Professional publications of doctors 

Stroke. Clinic, diagnosis and treatment. Stroke, stroke treatment Ischemic stroke clinic diagnosis treatment

Ischemic stroke is an acute type of cerebrovascular accident that occurs due to insufficient blood supply to a certain part of the brain or to the complete cessation of this process, in addition, it causes damage to the brain tissue in combination with its functions. Ischemic stroke, the symptoms of which, as well as the disease itself, are most often noted among the most common types of cerebrovascular diseases, is the cause of subsequent disability and often death.

general description

One of the most important mechanisms of the pathogenetic nature of the development of the condition under consideration is the narrowing of the lumen of intracranial vessels or great arteries as a result. Due to the deposition of lipid complexes in the intima of the artery, the endothelium is affected, which, in turn, leads to the appearance of an atheromatous plaque in this area. The gradual process of evolution of this plaque is accompanied by an increase in its size, which occurs due to the deposition of shaped elements directly on it. At the same time, the vessel undergoes narrowing, which often reaches the level of either a critical form of stenosis or absolute occlusion.

Most often, atherosclerotic plaques form in areas of bifurcation (branching) of large vessels.

The lumen of the cerebral arteries narrows under the influence of inflammatory diseases; in the overwhelming majority of cases, the relevance of congenital anomalies in the structure of the cerebral vascular system is also noted. The development of ischemic stroke is also facilitated to some extent by extravasal compression of the region of the vertebral arteries, which occurs as a result of various types of pathologies and leads to changes in the vertebrae. , - these factors also contribute to damage to arterioles and small arteries.

Due to the presence in the human body of a very powerful system that provides collateral circulation, it is possible to maintain a sufficiently high level of cerebral blood flow, even in situations when it comes to the relevance of a serious lesion of one or even two arteries of the main type.

If we are talking about a case with multiple vascular lesions, then here already such compensatory capabilities are not as powerful as required, and therefore all those prerequisites are created as a result of which ischemic stroke develops. The risk of its occurrence increases in the event of a violation of autoregulation (the ability of cerebral vessels to provide the required blood supply against the background of conditions leading to changes in blood pressure levels).

As for the main risk factors contributing to impaired cerebral circulation and, accordingly, ischemic stroke, the following can be distinguished among them:

  • age (elderly and senile);
  • arterial hypertension in the patient's history (with increased pressure, the risk of stroke doubles);
  • atherosclerosis of the vertebral and carotid arteries;
  • diabetes;
  • heart disease;
  • smoking.

Ischemic stroke: types and main periods

Ischemic strokes (IS) can be equated to various variants of their classification, which is determined based on their clinical and etiopathogenetic characteristics, as well as from the zone of their localization.

Ischemic strokes, whose features are determined based on the rate of formation that characterize neurological deficit, as well as on the basis of their duration:

  • – in this case, we are talking about a focal neurological disorder (this also includes monocular blindness, that is, the patient's blindness in one eye), which completely regresses in the next 24 hours from the moment of its appearance;
  • "Minor stroke" - means ischemic attacks of prolonged action, characterized by the occurrence of an inverse neurological defect. In this case, ischemic stroke involves the restoration of normal neurological functionality within 2-22 days;
  • ischemic stroke, progressive - it is characterized by the gradual development of actual focal and cerebral symptoms, which can occur within a few hours or a day. The restoration of functions after this occurs in an incomplete volume - the patient, as a rule, has some neurological symptoms of a minimal manifestation;
  • total (i.e. complete) ischemic stroke - means a completed cerebral infarction with an actual incomplete or stably regressing deficit.

Ischemic strokes, characterized by a specific severity of the lesion and, accordingly, the subsequent condition of patients:

  • IS of mild severity - the severity of neurological symptoms is determined by its own insignificance, regression occurs within the next three weeks after the onset of the disease.
  • AI of moderate severity - in this case, focal neurological symptoms prevail, no disturbances of consciousness are observed.
  • IS severe - the course of a stroke is characterized by a pronounced nature of cerebral disorders with the relevance of oppression of consciousness and gross neurological focal deficit (in frequent cases, dislocation symptoms appear).

Ischemic strokes corresponding to the pathogenetic features of the manifestations:

  • atherothrombotic stroke - its appearance is provoked by atherosclerosis of the cerebral arteries of medium or large caliber. The development of this type of stroke occurs stepwise, the increase in symptoms occurs over a period of time from several hours to several days, often the "debut" is noted in a dream. In this case, a stroke occurs due to the detachment of an atherosclerotic plaque and its blockage of the vessel;
  • cardioembolic stroke - its occurrence is accompanied by partial or complete blockage of the cerebral artery by an embolus. Such a stroke begins, mostly suddenly, at the time of the patient's wakefulness. The neurological deficit at the time of the onset of the disease is most pronounced. Localization of a stroke is mainly concentrated in the area of ​​blood supply to the cerebral middle artery. As for the size of the focus of actual ischemic damage, it can be medium or large. In other words, or - all this can provoke a detachment of a blood clot, which, in turn, will end up in the specified artery, leading to its blockage;
  • hemodynamic stroke - caused by the influence of hemodynamic factors (lowering blood pressure, falling cardiac output, etc.). It can be characterized by a suddenness or stepwise onset of manifestations, they can appear both in the active state of the patient and at rest. This type of stroke occurs against the background of pathologies of intracranial or extracranial arteries, among which atherosclerosis, stenosis and another type of anomaly can be distinguished.
  • lacunar stroke - It is caused by circulatory disorders against the background of such factors as, for example, hypertension or diabetes mellitus, in which the pathological process is localized in arteries with a small diameter;
  • rheological stroke (or stroke corresponding to the type of hemorheological microocclusion) - is formed without a patient's history of hematological or vascular disease of the previously established type of origin. As the causes of such a stroke, hemorheological changes, as well as violations of the fibrinolysis and hemostasis system, can be distinguished.

Ischemic strokes, determined by a specific type of localization. In particular, the corresponding area of ​​the lesion of the arterial basin is considered:

  • carotid artery (internal);
  • vertebral arteries, the main artery, as well as their branches;
  • cerebral posterior, middle and anterior arteries.

As for the periods of ischemic strokes, it is customary to distinguish the following of them:

  • sharpest - time interval within the first three days;
  • spicy - about 28 days;
  • restorative (early) - term of the order of six months;
  • restorative (late) - about two years;
  • residual effects - period after 2 years.

Ischemic stroke: symptoms

The clinic of this disease is characterized by symptoms arising against the background of a sudden loss of function in one or another part of the brain under the influence of one or another specificity of the factors discussed above.

Actually ischemic stroke, the symptoms of which are manifested in the patient, is directly determined by the department that was affected. The overwhelming majority of symptoms in ischemic stroke are speech disorders, as well as sensory and motor disorders. In addition, the course of the process may also affect the vision (on one side). Let us consider in more detail the features of the symptoms.

Movement disorders

They manifest themselves in the awkwardness of movements and in their weakness, concentrated on one side of the body. Weakness in the limbs can also develop bilaterally. In addition, there are impaired swallowing and coordination.

Speech disorders

Sensitivity on one side of the body is subject to changes, this manifestation can be complete or partial. Also, visual changes are noted, in which vision is reduced in one eye, the field of vision can "fall out" on the right or left side, bilateral blindness and double vision occurring before the eyes are possible.

Vestibular disorders

The feeling is created that objects in front of the eyes are rotating (this is defined as systemic dizziness).

Behavioral disorders, cognitive impairments

It is difficult for the patient to dress and brush his teeth, comb his hair and perform a number of other standard actions. Orientation in space is also impaired, memory impairments are noted, as well as impaired spatial-visual perception.

A number of symptoms are also noted that require an immediate call to an ambulance: severe headache, dizziness (in combination with nausea, vomiting), again, the symptoms noted above, speech disorders. Ischemic stroke requires immediate first aid, prompt hospitalization of the patient is extremely important.

During the first 90min. 50% of this disease develops, and within 360 minutes. - up to 80%. Accordingly, as a "therapeutic window" there is a time reserve of 2 hours, during which therapeutic measures can be most effective in rescuing neurons in the corresponding region of the brain.

Complications

Unfortunately, complications are an almost inevitable companion of this condition, especially if the treatment of a stroke began later than required. Let's highlight the following types of complications:

  • infectious complications (arise due to a prolonged lying position in the complex by the addition of an infection, which leads to an infection of the urinary system, in pneumonia, bedsores, etc.);
  • deep vein thrombosis of the lower leg;
  • general blood test, lipid profile, coagulogram.

    Treatment of ischemic stroke

    The main goal of treatment in this case is to restore neurological reactions affected by impairments, as well as to determine preventive measures and measures aimed at eliminating complications. Ischemic stroke can be treated with medication and surgery.

    Drug treatment is focused on maintaining vital functions for a person as a whole. Accordingly, in this case, sharp surges in pressure should be medically excluded (it should be slightly increased, because a sharp decrease in pressure is accompanied by the process of gradual necrosis of the brain).

    In addition, it is required to normalize blood levels of electrolytes and glucose. As a prevention of cerebral edema and for treatment, diuretics are prescribed. With the relevance of diabetes mellitus for the patient, it is transferred to the introduction of insulin subcutaneously, which ensures control over the level of sugar in the blood, and also makes it possible to exclude conditions with a sharp decrease or increase in sugar level.

    A few weeks after the stroke, the treatment is already restorative, which implies the introduction of nootropics (drugs to improve brain function), as well as vascular drugs and drugs to gradually reduce blood pressure.

    As for the surgical treatment, it implies, accordingly, the surgical removal of the formed thrombus. At the moment, this method is very promising for use in the treatment of the condition in question.

    In the event of the occurrence of extensive zones of necrosis, decompression is carried out - this makes it possible to exclude the development of a pronounced increase in intracranial pressure, the elimination of which is impossible only with drug therapy.

    If a stroke is suspected, an examination by a neurologist, therapist and ophthalmologist is necessary.

Stroke is a formidable disease with high prevalence, mortality and disability rates. It is believed that every two minutes someone has a stroke in Russia. It is from this disease that every third person in the world dies. Unfortunately, at present, stroke is "getting younger" and often develops in people of working age. All this makes the problem of stroke and its consequences not only medical, but also socially significant.

Ischemic stroke (or cerebral infarction) is an acute vascular catastrophe that has arisen as a result of the cessation of blood supply to a particular area of ​​the brain. It manifests itself as cerebral and focal neurological symptoms that persist for more than a day, or leads to death at an earlier date.

The following diseases can lead to the development of ischemic stroke:

Acute cerebral ischemia triggers pathological biochemical cascade reactions. The consequence of these phenomena is the formation of a heart attack, which occurs by two mechanisms: necrosis of nerve cells and apoptosis - genetically programmed cell death.

The reactions of the ischemic cascade include acute tissue hypoxia, acidosis, pathology of glycolipid metabolism, disturbances in the neurotransmitter system, leading to excitotoxicity. The development of these processes forms the core of ischemia. The reaction of the vessels surrounding the center of ischemia forms a zone of perifocal edema.

Classification

According to the mechanism of development, ischemic stroke is divided into:

The clinical picture of ischemic stroke. The manifestations of cerebral stroke directly depend on the area of ​​the brain where the vascular catastrophe occurred. However, there are so-called clinically "silent" strokes of small sizes, which do not show any neurological symptoms and can be accidental findings during diagnostic neuroimaging procedures.

Stem structures infarction

In the trunk, which is supplied with blood by the vertebrobasilar vascular system, the main vital centers are localized. As a rule, cerebral syndrome is pronounced with loss of consciousness, a sharp headache, nausea and vomiting.

Since practically all the nuclei of the cranial nerves are embedded in the stem structures, the clinic may be associated with their defeat. With infarction of the legs and pons, symptoms of damage to the nuclei of the cranial nerves appear - oculomotor disorders, diplopia, paresis of the vertical gaze, hypoesthesia on the face and weakness of the masticatory muscles, peripheral paresis of the circular muscle of the mouth.

With damage to the medulla oblongata, bulbar syndrome will be formed. It is manifested by dysphagia (violation of swallowing due to damage to the nucleus of the glossopharyngeal nerve), dysphonia (dullness of the voice as a result of the pathology of the vagus nerve), dysarthria (blurred speech, if the focus of the heart attack has affected the nucleus of the hypoglossal nerve).

It is worth remembering that pyramidal paths also pass through the trunk. Their defeat leads to contralateral paresis and paralysis of the muscles of the extremities. Tetraplegias are also possible.

Together with the symptoms of cranial nerve pathology, pyramidal symptoms appear in the form of alternating syndromes (Weber, Fauville, Miyard-Gubler, Jackson). Spinothalamic and bulbothalamic pathways may be involved in the pathological process. The consequences of this will be manifested by disorders of sensitivity of the cerebral-conductive type.

Cerebellar infarction

Ischemic cerebellar stroke is manifested by a gross disorder of the coordination system, vestibulo-atactic syndrome, static and dynamic ataxia, and the appearance of chanted speech. The nuclei of the cranial nerves, with which the cerebellum has extensive connections, can also be affected.

Ischemic stroke in the posterior cerebral artery system

When the posterior cerebral artery, which supplies the occipital lobe, is damaged, the main signs of ischemic stroke are manifested in the form of contralateral homonymous and quadrant hemianopsias.

The consequence of the defeat of the cortical fields is visual agnosia (a condition when the patient does not recognize a previously seen object or people).

In addition, the pathology of higher cortical functions when the focus is localized in the dominant hemisphere can manifest itself in the form of amnestic aphasia (a person cannot name a familiar object) and alexia (a person who could read does not know how to do this).

Alexia can be viewed as a particular manifestation of visual agnosia. The patient sees the letters, but does not recognize them, therefore he cannot read them.

One of the branches of the posterior cerebral artery is the deep thalamic artery. With its defeat, hyperpathy, paroxysmal pain and disorders of both superficial and deep sensitivity can occur.

Disorders in the anterior cerebral artery system

With the suffering of the anterior cerebral artery, contralateral monoparesis and sensory disorder in the cortical and cerebral-conduction type of the lower limb appear clinically.

Due to the defeat of the cortical-cerebellar pathways, ataxia with symptoms of astasia-abasia is clinically manifested.

When the center of ischemia captures the middle parts of the parietal lobe, elements of apraxia may appear (impairment of the ability to perform purposeful, conscious everyday actions).

Changes in the psyche are of a specific nature with a decrease in criticism of their own state, a tendency to black humor and vulgar jokes.

Disorders in the middle cerebral artery system

The most extensive clinic is observed in acute cerebrovascular pathology in this vascular basin. The defeat of the pyramidal tract gives contralateral monoparesis in the arm or hemiparesis with a predominance of muscle weakness in the upper limb.

The pathology of sensitivity manifests itself as a symptom of hemianesthesia on the side opposite to the focus. In addition, there may be homonymous hemianopsia, paresis of the horizontal gaze, central paresis of the lower part of the facial muscles and muscles of the tongue.

When the lesion is localized in the dominant hemisphere (left for right-handers and right for left-handers), disorders of phase (speech), gnosis (the process of cognition) and praxis (practical human activity) are manifested.

Speech disorders are detected in the form of motor and sensory aphasia, agraphia. Disorders of higher cortical functions are noted, such as anosognosia (lack of criticism of one's defect), astereognosis (inability to identify objects by touch), alexia, acalculia, and apraxia.

Stroke in the internal carotid artery system

If the internal carotid artery is damaged, one should expect the formation of an opticopyramidal syndrome: a drop in vision up to amaurosis on the affected side and hemiparesis on the opposite side.

The consequence of damage to the postganglionic sympathetic fibers that braid the wall of the internal carotid artery can be a vegetative symptom of ptosis of the upper eyelid (ptosis), constriction of the pupil (miosis) and retraction of the eyeball (enophthalmos).

Hemiplegia, hemianesthesia are contralaterally determined, violations of the higher cortical functions are revealed. An increase in the pulsation of the vessel can be noted proximal to the blockage.

Diagnostics and treatment

Laboratory and instrumental examination methods help to clarify the diagnosis and determine the tactics of patient management. The list of diagnostic procedures includes:


There is a basic stroke therapy that is carried out to patients, regardless of the type of acute cerebrovascular accident and neurological symptoms. In another way, it is also called undifferentiated.

First of all, it is necessary to normalize the work of the vital functions of the body - respiration and blood circulation. It is required to ensure patency of the upper respiratory tract, oxygen inhalation is possible, if the patient is breathing ineffectively, the patient is transferred to artificial ventilation.

To correct the activity of the cardiovascular system, the level of blood pressure is first normalized. At the same time, blood pressure is reduced, only when its values ​​are above 200 and 120 mm Hg. Otherwise, secondary hemodynamic cerebral ischemia can be provoked. Less severe hypertension needs treatment when it is combined with cardiac pathologies (gross arrhythmias, heart failure).

If an ischemic stroke is hemodynamic in nature, a fight against the symptom is required - arterial hypotension. In this case, sympathomimetics are prescribed.

Rhythm disturbances are corrected by antiarrhythmics. Mandatory control of the main biochemical parameters of blood, water-salt and acid-base states is carried out.

Neuroprotective therapy aimed at protecting brain cells from structural damage is mandatory. The fight against edema that has formed around the ischemic zone is carried out using osmotic diuretics.

Do not forget about the prevention of somatic complications such as bedsores, phlebothrombosis, uroinfection, etc. If necessary, symptomatic therapy is prescribed.

For patients with cerebral infarction, in order to improve the rheological properties of blood, prevent secondary formation of blood clots and vascular protection, therapy with antiplatelet agents and vasoactive drugs is prescribed.

Neurosurgical intervention is indicated for cerebellar infarctions with the formation of obstructive hydrocephalus and severe deformity of the cerebral trunk.

When the diagnosis of atherothrombotic cerebral infarction is established, with early hospitalization of the patient in the first 4 hours from the onset of the disease, with stabilization of blood pressure and the absence of contraindications, thrombolysis is possible.

More than half a million people suffer strokes in Russia every year. At the same time, only 18 percent of patients turn to doctors on time. In Moscow, for a more effective fight against this disease, the Department of Health on the basis of vascular centers has created a stroke network of operative care. In December, the chain's clinics will begin to carry out the first emergency clot removal operations. On the eve of the Day of Fight Against Stroke, which is celebrated on October 29, the chief neurologist of the capital, Nikolai Shamalov, spoke about how to recognize an insidious disease and what help Muscovites can count on.

- Nikolai Anatolyevich, tell us, how many strokes happen in Moscow?

In Moscow, more than 42 thousand people are admitted to the hospital every year with acute cerebrovascular accidents, which include not only strokes, but also transient ischemic attacks, that is, what is popularly called a microstroke.

It is important to see a doctor in the first 4.5 hours after the onset of signs of the disease.

Stroke is closely related to age: the older the person, the higher the risk. For example, in people over 55, the risk of having a stroke doubles every subsequent decade. The most common type is ischemic stroke (caused by a blood clot), accounting for approximately 70–80 percent of patients. About 15 percent of patients have a hemorrhagic stroke (hemorrhage). Well, 7-15 percent of patients in different periods go to doctors with transient ischemic attacks. Patients tolerate microstrokes more easily, but this is a harbinger of a serious illness, so they require special attention.

Stroke is the leader among all diseases in terms of disability of people, this is the world statistics, and our country is no exception. This is both a medical and a social problem.

- And what is the social component of the problem?

Unfortunately, this disease often leads a person to complete or partial loss of motor, communication and social skills. This places a heavy burden on both the patient and his relatives and the state, of course, since additional funds are required to maintain, for treatment, and rehabilitation of people who have suffered a stroke. The tariff for treatment is 120 thousand rubles. It includes all procedures, medicines, care and rehabilitation that are carried out in city medical institutions. These services are paid for from the budget, treatment is provided under the compulsory medical insurance policy.

For successful treatment, experts say it's important to see your doctor as soon as possible at the first sign of a stroke. However, only 18 percent of patients manage to do this. Why it happens?

It is important to see a doctor in the first 4.5 hours after the onset of signs of the disease. This is the therapeutic window that allows doctors to most effectively perform thrombolysis - to dissolve the thrombus with the help of drugs. Doctors will quickly cope with a blood clot, blood flow will be restored, which means that the brain will not have time to seriously suffer.

The problem of late visits is associated with a very low awareness of the population, with a low literacy of the population regarding the symptoms of stroke.

Its peculiarity lies in the fact that there are no painful sensations, even the head does not hurt very often. And pain is a very powerful sentinel reaction for a person, it is because of it that he immediately seeks medical help. With a stroke, the most common are unilateral weakness in the arm, leg, asymmetry of the face. Speech disturbances, a decrease (feeling of numbness) in the hand and leg on one side of the body may appear. The painlessness of the symptoms leads to the fact that the person decides to lie down at home, go to the doctor later. That is, unfortunately, most people delay treatment, because, firstly, they do not know the symptoms of a stroke, and secondly, simply because there is no sharp, bright signal in the form of pain, as is the case with some other illness.

How is the problem of informing the population about the symptoms of this disease being solved in Moscow? Is there any effect from this information?

The Department of Health is doing a lot of work related to informing the population through the media. There are stroke schools in polyclinics, where doctors regularly talk about the symptoms of the disease, its treatment and rehabilitation. Also, polyclinics distribute information materials in the form of leaflets, brochures, booklets. The upcoming classes, for example, will be held on October 29 - Stroke Day. On the same day, in all health centers of city polyclinics, it will be possible to consult neurologists, do an ultrasound examination of the great vessels of the head and screening to identify risk factors for stroke.

Of course, the medical community also uses social networks to inform people. So, in social networks, tips, banners and pictures are common to attract attention, which list the signs of a stroke.

I would like to note that the number of people informed about this disease, its symptoms and methods of treatment has increased in Moscow. Among those who seek medical help in the first 4.5 hours, already 24 percent, which is six percent more compared to last year.

- Tell us what kind of help patients receive in Moscow, are there any innovative methods of dealing with stroke?

Regional and primary vascular departments provide assistance to patients with stroke. It is there, in the vascular centers, that the patient is hospitalized to remove a blood clot or for neurosurgical surgery for hemorrhage. Then, depending on the changes that have occurred (are there any difficulties with speech, movement, perception of information) caused by a stroke, treatment and rehabilitation of the patient in the hospital begins. Rehabilitation continues after discharge as long as it takes effect.

In the near future, a new method of treating patients with ischemic stroke called "thromboextraction" will be introduced in the vascular centers. Now the thrombus in the vessel is dissolved with the help of drugs, thrombolysis is performed. The essence of the new method is that with the help of special instruments for minimally invasive operations (with minimal intervention. - Approx.mos.ru) will perform surgical removal of blood clots. The new technique, as well as thrombolysis, is recommended by the world expert community as the most effective.

In a number of Moscow hospitals, at the first stages, there will be eight departments, the first surgical removal of blood clots will take place in December this year. Doctors, nurses and vascular center staff are completing their training in the new method. Thus, the stroke network in Moscow is ready for operation.

In the near future, a new method of treating patients with ischemic stroke will be introduced in vascular centers

- How exactly is thromboextraction done and for which patients is it indicated?

Ambulance teams will receive certain criteria according to which they will evacuate the patient to the stroke network unit for possible thromboextraction.

First of all, she will be able to help patients with ischemic stroke without gross impairment of consciousness, but with a rather severe motor deficit (paralysis. - Approx.mos.ru). That is, these are situations when we have grounds at the prehospital stage to assume blockage of a large artery - the one that is the target of thromboextraction.

The operation will resemble the placement of a coronary artery stent, which is done in patients with a heart attack. A special stent is inserted through the puncture in the groin area using a long instrument. Only the path of this stent will go not to the heart, but to the brain. The stent will be able to capture the blood clot for doctors to remove from the vessel. They will also use catheters that pull the blood clot out of the vessel.

You need to call as early as possible, call the ambulance team. You may not eat, drink, smoke, or walk. Better to lie down and wait for the arrival of the medical team. If a person is unconscious, he must be turned on his side to prevent him from suffocating with a possible attack of vomiting. And in no case give medicine

Thrombus extraction allows you to completely remove a blood clot, such operations reduce deaths from stroke around the world, after which patients recover better.

In Russia, about 19 percent of patients with stroke die, 30 percent of patients remain lying after illness, another 30 percent of patients do not fully return to full life, the rest are able to fully recover. We hope that with the application of the new method, there will be more people who survive and restore health.

- Is there a way to minimize the damage from this disease when the first symptoms are detected?

You need to call as early as possible, call the ambulance team. You may not eat, drink, smoke, or walk. Better to lie down and wait for the arrival of the medical team. If a person is unconscious, he must be turned on his side to prevent him from suffocating with a possible attack of vomiting. And in no case give medicine.

In many stroke patients, swallowing disorder occurs, and tablets, water, even a small sip, can enter the lungs. Because of this, pneumonia will then occur. This is a serious complication that can often be fatal. The simplest actions can prevent the development of complications.

When the doctors arrive, they need to quickly and briefly tell everything that you know about the onset of the disease, indicating the exact time of the onset of the disease.

And how often do you need to be examined in order to keep your blood vessels under control and track the formation of cholesterol plaques and blood clots in time?

First, you need to undergo regular medical examinations. Secondly, regularly measure your blood pressure and, if it is above the normal value, above 130 to 80, contact your GP to understand what is the cause and how to deal with it further. Thirdly, people over 40 should regularly, at least once a year, monitor their cholesterol - do a biochemical blood test plus conduct a duplex study of the main arteries of the head. Such activities will allow early identification of risk factors and take them under control. All these analyzes and procedures can be done free of charge according to the appointment of a therapist and neurologist in any clinic in the capital.

Stroke- This is a violation of cerebral circulation, which is accompanied by the appearance of neurological symptoms.

Causes of Stroke

To understand the causes of stroke, you should know that there are two types of stroke: ischemic and hemorrhagic. They differ both in origin and in the method of treatment.

Ischemic stroke occurs due to the formation of a blood clot or clot, which clogs the arteries of the brain and disrupts the blood supply.

Hemorrhagic stroke appears due to a rupture of a cerebral vessel, as a result of which blood accumulates in adjacent tissues. The blood formed in large quantities exerts high pressure on the brain tissue, as a result of which their work is disrupted.

In medicine, there are many reasons for the development of such a terrible ailment as a stroke. Among them are:

  • high blood pressure - constant changes in blood pressure violate the elasticity of blood vessels and lead to their rupture,
  • frequent arrhythmias - interruptions in the heart rhythm can lead to the formation of blood clots, which interfere with blood circulation in the brain,
  • exceeding the permissible level of cholesterol in the blood - high cholesterol contributes to the formation of plaques that block blood vessels and lead to the development of a stroke,
  • high blood sugar causes fragility and fragility of the walls of blood vessels, as a result of which the likelihood of their rupture increases,
  • the formation of aneurysms on the vessels of the brain,
  • poor blood clotting leads to the formation of clots in blood vessels,
  • overweight,
  • alcohol consumption,
  • smoking.

The most common causes of stroke are thrombosis, internal bleeding in the brain.

Thus, the main cause of stroke is damage to nerve cells, which are located in the brain and are responsible for all functions of the human body.

Stroke symptoms

In most cases, the symptoms that stroke patients experience are:

  • movement disorders. Weakness or awkwardness of movement, lack of coordination,
  • speech disorders,
  • sensitive disorders,
  • violations of behavior and cognitive functions. It's hard to dress, brush your hair, brush your teeth,
  • memory impairment,
  • sharp headache, vomiting,
  • increased breathing
  • violation of consciousness.

Stroke and its treatment

Treatment of a patient during a stroke should be carried out in the department of neurology, which will ensure accurate diagnosis of stroke and intensive treatment, reduce mortality and disability among patients.

V stroke treatment there are two main directions:

  1. treatment of the consequences of a stroke,
  2. prevention of recurrent stroke.

Movement disorders are among the most common consequences of stroke. The patient's motor activity is restored within about two to three months after the stroke and can continue for a year.

Therapeutic exercises should be carried out in the first days after the diagnosis of a stroke, if there are no contraindications to physical activity. To reduce pain before gymnastics, you can use anesthetic ointments or compresses.

If a patient after a stroke has problems with speech, you should contact a speech therapist. The patient should be in constant contact with people, listen to the radio, TV.

An important role in stroke treatment its prevention plays. The risk of recurrence of stroke exists in the presence of arterial hypertension, arrhythmia, pathology of the heart valves, heart failure, diabetes mellitus. Preventive measures for recurrent stroke should begin as early as possible and last for less than 4 years.

In addition, maintaining a healthy lifestyle is of great importance. It is recommended to reduce the consumption of foods containing a large amount of cholesterol, increase the amount of fresh vegetables and fruits in the diet.

Recovery course stroke treatment includes remedial gymnastics, training on simulators, massage, physiotherapy, stimulation treatment.

The consequences of a stroke

Various conditions that begin to appear after a stroke depend on the location of the pathology, its size, and in case of hemorrhage in the brain, the consequences that arise depend on the size of the hematoma, and how much it compresses the surrounding tissues and organs.

Possible consequences of a stroke:

  • movement disorders that lead to paralysis. Motor functions are actively restored after a stroke in the first three months. Remedial gymnastics is of great importance in this process. The desire and desire of the patient to perform the prescribed set of exercises is also important.
  • speech disorders can persist for a long time. To eliminate such violations, constant classes with a speech therapist, speech training are required.
  • mental disorders, which are most often manifested by depression. The development of depressive conditions is caused by the severity of the disease, the loss of many opportunities for self-service. Possible manifestations of aggression, anxiety. If the disorders do not recover on their own, it is possible to take medications.
  • memory impairment, sometimes even memory loss. In most cases, memory is restored, but this requires regular training.
  • violations in the coordination of movements, which manifest themselves in different ways depending on the affected area. A good result for restoring coordination of movements is observed when taking medications.

Rehabilitation after a stroke

It is possible to eliminate the consequences of a stroke only by following a series of measures for proper rehabilitation. Among them are the following procedures:

  • light massage of the upper and lower extremities,
  • physiotherapy exercises, which will help to restore the patient's physical activity,
  • special exercises for the development of fine motor skills of the hands,
  • water massage, water treatments that stimulate muscle stretching.

Competent implementation of all medical procedures aimed at the rehabilitation of the patient leads to the fact that the patient can return to an independent life. Typically, the rehabilitation period takes about 3 years.

Stroke prevention

Strict adherence to doctor's prescriptions, as well as maintaining a healthy lifestyle will help you avoid developing a stroke. If you have had a stroke, then in order to avoid recurring cases, you should follow these recommendations:

  • control your blood pressure. By lowering your blood pressure, you decrease your risk of having another stroke.
  • you should reconsider your diet and exclude foods rich in cholesterol and fats. This will reduce the formation of plaque on the vessel walls. If on your own you cannot exclude these foods from food, you need to see a doctor who will prescribe you special drugs that will lower your cholesterol levels.
  • quit smoking. The very process of smoking or the presence of smokers in the environment leads to the appearance of a stroke.
  • carry out medication for diabetes, if present, and constantly monitor blood sugar levels. This will significantly reduce the risk of developing a stroke.
  • to reduce excess weight, which contributes to the causes of stroke.
  • follow a diet rich in fresh fruits and vegetables.
  • exercise. Regular physical activity lowers blood pressure, lowers blood cholesterol levels, reduces body weight, and improves the condition of your blood vessels. Which significantly reduces the risk of developing the disease.
  • reduce the amount of alcohol you drink. Since alcohol increases blood pressure, it is the main cause of stroke.

According to the WHO (World Health Organization), about 15 million people are affected by this disease every year, of these 15 million, 5 million die, and another 5 million are completely immobilized. High blood pressure (Hypertension) is the cause of about 12 million strokes. According to statistics, stroke ranks fourth in the world among diseases in terms of the number of deaths. Stroke is the main cause of disability in people, and 75% of patients are people over the age of 65.

Intra-arterial thrombolysis- represents the administration of the drug ( TAP) directly at the site of vessel thrombosis. This procedure consists in the introduction of a thin catheter into a large vessel in the thigh, from where it will be held to the location of the thrombus, and a drug will be injected there that will destroy the thrombus. The advantages of this procedure are that the dose of the drug is significantly reduced, which minimizes the risk of bleeding. This procedure is complex and time-consuming to complete.

Mechanical thrombus removal- the given procedure is similar to the procedure of intra-arterial thrombolysis, but unlike it, the thrombus is not destroyed by the drug, but is pulled out with the help of a special device. With the help of a catheter with a special capture device, the place of thrombosis is reached through the carotid artery, the thrombus is "captured" and then removed in the same way.

In some cases, when it is necessary to prevent the recurrence of ischemic stroke, special procedures are carried out to "clean" the arteries heavily affected by atherosclerotic plaques.
Carotid endarterectomy Is a surgical procedure aimed at cleaning the carotid artery from atherosclerotic plaques. During this procedure, a longitudinal incision is made in the front of your neck, access to the carotid artery is created, and plaque is removed. The surgeon then repairs the artery by suturing it or using an implant from a vein or artificial material. This procedure can reduce the risk of ischemic stroke.

Angioplasty and vascular stenting- this procedure is aimed at increasing the lumen of the vessel and improving blood flow in the vessels affected by atherosclerosis. It is most often used in the elimination of atherosclerosis of the carotid arteries. The procedure consists in the introduction of a catheter with a special balloon and an elastic tube (stand) through a large vessel of the thigh, and advancement to the site of the vessel affected by atherosclerosis (if the vessel is damaged by plaques, the vessel lumen narrows). At the site of the lesion, the balloon is inflated, thereby increasing the lumen, and then a stand is inserted into this place, which prevents further narrowing of the vessel walls. This procedure can reduce the risk of ischemic stroke.

Hemorrhagic stroke - treatment

Emergency treatment for hemorrhagic stroke is aimed at establishing control over the bleeding, as well as reducing the pressure on the brain.

Drug treatment is effective in the simplest cases and consists in eliminating the cause of bleeding. Thus, if bleeding is caused by high blood pressure, measures are taken to reduce pressure, If the cause is a side effect of the use of blood thinners or thrombolytics (aspirin, warfarin, clopidogrel), it is necessary to stop using them and use drugs with a reverse effect. Once the bleeding has stopped, further treatment is bed rest, supportive treatment, and diet. If the volume of bleeding is large, then surgery is used to remove blood and reduce intracranial pressure.
Surgery- is aimed at eliminating the cause of bleeding ("bursting" vessels, "bursting" aneurysms), as well as preventing the development of stroke (the same aneurysms and vascular malformations (vascular malformation)).

Surgical clipping- this surgical intervention consists in "turning off" the aneurysm from the bloodstream. During the operation, the neurosurgeon attaches small clamps (clips) to the base of the aneurysm so that blood does not enter it. This will prevent or stop bleeding from the aneurysm, or prevent possible future stroke.

Endovascular embolization- This procedure is an artificial clogging of the aneurysm. During this procedure, the surgeon, under X-ray control, introduces a special catheter through the femoral artery, advances the catheter to the aneurysm, then inserts the catheter into the aneurysm cavity, and then injects a special substance into the cavity that, while solidifying, forms a kind of thrombus that closes blood access to the aneurysm and consequently prevents rupture. and the development of stroke.

Removal of arteriovenous malformations- Arteriovenous malformation (AVM) is a glomerulus, consisting of small pathological arteries and veins, formed during intrauterine development. AVMs can cause hemorrhagic stroke, so they need to be removed.
There are 3 ways to delete:

  • Surgical removal of AVM
  • Embolization of AVM vessels
  • Radiation exposure of AVM vessels

Rehabilitation of patients with stroke

According to the latest research, there are the following statistics on the recovery of patients after a stroke:


  • 10% are almost completely recovered
  • 25% recover with minor disruptions
  • 40% recover with moderate to severe disabilities and require special care
  • 10% require constant care in specialized institutions
  • 15% die soon after a stroke
  • approximately 14% of stroke survivors have another stroke within a year of the first stroke.

Rehabilitation is a complex of processes aimed at restoring lost or weakened functions, as well as improving the quality of life of a person who has suffered a stroke.
The most successful rehabilitation process depends on:

  • amount of brain damage
  • high professionalism of specialists involved in rehabilitation
  • caring for and participating in the rehabilitation process of family and friends (may be one of the most important factors)
  • the timing of the start of rehabilitation (the earlier the rehabilitation measures begin, the greater the chances of recovery)

Rehabilitation measures include the following techniques:

  • Therapy of communication disorders - helps to restore speech disorders, speech impairments, writing and communication skills.
  • Strengthening or restoration of motor functions - includes a set of exercises aimed at increasing (restoring) muscle strength and coordination.
  • Mobility aids training - includes the use of crutches, wheelchairs, walking sticks, and other aids.
  • Kinetotherapy - consists in the use of special exercises and procedures aimed at relieving muscle tension, eliminating muscle spasms, and also aimed at strengthening muscles and restoring movement.
  • Psychological assessment and assistance - tests of cognitive skills and mental state of the patient are carried out, psychological assistance is also provided, aimed at eliminating depression and awareness of what happened. It is also possible to use medications such as antidepressants.
  • Physiotherapy (electrostimulation is used in stroke rehabilitation) - This technique uses electrical impulses to stimulate weakened muscles, causing them to contract. This can help them strengthen and regain control over their work.
  • Therapy "forced use of movements" - this method is aimed at developing the movement of the limbs of victims of a stroke, the meaning is that it is forbidden to use a healthy arm or leg to perform any action, but it is allowed to use only the affected arm or leg, thereby stimulating the restoration of its function and control over her.
  • Robotics - is the use of a robotic device that helps the affected limb perform repetitive movements, which helps them regain lost function and strength.
  • Virtual reality is the newest type of rehabilitation therapy using computer technology, which represents the restoration of lost or partially reduced functions using a person's interaction with a simulated special virtual environment in real time.

Stroke prevention

Strict adherence to the recommendations of your attending physician, as well as maintaining a healthy lifestyle are the main conditions, adherence to which will help prevent the occurrence of a stroke. If you have had a stroke, then following these guidelines will help you avoid another stroke.
Stroke prevention includes the following guidelines:

  • Controlling blood pressure (treating hypertension) - One of the most important things you can do to prevent stroke is controlling your blood pressure. If you have had a stroke, lowering your blood pressure will help prevent another stroke. Exercise, controlling your weight, reducing stress levels, and reducing alcohol and salt intake can help lower high blood pressure. You should also be strict with the drug treatment of hypertension, and follow all the instructions of your doctor.
  • Reducing cholesterol and saturated blood fats - Avoid eating foods high in cholesterol and fat. This will avoid or minimize the formation of atherosclerotic plaques on the vessel walls. If you are unable to eliminate foods containing cholesterol and saturated fats, you should contact your doctor for prescribing blood cholesterol-lowering medications.
  • Quitting Smoking - Smoking increases your risk of stroke, whether you smoke or are surrounded by smokers (secondhand smoke). Smoking or any contact with cigarette smoke should be avoided.
  • Diabetes care and blood sugar control - Exercise, diet, weight loss, and medication can help you lower your blood sugar and thereby reduce your risk of stroke.
  • Losing excess weight - Being overweight contributes to the development of causes of stroke, such as hypertension, cardiovascular disease and diabetes mellitus. Losing at least 5 kg in weight will lower your blood pressure and blood cholesterol levels, which in turn will reduce your risk of stroke.
  • Diet Rich in Fruits and Vegetables - Increasing meals that are high in fruits and vegetables will help you lose weight and reduce blood cholesterol.
  • Regular exercise - Exercise can significantly reduce the risk of stroke. Exercise can lower blood pressure, lower cholesterol levels, and improve the health of your blood vessels and heart and help you lose weight. Exercise such as walking, running, swimming and cycling for at least 30 minutes a day can significantly reduce your risk of stroke.
  • Reducing the amount of alcohol consumed - drinking large amounts of alcohol contributes to the development of both hemorrhagic and ischemic stroke. Alcohol increases blood pressure, which is the main cause of stroke. However, moderate alcohol consumption (1 dose for women and 2 doses for men per day (1 dose = 250 ml beer or 100 ml wine)) can reduce the risk of stroke and reduce the likelihood of blood clots.

If you have had a stroke, your doctor may prescribe prophylactic treatments to reduce your risk of having another stroke. Usually, two types of drugs are used for prevention: anticoagulants and antiplatelet agents.

  • Antiplatelet agents are drugs that prevent blood clots from forming. Blood clots are formed thanks to special blood cells called platelets, when they stick together, a blood clot forms with each other. Antiplatelet agents prevent this adhesion. Your doctor may prescribe medications such as aspirin, dipyridamole or clopidogrel for you, and can help you choose the right dose, as it is individual for each case.
  • Anticoagulants - These drugs reduce the chances of blood clots or blood clots forming. This group of drugs includes drugs such as: heparin, warfarin. Heparin works for a short period of time and therefore most often it will be given to you in the hospital, and warfarin works for a longer period of time, you may be prescribed it for home administration. However, the dose and timing of the drug intake should be strictly observed. Warfarin is usually prescribed to reduce the risk of stroke, which can be caused by heart arrhythmias.

The first signs of a stroke and first aid