called vasogenic

The feeding artery is necessarily involved in the development of ischemic stroke. The cessation of blood flow leads to oxygen deficiency in the lesion formed in accordance with the boundaries of the basin of the affected vessel.

Local ischemia causes necrosis of an area of ​​brain tissue.

Depending on the pathogenesis of ischemic changes, types of ischemic strokes are distinguished:

• atherothrombotic - develops when the integrity of an atherosclerotic plaque is disrupted, which causes complete closure of the internal or external feeding arteries of the brain or their sharp narrowing;
• cardioembolic - the source of thrombosis is pathological growths on the endocardium or heart valves, fragments of a blood clot, they are delivered to the brain with the general blood flow (especially when the foramen ovale is not closed) after attacks of atrial fibrillation, tachyarrhythmia, atrial fibrillation in patients in the post-infarction period;
• lacunar - more often occurs when small intracerebral vessels are damaged in arterial hypertension, diabetes mellitus, is characterized by the small size of the lesion (up to 15 mm) and relatively minor neurological disorders;
• hemodynamic - cerebral ischemia with a general decrease in blood circulation speed and a drop in pressure against the background of chronic heart diseases, cardiogenic shock.

In case of hemodynamic disturbances, blood flow in the vessels of the brain may decrease to a critical level and below

It is worth explaining the variant of development of strokes of unknown etiology. This often happens when there are two or more reasons. For example, in a patient with carotid artery stenosis and fibrillation after an acute infarction. It should be taken into account that elderly patients already have stenosis of the carotid arteries on the side of the suspected disorder, caused by atherosclerosis, in the amount of up to half the lumen of the vessel.

Stages of cerebral infarction

The stages of pathological changes are distinguished conditionally; they are not necessarily present in every case:

• Stage I - hypoxia (oxygen deficiency) disrupts the permeability of the endothelium of small vessels in the lesion (capillaries and venules). This leads to the transfer of fluid and protein from the blood plasma into the brain tissue and the development of edema.
• Stage II - at the level of capillaries, pressure continues to decrease, which disrupts the functions of the cell membrane, the nerve receptors located on it, and electrolyte channels. It is important that all changes are reversible for now.
• Stage III - cell metabolism is disrupted, lactic acid accumulates, and a transition to energy synthesis occurs without the participation of oxygen molecules (anaerobic). This species does not allow maintaining the necessary level of life of neuronal cells and astrocytes. Therefore, they swell and cause structural damage. Clinically expressed in the manifestation of focal neurological signs.

What is the reversibility of the pathology?

For timely diagnosis, it is important to establish a period of symptom reversibility. Morphologically, this means preserved neuronal functions. Brain cells are in a phase of functional paralysis (parabiosis), but retain their integrity and usefulness.

The ischemic zone is much larger than the necrosis area; the neurons in it are still alive

In the irreversible stage, it is possible to identify a zone of necrosis in which cells are dead and cannot be restored. Around it there is an ischemic zone. Treatment is aimed at supporting adequate nutrition of neurons in this area and at least partially restoring function.

Modern research has shown extensive connections between brain cells. A person does not use all reserves and opportunities in his life. Some cells are able to replace dead ones and provide their functions. This process is slow, so doctors believe that rehabilitation of a patient after an ischemic stroke should continue for at least three years.

Signs of transient cerebral circulatory disorders

Clinicians include the following in the group of transient cerebrovascular accidents:

• transient ischemic attacks (TIA);
• hypertensive cerebral crises.

Features of transient attacks:

• the duration ranges from several minutes to a day;
• every tenth patient after a TIA develops an ischemic stroke within a month;
• neurological manifestations are not grossly severe;
• mild manifestations of bulbar palsy (focus in the brain stem) with oculomotor disorders are possible;
• blurred vision in one eye combined with paresis (loss of sensation and weakness) in the limbs of the opposite side (often accompanied by incomplete narrowing of the internal carotid artery).

Features of hypertensive cerebral crises:

• the main manifestations are cerebral symptoms;
• focal signs occur rarely and are mild.

The patient complains of:

• sharp headache, often in the back of the head, temples or crown of the head;
• state of stupefaction, noise in the head, dizziness;
• nausea, vomiting.

• temporary confusion;
• excited state;
• sometimes - a short-term attack with loss of consciousness, convulsions.

Signs of a cerebral stroke

Ischemic stroke means the occurrence of irreversible changes in brain cells. At the clinic, neurologists distinguish periods of the disease:

• acute - continues from the onset of symptoms for 2–5 days;
• acute - lasts up to 21 days;
• early recovery - up to six months after the elimination of acute symptoms;
• late recovery - takes from six months to two years;
• consequences and residual effects - over two years.

Some doctors continue to distinguish small forms of stroke or focal ones. They develop suddenly, the symptoms do not differ from cerebral crises, but last up to three weeks, then completely disappear. The diagnosis is also retrospective. During the examination, no organic abnormalities were found.

Cerebral ischemia, in addition to general symptoms (headaches, nausea, vomiting, dizziness), manifests itself locally. Their nature depends on the artery that is “turned off” from the blood supply, the state of the collaterals, and the dominant hemisphere of the patient’s brain.

Let's consider the zonal signs of blockage of the cerebral and extracranial arteries.

If the internal carotid artery is damaged:

• vision is impaired on the side of the blocked vessel;
• the sensitivity of the skin on the limbs and face on the opposite side of the body changes;
• paralysis or muscle paresis is observed in the same area;
• possible loss of speech function;
• inability to realize one’s illness (if the focus is in the parietal and occipital lobes of the cortex);
• loss of orientation in parts of one’s own body;
• loss of visual fields.

Narrowing of the vertebral artery at the level of the neck causes:

• hearing loss;
• nystagmus of the pupils (twitching when deviating to the side);
• double vision.

If the narrowing occurs at the confluence with the basilar artery, then the clinical symptoms are more severe, since cerebellar damage predominates:

• inability to move;
• impaired gesticulation;
• chanted speech;
• violation of joint movements of the trunk and limbs.

If there is insufficient blood flow in the basilar artery, manifestations of visual and brain stem disorders (impaired breathing and blood pressure) occur.

If the anterior cerebral artery is damaged:

• hemiparesis of the opposite side of the body (unilateral loss of sensation and movement), often in the leg;
• slowness of movements;
• increased tone of flexor muscles;
• loss of speech;
• inability to stand and walk.

Blockage of the middle cerebral artery is characterized by symptoms depending on the damage to the deep branches (feeding the subcortical nodes) or long ones (approaching the cerebral cortex)

Obstruction of the middle cerebral artery:

• when the main trunk is completely blocked, a deep coma occurs;
• lack of sensitivity and movement in half of the body;
• inability to fix the gaze on an object;
• loss of visual fields;
• loss of speech;
• inability to distinguish the left side from the right.

Obstruction of the posterior cerebral artery causes:

• blindness in one or both eyes;
• double vision;
• gaze paresis;
• seizures;
• large tremor;
• impaired swallowing;
• paralysis on one or both sides;
• respiratory and blood pressure disturbances;
• brain coma

When the optic geniculate artery is blocked, the following appears:

• loss of sensation in the opposite side of the body, face;
• severe pain when touching the skin;
• inability to localize the stimulus;
• perverted perceptions of light, knocking;
• “thalamic hand” syndrome - the shoulder and forearm are bent, the fingers are extended at the terminal phalanges and bent at the base.

Impaired blood circulation in the area of ​​the visual thalamus is caused by:

• sweeping movements;
• large tremor;
• loss of coordination;
• impaired sensitivity in half of the body;
• sweating;
• early bedsores.

In what cases can acute stroke be suspected?

The above clinical forms and manifestations require careful examination, sometimes not by one, but by a group of doctors of different specialties.

Cerebrovascular accident is very likely if the patient exhibits the following changes:

• sudden loss of sensation, weakness in the limbs, face, especially one-sided;
• acute loss of vision, the occurrence of blindness (in one eye or both);
• difficulty in pronunciation, understanding words and phrases, composing sentences;
• dizziness, loss of balance, impaired coordination of movements;
• confusion;
• lack of movement in the limbs;
• intense headache.

Additional examination allows us to establish the exact cause of the pathology, the level and location of the vessel lesion.

Purpose of diagnosis

Diagnosis is important for choosing a treatment method. To do this you need:

• confirm the diagnosis of stroke and its form;
• identify structural changes in brain tissue, focal area, affected vessel;
• clearly distinguish between ischemic and hemorrhagic forms of stroke;
• based on pathogenesis, establish the type of ischemia for starting specific therapy in the first 3–6 in order to get into the “therapeutic window”;
• assess indications and contraindications for drug thrombolysis.

It is practically important to use diagnostic methods on an emergency basis. But not all hospitals have enough medical equipment to operate around the clock. The use of echoencephaloscopy and cerebrospinal fluid studies yields up to 20% errors and cannot be used to resolve the issue of thrombolysis. The most reliable methods should be used in diagnosis.

Foci of softening on MRI allow differential diagnosis of hemorrhagic and ischemic strokes

Computed and magnetic resonance imaging allows you to:

• distinguish a stroke from space-occupying processes in the brain (tumors, aneurysms);
• accurately determine the size and location of the pathological focus;
• determine the degree of edema, disturbances in the structure of the ventricles of the brain;
• identify extracranial locations of stenosis;
• diagnose vascular diseases that contribute to stenosis (arteritis, aneurysm, dysplasia, vein thrombosis).

Computed tomography is more accessible and has advantages in studying bone structures. And magnetic resonance imaging better diagnoses changes in the parenchyma of brain tissue and the size of edema.

Echoencephaloscopy can only reveal signs of displacement of the median structures with a massive tumor or hemorrhage.

During ischemia, cerebrospinal fluid rarely shows slight lymphocytosis with increased protein. Most often no change. If the patient has a hemorrhage, blood may appear. And with meningitis - inflammatory elements.

Ultrasound examination of blood vessels - Dopplerography method of the arteries of the neck indicates:

• development of early atherosclerosis;
• stenosis of extracranial vessels;
• sufficiency of collateral connections;
• the presence and movement of an embolus.

Duplex sonography can determine the condition of the atherosclerotic plaque and artery walls.

Cerebral angiography is performed if technically possible for emergency indications. Typically, the method is considered more sensitive in identifying aneurysms and foci of subarachnoid hemorrhage. Allows you to clarify the diagnosis of pathology identified on tomography.

Cardiac ultrasound is performed to detect cardioembolic ischemia in heart disease.

Examination algorithm

The examination algorithm for suspected acute stroke proceeds according to the following plan:

1. examination by a specialist in the first minutes after the patient’s admission to the hospital, examination of the neurological status, clarification of the medical history;
2. taking blood and studying its coagulability, glucose, electrolytes, enzymes for myocardial infarction, and the level of hypoxia;
3. if it is not possible to conduct MRI and CT, do an ultrasound of the brain;
4. spinal puncture to exclude hemorrhage.

Treatment

The most important importance in the treatment of cerebral ischemia belongs to the urgency and intensity in the first hours of admission. 6 hours from the onset of clinical manifestations is called the “therapeutic window”. This is the time for the most effective use of the thrombolysis technique to dissolve a blood clot in a vessel and restore impaired functions.

Regardless of the type and form of stroke, the following are carried out in the hospital:

• increased oxygenation (filling with oxygen) of the lungs and normalization of respiratory function (if necessary, through transfer and mechanical ventilation);
• correction of impaired blood circulation (heart rhythm, blood pressure);
• normalization of electrolyte composition, acid-base balance;
• reducing cerebral edema by administering diuretics and magnesium;
• relief of agitation and seizures with special antipsychotic drugs.

A semi-liquid diet is prescribed for the patient's nutrition; if swallowing is impossible, parenteral therapy is prescribed. The patient is provided with constant care, prevention of bedsores, massage and passive exercises.

Rehabilitation begins from the first days

This allows you to get rid of negative consequences in the form of:

• muscle contractures;
• congestive pneumonia;
• DIC syndrome;
• pulmonary embolism;
• damage to the stomach and intestines.

Thrombolysis is a specific therapy for stroke of ischemic type. The method allows you to preserve the viability of neurons around the necrosis zone, returning all weakened cells to life.

The administration of anticoagulants begins with Heparin derivatives (in the first 3–4 days). Drugs of this group are contraindicated for:

• high blood pressure;
• peptic ulcer;
• diabetic retinopathy;
• bleeding;
• impossibility of organizing regular monitoring of blood clotting.

After 10 days they switch to indirect anticoagulants.

Drugs that improve metabolism in neurons include Glycine, Cortexin, Cerebrolysin, Mexidol. Although they are not listed as effective in the evidence-based medicine database, their use leads to improvement in the condition.

Decompression craniotomy is performed in case of increasing edema in the brain stem area

Patients may need symptomatic treatment depending on the specific manifestations: anticonvulsants, sedatives, painkillers.

Antibacterial agents are prescribed to prevent kidney infection and pneumonia.

Forecast

Data on prognosis are available only for ischemic infarction; other changes represent precursors indicating an increased risk of stroke.

Atherothrombotic and cardioembolic types of ischemia have the most dangerous mortality rate: during the first month of the disease, from 15 to 25% of patients die. Lacunar stroke is fatal in only 2% of patients. The most common causes of death:

• in the first 7 days - cerebral edema with compression of vital centers;
• up to 40% of all deaths occur in the first month;
• after 2 weeks - pulmonary embolism, congestive pneumonia, cardiac pathology.

Patient survival time:

After this period, 16% die per year.

Only 15% of patients return to work

The following have signs of disability:

• after a month - up to 70% of patients;
• six months later - 40%;
• by the second year - 30%.

The rate of recovery is most noticeable in the first three months by an increase in the range of movements, while the functions of the legs return faster than the arms. Remaining immobility in the hands after a month is an unfavorable sign. Speech is restored after years.

The rehabilitation process is most effective with the volitional efforts of the patient and the support of loved ones. Complicating factors include advanced age and heart disease. Seeing a doctor during the phase of reversible changes will help avoid serious consequences.

My husband was diagnosed with stroke, spent a month in the hospital, and then spent a month receiving treatment at home. Paresis on the right side, he walked on crutches. After 2 months, paralysis of the left side was treated for 10 days. An MRI showed that there was no stroke at all. Did the course of treatment for STROKE - PARALYSIS OF THE LEFT arm and leg cause harm?

Three months after the acute stroke, he lost his speech and could not swallow. They put me back in the hospital. They are fed through a tube. What is the prognosis? And are they discharged from the hospital with a tube?

In 2011, she suffered an ischemic stroke on the left side, functions were restored, but now the left side of the head is numb. In 2014, she had an MRI, blood flow to the brain was 30%, constant headaches, the pressure rose to 140 over 85. The stroke was at a pressure of 128 over 80, working blood pressure is 90 over 60, I’m 65 years old.

Ischemic stroke, its symptoms and treatment

ACVA or acute cerebrovascular accidents are a group of clinical syndromes that are a consequence of impaired blood flow to the brain. The pathology can be caused by a blood clot formed in the blood vessels of the brain or damage to them, which leads to the death of a large number of blood and nerve cells. Highlight:

1. ACVA of ischemic type (ischemic stroke).
2. Stroke of hemorrhagic type (hemorrhagic stroke). This diagnosis is made when a cerebral hemorrhage is confirmed.

The above classification is very important for the correct choice of treatment method.

A stroke caused by damage to brain tissue and critical disruption of the blood supply to its areas (ischemia) is called ischemic stroke.

The main reason for the manifestation of pathology is a decrease in the amount of blood entering the brain. The following factors and diseases can lead to this:

• Persistent increase in blood pressure.
• Damage to the main arteries of the brain and vessels of the neck in the form of occlusion and stenosis.
• Atherosclerotic changes.
• Inflammation of the connective tissue membrane of the heart.
• Inflammatory processes or injuries of the carotid arteries, which significantly reduce blood flow through the vessels.
• Hemorheological changes in the cellular composition of the blood.
• Cardiogenic embolism.
• Changes in heart rate.
• Myocardial infarction.
• Various changes in the heart, as well as in the main arteries of the cervical spine (observed in 91% of patients).
• Diabetes.
• Immunopathological inflammation of blood vessels.
• Pathological disturbance of blood vessel tone.
• Thrombotic formations on the walls of blood vessels.
• The presence of artificial valves in the heart.
• Smoking.
• Overweight.
• Everyday stress.

At risk are the elderly (however, there are cases of the disease in children) and patients suffering from osteochondrosis of the cervical spine, since this leads to significant compression of the blood vessels.

The disease has a wide variety of symptoms. General symptoms of ischemic stroke include sudden headaches, deterioration in speech and vision, impaired reflexes and coordination, nausea, vomiting, dizziness and disorientation of the patient in space, pain in the eyeballs, paralysis of the face and limbs. Psychomotor agitation and short-term loss of consciousness and convulsions are also possible.

There are zonal signs of thrombolization of the cerebral arteries. Characterized by the following types of violations.

If the internal carotid artery is affected, the patient’s vision deteriorates (visual fields are lost), skin sensitivity and speech are impaired, muscle paralysis and loss of orientation in one’s own body occur.

Impaired patency in the middle cerebral artery causes sensory disturbances in half of the body, the inability to focus on a specific object, loss of visual fields and loss of speech. The patient is unable to distinguish the right side from the left.

If disturbances occur in the posterior cerebral artery, the following may occur: blindness, seizures, complete or partial paralysis, breathing problems, large tremors and deterioration of swallowing function. In the worst case, a cerebral coma occurs.

When the anterior cerebral artery is damaged, unilateral loss of sensation and loss of speech are observed. The patient's movements slow down or there is no ability to walk or stand at all.

If the slightest symptoms of pathology are detected, it is necessary to carry out timely treatment of stroke.

The purpose of diagnosis is to determine the necessary treatment method. It is very important to conduct an examination by a specialist in the first hour after the patient’s admission. The following procedures are followed:

• Blood sampling to determine blood clotting: viscosity, hematocrit, fibrinogen, electrolytes and antiphospholipid antibodies.
• CT and MRI. This is the most reliable method for detecting acute cerebrovascular accidents. It allows you to correctly determine the type of stroke, exclude tumors and aneurysms, determine the size and location of the lesion, and also diagnose vascular diseases.
• Echoencephaloscopy. This technique is not very informative in the first hours of a stroke.
• X-ray examination of cerebral vessels.
• ECG changes in blood pressure.
• Ultrasound of the brain. It is used if it is not possible to conduct computed tomography and magnetic resonance imaging.

The main task is emergency and intensive treatment in the first minutes of the patient’s admission, since at this time the thrombolysis technique is effective. This will preserve the vitality of neurons near the necrosis zone, as well as weakened cells. Further, in the hospital, if the patient has a stroke, treatment is carried out in the following order:

1. 1. A general complex is carried out to maintain the vital functions of the body.
2. 2. If necessary, antihypertensive drugs, anticoagulants (if the patient has high blood pressure, ulcers, diabetes or bleeding), vasoactive and decongestant drugs, antiplatelet agents and others are prescribed.
3. 3. To normalize breathing and saturate the lungs with oxygen, perform breathing exercises. In extreme cases, artificial ventilation is performed.
4. 4. Restore blood circulation.
5. 5. Using diuretics, they reduce swelling of the brain.
6. 6. Antipsychotic drugs are prescribed to exclude the possibility of repeated convulsive seizures.
7. 7. If the swallowing function of the body is impaired, the patient is prescribed a semi-liquid diet or undergoes parenteral therapy.

Acute ischemic cerebrovascular accident can lead to the following complications:

• paralysis or paresis of one side of the body;
• disorders of pain sensitivity in any part of the body;
• loss of taste, hearing, sudden blindness or double vision;
• problems with speech (when speaking, it is difficult for the patient to select and pronounce words);
• disorders of complex, purposeful movements (apraxia);
• disorders of the body's swallowing function;
• loss of visual fields;
• spontaneous fainting;
• involuntary urination.

It should be noted that with proper treatment and regular rehabilitation sessions, it is possible to completely eliminate the above complications, as well as complete restoration of the patient’s body. And after some time, a person can completely return to normal life.

If you have the slightest suspicion of stroke, you must immediately call an ambulance. At this time, the patient should not be disturbed for no reason (and it is best to isolate him) and put him in such a position that the upper body and head are elevated. Next, you need to allow the patient to breathe freely. To do this, you need to massage the neck-collar area and provide fresh air access to the room.

If a person has gag reflexes, turn their head to the side and clean the mouth with a napkin or gauze. This will eliminate the risk of vomit entering the respiratory tract.

Quite often, with stroke, an epileptic seizure occurs, which is accompanied by loss of consciousness and convulsions. In this case, the main thing is not to get confused. The patient must be positioned on his side and a pillow placed under his head. Next, you should place, for example, a pencil or pen in your mouth to prevent biting your tongue. Under no circumstances should you restrict the patient’s movements (hold him by the arms and legs or press him with your body), as this will only increase cramps and the risk of a fracture or dislocation.

A common mistake is to use ammonia, which can lead to respiratory arrest. If a person has lost their heartbeat or breathing, direct cardiac massage and artificial respiration can help.

Every year the number of people suffering from this terrible and deadly disease increases. This is facilitated by a modern sedentary lifestyle, as well as poor nutrition, which leads to obesity. Therefore, it is recommended to exercise regularly (spontaneous exercise can lead to a jump in blood pressure and cause rupture of blood arteries and veins), lead an active lifestyle and maintain a proper diet. Following these simple recommendations will significantly reduce the risk of stroke.

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What is stroke, what types of disorders exist and how each type of pathology is diagnosed

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 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:

• Hypertonic disease;
• Atherosclerotic vascular lesions;
• Previous myocardial infarction;
• Inflammatory disease of the inner lining of the heart;
• Disorder of the rhythm of contractions of the heart muscle;
• Changes in the functioning of the heart valve;
• Inflammatory processes in the walls of blood vessels of a systemic nature;
• Disorder of blood vessel tone;
• Dilation and abnormal development of blood vessels;
• Pathologies of the circulatory system;
• The occurrence of blood clots;
• Diabetes.

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.

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

1. mild headache;
2. Vomiting;
3. High blood pressure for a long period;
4. Increased neck muscle tone;
5. From the very beginning, the disease is accompanied by impaired motor function;
6. Disorder in the functioning of the speech apparatus;
7. In laboratory diagnostics of cerebrospinal fluid, it has a colorless tint;
8. There is no retinal hemorrhage.

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 the internal carotid artery is affected, 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 the lesion occurs in the area combined with an unpaired blood vessel, then the symptoms manifest themselves in a more severe form:

• Severe disturbances in the functioning of the musculoskeletal system;
• Problems with gesturing;
• Jerky articulation of speech;
• Disorder in the joint functioning of the motor system of the body and limbs;
• Malfunctions of the respiratory system;
• Blood pressure disorders.

In case of damage to the 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 interfere with 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.

If the patency of the posterior cerebral artery is impaired, the following clinical picture is observed:

• Loss of vision in one or both eyes;
• Doubling of objects in the eyes;
• Inability to move the eyeballs together;
• The patient experiences convulsive movements;
• Characterized by severe tremor;
• Inability to swallow food and saliva normally;
• Paralysis of the body on one side or on both sides at once;
• Disorders in the respiratory system;
• Brain coma.

Blockage of the optic geniculate artery is 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.

Lesions in the area of ​​the visual thalamus are 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.

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

Disturbances in the work of facial muscles. 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 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 in the visual system can be of different types and depend on the size and location of the stroke lesion. Usually they are expressed in loss of visual fields;

Impaired sensitivity 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 involves 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

• Those who consume excessive amounts of tobacco and alcohol products;
• Suffering from chronic high blood pressure;
• Having high levels of cholesterol in the blood;
• People suffering from diabetes;
• Having excess body weight;
• Leading a sedentary lifestyle.

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 to assess the state of glucose levels, coagulation, enzymes;

Computed tomography in this case 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;

Taking cerebrospinal fluid 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.

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 a complete stop 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.

Acute cerebrovascular accident (ACVA) occurs suddenly, but there are situations that can act as triggers, these are:

• high blood pressure;
• cholesterol;
• obesity;
• smoking;
• stress.

What is ischemia?

Cerebral ischemia occurs when there is insufficient blood flow to a certain area of ​​the brain. When there is not enough blood, the nerve cells in this area are deprived of oxygen and nutrients because they are not working in the correct format.

If blood flow is not immediately restored, cells in the affected area begin to die, and this can lead to injury and damage that can trigger related changes.

The extent of these effects will depend on several factors, such as the victim's previous health, the time at which blood flow was cut off, or the area of ​​the brain where the injury occurred.

Risk factors

Cerebral ischemia or stroke usually occurs suddenly. There are people who are more predisposed than others to suffer from it, and it largely depends on their health status and lifestyle. We detail the aspects that need to be taken into account to prevent these dangerous episodes:

• Blood pressure control: Hypertension is the most important risk factor. Having high blood pressure can increase the risk of ischemia or cerebral hemorrhage by up to 5 times.
• Controlling your cholesterol: Helps keep our arteries healthy and therefore prevents stroke. Follow a diet, preferring foods rich in fiber and vitamins, and limiting animal fats.
• Preventing diabetes: This is an important risk factor because it accelerates the aging process of blood vessels, affecting all blood vessels in the body. Try to maintain a healthy weight and limit refined foods.
• Exercise: This protects the arteries of the brain and heart. With 25 minutes of moderate physical activity, you can significantly reduce your risk of suffering from cerebral ischemia.
• No to smoking: Quitting smoking and controlling alcohol consumption should be one of your first priorities to protect yourself from stroke and other cardiovascular diseases.
• Hormonal contraceptives: There are medications that make people more likely to suffer from cerebral ischemia, especially if they are added to other risk factors. Hormones in birth control pills may promote clot formation and therefore increase the likelihood of ischemia. The risk is low, it is better to limit their use in women over 30 years of age who also have hypertension, obesity and bad habits.

Signs

To combat a stroke, the most important thing is to act quickly, because every minute counts. Learning to recognize the symptoms of a stroke is necessary in order to be able to act quickly and thus reduce the consequences of the disease.

You may know what is happening to you, but your condition may remain a mystery to others. When the first signs appear, you must act as soon as possible by notifying emergency services.

Here are some of the symptoms and signs that should alert you.

Lack of strength

We may feel weakness and lack of strength in a leg or arm. This symptom is the most common and can be seen in both limbs and on one side of the body. You may also notice tingling and decreased sensation. Similar sensations can also be noticed on the face.

Asymmetrical smile

It often happens that during a stroke you may see that the mouth is slightly distorted and the person has difficulty smiling. He may have difficulty drinking liquid because it will spill out on one side.

Other signs

If the disease affects the back of the brain (vertebrobasilar region), it may cause double vision and difficulty speaking.

If you feel dizzy, it may be that an ischemic cerebrovascular accident is affecting the area of ​​the brain that controls balance. In this case, you may also notice that you have difficulty coordinating your movements.

Another of the symptoms that should make us suspect that we are facing cerebral ischemia is sudden change in vision. Sometimes it can be double vision, and in other cases it can be a sudden loss. This loss may be complete, although it most often affects only one area of ​​vision. This can happen in one or both eyes.

Sudden difficulty speaking or understanding may also indicate a stroke. If you're having a conversation and suddenly have trouble forming words or composing sentences, it could be a symptom of an illness. Likewise, if you feel like you can't understand words as if they were speaking to you in another language, this could be a sign of vascular disease.

Sudden headache

Feeling a severe headache, a stroke, especially a cerebral hemorrhage, may suddenly appear. However, it is important not to worry because it could also be a headache due to another reason. You should be concerned if the pain is accompanied by some other suspicious symptoms, such as tingling or difficulty moving a body part.

A stroke is a situation in which blood does not reach the brain. This can happen for two different reasons: due to a blood clot, which is something that is blocking the veins or arteries, or due to a rupture in one of these veins through which the blood "moves."

Ischemic stroke, also known as ischemic stroke, occurs when the interruption of blood flow is caused by a clot that blocks a blood vessel in the brain. This is also known as thrombosis or embolism. We talk about thrombosis when a clot or embolus forms in the wall of a cerebral artery, and we talk about embolism when this clot originates elsewhere in the body (such as the heart) and travels through the bloodstream until it reaches the vessels of the brain.

A hemorrhagic stroke, also known as a hemorrhage, occurs when a lack of blood supply to the brain is caused by a ruptured vessel and the subsequent internal hemorrhage it causes.

The onset of symptoms can be very rapid. The main symptoms of cerebral ischemia are:

• blurred vision;
• difficulty controlling muscles;
• speech disorders.

There are two types of cerebral ischemia:

• Focal cerebral ischemia. It occurs when a blood clot occludes a brain vessel, which reduces blood flow to a specific area of ​​the brain, increasing the risk of cell death in that specific area. This may be caused by thrombosis or embolism.
• Global OMNC of the brain. This occurs when blood flow to the brain stops or is significantly reduced. This is often caused by cardiac arrest. If sufficient circulation is restored within a short period of time, symptoms may be temporary.

A person suffering from focal cerebral ischemia will still have some degree of blood flow to part of the brain, however a patient with global ischemia will not have any blood flow to any area of ​​the brain.

Risk factors

Cerebral ischemia can be caused by a variety of diseases and abnormalities, including:

• Vascular abnormalities. Blood vessels can form clots that impede circulation, causing a stroke. They can also rupture or cause vascular malformations, where blood vessels grow abnormally.
• Trauma in the brain. Severe head trauma can also cause ischemia, or rupture, of blood vessels and prevent blood from reaching certain areas of the brain.
• Ventricular tachycardia. It generates a series of irregular heartbeats that can lead to cardiac arrest, cutting off the flow of oxygen completely.
• Plaque deposition in the arteries (atherosclerosis). Even a small buildup of plaque can cause the arteries to narrow, making clots more likely to form.
• Blood clots. Large blood clots can also cause ischemia by blocking blood flow.
• Low blood pressure after a heart attack. Hypotension, in other words, extremely low blood pressure, usually results in insufficient tissue oxygenation.
• Congenital heart defects. People with congenital heart defects may also be prone to developing blood clots.
• Tumors. They cause compression of blood vessels.
• Sickle cell anemia. This can cause cerebral ischemia due to a defect in the blood cells. Cardiac blood cells coagulate more easily than normal blood cells, blocking blood flow to the brain.

Even short-term interruptions in blood supply can cause cerebral ischemia and potentially lead to a situation called ischemic stroke, where brain cells with insufficient blood supply become necrotic and release toxins that damage surrounding cells, causing them to become damaged and release toxins.

Complications

When cerebral ischemia involves areas responsible for regulating functions such as breathing, heart rate and metabolism, it can lead to autonomic manifestations.

Interruption of blood flow to the brain for a few minutes usually results in permanent brain damage. The brain stem cannot recover from severe damage. Mild brain damage may worsen the condition, requiring the use of a ventilator for breathing.

Treatment

If prompt treatment is provided, chances of recovery are possible. Other patients may suffer from brain damage and need therapy to learn certain skills. In some cases, the damage can be reversed with therapy and the patient will have permanent disability.

Prevention

A transient ischemic attack is a brief episode in which blood flow to a vessel in the brain is temporarily stopped. Recognizing and treating a transient ischemic attack when it occurs is important because the patient may be at risk for myocardial paralysis or stroke in the future.

Cerebral ischemia or ischemic stroke occurs when there is a decrease or absence of blood flow to the brain, which reduces the amount of oxygen that reaches the organ and characterizes the picture of cerebral hypoxia. Cerebral hypoxia can lead to complications if not identified and treated as soon as symptoms appear, such as drowsiness, paralysis of the arms and legs, and changes in speech and vision.

Cerebral ischemia can occur at any time during physical activity or even sleep, and is more common in people with diabetes, atherosclerosis, and sickle cell disease. Diagnosis can be made based on imaging tests such as MRI and CT.

There are 2 types of cerebral ischemia:

• In which a clot blocks a blood vessel in the brain and prevents or slows the flow of blood to the brain, which can lead to the death of cells in the area of ​​the brain that has been blocked.
• Where the entire blood supply to the brain is blocked, which can lead to permanent damage to brain tissue if it is not identified and corrected quickly.

Symptoms of cerebral ischemia can last from seconds to longer periods and may be:

• weakness in arms and legs;
• dizziness;
• tingling;
• speech difficulties;
• headache;
• increased blood pressure;
• problems with coordination;
• weakness on one or both sides of the body.

Symptoms of cerebral ischemia should be identified as soon as possible to begin treatment, otherwise permanent brain damage may occur.

In transient cerebral ischemia, symptoms are temporary and last less than 24 hours, but must also be treated clinically.

What is transient cerebral ischemia?

Transient cerebral ischemia, also called a mini-stroke, occurs when there is a short period of reduced blood flow to the brain, usually lasting about 24 hours, and requires immediate care as it may be a sign of more severe cerebral ischemia.

Transient ischemia should be treated according to medical recommendations, usually with vasodilators. Changes in eating and living habits are important, including physical exercise and reducing fat and alcohol intake, as well as avoiding smoking.

Possible consequences of cerebral ischemia

Cerebral ischemia can cause complications such as:

• permanent brain damage;
• paralysis of all or one side of the body;
• loss of coordination;
• difficulty swallowing;
• difficulties with speech;
• emotional problems such as depression;
• vision problems;
• bone fragility;
• weakness or paralysis of an arm, leg, or face.

The effects of cerebral ischemia vary greatly from one person to another and depend on the time taken to begin treatment, and it is often necessary to see a physical therapist, speech therapist or occupational therapist to improve quality of life and prevent complications.

The causes of cerebral ischemia are closely related to a person’s lifestyle. Thus, people suffering from atherosclerosis, diabetes and high blood pressure, which are diseases associated with dietary habits, are at greater risk of cerebral ischemia.

In addition, people who have sickle cell disease are also more likely to suffer from decreased oxygenation of the brain because the altered shape of red blood cells prevents them from carrying oxygen properly.

Coagulation-related problems such as platelet retention and impaired coagulation also contribute to the occurrence of cerebral ischemia since there is a high likelihood of cerebral vascular obstruction.

How is cerebral ischemia treated and prevented?

Treatment of cerebral ischemia is based on the size of the clot and the possible effects on the person, and the use of clot-melting drugs such as Alteplase may be indicated. Treatment should be carried out in a hospital so that blood pressure and intracranial pressure can be controlled while avoiding possible complications.

• nutrition;
• fatty foods should be avoided;
• salt;
• perform physical exercises;
• stop drinking alcoholic beverages;
• stop smoking.

There are some home remedies that can prevent stroke because they have properties that cause the blood to become too thick and form clots.

The terms: ischemic infarction, apoplexy and others mean in different languages ​​the word “stroke”, which is a critical condition with an acute onset, the severity of the stroke depends on the extent of the affected area and the functions controlled by this zone.

A stroke can be an ischemic infarction (white infarction) due to the lack of bleeding and have a thrombotic (25%) and embolic (70%) nature. Red infarction - hemorrhagic stroke (15-20%) - the term is used for intracerebral bleeding, less often subarachnoid or meningeal forms (cerebral aneurysms, severe hypertensive crisis, amyloid angiopathy).

Classification of stroke depending on the affected vascular area:

• Posterior infarction due to pathology of the vertebral arteries.
• Lacunar infarction occurs in a single peripheral and deep artery, affecting the thalamus, internal capsule, or brainstem.

The brain is involved in such vital functions as breathing, metabolic homeostasis, sleep rhythm, swallowing, chewing, eye movements, hearing, maintaining balance, articulation of speech, facial sensitivity in case of illness, certain functions may be impaired.

The trunk is also a kind of crossroads of nerve pathways that regulate movement and its regulation, muscle tone and all the different types of sensitivity, while, as far as vision is concerned, disturbances of the visual field (Mesencephalic region) must be taken into account, but also acute episodes of loss visibility. Often this symptomatology is called “intoxication.”

Deep infarcts affecting the internal capsule give symptoms of contralateral hemiparesis, more or less extensive, with or without tenderness (all or part of the internal capsule).

Lesions of the midbrain cause a significant stroke that affects almost the entire hemisphere, accompanied by contralateral paralysis with loss of speech, motor or sensory aphasia. People do not understand what is being said and appear crazy if the affected hemisphere is dominant, resulting in the inability to see the visual field on one side of the hemiparesis or leading to hemiplegia (strength deficiency).

Strokes caused primarily by vascular pathologies include risk factors that are divided into:

• constant factors: age, gender, race.
• modifiable factors: smoking, alcoholism, obesity, use of oral contraceptives, hypertension and hypertensive heart disease with left ventricular hypertrophy, embolic heart diseases such as heart valve stenosis, bacterial endocarditis, predisposition to deep vein thrombosis, Marfan syndrome, blood viscosity, hypercholesterolemia, diabetes mellitus, coagulation changes, migraine with aura, vasculitis associated with diseases such as lupus, Sjogren's syndrome, arteritis, Cogan's syndrome, etc.

It is clear that primary prevention (that is, measures that must be implemented before the onset of disease) consists of preventing diseases through a lifestyle that leads to avoidance of smoking, alcohol, stress, the use of contraceptives or, if necessary, periodic monitoring of coagulation factors and any thrombotic injury. Inactivity, excess salt, sugar, potatoes, red meat and sausages are unfavorable; preference should be given to river fish, vegetables, and fresh fruits.

Adequate treatment of existing diseases, such as:

• diabetes;
• renal failure;
• hypertension;
• chronic obstructive bronchopathy;
• dental caries;
• recurrent angina;
• tonsillitis.

Diseases such as congenital or acquired heart defects, deep venous insufficiency, blood coagulation defects that may predispose not only to thrombosis but also to bleeding, folic acid deficiency with hyperhomocysteinemia, hemolytic anemia.

Cerebral ischemia is not a simple disease. It is a cardiovascular disease that can occur in two ways.

These are cerebral ischemia, which occurs due to a decrease in blood supply to the brain, and hemorrhagic stroke, which is the entry of blood into the brain tissue due to damage to cerebral vessels.

Cerebral ischemia can be of different types: one of them is when a stroke occurs due to some disease, such as diabetes or problems with uncontrolled hypertension. Here the walls of the cerebral artery are damaged, they begin to become overgrown with platelets, forming what is called a thrombus, and then the so-called thrombosis occurs.

This is a clot in one of the branches of the internal carotid artery, which is located inside the brain. The plaque completely obstructs blood circulation at a certain point. If it persists, this decrease in blood flow results in a heart attack or permanent brain injury.

This obstruction can be caused by a plaque, which is nothing more than a blood clot located at a distance from the damaged artery. It may be at the level of the heart or the great vessels of that organ, and for a moment it becomes detached, travels with the blood, and obstructs the flow of blood to the more distant vessels of the brain.

Another disease that can cause ischemic damage is hypoxia, that is, a decrease in the concentration of oxygen in the blood that reaches the brain, and this may be caused by a decrease in blood pressure or hypotension, which can be secondary to myocardial infarction.

In this case, cardiac output and cerebral circulation may decrease. If this occurs over a long period of time, permanent ischemic brain damage will occur.

Patients with higher risk factors are smokers, as well as those people who have poor eating habits, suffer from cholesterol, triglycerides and patients with heart injuries.

As for the consequences that ischemia can cause, it all depends on the size of the blocked vessel.

A large occluded vessel that has multiple branches can cause a large cerebral infarction. In this case, over time it will lead to long-term disability.

When it comes to small vessels that can be fed by collateral circulation, the consequences will be minimal.

The effects depend on the area of ​​the brain affected. If the disease affects an area that is related to speech, the person may become speechless, if it affects areas such as movement, sensation, hearing, vision, the patient is left with certain dysfunctions, losing the ability to express ideas or understand them.

There are degenerative diseases of the arterial vessels that can accompany childhood pathology, but the disease is most associated in elderly patients.

Manifestations that tend to occur and that are sometimes felt but go unnoticed include, but are not limited to, food intolerances, dizziness, dyspepsia, chest pain and high blood pressure.

Experts say that excess of certain types of food, such as fatty and smoked foods, or habits such as smoking or drinking alcohol, can lead to such a disease.

When there are cases of cerebral ischemia, doctors tend to use general measures aimed at controlling the causes that caused it and which restore the flow of oxygen to the affected tissue. They may also offer surgical treatment in cases of atherosclerotic occlusive disease. However, based on each patient's characteristics, your doctor may recommend certain procedures and tests.

Knowledge of pathophysiological mechanisms allows us to understand neuroimaging changes at different stages of cerebral ischemia and the mechanisms of action on which many therapeutic aspects are based.

The pathophysiology of cerebral ischemia differs in the gray and white matter of the brain. In gray matter, blood vessel obstruction causes ischemic stroke. In the peripheral zone, functional changes in neurons occur, but with the preservation of their structural integrity for some time. The penetration of calcium into cells leads to the launch of a number of biochemical processes that end in the death of neurons. In white matter, loss of energy capacity reverses the direction of ion exchange pumps, resulting in the entry of calcium into tissues. The release of GABA activates specific receptors that protect nerve fibers from the consequences of this phenomenon.

Conclusions. Acute cerebral stroke accompanying ischemia has a dual mechanism: initially it is cytotoxic and then vasogenic. Both factors contribute to increased neurological damage caused by cerebral ischemia.

Cardiovascular diseases are the most common causes of neurological disability. Most vascular lesions of the brain are secondary to atherosclerosis and arterial hypertension.

The main types of brain diseases are:

• Cerebral insufficiency due to transient changes in blood flow.
• Cerebral infarction caused by embolism or thrombosis of intracranial or extracranial arteries.
• Hypertensive parenchymal cerebral and subarachnoid hemorrhage due to congenital aneurysm.
• Arteriovenous malformation, which may cause symptoms due to mass effect, infarction, or hemorrhage.

The neurological signs and symptoms of cerebrovascular disease reflect the area of ​​the brain that is damaged. Ischemic stroke and cerebral hemorrhage tend to occur suddenly, with the hemorrhage usually having a more acute onset.

Ischemic syndrome

According to the latest statistics, in our country there are more than a hundred thousand new cases of the disease per year, as a result of which tens of thousands of people are in need of government assistance.

Stroke is now the leading cause of death among women and the second leading cause of death among men, and is also the leading cause of disability and dementia in adults.

A third of stroke patients develop dementia within the next three months. Specifically, of every three people who suffer a stroke, one is left with a severe disability that leaves them completely dependent on someone else, and the rest, although they do not require ongoing assistance, may suffer the consequences.

This is a problem that appears suddenly and in most cases without previous symptoms, so it is important to control living habits.

The public should be aware of the symptoms of the disease that will prompt them to visit their doctor soon, such as loss of strength, difficulty speaking or understanding, sudden loss of vision, double vision, feeling dizzy or intense and unusual pain in the head.

Etiology: Intracerebral thrombosis or embolism formed from atheroma plaque due to arteritis, valve disease, endocarditis, or atrial fibrillation often causes ischemic arterial occlusion.

Sympathomimetic drugs such as cocaine and amphetamine can cause ischemic strokes.

Vertebral osteophytes can cause compression of the arteries with a risk of cerebral ischemia, and the artery may also have stenosis due to plaque encroachment into the lumen.

Factors that favor the pathology include atherosclerosis, heart disease, diabetes mellitus, and polycythemia.

In both situations, thrombosis or embolism, if deprivation of oxygen and nutrients from the brain continues, triggers a heart attack that can lead to brain damage and neurological injury. They may be permanent.

Westerners' diets high in processed red meat, grains and refined sugars may be associated with an increased risk of cerebral infarction.

People who suffer from migraines with aura are four times more likely to have a stroke or heart disease before age 45. According to recent research, there should be a general predisposition to migraines and heart disease, regardless of risk factors such as alcohol, smoking or oral contraceptive use.

Drinking three or more glasses of alcoholic beverages per day increases the likelihood of cerebral ischemia and embolism by 45%.

More than 20% of the adult population suffers from sleep apnea, and there is an association between these repeated stops of breathing during the night if a cerebral infarction has occurred. In fact, the frequency of apnea is directly proportional to the risk of complications after a cerebral infarction.

Treatment for stroke depends on the cause and type of illness. For cerebral infarction, which is the most common type, medications that prevent blood clotting and facilitate blood circulation are indicated only in selected cases.

Statins have demonstrated their effectiveness in treating myocardial infarction and stroke in patients with diabetes. Patients with diabetes II and receiving atorvastatin have a 48% lower risk of stroke.

Other alternatives aim to kill intra-arterial thrombi with thrombolytic agents that activate tissue plasminogens, such as rt-PA, in the first three hours and in selected cases.

Surgery is limited to very specific situations, such as intervention in the carotid arteries, provided that they exhibit a certain degree of obstruction and that no important sequelae remain.

Any cerebral ischemic process prevents the disappearance of symptoms and neurological signs, varying in their expression depending on the area of ​​the affected brain. To be able to manage the disease, the cause of cerebral ischemia must be known and treatment must be initiated to prevent recurrence of the episode.

If the risk of new episodes of ischemia persists, driving is not recommended.

Patients on anticoagulants should be aware of the increased risk of bleeding from minor impacts and should use caution when driving. It is recommended that the driver not perform forced lateral movements, which reduce cerebral blood flow. Panoramic mirrors are useful for making maneuvers easier.

Cerebral ischemia can occur unexpectedly in men and women. Despite the severity of the disease, it provides treatment and prevention.

Ischemia occurs when there is an interruption or deficiency of blood circulation due to atherosclerosis - thickening and hardening of the arterial wall - or a clot from the heart. In this case, there are difficulties in moving the body and a sudden loss of the ability to speak. Possible weakness of arms and legs. Symptoms appear instantly.

What are the consequences?

It depends on the area of ​​the brain affected. The disease can paralyze one side of the body, impair speech, or affect vision. These effects will be temporary or permanent depending on recovery, i.e. the faster the ischemia disappears, the greater the likelihood of no complications.

Treatment is with medications that dissolve the clot or reduce blockage. However, medications should be taken orally, especially in the first three hours after the problem occurs. After this time, the chances of improvement decrease.

How to prevent the disease?

Controlling blood pressure, diabetes and high blood cholesterol are the main points. Also, by practicing physical exercise, avoiding obesity and following the treatment prescribed by your doctor, you can hope for a favorable prognosis.

Acute cerebral ischemia is a complete or partial decrease in blood flow in a certain area of ​​the brain as a result of a thrombus (blood clot that forms inside an artery or vein) or embolus (solid, liquid or consisting of gaseous bacteria, a fat droplet, an air bubble). An embolus can become lodged in a smaller artery or vein and impede blood circulation.

This decrease in blood flow means that oxygen and glucose do not reach the neurons. This may explain the cognitive and behavioral changes caused by acute cerebral ischemia.

When the blood supply to the brain is interrupted, neurons survive for only three minutes, no more. If this irrigation is not restored, neurons begin to die. Risk factors for this disease primarily occur in the sixth decade of life and include hyperlipidemia (high levels of fats in the blood) and hypertension (high blood pressure).

It has also been observed that frequent consumption of alcohol and tobacco, drug abuse in general and the use of contraceptives can contribute to the formation of blood clots and, as a result, cause acute cerebral ischemic attack.

Additionally, when a person suffers a cardiac infarction, the heart stops pumping enough blood to the brain, resulting in an ischemic process that can lead to cerebral vascular stroke.

As already stated, this disease usually appears at age 60 and, although it is rare in young people, people with obesity, hyperlipidemia and hypertension are susceptible to it.

Several signs or symptoms herald the imminent occurrence of an acute cerebral ischemic attack. The main thing is that a person has problems with speech because he loses control over his speech.

The unexpected presence of a nervous eyelid tic can also be alarming. Disorientation and trembling are possible. The duration of treatment aimed at reducing the damage from acute cerebral ischemic attack is very short: three hours. In fact, the only drug used today in the clinic is prescribed only for those three hours that are considered from the moment of the stroke, because after three hours the drug, instead of helping, can harm the person.

Just three minutes

Acute cerebral ischemia is the third and fifth cause of death in men and women aged 60 years and older. According to global epidemiological studies, most of those who survive are left with walking, speaking, hearing and cognitive problems (that is, attention, thought and memory), depending on the area of ​​the brain that has lost blood supply.

Once the blood supply to the brain is interrupted, neurons survive for only three minutes, no more. If blood flow is not restored, neurons begin to die. It turns out that the prognosis depends on the speed of assistance.

Healthy diet and exercise

After an acute cerebral ischemic attack, some people enter a vegetative state; others cannot walk or move on their own, or speak or write, suffer from dyslexia, or have changes in memory and personality; but others do recover unusually quickly.

The body's response to a cerebral vascular complication is very variable and is related to the area of ​​the affected brain and the general condition of the person.

The severity of acute cerebral ischemic stroke is lower in a person who has followed a healthy, low-fat diet and exercise throughout their life, compared with people who are overweight or obese, have hypertension, and have never exercised.

Video “What is ONMK”

This video explains what acute cerebrovascular accident (ACVA) is, its symptoms and consequences.

And a little about secrets...

Have you ever tried to get rid of varicose veins on your own? Judging by the fact that you are reading this article, victory was not on your side. And of course you know firsthand what it is:

• again and again to observe the next portion of spider veins on the legs
• wake up in the morning wondering what to wear to cover the swollen veins
• suffer every evening from heaviness, schedule, swelling or buzzing in the legs
• a constantly seething cocktail of hope for success, agonizing anticipation and disappointment from a new unsuccessful treatment

Education: Federal State Budgetary Institution Clinical Hospital, Moscow. Field of activity: general surgery…

As a doctor, every day I encounter a lot of questions regarding this vascular complication, and today I will present all the important information on this topic here.

Diagnosis of stroke (stroke) - what is it?

“Stroke” (from the Latin insulto) - literally “jump, jump”, meaning “attack, blow, onslaught”, the diagnosis of “stroke” is an acute cerebrovascular accident (CVA).

Acute cerebrovascular accident resulting in stroke is a condition accompanied by cessation of blood flow in any of the structures of the brain due to acute vascular insufficiency in one of the cerebral vessels. This leads to permanent impairment of neurological function due to the death of a section of nerve tissue.

It is a disease with a high mortality rate, accounting for about 20% of all deaths from diseases in Russia. At least 50% of those who have suffered an acute cerebrovascular accident become disabled. The incidence of this disease in Russia varies from 1 to 5 for every 1000 people, depending on the region. The urban population gets sick more often.

Stroke is often disabling; according to the National Stroke Registry, this occurs in at least 50% of all cases. Mortality is about 30% within the first 30 days after a stroke, and about half of all patients die within a year.

Yes, that’s right, a heart attack is an area of ​​dead tissue in the human body that died as a result of ischemia.

Acute cerebrovascular accident.

As has already been written, the basis of a stroke is acute cerebrovascular accident (ACVA) - this is exactly what the diagnosis sounds like in medical practice, characterizing this vascular catastrophe.

Examples of medical diagnoses indicating stroke as an outcome of stroke:

Diagnosis: “CVD. Stroke of ischemic type in the basin of the left middle cerebral artery from 01/01/01 - ischemic stroke

Diagnosis: “CVD. Stroke of hemorrhagic type with the formation of intracerebral hematoma in the left temporal lobe from 01/01/01 - hemorrhagic stroke

Each tissue in the human body has its own need for oxygen and nutrients, which are supplied with blood through the arteries. Nervous tissue in the human body has a highly intensive metabolism. The intensity of blood circulation in the brain is one of the highest in the body, this is due precisely to the high need for oxygen and nutrients. When this access is terminated, the function of the nerve cells (neurons) is first impaired, and then they die (if blood circulation is not restored).

The area of ​​dead nerve tissue is, in fact, the substrate for a stroke. Dead brain tissue cannot perform the functions originally assigned to it. The nature and degree of their loss determine the clinical picture after a stroke. The larger the area, the more severely the functions are impaired. Read more about the consequences of these violations in the case of acute stroke, what it is and all about their consequences in this post.

The most common consequences of stroke are:

• speech disorder (dysarthria, for example)
• blurred vision
• decreased strength and mobility in the limbs
• sensory disturbance
• impaired coordination of movements, which may result in unsteadiness when walking and dizziness
• memory impairment due to cognitive deficits

The peculiarity of such disorders, which distinguish stroke from other vascular diseases of the brain, is their persistence - they persist for more than 24 hours.

There are situations when a sudden speech disorder or decrease in strength and/or sensitivity in half of the body goes away on its own within a few hours, and sometimes a few minutes. In this situation, we are talking about a transient disorder of cerebral circulation and it contains one very important feature for people who have avoided the misfortune of a stroke; read more about it in the article about the diagnosis of transient ischemic attack. Diagnosis: transient ischemic attack is not a stroke, although it is also an acute cerebrovascular accident.

Diagnosis of ischemic and hemorrhagic stroke - what is it?

Ischemic stroke (ischemic stroke) is a type of stroke in which an acute disturbance of cerebral circulation occurred as a result of an obstruction to the flow of blood to any part of the brain, resulting in the development of acute ischemia in any structure of the brain. As I wrote above, we are talking about a cerebral infarction.

Hemorrhagic stroke (hemorrhagic stroke) is an acute disorder of cerebral circulation caused by intracerebral hemorrhage from a damaged blood vessel. The consequence of this hemorrhage may be the formation of an intracerebral hematoma limited to brain tissue or hemorrhage into the space surrounding the brain. A separate article is devoted to hemorrhagic stroke, as well as ischemic stroke; hemorrhagic stroke - what it is and how to treat it and recover from it, read more here.

That is, to put it simply, in the first case there was a “blockage” of the vessel, in the second it “burst”.

How dangerous is a cerebral stroke and what can be the consequences after a stroke?

The condition of most people who have had a stroke is assessed as serious. The brain contains vital centers, and if their functioning is disrupted, a person often dies or is left with severe impairments of body functions, sometimes disabling them.

After a stroke, a period of recovery (rehabilitation after a stroke) is necessary, which is no less important than the treatment process itself, and ideally is an integral part of the entire recovery process after a stroke. What needs to be done for rehabilitation if a stroke occurs - what it is and what the rehabilitation process is, read more in the continuation of the article on recovery here.

Treatment and rehabilitation.

Treatment of confirmed stroke is carried out in a hospital setting. In urban settings, these are vascular centers, emergency hospitals, urban multidisciplinary hospitals and research institutes. In the provinces, these are the central district hospital and numerous small rural hospitals. Treatment of stroke is an extremely important stage and important, first of all, for the possibility of preventing recurrent cerebrovascular accidents.

In the first days of the disease, the priority task is to prevent a recurrence of stroke and stabilize the person’s condition.

The duration of treatment in hospital is on average 2 weeks. Two weeks is the time for a small and uncomplicated stroke. If the stroke is moderate or severe, then the course of treatment may drag on for months, especially if in the acute period of the stroke there was an episode of coma and a course of intensive care in the intensive care unit.

There are rarely cases of complete recovery after discharge from the hospital. In most cases, lasting consequences remain that require qualified assistance in restoring and returning a person to their previous normal life.

The process of rehabilitation treatment is no less important than treatment in a hospital. Unfortunately, in most cases it is not possible to completely regain lost functions after undergoing treatment in a hospital. Often, a rehabilitation course is not carried out at all, although it may be necessary. In the overwhelming majority of cases, this is due to the fact that relatives and friends were simply not informed about this, and if they were, they did not know where to undergo rehabilitation and how to do it.

Rehabilitation treatment is carried out in an emergency hospital setting. The duration of the course can vary from 2-3 weeks to several months. It depends on the depth of the consequences in which it is necessary to return the lost functions.

What increases the risk of stroke?

1. High blood pressure (arterial hypertension). This is the most common cause of acute cerebrovascular accident. Most strokes occur against the background of high blood pressure, and this applies to both ischemic and hemorrhagic types. In the case of ischemic nature, increased blood pressure narrows the lumen of cerebral vessels due to the spasm that accompanies this.

In the case of hemorrhagic, it creates high mechanical pressure on the wall of the vessel and sooner or later it cannot withstand it and ruptures in this place. Of course, for a vessel to rupture, other reasons are needed that will thin its wall and reduce its elasticity. This is due to underlying vascular diseases.

• atherosclerosis of cerebral vessels,
• systemic inflammatory diseases with damage to the vessel wall
• oncological diseases
• anomalies in the structure of blood vessels with disruption of the structure and loss of strength of the vessel wall
• chronic exogenous intoxication (alcohol, drugs)

2. Physical inactivity - low level of physical activity. This factor plays a very important role in increasing the risk of stroke. With regular moderate physical activity, it is possible to reduce the influence of several factors on the occurrence of stroke. :

• reduction in blood pressure
• decrease in the level of glucose and lipoproteins in the blood, which can be deposited in the vessel wall and contribute to the growth of atherosclerotic plaque
• maintaining the elasticity of the vascular wall

3. Smoking. Smokers have a risk of stroke that is 5 times higher than non-smokers and this is due to several factors.

Smoking increases blood pressure; in smokers it is, on average, higher than in those who do not smoke.

• In smokers, the vascular wall loses its elasticity faster and cholesterol plaques grow faster on it
• brain cells are more likely to be in a state of prolonged hypoxia (lack of air)

4. Desynchronosis and overfatigue - disruption of sleep and wakefulness. Cases of strokes occurring after episodes of lack of a period of sleep adequately preceding the period of wakefulness are a frequent phenomenon. Such strokes are often classified as having an unknown cause.

Is a stroke a death sentence?

At the mere mention of this diagnosis, many who hear it feel, if not panic, then some kind of anxiety and internal discomfort. Indeed, the vast majority of the population associates this diagnosis with disability or even death.

Let's take a closer look to see if this is really the case.

There are many cases of recovery, if not complete, then almost complete.

In fact, the state of affairs is such that in the same neurological department a person can be treated for stroke, physical activity is limited only by doctor’s orders and bedridden, unable to move independently even within the hospital ward.

In the first case: the hospital patient walks calmly without support or auxiliary objects. He can even walk up stairs without handrail support. Speech is preserved, completely oriented in time and space. Coordination of movements is also not impaired. Externally, there are no signs of a serious illness. The loss of neurological function is minimal and its manifestations can only be detected by neurological examination.

In the second case: a person cannot move independently; strength is only in the left arm and leg, coordination of movements in them is impaired. He is in a hospital bed. He can only turn slightly in bed to one side. Raising the head end of the bed causes dizziness. The speech is not intelligible; only certain fragments of it are understandable. Verbal communication - responds with gestures and facial expressions, selectively - to individual questions.

As you can see, the difference between stroke cases can be enormous. Moreover, both in its acute period - the first 21 days, and a year after the stroke.

This difference is due, first of all, to the size of the lesion in the substance of the brain. This is one of the most important factors influencing the depth of impairment of the neurological consequences of a stroke.

Foci of pain in diameter, localized in places where large nerve tracts pass or in the region of the brain stem, have an unfavorable prognosis in terms of the depth of neurological disorders and recovery from them.

The location of the stroke site plays a major role in recovery. More pronounced symptoms of brain damage will occur when the source of the stroke is localized near the nerve pathways or in their area, even if they are small in size. This also applies to the brainstem localization of stroke. With equal sizes of dead nervous tissue, the depth of loss of function will be greater when localized in the region of the trunk.

This happens due to the high density of nerve conductors located here. The danger of this localization is due to the location in this area of ​​a large number of vital nerve centers, including those responsible for blood circulation, breathing, digestion and other vital functions of the human body.

What is a stroke today?

So, acute cerebrovascular accident is a serious problem in maintaining the health and vital activity of the population after a case of illness. Most victims of this disease are treated in hospitals for emergency reasons. Regional vascular centers have emerged in the last decade.

In large cities there may be several of them. What is special about such a center? -The fact that it is “tailored” to providing assistance to patients with stroke, there is the possibility of thrombolysis (dissolution of a blood clot, if it caused an acute cerebrovascular accident, within the first 4 hours). Other mandatory conditions for the operation of the vascular center is the presence on staff of all specialists necessary for early rehabilitation. These include: a speech therapist, a doctor and exercise therapy instructor (kinesiotherapist), an occupational therapist (not everywhere has one).

In medicine, this is called a multidisciplinary team. Such centers must be equipped with SCT (computed tomography) devices to detect the source of stroke and differentiate it into ischemic and hemorrhagic. There must be a neuro intensive care unit and/or an intensive care unit (ICU). Not everything is always exactly as it is written in the orders for organizing such centers.

The timing of assistance is an extremely important point; a timely diagnosis of a stroke and the treatment measures taken can reduce the severity of the consequences, and sometimes eliminate persistent dysfunction. Unfortunately, the creation of vascular centers did not significantly affect this “golden time”. There are quite a lot of cases of assistance in such centers after 5 hours or more, when an acute cerebrovascular accident has already occurred and a persistent focus of necrosis (infarction or necrosis) has formed in the brain. The reason for this is the late presentation of the patients themselves and the overload of hospitals.

Hospitals are overloaded in large cities and examination and diagnosis often take quite a lot of time. In general, the issue is organizational and, unfortunately, not completely resolved. But still, there are still some positive developments. Not many people know what a stroke is today and what problems of treatment and recovery fall on the shoulders of family and friends.

The diagnosis of stroke in medicine is a “red flag” for any physician. A lot of health problems that arise in the subsequent years after suffering a stroke are associated with it. Unfortunately, it is often unreasonable.

The main unresolved issue today is rehabilitation after a stroke - this applies to the patients themselves and their relatives. There are still not enough centers and queues for existing ones often drag on for years. People are not informed about what a stroke is; this diagnosis causes fear and anxiety. There is also a lot of uncertainty about the methods and timing of recovery, which does not add to the positive results of recovery after the hospital.

Acute ischemic cerebrovascular accident

Sudden changes in blood flow to the brain are classified as hemorrhagic (bleeding) and ischemic disorders. Such a division is important for the correct choice of therapy method.

The classic abbreviated name for the pathology in acute cerebrovascular accident is “ischemic stroke.” If hemorrhage is confirmed, then it is considered hemorrhagic.

In ICD-10, ACME codes may vary, depending on the type of violation:

• G45 is an established designation for transient cerebral attacks;
• I63 - recommended for statistical registration of cerebral infarction;
• I64 - an option used for unknown differences between cerebral infarction and hemorrhage, used when a patient is admitted in an extremely serious condition, unsuccessful treatment and imminent death.

The frequency of ischemic strokes exceeds hemorrhagic strokes by 4 times and is more associated with general human diseases. The problem of prevention and treatment is considered in programs at the state level, because 1/3 of patients who have suffered the disease die in the first month and 60% remain permanently disabled requiring social assistance.

Why does a lack of blood supply to the brain occur?

Acute ischemic cerebrovascular accident is often a secondary pathology and occurs against the background of existing diseases:

• arterial hypertension;
• widespread atherosclerotic vascular lesions (up to 55% of cases develop due to pronounced atherosclerotic changes or thromboembolism from plaques located in the aortic arch, brachiocephalic trunk or intracranial arteries);
• previous myocardial infarction;
• endocarditis;
• heart rhythm disturbances;
• changes in the valvular apparatus of the heart;
• vasculitis and angiopathy;
• vascular aneurysms and developmental anomalies;
• blood diseases;
• diabetes mellitus

Up to 90% of patients have changes in the heart and main arteries of the neck. The combination of these reasons sharply increases the risk of ischemia.

Possible compression of the vertebral artery by the processes of the vertebrae

Transient attacks are most often caused by:

• spasm of the arterial brain stems or short-term compression of the carotid and vertebral arteries;
• embolization of small branches.

The following risk factors can provoke the disease:

• elderly and senile age;
• excess weight;
• the effect of nicotine on blood vessels (smoking);
• experienced stress.

The basis of the influencing factors is the narrowing of the lumen of the vessels through which blood flows to the brain cells. However, the consequences of such a malnutrition may vary according to:

The combination of factors determines the form of the disease and clinical symptoms.

Pathogenesis of various forms of acute cerebral ischemia

Transient ischemic attack was previously called transient cerebrovascular accident. It is identified as a separate form because it is characterized by reversible disorders; the heart attack does not have time to form. Usually the diagnosis is made retrospectively (after the disappearance of the main symptoms), within a day. Before this, the patient is treated as if he had a stroke.

The main role in the development of hypertensive cerebral crises belongs to the increased level of venous and intracranial pressure with damage to the walls of blood vessels and the release of fluid and protein into the intercellular space.

Swelling of brain tissue in this case is called vasogenic

The feeding artery is necessarily involved in the development of ischemic stroke. The cessation of blood flow leads to oxygen deficiency in the lesion formed in accordance with the boundaries of the basin of the affected vessel.

Local ischemia causes necrosis of an area of ​​brain tissue.

Depending on the pathogenesis of ischemic changes, types of ischemic strokes are distinguished:

• atherothrombotic - develops when the integrity of an atherosclerotic plaque is disrupted, which causes complete closure of the internal or external feeding arteries of the brain or their sharp narrowing;
• cardioembolic - the source of thrombosis is pathological growths on the endocardium or heart valves, fragments of a blood clot, they are delivered to the brain with the general blood flow (especially when the foramen ovale is not closed) after attacks of atrial fibrillation, tachyarrhythmia, atrial fibrillation in patients in the post-infarction period;
• lacunar - more often occurs when small intracerebral vessels are damaged in arterial hypertension, diabetes mellitus, is characterized by the small size of the lesion (up to 15 mm) and relatively minor neurological disorders;
• hemodynamic - cerebral ischemia with a general decrease in blood circulation speed and a drop in pressure against the background of chronic heart diseases, cardiogenic shock.

In case of hemodynamic disturbances, blood flow in the vessels of the brain may decrease to a critical level and below

It is worth explaining the variant of development of strokes of unknown etiology. This often happens when there are two or more reasons. For example, in a patient with carotid artery stenosis and fibrillation after an acute infarction. It should be taken into account that elderly patients already have stenosis of the carotid arteries on the side of the suspected disorder, caused by atherosclerosis, in the amount of up to half the lumen of the vessel.

Stages of cerebral infarction

The stages of pathological changes are distinguished conditionally; they are not necessarily present in every case:

• Stage I - hypoxia (oxygen deficiency) disrupts the permeability of the endothelium of small vessels in the lesion (capillaries and venules). This leads to the transfer of fluid and protein from the blood plasma into the brain tissue and the development of edema.
• Stage II - at the level of capillaries, pressure continues to decrease, which disrupts the functions of the cell membrane, the nerve receptors located on it, and electrolyte channels. It is important that all changes are reversible for now.
• Stage III - cell metabolism is disrupted, lactic acid accumulates, and a transition to energy synthesis occurs without the participation of oxygen molecules (anaerobic). This species does not allow maintaining the necessary level of life of neuronal cells and astrocytes. Therefore, they swell and cause structural damage. Clinically expressed in the manifestation of focal neurological signs.

What is the reversibility of the pathology?

For timely diagnosis, it is important to establish a period of symptom reversibility. Morphologically, this means preserved neuronal functions. Brain cells are in a phase of functional paralysis (parabiosis), but retain their integrity and usefulness.

The ischemic zone is much larger than the necrosis area; the neurons in it are still alive

In the irreversible stage, it is possible to identify a zone of necrosis in which cells are dead and cannot be restored. Around it there is an ischemic zone. Treatment is aimed at supporting adequate nutrition of neurons in this area and at least partially restoring function.

Modern research has shown extensive connections between brain cells. A person does not use all reserves and opportunities in his life. Some cells are able to replace dead ones and provide their functions. This process is slow, so doctors believe that rehabilitation of a patient after an ischemic stroke should continue for at least three years.

Signs of transient cerebral circulatory disorders

Clinicians include the following in the group of transient cerebrovascular accidents:

• transient ischemic attacks (TIA);
• hypertensive cerebral crises.

Features of transient attacks:

• the duration ranges from several minutes to a day;
• every tenth patient after a TIA develops an ischemic stroke within a month;
• neurological manifestations are not grossly severe;
• mild manifestations of bulbar palsy (focus in the brain stem) with oculomotor disorders are possible;
• blurred vision in one eye combined with paresis (loss of sensation and weakness) in the limbs of the opposite side (often accompanied by incomplete narrowing of the internal carotid artery).

Features of hypertensive cerebral crises:

• the main manifestations are cerebral symptoms;
• focal signs occur rarely and are mild.

The patient complains of:

• sharp headache, often in the back of the head, temples or crown of the head;
• state of stupefaction, noise in the head, dizziness;
• nausea, vomiting.

• temporary confusion;
• excited state;
• sometimes - a short-term attack with loss of consciousness, convulsions.

Signs of a cerebral stroke

Ischemic stroke means the occurrence of irreversible changes in brain cells. At the clinic, neurologists distinguish periods of the disease:

• acute - continues from the onset of symptoms for 2–5 days;
• acute - lasts up to 21 days;
• early recovery - up to six months after the elimination of acute symptoms;
• late recovery - takes from six months to two years;
• consequences and residual effects - over two years.

Some doctors continue to distinguish small forms of stroke or focal ones. They develop suddenly, the symptoms do not differ from cerebral crises, but last up to three weeks, then completely disappear. The diagnosis is also retrospective. During the examination, no organic abnormalities were found.

Cerebral ischemia, in addition to general symptoms (headaches, nausea, vomiting, dizziness), manifests itself locally. Their nature depends on the artery that is “turned off” from the blood supply, the state of the collaterals, and the dominant hemisphere of the patient’s brain.

Let's consider the zonal signs of blockage of the cerebral and extracranial arteries.

If the internal carotid artery is damaged:

• vision is impaired on the side of the blocked vessel;
• the sensitivity of the skin on the limbs and face on the opposite side of the body changes;
• paralysis or muscle paresis is observed in the same area;
• possible loss of speech function;
• inability to realize one’s illness (if the focus is in the parietal and occipital lobes of the cortex);
• loss of orientation in parts of one’s own body;
• loss of visual fields.

Narrowing of the vertebral artery at the level of the neck causes:

• hearing loss;
• nystagmus of the pupils (twitching when deviating to the side);
• double vision.

If the narrowing occurs at the confluence with the basilar artery, then the clinical symptoms are more severe, since cerebellar damage predominates:

• inability to move;
• impaired gesticulation;
• chanted speech;
• violation of joint movements of the trunk and limbs.

If there is insufficient blood flow in the basilar artery, manifestations of visual and brain stem disorders (impaired breathing and blood pressure) occur.

If the anterior cerebral artery is damaged:

• hemiparesis of the opposite side of the body (unilateral loss of sensation and movement), often in the leg;
• slowness of movements;
• increased tone of flexor muscles;
• loss of speech;
• inability to stand and walk.

Blockage of the middle cerebral artery is characterized by symptoms depending on the damage to the deep branches (feeding the subcortical nodes) or long ones (approaching the cerebral cortex)

Obstruction of the middle cerebral artery:

• when the main trunk is completely blocked, a deep coma occurs;
• lack of sensitivity and movement in half of the body;
• inability to fix the gaze on an object;
• loss of visual fields;
• loss of speech;
• inability to distinguish the left side from the right.

Obstruction of the posterior cerebral artery causes:

• blindness in one or both eyes;
• double vision;
• gaze paresis;
• seizures;
• large tremor;
• impaired swallowing;
• paralysis on one or both sides;
• respiratory and blood pressure disturbances;
• brain coma

When the optic geniculate artery is blocked, the following appears:

• loss of sensation in the opposite side of the body, face;
• severe pain when touching the skin;
• inability to localize the stimulus;
• perverted perceptions of light, knocking;
• “thalamic hand” syndrome - the shoulder and forearm are bent, the fingers are extended at the terminal phalanges and bent at the base.

Impaired blood circulation in the area of ​​the visual thalamus is caused by:

• sweeping movements;
• large tremor;
• loss of coordination;
• impaired sensitivity in half of the body;
• sweating;
• early bedsores.

In what cases can acute stroke be suspected?

The above clinical forms and manifestations require careful examination, sometimes not by one, but by a group of doctors of different specialties.

Cerebrovascular accident is very likely if the patient exhibits the following changes:

• sudden loss of sensation, weakness in the limbs, face, especially one-sided;
• acute loss of vision, the occurrence of blindness (in one eye or both);
• difficulty in pronunciation, understanding words and phrases, composing sentences;
• dizziness, loss of balance, impaired coordination of movements;
• confusion;
• lack of movement in the limbs;
• intense headache.

Additional examination allows us to establish the exact cause of the pathology, the level and location of the vessel lesion.

Purpose of diagnosis

Diagnosis is important for choosing a treatment method. To do this you need:

• confirm the diagnosis of stroke and its form;
• identify structural changes in brain tissue, focal area, affected vessel;
• clearly distinguish between ischemic and hemorrhagic forms of stroke;
• based on pathogenesis, establish the type of ischemia for starting specific therapy in the first 3–6 in order to get into the “therapeutic window”;
• assess indications and contraindications for drug thrombolysis.

It is practically important to use diagnostic methods on an emergency basis. But not all hospitals have enough medical equipment to operate around the clock. The use of echoencephaloscopy and cerebrospinal fluid studies yields up to 20% errors and cannot be used to resolve the issue of thrombolysis. The most reliable methods should be used in diagnosis.

Foci of softening on MRI allow differential diagnosis of hemorrhagic and ischemic strokes

Computed and magnetic resonance imaging allows you to:

• distinguish a stroke from space-occupying processes in the brain (tumors, aneurysms);
• accurately determine the size and location of the pathological focus;
• determine the degree of edema, disturbances in the structure of the ventricles of the brain;
• identify extracranial locations of stenosis;
• diagnose vascular diseases that contribute to stenosis (arteritis, aneurysm, dysplasia, vein thrombosis).

Computed tomography is more accessible and has advantages in studying bone structures. And magnetic resonance imaging better diagnoses changes in the parenchyma of brain tissue and the size of edema.

Echoencephaloscopy can only reveal signs of displacement of the median structures with a massive tumor or hemorrhage.

During ischemia, cerebrospinal fluid rarely shows slight lymphocytosis with increased protein. Most often no change. If the patient has a hemorrhage, blood may appear. And with meningitis - inflammatory elements.

Ultrasound examination of blood vessels - Dopplerography method of the arteries of the neck indicates:

• development of early atherosclerosis;
• stenosis of extracranial vessels;
• sufficiency of collateral connections;
• the presence and movement of an embolus.

Duplex sonography can determine the condition of the atherosclerotic plaque and artery walls.

Cerebral angiography is performed if technically possible for emergency indications. Typically, the method is considered more sensitive in identifying aneurysms and foci of subarachnoid hemorrhage. Allows you to clarify the diagnosis of pathology identified on tomography.

Cardiac ultrasound is performed to detect cardioembolic ischemia in heart disease.

Examination algorithm

The examination algorithm for suspected acute stroke proceeds according to the following plan:

1. examination by a specialist in the first minutes after the patient’s admission to the hospital, examination of the neurological status, clarification of the medical history;
2. taking blood and studying its coagulability, glucose, electrolytes, enzymes for myocardial infarction, and the level of hypoxia;
3. if it is not possible to conduct MRI and CT, do an ultrasound of the brain;
4. spinal puncture to exclude hemorrhage.

Treatment

The most important importance in the treatment of cerebral ischemia belongs to the urgency and intensity in the first hours of admission. 6 hours from the onset of clinical manifestations is called the “therapeutic window”. This is the time for the most effective use of the thrombolysis technique to dissolve a blood clot in a vessel and restore impaired functions.

Regardless of the type and form of stroke, the following are carried out in the hospital:

• increased oxygenation (filling with oxygen) of the lungs and normalization of respiratory function (if necessary, through transfer and mechanical ventilation);
• correction of impaired blood circulation (heart rhythm, blood pressure);
• normalization of electrolyte composition, acid-base balance;
• reducing cerebral edema by administering diuretics and magnesium;
• relief of agitation and seizures with special antipsychotic drugs.

A semi-liquid diet is prescribed for the patient's nutrition; if swallowing is impossible, parenteral therapy is prescribed. The patient is provided with constant care, prevention of bedsores, massage and passive exercises.

Rehabilitation begins from the first days

This allows you to get rid of negative consequences in the form of:

• muscle contractures;
• congestive pneumonia;
• DIC syndrome;
• pulmonary embolism;
• damage to the stomach and intestines.

Thrombolysis is a specific therapy for stroke of ischemic type. The method allows you to preserve the viability of neurons around the necrosis zone, returning all weakened cells to life.

The administration of anticoagulants begins with Heparin derivatives (in the first 3–4 days). Drugs of this group are contraindicated for:

• high blood pressure;
• peptic ulcer;
• diabetic retinopathy;
• bleeding;
• impossibility of organizing regular monitoring of blood clotting.

After 10 days they switch to indirect anticoagulants.

Drugs that improve metabolism in neurons include Glycine, Cortexin, Cerebrolysin, Mexidol. Although they are not listed as effective in the evidence-based medicine database, their use leads to improvement in the condition.

Decompression craniotomy is performed in case of increasing edema in the brain stem area

Patients may need symptomatic treatment depending on the specific manifestations: anticonvulsants, sedatives, painkillers.

Antibacterial agents are prescribed to prevent kidney infection and pneumonia.

Forecast

Data on prognosis are available only for ischemic infarction; other changes represent precursors indicating an increased risk of stroke.

Atherothrombotic and cardioembolic types of ischemia have the most dangerous mortality rate: during the first month of the disease, from 15 to 25% of patients die. Lacunar stroke is fatal in only 2% of patients. The most common causes of death:

• in the first 7 days - cerebral edema with compression of vital centers;
• up to 40% of all deaths occur in the first month;
• after 2 weeks - pulmonary embolism, congestive pneumonia, cardiac pathology.

Patient survival time:

After this period, 16% die per year.

Only 15% of patients return to work

The following have signs of disability:

• after a month - up to 70% of patients;
• six months later - 40%;
• by the second year - 30%.

The rate of recovery is most noticeable in the first three months by an increase in the range of movements, while the functions of the legs return faster than the arms. Remaining immobility in the hands after a month is an unfavorable sign. Speech is restored after years.

The rehabilitation process is most effective with the volitional efforts of the patient and the support of loved ones. Complicating factors include advanced age and heart disease. Seeing a doctor during the phase of reversible changes will help avoid serious consequences.

Ischemic cerebral stroke

Ischemic cerebral stroke is an acute disruption of the blood supply to the brain resulting from interruption or obstruction of blood supply. The disease is accompanied by damage to brain tissue and disruption of its functioning. Acute ischemic circulatory disorders of the brain account for 80% of all strokes.

Stroke poses a serious threat to able-bodied and elderly people, leading to prolonged hospitalization, severe disability, large financial costs for the state, and deterioration in the quality of life of the affected people and their family members.

Stroke - the disease of the century

Every year, stroke affects about 6 million people in the world, about 4 million of them die, half remain disabled. The number of patients in Russia is at least 450 thousand people per year. The worst thing is that the incidence rate is increasing and the age of sick people is getting younger.

There are 5 types of ischemic stroke depending on the mechanism of its origin, that is, pathogenesis:

• Thrombotic. The cause (or etiology) is atherosclerosis of the large and medium arteries of the brain. Pathogenesis: an atherosclerotic plaque narrows the lumen of the vessel, then, after exposure to certain factors, a complication of atherosclerosis occurs: the plaque ulcerates, platelets begin to settle on it, forming a blood clot that blocks the internal space of the vessel. The pathogenesis of thrombotic stroke explains the slow, gradual increase in neurological symptoms; sometimes the disease can develop within 2–3 hours in several acute episodes.

Thrombotic stroke usually develops against the background of atherosclerosis

• Embolic. Etiology – blockage of a vessel with a blood clot coming from internal organs. Pathogenesis: a blood clot forms in other organs, then it breaks off and enters the brain vessel with the bloodstream. Therefore, the course of ischemia is acute and rapid, and the lesion is of impressive size. The most common source of blood clots is the heart; cardioembolic stroke develops with myocardial infarction, cardiac arrhythmias, artificial valves, endocarditis; less often, the source of blood clots is atherosclerotic plaques in large main vessels.

A common cause of cerebral vessel obstruction is cardiogenic embolus.

• Hemodynamic. The pathogenesis is based on a violation of blood flow through the vessels. The etiology is low blood pressure, this phenomenon can be observed with a slow heart rate, ischemia of the heart muscle, during sleep, and prolonged stay in an upright position. The onset of symptoms can be both rapid and slow, the disease occurs both at rest and during wakefulness.
• Lacunar (the size of the lesion does not exceed 1.5 cm). Etiology – damage to small arteries due to hypertension, diabetes mellitus. The pathogenesis is simple - after a cerebral infarction, small cavities-lacunae appear in its depth, the vascular wall thickens or the lumen of the artery is blocked due to compression. This explains the peculiarity of the course - only focal symptoms develop, there are no signs of cerebral disorders. Lacunar stroke is most often recorded in the cerebellum, the white matter of the brain.

Lacunar stroke is usually a consequence of arterial hypertension

• Rheological. Etiology is a blood clotting disorder not associated with any diseases of the blood or vascular system. Pathogenesis – the blood becomes thick and viscous, this condition prevents it from entering the smallest vessels of the brain. During the course of the disease, neurological disorders, as well as problems associated with blood clotting disorders, come to the fore.

The most common causes of ischemic stroke are thrombosis and embolism.

Types of stroke according to the rate of increase in neurological symptoms

Depending on the speed of formation and duration of persistence of symptoms, 4 types are distinguished:

• Microstroke or transient ischemic attack, transient cerebral ischemia. The disease is characterized by mild severity, all symptoms disappear without a trace within 1 day.
• Minor stroke. All symptoms persist for more than 24 hours but less than 21 days.
• Progressive ischemic stroke. It is distinguished by the gradual development of the main neurological symptoms - over several hours or days, sometimes up to a week. After this, the health of the sick person is either gradually restored, or neurological abnormalities persist.
• Completed stroke. Symptoms persist for more than 3 weeks. Usually a cerebral infarction develops, after which severe physical and mental health problems sometimes persist. With a major stroke, the prognosis is poor.

Clinic

• Movement disorders of varying severity. Cerebellar dysfunction: lack of coordination, decreased muscle tone.
• Impaired pronunciation of one’s own and the perception of someone else’s speech.
• Visual impairment.
• Sensory disorders.
• Dizziness, headache.
• Violation of the processes of memorization, perception, cognition. The severity depends on the size of the lesion.

The clinic depends on the cause of the disease, the size and location of the lesion. It is worth distinguishing between lacunar infarction, lesions of the carotid, anterior, middle, posterior and villous cerebral arteries; special attention is paid to ischemia of the vertebrobasilar region.

Ischemic stroke of the vertebrobasilar region (VBB)

The vertebral arteries merge at the base of the brain into the basilar artery

Two vertebral arteries, merging, form one basilar, that is, the main one. With vascular insufficiency of these arteries, two important parts of the brain are affected at once - the brainstem and the cerebellum. The cerebellum is responsible for coordination, balance and tone of the extensor muscles. Dysfunction of the cerebellum can be called “cerebellar syndrome”. The brainstem contains 12 cranial nerve nuclei, which are responsible for swallowing, eye movement, chewing, and balance. After a stroke in the brain stem, these functions may be impaired to varying degrees. In ischemic strokes, focal dysfunction of the cerebellum in combination with symptoms of brain stem damage predominate.

Symptoms of acute vascular insufficiency of the vertebral arteries: as a result of damage to the cerebellum, an imbalance and coordination of movements occurs; if the cerebellum is damaged, muscle tone decreases; as a result of damage to the cerebellum, there is a violation of the coordination of muscle movements. When the trunk is damaged, oculomotor disorders, paralysis of the facial nerve, paresis of the limbs (alternating syndrome), chaotic movement of the eyeballs, combined with nausea, vomiting and dizziness, appear, and the person has difficulty hearing. The trunk also regulates chewing and swallowing reflexes.

With simultaneous damage to the basilar or both vertebral arteries, the course of the disease worsens, paralysis of both arms and legs, and coma are observed.

The course of TIA with damage to the intracranial part of the vertebral artery and the posterior cerebellar artery is not severe; it is manifested by nystagmus, dizziness with vomiting and nausea, impaired facial sensitivity, changes in the perception of pain and temperature.

Diagnostics

Treatment tactics are determined by the type of stroke

To select a treatment regimen, it is very important to establish the form of the acute vascular disorder, because medical tactics for hemorrhage and ischemia have serious differences.

Diagnosis of ischemic cerebrovascular accidents begins with a medical examination, taking into account the main symptoms of the disease and existing risk factors. The doctor listens to the heart and lungs, measures the pressure in both arms and compares the readings. To clarify neurological disorders and determine the severity, it is necessary to undergo an examination by a neurologist.

To make an emergency diagnosis and find out the cause of the disease, an ultrasound examination of the vascular bed of the brain and an electroencephalogram are performed; angiography allows you to more accurately see changes in the vascular system of the brain - contrast is injected into the vessels and an X-ray is taken; often it is necessary to do an MRI and CT scan of the brain. In addition, the diagnosis of ischemic stroke should include a blood test from a finger and a vein, a coagulation test, and a general urine test.

Prevention

Prevention of ischemic cerebrovascular accidents is aimed at eliminating risk factors and treating concomitant diseases. Primary prevention is aimed at preventing the first attack in life, secondary prevention is aimed at preventing stroke recurrence.

The International Health Organization has established a list of preventive measures:

• Quitting cigarettes. After quitting active and passive smoking, the risk of developing a stroke decreases significantly, even in older people who have smoked their entire adult life.
• Quitting alcohol. It is not recommended to drink alcohol even in moderation, because each person has his own individual concept of moderation. It is necessary to completely give up alcohol for people who have already suffered an acute disorder of cerebral blood supply in their lives.
• Physical activity. Regular physical activity at least 4 times a week will have a positive effect on the weight, condition of the cardiovascular system, and the fat composition of the blood of a sick person.
• Diet. The diet consists of moderate consumption of fats, it is recommended to replace animal fats with vegetable fats, eat less simple carbohydrates, eat more fiber, pectins, vegetables, fruits and fish.
• Reducing excess body weight. Weight loss should be achieved by reducing the caloric content of food, establishing a 5-6 daily diet, and increasing physical activity.
• Normalizing blood pressure is the most effective prevention of ischemic stroke. With healthy blood pressure, the risk of developing a primary and recurrent stroke is reduced, and heart function is normalized.
• It is necessary to adjust blood sugar levels in case of diabetes.
• It is necessary to restore the functioning of the heart.
• Women are advised to avoid contraceptives containing large amounts of estrogen.
• Drug prevention. Secondary prevention of ischemic stroke must necessarily contain antiplatelet and anticoagulant drugs - Aspirin, Clopidogrel, Dipiradamol, Warfarin.

Medication measures for secondary prevention

By following the listed preventive measures for a long time, you can reduce the risk of developing any diseases of the cardiovascular system.

75% of strokes are primary, which means that by following preventive measures, the overall incidence of stroke can be reduced.

Forecast

The chances of a favorable outcome are different for each person and are determined by the size and location of the lesion. Patients die after developing cerebral edema, displacement of internal brain structures. 75–85% of patients have a chance of survival by the end of the first year, 50% after 5 years, and only 25% after 10 years. Mortality is higher in thrombotic and cardioembolic strokes, and is very low in the lacunar type. Low survival rate in elderly people, hypertensive patients, smokers and alcohol drinkers, people after a heart attack, and arrhythmia. The chances of a good recovery decrease rapidly if neurological symptoms persist for more than 30 days.

In 70% of surviving people, disability persists for a month, after which the person returns to normal life, 15–30% of patients after a stroke remain permanently disabled, and the same number of people have every chance of developing a recurrent stroke.

Patients who have suffered a microstroke or minor stroke have a chance to go to work early. People with major strokes may return to their previous place of work after a long recovery period or may not return at all. Some of them can return to their previous place, but to an easier job.

With timely assistance, properly selected treatment and rehabilitation, it is possible to improve the patient’s quality of life and restore ability to work.

Stroke is not a hereditary, chromosomal and inevitable disease. For the most part, stroke is the result of chronic human laziness, overeating, smoking, alcoholism and irresponsibility to doctor’s prescriptions. Enjoy life - run in the morning, go to the gym, eat natural light foods, spend more time with your children and grandchildren, spend the holidays with delicious non-alcoholic cocktails and you will not have to familiarize yourself with the causes and statistics of stroke.