1 Transient ischemic attack
This condition is sometimes considered as a precursor of a stroke - an episode of cerebral ischemia, which is stopped by itself within an hour. It manifests itself by a sharp violation of the functions of the arm or leg on the one hand, headache, sometimes - speech disorders and syncope.
The presence of at least one transient ischemic attack in the anamnesis indicates a very high risk of stroke, but some patients live waiting for such attacks for several years.
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2 Localization of lesions
Neurological disorders that develop in stroke depend on which area of the brain is affected. As most of the nerve fibers in the brain cross, the motor disorders occur on the side opposite the lesion( if the left side is affected, the right side will be affected, and vice versa).In the defeat of the cerebellum there are gross violations of coordination and movement from the opposite side: a decrease or increase in muscle tone, involuntary twitching, muscle weakness, nystagmus( eye trembling, usually on both sides).They lead to the fact that the patient is completely unable to move independently and fix his eyes. Sredneozgovye strokes lead to auditory( on the side of defeat) and visual( on the opposite side) violations. Stem strokes are life-threatening, since they affect the centers of regulation of breathing, palpitation, body temperature.
But the most important from a social point of view are the lesions of the cerebral cortex. They develop a rather large range of disorders - paresis, paralysis, loss of sensitivity on the opposite side( hemiparesis, hemiplegia), visual disturbances - blindness to one eye or loss of visual fields, memory loss, intellect, attention, speech disorders, which depend on the side of the lesion.
If the right-hander is hit with the left side, then the patient is disturbed by the letter and reading, the ability to memorize what was said out loud is lost. Articulation becomes fuzzy, speech - fragmented, incoherent, loses its grammatical structure. Because of these violations, the patient can not fully communicate with others. If the right side is affected, the consequences are no less severe: a violation of the ability to assess the size of objects and the distance to them, the patient does not understand oral speech well, but can be able to read and write, there are feelings of "not his own" body, depression, delirium and hallucinations. With the same localization of lesions in left-handed, the picture of neurological disorders will be directly opposite.
3 Persistent neurological disorders
Persistent are those disorders that remain in the patient a year or more after he suffered a stroke. Ischemic stroke of the cerebral cortex on the left side leaves persistent motor disturbances - paresis or paralysis of the right arm or leg, less often - hemiparesis, that is, defeat of both hands and feet, in more mild cases - a violation of their functions, which leads to instability of gaitand the need for a cane or wheelchair, a violation of the coordination of the fingers, as a consequence - the inability to perform precise movements.
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Persistent speech disorders - dysgraphy( inability to write, rearranging letters in words, incorrect writing of some letters), dyslexia, violation of speech memory, resulting in gradual depletion of vocabulary( inability to pronounce words, build long phrases).All these disorders can be partly compensated by the timely start of treatment in the hospital and correct rehabilitation, but the prognosis for work capacity for ischemic stroke is more often unfavorable.
The prognosis for life depends on the extent of the lesion: according to statistics, up to 20% of stroke survivors die in the first month, but about 25% live 10 or more years after the stroke.
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The time when treatment is most effective is considered the first 3-6 hours after a stroke. It is at this time that there is a chance for successful management of hemodynamic disorders in the brain and a reduction in neurologic symptoms in the future, so patients with a suspected stroke should be hospitalized in the neurological department.
In the hospital, CT and MRI of the brain are performed, which allows to confirm the diagnosis of a stroke, if necessary, carry out artificial ventilation of the lungs, maintenance of cardiac activity, parenteral nutrition. Of the drugs used thrombolytics and antiaggregants to improve cerebral blood flow, diuretics to relieve cerebral edema, nootropics for the preservation of cognitive functions. In very severe cases( for example, blockage of the common or internal carotid artery), a surgical removal of the thrombus is used. In the hospital, the first stage of rehabilitation begins.
4 Rehabilitation after a life-threatening
It is believed that patients who underwent left-sided stroke are more determined to recover, because the centers of motivation are located in the frontal cortex mainly on the right, and accordingly, they can more often cope with the negative consequences of a stroke.
A prerequisite for successful rehabilitation is the observance of a rational mode of work and rest and a diet. The patient after a stroke needs to get enough sleep and fully rest, so that the brain can recover and work. In food it is better to adhere to moderation, fruits and vegetables containing fiber, white meat and nonfat fish, milk and sour-milk products, fruit juices and mineral waters, preferably without gas, are preferred from the products. Categorically contraindicated alcohol, should limit coffee, strong tea and chocolate. It also contributes to the rehabilitation of moderate physical activity: feasible sports exercises, breathing exercises, easy physical work.
At first, after leaving hospital, the patient will have to learn how to stand and walk again, so an important part of rehabilitation is the exercise therapy department. At this stage, the main goal of the exercises is to increase tolerance to physical activity, to develop accuracy of movements, to restore walking skills first with additional support - crutches or walking stick, then independently, if possible. Special simulators have been developed that allow to restore motor functions. It is useful to perform feasible household tasks.
After a stroke on the left side, social rehabilitation becomes especially important.
Completely restore lost skills and return to previous activities can not always, but to preserve social activity, the patient needs classes with a speech therapist, solving simple logical problems, regular reading and writing small texts. This will allow the patient to feel still necessary and workable.
At a later stage, social rehabilitation is of paramount importance. At this time it is important to improve speech, writing and reading skills, it is possible to learn some additional profession that will allow the patient to work, despite the stroke. LFK exercises also need to continue to maintain physical fitness. How many years the patient will be able to live after a stroke depends not only on the degree of damage to the brain tissue, but also on the willingness of his loved ones to help him in recovering lost skills.