Ischemic cerebral stroke is a cerebral infarction that develops with a significant decrease in blood flow due to an obstruction in the blood vessels that supply blood to the brain.
Among the diseases leading to the development of cerebral infarction, at the first place you can put atherosclerosis( cerebral) with the defeat of the main cerebral vessels on the neck or intracranial vessels, individually or simultaneously.
Cerebral atherosclerosis is most often combined with hypertension, or hypertension. Acute ischemic stroke is a dangerous condition requiring immediate hospitalization of the patient in the therapeutic department of the hospital and the provision of emergency medical services.
The ICD code 10 for cerebral infarction is coded under I 63 with the addition of a period and digits after it to clarify the type of stroke. In addition, when encoding such diseases, the letter "A" or "B"( lat.) Is added, which indicates:
- Brain infarction against a background of arterial hypertension;
- Brain infarction without hypertension.
Consider the causes of cerebral ischemia, the consequences after a stroke, the prognosis of the patient's life, his treatment and rehabilitation.
CONTENTS
Ischemic cerebral stroke: causes
As we have said, for developmentstroke requires obstacles to blood circulation in the brain. Violation of the cerebral blood flow is promoted by fat deposits inside the walls of the cerebral vessels. This is cerebrosclerosis.
The state of ischemic stroke causes a thrombus, which can form in a blood vessel( thrombosis) or elsewhere in the circulatory system( embolism).
The diagnosis of the disease nosology form is based on three independent pathologies characterizing the local circulatory disorder in the brain, denoted by the terms: " Ischemia ", " Infarct ", " Stroke ". Ischemia lacks blood supply in the local area of the organ or tissue. Stroke - a violation of blood flow in the brain during rupture and / or ischemia of one of the vessels, accompanied by death of brain tissue.
Symptoms depend on the type of pathology
Symptoms in ischemic stroke symptoms will depend on the type of the disease:
- Atherothrombotic attack - occurs due to atherosclerosis of an artery of large or medium size, develops gradually, most often occurs in a dream.
- Ischemic , associated with rare causes - stratification of the artery wall, excessive coagulability of blood, vascular pathology( non-atherosclerotic), hematological diseases.
- Cardioembolic form - develops as a result of partial or complete blockage of the middle artery of the brain with the embolus, occurs suddenly during wakefulness, and subsequently embolisms can occur in other organs.
- Lacunar - diabetes mellitus or hypertension can cause circulatory disorders in small-diameter arteries.
- The unknown origin of is characterized by the inability to determine the exact causes of occurrence or the presence of several causes.
Simple ischemic stroke - impaired circulation in one part of the brain due to its clogging with a thrombus or cholesterol plaque.
Stroke periods
Five main periods of completed ischemic stroke are distinguished:
- The acute period is the first three days.
- Acute period - up to 28 days.
- Early recovery period - up to six months.
- Late recovery period - up to two years.
- The period of residual events is after two years.
Most ischemic cerebral strokes begin suddenly, develop rapidly, and lead to the death of the brain tissue from a few minutes to several hours.
Types of ischemic stroke: right-sided, left-sided, cerebellar, extensive
In the area of the lesion, the cerebral infarction is divided into:
- Right-hand .Stroke ischemic right side - the consequences affect mainly motor functions, which are subsequently poorly restored, psycho-emotional indicators may be close to normal;
- Left-hand .Stroke ischemic left side - as the consequences are mainly psychoemotional sphere and speech, motor functions are restored almost completely;
- Cerebellum - impaired coordination of movements;
- Extensive - occurs with complete absence of blood circulation in a large area of the brain, causes swelling, often leads to complete paralysis with the inability to recover.
Pathology most often occurs with people in old age, but it can happen in any other. The prognosis for life in each case is individual.
Right-sided ischemic stroke. Ischemic stroke on the right side affects the zones responsible for motor activity of the left side of the body. The consequence is paralysis of the entire left side.
Conversely, if the left hemisphere is damaged, the right half of the body refuses. An ischemic stroke in which the right side is struck can also cause speech impairment.
Left-sided ischemic stroke. With ischemic stroke on the left side, the speech function and ability to perceive words are seriously disrupted. Possible consequences - for example, if Broca center is damaged, the patient is deprived of the opportunity to compose and accept complex sentences, only single words and simple phrases are available to him.
Stem. This type of stroke as a stroke ischemic stroke is the most dangerous. In the brain stem are the centers that regulate the work of the most important from the point of view of life support systems - cardiac and respiratory. The lion's share of deaths are due to stem marrow infarction.
Symptoms of stem ischemic stroke - inability to navigate in space, reduced coordination of movement, dizziness, nausea.
Cerebellar. The ischemic stroke of the cerebellum in the initial stage is characterized by a change in coordination, nausea, dizziness, vomiting. After a day, the cerebellum begins to press on the brain stem. Facial muscles can become numb, and a person can fall into a coma. Coma in ischemic stroke of the cerebellum is very common, in the overwhelming majority of cases such a stroke is pumped by the patient's death.
Ischemic stroke of the brain: symptoms of
Stroke in 80% of cases is observed in the system of the middle cerebral artery, and in 20% - in other cerebral vessels. With ischemic stroke, as a rule, the symptoms manifest suddenly, in seconds or minutes. Less often the symptoms come gradually and intensify over a period of a few hours to two days.
Symptoms of ischemic stroke depend on which part of the brain is damaged. They are similar to the symptoms of transient ischemic attacks, but the impairment of brain function is more difficult, manifests itself for more functions, for a larger area of the body, and is usually resistant. It can be accompanied by a coma or a more mild depression of consciousness.
For example, if a vessel that holds blood to the brain along the front of the neck is blocked, the following disorders occur:
- Blindness in one eye;
- One of the arms or legs of one side of the body will be paralyzed or very weakened;
- Problems in understanding what others are saying, or inability to pick up words in conversation.
When a vessel that carries blood to the brain along the back of the neck is blocked, such abnormalities can occur:
- Blindness in one eye;
- One of the arms or legs of one side of the body will be paralyzed or very weakened;
- Problems in understanding what others are saying, or inability to pick up words in conversation.
In cases where a vessel that holds blood to the brain along the back of the neck is blocked, such disturbances may occur:
- Doubling in the eyes;
- Weakness in both sides of the body;
- Dizziness and spatial disorientation.
If you notice any of these symptoms, be sure to call at an ambulance .The earlier the measures are taken, the better the prognosis for life and the likelihood of more severe consequences.
Symptoms of transient ischemic attacks( TIA)
Often they precede ischemic stroke, and sometimes TIA is a continuation of a stroke. Symptoms of TIA are similar to focal symptoms of a small stroke.
The main differences between TIA and strokes are revealed in CT / MRI studies, by clinical methods:
- There is no( not visualized) focus of cerebral infarction;
- The duration of neurologic focal symptoms is no more than 24 hours.
Symptoms of TIA are confirmed by laboratory, instrumental studies.
- Blood to determine its rheological properties;
- Electrocardiogram( ECG);
- ultrasound - dopplerography of the vessels of the head and neck;
- Echocardiography( Echo KG) of the heart - revealing the rheological properties of blood in the heart and surrounding tissues.
Diagnostic methods
Basic methods for diagnosing ischemic stroke:
- Anamnesis, neurological examination, physical examination of the patient. Identification of concomitant diseases that are important and affecting the development of ischemic stroke.
- Laboratory tests - biochemical blood test, lipid spectrum, coagulogram.
- Measurement of blood pressure.
- ECG.
- MRI or CT of the brain can determine the location of the lesion, its size, the prescription of its formation. If necessary, CT angiography is performed to identify the exact site of the occlusion of the vessel.
It is necessary to differentiate ischemic stroke from other brain diseases with similar clinical signs, the most common of which include - a tumor, an infection of the membranes, epilepsy, a hemorrhage.
Ischemic cerebral stroke: after-effects after
In the case of an ischemic stroke, the consequences can be varied - from very severe, with extensive ischemic stroke, to minor, with micro attacks. Everything depends on the place of localization and the volume of the focus.
The most likely consequences of an ischemic stroke:
- Mental disorders - many stroke survivors experience post-stroke depression. This is due to the fact that a person can no longer be the same as before, he is afraid that he has become a burden to his relatives, he is afraid that he will remain an invalid for life. Also, there may be changes in the behavior of the patient, he can become aggressive, fearful, disorganized, may be prone to frequent mood swings for no reason.
- Sensitivity disorder in the limbs and face .Sensitivity is always restored longer than muscle strength in the limbs. This is due to the fact that the nerve fibers responsible for the sensitivity and conduct of the corresponding nerve impulses are restored much slower than the fibers responsible for movement.
- Disturbance of the motor function - the strength in the limbs can not recover completely. Weakness in the leg will force the patient to use the cane, weakness in the hand makes it difficult to do some household activities, up to dressing and holding the spoon.
- Consequences can manifest as cognitive impairment - a person can forget many things that are familiar to him, phone numbers, his name, his family's name, address, he can behave like a small child, underestimating the difficulty of the situation, he can confuse time and place,in which it is located.
- Speech disorders - may not be in all patients who underwent ischemic stroke. They make it difficult for the patient to communicate with his family, sometimes the patient can talk absolutely incoherent words and sentences, sometimes it can be just difficult to say something. Less frequent such violations with right-sided ischemic stroke.
- Swallowing disorders - the patient can sweat both liquid and solid food, this can lead to aspiration pneumonia, and then to death.
- Disorders of coordination of are manifested in staggering when walking, dizzy, falling with sudden movements and bends.
- Epilepsy - up to 10% of patients after ischemic stroke may suffer from epileptic seizures.
Prognosis for life with ischemic stroke
The prognosis of the outcome of ischemic stroke in old age depends on the degree of brain damage and on the timeliness and systematic nature of treatment interventions. The earlier the qualified medical aid and the correct motor rehabilitation were provided, the more favorable the outcome of the disease will be.
The time factor plays a huge role, the chances for recovery depend on it. In the first 30 days, about 15-25% of patients die. Mortality is higher for atherothrombotic and cardioembolic strokes and is only 2% for lacunar. The severity and progression of a stroke is often assessed using standardized meters, such as the stroke scale of the National Institutes of Health( NIH).
The cause of death in half the cases is cerebral edema and the resulting dislocation of brain structures, in the remaining cases - pneumonia, heart disease, pulmonary embolism, renal failure, or septicemia. A significant part( 40%) of deaths occurs in the first 2 days of the disease and is associated with extensive infarct size and brain edema.
About 60-70% of the survivors have a disabling neurological disorder by the end of the month. Six months after the stroke, disabling neurological disorders remain in 40% of surviving patients, by the end of the year - 30%.The more significant the neurological deficit is at the end of the first month of the disease, the less likely a complete recovery is.
Restoration of motor functions is most significant in the first 3 months after a stroke, while the function of the leg is often restored better than the function of the hand. Complete absence of hand movements towards the end of the 1st month of the disease is a poor prognostic sign. A year after the stroke, further recovery of neurological functions is unlikely. In patients with lacunar stroke, there is a better recovery than with other types of ischemic stroke.
Survival of patients after an ischemic stroke is approximately 60-70% at the end of the first year of the disease, 50% after 5 years after a stroke, and 25% in 10 years.
To poor prognostic signs of survival in the first 5 years after the stroke include the elderly patient, previous myocardial infarction, atrial fibrillation, previous stroke, congestive heart failure. A recurrent ischemic stroke occurs in about 30% of patients in the period of 5 years after the first stroke.
Ischemic cerebral stroke: treatment of
Medical treatment
The main treatment for ischemic stroke is aimed at maintaining the vital functions of the patient. Measures are being taken to normalize the respiratory and cardiovascular systems.
In the presence of coronary heart disease, the patient is prescribed antianginal drugs, as well as means that improve the pumping function of the heart - cardiac glycosides, antioxidants, drugs that normalize tissue metabolism. Special measures are also taken to protect the brain from structural changes and swelling.
Specific therapy for ischemic stroke has two main objectives: restoration of blood circulation in the affected area, as well as maintenance of brain tissue metabolism and their protection against structural damage. Specific therapy of ischemic stroke involves the provision of medication, non-pharmacological, as well as surgical methods of treatment.
In the first few hours since the onset of the disease, it makes sense to conduct thrombolytic therapy, the essence of which is reduced to lysis of the thrombus and restoration of blood flow in the affected part of the brain.
Rehabilitation after an ischemic stroke
All patients who underwent stroke undergo the following stages of rehabilitation: neurological department, neurorehabilitation department, sanatorium treatment, outpatient dispensary supervision.
The main objectives of rehabilitation:
- Restoration of impaired functions;
- Mental and social rehabilitation;
- Prevention of post-stroke complications.
In accordance with the peculiarities of the course of the disease, the following treatment regimens are consistently used in patients:
- Strict bed rest - all active movements are excluded, all movements in bed are performed by medical personnel. But already in this mode rehabilitation begins - turns, wiping - prevention of trophic disorders - bedsores, respiratory gymnastics.
- Moderately expanded bed rest - a gradual expansion of the patient's motor abilities - independent rollovers in bed, active and passive movements, transition to the sitting position. Gradually allowed to eat in the sitting position 1 time a day, then 2 and so on.
- Chambers - with the help of medical personnel or with support( crutches, walkers, stick) you can move within the chamber, perform the available types of self-service( eating, washing, changing clothes).
- Free mode.
The duration of regimens depends on the severity of the stroke and the magnitude of the neurological defect.
Food
The diet implies restrictions in the consumption of salt and sugar, fatty foods, flour foods, smoked foods, pickled and canned vegetables, eggs, ketchup and mayonnaise. Doctors advise to add to the diet more fruits and vegetables that are full of fiber, eat soups prepared according to vegetarian recipes, sour-milk products. Particular benefit can boast those of them that have in their composition potassium. To such belong to dried apricots or apricots, citrus fruits, bananas.
Food should be a fraction, used in small portions five times every day. In this case, a diet after a stroke suggests a volume of fluid that does not exceed one liter. But do not forget that all actions should be discussed with your doctor. Only a specialist in the field of strength can help a patient recover faster and recover from a serious illness.
Prevention of
Prophylaxis of ischemic stroke is aimed at preventing the occurrence of a stroke and preventing complications and repeated ischemic attack.
It is necessary to treat arterial hypertension in a timely manner, to conduct a test with pains in the heart, to avoid sudden pressure rises. Proper and adequate nutrition, refusal to smoke and drink alcohol, a healthy lifestyle is the main thing in the prevention of cerebral infarction.
How to live after an ischemic stroke: doctor's advice MM Shperling
Neurologist MM Shperling( Novosibirsk) has an honest but tough conversation with people who underwent an ischemic stroke who wish or do not want to live a full-fledged,normal life. How to avoid a second stroke?
Ischemic stroke in diabetes mellitus: Dr. Myasnikov
Telecast "About the most important".Fragment, the answer to the viewer's question: Ischemic stroke in a 86-year-old woman suffering from diabetes mellitus. How to avoid recurrence and how to recognize a stroke?
Source of publication: http://simptomy-lechenie.net/ishemicheskij-insult-golovnogo-mozga/
