Stroke: the first signs and symptoms

Stroke, or cerebral vascular accident - a disease in which early diagnosis and the provision of qualified medical care are the most important factors affecting the prognosis.

After a stroke under the influence of hypoxia, changes in nerve cells begin to occur. Around the brain cells affected by necrosis there is an "ischemic penumbra" - a zone whose life outcome depends on the restoration of blood flow. During the "therapeutic window" (conventionally called the first 3-6 hours after a stroke), it is possible to prevent the irreversible consequences of ischemia and cell death by therapeutic manipulation.

In this regard, any person needs to know about the first signs of a stroke. It is important to be able to suspect the disease in time and to arrange the delivery of the victim to the hospital as quickly as possible.

Risk factors for stroke

On the one hand, clear pathognomonic (that is, inherent only in this disease) signs of stroke do not exist. Even the most specific focal symptomatology requires differential diagnosis, as this is not always the result of a stroke.

On the other hand, risk factors should be considered: if the symptoms occur against their background, then the probability of stroke increases dramatically. Their list is called a "deadly quintet", because even if there are 2-3 factors, the risk of a lethal outcome of an insult increases many-fold. These include:

1. Arterial hypertension. With increased arterial pressure, the risk of stroke increases fivefold.

1. Left ventricular hypertrophy. Almost always, "hypertension with experience" is accompanied by changes from the left side of the heart, as the cardiac muscle has to redouble blood to the blood vessels.

1. Increased cholesterol in the blood. Cholesterol of the blood can be called an "indicator" of the presence of atherosclerotic plaques in the vessels. As is known, most often the negative consequences of their presence are felt in the coronary and cerebral vessels.

1. Diabetes. With an increased level of sugar in the blood, the probability of developing a stroke increases by 2-4 times, since the glucose molecule damages the wall of blood vessels.

1. Smoking. It is proved that the regular use of nicotine increases the incidence of cardiovascular diseases by 2-4 times, in older age it is higher.

Precursors of stroke

It happens that a stroke occurs suddenly, but more often it occurs against the background of harbingers. For example, in half of cases, ischemic stroke is preceded by transient ischemic attacks (TIA). They should be regarded as the first signs of cerebral circulatory disorders requiring immediate diagnosis and treatment. Hypertensive crises can provoke their appearance or be independent precursors of the disease.

The treatment of these conditions can be considered as the prevention of the clinical form of stroke.

Also, the rapid development of stroke can be judged by the signs of cerebral circulation disorders, identified by special tests. One such questionnaire is Manvelov's test.

If at least three of the following symptoms are repeated once a week or more frequently in the last three months, an immediate medical attention is required:

1. Headache, which has no specific localization and occurs when fatigue or weather cataclysms occur.
2. Dizziness, appearing at rest and increasing with movement.
3. The presence of noise in the ears, both permanent and transient.
4. "Failures" of memory for events of the current period of time.
5. Change in the intensity of working capacity and sleep disturbance.

These symptoms should be considered as precursors of stroke.

Clinical features of the types of stroke

Despite the specific area of ​​damage and the clinical picture, the severity of the first symptoms is so different that diagnosis is difficult. With minor manifestations, many do not go to the doctor at all, and sometimes hospitalization is too late.

Talk about the differences in the first signs of the disease in men and women is not possible, because they are the same.

At a young age, the signs of a stroke usually do not have a strong expression, only one or two symptoms of a neurological deficit can be detected. In the elderly, the clinical picture of stroke is more likely to cause doubt, and the disease is more severe.

Ischemic and hemorrhagic stroke distinguish in the first hours of the disease is very difficult, and in this there is no special need: it is important to deliver the victim in time to the hospital, where they will conduct differential diagnostics and qualified help.

Differences in ischemic and hemorrhagic strokes are important in the prognostic plan: the first type of vascular catastrophe occurs much more often (in 80% of cases), more in the elderly, but it is easier than hemorrhagic. With ischemic stroke, there is rarely a severe headache and there is no loss of consciousness.

Hemorrhagic stroke is characterized by a sudden onset and is more severe. We can say that it combines two injuries: in addition to hemorrhage due to rupture of the vessel and the formation of a hematoma, around this zone is formed ischemia. Due to this, the size of the stroke is much wider. This type of vascular catastrophe is often accompanied by an intense headache, a state of impaired consciousness, an epileptic seizure.

In order to timely suspect the occurred vascular catastrophe in the brain tissue, it is important to know about the first signs of a stroke. The degree of their severity depends on the zone and extent of the lesion. In this regard, the article will describe the signs of severe, minor and lacunar strokes.

The first signs of a severe stroke

A severe form of stroke can manifest as a disorder of consciousness, right up to the coma.

With a large volume of the stroke zone, so-called classical signs of the disease develop. Their peculiarity consists in the fact that massive hemorrhages or zones of ischemia are accompanied by a disruption of the functioning of a large number of nerve cells and, as a result, a vivid clinical picture:

1. General cerebral symptoms are pronounced: the swelling of the brain is rapidly increasing. It may first appear severe headache, vomiting, develop a state of stun or coma immediately. Sometimes there are convulsions, tension (rigidity) of the back muscles of the neck is observed. Often the body temperature rises.
2. Focal symptoms depend on the affected area:

• paralysis or paresis (hemiplegia or hemiparesis) is observed on the half of the trunk opposite to the lesion. For example, with localization of a stroke in the right hemisphere, motor disturbances will appear on the left. There is an asymmetry of the face;
• the sight is directed towards the paralyzed limbs;
• if the patient is conscious, speech, orientation, vision, awareness of his condition and other focal symptoms can be observed.

When the zone of the respiratory center is affected, the character of breathing changes: it becomes frequent and superficial or can be wheezing and intermittent, up to a stop. Blood pressure can decrease, the pulse becomes frequent and weak. Possible involuntary urination and defecation.

Sometimes stroke will debut in the form of an epileptic fit. In a person who has never suffered from epilepsy, there is a brief loss of consciousness and against this background there are attacks of convulsive contractions of muscles. Foam is released from the mouth.

Extensive strokes are sometimes accompanied by a secondary stem syndrome. It is manifested by tonic contractions of different muscle groups and a violation of oculomotor functions:

• the pupil on the side of the lesion can be enlarged;
• pupillary reaction to light may be absent;
• can be observed a continuous rhythmic movement of the eyeballs to the right and left.

Usually such a bright symptomatology of none of the surrounding people does not cause doubts about the need for an early hospitalization, but is a prognostically unfavorable sign. Massive strokes occur in a vascular accident in the main cerebral arteries. For such damage, a high level of lethality or lifelong disability is characteristic.

The first signs of a micro-stroke

Microinsult occurs in 10-15% of cases and differs from other forms by rapid (from 2 to 21 days) regression of the syndrome of neurological deficit (SND). The presence of this syndrome is indicated by a combination of 2 or more of the following:

• paresis (weakening of muscular activity) of one or two (for example, right arm and right leg) of the limbs;
• spasm, or hypertonic muscle;
• convulsions;
• unsteady, unsteady walk;
• uncontrolled emotions in the form of rage or fun;
• loss of smell or vision;
• eye paralysis.

With a small form of stroke, foci of necrosis are formed and remain, but they are of small size or are located in functionally insignificant zones. In the presence of a developed network of anastomoses, it is possible to restore blood supply and reverse development of neurological symptoms.

The first signs of micro-stroke are very similar to TIA, however there are two cardinal differences. With TIA:

1. One of the symptoms of a neurological deficit is revealed, not a syndrome;
2. With instrumental studies (more often MRI), the focus of necrosis is not detected.

However, do not try to conduct a differential diagnosis yourself. If there is a symptomatology described above, you should immediately bring a person to the hospital, so that he is provided with qualified assistance.

TIA should not be considered an innocuous manifestation that does not require a doctor's appointment: 50% of patients who underwent TIA undergo a stroke within five years, and 50% have a myocardial infarction.

The first signs of lacunar stroke

About a quarter of ischemic infarcts are called lacunar and are the result of damage to small intracranial arteries. Perforating vessels connect the deep and superficial branches of the cerebral arteries and are thin stems with a diameter of up to 2 mm and a length of not more than 10 cm. The lacunar stroke has received such a name, because as a result of damage to the vessels, small cavities with liquid contents of up to 1 -

Symptoms of lacunar strokes are so unexpressed that often the disease goes unnoticed.

With this type of vascular accident, general cerebral symptoms in the form of disorders of consciousness or meningeal (rigidity of neck muscles, etc.) does not happen. A third of patients among the first signs may have a headache. However, it usually does not have a pronounced intensity.

The focal symptomatology is present, but it is shown insignificantly.

1. Among the first signs of lacunar stroke, we can note a change in gait, a violation of coordination. A person may have a feeling that this is a banal dizziness, it was "taken" somewhere.
2. Thus there is a muscle weakness in one limb or in the eponymous upper and lower, right or left half of the face. Sensitivity may be impaired: there is a sensation of numbness on the face, in the hand and leg on one side.
3. The control not only of movements, but also of one's own emotions changes: an inexplicable depression, tearfulness or, on the contrary, fun can come.
4. Speech can be difficult: a person can not utter simple phrases, says, stammering, forgets words.

To suspect a stroke and to hospitalize a patient is the main task of the prehospital stage, so there are many simple tests for preliminary confirmation of the diagnosis. Anyone without medical education can take advantage of them.

Most often, if you suspect a stroke, you are offered to smile (one corner of the mouth can be omitted), raise both hands (one will be lower) and say something (speech is broken). Even the presence of one of the signs indicates mandatory hospitalization.

Sometimes, with small strokes, visible to an outsider, the symptoms are not detected. However, the victim feels that he can worse perform the usual actions due to weakness in one half of the body. In such a situation, you should also immediately consult a doctor.

It is worth considering that if there are signs of a stroke, then the time of irreversible changes in the brain has already begun its countdown. Those 3-6 hours, which are to carry out restoration of impaired blood circulation and struggle to reduce the affected area, decrease with every minute.

Mariupol TV, the "Call the Doctor" program on "Hemorrhagic and ischemic stroke of the brain. Stroke. Symptoms, first signs »:

Hemorrhagic and ischemic cerebral stroke stroke treatment. Stroke symptoms first signs

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The first signs of a stroke! How in time to recognize the disease?

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