From this article you will learn: what is a microinsult, how does it differ from a vast stroke, how to prevent it, in time to determine the first signs and begin the necessary treatment.
The reasons for the micro stroke
The microinsult is a rather conventional term called acute cerebral circulation disorder in which the areas of the brain experience oxygen starvation and die or are necrotic. The principle of any stroke or cerebral circulation is simple - there is a blockage or spasm of blood vessels that feed brain tissue, brain cells die, and the person loses those functions for which the deceased part of the brain( speech, hearing, vision, controlled muscle movement) was responsible.
The main difference between the micro-stroke is seen already from the term "micro", or small. With this type of cerebral circulatory disturbance, small arteries, which feed brain tissue, are affected, and therefore a much smaller volume of brain tissue dies as compared to an extensive stroke.
The consequences of such microscopic lesions are much smaller, a person can almost completely restore the lost function of speech, hearing or movement, but this requires an excellent body reserves and persistent labor over themselves.
The main insidiousness of micro strokes lies in the erased clinical picture - the first signs of micro-stroke appear later and slower, so the beginning of diagnostic and therapeutic activities is significantly delayed. And the later the specialized treatment of cerebral circulation disorders is started, the worse the results and forecasts.
Usually, a neurologist is involved in the diagnosis and treatment of any stroke. However, the first doctor to whom a patient with a micro-stroke can apply may become a doctor of any specialty, depending on the nature of the patient's complaints - headache, visual impairment, heart failure, and so on.
Causes of a micro stroke
As we have already mentioned, the main cause of any kind of stroke is some obstacle to the current of blood, which supplies brain cells with nutrients and oxygen. Conditionally the causes of such obstacles can be divided into three groups:
- VAS spasm. This pattern is most often observed in people with constantly high blood pressure - arterial hypertension. However, a stroke can also occur in a completely healthy person with constantly normal pressure against the background of stress, taking certain drugs, dehydration, shock and so on. A sharp jump in pressure in such patients can cause both a micro-stroke and other types of disorders of the cerebral circulation.
- Clogging of vessels. Violation of the lumen of the vessel makes blood flow difficult - there is oxygen starvation of tissues. Blockage of the vessel can occur atherosclerotic or cholesteric plaque, thrombus, gas bubble, less often - bacterial screening, metastasis or foreign body.
- Rupture of the feeding vessel. Strokes, formed in this way, are called hemorrhagic. The blood that has poured from the vessel, not only does not reach the "destination", but also impregnates the surrounding tissues, exacerbating the defeat. The cause of rupture of the vessel may be a jump in pressure, arteriosclerosis of the vessels, head trauma, a violation of the venous outflow from the head - for example, an attempt at strangulation.
At-risk groups for the development of
disease Modern medicine clearly identified patients whose health status and lifestyle significantly increase the risk of developing cerebrovascular disorders:
- People with diseases of the cardiovascular system, especially those with heart rhythm disorders and arterial hypertension.
- Atherosclerosis of vessels - deposition of cholesterol salts on the inner lining of blood vessels - formation of plaques.
- Hereditary and acquired blood clotting disorders - antiphospholipid syndrome, polycythemia, defect factor Leiden and so on.
- Obesity and consumption of large amounts of fatty and sweet foods.
- Diabetes mellitus. Smoking and taking alcohol in large doses.
- Admission of combined oral contraceptives by women.
- The period of menopause in women, especially against a background of severe climacteric syndrome.
- Strokes and heart attacks in the past.
- Hereditary predisposition and family history.
- A sedentary lifestyle - especially bedridden patients.
- Chronic fatigue, stress, emotional distress.
Symptoms of micro-stroke
In this section, we will try to describe in more detail the first signs of micro-stroke manifestation, so that the reader can assume the development of the disease in himself or others.
At once it would be desirable to note, that at a micro stroke the symptoms directly depend on the localization of the focus and the caliber of the infected vessel feeding it. Simply put, the smaller the vessel, the less reliable the first symptoms of the disease.
- Severe headache. Such a headache arises or intensifies quite sharply, it is not removed by ordinary tablets and does not go away after sleep or rest.
- Numbness of face, limbs, tongue. In the presence of a stroke, it is often noticeable that the patient descends the corner of the mouth, the lip hangs and the eye closes.
- Violations of the functions of sensitive analyzers - hearing, smell and vision. The patient can complain about the flickering of "circles" or "flies," the vagueness of structures, white and dark spots, tinnitus, perversion or loss of smell.
- Speech disturbances - the patient's tongue "sticks", speech becomes fuzzy. Unfortunately, such patients are often referred to as "drunkards", so help them begins to turn out much later.
- Numbness or complete "failure" of the hands or feet. For micro strokes, the numbness of the fingers and hands, the muscle weakness, the unsteadiness and gait of the gait are more typical.
- Common symptoms can be added to the listed typical symptoms: anxiety, sweating, palpitations, shortness of breath, dizziness, feelings of panic and fear.
These symptoms may be present in equal measure, or will be allocated to any one. In any case, the headache, which is not removed by conventional medications, numbness and refusal of the limbs or tongue, especially against the background of a high level of blood pressure - is an occasion to visit a neurologist immediately.
It is important to understand some complexity in defining concepts. Micro-stroke these symptoms have the right to be called if such neurological symptoms persist for a day or more. Everything that passes before 24 hours is referred to as acute transient disturbances of cerebral circulation, or TIA-transient ischemic attack. In fact, the line between all these concepts is very subtle and is based more on long-term consequences - that is, one or another neurological symptomatology will persist after 24 hours or not.
Diagnosis of
The "gold standard" of any disorder of cerebral circulation is magnetic resonance imaging, or MRI, of the brain. In the picture, you can examine in detail all the structures of the brain and see the smallest - to fractions of a millimeter - lesions. With the help of MRI also you can monitor the dynamics of regression or "resorption" of pathological foci.
But MRI is a rare, inaccessible and extremely expensive method of investigation, and it is extremely difficult and impractical to perform it for emergency indications to any patient with a headache. That is why there are a number of indicative tests, the results of which can assess the need for this method of research for a particular patient:
- Inspection of the neurologist with specific neurological tests to assess the patient's stability, the state of his muscles, reflexes, pupils.
- Measurement of pressure and cholesterol levels - the higher these values, the higher the risk of stroke.
- Determination of blood clotting - in the presence of certain trends to increase coagulability - hypercoagulable - the risk of blood clots in the vessels of the brain is higher.
Initial diagnosis of stroke at home
I want to pay special attention to pre-medical diagnosis of ischemic brain lesions. The first signs of a micro-stroke do not always appear in the medical institution, more often it happens at work, on the street or in the family circle. It is important to know which orientation tests can be conducted before contacting a doctor.
- Smile. If you ask the patient to smile, the asymmetry of the mouth will be noticeable - one corner will be lower.
- Speech - it is worth asking the patient to say a few simple phrases - for example, a proverb or proverb. The speech will be more slow and fuzzy.
- Movement. It is necessary to ask the patient to raise arms or legs. If there are violations of the cerebral circulation - one of the limbs will lag behind or do not obey the master at all.
These tests, with apparent simplicity, are very effective and saved lives and health for many people.
Methods of treatment
Ideally, if the reason for the beginning of therapy are already the very first signs of cerebral circulation disorders, but this happens very rarely. In the presence of blurred symptoms of a micro-stroke, treatment rarely begins earlier than a day from its onset.
The main drugs for the treatment of cerebral circulation disorders are:
- Thrombolytics - this group of drugs hits the heart of the blood clots - dissolves the blood clot and restores the blood flow in the vessel( streptokinase, urokinase, alteplase and others).But the effect of thrombolytic therapy can be obtained only within 72 hours of the onset of thrombosis, but with hemorrhagic strokes such drugs will kill the patient. It is important to clearly know what kind of stroke you have to fight.
- Anticoagulants - a group of drugs aimed at preventing blood clotting and the formation of thrombi - heparin and its low molecular weight analogues( fragmine, fractiparin and others).
- Disaggregants are agents that prevent the "knocking" of blood cells: aspirin, clopidogrel, dipyridamole and so on.
- Diuretics, especially mannitol - selectively remove edema from the brain tissue, preventing more severe complications - wedging of swollen brain tissue into the occipital opening.
- Antihypertensive drugs - use both "emergency" drugs, and permanent, specially selected therapy in the recovery period.
- Neuroprotectors are a broad group of medicines and vitamins to support brain cells during the recovery phase - an antioxidant complex, B vitamins, magnesium, nootropics and so on.
Types of drugs, their combinations and treatment is prescribed only by a doctor.
Rehabilitation measures are extremely important at the rehabilitation stage: physical therapy, water procedures, physiotherapy, exercises with speech therapist and rehabilitologist, therapeutic diets, sanatorium treatment. The more persevering and hard-working the patient will be, the sooner will the lost functions of the brain return to him and speech, hearing, vision, and muscular strength will be restored.
It is very important to undergo a doctor-appointed treatment, take drugs from pressure, antiaggregants. It is necessary to follow a diet, give up alcohol and smoking, play sports, sleep well and walk a lot.
Prognosis for
The micro-stroke consequences depend on the age of the patient, his initial condition, the diameter of the affected vessel and the volume of deceased brain tissue, as well as the rate of initiation of treatment and the quality of rehabilitation.
Microinsult most often implies a complete restoration of the health and quality of life of patients, but significantly increases the risk of recurrence of an episode of circulatory disturbance in the future. According to statistics, about 60% of cases after a micro stroke within a year comes a repeated ischemic attack.
That is why the guarantee of health and quality of life is a hard measure to prevent the disease, because each subsequent episode is more and more difficult.
