Causes, types, signs and consequences of stroke
Strokes are characterized by a variety of causes of the disease. It has been proven that the etiology of stroke in women and men in some cases is different. The causes of stroke in women mainly lie in the plane of the pathophysiology of the fertile period and menopause, in men they are more often due to occupational risks and bad habits. Differences in the pathogenesis and consequences of stroke among gender groups are associated with the same features.
What is a stroke?
Stroke is an acute disorder of cerebral circulation (CVA) - the result of one of two reasons:
- Narrowing or blockage of blood vessels in the brain - ischemic stroke;
- Hemorrhages in the brain or in its membranes - hemorrhagic stroke.
Strokes occur in individuals in a wide age range: from 20-25 years old to very old age.
Strokes in young and middle-aged people
Ischemic stroke - has common etiological factors for women and men (arterial hypertension and atherosclerosis).
Factors of ischemic stroke with a gender predisposition:
- In women - rheumatism of the heart in combination with a cardiogenic cerebral embolism (blockage of the middle cerebral artery by a fatty or air embolus formed in the left heart);
- In men, traumatic occlusion of the neck vessels (injury and subsequent blockage of the carotid artery located in the muscles of the neck).
Hemorrhagic stroke - has common etiological factors for women and men (arterial aneurysms, arterial hypertension, arteriovenous aneurysms).
Factors of hemorrhagic stroke with a gender predisposition:
- In women, arterial hypertension;
- In men - arterial aneurysm, post-traumatic arterial dissection, subarachnoid hemorrhages.
In young women during gestation (gestation), hemorrhagic stroke develops eight to nine times more often than men of the same age.
Features of the clinical course and consequences of strokes in young people are very different. In ischemic stroke, the disease often occurs in the presence of clear consciousness and develops against the background of moderate neurological deficit. Severe forms of stroke in women develop as a cardiogenic cerebral embolism, in men as atherosclerosis and thrombosis of the main arteries.
Strokes in the elderly
Strokes are more common in men between the ages of 65 and 79, and in women after 80.
The main causes of stroke in older people are:
- In men - arterial hypertension, high blood cholesterol levels;
- In women, atrial fibrillation, stenosis of the carotid arteries, ischemic heart disease, cardiovascular failure.
The features of the clinical course and the consequences of strokes in the elderly do not depend much on gender. The disease usually occurs against a background of severe neurological deficit with a high level of disability. This is due to a complex health condition before stroke: chronic diseases, age-related changes in brain structures. In patients over 65 years of age, the risk of stroke recurrence is three times higher than in those who have had a stroke at a young age.
How many years do people live after a stroke?
There is no single answer to this question. Death can occur immediately after a stroke. However, a long, relatively full life for decades is also possible.
Meanwhile, it was found that mortality after strokes is:
- During the first month - 35%;
- During the first year - about 50%.
The prognosis of stroke outcome depends on many factors, including:
- The age of the patient;
- Health conditions before stroke;
- Quality of life before and after stroke;
- Compliance with the regime of the rehabilitation period;
- Completeness of eliminating the causes of stroke;
- The presence of concomitant chronic diseases;
- The presence of stress factors.
The main risk factors for stroke (the `` fatal quintet ''):
- Left ventricular hypertrophy.
A combination of 2-3 of these factors significantly increases the risk of an unfavorable outcome of the disease.
Stroke mortality statistics
Every year, from 5 to 6 million strokes are diagnosed in the world, in Russia - up to 450 thousand. For this reason, 29% of men and 39% of women die. Disabled people are 3.2 per 10 thousand. During the first month, up to 35% die, and by the end of the year - up to 50%. Repeated strokes are dangerous. In the first year, a relapse develops in 5-25%, within three years - in 20-30%, within five years - in 30-40% of those who have recovered. The highest risk of developing stroke in people over 65 years old, the incidence in this age segment is up to 90% of all cases. At the same age, the largest number of deaths. Up to 80% of strokes develop as ischemic brain pathologies with a mortality rate of up to 37%. In the remaining 20% of patients with hemorrhagic stroke, mortality is up to 82%.
The reason for the high mortality rate from stroke in Russia is the rapid aging of the population, late admission to a hospital, poor educational work and insufficient measures to prevent stroke. Statistics of recent years indicate that 39.5% of people at risk of stroke do not think about its dangers.
Stroke rarely occurs without previous symptoms - the initial manifestations of insufficient blood supply to the brain (NPKM) in the form of transient attacks or hypertensive crises in persons at risk. The risk group for NPNCM includes people with hypertension, heart rhythm disturbances, who are in chronic stress, who have a history of chronic diseases, smoking, a tendency to aggregation of blood cells, and overweight.
- Causes of Stroke
- Stroke symptoms
- Signs of stroke in women and men
- Classification and types of stroke
- Risk factors for stroke
- The consequences of a stroke
- Coma after a stroke
- What to do, how to recover from a stroke?
Causes of Stroke
The causes of stroke include ischemia (a violation of blood supply), embolism (blockage of blood vessels by an embolus), thrombosis, atheroma (degenerative changes in the walls of blood vessels), and intracerebral hemorrhage. Thrombosis is the formation of blood clots. If a blood clot occurs in a blood vessel that feeds the brain, it causes swelling of the brain tissue.
Thrombosis often develops in the morning or at night after surgery or a heart attack. It is thrombosis that causes most of the strokes that occur in the elderly. Most often, thrombosis occurs in people who are overweight, in those who abuse smoking, and in women who are protected by oral hormonal contraceptives. At this point, thrombosis can also develop in very young people who use cocaine.
With a hemorrhage, an artery in the brain ruptures. This type of stroke can happen at any age. Hemorrhage occurs with high blood pressure. This type of stroke can occur with hardening of the arteries, arrhythmias, diabetes, low or sudden rise in blood pressure, a sedentary lifestyle, smoking, or oral contraceptive use.
With an embolus, a clot of fat-like substances (emboli) forms in a blood vessel. Stuck in the vessels, the embolus blocks the blood flow. This type of stroke can occur after heart surgery or arrhythmias.
The signs of the disease identified by doctors on the basis of general clinical, instrumental and laboratory studies of the patient for the purpose of making a diagnosis are called symptoms. The first symptoms of a stroke are determined by the doctor or paramedic of an ambulance on the scales (GCS / FAST). Based on years of research, the most common symptoms of stroke have been identified, which are divided into two conditional groups.
- General cerebral symptoms that are common in many pathologies associated with brain damage are dizziness, lightheadedness, stunning or agitation.
- Focal symptoms - sudden paresis, paralysis, loss of vision or change in the position of the pupil, uncertain speech, impaired coordination of movement, rigidity (pathological tension) of the muscles of the back of the head.
The first symptoms of a stroke
A patient with suspected stroke is admitted to the neurological department or intensive care unit. Hope for a favorable outcome (maximum rehabilitation of the patient) is possible within the first three to six hours from the onset of stroke to the start of intensive therapy or resuscitation. The first symptoms that reliably indicate a certain type of stroke:
- Hemorrhagic stroke - hemorrhage (hemorrhage) in the tissues of the brain;
- Ischemic stroke is a site of infarction (necrosis) in the tissues of the brain.
These signs are detected using CT, MRI, EEG. link
Symptoms of cerebral or focal brain lesions obtained by publicly available methods are not always the result of a stroke. Work on the classification of vascular lesions of the brain began in 1971 by E. N. Schmidt, in the final version he proposed in 1985.
Signs of stroke in women and men
The signs of a stroke are a subjective (personal) feeling of a person or an objective (obvious) description of the disease by an outside observer, which serves as a reason for the patient to seek help from a medical institution.
All people should be aware of the signs of a stroke, regardless of whether they have medical education. These symptoms are primarily associated with a violation of the innervation of the muscles of the head and body, so if you suspect a stroke, ask the person to do three simple steps: smile, raise your hands, say any word or sentence.
If the person has a stroke, this simple test will show the following results:
- The smile looks unnatural, the corners of the lips are located on a different line, which is associated with the limitation or complete impossibility of contraction of the facial muscles;
- Raising arms looks like an asymmetrical action, the arm on the affected side has no strength, that is, it spontaneously lowers, the handshake is weak;
- Pronunciation of words or phrases due to paresis or paralysis of the muscles of the face is difficult.
There are other similar tests. Unfortunately, the identification of signs of a stroke means a statement (confirmation) of the onset of irreversible consequences in the brain. The sooner qualified assistance is provided to the patient, the greater the chances of eliminating the consequences of a stroke.
Signs of some types of stroke (ischemic) appear before the development of changes in the tissues of the brain. Such signs are called the initial manifestations of insufficient blood supply to the brain (NPKM), they consist in transient (passing) ischemic attacks or hypertensive crises. Their timely detection is recommended to prevent the development of clinical forms of stroke.
NPNKM is easy to determine at home using the L. S. Manvelova. One positive answer (+) equals one point. To confirm the diagnosis, you should answer at least twice (+) to questions about the presence of the following sensations at least once a week or constantly during the last three months:
- Headache without a clear localization, not caused by hypertension, often associated with overwork and changes in weather: (+) or (-);
- Dizziness, aggravated by a change in the position of the body in space: (+) or (-);
- The noise in the head is constant or transient: (+) or (-);
- Memory impairment that extends to current events, logical memory usually does not suffer: (+) or (-);
- Sleep and / or performance disorder: (+) or (-).
If the examined person scored two or more points, this means that he has the prerequisites for the rapid development of a stroke. You should contact your local therapist to get a referral to a neuropathologist for laboratory and instrumental examinations and treatment.
A stroke does not always have signs visible to outsiders. Sometimes they are obvious only on the basis of personal feelings when performing habitual actions, for example, typical only for women or only for men.
First aid at the first sign of a stroke
After identifying signs of a stroke, you must do the following:
Call an ambulance, call is free:
- call from landline phone 03;
- call from mobile phone 112 or 03 *.
The patient should take a horizontal position on the bed, the head is slightly higher than the body:
- if you have dentures, eye lenses, glasses - remove;
- if the patient is unconscious, help him open his mouth, tilt his head slightly to one side, monitor breathing.
Before the arrival of the ambulance team:
- write down the names, dosage and frequency of medications taken by the patient;
- write down the names of drugs intolerable to the patient (if any);
- prepare a passport, medical insurance policy, outpatient card, if the patient has one.
- Tell the ambulance doctor known information about the patient.
- If possible, accompany the patient to the hospital emergency room.
Help to a patient in a hospital is provided in accordance with the standards of medical care for patients with stroke, approved by the Order of the Ministry of Health and Social Development of the Russian Federation of 01.08.2007 N 513.
A number of scientific publications show the negative impact of high temperature on the outcome of stroke. At the same time, it is reported about the use of low temperature (hypothermia and normothermia) in the neuroprotection of brain cells in the course of therapy for cerebrovascular accidents.
The pathogenesis of strokes is largely determined by the state of the patient's thermoregulation. One of the reasons for the coma of a patient with a stroke is a violation of thermoregulation.
Hyperthermia is diagnosed in 40-70% of patients with hemorrhagic stroke and in 18-60% with ischemic stroke.
- The leading cause of hyperthermia in acute cerebrovascular accident is purulent-inflammatory processes in the body, which developed as complications of pneumonia, urinary tract infections, and bedsores.
- The second cause of hyperthermia is supratentorial brain tumors. An increase in temperature with them does not depend on purulent processes in the body.
The method of hypothermia with the aim of preserving brain structures damaged by stroke was widely used until the 70s and 80s of the last century. The promising method was abandoned due to numerous complications. At present, with the discovery of new means and methods in biology and medicine, the use of hypothermia in stroke is again widely discussed with the aim of neuroprotection of neurons from a cascade of pathological reactions in the brain in stroke in the first stage.
Classification and types of stroke:
- Ischemic stroke
- Hemorrhagic stroke
- Major stroke
- Lacunar stroke (LI)
- Spinal stroke
- Acute stroke
Ischemic stroke (IS) is the most common form of stroke. According to various sources, up to 80% of all strokes are ischemic. AI has another name - cerebral infarction, that is, a focus of necrosis, formed on the periphery of the blood flow retention area. Necrosis in IS is the result of metabolic disorders in brain cells with symptoms of blood stagnation in the area of nerve tissue.
The reasons for stagnation of blood in the blood vessels of the neuronal and glial tissues of the brain:
- Stenosis (narrowing) or occlusion (blockage) of large arterial vessels in the brain;
- Thrombosis - blockage of an arterial vessel by a thrombus (thrombus is a clot of blood cells);
- Embolism is a blockage of an arterial vessel by an embolus (an embolus is a clot of fat cells that are normally absent in the bloodstream).
Hemorrhagic stroke (GI) is the most dangerous form of stroke. According to various sources, the lethal outcome of GI is up to 82% of cases. GI is the result of rupture of a blood vessel and the formation of a blood clot in this place and then a site of necrosis. A more severe pathogenesis of GI in comparison with IS is explained by the development of a focus of hemorrhagic stroke and layering of ischemia.
The development of hemorrhagic stroke at the first stage occurs in the following sequence:
- Hematoma causes direct mechanical compression of the brain tissue,
- Formation occurs in this area of the ischemic zone;
- Hematoma and ischemia around it trigger a cascade of pathogenetic processes.
The volume of hematoma in GI is several times less than extensive ischemia around the focus of hemorrhagic stroke.
Massive stroke is the generic term for massive strokes. According to the classification of acute cerebral ischemias (E. I. Gusev, 1962), OI corresponds to severe stroke with pronounced cerebral symptoms:
- Depression of consciousness;
- Cerebral edema;
- Hemiparesis or hemiplegia on the opposite side of the lesion;
- Paresis of the gaze towards the paralyzed limbs;
- Disorder of consciousness in the form of hemispheric injuries (aphasia - speech disorder, heminopsia - loss of half of the visual field, anosognosia - the patient does not understand his condition);
- Vegetative disorders - disorders of the nervous regulation of internal organs and body systems.
- Trophic disorders - disorders of nerve conduction, which are manifested by skin ulcers.
Massive strokes are complicated by a secondary-type stem syndrome in the form of impaired consciousness and oculomotor disorders:
- Anisocoria - changes in the size of the pupil, it is enlarged on the side of the affected hemisphere;
- Ophthalmoplegia - weakening or lack of reaction of the pupils to light;
- Strabismus and strobism (pendulum movements of the eyeballs);
- Hormetonia - generalized disorders in the form of muscle spasm of tonic muscles;
- Decerebral rigidity - increasing the tone of the extensor muscles,
In terms of localization, extensive strokes correspond to lesions in the basins of large precerebral and cerebral main arteries (classification by E. V. Schmidt, 1985 and ICD-10).
No data was found to compare the incidence of major strokes in men or women. Extensive strokes are a common cause of death of patients or long-term (lifelong) disability.
Lacunar stroke (LI)
Lacunar stroke is a type of ischemic cerebral infarction. LI is characterized by a limited lesion of one of the small perforating arteries. Perforating arteries are small vessels ranging in size from lobes to 2 mm, with a length of up to 10 cm, connecting the larger deep and superficial arteries. The name "lacunar stroke" is derived from the formation of round cavities (lacunae) at the site of the infarction (less than 1.5 cm in diameter) filled with liquid contents - cerebrospinal fluid.
The incidence (occurrence) of lacunar stroke averages 20% of all ischemic strokes. They are not characterized by general cerebral and meningeal symptoms.
Lacunar stroke is detected by focal symptoms:
- Atactic hemiparesis - impaired coordination of half of the body;
- Dysarthria - a violation of the clear pronunciation of words;
- Monoparesis is a violation of the motor activity of one arm or leg.
Of the group of patients with a diagnosis of lacunar stroke, women account for approximately 54%, men - 46%. Average age of patients diagnosed with LI: from 48 to 73 years.
The most common cause of lacunar stroke is atherosclerosis associated with hypertension. The embolic nature of LI has also been proven, in this case the disease is more severe for patients due to the involvement of a larger part of the brain in the pathogenesis after the vessel is blocked by an embolus. The prognosis of lacunar stroke depends on the location of the lesion and the time of initiation of treatment.
A spinal stroke is an acute circulatory disorder in the spinal cord. Spinal stroke can be caused by ischemic or hemorrhagic cerebral stroke. The usual site of spinal stroke localization is in the large arteries of the cervical and lumbar thickening or small branches of the reticulomedullary arteries.
SI is more common in older people. No differences in the pathogenesis of spinal strokes in men and women were found.
There are no precise data on the prevalence of spinal strokes. This is probably due to the difficulty of differential diagnosis. More accurate diagnosis became possible after the widespread introduction of CT, MRI and selective spinal angiography.
Some sources point to the following harbingers of spinal stroke:
- Radicular syndrome - pains of different localization (neck, arms, legs, lower back);
- Chronic vascular and cerebrospinal insufficiency (CHF);
- Recurrent severe headaches;
- Noise and heaviness in the head;
- Short-term dizziness;
- Increased fatigue and sleep disorder;
- Memory impairment;
- The syndrome of myelogenous intermittent claudication is a feeling of numbness in the legs during prolonged walking with a rapid disappearance after rest, there is no pain in the legs.
The clinical picture of SI is varied, it depends on the location of the stroke in the spinal column.
Ten spinal ischemic syndromes:
- The ventral half of the spinal cord or anterior spinal artery blockage or Preobrazhensky syndrome;
- Anterior poliomyelopathy;
- Centromedullary stenosis;
- The marginal zone of the anterior and lateral cords;
- Amyotrophic lateral sclerosis;
- Dorsal part of the spinal cord diameter (Williamson syndrome);
- Spinal cord diameter;
- Occlusion of the artery of the cervical thickening;
- Turning off the artery of the lumbar thickening.
Diagnostics and differential diagnostics of SI is carried out using instrumental methods.
This is the initial period of stroke development. It lasts on average twenty-one days, sometimes less. During this period, there is an increase in pathogenetic processes in the tissues of the brain, especially intensively during the first six hours of the disease.
The following stages of OI are distinguished:
- Formation of a nucleus from damaged brain cells - 5-8 minutes;
- Increased penumbra (an area of metabolic changes around the nucleus of a cerebral infarction):
- by 50% within 1 hour 30 minutes;
- 80% within 6 hours.
Six hours is the time of the “therapeutic window” when it is possible to carry out therapeutic interventions with maximum effect. From the first minutes, a pathogenetic cascade is activated, which at the cellular level begins with the cessation of blood flow and ends with apoptosis (death) of the brain cell. If untreated, cell apoptosis expands exponentially. On the 3-5th day, damaged brain cells undergo necrosis, and partial localization of the process occurs.
Further, the formation and / or growth of neurological disorders in the form of general cerebral and focal symptoms occurs.
Intensive therapy during the `` therapeutic window '' includes:
- Improvement of hemodynamics of brain tissues due to drip injection of saline solutions;
- Neuroprotection (protection) of brain cells.
- Improvement of rheological (viscosity) and coagulation (clotting) properties of blood;
- Improving blood microcirculation.
- Prevention of cerebral edema.
It is also called a minor stroke (MI). The name was given because of the relatively fast (2–21 days) disappearance of the symptoms of neurological deficit.
Neurological deficiency syndrome is accompanied by two to three or more of the following symptoms:
- Unsure gait;
- Hypertonicity of muscles;
- Mono- or hemiparesis;
- Paralysis of the gaze or head;
- Aphasia / anosmia;
- Seizures / epilepsy;
- Unreasonable fun / rage.
With a microstroke, foci of cell necrosis are formed and retained in the brain. The symptoms of MI are similar to those of transient ischemic attacks (TIA).
The fundamental difference between a microstroke and transient ischemic attacks is that with TIA:
- There are symptoms of neurological deficiency;
- CT / MTP does not reveal a focus of necrosis (ischemia) in the brain.
The development of minor stroke is noted in the age group from 25 to 45 years. Sexual correlation has not been established.
The causes of MI are a combination of several of the following factors:
- Arterial hypertension;
- Regular use of oral contraceptives and other drugs that increase blood viscosity;
- Venous thrombosis;
- Systemic blood diseases;
- Drugs, alcohol;
- Head and neck injuries.
Microstroke is a risk factor for the development of one of the types of completed stroke. Repetitive MI is the cause of decreased intelligence and dementia.
The main cause of recurrent strokes is previous cerebrovascular diseases (CVD). It should be considered that CVD are strokes and TIAs. During the first year, individuals who have had extensive strokes may develop:
- Recurrent strokes;
- Dementia disorders (acquired decrease in intelligence to varying degrees);
- Lethal outcome.
The impact on risk factors is a real chance of preventing recurrent strokes. Prevention must be consistent and continuous.
The standard algorithm for influencing risk factors in secondary stroke has the designation - A-B-C therapy (A - antihypertensive, B - blockers, C - statins). For the prevention of recurrent strokes are used:
- Antihypertensive drugs (micardis, agrenox);
- Thrombus blockers (aspirin, warfarin, agrenox, clopidogrel);
- Statins to counteract the formation of cholesterol. Drugs from the statin group are used to block the enzyme (HGM-CoA) involved in the production of cholesterol. For this purpose, lovastatin, fluvastatin, atorvastatin, rosuvastatin and others are prescribed.
Risk factors for stroke
- Smoking and drinking alcohol are among the main risk factors for stroke, especially in older people. Smoking and alcohol, together, significantly increase the risk of developing cardiovascular diseases, in addition, alcohol intake contributes to weight gain.
- Taking certain medications without a doctor's prescription puts you at risk of developing heart and blood diseases, which can lead to stroke. The likelihood of developing a stroke is significantly increased with the use of oral contraceptives containing estrogens. This risk is increased with the use of oral contraceptives for women who smoke with high blood pressure.
- It is necessary to monitor the level of cholesterol in the blood, as its high content is one of the risk factors for stroke. Improper (oversaturated with fats) and irregular nutrition leads to an increase in cholesterol levels.
- Arterial hypertension many times increases the risk of developing a stroke, especially in combination with all of the above factors. You need to be more careful for pregnant women suffering from arterial hypertension and women taking oral contraceptives.
- One of the reasons for the development of cardiovascular diseases is physical inactivity (a sedentary lifestyle). Exercise daily, jogging and walking in the fresh air. Following these recommendations has a beneficial effect on blood sugar levels and helps to lower blood pressure. The risk of developing a stroke is huge in people with a large weight, even in the absence of other risk factors. Heavy weight contributes to the development of high blood pressure, diabetes, and puts an increased strain on the heart muscle.
- The risk of developing a stroke increases in people with diabetes. A huge percentage of people with diabetes die from the effects of a stroke.
- The mental state of a person plays a huge role in the occurrence of a stroke. Stress, anxiety, nervous stress increase the risk of developing the disease, especially for people who have previously suffered a stroke.
The consequences of a stroke
Excluding deaths, some patients return to normal or partially limited work activity. With a slow recovery of body functions and the impossibility of returning to work within 3-3.5 months, the patient is sent for a medical and social examination (MSE). The Medical Commission (VC) decides whether to continue treatment on sick leave or the need to determine III or II group of disability. When considering the grounds for disability, VC takes into account the persistence and duration of the consequences of a stroke:
- Pyramidal defects (movement disorders - paresis, paralysis);
- Extrapyramidal motor (speech disorder, slow movements of the active side of the body, inability to self-service);
- Extrapyramidal hyperkinesis (decreased motor functions, inability to maintain a certain posture);
- Atactic violations;
- Visual impairment in the form of partial or complete loss of vision;
- Brain dysfunctions such as aphasia;
- Epileptic seizures;
- Depression of mental functions (dementia);
- Complications from the cardiovascular system (peripheral edema, weakness).
Swelling of the legs after a stroke
Edema refers to the long-term consequences of a stroke caused by a failure of the cardiovascular system of the body. Edema is characterized by:
- Slow development and preservation for several hours;
- Localization on the limbs, spreading from the bottom up and symmetry;
- Dense consistency, when pressed, a pit remains.
Of the available means for the prevention of leg edema, the use of herbal diuretics (kanephron, cyston), medicinal herbs or preparations with a diuretic effect is allowed. Carefully apply ointments and liquids as rubbing in, it may injure the skin.
Cerebral edema in stroke
This complication can develop at any stage of the stroke, more often during the first hours of pathogenesis. Cerebral edema is an increase in intracranial pressure due to pathological swelling of the glial tissue of the brain. Cerebral edema in stroke is a consequence of impaired cerebral circulation caused by blockage of a large vessel of the brain and its basin and the effusion of the liquid part of the blood outside the vascular bed.
Prevention of cerebral edema is an indispensable part of therapy for the initial period of stroke, regardless of the presence of symptoms.
The events are carried out by a specialized team authorized to provide therapy for critically ill patients.
The team performs the following actions.
- Supports stable hemodynamics;
- Selectively controls blood pressure (only with hypertension and / or with the simultaneous development of pulmonary edema, some other conditions), shown - clonidine, captopril, atenolol, labetalol, benzohexonium and others, it is impossible to reduce blood pressure more than 15% of the initial level;
- Prevents edema of the brain and lungs, artificial ventilation and drug therapy are indicated;
- Relieves the syndrome of psychomotor agitation and / or convulsive syndrome, benzodiazepine drugs are indicated, a non-narcotic dose of sodium oxybutyrate;
- Temperatures above 37.5 ° C, it is advisable to reduce, paracetamol and physical methods are indicated;
- Controls blood glucose levels. For hyperglycemia, short-acting insulin is indicated. Intravenous glucose is contraindicated. Not recommended: dibazol, nifedipine, aminophylline, vinpocetine, nicergoline, papaverine, furosemide and mannitol without blood osmolarity control.
Disorders of motor activity of varying degrees of regression are frequent companions of strokes.
Disorders usually manifest as paresis (partial loss of movement) and paralysis (complete loss of motor activity).
With strokes observe:
- Monoplegia - paralysis of one limb (arm or leg);
- Hemiplegia - paralysis of the arms and legs of one side of the body;
- Paraplegia is paralysis of two arms or legs.
Peripheral paralysis is characterized by a complete lack of motor activity in the affected area of the body.
For central paralysis synkinesis is characteristic - a friendly movement. In synkinesis, a paralyzed arm or leg does not act independently, but when a healthy arm or leg is raised, the paralyzed limb performs a similar movement.
Simultaneously with paralysis, speech disorders occur in the form of aphasia or difficulty in pronouncing words, as well as a lack of understanding of one's own speech errors.
Coma after a stroke
Coma after a stroke - depression of the central nervous system as a result of secondary disorders of cerebral circulation, or apoplectiform coma. It develops against the background of stroke and an increase in body temperature, as a result of necrotic processes in the brain and purulent pathologies (complications in the form of pressure sores and others).
Coma is characterized by stages, it begins with precoma - confusion of consciousness.
Reflex regression manifests itself in four stages:
- Stun - 1 stage;
- Deep sleep (stupor) - stage 2;
- Loss of corneal and ocular reflexes - stage 3;
- Loss of deep reflexes, muscle atony - stage 4.
How long does a coma last after a stroke?
The duration of a coma after a stroke is from several hours to several weeks.
The duration of the coma depends on:
- Its depth - at stages 1-2, it is possible to remove from a coma, at 3-4 stage the prognosis is unfavorable;
- The general condition of the patient's body;
- Completeness of measures to support the patient's life;
- Carefulness of caring for an unconscious patient (prevention of pressure sores).
Coma 3 degrees
The third degree is also called atonic coma.
The signs of a III degree coma are manifested:
- pain response;
- corneal reflexes (closing the eyes in response to corneal irritation);
- pupil reactions (lack of reaction to eye lighting).
- pharyngeal reflex;
- tendon reflexes;
- muscle tone;
- blood pressure;
- body temperature;
- breathing rhythm.
- paralytic miosis (permanently dilated pupil);
- local or generalized seizures;
- acts of urination and defecation.
The prognosis of stroke outcome in a stage III coma (atonic coma) is “poor” or “fatal.” The basis of the medical decision is the absence of vital signs of the patient's habit.
The fatal prognosis of stroke outcome can also be in the case of:
- Extensive bleeding with severe hormonal syndrome (attacks of increased muscle tone in the initial stages of coma);
- Gross breathing disorder;
- Hyperthermia above 40-42 ° C;
- Recurrent stroke with severe residual effects (paralysis, dementia disorders);
- Stroke against the background of oncology in an incurable (hopeless) stage.
A favorable outcome is possible with:
- Transient ischemic attacks (pre-stroke state);
- Small strokes (micro strokes);
- Timely treatment of certain types of stroke in the period earlier than 3-6 hours after the onset of the first signs of the disease.
What to do, how to recover from a stroke?
The recovery period for men and women takes approximately the same time. Adaptation depends on the individual characteristics of the organism. The recovery period after a microstroke passes quickly, patients return to a relatively normal existence within two to three months. With extensive strokes, rehabilitation is long-term or lifelong.
It is desirable to involve specialists in the field of neurology, massage, manual therapy, speech therapists, nutritionists in rehabilitation. Separate stages of rehabilitation are possible both in a hospital, an outpatient clinic and a sanatorium, and at home.
During the rehabilitation period, patients who have suffered a massive stroke are shown:
- Electrical stimulation with sinusoidal currents;
- Electrophoresis with occipital electrodes;
For the normalization of motor and sensory functions, a combination of massage, manual therapy and acupuncture is recommended. The restoration of neuropsychological functions takes place in the classroom on an outpatient / home basis with an individual speech therapist or a group method, it takes from a year or more.
On the topic: rehabilitation and recovery after a stroke at home
During the rehabilitation period, the following drugs are shown:
- With ischemic stroke - Actovegin, Berlition, Instenon, Gliatilin;
- For hemorrhagic stroke - Actovegin and gliatilin;
- For the correction of muscle tone - midocalm and sirdalud;
- As antidepressants - trittico, coaxil, stimuloton.
Stroke Prevention Products
The population of the Earth as of July 2011 was already more than 7 billion, of which about a billion are at risk for stroke. For every six seconds on the planet, one person dies from a stroke.
Having heard this data, one has to think about whether it is possible to reduce the number of deaths from stroke. Although the number of strokes is higher and higher, researchers indicate that in 85% of such cases, it is possible to prevent stroke by making changes in your daily lifestyle and diet. It is necessary not to abuse alcohol, include in your daily menu fresh vegetables and fruits, preferably homemade, which do not contain various chemical additives, and you should also exercise regularly.
[Video] Dr. Berg - Post-Stroke Rehabilitation. Top 7 things to do!
On the subject: How to make the right menu after a stroke?
Fish is a food that research shows that eating at least once a week can help prevent stroke. The fact is that a stroke most often occurs due to the presence of bad habits in a person: alcohol abuse, smoking, constant overeating. And fish contains substances such as omega-3s that reduce the risk of stroke. These are polyunsaturated fatty acids, they help stabilize blood pressure and also lower blood cholesterol.
Coffee is a drink that contains antioxidants that prevent the accumulation of cholesterol in the body, thereby stopping the formation of blood clots in the human brain. With three to four cups of coffee drunk during the day, the risk of suffering a stroke is reduced by 17%. However, coffee is only healthy in limited quantities. For example, if you consume more than seven cups per day, your risk of blood clots will be reduced by only 7%. Also keep in mind that we are only talking about the benefits of natural coffee!
Pears and apples are fruits that have a white pulp due to a substance that helps the body prevent stroke. This is proved by the data of one of the studies, which involved 20069 people aged 40 years. The study lasted 10 years, during which scientists recorded 233 cases of stroke. As a result, it was concluded that the risk of suffering a stroke was 52% lower in those people who ate fruits and vegetables with white flesh. However, despite the results of various studies, I would like to note that the consumption of various fruits and vegetables in any case increases immunity and strengthens the body's natural defenses.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".