Hood

Energy exchange in the human body physiology. Physiology of metabolism and energy

Passport data:

FULL NAME. Kriksina Alexandra Dmitrievna

Gender Female

Age: 60 years old (21.02.41)

Permanent residence: Moscow, st. Leskova, 9-179

Profession: Pensioner

Date of receipt: 29.10.01

Curation date: 22.11.01

Complaints of sudden speech disorders, weakness in the right leg and right arm.

History of the present disease. (Anamnesis morbi.)

According to the son-in-law: she fell ill acutely on November 29, 2001, when the patient suddenly lost her speech, weakness appeared in her right limbs, the patient fell to the floor, did not lose consciousness. The patient suffers for a long time hypertension(IIIst.) In September 2001, the patient suffered an acute cerebrovascular accident with speech disorders without paresis. However, within a month, speech was almost completely restored.

Life story. (Anamnesis vitae).

Born in 1941 on February 21 in Moscow. Childbirth was normal, without pathology. The patient is the second child in the family, her mental and physical development did not lag behind her peers. Secondary education.

Family and sexual history:

Married, 2 children.

Nutrition: Excessive, varied, high-calorie.

Past illnesses:

childhood infections (whooping cough, chickenpox, scarlet fever). The patient has tuberculosis. The patient denies the transfer of jaundice, sexually transmitted diseases

Allergic history:

Allergic reactions to food, serum drugs and vaccines are absent.

Heredity:

Not weighed down.

The present state of the patient. (status praesents).

General inspection.

On general examination, the patient's condition is satisfactory, the position is active. The physique is correct, the constitutional type is normosthenic. The posture is stooped. Body temperature 36.4 degrees Celsius.

The skin is pale in color, the face is hyperemic, dry on the entire surface of the body, without age spots. Visible mucous membranes are pale pink in color, without any pigment spots.

Subcutaneous fatty tissue is moderately developed, there is no pain and crepitus on palpation. Edema is absent.

Lymph nodes: inguinal, axillary, cervical are non-palpable and painless. Zev: the root of the tongue and the soft palate are not hyperemic, there is no plaque and swelling. The tonsils are enlarged, not hyperemic, without plaque.

On palpation of the skeletal system, there is no pain, deformation is not noted.

Respiratory system.

On examination of the respiratory organs, no cough is observed. Shortness of breath in the active and passive position is not observed. There are no pains in the chest.

Auscultation of breathing in symmetrical areas of both lungs is vesicular. Bronchophony in symmetrical areas of the chest is the same.

The cardiovascular system.

At the time of curation of complaints, there were pains in the region of the heart, shortness of breath, suffocation, palpitations, and no edema. Arteries and veins are not enlarged, there is no visible pulsation (positive venous pulse is absent). The area of the heart without visible changes.

There is an expansion of the left border of the heart to the left.

On auscultation of the heart, the tones are muffled. The rhythm is right.

Pulsation of the aorta in the jugular fossa is absent.

The arterial pulse is the same on both arms, 92 beats per minute, of medium magnitude, tension and filling. Blood pressure 180/100 mm Hg.

During examination and palpation of the veins of the neck, swelling, pulsation was not detected. Expansion of the veins of the chest, abdominal wall, no limbs.

Digestive system.

Gastrointestinal tract.

Vomiting, dyspepsia, flatulence, stool disorders are absent. When examining the oral cavity, the tongue is moist, pink, without plaque, cracks, ulcers. Gums, hard and soft palate of pink color, without visible damage. Appetite is reduced.

On examination, the abdomen is of the correct shape, symmetrically participates in the act of breathing, there is no bulging and retraction of the abdominal wall, there is no visible peristalsis.

With percussion of the abdomen, there is no free and encapsulated fluid. Mendel's sign is negative.

With superficial palpation, there is no pain and tension in the abdominal muscles.

Auscultation: peristalsis of normal strength, duration, periodic. The noise of friction of the peritoneum and vascular noises are not auscultated.

Liver and gallbladder.

At the time of curation, there were no complaints of pain in the right hypochondrium and dyspeptic symptoms.

On examination, there are no protrusions and retractions in the area of the right hypochondrium.

The gallbladder is not palpable.

Spleen.

At the time of curation, there were no complaints of pain in the left hypochondrium.

When examining a limited protrusion in the area of the left hypochondrium and respiratory restriction in this area was not revealed.

The spleen is not palpable.

The noise of friction of the peritoneum is not auscultated.

Pancreas.

Pain in the upper abdomen, dyspeptic symptoms are absent.

On palpation, enlargement and induration of the pancreas were not detected.

Urinary system.

When examining the genitourinary system, there is no pain in the lumbar region. There is no pain in the bladder area, urination is not disturbed and painless. Urine: straw-yellow color, transparent, no blood impurities.

Examination of the lumbar and suprapubic region revealed no pathological changes.

The kidneys in a horizontal and vertical position are not palpable, the bladder is not palpable. Soreness at the costovertebral point and along the ureters is not determined.

Endocrine system.

Violations of growth and physique were not revealed, the physique is proportional. Obesity is absent. The skin is dry, thinned, without roughness. An increase in the size of the nose, jaws, auricles, hands, feet is absent.

The thyroid gland is not enlarged, painless.

neurological status.

In the mind, contact is difficult due to speech disorders. Cerebral and meningeal symptoms are absent.

cranial nerves.

I. Olfactory nerve. The sense of smell is preserved. Perversions of smell, olfactory hallucinations are not present.

II. The optic nerve. Vision is reduced. Loss of the right visual fields of both eyes. The color perception is preserved.

III Oculomotor, IV trochlear, VI abducens nerves. The right palpebral fissure is dilated D>S. The volume of eye movements in all directions is fully preserved. There are no floating eye movements. Paresis of gaze to the right. Set gaze to the left. Pupils of medium size, D=S. Photoreaction (direct and friendly) is preserved. There is no strabismus, diplopia, exophthalmos.

V. Trigeminal nerve. Pain in the exit area of the nerve branches is absent. There are no paresthesias. Violation of sensitivity in the peripheral and segmental tip was not detected. The sensitivity of the mucous membranes of the mouth, the tongue of the nose of the eyes is intact. When opening the mouth, the lower jaw does not deviate to the side. The trophic muscles are not broken. Corneal and conjunctival reflexes (V-VII) are positive.

VII. Facial nerve. There is no immobility, maskedness of the face. The right nasolabial fold is smoothed out. The right palpebral fissure is dilated. Asymmetry is observed when the forehead is wrinkled, the eyebrows are furrowed, and the teeth are bared. Positive "sail" symptom.

VIII. Auditory nerve. Hearing preserved on both sides. There is no ringing and noise in the ears. Nystagmus, no systemic dizziness.

IX. Glossopharyngeal, X vagus nerves. Mild dysphagia, pharyngeal reflexes high D=S. The sensitivity of the upper part of the pharynx is preserved. The voice is quiet, hoarse.

XI. Accessory nerve. Raising the shoulder girdle and turning the head, raising the left arm above the horizontal, convergence of the shoulder blades are preserved. On the right side, these arbitrary movements are limited. Head position without tilting to the side. The trophism of the sternocleidomastoid muscles is not disturbed.

XII. Hypoglossal nerve. When protruding, the tongue deviates into right side without atrophy and fibrillar twitching. Dysarthria.

Propulsion system.

On examination and palpation of the muscular system, atrophy, pseudohypertrophy, fibrillar and fascicular twitches are absent. Passive movements upper and lower extremities are preserved in full. Lack of active movements in the right limbs. There is a weakening of muscle strength, detected in the Barre test, up to 2-3 points in the right limbs with an increase in muscle tone (in the upper limbs, the flexor tone is increased, in the lower limbs, the extensor tone is increased) according to the spastic type. Akinesis, bradykinesia, hyperkinesis (tremor, chorea, athetosis, choreoathetosis, hemiballismus, myoclonus, torsion dystonia, tics) are absent. Automated gesticulation syndrome was not identified.

Seizures and convulsive twitches are absent.

Movement coordination.

The finger-nose test is carried out confidently. There is no intentional tremor, adiadochokinesis, hypermetry, or chanted speech.

Reflexes.

Tendon and periosteal reflexes are brisk: from the upper limbs D>S, from the lower limbs: knee (L2-L4, femoral nerve), Achilles (S 1

S2, tibial nerve) - D>S.

Skin reflexes: upper (Th7-Th8), middle (Th9-Th10), lower (Th11-Th12) abdominal, plantar (tibial nerve, L5-S2) decreased D>S.

Articular reflexes Mayer (ulnar and median nerves, C7-Th1) and Lehry (ulnar and median nerves, C6-Th1) are reduced.

Pathological reflexes:

pyramidal: Babinski's reflex is detected on the right, Oppenheim's, Gordon's, Schaeffer's reflexes are negative;

the reflections of the Rossolimo group (Bekhterev 1, 2, Zhukovsky) are negative.

Protective reflexes:

positive on the right.

Reimist's synkinesis is revealed.

Pseudobulbar reflexes:

positive reflexes of oral automatism were revealed: naso-labial, labial, proboscis, palmar-chin.

Sensitivity.

Superficial sensitivity (pain, temperature, tactile, hair) is absent on the right, preserved on the left. Deep sensitivity (muscle-articular feeling, vibration, feeling of pressure and weight) is absent on the right, preserved on the left. Complex sensitivity (kinesthetic, discriminatory, two-dimensional, stereognosis) is absent on the right, it is determined on the left. Pain points along the peripheral nerves and roots are not determined.

autonomic nervous system.

Hyperthermia and hyperemia of the face are determined on both sides. Persistent white dermographism. Acrocyanosis is absent. The function of the pelvic organs, as well as the control over them of the patient, is not impaired.

Higher cortical functions.

Results of instrumental methods and laboratory research.

Complete blood count dated 11/20/01:

Hemoglobin 128g/l

Hematocrit 0.5

Leukocytes 6.5

Band 13

Segmented 61

Eosinophils5

Basophils 0

Lymphocytes 20

Monocytes 4.2

General urine analysis:

Color straw yellow

Transparency is complete

Density 1018

The reaction is sour

Glucose

Leukocytes absent.

Protein absent.

Syndromic diagnosis.

During the examination, the patient reveals:

Movement disorders in the form of:

A) Central right-sided hemiparesis:

hyperreflexia, decreased skin reflexes D>S,

Synkinesia Reinest,

B) Central paresis of 7 and 12 nerves on the right:

smoothness of the right nasolabial fold,

asymmetry when wrinkling the forehead, frowning the eyebrows, baring the teeth,

Positive "sail" symptom,

protrusion deviates to the right side without atrophy and fibrillar twitches,

C) Pseudobulbar palsy:

dysphagia,

dysphonia,

Violation of sensitivity in the form of:

A) Right-sided hemianesthesia: a violation of all types of sensitivity on the right according to the hemitype.

B) Right-sided homonymous hemianopia.

C) Paresis to the right.

Violation of higher cortical functions:

A) Sensorimotor aphasia, agraphia, alexia.

Thus, the patient revealed the syndrome of three "hemi" (hemiparesis, hemianesthesia, hemianopsia).

Topical diagnosis.

1. Motor disorders in the form of a central right-sided hemiparesis indicate a lesion of the pyramidal tract, which begins in the right hemisphere in the neurons of the precentral gyrus, then it goes to the internal capsule (anterior two-thirds of the posterior thigh), then it passes in the middle part of the legs of the brain, descends through the base of the bridge and into the lower part of the medulla oblongata passes to the opposite side and approaches the anterior horns.

Central paresis of the VII and XII nerves indicates a unilateral lesion of the corticonuclear tract, passing in the knee of the internal capsule, in the middle part of the legs of the brain. When approaching the nuclei, this path also crosses. This pathology is due to the fact that only the nucleus XII and the lower pole of the nucleus VII of the cranial nerve have unilateral connections with the cortex.

Pseudobulbar syndrome indicates a bilateral lesion of the corticonuclear pathway (its supranuclear region).

2. Sensory disorders in the form of:

A) right-sided hemianesthesia refers to the defeat of the fibers passing in the posterior third of the posterior thigh of the internal capsule.

Surface sensitivity:

The first neuron is located in the spinal ganglion, the second neuron (spinothalamic) begins at the cells of the posterior horn, its fibers pass through the anterior commissure to the opposite side, entering the white matter. They rise up the brainstem and end in the ventral part of the thalamus. The third neuron starts at the outer part of the optic tubercle, goes through the posterior third of the posterior thigh of the left inner capsule to the superior parietal lobe (thalamo-cortical tract).

Deep Sensitivity:

The central process of the first neuron participates in the formation of the posterior root and, without entering the posterior horn of the segment, goes to the posterior columns. As part of the bundles of Gaulle and Burdakh, the paths rise, without interruption, to the nuclei of the same name in the lower part of the medulla oblongata. They are the beginning of the second neuron (bulbothalamic tract), which immediately passes to the opposite side of the medulla oblongata and, after decussation, forms a medial loop, to which the spinothalamic tract approaches in the area of the bridge. The third neuron is formed from the cells of the outer nucleus of the thalamus and their fibers, which through the posterior part of the posterior femur of the internal capsule to the cortex of the posterior central gyrus and the superior parietal lobe.

B) right-sided homonymous hemianopsia with preservation of the pupil's reaction to light indicates a lesion of Graziola's radiance, because there are non-pupillary fibers in it.

C) gaze paralysis to the right indicates damage to the left frontal oculomotor tract.

Violation of higher cortical functions in the form of sensory-motor aphasia, agraphia, alexia with damage to the posterior part of the lower frontal gyrus - Broca's area (field 44), superior temporal gyrus - Wernicke's area (field 22) of the left hemisphere.

The syndrome of three "hemi" indicates the defeat of the entire posterior posterior femur of the left internal capsule. This area is vascularized by the middle cerebral artery, which is a branch of the left internal carotid artery. Also, this patient was found to have lesions in the radiance of Graziola, 44 and 22 fields of the cortex of the left hemisphere.

Clinical diagnosis.

Primary disease: repeated acute violation of cerebral ischemic type in the system of the left internal carotid artery. Atherosclerosis of cerebral vessels. Dyscirculatory encephalopathy IIIst.

Concomitant diseases: hypertension III stage, circulatory failure 1.

The clinical diagnosis was made on the basis of:

Complaints: according to the words of the son-in-law (due to the speech disorder of the patient), the patient fell due to sudden weakness in the right limbs. However, without loss of consciousness, vomiting. Also complaints about speech impairment. History of the development of the present disease: a patient with a vascular history suffers from hypertension for a long time (20 years), overnutrition. The patient has atherosclerosis of cerebral vessels. Also in September 2001, the patient suffered an ischemic stroke in the basin of the left internal carotid artery. Survey data: lack of cerebral and meningeal symptoms, left-hemispheric focal symptoms in the form of right-sided hemiparesis, right-sided hemianopsia and hemianesthesia. The presence of pseudobulbar paralysis, as well as sensory-motor aphasia, alexia, agraphia.

Thus, given the patient's age, long-term vascular history, ischemic stroke in the past, we can talk about damage to the left internal capsule (its posterior thigh), as well as damage to the cortex of the cerebral hemispheres due to ischemic stroke of the artery supplying these zones. The proposed mechanism of damage is non-thrombotic, which occurs more often due to occlusion of the vessel by an atherosclerotic plaque, tortuosity of the vessels.

Treatment plan.

Stationary mode. Table 10 Sol.Rheopholyglucini 400 IV drip. Tab.Glicini up to 1 g per day under the tongue. Tab.Aspirini ¼ at night. exercise therapy. Massage. Barotherapy. Expert advice.

22.11.01 Condition is satisfactory. The patient does not present any complaints because of a speech disorder. Right-sided hemiparesis, hemianesthesia persist. Pseudobulbar symptomatology is pronounced. Muscle tone is increased in the right extremities of the postspastic type.

Heart rate 80 beats/min, respiratory rate 18/min. BP 150/100.

26.11.01 Condition is satisfactory. No complaints due to the preservation of speech disorders. Neurological and somatic status unchanged. There is an increase in muscle strength in the right limbs up to 3.5 points.

Physical therapy, massage, barotherapy are carried out.

HR 75 beats/min, RR 19/min, BP 140/100.

The greatest severity of the condition in patients with ischemic stroke is observed in the first 10 days of the disease, then there is a period of improvement, when the patient begins to decrease the severity of symptoms. In this case, the rate of recovery may be different. With a good and rapid development of collateral circulation, it is possible to restore function on the very first day of a stroke, but more often after a few days. Mortality reaches 20-25%. However, in the case of this patient, an unfavorable prognosis is possible due to the fact that she has recently had a stroke and the risk of another stroke increases significantly.

Stage epicrisis.

21st day of stay.

Prevention.

Primary prevention of cerebral stroke consists in the exclusion of possible risk factors (overeating, smoking, stress, etc.), the organization of the patient's work and rest regimen, nutrition, and health improvement. Secondary prevention includes measures aimed at systematic monitoring of the condition of patients with cardiovascular diseases, their treatment, and antiplatelet therapy.

Rationale

In a patient with a burdened vascular history, who suffers for a long time……. Against this background, the extremities suddenly weakened without general cerebral and meningeal symptoms.

Inspection of a speech therapist from 11/22/01.

The patient is generally active, responds adequately to the speech addressed to her, performs simple tasks, with the complication of speech instructions, partial sensory aphasia is detected. Expressive speech is poor, monosyllabic, with large lateral paraphasias, which are noted both in spontaneous and repeated speech. Automated speech sequences are relatively preserved (their detached repetition is possible). Alexia, agraphia.

Stage epicrisis.

21st day of stay.

Dynamics of complaints: no clear complaints in connection with aphasic disorders.

Dynamics of the state: the state is relatively satisfactory, conscious, contact. Against the background of vascular-metabolic therapy, hemodynamic parameters returned to normal - BP 150-180/100. Neurological status without negative dynamics. Sitting, active, trying to restrain himself. Speech disorders persist. Right-sided central hemiparesis with spastic muscle tone.

ECG from 11/16/01 in dynamics from 11/6/01: blood supply to the anterior wall of the left ventricle is improving.

Ds: Recurrent acute ischemic cerebrovascular accident in the system of the left internal carotid artery.

Results of instrumental methods and laboratory studies.

Complete blood count dated 26.02.01:

Hemoglobin 128 g/l

Hematocrit 0.5

Leukocytes 6.5

Band 13

Segmented 61

Eosinophils 5

Basophils 0

Lymphocytes 20

Monocytes 4.2

General urine analysis:

Color straw yellow

Transparency is complete

Density 1018

The reaction is sour

Glucose

Leukocytes absent.

Protein absent.

Treatment plan.

Stationary mode. Table 10 Sol.Rheopholyglucini 400 IV drip. Tab.Glicini up to 1 g per day under the tongue. Tab.Aspirini ¼ at night.

In recent years, the percentage of mortality from pathological lesions of the cerebral vessels has significantly increased, which were previously associated with aging and were diagnosed only in elderly people (after 60 years). Today, the symptoms of cerebrovascular accident have rejuvenated. And people under the age of 40 often die from a stroke. Therefore, it is important to know the causes and mechanism of their development, so that diagnostic and therapeutic measures give the most effective result.

What is cerebrovascular accident (MK)

The vessels of the brain have a peculiar, perfect structure that ideally regulates blood flow, ensuring the stability of blood circulation. They are designed in such a way that with an increase in blood flow to the coronary vessels by about 10 times during physical activity, the amount of circulating blood in the brain, with an increase in mental activity, remains at the same level. That is, there is a redistribution of blood flow. Part of the blood from parts of the brain with a lower load is redirected to areas with enhanced brain activity.

However, this perfect process of blood circulation is disturbed if the amount of blood entering the brain does not satisfy its need for it. It should be noted that its redistribution among brain regions is necessary not only for its normal functionality. It also occurs when various pathologies occur, for example, (narrowing) or obturation (closure). As a result of impaired self-regulation, there is a slowdown in the speed of blood movement in certain parts of the brain and them.

Types of violations of MK

There are the following categories of blood flow disorders in the brain:

Acute (strokes) that occur suddenly with a long course, and transient, the main symptoms of which (visual impairment, loss of speech, etc.) last no more than a day.
Chronic, caused. They are divided into two types: origin and caused.

Acute disorders of cerebral circulation (ACC)

Acute cerebrovascular accident causes persistent disorders of brain activity. It is of two types: and (it is also called a cerebral infarction).

hemorrhagic

Etiology

Hemorrhage (hemorrhagic disturbance of blood flow) can be caused by various arterial hypertension, congenital, etc.

Pathogenesis

As a result of the increase blood pressure there is an exit of plasma and proteins contained in it, which entails plasma soaking of the walls of blood vessels, causing their destruction. A peculiar hyaline-like specific substance (a protein resembling cartilage in its structure) is deposited on the vascular walls, which leads to the development of hyalinosis. Vessels resemble glass tubes, lose their elasticity and ability to hold blood pressure. In addition, the permeability of the vascular wall increases and blood can freely pass through it, soaking the nerve fibers (diapedetic bleeding). The result of such a transformation can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. Thus, hemorrhage occurs as a result of:

Plasma impregnation of the walls of the vessels of the white medulla or visual tubercles;
diapedetic bleeding;
formation of microaneurysms.

Hemorrhage in the acute period is characterized by the development of hematomas during wedging and deformation of the brain stem into the tentorial foramen. At the same time, the brain swells, extensive edema develops. There are secondary hemorrhages, smaller ones.

Clinical manifestations

Usually occurs during the day, during a period of physical activity. Suddenly, the head starts to hurt badly, there are nauseating urges. Consciousness is confused, a person breathes often and with a whistle, occurs, accompanied by hemiplegia (unilateral paralysis of the limbs) or hemiparesis (weakening of motor functions). Lost basic reflexes. The gaze becomes motionless (paresis), anisocoria (pupils of different sizes) or divergent strabismus occurs.

Treatment

Treatment of this type of cerebrovascular accident includes intensive therapy, the main goal of which is to lower blood pressure, restore vital (automatic perception of the external world) functions, stop bleeding and eliminate cerebral edema. In this case, the following medicines are used:

Decreasing - ganglionic blockers ( Arfonad, Benzohexanium, Pentamine).
To reduce the permeability of the walls of blood vessels and increase blood clotting - Dicynon, vitamin C, Vikasol, Calcium gluconate.
To increase the rheology (fluidity) of blood - Trental, Vinkaton, Cavinton, Eufillin, Cinnarizine.
Inhibiting fibrinolytic activity - ACC(aminocaproic acid).
Decongestant - Lasix.
Sedative drugs.
A lumbar puncture is prescribed to reduce intracranial pressure.
All drugs are administered by injection.

Ischemic

Etiology

ischemic NMC due to atherosclerotic plaque

Ischemic circulatory disorders are most often caused by atherosclerosis. Its development can provoke strong excitement (stress, etc.) or excessive physical activity. It can occur during a night's sleep or immediately after waking up. Often accompanies a pre-infarction state or.

Symptoms

They may appear suddenly or increase gradually. They manifest themselves in the form of headaches, hemiparesis on the side opposite to the lesion. Disturbance of coordination of movement, as well as visual and speech disorders.

Pathogenesis

An ischemic disorder occurs when an area of the brain does not receive enough blood. In this case, a focus of hypoxia arises, in which necrotic formations develop. This process is accompanied by a violation of basic brain functions.

Therapy

Injections are used in the treatment medicines to restore the normal functioning of the cardiovascular system. These include: Corglicon, Strofantin, Sulfocamphocaine, Reopoliklyukin, Cardiamin. Intracranial pressure decreases Mannitol or Lasix.

Transient cerebrovascular accident

Transient cerebrovascular accident (TIMC) occurs against the background of arterial hypertension or atherosclerosis. Sometimes the cause of its development is their combination. The main symptoms of PNMK are manifested in the following:

If the focus of the pathology is located in the basin of the carotid vessels, the patient becomes numb half of the body (on the opposite side of the focus) and part of the face around the lips, paralysis or short-term paresis of the extremities is possible. Speech is impaired, an epileptic seizure may occur.
In case of circulatory disorders, the patient's legs and arms weaken, it is difficult for him to swallow and pronounce sounds, photopsia occurs (appearance of luminous points, sparks, etc. in the eyes) or diplopia (doubling of visible objects). He loses his bearings, he has memory lapses.
Signs of cerebrovascular accident against the background of hypertension are manifested in the following: the head begins to hurt and eyeballs, a person experiences drowsiness, he has stuffy ears (as in an airplane during takeoff or landing) and nauseating urges. The face turns red, sweating increases. Unlike strokes, all these symptoms disappear within a day. For this they received the name.

PNMK is treated with antihypertensive, tonic and cardiotonic drugs. Antispasmodics are used, and. The following medications are prescribed:

Dibazol, Trental, Clonidine, Vincamine, Eufillin, Cinnarizine, Cavinton, Furasemide, beta-blockers. As tonic - alcohol tinctures of ginseng and Schisandra chinensis.

Chronic disorders of cerebral circulation

Chronic cerebrovascular accident (CIC), in contrast to acute forms, develops gradually. There are three stages of the disease:

In the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person quickly gets tired, his sleep is disturbed, he often hurts and his head is spinning. He becomes short-tempered and distracted. He often changes his mood. He forgets some minor things.
In the second stage, chronic cerebrovascular accident is accompanied by a significant memory impairment, small motor dysfunctions develop, causing unsteady gait. There is constant noise in the head. A person does not perceive information well, with difficulty concentrating his attention on it. He is gradually degrading as a person. Becomes irritable and insecure, loses intelligence, reacts inadequately to criticism, often becomes depressed. He is constantly dizzy and has a headache. He always wants to sleep. Efficiency - reduced. He does not adapt well socially.
In the third stage, all symptoms intensify. Personality degradation turns into, memory suffers. Leaving the house alone, such a person will never find his way back. Motor functions are impaired. This is manifested in the tremor of the hands, stiffness of movements. Speech impairment, uncoordinated movements are noticeable.

Violation of cerebral circulation is dangerous because if treatment is not carried out in the early stages, neurons die - the main units of the brain structure, which cannot be resurrected. Therefore, early diagnosis of the disease is so important. It includes:

Identification of vascular diseases that contribute to the development of cerebrovascular accidents.
Making a diagnosis based on the patient's complaints.
Conducting a neuropsychological examination on the MMSE scale. It allows you to detect cognitive impairment by testing. The absence of violations is evidenced by 30 points scored by the patient.
Duplex scanning in order to detect lesions of cerebral vessels by atherosclerosis and other diseases.
Magnetic resonance imaging, which allows to detect small hypodense (with pathological changes) foci in the brain.
Clinical blood tests: general analysis blood, lipid spectrum, coagulogram, glucose.

Etiology

The main causes of cerebrovascular accident are as follows:

Age. Basically, they occur in people who have stepped into their fifth decade.
genetic predisposition.
Traumatic brain injury.
Overweight. Obese people often suffer from hypercholesterolemia.
Physical inactivity and increased emotionality (stress, etc.).
Bad habits.
Diseases: diabetes mellitus (insulin-dependent) and atherosclerosis.
Hypertension. High blood pressure is the most common cause of strokes.
In old age, blood flow disorders in the brain can lead to:
- shimmering ,
- various diseases of the hematopoietic organs and blood,
- chronic,

Treatment

In chronic disorders of blood flow in the brain all therapeutic measures are aimed at protecting the neurons of the brain from death as a result of hypoxia, stimulate metabolism at the level of neurons, normalize blood flow in brain tissues. Medicines for each patient are selected individually. They should be taken in a strictly specified dosage, constantly monitoring blood pressure.

In addition, for disorders of cerebral circulation, accompanied by manifestations of a neurological nature, antioxidants, vasodilators, drugs that increase blood microcirculation, sedatives and multivitamins are used.

Chronic cerebrovascular accident can also be treated with traditional medicine, using various fees and herbal teas. Especially useful is the infusion of hawthorn flowers and the collection, which includes chamomile, marsh cudweed and motherwort. But they should be used as an additional treatment course that enhances the main drug therapy.

Overweight people who are at risk for developing atherosclerosis due to need to pay attention to nutrition. For them, there are special diets, which you can learn about from a dietitian who monitors the organization of nutrition for patients who are being treated in a hospital at any hospital. Dietary products include everything of vegetable origin, seafood and fish. But milk products, on the contrary, should be low in fat.

If cholesterolemia is significant, and the diet does not give the desired results, are prescribed medicines included in the group: Liprimar, Atorvakar, Vabarin, Torvakard, Simvatin. With a large degree of narrowing of the lumen between the walls of the carotid arteries (more than 70%), a carotid (surgical operation) is required, which is performed only in specialized clinics. With stenosis less than 60%, conservative treatment is sufficient.

Rehabilitation after acute cerebrovascular accident

Drug therapy can stop the course of the disease. But she cannot return the opportunity to move. Only special gymnastic exercises can help with this. We must be prepared for the fact that this process is quite lengthy and be patient. Relatives of the patient should learn how to perform massage and therapeutic exercises, since it is they who will have to do them to him for six months or more.

Kinesiotherapy is shown as the basis for early rehabilitation after a dynamic violation of cerebral circulation in order to fully restore motor functions. It is especially necessary in the restoration of motor skills, as it contributes to the creation of a new model of the hierarchy of the nervous system for the implementation of the physiological control of the body's motor functions. The following methods are used in kinesitherapy:

Gymnastics "Balance", aimed at restoring coordination of movements;
The Feldenkrais Reflex System.
Vojta system, aimed at restoring motor activity by stimulating reflexes;
Microkenisotherapy.

Passive gymnastics "Balance" is assigned to every patient with impaired cerebral circulation, as soon as consciousness returns to him. Usually relatives help the patient to perform it. It includes kneading the fingers and toes, flexion and extension of the limbs. Exercises begin to be performed from the lower extremities, gradually moving up. The complex also includes kneading the head and cervical regions. Before starting the exercises and finishing the gymnastics should be light massaging movements. Be sure to monitor the patient's condition. Gymnastics should not cause him overwork. The patient can independently perform exercises for the eyes (squinting, rotation, fixing the gaze at one point, and some others). Gradually, with the improvement of the general condition of the patient, the load is increased. For each patient, an individual recovery method is selected, taking into account the characteristics of the course of the disease.

Photo: basic exercises of passive gymnastics

The Feldenkrais Method- This is a therapy that gently affects the human nervous system. It contributes to the complete restoration of mental abilities, physical activity and sensuality. It includes exercises that require smooth movement during execution. The patient must focus on their coordination, make each movement meaningful (consciously). This technique forces you to divert attention from the existing health problem and focus it on new achievements. As a result, the brain begins to "remember" the old stereotypes and returns to them. The patient is constantly exploring his body and its capabilities. This allows you to find quick ways to get him moving.

The methodology is based on three principles:

All exercises should be easy to learn and remember.
Each exercise should be performed smoothly, without muscle strain.
Performing the exercise, a sick person should enjoy the movement.

But most importantly, you should never divide your achievements into high and low.

Additional rehabilitation measures

Breathing exercises are widely practiced, which not only normalizes blood circulation, but also relieves muscle tension arising under the influence of gymnastic and massage loads. In addition, it regulates the respiratory process after performing therapeutic exercises and gives a relaxing effect.

With disorders of cerebral circulation, the patient is prescribed bed rest for a long time. This can lead to various complications, for example, a violation of the natural ventilation of the lungs, the appearance of bedsores and contractures (mobility is limited in the joint). Prevention of bedsores is the frequent change of position of the patient. It is recommended to turn it over on the stomach. At the same time, the feet hang down, the shins are located on soft pillows, under the knees there are cotton pads lined with gauze.

Give the patient's body a special position. In the first days, he is transferred from one position to another by relatives caring for him. This is done every two or three hours. After stabilizing blood pressure and improving the general condition of the patient, they are taught to do it themselves. Early seating of the patient in bed (if health permits) will not allow contractures to develop.
Do the massage necessary to maintain normal muscle tone. The first days it includes light stroking (with increased tone) or kneading (if muscle tone is reduced) and lasts only a few minutes. In the future, massage movements are intensified. Rubbing is allowed. The duration of massage procedures also increases. By the end of the first half of the year, they can be completed within an hour.
Perform exercise therapy exercises, which, among other things, effectively fight synkinesis (involuntary muscle contractions).
Vibrostimulation of paralyzed parts of the body with an oscillation frequency of 10 to 100 Hz gives a good effect. Depending on the condition of the patient, the duration of this procedure can vary from 2 to 10 minutes. It is recommended to carry out no more than 15 procedures.

For cerebrovascular accidents, alternative methods of treatment are also used:

Reflexology including:
1. Treatment with smells (aromatherapy);
2. classic version of acupuncture;
3. acupuncture to reflex points located on the auricles (auricol therapy);
4. acupuncture of biologically active points on the hands (su-Jack);
Coniferous baths with the addition of sea salt;
Oxygen baths.

Video: rehabilitation after a stroke, the program “Live healthy!”

Read more about comprehensive rehabilitation after strokes and ischemic attacks.

Consequences of NMK

Acute cerebrovascular accident has serious consequences. In 30 cases out of a hundred people who have had this disease become completely helpless.

He cannot eat, perform hygiene procedures, dress himself, etc. on his own. Such people have a completely impaired ability to think. They lose track of time and do not orient themselves in space at all.
Some people still have the ability to move. But there are many people who, after a violation of cerebral circulation, forever remain bedridden. Many of them keep a clear mind, understand what is happening around them, but are devoid of speech and cannot put into words their desires and express feelings.

Disability is a sad result of acute and in many cases chronic disorders of cerebral circulation. About 20% of acute cerebrovascular accidents are fatal.

But it is possible to protect yourself from this serious disease, regardless of which category of classification it belongs to. Although many people neglect it. This is an attentive attitude to your health and all the changes that occur in the body.

Agree that a healthy person should not have headaches. And if you suddenly feel dizzy, it means that there is some kind of deviation in the functioning of the systems responsible for this organ.
Elevated temperature is an indication of a malfunction in the body. But many go to work when it is 37 ° C, considering it normal.
Does it happen for a short time? Most people rub them without asking the question: why is this happening?

Meanwhile, these are the satellites of the first minor changes in the blood flow system. Often, an acute cerebrovascular accident is preceded by a transient one. But since its symptoms disappear within a day, not every person is in a hurry to see a doctor in order to be examined and receive the necessary medical treatment.

Today, doctors have effective drugs in service -. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one "but". To achieve maximum effect, they should be administered to the patient within three hours after the onset of the first symptoms of a stroke. Unfortunately, in most cases, seeking medical help is too late, when the disease has passed into a severe stage and the use of thrombolytics is no longer useful.

Video: brain blood supply and the consequences of a stroke

Elderly people are familiar with such a disease, the name of which CVA - acute cerebrovascular accident Or just a stroke. Almost every older person has experienced this disease on himself. It is very important to understand the causes of stroke and the proper treatment of the disease.

What it is?

A stroke is a clinical symptom manifested by sharp failures in the normal operation of the existing options of the brain of the head, the duration of which is more than one day.

The main symptoms of CVA are:

The inability of the patient's body to move normally;
Disorders of the organs responsible for sensitivity;
Violations of the proper functioning of the speech apparatus;
The inability of the patient to make swallowing movements;
Frequent headache;
Loss of consciousness.

An unexpectedly appeared violation of the speech apparatus, loss of body sensitivity and problems with coordination of movement pass over the next day. Then they talk about transistor ischemic attack. It's not like that dangerous disease like a stroke, but also applies to stroke.

If the disease refers to disorders in the functioning of the circulatory system, then it is characterized as "stroke by the type of ischemia." In the case when bleeding is confirmed by a specialist, then the disease has the characteristic "CVA by hemorrhagic type".

A stroke that ends in a stroke is the stage when blood flow to some part of the brain stops. This phenomenon is caused by a decrease in the tone of the walls of the arteries of the brain and is accompanied by a disorder of the neurological system, which is a consequence of the destruction of part of the nerve tissue.

ONMK - code according to ICD-10

In the tenth international classification of diseases, stroke has several codes that differ from each other according to the disorders that caused the disease.

Prevention and treatment of this disease are considered at the state level, since stroke ends in death in a third of cases. Sixty percent of patients who have had the disease turn out to be disabled, who cannot do without social assistance.

Causes of stroke

CVA, related to the ischemic type, develops as a result of already existing pathologies in the patient's body.

These diseases include:

ACVE is found not only in the adult category of the population, but also in children. This is due to the fact that the vessels of the child's brain have any anomalies in their development. high risk development of stroke is observed in children who have congenital heart disease.

When stroke occurs, only 30% of children recover completely. About fifty percent have incurable disorders in the work of the neurological system. Twenty percent of cases of acute cerebral circulatory disorders in children end in death.

In what cases can CVD be suspected?

The diagnosis of stroke is made if the patient has the following disorders in the body:

A sharp lack of sensitivity in the limbs;
Loss of vision up to blindness;
Inability to recognize the opponent's speech;
loss of balance, problems with coordination;
Very severe headaches;
Clouding of consciousness.

An accurate diagnosis can be established only after the diagnosis.

Stages of cerebral infarction

ONMK has several stages of development. Let's consider each of them in more detail.

Stage number	Stage symptoms
First stage	There is a lack of oxygen, which leads to failures in the permeability of flat cells located on the surface of blood vessels. As a result, fluid and protein from blood cells enter the brain tissue. Edema develops;
Second stage	At the capillary level, blood pressure continues to fall, which leads to disruption of the cell membrane. Nerve receptors and electrolyte channels also cease to function properly. At this stage, the disease can be prevented;
Third stage	There are disturbances in the work of cell metabolism, lactic acid accumulates in the tissues. Energy synthesis occurs, in which oxygen molecules do not participate. The anaerobic mode does not allow the tissues of neurons and astrocytes to maintain a normal level of vital activity. These cells increase in volume, causing malfunctions in the structure. The clinical picture is focal signs of a neurological nature.

Ischemic stroke

This type of stroke is accompanied by a complete cessation of blood flow delivery to specific areas of the brain tissue, which is accompanied by the destruction of brain cells and the cessation of its main functions.

Causes of ischemic stroke

A stroke of this plan is caused by obstruction of blood flow to any brain cell. As a result, the normal functioning of the brain stops. Plaque, consisting of cholesterol, can also become an obstacle to the normal flow of blood. This causes more than 80% of all diseases.

Risk group

CVA is most often manifested in the category of the population that have the following pathologies:

Vascular disorders that are atherosclerotic in nature;
A sharp increase in blood pressure;
Previous myocardial infarction of an extensive nature;
stretching of the artery;
Heart defects that are acquired or congenital;
Increased blood density caused by diabetes:
Decreased blood flow rate, which is a consequence of cardiac insufficiency;
Excess body weight;
Transistor ischemic attacks previously transferred to the patient;
Excessive consumption of alcohol and tobacco industry products;
Reaching the age of sixty;
The use of oral contraceptives that contribute to the occurrence of blood clots.

Symptoms of the disease

Neurologists distinguish several intervals in the development of ischemic stroke according to the severity of the disease:

The sharpest. Lasts up to five days;
Spicy. The duration is 21 days;
Recovery at an early stage. Since elimination acute symptoms takes six months;
Late recovery. The rehabilitation period lasts for two years;
Eliminate traces. Over two years.

In addition to general symptoms, ischemic stroke of the brain is characterized by local symptoms. It depends on the area in which the disease occurred.

And so, if struck then the following symptoms appear:

Disorder of the visual system in the direction where the blockage of the vessel occurred;
The sensitivity of the extremities disappears on the opposite side of the focus of the disease;
In the same area, paralysis of muscle tissue occurs;
There are disorders in the work of the speech apparatus;
The inability to recognize your illness;
Problems with body orientation;
Loss of field of view.

With narrowing of the artery of the spine, another symptomatology is noticeable:

Hearing loss;
Twitching of the pupils when moving in the opposite direction;
Objects double in the eyes.

If the defeat happened on the junction with an unpaired blood vessel, then the symptoms manifest themselves in a more severe form:

In case of defeat anterior cerebral artery:

Loss of sensation in the opposite side, usually in the leg area;
Slowness in movement;
Increased tone of the musculoskeletal tissue;
Lack of speech;
The patient cannot stand or walk.

If failures interfere with normal patency of the middle artery of the brain:

The result of a complete blockage of the main trunk is a state of severe coma;
In half of the body there is a loss of sensitivity;
Refuses the motor apparatus;
The inability to fix the gaze on the subject;
Fields of vision fall out;
There is a failure of the speech apparatus;
The patient is unable to distinguish the right limb from the opposite.

In case of violation patency of the posterior cerebral artery the following clinical picture is observed:

Obstruction of the optic geniculate artery accompanied by the following symptoms:

Lack of tactile sensations from the opposite side of the face and body;
If you touch the patient's skin, then he experiences severe pain;
Incorrect perception of light and knock;
Forearms and shoulder joints are bent. The fingers are also bent at the base.

Defeat on the site thalamus are characterized by the following symptoms:

The movements of the patient have a wide scope;
There is a strong tremor;
There is a loss of coordination;
Half of the body loses sensation;
Severe sweating is characteristic;
Bedsores occur.

The most severe case of stroke is the process of breakthrough intracerebral hematoma. Hemorrhage occurs in the cerebrospinal fluid, fills the cerebral stomachs with blood. This disease is called "ventricular tamponade."

This case of stroke is the most severe and in almost all cases ends in death. The explanation for this lies in the unhindered flow of blood into the patient's brain.

Treatment of stroke by ischemic type

The above symptoms may appear unexpectedly in native person. It is very important to provide the first first aid sick.

After calling an ambulance, it is necessary to alleviate the patient's condition using the following methods:

Put the patient on the side so that vomiting freely leaves the victim's oral cavity;
The head should be slightly raised;
If there is a tonometer, then it is necessary to measure blood pressure. If a sharp increase in pressure to critical values \u200b\u200bis noticed, then a drug should be placed under the patient's tongue to reduce it;
Provide the patient with the necessary amount of fresh air;
Release the patient's neck from any squeezing things.

Treatment in a hospital

After arriving at the medical facility, the victim is placed in the ward intensive care. Next, the patient is prescribed a special diet, which focuses on the balance of all the necessary trace elements. Nutrition is adjusted so that fatty, spicy, salty foods are not observed in the diet.

Mayonnaise and other seasonings should also be excluded. Vegetables and fruits are limited only during the acute stage of the disease. If the patient's consciousness is absent, then food intake is carried out through a medical probe no earlier than two days later.

After confirmation of stroke, inpatient treatment continues for a month. The consequences after the transfer of this disease are extremely severe.

Severe loss of strength in muscle tissue on the opposite side of the brain, the area of which was damaged. A certain category of patients practically learns to walk again and perform normal movements;

. The decrease in strength occurs only in the area of the mouth, cheeks and lips. The patient is unable to properly eat and drink fluids;

Quite often there is a disrupted work of the speech apparatus. This is caused by damage to the speech center in the human brain. The patient either completely loses speech, or does not perceive the words of another person;

Movement coordination disorder and is caused by a lesion in the parts of the central nervous system that are responsible for the normal functioning motor system person. In severe cases, disturbances may persist for several months;

Malfunctions of the visual system are of a different nature and depend on the size and localization of the lesion with a stroke. Usually they are expressed in the loss of visual fields;

Sensory disturbance expressed in the loss of pain, sensations of heat and cold.

Rehabilitation

A very important stage on the path of recovery after stroke.

Quality therapy includes the following categories of treatment:

Physiotherapy. It is necessary to return the patient to normal movement of the limbs. A set of exercises is selected by the attending physician;
Visiting a speech pathologist. It is prescribed if the patient has speech and swallowing disorders;
Physiotherapy. The most affordable type of therapy, which is in every clinic;
Therapy with medicines. The main stage in the recovery process. Drugs mitigate complications after the disease and prevent the risk of relapse;
Mind training. It is desirable for the patient to read as much literature as possible, to memorize poems or excerpts from works.

CVA by hemorrhagic type

Components that have a nutritional effect, which include oxygen, enter the brain through the carotid arteries. Being in the box of the skull, they form a network of vessels, which is the root of the blood supply. central system nerves. When arterial tissues are destroyed, the blood flow rushes to the brain.

Causes

A stroke of the hemorrhagic type occurs in the event of a hemorrhage into the brain from a vessel whose integrity has been compromised. As a result, a hematoma occurs in the patient's brain, which is limited to the brain tissue. Also, blood from a burst vessel can penetrate into the area surrounding the brain.

Risk group

Particular attention should be paid to the state of their health of the following category of citizens:

suffering from expansion blood vessels innate character;
Having anomalies in the development of arteries and veins;
Suffering from inflammatory diseases of the walls of blood vessels;
With pathologies of connective tissues of a systemic nature;
Having lesions of blood vessels, accompanied by a violation of protein metabolism;
Abuse of drugs that stimulate the nervous system.

Symptoms

Acute headache;
Constant vomiting;
Frequent loss of consciousness over a long period;
In almost all cases, there is an increase in blood pressure;
Increasing sensations of weakness in the limbs;
A disorder in the functioning of the organs responsible for sensitivity or a complete loss of sensitivity;
Violation of the motor system;
Disorder of the visual system;
Strong nervous excitement;
When analyzed, a small amount of blood is observed in the cerebrospinal fluid;

Treatment of stroke by hemorrhagic type

Drug therapy consists in the use of drugs whose action is aimed at stopping bleeding, reducing the size of cerebral edema, and calming the nervous system. Antibiotics and beta-blockers are used.

Medications can cause stroke recurrence, so it is advisable to eliminate the problem through surgery. First of all, the neurosurgeon removes the lesion, and then eliminates the failure in the vessel.

Reversibility of pathology

During diagnostic studies, whether the symptoms of stroke are reversible is essential. When the stage is reversible, brain cells exist in the paralysis phase, but their integrity and full-fledged work are not disturbed.

If the stage is irreversible, then the brain cells have died and cannot be restored in any way. This area is called the ischemia zone. But therapeutic treatment in this case is possible.

Its meaning is to provide neurons with all the nutrients in the ischemic zone. With proper treatment, cell functions can be partially resuscitated.

It was found that a person does not use all the resources of his body in the course of his life, including not all brain cells are involved. Cells that are not involved in the work can replace the dead cells and ensure their full functioning. The process is rather slow, so full rehabilitation lasts for three years.

Transistor ischemic attack (TIA)

This disease is also a stroke, but unlike ischemic and hemorrhagic stroke, it is temporary. For a certain period of time, there is a sharp violation of blood flow in the large vessels of the brain, as a result of which its cells suffer from a lack of oxygen and nutrients. The symptoms of TIA - transistor ischemic attack last for days and are similar to the symptoms of a stroke.

If more than 24 hours have passed, but the disease has not receded, then most likely a stroke of an ischemic or hemorrhagic type has occurred.

Symptoms

Consider the symptoms of a transistorized ischemic attack:

There is a decrease in sensitivity in one of the sides of the face, body, lower or upper extremities;
Weakness in the body, which is mild or moderate;
Violations in the work of the speech apparatus up to the complete absence of speech or problems with understanding the words of the opponent;
Dizziness and incoordination;
Sudden noise in the ears and head;
Headache and heaviness.

These symptoms appear abruptly and disappear after 3-4 hours. The deadline that distinguishes a transistor ischemic attack from a stroke is no more than a day.

What diseases can cause TIA?

TIA can be caused by the following conditions:

Persistent increase in blood pressure, which is chronic;
Chronic cerebrovascular disease;
Changes in blood clotting;
sudden drop in blood pressure;
The impossibility of the normal flow of blood through the artery, caused by a mechanical obstruction;
Pathology of the structure of cerebral vessels.

Transistor ischemic attack can and should be treated! Despite the fact that its symptoms pass quite quickly, this ailment already signals a malfunction in the body and, in case of relapse, can turn into a stroke!

Risk group

Transistor ischemic attack is no less dangerous than a stroke. Up to 8% of patients who have had a TIA in the future suffer from a stroke that occurred within a month after the attack. In 12% of patients, a stroke occurs within a year and in 29% within the next five years.

Treatment of transistorized ischemic attack

It is carried out in a hospital.

Diagnostic studies include the following procedures:

Visiting a cardiologist, angiologist and ophthalmologist. The patient is assigned a consultation with a medical psychologist;
To conduct a laboratory analysis, the patient must pass a general blood and urine test, as well as blood for a biochemical analysis;
electrocardiography;
Computed tomography of the brain;
X-rays of light;
Regular blood pressure checks.

The victim is allowed to go home only if the recurrence of TIA is excluded or the patient has the opportunity to be immediately hospitalized in case of a recurrent attack.

The treatment of transistorized ischemic attack is to take the following oral medications:

The action of which is aimed at thinning the blood;
Vasodilating agents;
Lowering cholesterol levels in the blood;
Designed to normalize blood pressure.

It is good to combine drug therapy with balneotherapy and physiotherapy.

Prevention

To avoid the occurrence and recurrence of a transistor ischemic attack, a set of preventive measures should be observed:

Go in for sports, having previously drawn up a lesson plan together with your specialist;
Adjust the diet by reducing the amount of fatty, salty and spicy foods;
Reduce the use of alcohol and tobacco products;
Monitor your body weight.

Survey algorithm

It is possible to diagnose stroke by characteristic symptoms, but in order to determine the degree of the course of the disease, what type of stroke it belongs to,

It is necessary to undergo a series of diagnostic studies.

Examination by a specialist immediately after the patient enters the medical facility;

Taking blood for laboratory analysis, in order to assess the state of glucose levels, coagulation, enzymes;

CT scan in this case, allows you to get more complete information about the disease. In the first 24 hours after an ischemic disorder, it is not possible to find out the localization of the affected area.

This problem can be solved by conducting magnetic resonance imaging;

Angiography of cerebral vessels helps to determine with reliable accuracy the area where the lesion occurred or the level of narrowness of the artery. With this study, an aneurysm and a pathological connection between the veins and arteries of the brain can be diagnosed.

But the obtained results do not allow to correctly assess the amount of destruction of the nerve tissue. The solution to this problem is to combine vascular angiography with other diagnostic methods;

Collection of cerebrospinal fluid for laboratory research is a threat to the patient's life, but this study allows you to determine what type of stroke belongs to.

This diagnostic method is used mainly in medical institutions that lack more advanced equipment.

Forecast

A favorable outcome after the disease has a category of citizens who have experienced a small form of stroke. With few restrictions, these patients can normalize their life.

Statistics show that 40% of deaths occur within the first month after illness. 70% show signs of disability in the first month. Over the next 6 months, 40% become disabled. After two years, signs of disability are noticeable in 30% of patients.

Video: ONMK. Signs of a stroke.

Due to frequent fluctuations in blood pressure and various problems associated with the work of the cardiovascular system, including a violation of the structure of the walls of large or small blood vessels, a person can experience an acute ischemic cerebrovascular accident, which is a type of stroke.

This is when a cessation occurs in one of the parts of the brain, a disorder of normal blood circulation, that is, in the area of \u200b\u200bthe pathology, the cells die due to a lack of oxygen. It is impossible to treat them, however, the functions for which they were previously responsible can be revived if more attention is paid daily during the rehabilitation period to the victim of stroke.

Based on this, it is also proved that the number of deaths of stroke victims is constantly increasing every year, as well as the number of people who have received a disability. This may be due not only to concomitant diseases, but also to polluted air, which is especially sinful for cities with a large population. Plus to everything malnutrition and bad habits further exacerbate the condition of many people.

Symptoms of ischemia in stroke

Stroke is one of the diseases that belongs to the type of neuralgia. She never comes alone, but is always accompanied by a number of ailments. Basically, it is important to note that the patient may experience the symptoms of acute ischemic stroke during deep sleep or in the very morning.

Usually, bad feeling begins to gradually increase, thereby increasing the restless state of a person every hour, so, within a day or several days.

At this very time, patients may experience the following ailments:

Cutting pain in the head.
Lethargy in movement.
Decreased sensation in the body, on any side.
The picture before my eyes becomes less clear.

Distortion of speech functions.
There are periods when, after a cerebral ischemic stroke, patients deny the presence of lethargy and low functionality of the arms and legs.

Together with the listed symptoms, the doctor can also identify a syndrome of lowering the pain threshold, unilateral decrease in vision and a severe form of speech disorders.

This includes the distortion of one half of the nasolabial line, the deterioration of reading processes and the functions of swallowing food, and due to poor cerebral circulation, the patient has a violation of the logic of judgment when solving arithmetic problems. Which can sometimes manifest itself as the inability of the victim to adequately assess his condition in the period after the stroke.

What can increase the risk of an acute period?

Ischemic stroke has never been an independent disease, on the basis of which, in a number of situations, stroke by the type of ischemia basically always overtook people at the most unexpected moments as a result of many ailments caused by the following reasons:

Regular pain in the region of the heart.
Disproportionate consumption of sugar, fat and flour products.
A high body mass index is the main reason for the development of diabetes mellitus and blockage of blood vessels.
Ischemic stroke is a common problem among the drinking and smoking population.
As a rule, many young women, fearing their pregnancy, begin to take hormonal drugs on their own, without warning their loved ones about it, including without consulting a doctor.

Hemoglobin in the blood may be high due to insufficient oxygen supply to the brain. In this case, a violation of cerebral circulation can result in a stroke of cerebral ischemia.
The advanced age of a person.
Consequences after head trauma.

Perhaps not all the reasons are listed here, however, even in this case, you should always pay attention to the daily menu, namely, which foods are most often present in the diet, fresh herbs and fruits, or are they sweet rolls with carbonated drinks. This also includes bad habits, when people who choose instead of a healthy active lifestyle can get a lot of problems leading to impaired cerebral circulation.

Necessary restorative actions during stroke

The person himself, who has experienced an acute malaise during an ischemic stroke, cannot determine in advance at what stage he will be able to fully recover. Together with this, he does not have the opportunity to find out what can happen to him in the future after the illness, how he will live on, will remain in a wheelchair for life, or will die during the first day.

Therefore, in order to prevent further deterioration of the patient's condition, doctors immediately during hospitalization begin to reduce the influence of the pathology through drug treatment or, in an extremely acute period of the ischemic type, they can refer the patient to the surgery department.

After the treatment of ischemic stroke in the acute period, when the patient improves, stability in terms of pressure and cholesterol, doctors can proceed to the next stage of the patient's recovery, for example, to the use of physiotherapy procedures. In this case, also, depending on certain consequences, rehabilitation courses of exercise therapy, massage and ergotherapy procedures are prescribed to restore mental and motor activity.

Pathological causes of brain stroke

Violation of blood circulation during an ischemic stroke leads to very serious consequences. When practically in the same proportions, patients can die or completely turn into incapacitated people. But, despite the danger of a brain stroke, 5-7% of the victims fully begin to serve themselves and walk without outside help already during the first rehabilitation stage.

But what the patient will eventually expect after a stroke will depend entirely on a number of the following reasons:

Occlusion in the large arteries of the hemispheres and cervical region, accompanied by obstruction of the blood due to a sharp blockage of the lumen due to the high content of platelets in the blood.
The presence in the patient's body of a focus of the inflammatory process.
The postoperative period on the heart, when, due to the formation of a blood clot, there is an immediate acute violation of blood circulation.
Due to dissection of the main artery.
The formation of a transparent dense mass in internal environment connective tissues of the human body.
Violation of blood clotting, this phenomenon occurs mainly with manifestations of infections of the internal organs of a protracted nature.

It is also important to note that it will contribute to the development of ischemic brain stroke and various types of inflammation of the cervical regions, especially if the carotid arteries were affected in the process, there is such a possibility, but, by the way, it rarely causes a stroke.

That's why great importance should be given to those people who already have a history of osteochondrosis of the upper spine, when there is a possibility that there may be a violation of blood circulation in the area where blood passes from the neck to the brain.

In this connection, in order to improve blood permeability, such people need to constantly massage using an ointment or cream with a warming effect, due to which the blood permeability will be better, by increasing the lumen in the vessels.

Possible consequences after a difficult rehabilitation stage

During the period of a cerebral stroke, patients can get both very serious and quite mild consequences, which after some time can recover and return to their normal environment. If, in the process of recovery, a violation of the blood flow managed to affect larger areas of the medulla, then, most likely, the patient may develop the following ailments as a result:

In certain areas of the body, the patient will have a low threshold of sensitivity.
As a rule, in the post-stroke period, patients cannot fully feel their paralyzed arms and legs.
Violation of the swallowing function, when the patient requires intravenous feeding or by introducing food using a gastric tube.
Patients may not feel the taste of food, as the taste buds on the tongue will also have low sensitivity from the paralyzed part.
Partial or complete loss of hearing and vision after ischemic cerebral stroke.
A frequent sign of poor blood circulation in the brain is a violation of the perception and reproduction of speech.

During the beginning of rehabilitation, the patient can often feel signs of severe dizziness.
The patient's thoughts become less objective and reasonable, so he does not have the opportunity to put together a sentence even from the simplest words.
Violation of the processes of urination and defecation.
Due to low blood circulation during the period of illness, in most cases, coma for a long time.
Patients lack the ability to control their body position in space.

However, if more time is given to the patient from the beginning of the first and subsequent days, and preferably from the first second when he had a stroke, then there will be much more chances for his rehabilitation. Compared with the moment when help was provided to the patient not immediately, but after a few hours.

What basically happens when the patient himself does not pay more attention to own health. But, most importantly, everything will depend on the specific area in which circulatory problems in the brain were recorded, and how quickly further complications were eliminated.

Stroke, regardless of form (except for transient ischemic attack - TIA) and causes, leads to the death of brain cells. Side effects of stroke (acute cerebrovascular accident) can be varied and depend on the location of the vascular accident. So, convulsions after a stroke often occur when the frontal lobe is affected.

It is impossible to avoid the consequences of stroke, but it is possible to create conditions for an early partial or complete recovery

The neurons of the cortex are extremely sensitive to the lack of oxygen, and in fact they are responsible for higher nervous activity. Their death means that a person ceases to exist as a person, even if the vital functions are preserved. Changes in the cerebral cortex can lead to cognitive and mental disorders. Their degree of expression is different. In a severe form, these violations can make a person's life in society extremely difficult.

What happens to brain cells after stroke?

A stroke ends in different ways. Transient attack, for example, passes without a trace. However, stroke, causing tangible side effects, are accompanied by the formation of areas of necrosis.

The functions of dead cells can be taken over by neighboring neurons, but this is not always possible with extensive lesions.

What happens after the formation of a focus of necrosis? Necrotic masses are replaced by connective tissue (sclerosis of a part of the brain occurs). Other outcomes are also possible. So, when melting necrotic masses, a cavity with liquid (cyst) is formed.

Changes in brain tissues after stroke

With a favorable course of the disease, resorption of necrotic tissue occurs with the formation of a scar or cystic cavity.

Sclerosis or cysts are irreversible changes in tissues that have undergone prolonged ischemia. How dangerous is it? A cyst is a favorable outcome of brain tissue necrosis. It may not make itself felt if it does not increase and does not compress significant nerve centers. Persistent blood flow disorders (the cause may be atherosclerosis), the combination of stroke with a disease such as multiple sclerosis, lead to the appearance of additional foci of necrosis. As a result, a new cyst may appear or an old one may increase in size. And this leads to the appearance of neurological symptoms. When a cyst is formed in the projection of the nerve centers of the sense organs, hallucinations are possible.

What to do if the cyst begins to grow and squeeze the surrounding tissue? In this case, you can not do without surgical intervention. The cyst is removed or drained. If it does not cause complaints and does not progress, the operation is not necessary.

Vascular disorders after stroke

Atherosclerosis - common cause ONMK. It should not be forgotten that in the post-stroke period, it continues to have an adverse effect on blood flow in the brain. Atherosclerosis after stroke can cause a second stroke.

Accumulation of cholesterol plaques

Atherosclerotic plaques on the vascular walls impair blood flow, forcing brain cells to suffer from a lack of oxygen. It doesn't always end in a stroke. Prior to the development of a catastrophe, neurons can exist for a long time under conditions of moderate oxygen starvation. A person often complains that he is dizzy. Mild cognitive impairment, weakness, drowsiness, headache are common side effects of compensated lack of blood supply in atherosclerosis.

Atherosclerotic plaque can undergo sclerosis (replacement by connective tissue), which will lead to the development of another vascular pathology - sclerosis. This condition is also accompanied by malnutrition of neurons.

Sclerosis and atherosclerosis of cerebral vessels in early stages hardly noticeable. Weakness, dizziness, decreased attention, headaches - these are the frequent complaints of patients, indicating that the problem with the state of the cerebral vessels after stroke has not been resolved, which means that the risk of a second stroke remains high.

How to protect yourself from a new vascular catastrophe? If you feel dizzy, you should think about whether the neurons receive enough oxygen. A person usually does not pay attention to such symptoms, although preventive measures should be taken already at this stage. Pathological changes can be prevented by antiplatelet agents, neuroprotectors, as well as drugs intended for the treatment of atherosclerosis (statins, lipid-lowering agents).

Stroke and heart disease

Cardiac pathology plays an important role in the development of cerebrovascular accidents.

One of the causes of stroke is atrial fibrillation. It can also lead to a second stroke. The arrhythmia must be eliminated, otherwise the likelihood of the formation of emboli in the cavities of the heart and their movement into the vessels of the brain will continue.

Typical complaints that make it possible to suspect the presence of atrial fibrillation:

The head is spinning.
The pulse is uneven and frequent (arrhythmia).
Heart hurts.
Sweating, fear.

Atrial fibrillation is the result of a violation of the conduction of a nerve impulse through the myocardium. As a result, the fibers of the heart muscle contract unevenly. The expulsion of blood from the atria is not carried out in full, creating conditions for the aggregation of blood cells with the formation of blood clots. Arrhythmia increases the risk of recurrent stroke, so adequate treatment of this condition must be carried out. The appointment of antiarrhythmic drugs can successfully correct atrial fibrillation, preventing the formation of thromboembolism.

Attention! Cardiovascular pathology, which led to the development of stroke, with inadequate treatment can cause a recurrent stroke. Sclerosis and atherosclerosis of vessels, atrial fibrillation must necessarily be treated.

If you feel dizzy, this is a sign of circulatory failure in the vessels of the brain. In this case, measures should be taken to normalize blood flow.

Influence of stroke on higher nervous activity

Cognitive impairment after stroke can reach the degree of dementia

Cognitive disorder is a violation of the ability to perceive, understand, analyze information. In severe cases, it manifests itself in the form of dementia, when the patient's intellect is seriously affected: memory, attention, and the ability to learn are reduced. In terms of severity, cognitive impairment can be:

mild (changes are caused by damage to one part of the brain and do not have a significant effect on everyday life);
moderate (symptoms are noticeable to others and worsen the quality of life of the patient);
severe (changes are characterized by the term dementia and are accompanied by complete maladaptation of the patient).

The latter condition not only adversely affects the intellect, but also destroys the patient's personality. A person ceases to navigate in the world around him, to understand what is happening, to recognize loved ones. There may be mental disorders and hallucinations, behavioral disorders (for example, others notice that the patient has become aggressive). Atherosclerosis of the vessels exacerbates the situation. Neurons, already affected by stroke, lose their ability to recover in conditions of poor blood flow.

What to do? Treatment should be directed at eliminating the cause. For this, drugs are prescribed that improve blood flow in the vessels of the brain, vasodilators, neuroprotectors. You can not do without symptomatic treatment (anticonvulsants, antidepressants).

Visual disorders

CVA may be accompanied by partial or complete loss of vision. In the first case, blind spots (spots) appear, in the second - blindness. Symptoms depend on the location of the lesion.

Human vision in normal and with cataracts

Cataract - clouding of the lens, in different parts of which opaque spots appear, reducing the clarity of vision. Vascular problems (atherosclerosis) that cause stroke can lead to malnutrition of the lens, creating conditions that predispose to cataracts. This, however, is not the main reason. The exact mechanism of cataract formation has not been reliably established.

Clouding of the lens leads to blindness. In the early stages, cataracts can be treated conservatively. This allows you to slow down its progression, but sooner or later the operation becomes inevitable. A radical method of treating cataracts is lens replacement.

Another possible consequence of a stroke is visual hallucinations. Damage to the occipital lobe, the formation of sclerosis or cysts in this area may be accompanied by irritation of the nerve centers of the visual analyzer. The result is hallucinations. They can disappear on their own with treatment that improves blood flow and recovery processes in the brain. With the severity of hallucinations, it is possible to prescribe tranquilizers. It should not be forgotten that stroke can also lead to a mental disorder. Its symptoms are also often hallucinations.

Respiratory damage after stroke

Prolonged bed rest can lead to the development of pneumonia. Other reasons are the ingress of food particles into the respiratory tract, mechanical ventilation (especially long-term).

Pneumonia is a dangerous condition, as it is not always diagnosed in a timely manner and, against the background of a general weakening of the body, is difficult to treat. A patient in a coma cannot complain, so it is not immediately possible to suspect pneumonia in him. However, successful treatment is not able to protect against recurrence. Pneumonia may recur if the risk factors for its development are not eliminated.

The presence of other pathology of the respiratory system also increases the likelihood of the disease. Pneumonia after stroke primarily affects patients who have previously suffered or are currently suffering from lung diseases.

Diagnosis is associated with difficulties due to the severity of the consequences of stroke (speech disorders, depression of consciousness). Therefore, treatment of pneumonia often begins late, which increases the likelihood of complications. It is much better to pay attention to prevention and prevent this condition. What needs to be done for this? Respiratory gymnastics, postural drainage and sanitation of the respiratory tract in patients on mechanical ventilation prevent the development of pneumonia. An effective method of prevention is the early activation of the patient. In this case, the cause for the occurrence of congestive pneumonia is eliminated.

Some other consequences of stroke

Seizures after a stroke are a manifestation of damage to the neurons of the brain. The occurrence of a convulsive syndrome may mean that a site of sclerosis or a cyst has formed in the stroke area. If a person began to complain that he was dizzy, worried about weakness and headache, this is a reason to suspect problems with blood flow. The occurrence of seizures against this background may indicate a recurrent stroke.

Convulsive seizure due to the consequences of a stroke

Hallucinations after a stroke indicate the involvement of the cortical centers of the sense organs in the process. CVA leads to disruption of their activity with the occurrence of disorders of perception of the surrounding reality. Hallucinations after a stroke may also indicate mental disorders, which often occur against the background of insufficient blood supply (atherosclerosis and vascular sclerosis contribute to this).
Behavioral disorders are consequences that usually occur when the right hemisphere is affected. Unmotivated aggression in such patients complicates life not only for them, but also for those around them. If the patient began to complain of hallucinations, began to demonstrate behavioral disorders, care should be taken to involve a psychotherapist or psychiatrist in the treatment process.
Salivation. Usually associated with a violation of the function of swallowing, as well as the inability to completely close the mouth with paralysis of the muscles of the face. Saliva is secreted not because of their increased secretion, but as a result of their excessive accumulation in the oral cavity. Treatment should be aimed at eliminating the cause, but it is also possible to prescribe drugs that reduce salivation.
Spots of reddish color on the body are signs of a disorder of blood flow in these parts of the body in bedridden patients. Bedsores occur with improper care, when the patient is in one position for a long time. This contributes to the compression of soft tissues, as a result, characteristic bluish-red spots first appear, and then areas of necrosis. To avoid this, it is important to know and take preventive measures against bedsores.

Anti-decubitus mattress

Your legs may hurt after a stroke. These sensations are associated with damage to the thalamus, as well as muscle spasms in the paralyzed limb. Legs can also hurt due to peripheral circulatory disorders in vascular pathology (atherosclerosis) associated with stroke. What to do in this situation? With thalamic pain, the appointment of antidepressants and anticonvulsants, as well as drugs that improve blood flow in the vessels of the brain, is effective. If the legs hurt due to muscle spasm, exercise therapy, massage, physiotherapy are of great importance, if necessary, muscle relaxants and analgesics are prescribed.

The consequences of a stroke are varied: sclerosis, brain cyst, dementia, mental disorders, hallucinations, pneumonia, salivation, convulsions. All of them, one way or another, are associated with changes that occur in the brain after the death of neurons and the formation of a focus of necrosis. Therefore, measures aimed at restoring blood flow in the vessels of the brain are important for preventing the occurrence of these disorders.