Brain cerebellar stroke – treatment and consequences

Основными направлениями терапии являются:

  • Стабилизация гемодинамики и дыхания.
  • Дегидратационная терапия (борьба с отеком мозга).
  • Нейропротекция.
  • При ишемическом ОНМК – тромболизис и анитагрегантная терапия, при геморрагическом – применение кровоостанавливающих препаратов и средств с ангиопротективным действием.
  • Симптоматическое лечение.
  • Хирургическое вмешательство. Необходимость в нем возникает при опасности сдавливания жизненно важных центров, а также обструкции путей оттока ликвора. Учитывая анатомическое расположение мозжечка, такая ситуация возникает достаточно часто.

Таким образом, лечение инсульта мозжечка основывается на принципах, общих для всех видов ОНМК. Хотя хирургическое вмешательство применяется чаще (такая необходимость возникает из-за опасности сдавливания центров продолговатого мозга, отвечающих за витальные функции).

В первую очередь больному оказывают экстренную помощь. Что именно делать решают после МРТ. Существует 3 основных схемы лечения:

  • разрушение тромбов;
  • уменьшение густоты крови;
  • устранение кровотечения.

После оказания экстренной помощи назначают основное лечение.

При геморрагическом инсульте врачи назначают препараты, которые увеличивают густоту крови. Также подбирают средства, предназначенные для стимуляции работы нервных окончаний.

При ишемическом инсульте лечение направляется на то, чтобы устранить сгустки крови, образовавшиеся в сосудах, которые питают мозжечок.

Во многих случаях требуется хирургическое вмешательство. При ишемическом поражении:

  • кровяной поток перенаправляют по другому руслу вокруг заблокированного сосуда;
  • удаляют образовавшиеся тромбы;
  • проводят эндартерэктомию артерий;
  • делают ангиопластику или стентирование для расширения просвета артерии.

При геморрагическом поражении показана трепанация черепа, купирование кровотечения, помещение в аневризме заглушки.

При ишемическом поражении назначаются препараты, которые:

  • обеспечивают работу сердечной мышцы;
  • нормализуют давление;
  • поддерживают нормальные показатели качества крови;
  • препятствуют образованию новых тромбов.

При геморрагическом типе заболевания подбирают медикаменты, которые способны:

  • остановить кровотечение;
  • ускорить восстановление нервных клеток;
  • нормализовать показатели артериального давления.

Но даже своевременное проведение всех лечебных мероприятий не гарантирует, что пациент сможет выжить и восстановиться.

Для лечения геморрагического и ишемического инсультов используются различные препараты. Чтобы процесс выздоровления прошел успешно, врач дополнительно может выписать антиоксиданты и нейромодуляторы, которые показывают хорошие результаты как при лечении геморрагического, так и ишемического инсультов.

Для лечения ишемического инсульта используются такие медикаменты:

  • Тромболитики: их задача – разрушить старые тромбы и защитить организм от образования новых тромбов;
  • Препараты для поддержания нормального уровня давления;
  • Препараты для поддержания нормального уровня работы сердечной мышцы.

Для лечения геморрагического инсульта используются такие медикаменты:

  • Препараты, которые могут остановить кровотечение;
  • Нейропротекторы, помогающие восстановить нормальную работу нервных клеток;
  • Препараты для поддержания нормального уровня давления.

We have already talked about how to determine a stroke. After you called the ambulance, provide first aid:

  • help to take a horizontal position, but the head should be raised (about 30 cm higher), you can leave the patient lying on his side (if it is more convenient for him);
  • place a container nearby (useful in case of vomiting, and during an attack turn your head to the side so that the patient does not suffocate from vomit);
  • free body parts from squeezing elements – belts, tie, scarf, unfasten the top buttons of the shirt;
  • provide peace;
  • ventilate the room (or turn on the air conditioner);
  • if possible, it is necessary to measure the pressure (with increased, it is allowed to take drugs that reduce it) and check the pulse;
  • if the heart rhythm is broken and breathing is lost, it is imperative to begin resuscitation (even if the victim is conscious).

If a person is conscious, talk to him, be interested in changes in well-being. This will help doctors a lot.

After an attack, therapy is conducted in several directions at once: restore blood circulation, protect brain cells, strengthen blood vessels and prevent extracranial complications.

A mandatory point in treatment is to normalize blood pressure (lead to a level 10% higher than usual numbers) and heart function. There are several groups of drugs, and the choice of medication depends on the initial condition of the patient:

  • antioxidants;
  • drugs of the nitrate group;
  • means for optimizing tissue metabolism;
  • glycosides.
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After an attack, it is necessary to maintain homeostasis (balance). This implies control of biochemical constants, water-salt and acid-base balance.

Drugs of the neuroprotective group are used at the prehospital stage (by emergency doctors) and are prescribed only by specialists, since depending on the type of stroke, the specifics of the effect of the drugs may differ. With AI, therapy should include restoring blood flow in the damaged area.

Initial treatment is more likely symptomatic, aimed at eliminating the consequences – reducing cerebral edema (if any), prevention and treatment of somatic complications (bedsores, thromboembolism, etc.).

Depending on the cause of the stroke, therapy often involves the use of angioprotectors (drugs to protect blood vessels), anticoagulants (reduce blood coagulation), antiplatelet agents, and vasoactive drugs.

With cerebral infarction, edema often develops, and in this case surgical intervention is necessary.

If surgery for cerebral strokes is rarely necessary (for example, to remove a blood clot, when it is detected or to remove blood clots, to reduce intracranial pressure), then if there is a disturbance in blood circulation in the cerebellum, surgeons cannot do without hands. The main goal of the intervention is to remove excess fluid.

For the purpose of treatment, medications are used, operations are performed. For the subsequent restoration and improvement of the forecast, timely first aid is important.

How to recognize a stroke: characteristic symptoms

If the patient has the first signs of a stroke, immediately call an ambulance. Doctors have only 3,5 hours from the onset of the development of the disease in order to have time to hospitalize the patient, conduct differential diagnosis, and begin treatment. Before the doctors arrive, try to lay the victim so that the body is slightly below head level. Do not give water, food, or any pills.

Medication for cerebellar stroke consists of two main components:

  • basic therapy aimed at stabilizing the patient’s condition, eliminating symptoms, preventing brain edema, regardless of the nature of the stroke. Includes restoration of breathing (cleansing the airways, intubation), the introduction of a number of drugs;
  • specific therapy specific to a particular type, localization of a brain stroke.

The main components of basic therapy.

Type of procedures or drugs / mechanism of action Drug Examples
Antihypertensives / Normalize Pressure Captopril, enalapril
Antiarrhythmic drugs / Eliminate various types of cardiac arrhythmias (arrhythmias) Metoprolol, bisoprolol
Nitrates / Relieve symptoms of angina pectoris Nitroglycerine
Cardiac Glycosides / Helps the heart pump blood Digoxin, digitoxin
Neuroprotectors, antioxidants / Improve brain microcirculation, metabolism, protect neurons from adverse effects Vitamins C, E, glycine, magnesium sulfate, mildronate
Diuretics / Prevention, treatment of cerebral edema Diacarb, mannitol
Opioid Analgesics / Painkillers Morphine

Ischemic stroke involves the additional introduction of drugs:

  • preventing re-thrombosis (aspirin, clopidogrel);
  • dissolving existing blood clots (thrombolytics).

Consequences, complications

It is not necessary to count on the full recovery of a patient who has suffered a cerebellar stroke. But forecasts will depend on the degree of damage to this part of the brain. The probability of developing a fatal outcome approaches 50%. And most people who survived after cerebellar apoplexy remain disabled.

For any stroke, including cerebellar, the most dangerous prognosis is in the first week, for those who survive the month, life expectancy and the chances of recovery increase.

Doctors say that in all patients after a hemorrhagic or ischemic stroke of the cerebellum of the brain, the following effects are observed:

  • pallor is observed;
  • interruptions in the heart rhythm occur;
  • periods of incoherent or lethargic speech appear;
  • sweating increases.

Many people have problems trying to stand on one leg. Some experience difficulties while they are sitting on a chair. Patients have tremor of the extremities and malfunctioning of certain muscle groups.

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Improve the condition allows you to work with a psychologist and speech therapist. But it is difficult to recover if you do not carry out work that will be aimed at minimizing stress, abandoning addictions, and reviewing nutrition.

For a long time, it was believed that the main function of the cerebellum is control, coordination of movements, and ensuring balance. More thorough studies have found that this area of ​​the brain also takes part in the implementation of various cognitive functions: speech, behavior, cognition. Damage to the cerebellum leads to a complex of consequences affecting the motor, cognitive sphere. Clinically, this is manifested:

  • shaky gait;
  • coordination disorders;
  • involuntary twitching of the pupil (nystagmus);
  • speech disorders (mutism, dysarthria);
  • difficulty switching attention;
  • deterioration of working memory;
  • lack / decrease of ability to plan actions.

The most common complications of a stroke are:

  • cerebral edema – excessive accumulation of fluid by neurons;
  • hydrocephalus – excessive accumulation of cerebrospinal fluid in the cavity of the cerebral ventricles.

Both conditions are characterized by rapid deterioration, high mortality.

Development and prevalence

The likelihood of experiencing cerebellar apoplexy increases after 30 years. But most often the elderly suffer.

Cerebellar stroke is diagnosed in 5-10% of cases, in other situations we are talking about other types of cerebrovascular disorders.

As a result of damage to blood vessels, a sufficient amount of oxygen and other nutrients ceases to flow to the tissues. This causes their death. The disease develops when the blood supply to the cerebellum is stopped or when hemorrhage occurs in this area. To provide timely assistance to the patient, you need to know how it manifests itself.

Disaster management in the vertebro-basilar basin

After stroke, characteristic disturbances occur in the vessels of the cerebellum, persisting for a long time and requiring correction. Rehabilitation is needed for patients with impaired gait, coordination of movement, speech and swallowing. These are the most common consequences of cerebellar stroke. Of course, timely treatment increases the likelihood of recovery of the victims after stroke. However, it does not guarantee that all disorders will be completely eliminated. Only viable cells can recover, necrosis is irreversible.

Rehabilitation for imbalances and coordination is based on the implementation of special exercises:

  • To eliminate tremor, fast movements of small amplitude (jerk, click, etc.) are effective. They allow you to withstand the rhythm of trembling and change it.
  • After cerebellar stroke, restoration of coordination of movements is often required. Exercises to combat this violation are based on the fact that only one joint is involved in the action (the rest are “turned off” with the help of a longet).
  • The restoration of equilibrium is achieved by the following methods: the use of additional support; switching off during movements of certain senses (walking with eyes closed or with headphones, etc.); moving sideways, back forward, on an uneven surface.
  • Gymnastics for the eyes helps fight dizziness. It can be used in combination with the above exercises to restore balance.

Speech disturbance after cerebellar stroke requires training with a speech therapist.

One of the consequences of circulatory disorders in the vertebro-basilar basin is a speech disorder that requires training with a speech therapist

However, of all the consequences, the patient is most likely to experience swallowing disorders. Difficulty or inability to swallow food leads to weight loss, dehydration, metabolic disorders. The ingestion of food particles in the respiratory tract (this is possible with a violation of the act of swallowing) can lead to the development of aspiration pneumonia.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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