Ischemic stroke: causes, symptoms, principles of treatment
In recent years, the number of such diseases as ischemic stroke, have increased significantly. It is associated primarily with the peculiarities of the modern lifestyle and increase in cardiovascular morbidity, because this is the root cause of stroke. Ischemic stroke has a very important medical and socio-economic importance. It is a heavy pathology, the mortality of which comes to 20% of all cases, approximately 50-60% after stroke remain severe incapacitating consequences and only a few manage to survive cerebral infarction without residual effects.
As you know, there are two types of stroke – hemorrhagic (bleeding in brain tissue), and ischemic (cerebral infarction). If 20 years ago their number was about the same, today's statistics show that cases of ischemic stroke four times more than hemorrhagic.
What is an ischemic stroke of the brain?
Ischemic stroke is an acute violation of blood circulation in the brain, which leads to the cessation of krovoobrascheniya a certain area of brain tissue with a violation of its functions and the subsequent softening or necrosis (cerebral infarction).
The brain is the organ that consumes more oxygen in the body. To provide all the needs of brain tissue the energy, the intensity of the flow is approximately 55 milliliters per hundred grams of brain tissue per minute is the first place in the body. If the intensity of the flow due to any reasons, one of which is ischemic stroke, delivers below the threshold level (less than 15 ml), then develops acute
Causes of ischemic stroke
The immediate cause of ischemic stroke is the overlap of the lumen of the blood vessel by a clot, atherosclerotic plaque, embolus or prolonged spasm of the artery or compression of the outside. Diseases and pathological conditions that can cause this to happen very much. Consider the most common.
is the most common cause of ischemic stroke of the brain. This pathology leads to an increased risk of stroke in a direct way (contributes to the hyalinosis of vessels and narrowing of their lumen, disruption of the autoregulation of cerebral blood flow, leading to prolonged spasm of the arteries). Also has mediated mechanisms contributes to the development and progression of atherosclerosis, cardiovascular morbidity.
Atherosclerosis is the second largest causes of cerebral infarction. Atherosclerotic plaques often affect precerebral (carotid and vertebral artery), medium and large brain in the places of branching. In addition to the direct narrowing of the vessel lumen and plaque,there may come a rupture with the formation on the ulcerated surface of the thrombus and complete overlap of the lumen of the artery (thrombotic stroke) or part of atherothrombotic weight can come off and be moved in the distal blood stream of the brain with the development of embolic stroke.
Thrombosis of the cerebral vessels, if it is a chronic process, has a more favorable outcome than embolism. Thrombosis and narrowing of the lumen of the vessel plaque is a long process, during which the body adapts through the development of a collateral network of blood vessels to bypass the blockage. Thus, even a complete overlap of the lumen of one or more vessels with well-developed collaterals may not lead to the development of stroke. Abelia also occurs suddenly. The body has no time to adapt, which is almost always accompanied by clinical symptoms. The percentage of infarction of the brain due to hypertension and atherosclerosis is 50.
Cardiogenic embolism is the cause of ischemic stroke and transient ischemic attacks in 20% of cases. Any heart disease that proceeds with violation of intracardiac hemodynamics (abnormal blood flow) can cause the formation of intracardiac blood clot that the blood can throw in any part of the body, becoming an embolus, including in the brain, causing ischemic stroke. This conclusion was the state recognized atrial fibrillation and prosthetic heart valves. Such patients in the prevention of blood clots shown lifelong therapy with medications that thin the blood.
Diseases that cause damage to small blood vessels of the brainin the first place is diabetes mellitus and hypertension cause
Classification of ischemic stroke according to ICD-10
Cerebral infarction is in category “diseases of the circulatory, cerebrovascular diseases” under the following codes:
- I 63 – cerebral infarction;
- I 63.0 – caused by thrombosis of extracranial arteries;
- I 63.00 – caused by thrombosis of extracranial arteries hypertension;
- I 63.1 – induced embolism extracranial arteries;
- I 63.10 – induced embolism extracranial arteries hypertension;
- I 63.3 – induced embolism of cerebral arteries;
- I 63.30 – induced embolism of cerebral arteries c hypertension;
- I 63.9 – cerebral infarction unspecified;
- I 63.90 – cerebral infarction unspecified hypertension.
Signs of ischemic stroke
The clinical picture of ischemic stroke depends on the location of occlusion and size of the lesion. As a rule, cerebral infarction develops over several minutes, if due toembolism, or for several hours or even days, if the cause of the thrombosis.
In any case, the symptoms can be divided into two groups – General cerebral and focal neurological. Feature of ischemic stroke can be considered that the focal symptoms prevail over the brain, which in some cases may not be. In contrast, in hemorrhagic stroke, cerebral symptoms come to the fore.
Cerebral symptoms in ischemic stroke may include:
- mild impairment of consciousness (stupor), coma can be observed only in the case of extensive stroke, cerebral edema or infarction of the barrel;
- meningeal syndrome – resistant
Diagnosis of ischemic stroke
The experienced doctor can diagnose ischemic stroke, only leaving the data of objective inspection of patient, anamnesis of disease and presence of risk factors, such as atrial fibrillation. But there are diseases that show similar clinical picture, for example, brain tumors, infectious lesions of the brain tissue, traumatic brain injury. Because confirming the diagnosis required additional tests, which will also help to accurately distinguish cerebral infarction from haemorrhage, which is important for building therapeutic programs. In the diagnosis of used computer and magnetic resonance tomography. When CT and MRI in the pictures in ischemic stroke find the area of the reduced density of the brain tissue.
Also carry out the whole complex of laboratory and instrumental investigations to establish the cause of stroke, to develop secondary prevention re-infarction of the brain.
Implications and prognosis of ischemic stroke in the brain
The outcome after an ischemic stroke is determined by several important factors:
- the size and diameter of the arteries, which disrupted blood flow, the length of the defect;
- the presence of a collateral network of blood vessels and structure Velisava circulation of the brain (closed or open);
- the rate of development of blockage of an artery;
- localization of injury (what area of the brain is damaged);
- rheological properties of blood;
- the degree of brain edema;
- time from start of symptoms until the beginning of the specific specialized treatment.
In the first month after a stroke, if death did not come at once, dying up to 25% of the victims. The main cause of mortality is cerebral edema and wedging of the brain stem in the occipital hole, hospital pneumonia, sepsis, pulmonary embolism, myocardial infarction.
Survivors 60% during the first six months have a pronounced residual effects andneurological deficit. With good rehabilitation by the end of this period there are traces of brain infarction in 40% of the victims. Generally, if functions are not resumed to the first year after stroke, further recovery is unlikely.
Note a pattern: the deeper the neurological deficit by the end of the first month of the disease, the less chance for recovery.
Recurrent ischemic strokes occur in about 35% of patients during the first 5 years after the initial event. Poor prognostic factors include advanced age, atrial fibrillation, cardiac failure congestive nature, myocardial infarction, impaired blood rheology, high level of atherogenic cholesterol.
First aid in ischemic stroke
If it just so happens, and you witness the stroke, you need to know about how to help the person until the ambulance arrived. The first thing to do is call a specialized trauma team to the er. Then proceed to the next events:
- lay the patient horizontally with the head elevated (to prevent swelling of the brain) end preferably on a hard surface, because it may be necessary to carry out closed heart massage;
- if the victim is vomiting, turn his head to one side to avoid aspiration into the respiratory tract;
- free the man from tight clothing, belt, collar, and provide access of fresh air;
- if possible – measure
Principles of treatment of ischemic stroke brain
Therapeutic measures cerebral infarction include two groups: specific, which apply only in ischemic lesion, and reference that can be used with any kind of stroke.
The main goal of therapy is to maintain vital body functions at an adequate level, prevention of complications of stroke (cerebral edema, bedsores, stasis pneumonia, pulmonary embolism), as well as concomitant treatment of somatic pathology, for example, heart failure.
Patients in a coma, and those who have signs of respiratory distress, perform oxygen therapy or a ventilator. If concomitant cardiovascular diseases (CHD, hypertension) appropriate treatment in conjunction with a cardiologist.
In the treatment and prevention of cerebral edema use of osmotic diuretics (mannitol), glycerol, dexason, restrict fluid to 1000 ml per day. If all these measures are ineffective, used surgical procedure of craniotomy with the goal of decompressing and saving the patient's life.
Also, symptomatic treatment is prescribed whenfever, vomiting, disorders of water and electrolyte balance, establish adequate nutrition of the patient. For the prevention of pneumonia prescribe a course of antibiotics to prevent thrombosis – anticoagulants and bandaging of the lower extremities, therapeutic gymnastics.
This group treatment includes the use of thrombolytics, anticoagulants of antiplatelet agents, neuroprotective means of vasoactive substances. In some cases, surgical treatment is indicated.
Thrombolysis is effective in the period of the therapeutic window (the first 3-6 hours of onset of stroke). Drugs-thrombolytics (actilyse, metaliz, tenecteplase, plasminogen, etc.) have the ability to dissolve a thrombus or an embolus which has caused the blockage, thus greatly reduce the area of ischemic damage. You can spend as systemic thrombolysis (administered intravenously and drip) and regional (thrombolytics are injected directly into the affected area using catheterization of the artery).
To prevent further thrombotic used antiplatelet agents (aspirin, clopidogrel) and anticoagulants (heparin and low molecular weight heparins – fraxiparin, enoxaparin, etc.). Among the widely used neuroprotectors Cerebrolysin, Vinpocetine and piracetam.
Video about recovering after a stroke:
In the treatment of stroke is rehabilitation and reconstruction, which should begin immediately and not stop for years after a stroke, and further recovery should go smoothly in secondary prevention.