Ischemic stroke in the pool of the right pma. Stroke in the basin of the left middle cerebral artery: the ratio of speech disorders with a variant of cerebral infarction. Material and research methods

03.03.2020

Ischemic stroke is a cerebral infarction that develops with a significant decrease 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 in the neck or intracranial vessels, or both.

Often there is a combination of atherosclerosis with hypertension or arterial hypertension. Acute ischemic stroke is a condition that requires immediate hospitalization of the patient and 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 fatty deposits lining the walls of the vessel. It is called .

An ischemic stroke causes a blood clot, which can form in a blood vessel (thrombosis) or elsewhere in the bloodstream (embolism).

The definition of the nosological form of the disease is based on three independent pathologies that characterize a local circulatory disorder, denoted by the terms “Ischemia”, ” ”, ” ”:

ischemia - a lack of blood supply in a local area of an organ, tissue.
A stroke is a violation of blood flow in the brain due to rupture / ischemia of one of the vessels, accompanied by the death of brain tissue.

With ischemic stroke symptoms depend on the type of disease:

Atherothrombotic attack- occurs due to atherosclerosis of a large or medium-sized artery, develops gradually, most often occurs in a dream;
Lacunar - or hypertension can cause circulatory disorders in the arteries of small diameter.
Cardioembolic form- develops as a result of partial or complete blockage of the middle artery of the brain by an embolus, occurs suddenly during wakefulness, later embolisms may occur in other organs;
Ischemic associated with rare causes- stratification of the arterial wall, excessive blood clotting, vascular pathologies (non-atherosclerotic), hematological diseases.
Unknown origin- characterized by the impossibility of determining the exact causes of occurrence or the presence of several causes;

From all of the above, we can conclude that the answer to the question "what is an ischemic stroke" is simple - a violation of blood circulation in one of the parts of the brain due to its blockage by a thrombus or cholesterol plaque.

Allocate five major periods completed ischemic stroke:

The most 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 effects is after two years.

Most cerebral ischemic strokes begin suddenly, progress rapidly, and result in brain tissue death within minutes to hours.

By affected areas cerebral infarction is divided into:

Ischemic stroke on the right side - the consequences mainly affect motor functions, which are subsequently poorly restored, psycho-emotional indicators may be close to normal;
Ischemic stroke on the left side - mainly the psycho-emotional sphere and speech act as consequences, motor functions are restored almost completely;
Cerebellar - impaired coordination of movements;
Extensive - occurs when there is a complete lack of blood circulation in a large area of \u200b\u200bthe brain, causes swelling, most often leads to complete paralysis with the inability to recover.

Pathology most often occurs with people in old age, but 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 areas responsible for the motor activity of the left side of the body. The result is paralysis of the entire left side.

Accordingly, on the contrary, if the left hemisphere is damaged, the right half of the body fails. An ischemic stroke in which the right side is affected can also cause speech impairment.

Left-sided ischemic stroke

With an ischemic stroke on the left side, speech function and the ability to perceive words are seriously impaired. Possible consequences - for example, if Broca's center is damaged, the patient loses the ability to compose and perceive complex sentences, only individual words and simple phrases are available to him.

stem

Such a type of stroke as a stem ischemic stroke is the most dangerous. In the brain stem there are centers that regulate the work of the most important systems in terms of life support - cardiac and respiratory. The lion's share of deaths occur due to brain stem infarction.

Symptoms of stem ischemic stroke - inability to navigate in space, decreased coordination of movement, dizziness, nausea.

cerebellar

Ischemic stroke of the cerebellum in the initial stage is characterized by a change in coordination, nausea, bouts of dizziness, and vomiting. A day later, the cerebellum begins to put pressure on the brain stem.

The facial muscles may become numb, and the person may fall into a coma. Coma in ischemic stroke of the cerebellum is very common, in the vast majority of cases, such a stroke is completed by the death of the patient.

Code mkb 10

According to ICD-10, cerebral infarction is coded under heading I 63 with the addition of a dot and a number after it to clarify the type of stroke. In addition, when coding such diseases, the letter “A” or “B” (lat.) is added, which indicates:

Cerebral infarction on the background of arterial hypertension;
Cerebral infarction without arterial hypertension.

Symptoms of ischemic stroke

Strokes in 80% of cases are observed in the system of the middle cerebral artery, and in 20% - in other cerebral vessels. In ischemic stroke, symptoms usually appear suddenly, within seconds or minutes. Less commonly, symptoms come on gradually and get worse over a period of hours to two days.

The symptoms of an ischemic stroke depend on which part of the brain is damaged. They are similar to those seen in transient ischemic attacks, but the impairment of brain function is more severe, occurs for more functions, over a larger area of the body, and is usually persistent. It may be accompanied by coma or milder depression of consciousness.

For example, if a vessel that carries blood to the brain along the front of the neck is blocked, the following problems occur:

Blindness in one eye;
One of the arms or legs of one side of the body will be paralyzed or very weak;
Trouble understanding what others are saying, or inability to find words in conversation.

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

double vision;
Weakness in both sides of the body;
Dizziness and spatial disorientation.

If you notice any of these symptoms, be sure to call an ambulance. The sooner action is taken, the better the prognosis for life and the likelihood of dire 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 detected by CT / MRI examination, by clinical methods:

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

Symptoms of TIA are confirmed by laboratory, instrumental studies.

Blood in order to determine its rheological properties;
Electrocardiogram (ECG);
Ultrasound - dopplerography of the vessels of the head and neck;
Echocardiography (EchoCG) of the heart - identification of the rheological properties of blood in the heart and surrounding tissues.

Diagnosis of the disease

The main methods for diagnosing ischemic stroke:

History taking, neurological examination, physical examination of the patient. Identification of concomitant diseases that are important and affect the development of ischemic stroke.
Laboratory studies - lipid spectrum, coagulogram.
Measurement of blood pressure.
MRI or CT of the brain allows you to determine the location of the lesion, its size, the prescription of its formation. If necessary, CT angiography is performed to identify the exact location of vessel occlusion.

It is necessary to differentiate ischemic stroke from other brain diseases with similar clinical signs, the most common of which include a tumor, an infectious lesion of the membranes, and hemorrhage.

Consequences of ischemic stroke

In the case of an ischemic stroke, the consequences can be very diverse - from very severe, with an extensive ischemic stroke, to minor, with micro attacks. It all depends on the location and volume of the focus.

Possible consequences of ischemic stroke:

Mental disorders Many stroke survivors develop 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 for his relatives, he is afraid that he will remain disabled for life. There may also be changes in the behavior of the patient, he may become aggressive, shy, disorganized, may be subject to frequent mood swings for no reason.
Loss of sensation in the limbs and on the face. Sensitivity always recovers longer than muscle strength in the limbs. This is due to the fact that the nerve fibers responsible for the sensitivity and conduction of the corresponding nerve impulses recover much more slowly than the fibers responsible for movement.
Motor dysfunction- strength in the limbs may not be fully restored. Weakness in the leg will force the patient to use a cane, weakness in the hand will make it difficult to perform some household activities, up to dressing and holding a spoon.
Consequences can manifest as cognitive impairment- a person can forget many things familiar to him, phone numbers, his name, the name of relatives, address, he can behave like a small child, underestimating the difficulty of the situation, he can confuse the time and place where he is.
Speech disorders - may not be in all patients who have had an ischemic stroke. They make it difficult for the patient to communicate with his relatives, sometimes the patient can speak absolutely incoherent words and sentences, sometimes it may simply be difficult for him to say something. Such disorders are less common in right-sided ischemic stroke.
Swallowing disorders- the patient can choke on both liquid and solid food, this can lead to aspiration pneumonia, and then to death.
Coordination disorders manifested in staggering when walking, dizziness, falling with sudden movements and turns.
Epilepsy - up to 10% of patients after ischemic stroke may suffer from epileptic seizures.

Prognosis for life in ischemic stroke

The prognosis of the outcome of ischemic stroke in the elderly depends on the degree of brain damage and on the timeliness and systematicity of therapeutic measures. The earlier qualified medical care and proper 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 in atherothrombotic and cardioembolic strokes and is only 2% in lacunar. The severity and progression of a stroke is often assessed using standardized measures such as the National Institutes of Health (NIH) Stroke Scale.

The cause of death in half of the cases is cerebral edema and the dislocation of brain structures caused by it, in the remaining cases - 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 infarction and cerebral edema.

Of the survivors, about 60-70% of patients have disabling neurological disorders by the end of the month. 6 months after a stroke, disabling neurological disorders remain in 40% of surviving patients, by the end of the year - in 30%. The more significant the neurological deficit by the end of the 1st month of the disease, the less likely it is to fully recover.

Motor recovery is most significant in the first 3 months after a stroke, with leg function often recovering better than arm function. The complete absence of hand movements by the end of the 1st month of the disease is a poor prognostic sign. A year after a stroke, further recovery of neurological functions is unlikely. Patients with lacunar stroke have better recovery than other types of ischemic stroke.

The survival rate of patients after an ischemic stroke is approximately 60-70% by the end of the 1st year of the disease, 50% - 5 years after a stroke, 25% - 10 years later.

Poor prognostic signs of survival in the first 5 years after a stroke include the patient's advanced age, previous myocardial infarction, atrial fibrillation, congestive heart failure preceding stroke. Recurrent ischemic stroke occurs in about 30% of patients within 5 years after the first stroke.

Rehabilitation after ischemic stroke

All patients who have had a stroke go through the following stages of rehabilitation: neurological department, neurorehabilitation department, sanatorium and resort treatment, outpatient follow-up.

The main tasks of rehabilitation:

Restoration of impaired functions;
Mental and social rehabilitation;
Prevention of post-stroke complications.

In accordance with the characteristics of the course of the disease in patients, the following treatment regimens are consistently used:

Strict bed rest- all active movements are excluded, all movements in the bed are carried out by medical personnel. But already in this mode, rehabilitation begins - turns, rubdowns - prevention of trophic disorders - bedsores, breathing exercises.
Moderately extended bed rest- gradual expansion of the patient's motor abilities - independent turning in bed, active and passive movements, transition to a sitting position. Gradually, eating in a sitting position is allowed 1 time per day, then 2, and so on.
Ward mode - with the help of medical personnel or with support (crutches, walkers, sticks ...) you can move around within the ward, perform available types of self-service (eating, washing, changing clothes ...).
Free mode.

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

Treatment

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 drugs 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 goals: restoration of blood circulation in the affected area, as well as maintaining the metabolism of brain tissues and protecting them from structural damage. Specific therapy for ischemic stroke involves drug, non-drug, and surgical methods of treatment.

In the first few hours after the onset of the disease, it makes sense to carry out thrombolytic therapy, the essence of which is to lysis the thrombus and restore blood flow in the affected part of the brain.

Nutrition

The diet implies restrictions on the consumption of salt and sugar, fatty foods, flour foods, smoked meats, pickled and canned vegetables, eggs, ketchup and mayonnaise. Doctors advise adding more fiber-rich vegetables and fruits to the diet, eating soups prepared according to vegetarian recipes, fermented milk foods. Of particular benefit are those that have potassium in their composition. These include dried apricots or apricots, citrus fruits, bananas.

Food must be fractional, consumed in small portions five times every day. In this case, the diet after a stroke involves a volume of fluid not exceeding one liter. But do not forget that all actions taken must be discussed with your doctor. Only a specialist can help the patient recover faster and recover from a serious illness.

Prevention

Prevention of ischemic stroke is aimed at preventing the occurrence of a stroke and preventing complications and recurrent ischemic attack.

It is necessary to treat arterial hypertension in a timely manner, conduct an examination for pain in the heart, and prevent sudden increases in pressure. Proper and nutritious nutrition, quitting smoking and drinking alcohol, a healthy lifestyle - the main thing in the prevention of cerebral infarction.

Patient DAP, Year of birth -1983, Age - 29 years. Place of work - accountant, at the moment: disabled person of the 1st group.

Complaints
neurological
Speech disorder
Weakness in the right hand
Severe limitation of active movements
Contact with the patient is difficult due to aphasic disorders, anisognosia.

Other complaints
There are no complaints from other bodies and systems.

Medical history
05/05/11 - for the first time an increase in blood pressure (BP) to 160/100 mm. rt. Art., previously blood pressure was not controlled. Didn't ask for help.
05/10/2011 - against the background of a hypertensive crisis (180/110), an ischemic stroke developed in the basin of the left middle cerebral artery with deep right-sided hemiparesis to plegia in the arm, elements of sensory-motor aphasia. She was hospitalized by the SMP team to the district hospital.
May 20, 2011 - MRI showed signs of acute ischemic stroke in the LCMA basin, obstructive hydrocephalus with a block at the level of the cerebral aqueduct, which was a consequence of a previous infarction in the LCMA basin.
05/21/2011 - examined by a neurosurgeon - no need for neurosurgical correction.
August 2011 - was treated at the City Hospital. Discharged with some improvement.
14.01.20112 - for treatment and additional examination sent to the Central Clinical Hospital of Ultrasound.

Anamnesis of life
Acute rheumatic fever at age 10 (June 1993)
Viral hepatitis, tuberculosis, sexually transmitted diseases - denies
Infections transferred in childhood - denies
Other past illnesses: bronchitis, pneumonia (2010)
Hereditary diseases have not been established
Allergological history is not burdened
No blood transfusions were performed.
Drug history - not burdened.

Objective examination
General condition - moderate
The skin is clean, normal color
Rhythmic heart sounds, emphasis II tone on the aorta. AD 135/80 mm. rt. Art. Heart rate 78/min
In the lungs, auscultatory vesicular breathing, no wheezing
On palpation, the abdomen is soft and painless. Liver at the edge of the costal arch
Physiological departures - without features
No peripheral edema
Controls stool and urination
The symptom of tapping is negative on both sides.

Neurological status
Meningeal symptom complex is negative
Eye fissures and pupils D=S, convergent strabismus due to the left eye. Full eyeball movements. Pupillary reaction to light of average vivacity. Installation nystagmus
Central paresis of mimic muscles on the right
The tongue is slightly deviated to the left. The pharyngeal reflex is preserved. Elements of sensory aphasia
Muscle tone in the right limbs is increased according to the spastic type. There is a moderate increase in muscle tone of the spastic type in the left limbs. Muscle strength in the right limbs is reduced to 0-1 points in the arm, 1-2 points in the leg. Movement in the limbs is possible due to the proximal sections
Tendon and periosteal reflexes from the hands D>S, high, with an extended zone of evoking; from legs D>S, high, polykinetic. Pathological foot and hand phenomena on both sides
Convincing disorders of sensitivity have not been identified
Emotionally labile. Dysphoria. Elements of anosognosia

Diagnosis at admission
underlying disease
Condition after an ischemic stroke in the LSMA pool with severe right-sided hemiparesis in the arm to plegia, elements of sensory-motor aphasia, CSF-hypertension syndrome.
Accompanying illnesses
Combined rheumatic mitral defect with a predominance of insufficiency.

Examination plan and results

Magnetic resonance imaging of the brain
Occlusive hydrocephalus was the result of a heart attack in the basin of the left middle cerebral artery, as a result of prolonged ischemia - the formation of an adhesive process with a block at the level of the cerebral aqueduct.

Echo-KG
Sclerotic changes in the walls of the aorta, cusps of the aortic and mitral valves. Prolapse of the anterior and posterior leaflets of the mitral valve II stage. with regurgitation I-II Art. on the valve (formation of mitral insufficiency against the background of rheumatically altered mitral valve leaflets). Dilatation of the ascending aorta. Mild hypertrophy of the posterior wall of the left ventricle. Additional chord in the lumen of the left ventricle, hemodynamically insignificant.

ECG
sinus rhythm. Right. The horizontal position of the electrical axis. Signs of hypertrophy of the right atrium. Decreased repolarization processes in the apical anterolateral region.

Ultrasound of the carotid arteries
There were no hemodynamically significant blood flow disturbances in all segments of the carotid basin on both sides.
Ultrasound examination of the abdominal organs
Diffuse changes in the parenchyma of the liver and pancreas without their increase. Cholesterosis of the gallbladder walls. Microurolithiasis. Nephroptosis on the right - I st. Focal neoplasm of the right adrenal gland.

Chest x-ray
Focal and infiltrative changes in the lungs were not detected. Roots are structural. Not enlarged. The sinuses are free. The diaphragm is clearly defined. Heart of normal shape and size. The aorta is not changed.
Laboratory data

General blood analysis
Reactive thrombocytosis, leukocytosis, increased ESR
General urine analysis
Transient proteinuria due to damage to the basement membrane.
Lipid spectrum of blood
Hypercholesterolemia. Dyslipidemia: Type II-B

Blood chemistry

Hyperglycemia due to ischemia in the projection area of the left
middle cerebral artery.

Blood clotting indicators
Within the physiological norm.

Clinical Syndromes
Damage to the middle cerebral artery
Occlusive hydrocephalus
Arterial hypertension
Atherosclerosis
Dyslipidemia type II-B
Reactive thrombocytosis
Heart failure II B, FC III
The defeat of the mitral valve with a predominance of insufficiency I stage
Proteinuria
hyperglycemia

Clinical diagnosis
underlying disease
Ischemic stroke in the basin of the left middle cerebral artery (05/10/11). late recovery period. Arterial hypertension III degree, stage III. Heart failure II stage, FC III. Atherosclerosis. Dyslipidemia type II-B. reactive thrombocytosis.
Accompanying illnesses:
Post-rheumatic mitral valve disease with a predominance of insufficiency I st. Neoplasm in the adrenal gland.

Treatment
Normalization of lifestyle, rehabilitation measures
Motor rehabilitation (full or partial recovery): range of motion, strength and dexterity in paretic limbs, balance function in ataxia, self-care skills
Speech rehabilitation: classes with a speech therapist-aphasiologist and a neuropsychologist, exercises to restore writing, reading and counting that are usually impaired in aphasia (and preserved in dysarthria), using "homework" for the second half of the day
Psychological and social readaptation: creating a healthy climate in the family, developing an optimistic and at the same time realistic outlook on life, participating in cultural events within the social circle
Taking antidepressants: selective serotonin reuptake inhibitors.
Training in rehabilitation centers for stroke patients
Secondary prevention
Atorvastatin 40 mg/day
Cardiomagnyl 75 mg/day

It's important to know
Instant mortality in ischemic stroke is 20%
70% of patients have persistent defects in motor and sensory areas
In the absence of therapy, the recurrence rate is 10% per year
Antiplatelet agents reduce risk of recurrent stroke by 20%
Statins and a / hypertensive therapy (primarily ACE inhibitors!) Reduce the risk of relapse by 35%
50% of patients retain the ability to self-care
Up to 80% of patients regain the ability to walk
Almost 50% of patients with ischemic stroke die from myocardial infarction
Rehabilitation therapy (physical education, speech therapy, occupational therapy) is effective in 90% of cases of rehabilitation

Forecast
Favorable for life
For work - unfavorable, disability.

Ischemic stroke is one of the weather-dependent diseases, the risk of which increases sharply in adverse weather.

Timokhin A. V., Zaritskaya N. A., Ph.D. Lebedinets D. V., Assoc. Lysenko N. V., prof. Yabluchansky N.I.
Kharkiv National University. V.N. Karazin

Ischemic stroke in the vertebrobasilar basin

A disease such as ischemic stroke of the brain is the main cause of disability in our time. Pathology has a high mortality, and in surviving patients causes severe consequences of the cerebrovascular type. There are various reasons for the development of the disease.

What is vertebrobasilar insufficiency

The spinal arteries emerge from the subclavian vessels located in the upper part of the sternum cavity and pass through the openings of the transverse processes of the vertebrae of the neck. Further, the branches go through the cranial cavity, where they join into one basilar artery. It is localized in the lower part of the brain stem and provides blood supply to the cerebellum and the occipital region of both hemispheres. Vertebrobasilar syndrome is a condition characterized by a reduction in blood flow in the vertebral and basilar vessels.

Pathology is a reversible violation of brain functions, which occurred as a result of a decrease in the blood supply to the area fed by the main artery and vertebral vessels. According to ICD 10, the disease is called "syndrome of vertebrobasilar insufficiency" and, depending on concomitant disorders, it may have the code P82 or H81. Since the manifestations of VBI can be different, the clinical symptoms are similar to other diseases, due to the complexity of diagnosing pathology, the doctor often makes a diagnosis without proper justification.

Causes of ischemic stroke

Factors that can cause ischemic stroke in the vertebrobasilar basin include:

Embolism of various origins in the vertebrobasilar region or compression of the subclavian artery.
An arrhythmia in which thrombosis develops in the atria or other parts of the heart. At any moment, blood clots can break into pieces and enter the vascular system along with the blood, causing blockage of the arteries of the brain.
Atherosclerosis. The disease is characterized by the deposition of cholesterol fractions in the arterial walls. As a result, the lumen of the vessel narrows, which leads to a decrease in blood circulation in the brain. In addition, there is a risk that the atherosclerotic plaque will crack, and the cholesterol released from it will block the artery in the brain.
The presence of blood clots in the vessels of the lower extremities. They can be divided into segments and, together with the bloodstream, enter the cerebral arteries. Causing difficulty in the blood supply to the organ, blood clots lead to a stroke.
A sharp decrease in blood pressure or hypertensive crisis.
Clamping of the arteries supplying blood to the brain. This can happen during carotid surgery.
A strong thickening of the blood caused by the growth of blood cells leads to difficulty in the patency of blood vessels.

Signs of a cerebral infarction

The disease is an acute violation of cerebral blood supply (stroke of the ischemic type) with the subsequent development of signs of a neurological disease that persist for up to a day. In transient ischemic attacks, the patient:

temporarily loses sight;
loses sensation in any half of the body;
feels stiffness in the movements of the arms and / or legs.

Symptoms of vertebrobasilar insufficiency

Ischemic stroke of the brain with localization in the vertebrobasilar basin is perhaps the most common cause of disability in people under 60 years of age. The symptoms of the disease differ and depend on the localization of the violation of the main functions of the vessels. If blood circulation has been disturbed in the vertebrobasilar basin, the patient develops the following characteristic symptoms:

dizziness of a systemic nature (the patient feels as if everything around him is collapsing);
chaotic movement of the eyeballs or its limitation (in severe cases, complete immobility of the eyes occurs, strabismus is formed);
deterioration in coordination;
tremor during the performance of any action (trembling of the limbs);
paralysis of the body or its individual parts;
nystagmus of the eyeballs;
loss of body sensitivity (usually occurs in one half - left, right, bottom or top);
sudden loss of consciousness;
irregular breathing, significant pauses between inhalations / exhalations.

Prevention

The human cardiovascular system is constantly under stress as a result of stress, so the risk of stroke increases. With age, the threat of thrombosis of the head vessels increases, so it is important to prevent coronary disease. To prevent vertebrobasilar insufficiency from developing, you should:

to refuse from bad habits;
with hypertension (high pressure), it is imperative to take medications to normalize blood pressure;
timely treat atherosclerotic stenosis, keep cholesterol levels normal;
eat a balanced diet, stick to a diet;
control chronic diseases (diabetes mellitus, renal failure, arrhythmia);
often walk on the street, visit dispensaries and medical sanatoriums;
exercise regularly (exercise in moderation).

Treatment of vertebrobasilar syndrome

Therapy of the disease is prescribed after the doctor confirms the diagnosis. For the treatment of pathology are used:

antiplatelet agents, anticoagulants;
nootropics;
analgesics;
sedatives;
correctors of blood microcirculation;
angioprotectors;
histamine mimetics.

Ischemic brain disease is dangerous because seizures (strokes) gradually become more frequent, and as a result, an extensive violation of the blood circulation of the organ can occur. This leads to a complete loss of capacity. To prevent coronary disease from becoming severe, it is important to seek medical help in a timely manner. In the treatment of vertebrobasilar syndrome, the main actions are aimed at eliminating the problem with blood circulation. The main drugs that can be prescribed for ischemic disease:

acetylsalicylic acid;
Piracetam/Nootropil;
Clopidogrel or Agregal;
Troxerutin / Troxevasin.

Folk methods for the treatment of coronary disease can only be used as an additional measure. In case of ulceration of an atherosclerotic plaque or stenosis of the carotid artery, the doctor prescribes a resection of the affected area, followed by a shunt. After the operation, secondary prevention is carried out. For the treatment of VBS (vertebrobasilar syndrome), therapeutic exercises and other types of physiotherapy are also used.

Physiotherapy

Vertebrobasilar insufficiency cannot be cured with drugs alone. Along with drug treatment of the syndrome, therapeutic procedures are used:

massage of the occipital region;
magnetotherapy;
manual therapy;
therapeutic exercises to eliminate spasms;
strengthening the spinal trunk, improving posture;
acupuncture;
reflexology;
hirudotherapy;
use of a neck brace.

Treatment of cerebral ischemia

The most severe lesions in ischemic stroke that occurred in the vebrobasilar basin are brain stem injuries, since vital centers are located in it - respiratory, thermoregulatory, and others. Violation of the blood supply to this area leads to respiratory paralysis, collapse and other life-threatening consequences. Ischemic stroke in the vetebrobasilar basin is treated by restoring impaired cerebral circulation and eliminating inflammatory foci.

A stroke of the brain is a disease that is treated by a neurologist in a hospital setting. For therapeutic purposes, in ischemic stroke of the vertebrobasilar basin, a drug method is used. During the treatment period, the following drugs are used:

vasodilators to relieve spasms (nicotinic acid, Pentoxifylline);
angioprotectors that stimulate cerebral circulation, metabolism (Nimodipine, Bilobil);
antiplatelet agents to prevent thrombosis (Aspirin, Dipyridamole);
nootropics for enhancing brain activity (Piracetam, Cerebosin).

Drug treatment of ischemic stroke, which occurred in the vertebrobasilar basin, lasts for 2 years. In addition, an operative method of treating the disease can be used. Surgical intervention for vertebrobasilar syndrome is indicated for the third degree of coronary disease, if conservative treatment has not given the expected effect.

According to ongoing studies, severe consequences of ischemic stroke that occurred in the vertebrobasilar basin occur in two cases. This happens if the treatment was not started in a timely manner or did not give results in the later stages of the development of the disease. In this case, a negative outcome of vertebrobasilar insufficiency can be:

mental retardation;
isolation;
asociality;
difficulty in learning;
migraine.

First aid for stroke

If you observe symptoms of an ischemic stroke in a person, call an ambulance immediately. Describe the symptoms to the dispatcher as accurately as possible so that the neurological team arrives on call. Next, give the patient first aid:

Help the person to lie down. At the same time, turn it on its side, substitute any wide container under the lower jaw in case of vomiting.
Measure BP. With an ischemic stroke that occurred in the vertebrobasilar basin, the pressure is usually elevated (about 180/110).
Give the patient an antihypertensive agent (Corinfar, Captopril, others). In this case, it is better to put 1 tablet under the tongue - this way the remedy will work faster.
Give a person with a suspected ischemic stroke 2 diuretic tablets. This will help relieve swelling of the brain.
To improve the metabolism of the patient's brain, give him a nootropic, for example, Glycine.
After the arrival of the ambulance team, tell the doctor exactly what drugs and at what dosage you gave to a patient with an ischemic stroke.

How is rehabilitation after a left-sided ischemic stroke?

With such a problem as ischemic stroke, elderly people often face. It occurs due to the fact that plaques or blood clots appear in the vessels through which blood enters the brain. Often this occurs in the basin of the left middle cerebral artery.

When a blood clot or atherosclerotic plaque cuts off the blood supply to the brain, a stroke occurs.

Treatment, rehabilitation and consequences after such an event take a long time and pass in different ways, it depends on the hemisphere that is affected, as well as the volume of the lesion. It is very important to choose the right treatment, which will reduce the adverse effects. This article will discuss left-sided ischemic stroke and its consequences.

Symptoms and treatment of a stroke on the left side

There are two types of symptoms in ischemic stroke: general and specific. With the timely detection of general symptoms, it is necessary to start treatment as soon as possible, and get rid of the blood clot in the pool of the left middle cerebral artery. Specific symptoms make it possible to understand which side of the brain is affected, and what kind of treatment is needed.

General symptoms. The first thing that a person will feel after the appearance of a blood clot in the basin of the left middle cerebral artery is a violation of the purity of consciousness, a slowdown in reaction, some clouding of reason.

Then there are consequences such as severe dizziness, impaired coordination of movements. As a result, vomiting often begins. It is difficult to concentrate on something and talk. Breathing becomes irregular.

specific symptoms. With a stroke of the left hemisphere, disturbances appear on the opposite side. The sensitivity in this area is significantly reduced.

An arm or leg on the right side may suddenly become numb. The eyes begin to double and it becomes difficult to recognize objects. Speech is significantly impaired, a person either utters inarticulate sounds or unrelated words. It is also associated with a violation of the functions of thinking and logic.

Therefore, a person begins to carry nonsense, which is very difficult to parse. He falls into a depressive state, which occurs when the left hemisphere of the brain is damaged. Because of incoherent speech, it is difficult for patients to describe their symptoms.

In order to provide timely assistance, it is important to know a few rules that will help determine the onset of a stroke and prevent the consequences as much as possible:

If one of these symptoms is present, emergency hospitalization should be initiated. Depending on the individual, there is only three to six hours to provide assistance, otherwise the consequences will be irreversible.

After making a diagnosis and determining the affected hemisphere of the brain, it is necessary to urgently and immediately begin treatment. It is very important to do this as quickly as possible, since doctors have only a few hours to restore brain cells. After three hours, from the moment of the onset of the attack, the brain cells of the left hemisphere begin to die irrevocably.

Treatment of an attack takes place in several stages:

After a small number of brain cells are damaged, their partial or complete recovery is possible due to neuroplasticity. According to their physiological properties, the cells of the central nervous system are able to recover.

In order for this recovery to be carried out, complex therapy is necessary. First of all, anticoagulants and thrombolytics (or fibrinolytics) are administered intravenously.

After getting rid of a blood clot in the basin of the left middle cerebral artery, it is necessary to provide the body with drugs that protect and support neurons to facilitate their regeneration.

Consequences and rehabilitation

Stroke of the left hemisphere of the brain is much more common than the right. This is due to the high frequency of thrombus formation in the basin of the left middle cerebral artery. The consequences of such a stroke depend on how quickly help was provided and how correctly the combination of drugs was selected during emergency care.

How long people live after such strokes depends on proper rehabilitation and treatment. The consequences are reflected mainly on the right half of the body, as well as a number of cognitive functions. Among them are:

How long they live after an attack, and what is the severity of the consequences, depends on many factors, such as:

The doctor who will oversee the rehabilitation process, taking into account these factors, will prescribe treatment and monitor its effectiveness.

The beginning of rehabilitation should take place under the direct supervision of specialists.

Therefore, the first time after the attack, the patient is in the hospital, then he is transferred to a rehabilitation center or discharged home, depending on the condition at the time of discharge from the hospital.

During rehabilitation, physiotherapy exercises and massage are prescribed. For physical therapy, an individual set of exercises is selected depending on the severity of the disease. This is necessary in order to prevent the development of muscle atrophy.

Exercises can be very simple: from slight rotation of the limbs, in the prone position, to serious complexes that can be performed by a person with a slight loss of sensation without paralysis. As the patient's condition improves, the load is gradually increased under the supervision of a specialist so that the deterioration of the general condition does not begin.

Patients also need regular massage. In the case of bedridden patients, this prevents the formation of bedsores on the body. In any case, massage helps to improve blood circulation and stimulate muscle tone. You can use massage to influence individual muscle groups or to tone the body completely.

Due to the deterioration of the general mood, often the patient can be prescribed regular antidepressants. At the same time, there is often a reluctance of patients to contribute to rehabilitation, which greatly complicates the recovery process of the body. In some cases, patients are prescribed drugs that reduce brain activity (tranquilizers) so as not to interfere with treatment.

It is also important to pay attention to the prevention of congestive pneumonia that occurs due to lack of physical activity. It is necessary to regularly ventilate the room, but this should be done in such a way that the patient is not exposed to drafts.

Often, patients during the rehabilitation period are prescribed physiotherapy - electrically stimulating measures. They act by analogy with massage, but according to other principles of action, they help stimulate the activity of the motor apparatus and individual muscles.

There is a practice of treating muscles with thermal compresses. For this, compresses are made from heated paraffin with a periodic change of location.

It happens that patients experience constant pain in the affected area. In this case, painkillers and analgesics are used with the necessary regularity.

Many drugs of this spectrum of action are addictive, so they should be taken strictly under the supervision of a doctor.

In case of speech impairment, speech rehabilitation is carried out. Then the patient regularly works with a speech therapist and trains in pronunciation. With an integrated approach and regular exercises, speech disorders are safely eliminated after several months of classes. The desire of the patient himself to quickly start talking normally is also important.

In order for the patient to quickly adapt to society after the trauma and feel like a full-fledged member in it, classes with a psychologist are necessary. Throughout the rehabilitation period, the control of a psychologist is no less important than the control of a supervising physician. The psychologist conducts regular conversations and explains all the points that most often worry people in this position.

Thus, as a result of a stroke on the left side of the brain, a person can become disabled, and falling into depression leads to a loss of faith and desire to recover. In addition to therapy, the help and support of relatives, as well as positive emotions, is very important.

A positive attitude will only contribute to a speedy recovery. Therefore, it is important to pay attention to what kind of microclimate reigns in the patient's family and adjust it if necessary.

Left-sided ischemic stroke

Ischemic stroke of the left hemisphere is a violation of cerebral circulation, which is caused by a significant decrease or sudden cessation of blood supply to a certain area of the brain. This pathological condition causes left-sided stenosis, thrombosis or embolism of the cerebral arteries associated with atherosclerosis, arterial hypertension, vasculitis or congenital pathology of the cerebral vessels (often with hypoplasia and / or other anomalies in the structure of the arteries of the polygon of Willis).

Symptoms of a left-sided stroke

The clinical symptoms of ischemic stroke of the left hemisphere are due to a decrease in the volume of cerebral blood flow with a significant limitation in the supply of oxygen and glucose to the brain tissue. At the same time, a left-sided local ischemic pathological process develops with a pronounced circulatory disorder in a certain vascular pool with the manifestation of cerebral and focal symptoms.

General cerebral symptoms include - impaired consciousness of varying degrees, vomiting, severe headache, vestibular disorders (dizziness, unsteady gait). Focal neurological symptoms - movement disorders (paresis and paralysis), swallowing, vision, speech disorders, cognitive impairment, which depend on the location of the focus and the vascular basin of the lesion.

Specific symptoms of strokes on the left side

Left-sided ischemic stroke is characterized by the predominance of focal symptoms over cerebral neurological symptoms. Consciousness is usually preserved or impaired by the type of stunning. The development of sopor or cerebral coma is observed with the localization of cerebral infarction in the cerebral hemispheres with severe cerebral edema with the development of a secondary dislocation-stem syndrome. This occurs with blockage of the main trunk of the middle cerebral artery or with occlusion or severe stenosis in the carotid pool, as well as with the development of a pathological process in the arteries of the vertebrobasilar basin.

With the development of a cerebral infarction of the left hemisphere, the opposite side of the body is affected and complete or partial paralysis develops on the right with a change in muscle tone and / or persistent sensory disturbances, speech disorders, depressive states and impaired logical thinking.

You can recover from a stroke at home. Just remember to drink once a day.

Signs of a left-sided cerebral infarction in the carotid pool

Ischemic stroke in the system of the internal carotid artery is caused by severe hemodynamically significant stenosis or blockage inside or outside the cranial part of the left internal carotid artery. With thrombosis in the extracranial section of the internal carotid artery on the left, patients develop hemiparesis in combination with central paresis of the tongue and facial muscles, significant sensitivity disorders and the formation of visual field defects on the right (the opposite side of the body is affected).

With a left-sided lesion of the internal carotid artery, optopyramidal syndrome may develop, which is characterized by decreased vision or complete blindness on the side of the blockage (left) in combination with hemiparesis of the right side of the body.

Ischemic cerebral stroke with intracranial blockage of the internal carotid artery on the left is manifested by right-sided hemiplegia and hemianesthesia in combination with severe cerebral symptoms: severe headache, vomiting, significant impairment of consciousness and/or psychomotor agitation and the formation of a secondary stem syndrome.

Features of ischemic stroke in stenosis of the internal carotid artery

With a cerebral infarction, which is caused by severe stenosis in the extracranial section of the internal carotid artery on the left, there is a “flickering” of symptoms: numbness or transient weakness of the limbs, decreased vision on the right and motor aphasia.

The causes of hemodynamically significant stenosis of the internal carotid artery are in most cases severe atherosclerosis of the main vessels of the head, therefore, in the clinic, as a rule, there are previous transient ischemic attacks and systolic murmur over the affected artery (left) and asymmetry of carotid artery pulsation are detected.

According to the clinical course, this type of stroke is distinguished - an apoplexy form, which is characterized by a sudden onset and resembles a hemorrhagic stroke, a subacute and chronic form (with a slow increase in symptoms).

Clinical signs of a lesion in the basin of the middle cerebral artery

Ischemic stroke with a lesion in the basin of the middle cerebral artery on the left manifests itself in patients with right-sided hemiplegia, hemianesthesia and hemianopsia, as well as gaze paresis and speech disorders in the form of motor or total aphasia.

In the presence of an ischemic stroke in the basin of the deep branches of the middle cerebral artery, right-sided spastic hemiplegia is formed with central paresis of the muscles of the face and tongue and with various types of sensory disturbances in combination with motor aphasia.

When the lesion is localized in the basin of the cortical branches of the middle cerebral artery, hemianopsia and motor disorders of the upper limb on the right with impaired sensitivity, as well as alexia, agraphia, sensorimotor aphasia and acalculia are noted in left-sided ischemic cerebral infarction.

Signs of cerebral infarction with damage to the anterior cerebral artery

Ischemic stroke in the basin of the anterior cerebral artery on the left is manifested by right-sided paresis of the lower limb on the right or hemiparesis with a more pronounced lesion of the lower limb on the right.

With blockage of the paracentral branch of the anterior cerebral artery, monoparesis of the foot on the right develops, resembling peripheral paresis. Manifestations are possible in the form of urinary retention or incontinence with reflexes of oral automatism and grasping phenomena. With left-sided localization of ischemic stroke, the left hand is affected with the formation of its apraxia.

Changes in the mental state are also characteristic in case of damage to the frontal lobe on the left in the form of a decrease in criticism and memory with the development of unmotivated behavior. All these changes are expressed in the formation of bilateral foci of cerebral infarction in the basin of the anterior cerebral arteries.

Symptoms of damage to the posterior cerebral artery

Cerebral infarction in the basin of the cortical branches of the posterior cerebral arteries is clinically manifested by visual impairment: quadrant hemianopsia or homonymous hemianopsia (while central vision is preserved) and visual agnosia with metamorphopsia phenomena. With left-sided localization of the lesion, alexia, semantic and sensory aphasia occur, and in the case of ischemia in the mediobasal parts of the temporal lobe, it determines the occurrence of memory impairment and emotionally affective disorders.

As a result of the development of cerebral infarction with damage to the deep branches of the posterior cerebral artery on the left, which vascularize the posterior hypothalamus, a significant part of the thalamus, visual radiation and thickening of the corpus callosum, a thalamic infarction develops. It is clinically characterized by the development of hemianesthesia, hyperpathia, hemialgia, hemiataxia, hemianopsia with transient right-sided hemiparesis. Less commonly, ataxia occurs in combination with intentional tremor in the right limbs and hyperkinesia of the choreoathetous type or "thalamic" hand syndrome.

Features of speech disorders in left-sided ischemic stroke

Aphasia in left-sided ischemic stroke often develops due to the formation of a focus of necrosis in the speech areas located in the left hemisphere (in right-handers) and only in rare cases does motor or total aphasia occur when the right hemisphere is affected (in left-handers). Speech disorders develop with occlusion or severe spasm of the middle cerebral artery, which is one of the main branches of the internal carotid artery.

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The severity of aphasia depends on the size of the ischemic focus and the level of arterial damage - a milder clinical picture is observed with extracranial occlusion of the vessel, and severe aphasia (total) is observed with intracerebral thrombosis of the middle cerebral artery.

Also, the severity of aphasia and its dynamics depend on the nature of the damage to the cerebral vessels - thrombosis, stenosis, or the presence of loops with kinks.

Features of speech recovery in ischemic strokes depend on the predominant localization of damage to the neurons of the speech center - the cortex, subcortical white matter or the spread of ischemia directly to the cortical areas of speech, the multifocal lesion, as well as the possibility of collateral circulation.

Do you still think that it is impossible to recover from STROKE and cardiovascular pathologies!?

Have you ever tried to restore the functioning of the heart, brain or other organs after suffering pathologies and injuries? Judging by the fact that you are reading this article, you know firsthand what is:

frequent discomfort in the head (pain, dizziness)?
sudden feeling of weakness and fatigue.
constantly feeling high blood pressure.
there is nothing to say about shortness of breath after the slightest physical exertion ...

Catad_tema Stroke - articles

Ischemic stroke: malignant infarction in the basin of the middle cerebral artery. Clinical guidelines.

Ischemic stroke: malignant infarction in the basin of the middle cerebral artery

ICD 10: I63.0, I63.1 , I63.2, I63.3, I63.4, I63.5, I63.8

Year of approval (revision frequency): 2016 (review every 10 years)

ID: КР573

Professional associations:

Association of Neurosurgeons of Russia

Approved

Agreed

2. Dzhindzhikhadze R.S., Dreval, ON, Lazarev V.A. Decompressive craniectomy for intracranial hypertension. - M. : GEOTAR-Media, 2014.

3. Krylov V.V., Nikitin A.S., Dashyan V.G., Burov S.A., Petrikov S.S., Asratyan S.A. Surgery for massive ischemic stroke. - M. : GEOTAR-Media, 2016.

4. Krylov V.V., Petrikov S.S., Belkin A.A. Lectures on neuroreanimation. – M.: Medicine, 2009.

5. Lebedev V.V., Krylov V.V., Tkachev V.V. Decompressive trepanation of the skull. Neurosurgery 1998; 2:38-43.

6. Nikitin A.S., Asratyan S.A. Functional outcome after decompressive craniotomy in patients with malignant massive ischemic stroke. Neurological Journal 2016; 3(21): 142-145.

7. Nikitin A.S., Krylov V.V., Burov S.A., Petrikov S.S., Asratyan S.A., Kamchatnov P.R., Kemezh Yu.V., Belkov M.V., Zavalishin E.E. Dislocation syndrome in patients with malignant course of massive ischemic stroke. Journal of Neurology and Psychiatry named after S.S. Korsakov 2015; 3 Stroke Special: 20-26.

8. Shevelev O.A., Tardov M.V., Kalenova I.E., Sharinova I.A., Shmyrev V.I. Craniocerebral hypothermia in the acute period of ischemic stroke: changes in the degree of neurological deficit and characteristics of cerebral blood flow. Kremlin Medicine. Clinical Bulletin 2012;3: 34-36.

9. Bereczki D. Mannitol for acute stroke. Cochrane Database Syst. Rev. 2007; 3: CD001153

10. Christensen M. Cerebral apoplexy (stroke) treated with or without advancedartificial hyperventilation. Cerebral circulation, clinical course, and cause of death. Stroke 1973; 4:568-619.

11. Dohmen C. Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction. Stroke 2007; 38:56-61.

13. Hacke W. "Malignant" middle cerebral artery territory infarction: clinical course and prognostic signs. Arch. neurol 1996; 53:309-315.

14. Krieger D. Cooling for acute ischemic brain damage (COOL AID): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 2001; 32:1847-1854.

15. Quizilbash N, Lewington SL, Lopez-arietta J. Corticosteroids for acute ischemic stroke. Cochrane library. Oxford (United Kingdom): Update software.- 2001(1).

16. Qureshi A.I., Suarez J., Yahia A.M. et al. Timing of neurological deterioration in massive middle cerebral artery infarction: a multicenter review. Crit. Care Med 2003; 31:272-277.

17. Schwab S., Schwarz S., Spranger M. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998; 29(12): 2461-2466.

18. Simard D., Paulson O. Artifical hyperventilation in stroke. Trans. Am. Neurol. Assoc. 1973; 98:309-310.

19. Steiner T., Pilz J., Schellinger P. Multimodal online monitoring in middle cerebral artery territory stroke. Stroke 2001; 32(11): 2500-2506.

20. Wijdicks E., Diringer M. Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome. Mayo Clinic. Proc 1998; .73(9): 829-836.

21. Wijdicks E ., Sheth K ., Carter B . et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(4): 1222-1238.

22. Woodcock J., Ropper A., Kennedy S. High dose barbiturates in non-traumatic brain swelling: ICP reduction and effect on outcome. Stroke 1982; .13: 785-787.

Annex A1. Composition of the working group

Krylov Vladimir Viktorovich	Academician of the Russian Academy of Sciences, Director of the Clinical Medical Center of the Moscow State University of Medicine and Dentistry. A.I. Evdokimova, Head of the Department of Emergency Neurosurgery, Research Institute for Emergency Medicine named after A.I. N.V. Sklifosovsky, Head of the Department of Neurosurgery and Neuroreanimation, Moscow State University of Medicine and Dentistry. A.I. Evdokimova
Dreval Oleg Nikolaevich	Doctor of Medical Sciences, Professor, Head of the Department of Neurosurgery of the Russian Academy of Postgraduate Education of the Ministry of Health of the Russian Federation
Dzhindzhikhadze Revaz Semenovich	Candidate of Medical Sciences, Associate Professor of the Department of Neurosurgery of the Russian Academy of Postgraduate Education of the Ministry of Health of the Russian Federation
Lazarev Valery Alexandrovich	Doctor of Medical Sciences, Professor of the Department of Neurosurgery of the Russian Academy of Postgraduate Education of the Ministry of Health of the Russian Federation
Dashyan Vladimir Grigorievich	Doctor of Medical Sciences, Professor of the Department of Neurosurgery and Neuroreanimation of the Moscow State University of Medicine and Dentistry named after M.V. A.I. Evdokimova
Nikitin Andrey Sergeevich	Candidate of Medical Sciences, Assistant of the Department of Neurosurgery and Neuroreanimation, Moscow State University of Medicine and Dentistry named after M.V. A.I. Evdokimova
Petrikov Sergey Sergeevich	Doctor of Medical Sciences, Professor of the Russian Academy of Sciences, Deputy Director of the Research Institute for Emergency Medicine named after V.I. N.V. Sklifosovsky, Professor of the Department of Neurosurgery and Neuroreanimation of the Moscow State University of Medicine and Dentistry. A.I. Evdokimova

Neurosurgery
Neurology
Anesthesiology and resuscitation

Table P1. Levels of certainty of evidence, indicating the classification of levels of evidence used

Table P2. Levels of strength of evidence, indicating the classification of levels of evidence used

Appendix B. Patient Management Algorithms

Algorithm 1. Stroke time less than 24 hours

no Yes

Decompressive craniotomy (in the absence of contraindications)

Appendix B. Information for Patients

Patients with malignant infarction in the basin of the middle cerebral artery in the acute period of the disease are deeply disabled. After discharge from the hospital, where the patient was treated for a stroke, a comprehensive rehabilitation is indicated in a specialized center aimed at partial regression of the neurological deficit. The nature of rehabilitation and the number of courses are determined by a rehabilitation specialist. Outside the rehabilitation center on an outpatient basis, the patient is under the supervision of a neurologist at the place of residence, which determines the treatment. They continue activities aimed at regression of neurological deficit (physiotherapy exercises, massage, classes with a speech therapist), prevention and treatment of extracranial complications. All patients in the first 3-6 months after a stroke need care. Against the background of rehabilitation, 3-6 months after a stroke, 50% of patients recover to the level of moderate disability with the ability to walk independently and self-care.

Symptoms of a left-sided stroke

Specific symptoms of strokes on the left side

With the development of a cerebral infarction of the left hemisphere, the opposite side of the body is affected and complete or partial paralysis develops on the right with a change in muscle tone and / or persistent sensory disturbances, speech disorders, depressive states and impaired logical thinking.

Signs of a left-sided cerebral infarction in the carotid pool

Features of ischemic stroke in stenosis of the internal carotid artery

Clinical signs of a lesion in the basin of the middle cerebral artery

Signs of cerebral infarction with damage to the anterior cerebral artery

Symptoms of damage to the posterior cerebral artery

Ischemic stroke is one of the leading causes of death. It is a violation of the blood circulation of the brain with damage to its tissue and can develop against the background of diseases associated with vascular damage: atherosclerosis, diabetes, coronary heart disease, etc.

Classification

Pathogenesis determines the likelihood of the following types of ischemic stroke:

These are the most common types of brain circulatory disorders.

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Less common are:

pathology caused by increased blood clotting, stratification of the arterial wall, non-atherosclerotic vasculopathies;
pathology of unknown origin - when the cause cannot be determined, or the violation is caused by a combination of reasons.

In situations where the manifestation of symptoms decreases within 3 weeks after the acute stage, a small ischemic stroke is diagnosed.

There is a classification depending on localization:

in the left carotid pool;
in the right carotid basin;
in the vertebrobasilar basin.

Causes

In 40% of cases occurring among young people, it is not possible to diagnose the cause. In general, causes can be correctable or non-correctable.

The development of the former can be influenced, they are the result of an unhealthy lifestyle or chronic diseases. The latter arise at birth, or under the influence of random factors.

Reasons that can be influenced:

atherosclerosis - blockage of blood vessels by cholesterol;
arterial hypertension - increased blood pressure;
hypodynamia - insufficient physical activity;
osteochondrosis of the cervical region - a violation of the functioning of the intervertebral discs;
obesity and diabetes;
effects on the body of alcohol and nicotine;
use of oral contraceptives.

The most common causes are atherosclerosis and arterial hypertension. They appear in connection with a violation in the body of lipid metabolism.

Already from the age of 20, there is a possibility of atherosclerotic plaques. As for high blood pressure, in people over 40 who follow it and maintain the pressure within the normal range, the risk of ischemic stroke is reduced by 40%.

Taking oral contraceptives causes an increase in blood clotting, which increases the risk of developing pathology.

Uncorrectable reasons:

age;
gender;
heredity;
stressful situations.

Over the years, the risk of ischemic stroke greatly increases. The age of 45 is considered critical, it is after it that the likelihood of violations increases significantly.

If among people of 20 years of age 1 case of pathology per 3000 is diagnosed per year, then among people from 84 years old - 1 case per 45 people. In women under 30 and after 80 years of age, the risk of developing disorders associated with the blood supply to the brain is greater, while between the ages of 30 and 80 more such cases occur among men.

A significant influence of the hereditary factor was also revealed. The incidence of stroke in children is on the rise. At a young age, the main causes are severe diseases of the cardiovascular system, metabolic disorders and endocrine diseases, congenital or acquired lesions of cerebral vessels.

Symptoms

Symptoms can be cerebral and zonal (focal). Zonal symptoms appear depending on which part of the brain is affected, cerebral symptoms reflect the state of the body as a whole.

Cerebral symptoms:

change of consciousness; the person may lose consciousness or appear overly agitated;
and dizziness;
nausea and vomiting;
feeling of fever, dry mouth, sweating;
disorientation in space.

Zone symptoms:

lack of coordination;
a feeling of weakness in one half of the body, however, violations can occur throughout the body;
speech dysfunction: fuzzy speech, disorders associated with the understanding and reproduction of speech, inability to read, write, count;
swallowing disorders;
violation of visual function: bifurcation of objects, loss of visual fields, deterioration of vision;
dysfunction of the vestibular apparatus: dizziness, sensation of rotation in space;
change in behavior, the inability to perform simple and familiar actions.

Emergency video

The speed of reaction at the onset of the first symptoms of ischemic stroke plays a crucial role. Before the arrival of the ambulance, it is necessary to lay the patient in such a way that the head and shoulders are slightly raised, the victim should be kept calm and movement should be avoided.

In case of loss of consciousness, it is necessary to monitor breathing and ensure that the tongue does not sink. The patient is brought to consciousness with a cotton swab with ammonia or wine vinegar. You need to rub your torso and limbs with your hands.

Do not take medications without consulting a doctor.

Damage zones

And	The left hemisphere is responsible for speech functions, so patients who have impaired blood circulation on the left suffer from speech defects, up to loss of speech. At the same time, there are no violations of the functions of perception. A left-sided stroke is manifested by limited motor activity on the right side of the body, so it may be difficult for the patient to eat or write on their own. Stroke on the right is more difficult to diagnose, because. its manifestations are associated with orientation in space, sensitivity - such violations from the outside are not always noticeable and time for assistance may be missed.
	Stem stroke is a consequence of atherosclerosis of blood vessels that feed the brain stem. Stroke of the brain stem is manifested by a violation of the movements of the facial muscles, respiratory, swallowing functions. This is the most dangerous type of stroke, which can be accompanied by the development of paralysis, the patient may be at risk of disability.
	Cerebellar stroke is accompanied by headaches, dizziness, impaired coordination of limb movement on one half of the body, and oculomotor disorders. Due to cerebellar edema, the brain stem is compressed, and may develop. Often this type of stroke ends, only surgery will help prevent it.

Consequences

The consequences depend on many factors: the localization of the focus, the amount of damage.

Major stroke	May end in complete paralysis, tk. with it, the blood supply to a large area of \u200b\u200bthe brain is disrupted.
Micro attack	The danger may not be so significant, a full recovery is possible.
Ischemic stroke in the basin of the right middle cerebral artery	Accompanied by anosognosia, i.e. patients ignoring the symptoms of the disease.
Ischemic stroke in the vertebrobasilar basin	It causes dizziness, impaired auditory and visual functions, can provoke the development of coma, paralysis of the limbs, diffuse hypotension, hormetonia (paroxysmal increase in tone).
Attack in the basin of the vertebral artery	This artery supplies blood to the cervical spinal cord, cerebellum, and medulla oblongata.

Depending on the localization of the damaged area, the consequences can be different: from a short-term loss of consciousness and impaired auditory and visual functions to a deep coma.

Differential diagnosis and examination

It is important to determine the type of stroke as quickly as possible in order to prescribe the correct treatment. The sooner help is provided, the higher the chances of recovery.

When diagnosing, laboratory and instrumental methods are used.

The mandatory list of tests and studies for stroke includes:

general blood analysis;
determination of the level of glucose in the blood;
coagulogram - analysis for blood clotting;
a study on the gas composition (blood oxygen, carbon dioxide);
lipidogram - analysis for cholesterol;
the level of urea in the blood;
electrolyte composition;
cardiogram - to exclude the likelihood of developing concomitant heart diseases;
brain tomography - used to determine the area of softening of the brain and the consequences that have occurred; if necessary, a special contrast agent is introduced, which contributes to the accurate identification of lesions;
oculist consultation.

If after receiving the results of these studies, the diagnosis is difficult, then additional examinations are prescribed:

Type of stroke depending on symptoms

The type of stroke can be determined depending on the symptoms:

sign	Ischemic	Hemorrhagic	subarachnoid hemorrhage
Previously diagnosed transient ischemic attacks	Often	Seldom	Not
Beginning of the current	Hours, days	Minutes, hours	A couple of minutes
Headaches	Usually no	Strong	Strong
Vomit	In rare cases	Often	Often
Loss of consciousness	A couple of minutes	long	Short term
Elevated blood pressure	Often	Is always	In rare cases
Pain when bending head forward	Not	Often	Is always
Weakness of half of the body	Often starts right away	Often starts right away	In rare cases, it appears later
Speech dysfunction	Often	Often	In rare cases
Fluid from spinal tap	Colorless	Often bloody	In all cases, bloody
Retinal hemorrhage	Not	In rare cases	Maybe

Forecast

It is difficult to give any forecast for the state of a person after a stroke - it all depends on the speed of assistance, the volume of damaged areas.

Even if doctors are optimistic, one should not forget that the essence of the disease is in violation of the blood supply to cells, i.e. their death, and it will take time to recover.

The most unfavorable are atherothrombotic stroke and thromboembolic cerebral infarction. Mortality after them within a month is 15-25%. With lacunar strokes, death occurs in 2% of cases.

NIHSS score

To assess the patient's condition, a scale is used that reflects the likelihood of recovery.

The result is represented by the sum of points, which has the following designation:

The NIHSS assessment involves the study of the following indicators:

level of consciousness - the patient's ability to perform simple actions and answer questions;
vision and oculomotor reflexes - coordinated movements of the pupils and the ability to follow a moving object.
checking the mobility of the facial muscles;
the ability to control movements, as well as the coordination of movements;
checking pain sensitivity (reaction to light pricking);
the ability to comprehend the information received;
speech function - reading sentences, describing objects in the picture.

Rankin scale - RS

Used to determine the level of the patient's capacity. It helps to track the dynamics of symptoms, the effect of rehabilitation measures, to assess the need to use assistive devices if the patient has movement disorders.

This scale includes 5 steps:

1st degree	Violations persist for some time, slight incapacitation
2nd degree	Slight incapacitation, in which the patient can serve himself and be at home alone for a week.
3rd degree	Medium disability, characterized by the patient's ability to move independently, but he needs help and tips in resolving some issues.
4th degree	Medium-heavy. The patient can move around, but needs care at all times.
5th degree	Severe, in which the patient can neither move independently nor take care of himself.

Barthel Index (IB)

This index shows the effectiveness of treatment, expressed in points, the maximum number of which is 100. It is built on the basis of the patient's ability to perform simple household activities. The norm is 100 points, when receiving 60 points or less, the patient will not be able to live without outside help.

Periods

There are several periods of the course of pathology:

the most acute period, which lasts for the first 3 days: in the first 3 hours, it is possible to administer thrombolytic drugs; doctors put a transient ischemic attack if the symptoms regress within a day.
the acute period lasts up to 4 weeks;
early recovery period takes six months;
late recovery period lasts for 2 years;
remote - after 2 years.

Treatment

Treatment consists in eliminating the causative mechanisms of the disease - dissolving a blood clot and restoring the patency of damaged vessels with the help of drugs. This can be done after tomography and exclusion of possible hemorrhage.

Assumes obligatory observance of a dairy and vegetable diet: cottage cheese, cereals, berries and fruits in a pureed form. Later, boiled fish and meat are introduced into the diet. Be sure to do physical exercise.

Also, the patient needs to communicate a lot, talk, listen to the radio, but mental overwork should not be allowed.

Folk remedies

Treatment with folk remedies may include the preparation of decoctions, ointments, infusions.

The use of bean infusion is widely used in the East. To prepare it, the beans (and the plant too) are completely poured with boiling water and, tightly wrapping the container, insist in a warm place for several hours. You can drink a drink without restrictions.

With paralysis of the limbs, you can use an ointment of pine needles (1 tsp) and bay leaf (6 tsp), crushed into dust, and 5 tbsp. homemade butter. The ointment is rubbed on the limbs 2 times a day.

Prevention

It is especially important to monitor your condition for people with high blood pressure. It is necessary to take drugs that bring it back to normal. A sharp drop in blood pressure is also dangerous. Statins are used to restore the heart rhythm during ischemia.

Diabetes greatly aggravates the recovery process, increases the risk of recurrent stroke. It is necessary to adjust the level of sugar in the blood, as well as monitor the pressure - it should be lower than in patients without diabetes.

People at risk should be registered (therapist, endocrinologist, neurologist) and undergo annual examinations.

The probability during the first year of rehabilitation is about 30%.

Secondary prevention includes the following points:

normalization of blood pressure;
taking antiplatelet agents (for example, aspirin tablets), statins (slow down the production of cholesterol);
a diet that excludes the intake of cholesterol-containing products;
, physiotherapy;
you may need to consult a psychologist, tk. stroke survivors often suffer from psycho-emotional disorders;
in case of violations of speech function, classes with a speech therapist are necessary.

Rehabilitation and recovery

Recovery includes neurorehabilitation and observation in the neurological department, sanatorium-and-spa treatment is recommended. Rehabilitation is carried out in order to restore impaired functions, prevent the occurrence of complications.

Recovery involves a sequential change of the following modes:

Strict bed rest, in which any movement in bed is allowed only with the participation of medical professionals. At this time, pressure ulcers are prevented, breathing exercises, turns are done.
Moderate-extended bed rest. The patient is allowed to roll over on his own, move to a sitting position, eat while sitting, first 1 time per day, then 2, etc.
Ward. It is allowed to move around the ward with the help of assistive devices or medical personnel, to carry out simple self-care procedures.
Free mode.

The duration of each of their modes is set individually depending on the severity of the condition.

Answers to popular questions

My dad was diagnosed with transient ischemic attack. What is it and how is it different from ischemic stroke?

TIA is the mildest form of ischemic cerebrovascular accident. All symptoms: dizziness and headaches, vomiting, numbness of the extremities and weakness disappear within a day. Hospitalization and examination, followed by registration with a neurologist and treatment of the causes that caused TIA, are mandatory.

Can a second stroke be avoided?

To do this, you need to take drugs that prevent the formation of blood clots, as well as control cholesterol levels. All drugs are taken only on the advice of a doctor.

Do I need a diet during the rehabilitation period?

Diet is required. It is necessary to consume fresh vegetables and fruits in large quantities, avoid fatty, sweet, stop smoking and drinking alcohol.

A cyst formed at the site of impaired blood supply. Do I need to operate and cut it out?

The formation of a cerebrospinal fluid cyst 1-3 months after a stroke is the norm. No operation needed.

Stroke in ICD-10

In the International Classification of Diseases (ICD), stroke is coded in category I 63 with the addition of a number after the dot specifying the type of stroke. The use of indices A and B is used to indicate the presence of arterial hypertension (A) or its absence (B).