Signs of stroke in men and women, first aid and treatment

Stroke is a decrease or complete stop of blood circulation in a certain part of the brain, leading to damage and necrosis of nerve cells. The disease occurs both in men and women and occupies leading positions in mortality and disability. Providing emergency medical care at the first sign of defeat helps save lives and avoid serious consequences.

• Types
• Ischemic
• Hemorrhagic
• subarachnoid
• reasons
• Women
• have
• men Children
• Older people
• Symptoms
• Consequences
• First Aid
• Diagnostics
• Treatment
• In ischemic
• In hemorrhagic
• Rehabilitation
• Avoiding

Types

The classification of strokes takes place according to many criteria.

Depending on the site of the lesions, the following are isolated:

• stroke of the brain;
• spinal cord( spinal cord).

The degree of damage is different:

• Small( colloquially - mini or microinsult) - necrosis of the brain tissue due to a thrombus or a sharp narrowing of small vessels. The brain stops working for a short time( up to half an hour), the body can cope with the problem on its own. Symptoms of the disease disappear within 3 weeks.
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• of moderate severity is a condition in which focal neurological symptoms predominate without signs of cerebral edema and deep or prolonged disorders of consciousness.
• Extensive - the defeat of large arteries feeding the brain, with damage to a large area of ​​nervous tissue. Such damage can spread to the whole hemisphere, and even graze the second, making it impossible for the body to function properly, and often for life.

Distinguish the following periods of the disease:

• acute - the first 3 weeks after the onset of the stroke;
• subacute - from the fourth week to 3 months;
• restorative - up to 12 months from the onset of the disease;
• period of consequences - after 1 year.

The main division of strokes occurs in accordance with the mechanism of damage to the brain tissue:

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Ischemic

There are several types of ischemic stroke:

• Atherothrombotic - appears in atherosclerosis of cerebral large and medium arteries. Beginning usually during sleep, the disease intensifies for several hours or days.
• Cardioembolic - occurs with complete or partial blockage of cerebral arteries by an embolus on the background of cardiac pathologies. Occurs suddenly during wakefulness of the patient and is localized in the zone of blood supply of the middle cerebral artery.
• Hemodynamic - occurs with a significant lesion of large arteries of the head and neck and is due to a decrease in pressure or a drop in the minute volume of the heart.
• Lacunar - most often appears at elevated pressure and is characterized by a limited lesion of small( perforating) arteries, connecting between larger vessels. At the site of the infarct, lacunas are formed - round-shaped cavities up to 1.5 centimeters in diameter.
• Rheological( by the type of hemorheological micro-occlusion) - caused by thrombosis due to hematological diseases leading to increased coagulability and blood viscosity.

Depending on which hemisphere is affected, distinguish between strokes:

• Left-sided - manifested by paralysis of the limbs of the right side of the body, speech disturbance and psycho-emotional perception.
• Right-sided - immobilization of the left extremities, partial memory loss relative to recent events, reduced concentration, inadequate behavior.

The clinical picture differs depending on which arteries are damaged:

• Carotid pool - includes lesions in the internal carotid artery, anterior and middle cerebral arteries.
• Vertebrobasilar system - consists of posterior cerebral, vertebral, basilar arteries, includes cerebellar, thalamus, and brain stem infarctions.

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Hemorrhagic

This type of stroke is less common, but is the most dangerous for life. It is characterized by a hemorrhage into the brain envelope due to rupture of the vessel. Blood under high pressure displaces tissues, making it difficult or blocking their work, fills cavities, causing the formation of intracerebral hematoma and brain edema.

An attack occurs after a physical or emotional load, and is accompanied by a headache, an increase in blood pressure.

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Subarachnoid

Most often it is traumatic in nature and is the most rare type of stroke with a high probability of death or disability. The cause of the appearance is hemorrhage in the space between the arachnoid and soft membranes of the brain and spinal cord. As a result, the tissues and blood vessels are squeezed in these areas.

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Reasons for

There are many factors contributing to the development of stroke:

• arterial hypertension - with frequent increase in pressure, the walls of the vessels wear out, become less elastic;
• heart diseases - arrhythmias, valve defects, enlargement of the heart chambers often lead to the formation of clots or blood clots that carry blood and can clog the blood vessels of the brain;
• elevated blood cholesterol level - leads to atherosclerosis( a decrease in the lumen of the vessels due to the formation of fatty plaques on their walls);
• diabetes mellitus - the disease causes fragility and fragility of blood vessels;
• cerebral aneurysms - saccule protrusions up to 1-2 cm in size, having thinner walls than healthy vascular sites;
• obesity and overeating - provoke an increase in the level of cholesterol in the blood;
• smoking, drinking alcohol and drugs - have a destructive effect on the integrity of blood vessels and cause an increase in pressure;
• long-term intake of hormonal contraceptives - the hormones that enter into them contribute to the formation of blood clots;
• coagulation disorder - excessive viscosity leads to clots, too liquid blood can cause bleeding;
• transient ischemic attacks( acute temporary disruption of cerebral circulation without necrosis of tissues) - often are harbingers of a stroke.
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For different population groups, the causes of stroke can vary:

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In women

Factors more common to the female:

• high susceptibility to certain diseases - migraine attacks, narrowing of the carotid arteries on the neck, mitral valve prolapse;
• pregnancy - this period( especially the third trimester) is characterized by an increase in blood clotting with the formation of clots, then an aneurysm rupture may occur;
• use of drugs to reduce weight - many of them contain additives that can cause bleeding in the brain.

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For men

Lifestyle of the stronger sex has the following effect:

• addiction to bad habits;
• frequent stresses and stresses - lead to a disruption in the metabolism, followed by an increase in the level of insulin in the blood, which causes arteriosclerosis of the vessels;
• non-compliance with the diet.

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Children

Juvenile( child) stroke is usually of a hemorrhagic nature and depends on the child's age and genetic predisposition. Most often it occurs in the womb or in the first month of life. The causes may be:

• brain tumor;
• weakened or improperly developed vessels( often caused by alcoholism of the mother);
• viruses that affect the condition of the arteries( for example, scarlet fever).

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In elderly people

The risk of the disease is significantly increased with age, this is facilitated by:

• wear of the internal organs( especially the heart) and vessels;
• is strongly susceptible to such diseases as diabetes, hypertension, atherosclerosis;
• decreased physical activity.

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Symptoms of

Signs of a stroke are:

• sudden severe headache - can occur during sleep and cause arousal, increase with a change in body position;
• dizziness or sensation of rotation with imbalance, coordination of movements and orientation in space;
• problems with eyesight - reducing its sharpness until loss, doubling, is characteristic of one or two eyes;
• decrease or total absence of hearing on one or both sides;
• a disorder of taste perception - can affect the entire surface of the tongue or part of it;
• tactile disorders - manifested by insensitivity of any part of the body to touch, pressure, temperature changes, pain;
• aphasia - problems with speech and its perception, inability to correctly pronounce words or even speak, misunderstanding of the meaning of words;
• swallowing difficulty;
• change of mood, emotions, personal qualities( inadequacy, aggression);
• loss of control over urination and defecation;
• strong weakness of the facial muscles, numbness or paralysis of the limbs - usually on one side of the body;
• drowsiness, loss of consciousness, coma.

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Consequences of

Among the most serious violations:

• problems with the musculoskeletal system - from the inability to perform actions associated with fine motor skills, to partial or complete immobilization of one or both limbs from the left or right side of the body or paralysis of the whole body;
• speech and logical thinking, impaired ability to write and read, to perceive information;
• impairment of the work of the senses - complete or partial loss of sight, hearing, smell, taste;
• partial or total memory loss;
• development of dementia - occurs when replacing damaged brain cells with a connective tissue;
• lethal outcome - most often happens in case of a major stroke.

Almost 80% of people who have suffered a stroke remain disabled.

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First aid

When the first symptoms of a stroke appear, you must call an ambulance. While waiting for the doctors, you can take some actions on your own:

• If the injured person is conscious, to reduce blood pressure on the brain, you should put it so that the head and shoulders are slightly elevated relative to the body. Do this with minimal movement.
• It is forbidden to take any medications.
• Do not allow the patient to drink and eat - in the event of a violation of the swallowing function, food can get into the respiratory tract.
• Clear the oral cavity of secretions - saliva, blood, mucus, food.
• Provide fresh air, remove clothing that impedes breathing.
• The unconscious person needs to turn on his side, putting his forward head on his arm and bending his leg in the knee to prevent overturning.
• In the absence of breathing, the injured person should be turned on his back and perform artificial respiration if there is no pulse - indirect cardiac massage.

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Diagnosis

Determining the type of stroke, the location of its location and the area of ​​the lesion are key aspects in the treatment. To diagnose, the following methods are used:

• computed tomography( CT) - a clear three-dimensional image of the brain, which shows the places of bleeding and the area of ​​injury, using X-rays;
• magnetic resonance imaging( MRI) - the image of the brain is obtained with the help of a strong magnetic field, with damage to tissues and the volume of damaged cells;
• Magnetic Resonance Angiography - similar to MRI, but provides information on the state of the vessels and the location of the thrombus;
• doppler examination of carotid arteries - ultrasound diagnosis, which allows to examine the condition of carotid arteries;
• transcranial doppler - ultrasound examination of cerebral vessels;
• cerebral angiography - the introduction of contrast material into vessels for obtaining X-ray images depicting defects;
• electroencephalogram( EEG) - study of brain activity with electrodes;
• electrocardiogram( ECG) - serves to detect irregular heartbeat rhythm;
• echocardiogram of the heart( Echo-KG) - ultrasound examination of the heart to detect pathologies in its work;
• coagulogram - a blood test for the rate of its coagulation;
• biochemical blood test for the content of glucose( sugar) and lipids( cholesterol) in it.

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Treatment

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With ischemic

Drug treatment is urgent, the speed of its delivery depends on the degree of complications of the disease. It is aimed at eliminating blood clots and blood clots and preventing their further formation:

• Drugs that dilute the blood - Aspirin, Warfarin, Dipiridamol, Clopidogrel, Cyclopidine.
• Means that have the properties of thrombolysis( destruction of a thrombus) - a tissue activator of plasminogen( thromboplastin).
• Special medical procedures for ischemic stroke contribute to the removal of thrombus and the treatment of arteriosclerosis damaged by atherosclerosis:
• Intraarterial thrombolysis is the introduction into a large vessel of the thigh of a thin catheter that delivers the drug that destroys the thrombus directly to its site. This procedure uses a minimum dose of thrombolytic, which helps to avoid extensive bleeding.
• Mechanical removal of thrombus - its extraction with a special device, delivered to the desired place by a catheter through the carotid artery.
• Carotid endarterectomy is a surgical method for cleaning the carotid artery from atherosclerotic plaques.
• Angioplasty and stenting of vessels - an increase in the lumen of vessels affected by atherosclerosis, using a catheter with a special balloon. Moving along the channel of the artery, in thin places the balloon is inflated, enlarging the lumen, and a stent is inserted into this place, which prevents further compression of the vessel walls.

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With hemorrhagic

Drug treatment is aimed at eliminating the cause of bleeding, reducing cerebral edema and intracranial pressure:

• Bleeding caused by taking blood thinning medications is discontinued using reverse action drugs.
• When high blood pressure is used to reduce it.
• To reduce cerebral edema, corticosteroids, osmodiuretics, muscle relaxants, sedatives are used.

Surgical treatment is used to eliminate bleeding and prevent strokes:

• Surgical clipping is the exclusion of an aneurysm from the blood stream with the help of special clamps that are placed on its base to prevent the filling of an aneurysm with blood.
• Endovascular embolization - artificial clogging of an aneurysm with a special substance to stop access to blood and prevent its rupture.
• The removal of arteriovenous malformations( glomeruli from small pathological arteries and veins, formed during fetal development) can be performed surgically, by embolization or by radiation irradiation of blood vessels.

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Rehabilitation

There is a whole complex of measures to restore lost or weakened functions and improve the quality of life of people who have suffered a stroke:

• taking medications that can prevent the development of recurrent stroke and necessary for dilution of blood, reduce vasospasms, supply the brain with oxygenMexidol);
• psychological assistance - includes assessing the cognitive skills and mental state of the victim, providing support in understanding what happened and eliminating depression, sopor, often with antidepressants and neurometabolic stimulants( Glycine, Ceraxon, Cerebrolysin);
• communicative therapy - helps to restore memory, as well as speech and its understanding, the ability to communicate, involves engaging a speech therapist;
• various techniques for improving motor functions - exercises to increase or restore muscle strength and coordination, including with the help of robotic devices and virtual reality;
• physiotherapy - except for the complex of exercises of physical therapy includes massage, acupuncture and the method of electrostimulation, consisting of the impact of electrical impulses on weakened muscles to reduce them;
• training in the use of auxiliary tools for movement( crutches, wheelchairs, walking sticks);
• adherence to the daily routine - lifting, eating, sleeping, if possible - walks are desirable at the same time;
• diet - proper nutrition after a stroke should consist of eating vegetables, fruits, lean meat and fish, whole grains, excluding eggs and fats.

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How to avoid

Stroke prevention includes the following measures:

• control of blood pressure, including medical treatment of hypertension;
• detection and treatment of heart disease, if there is a history of arrhythmia, it is necessary to do electrocardiography every 6 months;
• lowering the level of cholesterol and saturated fat in the blood - except for diet and exercise the doctor can prescribe antilipid drugs;
• combating bad habits;
• treatment of diabetes and blood sugar control;
• reduction in excess weight;
• balanced nutrition;
• regular exercise;
• limiting psychological stress and stress.

In case of a previous stroke and to prevent the onset of recurrence, medications often are prescribed - anticoagulants and antiaggregants, which interfere with the formation of embolus and thrombi.