Stroke: signs, types, treatment, rehabilitation
Contrary to popular belief, stroke is not a disease.Yes, a diagnosis exists and is exhibited, but more and more specialists cease to consider stroke an independent disease, calling it a complication of a number of vascular diseases.By frequency, this pathology ranks second among all causes of death.That is why the knowledge of her symptoms and diagnostic methods( including the prehospital stage) can seriously affect the health of both the whole society and the individual.Contents: Types of stroke causes of stroke Situations that can trigger symptoms of stroke for stroke diagnosis Transient ischemic attack Stroke Treatment
Experts distinguish between two main types of stroke on his main reason:
- Ischemic stroke,Arising as a consequence of various disorders leading to a sharp deterioration in the blood supply to areas of the brain;
- Hemorrhagic stroke, which refers to the outflow of blood from vessels of different calibres;In this case, pathological changes in the brain are caused by developing and increasing in size hematoma, compressing the brain structures.
There is a separate classification of an ischemic stroke, which takes into account most of the diseases that lead to its development.It is interesting only for specialists, it is important for us to understand in what cases this severe pathology can develop.
Causes of stroke
Since stroke is considered a complication, it is impossible to establish a single cause for it clearly. Here we are talking about risk factors that increase the probability of this pathology and are divided into two groups:
- modifiable and
- are unmodified.
The former provides a number of diseases, leading to damage of the vascular wall or otherwise circulatory deterioration:
- heart disease;Atrial fibrillation;
- ; atrial fibrillation;
- , a history of myocardial infarction;
- disorders of fat metabolism( dyslipoproteinemia);
- diabetes mellitus;
- diseases that damage the carotid arteries that feed the brain.
to the modifiable risk factors include lifestyle and features:
- improper diet with a predominance of saturated fats, a shortage of plant fibers;
- alcohol abuse;
- absence or severe lack of exercise;
- use of oral contraceptives;
- decreased blood testosterone;
- acute and chronic stress.
non-modifiable factors - this is what can not be changed by any means: gender, age, genetic predisposition.
To conditionally unmodified factors, chronic heart failure can be attributed, although it can be compensated to certain limits, but it is completely impossible to heal.
The above factors are primarily related to ischemic stroke, which is much more common than hemorrhagic stroke. To the development of the latter lead:
- arterial hypertension;
- any pathology of blood vessels supplying the brain;
- disorders of the blood coagulation function due to the use of anticoagulants, disaggregants, thrombolytic agents or due to the pathology of the thrombotic system;
- reception of various kinds of psychostimulants - amphetamines, cocaine, etc.;
- alcohol abuse.
Situations that can trigger a stroke
of complications and possible against the general well-being, but often the failure mechanisms of compensation arises in cases where the load on vessels exceeds a certain critical level. Such situations can be associated with everyday life, with the presence of various diseases, with external circumstances:
- a sharp transition from the prone position to the standing position( sometimes enough to pass into the sitting position);
- heavy food;
- hot tub;
- is a hot season;
- increased physical and mental stress;
- arrhythmia of the heart;
- sharp decrease in blood pressure( most often under the influence of drugs).
Symptoms of a stroke
In terms of diagnosis, stroke is a rather difficult task even for doctors.The usual inflammation of the trigeminal nerve, innervating the facial muscles, leads to the appearance of some symptoms characteristic of stroke.If at this moment the person has also increased blood pressure - the probability of error increases at times.
However, a stroke is a disease in which the doctor is better to assume the worst, rather than miss his appearance. Therefore, it is necessary to suspect it in all cases when:
- there are sudden weakness, numbness, "goose bumps" in the arm, leg, especially if the symptoms appear only in one half of the body;
- appears asymmetry of the face;
- vision decreases or disappears, visual artifacts appear that did not exist before( falling out of the field of view, "flies");
- worsens speech, becoming incoherent, meaningless;
- for no apparent reason, there is a strong headache, especially if its beginning is a "blow";
- is broken consciousness from mild stunnedness, when the patient reacts to external stimuli with a slight delay, until the consciousness is completely turned off - coma.
To simplify the prehospital diagnosis of stroke by a group of British doctors in 1998, the FAST complex was developed.This - a series of simple manipulations, with the help in most cases you can at least suspect this pathology.
The essence of this complex is as follows:F-face or face.
- .This element consists in determining the symmetry of the face and revealing the paresis of facial muscles.To identify problems the patient is offered:
.This element is necessary for detecting motor and sensory disturbances.For the detection of pathology, the patient is given several samples:
- Show teeth.In stroke, the shape of the mouth resembles a tennis racket - one half of the lips part, while the other remains closed.
- Smile.In stroke, there is a lack of work of mimic muscles on one side of the face.
- Inflate the cheeks.In stroke, one cheek retains its tone, while the other does not inflate( doctors say "sail", from the word "sail").A-arm or arm.
- The patient lying on the floor raises both arms at a 45 ° angle( sitting at 90 °).When a stroke occurs, one of the arms lags behind or does not rise at all.
- The doctor lifts both hands of the patient over his head, combining them with the palms of his hands, holds it for 5 seconds in this position, and then releases it.One of the hands is gradually lowered.
- The patient is bent both legs in the hip and knee joint at an angle of 90 °.In stroke, one of the legs of a man can not be held in such a position.
- The patient forms a ring( by type of OK sign) from the forefinger and thumb.The doctor enters the index finger into the ring and tries to break it without applying a lot of force.If successful, a stroke is suspected.
- The patient should squeeze the doctor's hands with both hands.In this case, a difference in the compression force, which is unavoidable in stroke, is revealed.
- What is your name?How old are you?- the patient may not answer these questions if he is not self-oriented.
- Where are you located?What is the date, day, month, year?- a patient with a stroke can be disoriented in place, time, space and will not be able to answer correctly.
- When receiving answers, the doctor pays attention to the delay time with the answer and the intelligibility of speech.T-time or time.
Although the FAST complex allows to establish a diagnosis of stroke with a sufficiently high degree of reliability( 80-90%), a full range of measures is required to confirm this fact definitively.Conducting laboratory and instrumental studies can also determine the tactics of further treatment and make a prediction about the outcome of the disease.
A survey begins with a survey of the patient or his loved ones.The doctor pays attention to the moment of the onset of a stroke, reveals the dynamics of the development of symptoms.It is very important to find out everything about the concomitant diseases that could lead to a stroke, as well as learn about the predisposition to it.
In the second stage, routine analyzes and studies are performed:
- blood pressure measurement;
- electrocardiographic study;
- general and biochemical blood tests;
- blood glucose test;
- general analysis of urine.
The third stage is instrumental diagnostics.Computer and magnetic resonance imaging is used to detect the fact of a stroke, clarify its nature( ischemic or hemorrhagic), the affected area, as well as to exclude other diseases with similar symptoms.Sometimes these methods are supplemented with angiography, which allows visualizing the state of vessels in the necrosis zone and adjacent tissues.
Ultrasonic Doppler ultrasound also allows you to find out the state of cerebral vessels, assess the degree of their contraction and deterioration of blood supply to intracranial structures.
Other diagnostic methods give little data to help doctors, so they are usually not used.
Transient ischemic attack
This is the most insidious form of brain ischemia( eating disorder).The danger is that the symptoms characteristic of a stroke, appear quite quickly and disappear just as quickly( within an hour).Being not very pronounced, they often pass by the attention of the patient and do not alarm him.And yet Hippocrates wrote: "Unusual attacks of stupor and anesthesia are signs of impending apoplexy" ( apoplexy used to call all forms of stroke).
Transient ischemic attack is far from as harmless as it seems.According to the researchers in the presence of ischemia within half an hour in a third of patients already observed organic changes in the brain tissue.That's why when you have the slightest signs of a stroke( even if they disappeared after a few minutes), you should immediately consult a doctor for the diagnosis and prevention of blood flow disorders in the brain.
Stroke is an extremely serious complication, so treatment should begin as early as possible.Nevertheless, drug therapy does not always have to be applied in the first few minutes, since often rush with the prescription of drugs worsens the prognosis of the disease.
We recommend to read: First aid for stroke
The main rule is to call an ambulance, provide first aid if necessary and send a patient to the hospital where he will have a full range of medical measures:
- adequate oxygen supply;
- monitoring of respiratory function;
- decrease in the expression of cerebral edema;
- elimination of a possible fever;
- correction of disturbed metabolic rate;
- symptomatic treatment.
In addition, specialists may prescribe a specific treatment:
- thrombolysis( the introduction of special drugs that dissolve the blood clot in the brain vessels);
- anticoagulant and antiplatelet therapy for the same purpose;
- surgical intervention for the removal of thrombus, vascular plastic.
Timely stroke treatment started allows to significantly limit the focus of necrosis of brain tissue.As a result, a person can avoid death, and in some cases, disability.Nevertheless, stroke is still an exceptionally severe pathology, which should be treated only under the supervision of a doctor.
Bozbey Gennady Andreevich, ambulance doctor