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Stroke prevention medical prevention center. Stroke treatment center. Instrumental diagnosis of stroke

Stroke (cerebral infarction) - This is a type of brain damage resulting from a disruption in the blood supply to the brain. Stroke ranks third in the structure of mortality in developed countries after heart disease and cancer. Every third stroke is fatal. Among the survivors, about half are steadfastly incapacitated. Stroke - the main cause of physical, intellectual, emotional, social and work disability.

It is necessary to call an ambulance as soon as possible if you notice that a person has sudden signs of a stroke:

    asymmetry of the face, drooping of the corner of the mouth;

    weakness in half of the body (you can see that in the position of holding outstretched arms, one arm drops);

    violation of speech and consciousness.

Even if the above symptoms disappear after a few minutes or hours, it is necessary to consult a doctor for an examination, because perhaps the symptoms were manifestations of a transient ischemic attack and the likelihood of developing a "full" stroke in the next few hours is very high.

What is TIA?

Transient ischemic attack (TIA) Like ischemic stroke, it is characterized by the sudden loss of function of a part of the body as a result of the cessation of blood supply to a specific part of the brain. Unlike a stroke, symptoms of impaired function are fully restored within no more than 24 hours. This is because the blockage in the artery is quickly removed, and the part of the brain fed by the artery does not have time to die (undergo a heart attack). Special attention should be paid to TIAs because they are a “wake-up call” for the patient. The occurrence of TIA indicates the highest risk of stroke in the coming hours and days. With prompt and adequate examination and treatment, stroke can be prevented, which means that the risk of death or disability can be reduced.


Why does a stroke occur?

Ischemic stroke is a consequence of blockage of the artery that feeds the brain. The normal functioning of the brain requires a regular supply of oxygen and glucose, which enter the brain through the bloodstream. If, due to blockage of an artery, the delivery of oxygen and glucose to one or another part of the brain stops, it ceases to function normally. If blood flow is not restored within a few hours, brain tissue can die, resulting in permanent loss of function.

Hemorrhagic stroke occurs as a result of rupture of an artery and hemorrhage into the brain tissue or along its surface. Distinguish between intracerebral hemorrhage, and subarachnoid hemorrhage - between the brain and its shell. At the site of the rupture, an accumulation of blood (hematoma) forms, which compresses the surrounding brain tissue and prevents its blood supply to other vessels. Therefore, the brain tissue adjacent to the hematoma may die.


Stroke treatment at EMC

At the Stroke Treatment Center of the EMC General Hospital on ul. Shchepkina, Moscow, a multidisciplinary team of specialists provides assistance to patients with acute stroke around the clock.

Our specialists regularly cooperate with leading Russian and foreign clinics, undergo medical internships abroad, which allows EMC patients to receive treatment that meets the highest European and American standards.

Time is brain! The earlier treatment is started, the greater the chances of a favorable stroke outcome. The best chance of recovery is if treatment to restore disturbed blood flow is started within the first 4.5 hours of symptom onset. This period is called the "therapeutic window". Thanks to the round-the-clock organization of the work of the services of the EMC multidisciplinary hospital on the street. Shchepkin, including the endovascular service, which provides the ability to mechanically remove a thrombus from a clogged vessel, the "therapeutic window" can be extended to 6-8 hours, in some cases up to 24 hours.

An accurate diagnosis of stroke is made based on analysis of symptoms and clinical experience of neurologists and is confirmed by fast, high-precision imaging techniques such as CT or “fast” 10-minute MRI, available 24 hours a day. Immediately after confirming the diagnosis, we carry out treatment that "dissolves" the thrombus - intravenous thrombolysis. In parallel, patients undergo CT angiography or MR angiography, if necessary, a diffusion / perfusion mismatch is determined on MRI to assess the potential reversibility of the ischemic zone. If indicated, the patient undergoes mechanical removal of the thrombus (thrombextraction) or other endovascular and neurosurgical treatment.

We do not deprive anyone of a chance for a positive outcome, because we treat patients with acute stroke as potential candidates for mechanical thromboextraction, which has been the gold standard for treating acute stroke in the world since 2015, but has not yet become a generally accepted standard in Russia.

Despite the high-tech equipment of Russian stroke centers, mechanical thromboextraction in acute stroke is extremely rare. Stroke clinic of the EMC multidisciplinary hospital on the street. Shchepkina is one of the few medical clinics, if not the only one in Moscow, ready to provide high-tech medical and surgical treatment of stroke 24 hours a day.

Patients undergo treatment in specialized neuro-beds of the intensive care unit, and then in the inpatient wards of the EMC multidisciplinary hospital on the street. Shchepkina. Patients are managed by a team of neurologists together with neuroresuscitators, endovascular surgeons and neurosurgeons, therapists, cardiologists and other specialists. During the hospital stay, the type and cause of the stroke is determined and appropriate treatment is provided to minimize the consequences of the stroke and protect against recurrent stroke or hemorrhage.

Provides the opportunity to stay in single and double comfortable wards, round-the-clock supervision of doctors, as well as the organization of an individual nursing station. Comfortable conditions of stay, top-class specialists and the ability to accommodate relatives and friends -

After the end of the acute period of stroke, we continue the outpatient management of the patient by a multidisciplinary team of specialists. The team of specialists includes doctors in vascular neurology, cardiologists, hematologists and endovascular neurosurgeons, rehabilitologists, speech therapists (), neuropsychologists, neuro-urologists and other specialists. Each case is discussed collegially, and a decision is made for each individual patient. If necessary, patients undergo surgical treatment (for example, endarterectomy for significant narrowing of the carotid artery), endovascular surgery (for example, to place a stent and open a narrowed artery) or special drug therapy according to the specific situation. After all, the most important thing after a stroke - it is to minimize the consequences of a stroke and the risks of a recurrent stroke through proper prevention.


Rehabilitation after a stroke

The severity of a patient with a stroke in the absence of an adequately structured treatment program that combines the continuous joint work of a neurologist and a rehabilitation therapist often leads to a complication of the patient's condition and increases the risk of disability.

Initial rehabilitation starts from the first days of a stroke - posture treatment, passive exercises and breathing exercises. Active recovery activities begin individually and depend on the severity of the condition. After stabilization and relief of an acute condition, it is extremely important to start rehabilitative treatment of the patient as soon as possible, saving him from the consequences of acute conditions (for example, paralysis, paresis), which contributes to a significant improvement in the patient's quality of life, increasing his social adaptation.

Rehabilitation tactics are determined by a neurologist together with a rehabilitation therapist. for many years they have been engaged in the recovery of patients after severe neurological conditions, using the most modern physiotherapy equipment and the latest neurorehabilitation technologies.

Techniques used by ECSTO rehabilitation doctors:

Applied kinesiotherapy:

    Brunstromm technique for correcting movement patterns;

    Bobit technique for the facilitation of muscle fibers using external stimuli;

    PNF on the upper / lower extremities in order to develop correct movement patterns, training static / dynamic balance while standing / sitting with the use of objects surrounding the patient to improve coordination / proprioception;

    various types of stretch marks in order to increase / decrease tone (important for strokes).

Massage and manual therapy

Hardware physiotherapy:

    infrared laser therapy;

    low-frequency magnetotherapy;

    anesthetic electrotherapy (SMT, DDT, SCENAR-therapy, interference currents);

    neuromuscular electrical stimulation for the treatment of paralysis, central and peripheral paresis;

    heat therapy (paraffin-ozokerite applications).

Physiotherapy, incl. Biodex-balance system for vertical stability, balance improvement.

Kinesio taping

The use of kinesiological taping (kinesio taping) allows you to create a physiological position of the paralyzed limb. Kinesio taping is widely used in neurorehabilitation, including rehabilitation after a stroke in combination with the main methods of treatment for:

    improving sensory control when it is insufficient;

    stabilization of the joints of the paretic limbs;

    activation of paretic muscles;

    implementation of the installation position of the limb with paresis.

Undergoing neurorehabilitation under conditions is possible both on an outpatient and inpatient basis. The hospital provides the possibility of staying in single and double comfortable wards, round-the-clock observation of doctors, as well as the organization of an individual nursing station. Comfortable conditions of stay, top-class specialists and the ability to accommodate relatives and friends - all this contributes to the maximum effectiveness of treatment and the speedy recovery of the patient.

Stroke "blow"- a disease that strikes suddenly, "like a bolt from the blue."

Distinguish:

  • - bleeding in the brain tissue, due to rupture of the vessel
  • - cessation of blood supply to brain tissue, resulting from blockage of an artery

In Russia, about 450 thousand strokes are registered a year. Stroke is the leading cause of disability among the population: a third of patients who have undergone it need outside help, another 20% cannot walk on their own, and only one in five can return to work.

Such prevalence and socio-economic significance of the disease determines the need for an integrated approach in the treatment of stroke, early secondary prevention, and rehabilitation measures.

Everyone should think about stroke prevention:

  • carried out in order to prevent the development of a stroke. To do this, it is necessary to identify the main risk factors, select individual drug therapy, and receive recommendations for lifestyle modification.
  • carried out to prevent the recurrence of stroke, taking into account the identified risk factors and mechanisms for the development of an acute vascular event

An individual approach to each patient makes it possible to significantly reduce the risk of re-development of cerebrovascular accident, avoid gross disability, and improve the patient's quality of life.

How to diagnose a stroke yourself?

The following symptoms will help you recognize a stroke:

1. Facial asymmetry

Ask to frown, close your eyes tightly, bared your teeth - the test is considered positive if you see that the muscles are not contracting, or there is significant asymmetry of the face.

2. Violation of speech

Ask to pronounce a phrase that requires good articulation: "yogurt whey", "thirty-third artillery brigade" - the speech is illegible, difficulties in understanding the addressed speech, the implementation of simple commands.

3. Decreased strength in the limbs:

  • In the hands - ask to raise your hands above the horizontal and try to keep them in this position - within one or several seconds, one hand begins to lower or does not rise at all
  • In the legs - ask to raise the legs bent at the knees and try to hold them - within one or several seconds one leg begins to fall or does not rise at all

In the presence of these symptoms, it is necessary toCall the ambulance team immediately!

The sooner you seek medical help, the sooner treatment of acute stroke will begin, which can significantly reduce the severity of neurological deficits and help avoid significant disability after a stroke.

Comprehensive stroke treatment should include 5 directions

Non-specific treatment (correction of respiratory and cardiovascular disorders, blood pressure, blood glucose levels, water-electrolyte balance)

  1. Specific (recanalization, neuroprotection)
  2. Prevention and treatment of complications (neurological, therapeutic)
  3. Early secondary prevention of stroke
  4. Early rehabilitation

Conducting specific therapy

The only treatment for ischemic stroke that has proven effective and safe in clinical trials is thrombolytic therapy.

The goal of thrombolysis is to restore blood flow in a region of the brain with a critical deficit in blood supply, but has not yet lost its viability.

Thrombolytic therapy allows you to save more brain cells from death, achieve complete regression or minimal neurological deficit, significantly reduce the degree of disability and the risk of death.

The most important predictor of thrombolysis success is the time from stroke to initiation of treatment.

The sooner thrombolytic therapy is started, the faster, in case of recanalization of an occluded artery, oxygenated blood will flow to the "ischemic penumbra" zone (a part of the brain with a critical deficit of blood supply, but has not yet lost its viability).

The time interval between the onset of stroke symptoms and the initiation of treatment is called the “therapeutic window”. When the exact time of onset of symptoms is not known, the time when the patient was last seen healthy is taken as the starting point of the "therapeutic window".

Before the start of thrombolytic therapy, the patient needs to perform neuroimaging to exclude intracerebral hemorrhage, to assess the focus and ischemia and "ischemic penumbra", the level of occlusion. Native computed tomography of the brain, computed tomography of the brain in perfusion mode and CT angiography of the cerebral vessels are performed.

Recanalization methods

Intravenous administration of rt-PA. It is carried out in a 0-4.5-hour "therapeutic window" - in the absence of contraindications.

Intra-arterial thrombolysis - the drug is injected just before the blood clot. It is carried out for patients who are in the 6-hour "therapeutic window" - in the absence of contraindications.

Mechanical thrombotic, emboloxtraction - performed in an 8-hour therapy window. Mechanical thrombectomy can be used in patients with ischemic stroke as monotherapy or in combination with thrombolytic drugs.

Mechanical thrombectomy can be used in patients with ischemic stroke if systemic thrombolysis is contraindicated for them, or the main cerebral artery is occluded and systemic thrombolysis is ineffective.

Stroke prevention is based on correcting risk factors

  • Age: after age 50, the risk of stroke doubles every 10 years
  • Floor: more often men are ill than women
  • Relatives first line: the likelihood of developing a stroke increases 2 times
  • Arterial hypertension
  • Diabetes
  • Obesity
  • Violation of lipid metabolism- an increase in blood total cholesterol and low-density lipoprotein LDL ("bad" cholesterol), a decrease in high-density lipoprotein HDL ("good" cholesterol)
  • Carotid artery stenosis
  • Abnormal heart rhythm- paroxysmal, persistent, permanent form of atrial fibrillation
  • Cardiac ischemia- angina pectoris, myocardial infarction
  • Heart failure increases the risk of developing a stroke by 3 times
  • Smoking accelerates the process of vascular damage and enhances the influence of other risk factors
  • Alcohol abuse
  • The use of tablets contraceptives and postmenopausal hormone therapy
  • Long-term negative psycho-emotional and psycho-social stress
  • Lack of physical activity
  • Obstructive sleep apnea syndrome
  • Metabolic syndrome

If a stroke has occurred, emergency hospitalization is necessary for the treatment of stroke in the acutest period using recanalization methods, selection of individual therapy for the prevention of recurrent acute vascular events based on the identified causes, mechanism and risk factors of stroke.

An integrated approach to the treatment and prevention of ischemic stroke / transient ischemic attack is provided by the interaction of doctors of related specialties:

  • functional diagnostics doctors -
  • cardiologists
  • somnologist -
  • endocrinologists
  • doctors - endovascular surgeons
  • neurosurgeons
  • cardiovascular surgeons
  • neurologists-botulinum therapists for. With post-stroke spasticity, severe headaches, blepharospasm, hemifacial spasm
  • doctors
  • ophthalmologists

In the Department of Neurology, for patients with cerebrovascular accidents, a comprehensive examination is carried out at the optimal time, aimed at identifying risk factors that contribute to the development of stroke, the mechanisms of the stroke, to determine the individual regimen of effective therapy and prevention of stroke, recommendations for modifying the patient's lifestyle.

Thus, early diagnosis, treatment and prevention of stroke is the basis for maintaining the health and quality of life of each patient.

Today, acute cerebrovascular accident or stroke occupies a leading position in the structure of morbidity and disability among all diseases of the cardiovascular system. Stroke has literally rejuvenated over the past decade. At the moment, more and more cases of acute cerebrovascular accident are recorded in the middle age group and even among young people, which only increases the relevance of preventive measures. In order to prevent the development of the disease, rationally selected prevention of stroke is necessary, only in this case it is possible to significantly reduce the risk of developing the disease.

Prevention of cerebral stroke is a priority "Clinical Institute of the Brain", since it allows not only to reduce the severity of the condition associated with cerebrovascular accident, but also to completely prevent the development of the disease.

Stroke or acute disturbance of cerebral circulation is a disease of the cardiovascular system with a neurological component, which is characterized by a sudden disturbance of blood circulation in the cerebral arteries and manifests itself as a pronounced neurological deficit.

There are two main forms of stroke:

  • The hemorrhagic form is characterized by hemorrhage in the brain tissue with an increase in intracranial pressure as a result of the development of a hematoma.
  • The ischemic form is characterized by thrombosis or occlusion of any cerebral artery, which leads to acute tissue hypoxia and subsequent necrosis of the nervous tissue of the brain.

Despite the different pathogenesis of the development of stroke, the clinical picture and its consequences for the victim are practically the same.

Analyzes Programs

Stop Stroke Program 4200 RUB

Composition of the program: Initial consultation with a neurologist blood sampling for blood biochemistry tests: LDL glucose ALT AST triglycerides Transcranial Doppler ultrasound, embolodetection, functional tests (turns, head tilts) Duplex scanning of the brachiocephalic vessels of the head

Neurologist's appointment 1200 rubles

Consultation with a specialist

Monitor your blood pressure.

Quit bad habits

Preventive actions

In order to reduce the risk and prevent the development of the disease, it is necessary to adhere to preventive measures aimed at combating risk factors. Prevention of cerebral stroke is divided into two main types: primary and secondary. Also, neurologists and rehabilitologists identify several general directions for preventing the development of cerebrovascular accidents.

General principles of stroke prevention

To effectively prevent the development of acute disorders of cerebral circulation, it is first of all necessary to exclude etiological risk factors for stroke. A key factor in the pathogenesis of stroke is dyslipidemic changes in the biochemical composition of the blood, which leads to the development of atherosclerotic changes in the walls of blood vessels, including cerebral arteries. The second largest risk is hypertension of the malignant form and other diseases associated with vascular pathology.

The general principles of prevention are aimed precisely at combating the main pathogenetic links of stroke. It is very important to timely identify changes in the biochemical composition of the blood, for this it is necessary, starting from the age of 30, at least once a year to undergo a comprehensive study, which includes:

  • blood chemistry,
  • study of the lipid spectrum of blood,
  • determination of cardiovascular risk using specialized scales,
  • consultative appointment with a cardiologist and neurologist.

When detecting arterial hypertension, it is very important to follow the recommendations of the attending physician and be under constant dispensary observation.

Primary prevention

The complex of primary prevention of cerebral stroke is aimed at preventing the development of acute vascular disorders. Primary prevention is aimed at forming a correct awareness of one's own health and the capabilities of the body. Maintaining a healthy and active lifestyle significantly reduces the risk of stroke in people of the middle and older age groups. In people prone to thrombosis and impaired rheological properties of blood, drug therapy is used to prevent ischemic stroke. For this purpose, lipid-lowering therapy is used with the use of drugs - statins, which help to normalize the metabolism of cholesterol and other atherogenic lipids. Antihypertensive therapy is becoming a mandatory component. Continuous and, in some cases, lifelong use of drugs significantly reduces the number of patients suffering from ischemic stroke.

A very important principle of the primary prevention of stroke in men is to get rid of bad habits such as smoking, drinking alcohol and overeating, especially high-carbohydrate foods with high fat content. Since the incidence of stroke among the male population is almost two times higher than among the female, the primary prevention of cerebral stroke in men should be more thorough and complete.

Features of stroke prevention in women

There are some features of stroke prevention in women and men. Prevention of stroke in women consists in constant monitoring of the state of hemostasis and coagulogram, since the peculiarities of the hormonal system of a woman lead to an increased risk of thrombus formation and other disorders of the blood coagulation system. Prevention of cerebral stroke in women is reduced in the additional supervision of a woman's neurologist during pregnancy and childbirth.

Secondary prevention

Secondary prevention of stroke implies measures aimed at preventing repeated episodes of acute cerebrovascular accident, as well as complications associated with the development of stroke. Secondary prevention has a complex therapeutic structure and is largely aimed at activating the patient's compensatory-adaptive mechanisms and his adaptation. Secondary prevention, like primary prevention, is divided into non-drug and drug. Non-drug therapy includes all the same measures as in primary prevention, however, physical activity is increased gradually, since during the recovery period an increase in blood pressure cannot be provoked.

For the purpose of drug therapy, thrombolytic drugs are used: aniagregants and anticoagulants, as well as drugs similar in primary prevention.

In severe cases, some patients are shown surgical intervention - carotid endarterectomy, which significantly reduces the risk of recurrent stroke. Secondary prophylaxis is carried out only in specialized medical centers. One of these centers is the Clinical Institute of the Brain, which deals with the prevention of strokes from mild to the most severe forms with repeated strokes and subsequent disability of the victims.

Frequently asked questions

What to do to prevent a stroke?

Stroke can be prevented with prevention. Also, you need to be aware of the increased risk of stroke. If you have one or more of the items listed below, you need to see a neurologist.

After a stroke. The program includes: ultrasound examinations of the vessels of the brain (head and neck), consultation with an angioneurologist, as well as laboratory diagnostics to assess the effectiveness and safety of therapy (not included in the cost of the program).

Before receiving an angioneurologist in the clinic, you can undergo laboratory diagnostics (blood biochemistry - cholesterol, LDL, HDL, triglycerides, AST, ALT, plasma glucose, total bilirubin, direct bilirubin, serum creatinine, serum urea and hemostasiological studies - INR, A fibrinogen, thrombin time) .

Based on the results of the above examinations, a consultation is carried out by an angioneurologist, a doctor specializing in the management of patients after a stroke. The angioneurologist prescribes or adjusts the existing therapy and treatment program. If necessary, a consultation is carried out by a rehabilitologist (free of charge). The tasks of a rehabilitation therapist include drawing up a program of physical rehabilitation, as well as methods for restoring lost physical functions.

Acute violation of cerebral circulation, leading to persistent focal brain damage. May be ischemic or hemorrhagic. Most often, a stroke is manifested by sudden weakness in the extremities according to the hemitype, asymmetry of the face, impaired consciousness, impaired speech and vision, dizziness, and ataxia. Stroke can be diagnosed by a combination of data from clinical, laboratory, tomographic and vascular studies. Treatment consists in maintaining the body's vital functions, correcting cardiac, respiratory and metabolic disorders, combating cerebral edema, specific pathogenetic, neuroprotective and symptomatic therapy, and preventing complications.

General information

Stroke is an acute vascular catastrophe resulting from vascular diseases or abnormalities of the cerebral vessels. In Russia, the incidence reaches 3 cases per 1,000 population. Strokes account for 23.5% of the total mortality of the population of Russia and almost 40% of mortality from diseases of the circulatory system. Up to 80% of stroke patients have persistent neurological disorders that cause disability. About a quarter of these cases are profound disabilities with loss of self-care. In this regard, the timely provision of adequate emergency medical care for stroke and full rehabilitation are among the most important tasks of the health care system, clinical neurology and neurosurgery.

There are 2 main types of stroke: ischemic and hemorrhagic. They have a fundamentally different mechanism of development and require radically different approaches to treatment. Ischemic and hemorrhagic strokes account for 80% and 20%, respectively, of the total population of strokes. Ischemic stroke (cerebral infarction) is caused by impaired patency of the cerebral arteries, leading to prolonged ischemia and irreversible changes in brain tissue in the area of ​​blood supply to the affected artery. Hemorrhagic stroke is caused by a pathological (atraumatic) rupture of a cerebral vessel with hemorrhage into cerebral tissues. Ischemic stroke is more often observed in persons over 55-60 years of age, and hemorrhagic stroke is characteristic of a younger category of the population (more often 45-55 years).

Causes of Stroke

The most significant factors in the onset of stroke are arterial hypertension, coronary artery disease and atherosclerosis. Improper nutrition, dyslipidemia, nicotine addiction, alcoholism, acute stress, weakness, and taking oral contraceptives contribute to the development of both types of stroke. At the same time, malnutrition, dyslipidemia, arterial hypertension and weakness do not have gender differences. Obesity is a risk factor that occurs mainly in women, and alcoholism in men. The risk of developing a stroke is increased in those persons whose relatives have suffered a vascular accident in the past.

Ischemic stroke develops as a result of a violation of the passage of blood through one of the blood vessels supplying the brain. Moreover, we are talking not only about intracranial, but also about extracranial vessels. For example, occlusion of the carotid arteries is responsible for about 30% of ischemic stroke cases. The cause of a sharp deterioration in cerebral blood supply may be vascular spasm or thromboembolism. The formation of thromboemboli occurs in cardiac pathology: after a myocardial infarction, with atrial fibrillation, valvular acquired heart defects (for example, with rheumatism). The blood clots formed in the heart cavity move with the blood flow to the cerebral vessels, causing their blockage. An embolus can be a part of an atherosclerotic plaque that has torn off the vascular wall, which gets into a smaller cerebral vessel and leads to its complete occlusion.

The occurrence of hemorrhagic stroke is mainly associated with diffuse or isolated cerebral vascular pathology, as a result of which the vascular wall loses its elasticity and becomes thinner. Such vascular diseases are: cerebral atherosclerosis, systemic vasculitis and collagenoses (Wegener's granulomatosis, SLE, periarteritis nodosa, hemorrhagic vasculitis), vascular amyloidosis, angiitis in cocaine addiction and other types of drug addiction. Hemorrhage may be due to a developmental abnormality with the presence of an arteriovenous malformation of the brain. A change in the area of ​​the vascular wall with a loss of elasticity often leads to the formation of an aneurysm - a protrusion of the artery wall. In the area of ​​the aneurysm, the vessel wall is very thinned and easily ruptured. The rupture is promoted by the rise in blood pressure. In rare cases, hemorrhagic stroke is associated with a blood clotting disorder in hematological diseases (hemophilia, thrombocytopenia) or inadequate therapy with anticoagulants and fibrinolytics.

Stroke classification

Strokes are divided into 2 large groups: ischemic and hemorrhagic. Depending on the etiology, the former can be cardioembolic (occlusion is caused by a thrombus formed in the heart), atherothrombotic (occlusion is caused by elements of an atherosclerotic plaque) and hemodynamic (caused by vascular spasm). In addition, lacunar cerebral infarction caused by blockage of a small-caliber cerebral artery and a small stroke with complete regression of the neurological symptoms that have arisen in the period up to 21 days from the moment of the vascular accident are isolated.

Hemorrhagic stroke is classified into parenchymal hemorrhage (bleeding into the substance of the brain), subarachnoid hemorrhage (bleeding into the subarachnoid space of the cerebral membranes), hemorrhage into the ventricles of the brain and mixed (parenchymal-ventricular, subarachnoid. The most severe course has a hemorrhagic stroke with a breakthrough of blood into the ventricles.

During a stroke, several stages are distinguished: the most acute period (the first 3-5 days), the acute period (the first month), the recovery period: early - up to 6 months. and late - from 6 to 24 months. Neurological symptoms that did not regress within 24 months. from the onset of a stroke are residual (persistent). If the symptoms of a stroke completely disappear within a period of up to 24 hours after the onset of its clinical manifestations, then we are not talking about a stroke, but about a transient violation of cerebral circulation (transient ischemic attack or hypertensive cerebral crisis).

Stroke symptoms

The stroke clinic consists of cerebral, meningeal (meningeal) and focal symptoms. Characterized by an acute manifestation and rapid progression of the clinic. Usually ischemic stroke has a slower development than hemorrhagic stroke. From the onset of the disease, focal manifestations come to the fore, cerebral symptoms are usually mild or moderate, meningeal symptoms are often absent. Hemorrhagic stroke develops more rapidly, debuts with cerebral manifestations, against the background of which focal symptoms appear and progressively increase. In the case of subarachnoid hemorrhage, meningeal syndrome is typical.

General cerebral symptoms are represented by headache, vomiting and nausea, disturbance of consciousness (deafness, stupor, coma). About 1 in 10 patients with hemorrhagic stroke will have an epileptic seizure. An increase in cerebral edema or the volume of blood poured out during a hemorrhagic stroke leads to a sharp intracranial hypertension, mass effect and threatens the development of a dislocation syndrome with compression of the brain stem.

Focal manifestations depend on the location of the stroke. With a stroke in the basin of the carotid arteries, central hemiparesis / hemiplegia occurs - a decrease / complete loss of muscle strength of the limbs of one side of the body, accompanied by an increase in muscle tone and the appearance of pathological foot signs. In the ipsilateral limbs of the half of the face, paresis of facial muscles develops, which is manifested by a skewed face, drooping of the corner of the mouth, smoothing of the nasolabial fold, logophthalmos; when trying to smile or raise eyebrows, the affected side of the face lags behind the healthy side or remains completely motionless. These motor changes occur in the limbs and half of the face contralateral to the lesion of the side. In the same limbs, sensitivity decreases / drops out. Possible homonymous hemianopsia - loss of the same halves of the visual fields of both eyes. In some cases, photopsies and visual hallucinations are noted. Aphasia, apraxia, reduced criticism, visual-spatial agnosia are often observed.

With a stroke in the vertebrobasilar basin, dizziness, vestibular ataxia, diplopia, visual field defects, dysarthria, cerebellar ataxia, hearing disorders, oculomotor disorders, and dysphagia are noted. Quite often, alternating syndromes appear - a combination of peripheral cranial nerve paresis ipsilateral to stroke and contralateral central hemiparesis. In lacunar stroke, hemiparesis or hemihypesthesia can be observed in isolation.

Stroke diagnostics

Differential diagnosis of stroke

The primary goal of diagnosis is to differentiate stroke from other diseases that may have similar symptoms. Closed craniocerebral trauma can be excluded by the absence of a traumatic history and external injuries. Myocardial infarction with loss of consciousness occurs as suddenly as a stroke, but there are no focal and cerebral symptoms, arterial hypotension is characteristic. A stroke manifesting loss of consciousness and epileptic seizure may be mistaken for epilepsy. The presence of a neurological deficit, which increases after paroxysm, and the absence of seizures in the anamnesis speaks in favor of a stroke.

At first glance, toxic encephalopathy in acute intoxication (carbon monoxide poisoning, liver failure, hyper- and hypoglycemic coma, uremia) is similar to stroke. Their distinctive feature is the absence or weak manifestation of focal symptoms, often the presence of polyneuropathy, a change in the biochemical composition of the blood corresponding to the nature of intoxication. Stroke-like manifestations can be characterized by hemorrhage in a brain tumor. Clinically, it is not possible to distinguish it from hemorrhagic stroke without an oncological history. Intense headache, meningeal symptoms, nausea and vomiting with meningitis may resemble a picture of subarachnoid hemorrhage. The latter may be supported by the absence of pronounced hyperthermia. A paroxysm of migraine may have a picture similar to subarachnoid hemorrhage, but it proceeds without meningeal symptoms.

Difdiagnosis of ischemic and hemorrhagic stroke

The next stage of differential diagnosis after the diagnosis is made is to determine the type of stroke, which is of paramount importance for differential therapy. In the classical version, ischemic stroke is characterized by gradual progression without impairment of consciousness in the onset, and hemorrhagic stroke is characterized by apoplectiform development with early onset of consciousness disorder. However, in some cases, ischemic stroke may have an atypical onset. Therefore, in the course of diagnosis, one should rely on a set of various signs that testify in favor of a particular type of stroke.

So, for a hemorrhagic stroke, a history of hypertension with hypertensive crises is more typical, and for ischemic - arrhythmia, valvular disease, myocardial infarction. The age of the patient also matters. In favor of ischemic stroke, the manifestation of the clinic speaks during sleep or rest, in favor of hemorrhagic stroke - the beginning during a period of vigorous activity. Ischemic stroke in most cases occurs against the background of normal blood pressure, focal neurological deficit comes to the fore, arrhythmia, deafness of heart sounds are often noted. Hemorrhagic stroke, as a rule, debuts with elevated blood pressure with general cerebral symptoms, meningeal syndrome and autonomic manifestations are often expressed, followed by the addition of stem symptoms.

Instrumental diagnosis of stroke

Clinical diagnostics allows the neurologist to determine the pool in which the vascular catastrophe occurred, to localize the focus of cerebral stroke, to determine its nature (ischemic / hemorrhagic). However, the clinical differentiation of the type of stroke in 15-20% of cases is erroneous. Instrumental examinations allow to establish a more accurate diagnosis. An urgent MRI or CT scan of the brain is optimal. Tomography allows you to accurately establish the type of stroke, clarify the location and size of the hematoma or ischemic focus, assess the degree of cerebral edema and displacement of its structures, identify subarachnoid hemorrhage or breakthrough of blood into the ventricles, diagnose stenosis, occlusion and aneurysm of the cerebral vessels.

Since there is not always the possibility of urgent neuroimaging, they resort to performing a lumbar puncture. Echo-EG is preliminarily carried out to determine / exclude the displacement of the midline structures. The presence of displacement is a contraindication for lumbar puncture, which in such cases threatens the development of a dislocation syndrome. Puncture may be required when clinical data indicate subarachnoid hemorrhage, and tomographic methods do not detect accumulation of blood in the subarachnoid space. In ischemic stroke, the cerebrospinal fluid pressure is normal or slightly increased, the study of cerebrospinal fluid does not reveal significant changes, a slight increase in protein and lymphocytosis can be determined, in some cases - a small admixture of blood. With hemorrhagic stroke, there is an increase in cerebrospinal fluid pressure, bloody color of the cerebrospinal fluid, a significant increase in protein concentration; in the initial period, unchanged erythrocytes are determined, later - xanthochromic.

In parallel, symptomatic therapy is carried out, which may consist of hypothermic agents (paracetamol, naproxen, diclofenac), anticonvulsants (diazepam, lorazepam, valproate, sodium thiopental, hexenal), antiemetic drugs (metoclopramide, perphenazine). With psychomotor agitation, magnesium sulfate, haloperidol, barbiturates are indicated. Basic stroke therapy also includes neuroprotective therapy (thiotriazoline, piracetam, choline alfoscerate, glycine) and prevention of complications: aspiration pneumonia, respiratory distress syndrome, pressure ulcers, uroinfections (cystitis, pyelonephritis), pulmonary embolism, thrombophlebitis.

Differentiated treatment for stroke corresponds to its pathogenetic mechanisms. In ischemic stroke, the main thing is the early restoration of blood flow in the ischemic zone. For this purpose, medication and intra-arterial thrombolysis using tissue plasminogen activator (rt-PA), mechanical thrombolytic therapy (ultrasonic thrombus destruction, thrombus aspiration under tomographic control) are used. With proven cardioembolic genesis of stroke, anticoagulant therapy with heparin or nadroparin is performed. If thrombolysis is not indicated or cannot be carried out, then antiplatelet drugs (acetylsalicylic acid) are prescribed. In parallel, vasoactive agents (vinpocetine, nicergoline) are used.

The priority in the treatment of hemorrhagic stroke is to stop bleeding. Hemostatic treatment can be carried out with calcium preparations, vikasol, aminocaproic acid, ethamsylate, aprotinin. Together with a neurosurgeon, a decision is made on the expediency of surgical treatment. The choice of surgical tactics depends on the location and size of the hematoma, as well as on the patient's condition. Possible stereotaxic aspiration of the hematoma or its open removal by craniotomy.

Rehabilitation carried out with the help of regular courses of nootropic therapy (nicergoline, pyritinol, piracetam, ginkgo biloba, etc.), exercise therapy and mechanotherapy, reflexology, electromyostimulation, massage, physiotherapy. Patients often have to re-establish motor skills and learn self-care. If necessary, psychocorrection is carried out by specialists in the field of psychiatry and psychologists. Correction of speech disorders is carried out by a speech therapist.

Stroke prognosis and prevention

The lethal outcome in the 1st month with ischemic stroke varies from 15 to 25%, with hemorrhagic stroke - from 40 to 60%. Its main causes are edema and dislocation of the brain, the development of complications (PE, acute heart failure, pneumonia). The greatest regression of neurological deficit occurs in the first 3 months. stroke. There is often poorer movement recovery in the arm than in the leg. The degree of restoration of lost functions depends on the type and severity of the stroke, the timeliness and adequacy of the provision of medical care, age, concomitant diseases. A year after the stroke, the likelihood of further recovery is minimal; after such a long period, only aphasia is usually amenable to regression.

The primary prevention of stroke is a healthy diet with a minimum amount of animal fats and salt, an active lifestyle, a balanced and calm nature, which allows avoiding acute stressful situations, and the absence of bad habits. The prevention of both primary and recurrent stroke is facilitated by effective treatment of cardiovascular pathology (blood pressure correction, coronary heart disease therapy, etc.), dyslipidemia (taking statins), reduction of excess body weight. In some cases, the prevention of stroke is surgery -