From this article you will learn all the important information about the extensive stroke - one of the most dangerous conditions in medicine.
Contents of the article:
- The reasons for the extensive stroke
- Characteristic symptoms
- Diagnosis of cerebral circulation disorders
- Principles of treatment
- Rehabilitation after a stroke
- Forecast
Extensive stroke is the most severe variant of acute cerebrovascular accident( abbreviated to ONMC).When stroke occurs necrosis of areas of the brain and the death of its nerve cells due to oxygen starvation.
The term "extensive" in this case is characterized by several options:
- The defeat and necrosis of large areas of the brain.
- Participation in the formation of the focus of stroke - "interest" of large arteries, blood supply to the brain.
- Many small areas of affected brain tissue.
Fabrics that are deprived of food and oxygen, die. Considering that every square millimeter of the substance of the brain is responsible for the regulation of certain functions of the body, then after the death of the nerve cells, important reflexes and abilities inevitably suffer. So, a patient after a stroke can lose speech, hearing, vision, lose the ability to control the muscles of the trunk and extremities, lose control over the operation of the sphincters of the rectum and urethra.
With small foci of stroke and rapid onset of treatment, such consequences can be completely or partially eliminated. In a number of cases, such problems can remain forever. With the death of brain areas responsible for the regulation of heartbeat or breathing, a person most often dies within a very short time - from a few seconds to several hours from acute respiratory or heart failure.
Extensive brain damage more often than usual stroke is rapid development of clinical picture, severity of the course and consequences. The more brain cells died, the heavier the course and the worse the prognosis for the patient.
Snapshot of computed tomography: A - norm;In - an extensive stroke of the brain in the temporal lobe Stroke, especially with massive damage to brain tissue, can rightly be called one of the most serious diseases in neurology. After extensive stroke, the chances of recovery and the full restoration of vital functions are small - about 15-20%.We will talk about life projections, recovery and risk factors for severe disability below.
Neurologists and neurosurgeons are usually involved in the treatment of cerebral circulation disorders. A very important contribution to further recovery and recovery after a stroke is made by rehabilitation doctors, whose task is the development and implementation of individual programs for each patient.
Causes of a stroke
It is very important to understand why a person has cerebral circulatory disorders and strokes. So you can prevent or predict this difficult condition.
- Atherosclerosis of cerebral vessels - deposition of salts of cholesterol and calcium on the internal lining of the arteries. This is the most common cause of extensive strokes. Atherosclerotic plaques, growing inside the vessel, gradually narrow its lumen. Sooner or later there comes a time when the lumen of the vessel is completely blocked and the area of the brain is deprived of food.
- Uncontrolled hypertension. Sudden "jumps" of blood pressure lead to a severe spasm of cerebral vessels and necrosis of its areas.
- A sharp and sudden drop in blood pressure. As a consequence, there is a sharp depletion of the blood flow and a stroke occurs. This situation is often satisfied with an illiterate and sharp decrease in the level of blood pressure when providing care to a patient with hypertensive crisis.
- Thromboembolism - occlusion of the lumen of the vessel by a thrombus from the systemic blood flow.
- Spontaneous thromboses in cerebral vessels due to the taking of certain drugs( combined oral contraceptives, estrogen preparations, anabolics and others), alcohol, dehydration and hereditary diseases of the blood coagulation system.
- Hemorrhage in the brain tissue or under its membranes is a special type of stroke - a hemorrhagic extensive stroke. Hemorrhage occurs due to rupture of the cerebral vessel. The reasons for this are head injuries, blood pressure jumps against the background of arteriosclerosis of the vessels, congenital anomalies of the vessels( aneurysms and vascular malformations - tangles of blood vessels).
- Factors that increase the risk of an extensive stroke include diabetes mellitus, hypertension, heart rhythm disorders, obesity, high cholesterol levels, smoking, alcoholism, taking oral contraceptives, severe stress, dehydration, and past episodes.
Symptoms of extensive stroke
Any damage to the brain tissue is characterized by the so-called neurological symptoms:
- Severe headaches. Pain, especially in the initial stages, is so strong that it provokes nausea and vomiting, which does not bring relief.
- Consciousness disorders: from easy confusion to coma. It should be noted that the rapid development of deep coma is extremely characteristic of a vast stroke.
- Speech disturbances: incoherence speech, the inability to pronounce complex sentences or phrases. Sometimes a person forgets how this or that subject is called.
- Memory impairments are memory dips, a person can forget his name or today's date, but remember less important things.
- Problems with eyesight: double vision, flickering of color and black spots, "dips" in the picture, visual hallucinations, impaired pupillary reaction to light, omission of one century.
- Hearing impairment: ear congestion, tinnitus, auditory hallucinations.
- Severe disorders of muscle tone - hemiparesis - unilateral paralysis of muscles. The patient can not raise his right or left arm or leg, and facial expression is unilaterally violated. What is characteristic, if the movements in the right half of the body are violated, then the lesion of the brain is in its left half.
- Heat, fever, redness of face, chills.
Any of the listed symptoms, much less their combination, is an occasion to consult a doctor immediately, especially if there have been episodes of high blood pressure or cerebrovascular accidents in the past.
Symptoms of a stroke: asymmetry of a smile, weakness in a hand. Diagnostic measures
The whole world community makes a huge accent on the diagnosis of a stroke "on the spot."Special scales and methods for assessing the likelihood of stroke, which should be owned by any person, even far from medicine, have been developed. An example of such an evaluation table is the Cincinnati scale or the UDAR rule:
- U - Smile. It is necessary to ask the patient to smile. A significant sign of cerebral circulation disorders is the asymmetry of the smile and the omission of one of the corners of the mouth.
- D - Movement. It is necessary to ask the patient to raise both arms and both legs simultaneously. If one of the extremities does not rise or rise asymmetrically, this may be a sign of a stroke.
- A - Articulation. The patient should say a simple sentence - for example, a well-known saying. If there is a stroke, the speech turns out to be smeared, indistinct, with words failing.
- P - Solution. According to the results of the test, it is necessary to make a decision on hospitalization of the patient in a medical institution. Two positive test results indicate a certain impairment of cerebral circulation with a probability of about 70%, three or more signs - 85 or more percent.
Click on the picture to enlarge A patient with suspected extensive stroke should be immediately taken to a neurological or neurosurgical unit where professionals will be examined. The following examinations will be made to the patient:
- A neurologic examination to identify special neurological stroke marks and a further survey algorithm.
- Computed tomography, or CT scan is a type of X-ray study. CT performs excellently with the search for "fresh" areas of brain damage( not older than 24 hours).
- Magnetic resonance imaging, or MRI, is the preferred method for diagnosing already formed areas of ischemia and brain damage.
- Electroencephalography( EEG), or recording electrical brain activity, is very valuable for diagnosing coma. EEG is used to predict the activity of the brain.
- Ultrasound examination of the BCA - brachiocephalic arteries of the neck, feeding the brain.
- Lumbar puncture - taking samples of cerebrospinal fluid and its biochemical analysis.
- Blood tests for platelet levels, biochemical blood test, blood for clotting.
Electroencephalography( EEG) Basic principles of
treatment The golden rule of specialized care is the initiation of therapy within the first three hours of the onset of the first symptoms. This "rule of three hours" significantly increases the chances of recovery of the patient.
Let's list the main principles of treatment of the pathology of an extensive stroke:
- Correction of the blood pressure level. With hypertensive crisis, the rate of pressure reduction should not exceed 20% of the initial for two hours. At low pressure, the rate of recovery of pressure digits is similar.
- Correction of the blood coagulation system - "dilution" of blood and dissolution of blood clots with the help of special preparations.
- Connecting the patient to life support devices: a ventilator, monitoring monitors for breathing and circulatory function.
- Hemorrhagic stroke with the accumulation of large volumes of blood in the brain substance, as well as the continuing bleeding - is an indication for trepanation of the skull for mechanical emptying of the hematoma and cavities.
Rehabilitation after a stroke
It can be said that rehabilitation after stroke and other disorders of the cerebral circulation is the basis for restoring the quality of life. Stroke requires restorative measures and care as much as possible.
As a rule, the rehabilitation course takes from several months to several years. Various researchers give average periods of rehabilitation within 6-36 months. The speed and usefulness of patient recovery directly depend on the quality of rehabilitation measures, the regularity of these procedures, as well as the vastness of the brain tissue damage, the age and the initial state of health of the patient.
Basic rehabilitation after a stroke
- Prophylaxis for the formation of decubitus - ulcerative skin defects and underlying fiber due to the patient's constant stay in a stationary position. To combat bedsores several times a day to turn the patient, put special rollers and "cheesecake" under the sacrum, shoulder blades, neck, limbs.
- Providing personal hygiene of the patient. Often patients after a stroke can not control their physiological needs. It is necessary to carefully monitor the purity of the genital area and perineum to avoid infections and purulent complications. The patient needs to be washed, wiped with wet towels, change diapers or serve the vessel.
- Passive gymnastics and massage. Nurses or trained relatives knead spasmodic immobile muscles, trying to "develop" and bend the joints.
- Therapeutic physical training. Classes are conducted by the instructor LFK or a doctor-rehabilitologist. With their help, the patient gradually, beginning with the most primitive exercises, learns to move his fingers, limbs, sit in bed.
- Classes with speech therapist and defectologist help to restore speech and understanding of speech.
- Psychologists and psychotherapists help the patient restore the functions of thinking, understanding, remembering. Often patients learn how to write, count, draw, analyze and draw conclusions.
- Social adaptation and support of close people is very important. The patient should not feel defective, it is necessary to encourage him and inspire him with faith in success.
It is important to understand and be prepared for the fact that all these activities need to be done daily for a long time to see at least a slight improvement.
A special mattress that prevents the occurrence of pressure sores Forecast for
Unfortunately, the serious disturbances of cerebral circulation do not leave the patient and his relatives hopeful. World statistics is inexorable:
- With extensive stroke, the consequences and chances of surviving on average are equivalent to 65-70%.Here we are not talking about the defeat of the vital centers of the brain - in this case the lethality is close to 95%.
- Of survivors, about 60-80% have a disability and the consequences of varying severity, leading to disability.
- Only 5% of the victims are fully recovered. Typically, these are young patients who received the first specialized care for the first three hours.
- Approximately 15% of cases during the year the patient has a second stroke, most often leading to death.
Preventive measures after cerebral circulation disorders are very important. Control of body weight, stable blood pressure and cholesterol level, rejection of bad habits and oral contraceptives, regular intake of medicines prescribed by a doctor can prevent such a serious illness.
