Ischemic cerebral stroke

Ischemic stroke is a brain infarction, it 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, affecting the great brain vessels 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 vessel walls. This is called atherosclerosis.

Ischemic stroke causes a blood clot that can form in a blood vessel (thrombosis) or somewhere else in the blood system (embolism).

The definition of the nosological form of the disease is based on three independent pathologies characterizing a local circulatory disorder, denoted by the terms Ischemia, Infarction, Stroke:

  • ischemia - lack of blood supply in the local part of the organ, tissue.
  • stroke is a violation of blood flow in the brain during rupture / ischemia of one of the vessels, accompanied by the death of brain tissue.

In ischemic stroke, the symptoms depend on the type of disease:

  1. Atherothrombotic seizure - occurs due to atherosclerosis of a large or medium-sized artery, develops gradually, most often occurs in sleep;
  2. Lacunar - diabetes mellitus or hypertension can cause circulatory disorders in the arteries of small diameter.
  3. Cardioembolic form - develops as a result of partial or complete occlusion of the middle artery of the brain with the embolus, it occurs suddenly while you are awake, and emboli in other organs can occur later;
  4. Ischemic, associated with rare causes - separation of the arterial wall, excessive blood clotting, vascular pathology (non-atherosclerotic), hematological diseases.
  5. Unknown origin - characterized by the impossibility of determining the exact causes of the occurrence or the presence of several causes;

From the foregoing, we can conclude that the answer to the question “what is ischemic stroke” is simple - a violation of blood circulation in one of the areas of the brain due to its blockage with a thrombus or cholesterol plaque.

There are five main periods of complete ischemic stroke:

  1. The sharpest period is the first three days;
  2. The acute period is up to 28 days;
  3. The early recovery period is up to six months;
  4. Late recovery period - up to two years;
  5. The period of residual effects - after two years.

Most cerebral ischemic strokes begin suddenly, develop rapidly, and result in the death of brain tissue within a few minutes to a few hours.

According to the affected area, cerebral infarction is divided into

  1. Ischemic right side stroke; the consequences mainly affect motor functions, which later do not recover, psycho-emotional indicators may be close to normal;
  2. Stroke ischemic left side - the psycho-emotional sphere and speech mainly act as consequences, motor functions are restored almost completely;
  3. Cerebellar - impaired coordination of movements;
  4. Extensive - occurs in the complete absence of blood circulation in a large area of ​​the brain, causes edema, most often leads to complete paralysis with the inability to recover.

Pathology most often happens to people in old age, but it can happen in any other. The prognosis for life in each case is individual.

Right ischemic stroke

Ischemic stroke on the right side affects the areas responsible for the motor activity of the left side of the body. The consequence is paralysis of the entire left side.

Accordingly, on the contrary, if the left hemisphere is damaged, the right half of the body fails. Ischemic stroke where the right side is affected may also cause speech impairment.

Left-sided ischemic stroke

In ischemic stroke on the left side, speech function and the ability to perceive words are seriously impaired. Possible consequences - for example, if the Brock center is damaged, the patient is deprived of the opportunity to make and perceive complex sentences, only individual words and simple phrases are available to him.

Stem

This type of stroke as a stem ischemic stroke is the most dangerous. In the brain stem are the centers that regulate the work of the most important in terms of life support systems - 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 movement coordination, dizziness, nausea.

Cerebellar

Ischemic cerebellar stroke in the initial stage is characterized by a change in coordination, nausea, bouts of dizziness, vomiting. After a day, the cerebellum begins to press on the brain stem.

The facial muscles can become numb, and the person falls into a coma. Coma with ischemic cerebellar stroke is very common, in most cases, such a stroke is injected with the death of the patient.

Code mkb 10

According to ICD-10, a cerebral infarction is coded under heading I 63 with the addition of a point and numbers after it to clarify the type of stroke. In addition, when encoding such diseases, the letter "A" or "B" (Latin) is added, which indicates:

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

Symptoms of ischemic stroke

In 80% of cases, strokes are observed in the system of the middle cerebral artery, and in 20% in other cerebral vessels. In ischemic stroke, the symptoms usually appear suddenly, in seconds or minutes. More rarely, symptoms come gradually and worsen over a period of several hours to two days.

Symptoms of ischemic stroke depend on how much of the brain is damaged. They are similar to signs in transient ischemic attacks, however, impaired brain function is more severe, manifests itself for a greater number of functions, for a larger area of ​​the body, and usually is persistent. It may be accompanied by a coma or a lighter depression of consciousness.

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

  1. Blindness in one eye;
  2. One of the arms or legs of one of the sides of the body will be paralyzed or greatly weakened;
  3. Problems in understanding what others are saying, or inability to find words in a conversation.

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

  1. Double eyes;
  2. Weakness in both sides of the body;
  3. Dizziness and spatial disorientation.

If you notice any of these symptoms, be sure to call an ambulance. The sooner the measures are taken, the better the prognosis for life and the dire consequences.

Symptoms of transient ischemic attacks (TIA)

Often they precede ischemic stroke, and sometimes TIA is a continuation of the stroke. The symptoms of TIA are similar to focal symptoms of a small stroke.

The main differences of TIA from strokes are detected by CT / MRI examination using clinical methods:

  1. There is no (not visualized) center of infarction of brain tissue;
  2. The duration of neurological focal symptoms is not more than 24 hours.

Symptoms of TIA are confirmed by laboratory, instrumental studies.

  1. Blood to determine its rheological properties;
  2. Electrocardiogram (ECG);
  3. Ultrasound - Doppler of the vessels of the head and neck;
  4. Echocardiography (EchoCG) of the heart - identifying the rheological properties of blood in the heart and surrounding tissues.

Diagnosis of the disease

The main methods of diagnosis of ischemic stroke:

  1. Medical history, neurological examination, physical examination of the patient. Identification of comorbidities that are important and affect the development of ischemic stroke.
  2. Laboratory tests - biochemical blood analysis, lipid spectrum, coagulogram.
  3. Blood pressure measurement.
  4. ECG.
  5. MRI or CT of the brain can determine the location of the lesion, its size, the duration of its formation. If necessary, CT angiography is performed to identify the exact site of occlusion of the vessel.

Differentiate ischemic stroke is necessary from other diseases of the brain with similar clinical signs, the most common of them include a tumor, an infectious lesion of the membranes, epilepsy, hemorrhage.

Sequelae of ischemic stroke

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

The likely consequences of ischemic stroke:

  1. 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 family, he is afraid of being left disabled for life. Changes in the behavior of the patient may also appear, he may become aggressive, fearful, disorganized, may be subject to frequent mood swings for no reason.
  2. Impaired sensation in the limbs and on the face. Sensitivity is always restored longer 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 are restored much slower than the fibers responsible for movement.
  3. Impaired motor function - strength in the limbs may not fully recover. Weakness in the leg will cause the patient to use the cane, weakness in the hand will make it difficult to perform some household actions, even dressing and holding the spoon.
  4. Consequences can manifest themselves in the form of cognitive impairments - a person can forget many things that are familiar to him, telephone numbers, his name, the name of his family, the address, he may behave like a small child, underestimating the difficulty of the situation, he may confuse the time and place in which he located.
  5. Speech disorders - may not be in all patients who have had ischemic stroke. It is difficult for the patient to communicate with his family, sometimes the patient may speak absolutely incoherent words and sentences, sometimes it may be just difficult to say something. Less common are such violations in case of a right-sided ischemic stroke.
  6. Swallowing disorders - the patient can choke on both liquid and solid food, this can lead to aspiration pneumonia, and then to death.
  7. Coordination disorders manifest themselves in staggering when walking, dizzy, falling during sudden movements and turns.
  8. Epilepsy - up to 10% of patients after an ischemic stroke may suffer from epileptic seizures.

Prognosis for life with ischemic stroke

The prognosis of the outcome of ischemic stroke in old age depends on the degree of brain damage and on the timeliness and systematic nature of therapeutic interventions. The earlier qualified medical assistance and proper motor rehabilitation were provided, the more favorable the outcome of the disease will be.

The time factor plays a huge role, it depends on the chances of recovery. 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 stroke is often evaluated using standardized gauges, such as the stroke scale of the National Institute of Health (NIH).

The cause of death in half the cases is brain edema and dislocation of brain structures caused by it, in other cases pneumonia, heart disease, pulmonary embolism, renal failure or septicemia. A significant proportion (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 the stroke, the disabling neurological disorders remain in 40% of the surviving patients, by the end of the year - in 30%. The more significant the neurological deficit is by the end of the 1st month of the disease, the less likely a complete recovery.

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

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

The poor prognostic signs of survival in the first 5 years after a stroke include the old age of the patient, myocardial infarction, atrial fibrillation, and congestive heart failure preceding the stroke. Repeated ischemic stroke occurs in approximately 30% of patients in the period of 5 years after the first stroke.

Rehabilitation after ischemic stroke

All stroke patients undergo the following stages of rehabilitation: the neurology department, the neurorehabilitation department, sanatorium-resort treatment, and outpatient dispensary observation.

The main objectives of rehabilitation:

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

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

  1. Strict bed rest - all active movements are excluded, all movements in the bed are carried out by medical staff. But already in this mode, rehabilitation begins - turns, rubdowns - prevention of trophic disorders - bedsores, breathing exercises.
  2. Moderately extended bed rest - a gradual expansion of the patient's motor capabilities - independent turning over in bed, active and passive movements, moving to a sitting position. Gradually allowed to eat in a sitting position 1 time per day, then 2, and so on.
  3. Ward mode - with the help of medical personnel or with a support (crutches, walkers, a stick ...) you can move within the chamber, perform available types of self-service (food, washing, changing clothes ...).
  4. 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, antianginal medications are prescribed to the patient, as well as agents that improve the pumping function of the heart — cardiac glycosides, antioxidants, drugs that normalize tissue metabolism. Special measures are also being taken to protect the brain from structural changes and swelling of the brain.

Specific therapy for ischemic stroke has two main objectives: restoration of blood circulation in the affected area, as well as maintaining the metabolism of brain tissue and their protection from structural damage. Specific therapy for ischemic stroke provides for medical, non-drug, as well as surgical treatment methods.

In the first few hours after the onset of the disease, there is a sense in conducting thrombolytic therapy, the essence of which comes down to the lysis of a thrombus and the restoration of blood flow in the affected part of the brain.

Nutrition

Diet implies restrictions in the consumption of salt and sugar, fatty foods, flour foods, smoked meats, pickled and canned vegetables, eggs, ketchup and mayonnaise. Doctors advised to add to the diet more vegetables and fruits, abundant in fiber, eat soups, cooked according to vegetarian recipes, dairy foods. Of particular benefit are those of them who have potassium in their composition. These include dried apricots or apricots, citrus fruits, bananas.

Meals should be fractional, used in small portions five times every day. At the same time, a diet after a stroke implies a volume of liquid not exceeding one liter. But do not forget that all actions taken must be negotiated with your doctor. Only a specialist in the forces to help the patient recover faster and recover from a serious illness.

Prevention

Prevention of ischemic stroke is aimed at preventing the occurrence of stroke and preventing complications and re-ischemic attack.

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

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