Treatment of ischemic stroke brain
Acute circulatory disorders in the brain is one of the most common pathological conditions in the neurological and General medical practice. Accompanied by high mortality in acute period of the disease, and after the stabilization process (here, play an important role complications of a stroke). Strokes also lead to the loss of certain body functions, which causes development disability.
According to statistics, each year nearly 15 million new cases of cerebral infarction, and 70% of them falls on
Cerebral infarction is polietiologic and pathogenetically heterogeneous clinical syndrome. That is, of pathological processes that can lead to such consequences, there are several. It
First aid for a heart attack brain tissue
The pre-hospital phase of care for stroke include emergency measures until the arrival of medical staff who are witnesses or relatives of the patient medical and hospital assistance until the arrival of man to the neurological hospital or intensive care unit. Let us consider, what can help others, rather than ambulance workers.
Event first aid:
- the first step is to call the emergency assistance;
- the patient should be gently placed on something solid (in case there is a need for resuscitation), the head should be slightly elevated to prevent swelling of the brain tissue;
- if a person has a vomiting, the head should turn to side to prevent aspiration of vomit into the respiratory tract and asphyxia;
- you need to set one free from tight clothing and components thereof, for example, you can undo the strap and collar for easy access of air into the body;
- need to the arrival of the ambulance to measure the level
After admission of patient in the hospital begins the main stage of therapy, and at the same time accurate diagnosis of type of stroke, its subtypes and localization, diagnosed comorbidities. All therapy at the hospital stage is divided into basic treatment (which is not dependant on the type of stroke and is used in all patients, without exception) and differential (which applies to a specific kind of stroke,
Differentiated therapy of ischemic stroke
The basis of the specific therapy of ischemic stroke is the elimination of the causes that called it. As is often the cause of infarction of brain tissue, is thrombosis of the cerebral arteries, the basis for differentiated therapy is the use of thrombolytic, anticoagulant andantiplatelet therapy. Also, this group of therapeutic interventions can be attributed to neuroprotection, which has its own characteristics for different types of strokes.
Thrombolysis can restore blood circulation in the ischemic focus by dissolution of the thrombus formed inside the vessel and led to the development of stroke. This treatment is also called reperfusion therapy. Distinguish between systemic thrombolysis, when specific drugs are administered intravenously into the systemic circulation, and the sighting when the drugs are fed through a catheter directly to the clogged vessel. But in the case of brain vessels to make it technically difficult, because ischemic stroke is used mainly systemic thrombolysis.
To lysis (dissolution of the thrombus or embolus) used such drugs:
- the metaliz;
- reteplase, etc.
The conduct of reperfusion therapy may be in the range of 3 to 6 hours from the onset of stroke. In this time interval is still possible to dissolve the clot, which will greatly reduce the lesions.
It must be remembered that to revive dead neurons will not happen, but you can save nerve cells that are in the area of ischemic penumbra, if you carry out thrombolysis in the period of “therapeutic window”.
Conduct tromboliticescoy therapy after 6 hours is not only inappropriate, but dangerous. This increases the risk of such terrible complications as hemorrhagic transformation of the ischemic stroke lesion. All drugs are applied in clearly defined doses and according to the strict scheme, which depends on the location of stroke, its causes and magnitude of the lesion in the brain.
Video about the conducting of selective thrombolysis in stroke:
Surgical treatment of ischemic stroke
Surgical treatment for ischemic strokes is assigned rarely. It mainly used when there is a blockage or narrowing of the carotid arteries. There are several types of neurosurgery and vascular surgery at a heart attack of the brain:
- Carotid endarterectomy is a surgery, which involves surgical removal of the inner part of the carotid artery, which affected the atherosclerotic plaque and narrows its lumen.
- Stenting vessels of the head and neck is a surgical treatment that is that the place of constriction, a catheter with an inflatable balloon at the end. The balloon is a stent is a mesh structure, which is installed in the narrowed vessel after inflation of the balloon).
- Selective thrombolysis or sighting toorefers to the category of surgical treatment of ischemic stroke, the essence lies in the fact that the site of the lesion using a special catheter inserted through a large artery of the body, is supplied thrombolitic and the clot dissolves.
- Decompressive craniotomy is a palliative surgical procedure that is performed when failure of conservative therapy. Directed this operation to reduce intracranial pressure with cerebral edema, to save a man's life.
Treatment of complications of cerebral infarction
Almost 60% of deaths after ischemic stroke death associated themselves with a cerebral infarction and with complications, which can be divided into two groups:
Neurologic complications include swelling of the brain tissue. The forecast deteriorates significantly with the development of edema. Usually, this complication occurs in the time interval from 24 to 48 hours after development of cerebral infarction, reaches its maximum in 3 to 5 days from the onset and gradually decreases (if the person was alive) 7-8 days after onset of stroke.
There is a direct relationship between the magnitude of the lesion in the brain and the degree of edema. In patients with extensive stroke occurs often fatal swelling with wedging of the stem in the foramen Magnum and death.
Prevention of edema:
- head end of the bed raised at 20-30 cm above;
- patient make sure and dress so that nothing was sitting in the jugular vein and blood from the brain flowing without obstacles;
- normalization of temperature;
- pain relief;
- normalization of blood pressure.
Treatment of cerebral edema starts with administration of osmotic diuretics (mannitol, lasix, glycerol). Also used for this purpose, dexametason, thiopental, hyperventilation. If these measures are not effective, resort to cerebral hypothermia or surgical treatment (decompressive craniotomy).
Among systemic complications during the acute phase of stroke is dominated by:
- infections of the genitourinary system;
- thrombosis and thrombophlebitis of deep veins of lower extremities;
- thromboembolic complications, particularly pulmonary embolism.
Timely treatment and adequate prevention of these complications greatly improves prognosis and the survival rate at a heart attack of the brain. In most cases this can be achieved by high-quality rehabilitation. It is important from the first days of the disease to perform passive exercises, breathing exercises, massage, all the necessary hygiene procedures.