Ischemic stroke of the brain

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Ischemic stroke is a cerebral infarction that develops with a significant reduction in cerebral blood flow.

Among the diseases leading to the development of cerebral infarction, the first place is occupied by atherosclerosis, which affects the main vessels of the brain on the neck or intracranial vessels or both.

There is often a combination of atherosclerosis with hypertensive disease or arterial hypertension. Acute ischemic stroke is a condition requiring immediate hospitalization of the patient and conducting adequate medical measures.

Ischemic stroke: what is it?

Ischemic stroke occurs as a result of an obstruction in the blood vessels that supply blood to the brain. The main condition for this type of obstruction is the development of fat deposits lining the walls of the vessel. This is called atherosclerosis.

Ischemic stroke causes a thrombus, which can form in a blood vessel( thrombosis) or elsewhere in the circulatory system( embolism).

The basis of the definition of the nosological form of the disease is three independent pathologies characterizing the local circulatory disorder, denoted by the terms "Ischemia", "Infarction", "Stroke":

• ischemia - blood supply deficiency in the local area of ​​the organ, tissue.
• stroke - is a violation of blood flow in the brain with rupture / ischemia of one of the vessels, accompanied by death of brain tissue.

In ischemic stroke , the symptoms depend on the type of the disease :

1. Atherothrombotic attack - arises due to atherosclerosis of an artery of large or medium size, develops gradually, most often occurs in a dream;
2. Lacunar - diabetes mellitus or hypertension can cause circulatory disorders in small-diameter arteries.
3. 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, subsequently, embolism in other organs may occur;
4. Ischemic, associated with rare causes - stratification of the artery wall, excessive coagulability of blood, vascular pathology( non-atherosclerotic), hematological diseases.
5. of unknown origin - characterized by the inability to determine the exact causes of occurrence or the presence of several causes;

From all of the above, it can be concluded that the answer to the question "what is an ischemic stroke" is simple - a violation of blood circulation in one part of the brain due to its clogging with a thrombus or cholesterol plaque.

Allocate five major periods of completed ischemic stroke:

1. Acute period - the first three days;
2. Acute period - up to 28 days;
3. Early recovery period - up to six months;
4. Late recovery period - up to two years;
5. 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 for a few minutes to several hours.

According to the area of ​​the lesion, the cerebral infarction is divided into:

1. Stroke ischemic right side-effects affect mainly motor functions, which subsequently are poorly restored, psycho-emotional indicators may be close to normal;
2. Stroke ischemic left side - as the consequences are mainly psychoemotional sphere and speech, motor functions are restored almost completely;
3. Cerebellum - impaired coordination of movements;
4. 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 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 the 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.

Stdovoy

This kind of type of stroke is like a stroke ischemic stroke - 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

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 may 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.

Code μb 10

In ICD-10, the brain infarction is coded in heading I 63, with the addition of a period and a digit after it to determine the type of stroke. In addition, when encoding such diseases, the letter "A" or "B"( lat.) Is added, which indicates:

1. Brain infarction against the background of hypertension;
2. Brain infarction without hypertension.

Symptoms of an ischemic stroke

Strokes in 80% of cases are 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 dysfunction of brain function is more severe, 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:

1. Blindness in one eye;
2. One of the arms or legs of one side of the body will be paralyzed or very weakened;
3. Problems in understanding what others are saying, or inability to pick up words in conversation.

And if a vessel that carries blood to the brain along the back of the neck is blocked, such violations can occur:

1. Doubling in the eyes;
2. Weakness in both sides of the body;
3. Dizziness and spatial disorientation.

If you notice any of these symptoms, be sure to call an ambulance. The earlier the measures are taken, the better the prognosis for life and the probabilities of deplorable consequences.

Symptoms of transient ischemic attacks( TIA)

They often 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:

1. There is no( not visualized) focus of cerebral infarction;
2. The duration of neurologic focal symptoms is not more than 24 hours.

Symptoms of TIA are confirmed by laboratory, instrumental studies.

1. Blood to determine its rheological properties;
2. Electrocardiogram( ECG);
3. ultrasound - doplerografiey vessels of the head and neck;
4. Echocardiography( Echocardiography) of the heart - revealing the rheological properties of blood in the heart and surrounding tissues.

Diagnosis of the disease

Basic methods of diagnosing ischemic stroke:

1. Anamnesis, neurological examination, physical examination of the patient. Identification of concomitant diseases that are important and affecting the development of ischemic stroke.
2. Laboratory tests - biochemical blood test, lipid spectrum, coagulogram.
3. Measurement of blood pressure.
4. ECG.
5. 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.

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.

Consequences of an ischemic stroke

In the case of an ischemic stroke, the consequences can be very diverse - from very severe, with extensive ischemic stroke, to minor, with micro attacks. Everything depends on the place of localization and the volume of the hearth.

Probable consequences of ischemic stroke:

1. 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.
2. 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.
3. Disturbance of motor function - the force 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.
4. Consequences can manifest as cognitive impairments of - 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 inwhich he is.
5. Speech disorders - may not be present 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 common are such violations with right-sided ischemic stroke.
6. Swallowing disorders - the patient can sweat both liquid and solid foods, this can lead to aspiration pneumonia, and then to death.
7. Disorders of coordination of are manifested in staggering when walking, dizzy, falling with sudden movements and bends.
8. 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 of 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 edema of the brain.

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 - in 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 a previous ischemic stroke is approximately 60-70% by the end of the first year of the disease, 50% - 5 years after the stroke, 25% - after 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.

Rehabilitation after ischemic stroke

All patients who underwent stroke undergo the following stages of rehabilitation: neurological department, neurorehabilitation department, sanatorium treatment, outpatient care.

The main objectives of rehabilitation:

1. Restoration of impaired functions;
2. Mental and social rehabilitation;
3. 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:

1. 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.
2. Moderately extended bed rest mode - 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.
3. Chamber mode - 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, dressing. ..).
4. Free mode.

The duration of regimens depends on the severity of the stroke and the magnitude of the neurological defect.

Treatment of

The basic 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 tools 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 cerebral edema.

Specific therapy for ischemic stroke has two main objectives: restoring blood circulation in the affected area, as well as maintaining the metabolism of brain tissues 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.

Food

The diet implies restrictions in consumption of salt and sugar, fatty foods, flour foods, smoked products, 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, and 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 check for pains in the heart, to prevent 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.