From this article you will learn: the course of the disease of a stroke, its symptoms. Possible complications, prognosis, how to treat pathology.
content of the article:
- essence and features of pathology
- relationship causes and types of diseases
- Characteristic symptoms
- Therapies
- forecast at
disease Stem stroke - death( necrosis, destruction) of nerve cells the most important part of the brain - its trunk - as a result of acute disorderscerebral circulation.
As with any other stroke, the destroyed tissues lose their functions. But with the localization of the process in the trunk there is an immediate threat to life. In this zone there are nerve centers that regulate the most important functions of maintaining the vital functions of the body - respiratory and cardiovascular( vasomotor).
Therefore, poor circulation in the barrel causes persistent disabling disorders( complete paralysis of the extremities, face, and even the act of swallowing) or ends in death within a few hours after the onset of the disease. Such distinctive features of the stroke stem allowed to separate it from a separate form from strokes of any other localization.
Survival is possible for a few( about 20%) provided early treatment( in the first 3 hours) for medical care. The prognosis of full recovery is not more than 2-3%.The treatment is carried out by neuropathologists( neurologists) together with resuscitators. In particular
than pathology
Stem stroke occurs due to the fact that the blood vessels that bring blood to the site of the brain, it is not able to provide nutrients and oxygen. This leads to the death of cells, the function of which the remaining neurons can not take over.
The stem part of the brain is a special zone not only for the nervous system, but for the body as a whole, since it contains the main centers that support its vitality.
A brief excursion into the anatomy of the
The trunk is the oldest part of the brain. In view of its importance, it occupies the deepest place in the skull - on its base( at the bottom).Through him, all the information from the senses passes through the cerebral cortex, and all motor impulses to the spinal cord come out of the cortex, as the stem directly passes into it. The anatomical sections of the trunk and the functions for which they respond are described in the table.
Functions of the brain stem. Click on the photo to enlarge | Part | trunk avilable and |
|---|---|
| function medulla oblongata | gives rise to the cranial nerves, which are responsible for swallowing, sensitivity and movement of the tongue, as well as the vagus nerve, through which the nervous system controls all the internal organs |
| Contains the mostmain pathways( pyramidal), which are conscious of the brain motor commands to muscles, as well as ways of conducting sensitivity | |
| respiratory and cardiovascular( sosudodvigatelny) centers - the main regulators of respiration and cardiac activity | |
| Bridge | gives rise to nerves through which the regulation of posture, perception of hearing sensitivity and |
| facial motion contains nerve fibers, through which there is coordination, the cerebellum connection with | |
| bark Middle | brain unconsciouslyregulates muscle tone, causes defensive motor reactions and reflexes to all sensitive stimuli, the position of the eyes at rest and when the head turns |
Stroke, affectingthe one or the other anatomical zone of the brain stem, in the first place, violates the functions for which it is responsible.
Interrelation of the causes and types of the disease
Because the stroke develops in the same way as the strokes of any other localizations, the causes of their development are common. They depend on the nature of the changes in blood vessels and nervous tissue. Accordingly, two types of disease are distinguished: ischemic and hemorrhagic stroke of the trunk. Their causes and characteristics are described in the table:
| Causes of ischemic process - cell death due to occlusion of cerebral arteries | Causes of hemorrhagic process - destruction of neurons by blood due to rupture of vessels |
|---|---|
| Atherosclerotic plaques | Increased pressure( hypertension) |
| Creation of blood clots in cerebrovascular vessels | Congenital arterial anomalies |
| Blood clotsembolism) | Bad blood clotting |
| Inflammation of the vascular wall | Craniocerebral injury |
| Disturbance of structure and weakening of blood vessels, due todiabetes |
Typical symptoms of brainstem stroke
Symptoms depend on what part of the trunk is most impressed. But specific focal features can be observed only in the first hours of illness, as well as in the recovery period. During the height of pathological changes, patients are immobilized, unconscious, and focal symptoms are versatile. But to understand that the trunk is affected, it is possible in 95-96% even according to the survey.
The clinical picture of an ischemic stroke of the trunk develops faster than similar changes in another location, but in stages - within a few minutes or hours. The hemorrhagic process occurs suddenly, proceeds lightning fast, and its prognosis is worse. But in general, the stem manifestations of ischemic and hemorrhagic strokes are the same.
Vertigo and impaired coordination of movements
In 60-70% of the earliest symptom of a stroke is persistent dizziness and inability to rest on legs, accompanied by a headache in the back of the head or in the temples. Such patients either suddenly fall, or are forced to accept a horizontal position due to the fact that they can not go or even sit. Attempts to hold the vertical posture further increase dizziness.
Movement disorders
Stem stroke significantly disturbs the motor activity of the extremities. Paralysis can spread as one half of the body( right or left hemiparesis), and on all limbs( tetraparesis).If a person is conscious, he can not move his arms and legs at all, despite the fact that he realizes it.
Swallowing disorder - dysphagia
In 65% of patients with stroke stroke, swallowing is difficult or impossible at all. This is an indication of an unfavorable prognosis. It is caused by the loss of mobility of the muscles of the pharynx and the soft palate. A person tries to swallow a food lump, but can not perform a full swallowing movement. As a result, food gets into the respiratory tract, causing a violent cough.
Speech disorders - dysarthria
In 30-40% it is difficult, distorted or even impossible pronunciation of words. This means that, unlike a normal stroke in the left hemisphere, a person wants to say something, knows the words and tries to pronounce them, but they either are not pronounced at all or sound distorted. The reason for this is a violation of the movements of the tongue, facial musculature, pharynx and vocal cords.
Eye Symptoms
Nerve centers responsible for eye movement upward, outward and raising the upper eyelid, are destroyed by stem stasis. Therefore, patients note doubling in the eyes, the inability to focus the sight on the object, one-sided strabismus, the deviation of the eye outward and the omission of the eyelid( ptosis) on the side of the lesion.
Osteoarthritis of the Stroke Stroke Alternating Syndrome - Paralysis and Skewed Face
In the presence of unilateral paralysis( a bent, immobilized arm and leg), the patient shows a distorted face - the upper eyelid, the sagging corner of the mouth and the skin of the entire facial area, opposite the paralyzed limbs. Such symptoms suggest that the stroke stroke affects mimic muscles on the side of brain damage, and limbs on the opposite.
Respiratory, heartbeat and temperature disorders
The most dangerous signs of a lethal prognosis of a stroke stem:
- Disturbance of breathing - rare, intermittent, periods of apnea( absence).
- Bradycardia - a rare heartbeat( less than 60 / min), which was preceded by an increase in the rhythm and pulse.
- Hypotension - pressure drop less than 100/60 mm Hg.st, replacing its increase.
- Malignant hyperthermia - a strong increase in body temperature( more than 39 ° C), not amenable to drug reduction.
All these symptoms are accompanied by a cerebral coma and spontaneous floating movements of the eyeballs. Confirm the diagnosis can only tomography( CT or MRI).
With the help of computed tomography( CT) it is possible to diagnose a stroke stroke Patients with a stem stroke in 75-80% lose consciousness, but for the time being it is preserved - they can not speak and perform any limb movements( "locked man" syndrome).
Brain CT images show the stroke of a patient with the syndrome of "locked man"( the area of the stroke is highlighted in red) Methods of treatment
When the first symptoms of a stroke occur, do the following:
- Call an ambulance( phone 103).
- Evaluate consciousness, breathing and palpitation - if they are stored, lay the patient sideways.
- If the parameters are not available, place the patient on his back, perform artificial respiration and cardiac massage.
- Take the patient to the nearest hospital, where there is a neurologist and resuscitator. They will provide specialized assistance:
- inhalation of oxygen or artificial respiration on the apparatus;
- control over pressure - magnesium sulphate, Enap, Metoprolol is added when increasing, and when dexamethasone is lowered, Atropine, Dopamine;
- treatment of cerebral edema - L-lysine, Furosemide, Mannitol;
- improved nutrition of neurons - Ceraxon, Thiocetam, Pyracetam, Cavinton, Neuromax, Neurobion, Cortexin;
- differentiated treatment for stroke - with haemorrhagic they inject haemostatic drugs, and with ischemic thrombolytics( Aktilis) or anticoagulants( Heparin, Clexane);
- symptomatic treatment - painkillers and anti-inflammatory, antibiotics, probe nutrition, urinary catheter.
If patients survive, this treatment lasts about 3-4 weeks. The prognosis will be maximally positive if the rehabilitation is continuously continued from 3 months to 1 year.
Forecast for
According to statistics, about 75-85% of stroke patients die within the first three days. Survivors become deep invalids, but not all are bedridden( 50-60%).Less than 20% of such people live longer than 5 years. Affect the forecast is almost impossible. Only helping in the first 3 hours of the onset of the disease can help save lives and recover more fully. The probability of full recovery is 2-3%.
The signs of an unfavorable prognosis are:
- "closed person" syndrome - deep disability;
- respiratory, cardiovascular and temperature disorders - death;
- preservation of neurological disorders for more than a year - their lifelong preservation.
The only salvation from stem stroke is its prevention, which consists in the early elimination of the potential causes of the disease.
