Pathological symptoms, tactics of treatment and the degree of cerebral ischemia

1 Etiology of the

problem Blood flow to the brain tissues is provided by arterial vessels. They go from the aorta and go to the side of the neck, then go inside the skull and there are divided into small arterioles, reaching all the "corners" of the brain. Constriction or blockage of one of the arteries that equip the brain with oxygenated blood is the main cause of cerebral ischemia. This is due to the appearance of plaques. The cause of blockage of the arteries are blood clots and stagnant conditions. The larger the size of the narrowed artery, the more serious the consequences of cerebral ischemia.

Sometimes the obstruction of one small arteriolus can be the cause of the catastrophe, since it can deliver blood to a very small but extremely important area of ​​the brain. In its trunk is a tiny group of cells that form the respiratory center. Chronic cerebral ischemia damages this center, as a result, it leads to death. This can happen as a result of the formation of a small blood clot that will close one small arteriol.

Brain ischemia has no age limitation, it is observed not only in adults, but also in children( even in newborns).

What distinguishes chronic cerebral ischemia from the acute form of the disease? The difference between the chronic form and the acute is that it progresses slowly and secretly. Even native people can not always notice the ongoing negative changes in the patient. The absence of timely treatment leads to the emergence of new pathological symptoms.

During the disease, there are 3 stages:

1. 1 degree - the symptoms of ischemia can be invisible to others. There may be minor motor disorders( changes in handwriting, gait, fine motor skills), the person becomes irritable, sometimes aggressive.
2. At 2 degrees of ischemia, there is a progression of symptoms. Perhaps the development of extrapyramidal disorders of the cranial nerves. In adults, emotional disorders cause a decrease in mental abilities.
3. The last degree of cerebral ischemia is characterized by a severe disruption of its function. In this case, the self-service of the patient is limited, which leads to its disability.

2 Consequences of cerebral ischemia

Loss of consciousness or syncope occurs as a result of temporary ischemia of the entire brain. The main causes of syncope are as follows:

• is a reduction in blood pressure( after excessive dehydration, for example, during dysentery, bleeding, after taking medications that lower blood pressure);
• arrhythmias( pulse interruptions, too slow heart rate);
• myocardial infarction with left ventricular failure.

Chronic cerebral ischemia can lead to a stroke.

Ischemic stroke is a necrosis or infarction of a part of the brain tissue due to a decrease in the influx of arterial blood. The most common causes of ischemic strokes is a blood clot of one of the brain arteries, or embolisms and thromboses originating from another place of the artery or heart. Blood clots in the arteries are formed on the surface of the plaques. They cover the lumen in the shallow artery. This leads to a halt in the flow of blood to a part of the brain tissue.

If a thrombus occurs in a large artery, it may not close it. However, if its fragment breaks and flows in the direction in which the arteries are narrower, eventually the vessel will clog. Thrombi from the left atrium or left ventricle of the heart fall into the aorta. They pass into various arterial vessels. Some can reach the arteries of the brain, causing congestion and ischemic stroke of the brain. The main reason for the formation of thrombi in the heart is chronic atrial fibrillation. The absence of mechanical atrial systole leads to residual blood in the heart, and this contributes to the formation of thrombi. They can occur on uneven surfaces of the heart valves.

Transient cerebral ischemia does not leave long-term effects, but initially it causes symptoms such as stroke. This condition may be its harbinger. It occurs as a result of temporary infringements of inflow of blood to a certain area of ​​the brain. The cause may be a small congestion, which eventually dissolves, due to which the passability of the clogged vessels is restored.

3 Symptoms of a stroke

Focal cerebral ischemia, ie ischemia of a strictly defined area of ​​brain tissue or its necrosis( infarction, stroke cerebral), is the cause of some neurological symptoms. They are called focal, because they are not caused by damage to the entire brain. The type of such symptoms can help in finding the site of damage. For example, the paresis of the left hand points to the right hemisphere of the brain as the place of impact.

By what symptoms are observed, determine the location and size of the stroke. Depending on which brain structures were damaged as a result of ischemia, different symptoms appear, in different combinations and varying degrees of severity. The signs of a stroke are the following:

• violation or destruction of sensitivity on the face, upper limb or the entire body half;
• paresis or complete paralysis of the muscles of one or both extremities;
• speech disorders - the so-called aphasia;
• visual impairment, eg bilateral amblyopia;
• urinary incontinence;
• loss of taste;
• speech deceleration;
• loss of consciousness as the first symptom of a stroke.

Many people who have a cerebral stroke, know what is happening to them. However, they can not call for help - this must be done by someone from their environment. Symptoms of cerebral ischemia are an indication for immediate hospitalization. The patient should be put in a neurologic department as soon as possible.

4 Diagnostic measures

Ischemic disease of the brain is diagnosed on the basis of a neurological examination.

If a patient's symptoms indicate an ischemic stroke or a brain tumor, a visual examination of the head is performed using computed tomography or MRI.Assessment of the state of the arteries that lead the blood to the brain is possible with the help of ultrasound. Accurate representation of arteries is achieved through arteriography - scanning arteries after the introduction of contrast. Chronic cerebral ischemia is an occasion for diagnosing heart failure. Determining on its basis further treatment is necessary for the prevention of episodes of cerebral embolism.

A blood test is under way to assess risk factors for atherosclerosis( cholesterol and triglyceride levels) and blood clotting tests.

5 How is modern treatment performed?

Therapy for chronic cerebral ischemia is aimed at the speedy improvement of blood flow to the affected area of ​​the brain. Treatment is primarily symptomatic and includes maintaining optimal blood pressure and taking drugs with anticoagulant action. In the case of a stroke after an acute stage of the disease, rehabilitation of the motor activity and speech of the patient begins. It must be continued on an outpatient basis, often for many weeks or months.

The treatment process for ischemic cerebral stroke includes 2 main phases:

• in the acute period of ischemic stroke;
• preventive measures for ischemic stroke.

Treatment of an acute period of the disease is multidirectional, it consists of procedures and the use of drugs.

During the first 24 hours after a stroke, strict monitoring of the patient's condition is carried out:

• monitoring of ECG, blood pressure, body temperature, measurement of oxygen saturation;
• decrease in arterial pressure in the acute phase of a stroke( the patient is given drugs that lower the pressure when it exceeds 220/120 mm Hg);
• control of water-electrolyte balance;
• assessment of swallowing disorders, with dysphagia - feeding a patient through a gastric tube;
• monitoring of a neurological condition;
• control of glycemia( ie, blood sugar level, both the too high and the too low index are unfavorable);
• counteracts the growth of intracranial pressure and the fight against brain edema;
• prophylaxis of deep vein thrombosis and pulmonary embolism( use of elastic stockings, early motor rehabilitation or heparin);
• the correct position of the patient in bed.

The pharmacological treatment of chronic cerebral ischemia is aimed at removing the most common causes of stroke, that is, stagnant phenomena or blood clots.

Currently, the following drugs are used:

1. Drugs with anti-aggregation action - prevent the formation of blood clots, platelet aggregation. Apply them in the first 48 hours after the onset of clinical symptoms. The most commonly used is acetylsalicylic acid( aspirin).
2. Thrombolytics - the task of these drugs is the dissolution of a thrombus that closes the lumen of the vessel. The most effective action is observed when they are applied up to 3 hours from the appearance of the first symptoms. The most commonly used drugs from this group are the recombinant tissue plasminogen activator.
3. Anticoagulants - in the acute stage of the disease they have limited applications. But they are very good drugs to prevent a relapse of the disease. The drug used in stroke therapy is heparin.

The last element of behavior in the acute stage of ischemic stroke is rehabilitation. It is an integral part of therapy from the first day of the disease. The earlier actions are taken to improve the patient, the consequences of the disease will be less, and the chance of recovery or improvement in efficiency will be greater. The most common methods used in therapy are:

• kinesitherapy, physiotherapy;
• psychotherapy;
• tachyphylaxis;
• therapy of aphasia-type disorders;
• social rehabilitation.

In an acute period of a stroke, some patients in very serious condition may need neurosurgery. The operation is performed in the following cases:

• of a malignant infarction in the blood supply zone of the central artery of the brain;
• of a cerebellar infarction.

Prevention of repeated episodes of cerebral ischemia is primarily a treatment for concomitant heart disease. Also used drugs that reduce the concentration of cholesterol and reduce blood clotting.

6 Forecast of

Disease The prognosis for ischemic stroke depends on the extent and place of cerebral ischemia, as well as on its duration.

If the cause of an ischemic stroke is a thrombus artery, the symptoms tend to increase as the blood clot increases over time. Only after a while he begins to be exposed to "dissolution".

A fragment of a blood clot brought from somewhere with a blood flow is usually small and easier to decompose and dissolve. Symptoms of a stroke tend to decrease or go away over time if the stroke is a consequence of blockage of the artery. The most serious are at the onset of the disease.

It happens that most neurologic symptoms or even all disappear, if you treat this condition on time. Unfortunately, it happens that the cerebral stroke leaves permanent damage. The patient can, for example, to the end of life suffer from a paresis of half of the body, as well as speech disorders.