A massive stroke and its consequences
Stroke, or acute cerebrovascular accident (CVA), are in second place in the overall number of deaths. Only more likely to die from myocardial infarction. A massive stroke affects large areas of the brain and can have severe consequences — permanent disability or death of the patient. The situation is aggravated by frequent relapses of the disease — re-strike occurs in 40 per cent recover.
The most frequent reasons of long flowing disease are hypertension and atherosclerosis.
Classification broad strokes
Massive strokes occur when for various reasons a large plot (or several plots) of the brain remains without blood flow. The viability of bloodless lesions did not last long, followed by their extinction.
Principal acute brain disorders
Extensive ischemic stroke, or cerebral infarction. This is the most common form, which develops in 80% of cases. Occurs as a result of the narrowing, thrombosis or embolism of one of the largest of the arteries that supply a certain area of the brain.
Extensive hemorrhagic stroke, or intracranial hemorrhage. The most dangerous category of brain disorders, lethality at which reaches 82%.
At the site of rupture of the vessel is formed a hematoma (blood clot), compressing the brain. Mechanical effects on tissue triggers a number of pathological processes: the termination of the outflow of venous blood, the development of high intracranial pressure and subsequent brain edema.
Some symptoms can appear weeks and even months before the disease.
The person should alert the following phenomena:
- Causeless headaches uncertain localization, severe dizziness;
- The darkening of the eyes after sudden waking up;
- Episodic memory loss;
- Sudden disorientation in space.
The symptoms of the onset of stroke are divided into two conditional categories:
- Brain — severe headache, nausea, impaired balance, dizziness, excitement, or torpor.
- Focal paralysis, muscle weakness (paresis), blindness in one eye, slurred speech, the inability to produce purposeful movement.
When a massive stroke is often marked by oculomotor disorders: different size pupils, no reaction to light, unusual eye movements, strabismus. Can also occur high tension of the extensor muscles.
Whensuspected brain stroke, conduct a simple test: the person is asked to smile or show your teeth, raise up your hands and something to say.
If a stroke has occurred, visible such violations:
- The corners of the mouth twisted, language turned, half his mouth slack. Eye the eyelid is lowered. This is due to paralysis of the facial muscles.
- Upon show of hands one of them spontaneously omitted. Man cannot shake the hand of the interlocutor.
- Illegible, pronunciation is difficult.
The presence of these signs means that began the death of brain cells. The faster man will deliver in a hospital, the greater the likelihood of recovery.
Features left and right stroke
Each hemisphere of the brain has its own function. The left controls speech and logical thinking. Its cells analyze the new information. The right hemisphere controls the emotional component — feelings, experiences, creative processes, perception of. In other words, it is processed synthesis of information.
A stroke of the left hemisphere found a little more often — in 57% of cases. Here it is necessary to mention that the left-sided hemorrhage (or ischemia) leads to the paralysis of the right side of the body, and the right — handed to the paralysis of the left side.
A lesion of the left hemisphere cause the following deviations:
- Indistinct pronunciation, lack of understanding addressed to the patient's speech;
- Loss of verbal memory;
- Violation of the articulation;
- The inability to write, to read, to talk. Restriction of communication leads to the fact that the patient becomes isolated, loses interest in life.
Speech disorders — a striking symptom of stroke, so patients are turning to faster doctors. Timely initiation of treatment significantly improve the prognosis.
If extensive brain stem stroke struck the right side, symptoms will be:
- Paralysis of legs, arms, facial muscles on the left side of the body;
- Distorted perception of own body. Patient feel that he has a lot of limbs, or numb hands and feet do not belong to him;
- Impaired memory, until its complete loss;
- Difficulties with understanding a foreign speech;
- The loss of orientation in space. The patient incorrectly worn, can not adequately assess speed of movement, size of object and distance to it;
- Depression, lethargy, indifference to the world.
In patients who survived right impact, often changing the attitude towards life. There is chronic depression, severe mental passivity.
The majority of stroke patients have ischemic disorders in the brain caused by stenosis (narrowing) of the supply vascular.
The situation worsens following reasons:
- Smoking and alcohol abuse;
- Diabetes mellitus;
- Mini-strokes in history;
- Asymptomatic carotid artery stenosis;
- A sedentary lifestyle;
- Uncontrolled use of certain drugs, particularly oral contraceptives. If the woman also smokes and suffers from hypertension, the risk of brain stroke increases many times;
- High levels of cholesterol in the blood;
- The negative attitude of life, stresses and nervous loads, especially for patients who has had a stroke.
Each of these factors may cause insufficient blood supply to the brain, but their combination greatly increases the risk of a major stroke.
For diagnosis following algorithm is used:
- A survey of the patient. The doctor finds out the exact time of onset of the disease, the rate of development of symptoms, identify risk factors — transferred vascular disease, Smoking, atherosclerosis, hypertension.
- Assessment of the functions of various body systems. Neurological impairment is determined by special scoring tables.
- Laboratory tests: urinalysis and blood tests clinical, biochemical, coagulation.
- Instrumental diagnostics — computed tomography and magnetic resonance imaging of the brain.
It is important to distinguish a stroke from other pathologies with similar symptoms: abscesses and tumors of the brain, subdural hematoma, epileptic seizure. To do this, conduct a differential diagnosis using the tomographic techniques and electroencephalography.
Treatment of stroke
The patient with stroke were sent to intensive care unit or neurological hospital.
If intensive treatment is started in the first 3-6 hours after the detection of brain disorders (the so-called "therapeutic window"), then there are chances of a full recovery. Treatment strokes of different kind of different because it is intended different purpose.
Therapy hemorrhagic form
First experts to investigate whether neurosurgical intervention. Indications for surgery:
- Subarachnoid hemorrhage;
- Ongoing bleeding;
- Rupture of the aneurysm;
- A large accumulation of blood in the cranial cavity.
If such diseases are not diagnosed, are medicationtreatment. It is aimed at maintaining respiration, heart rate, water-salt balance, prevention of cerebral edema and kidney failure. Appoint hemostatic agents, antioxidants, anticonvulsants, vitamin K.
Treatment of ischemic stroke
The first thing doctors focus their efforts — the restoration of blood flow. This applies to surgical intervention or conservative therapy (medication). Possible preference for the second option.
After the patient brought out the heavy States, prescribed emergency thrombolysis — intravenous drugs that dissolve blood clots. Further use of anticoagulants and antiplatelet agents, blood thinners and long-term support her in this condition. To improve blood flow and metabolism in the damaged neurons assign Ceraxon, Piracetam, Trental.
Supplementation helps to restore lost functions of the brain. At the same time conducted rehabilitation activities massage, physiotherapy, gymnastics, physiotherapy.
A portion of patients after stroke recover and return to normal life, sometimes with restrictions in the labour market.
Other recovery is slow, such violations:
- Paresis and paralysis;
- Speech defects (aphasia);
- Incomplete or absolute blindness;
- Swelling of the feet;
- Unsteadiness in movement, poor coordination of movements;
- Epileptic seizures;
- Acquired dementia associated with loss of neurons;
- Inability to daily activities and self-care.
In addition to these consequences of brain stroke may develop complications that threaten life.
It is a persistent disorder of the CNS that occurs as a result of poor blood supply to the brain. One of the signs of an impending stupor is a high temperature (a consequence of inflammation in the brain or in other organs).
First developed “precoma” (confusion), then the process goes through 4 main stages:
- Stun — the person is not oriented in time and around the world;
- Deep sleep — stupor;
- Loss of eye reflex, insensitivity to pain;
- Atony, loss of muscle and extensor reflexes.
If the patient is awake during the first 6 hours (stage 1-2 coma), then he has a chance to survive.
Upon the occurrence of the third stage the situation worsens. Weakened pharyngeal, tendon and corneal reflexes, decreases blood pressure andbody temperature, urahata breath.
Possible convulsions, involuntary acts of urination and defecation. Pupils are dilated all the time (paralytic miosis).
In this condition the patient may remain for several months. With each passing day the likelihood of a positive outcome decreases. The majority of patients, long been in a coma, doomed to vegetative existence.
After a massive stroke, the patient will have a long, often lifelong rehabilitation. Neurological deficit resulting from the death of brain cells can never be restored. However, the body adapts to life at the expense of neurons, remained intact. It's real, if the patient himself and his relatives actively interested in self-recovery.
Some of the stages of rehabilitation held in the hospital and sanatorium, but the daily care falls on the shoulders of loved ones. It is recommended to seek the assistance of speech therapists, physiotherapists, chiropractors, specialists in the field of acupuncture.
During the adaptation period the patient carried out such procedures:
- The effect of low-frequency magnetic field;
- Electrical stimulation of the AC sinusoidal current;
The consequences of a massive stroke cropped using drugs:
- Instenon, Tanakan, Lipemic — ischemic lesion;
- Gliatilin, Deletic, Actovegin — in hemorrhagic stroke;
- Sirdalud, Menovazin — to restore muscle tone;
- Trittico, Neural, Koaksil — in depressive States;
- Piracetam, Nootropil — with memory disorders.
Great importance is attached to physical therapy. From the first days after stroke should be to restore the motor function of limbs. Physical therapy to solve such problems as loss of muscle tone, improvement of microcirculation, prevention of joint contractures.
The heavier the stroke, the harder it is adaptation. Therefore, rehabilitation procedures should be carried out every day. This will help restore vitality and reduce the risk of a new stroke attack.
Despite the severity of the condition and obvious predictions, it is impossible to give up. The resources of the brain not well understood, and it is quite possible that persistent employment will lead to permanent improvement in health.