Prognosis for survivors of ischemic stroke

Ischemic stroke is also called “cerebral infarction.” This definition is fully consistent with the pathogenesis that occurs in the body during insufficient blood supply.

The word “ischemia” itself means a lack of blood supply to an organ or tissue due to a decrease or complete cessation of arterial blood flow to this part of the body.

The word “stroke” means a violation of the blood circulation of the brain, which is often accompanied by loss of consciousness or paralysis. If, simultaneously with this phenomenon, blood vessels burst, a quick death of brain cells occurs.

The process of tissue destruction does not stop even after normal blood flow has been restored. It is for this reason that it is extremely important that a person receives the necessary medical care in a timely manner. After a cerebral infarction, the patient needs rehabilitation. It is an important part of general therapy, preventing possible complications.

Classification of the disease

A variety of symptoms, causes, features of manifestation allows you to make a classification of ischemic stroke.

Taking into account the nature and characteristics of the course of the disease, they speak of several types of stroke:

  • Transient ischemic attack. The lesion is concentrated in a small area. Signs of pathology last no more than a day.
  • Small stroke. Functional recovery within 3 weeks is noted.
  • Progressive. Symptoms increase gradually over several hours or days. Normalization of the state is not complete, residual effects persist.
  • Total. It is characterized by brain damage and a developing deficit of functions.

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Because of

The types of disease are described based on the reasons that led to them:

  • Aterothrombotic shock occurs in a dream. It is characterized by slow development – cholesterol formations gradually reduce the diameter of the cerebral vessels.
  • The lacunar form does not immediately appear. On the first day, signs of this disease cannot be detected. With this disease, a spasm of cerebral arteries occurs, passing through several meninges. It is associated with arterial hypertension, atherosclerosis and embolism. With lacunar syndrome, small capillaries suffer, bringing blood to the tissues located deep in the brain.
  • On the contrary, a cardioembolic stroke suddenly occurs. A broken blood clot blocks blood flow in medium-sized arteries.
  • A sharp decrease in pressure or a decrease in the volume of filling the heart leads to hemodynamic. The shock is not associated with physical activity.
  • Hemorheological develops due to bleeding disorders.

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Ischemic stroke on the right side is called right-sided. The processes of processing sensory information, perception, and fantasy are disrupted. Creativity is narrowing. The patient loses the ability to sympathize, memory worsens. If the patient is left-handed, his speech suffers. It turns out that the left side is paralyzed, the arm and leg do not move, the sensitivity disappears.

By localization

The violation zone allows you to distinguish several types of stroke. The syndrome of the vertebro-basilar section is characterized by atrophy in the region of the trunk, cerebellum, nape.

In case of a disorder developing in the basilar section of the brain stem, the work of the heart and respiratory organs deteriorates. Death occurs most often due to the lesion located in this department.

Coordination suffers in patients, tremor appears when trying to make a targeted movement, vomiting, coma develops. The most common outcome is death; drug therapy rarely helps.

Circulatory disorder in the vertebro-basilar basin is characterized by confusion, nausea, and inability to swallow.

With a stroke of the middle cerebral artery, sensitivity is disturbed, paralysis develops. Patients are distinguished by a stopped look. Often they do not understand their illness.

In some cases, an ischemic crisis causes a violation of the blood supply to the spinal cord. In this case, the patients have paralyzed arms and legs, problems with stool control are observed.

Researchers have identified the extent of the lesion:

  • extensive atherothrombotic – 115 cm3;
  • cardioembolic – 62 cm3;
  • hemodynamic – 32 cm3;
  • lacunar – 2 cm3.

A rheological lesion is characterized by an area of ​​1,5 cm3.

2019 07 22 173613 1 - Prognosis for survivors of ischemic stroke

The formation of an ischemic stroke is caused by a stop in the blood supply to a specific area of ​​the brain. Due to the occurrence, such forms of the syndrome are distinguished:

  • thromboembolic – vascular passages are clogged by blood clots;
  • hemodynamic – due to prolonged spasm of the vessel, an insufficient supply of the brain with nutritional components occurs;
  • lacunar – a small area is affected (up to 15 mm), while the occurrence of neurological manifestations is observed.

Varieties by the nature of the lesion:

  • transient ischemic attack – a small area of ​​the brain is affected, while the symptoms disappear after a day;
  • minor stroke – patients after a lesion recover within 21 days;
  • progressive – clinical symptoms occur gradually, and after recovery, minor neurological disorders are observed;
  • completed (extensive) stroke – the clinical symptoms continue for a long time and after the treatment, serious neurological consequences remain.

According to the area of ​​damage, the syndrome is classified as follows:

  • right-sided ischemic stroke;
  • left-sided;
  • stem;
  • cerebellar.

Usually this pathological condition is detected in people in old age, but sometimes young patients are also found.

Right side

When an ischemic stroke occurs on the right side, areas of the brain that provide motor capabilities of the left side of the body are affected. One of the consequences of this pathology may be complete paralysis of the left side.

Left side

The formation of an ischemic stroke on the left side significantly affects the speech capabilities and perception of words. The consequences affect the psycho-emotional state of a person, his ability to formulate coherent sentences and perceive the speech of others.

The most dangerous variety of this syndrome, since the centers located in the brain stem are responsible for the functionality of the respiratory and heartbeat systems. The predominant number of deaths is observed in people with stem ischemic stroke. During the course of this pathological condition, the patient becomes disoriented in space, and also feels nauseous and dizzy.

Cerebellar

At the initial stage, ischemic stroke of the cerebellum is manifested by impaired coordination, nausea with bouts of vomiting and dizziness. At the end of the day, the cerebellum begins to exert pressure on the brain stem. In patients with this, the facial muscles become numb, and a coma occurs. Often, patients either for a long time fall into a coma, or end up fatal.

Development speed and age

In the process of how an ischemic stroke develops, several stages are distinguished. The first of them, acute, lasts up to 21 days from the start of the stroke. In it, one can distinguish the most acute stage lasting five days, when there is an increase in symptoms. This is the stage at which most people die. The second continues until six months.

The third conditionally begins 6 months after the strike and lasts up to a year. During this period, cysts and glial formations form in the lesion sites.

At the center of pathogenesis is the formation of a section of dead brain tissue around which edema occurs.

For several hours after the impact, the core is surrounded by still living tissue. However, she had already begun to lack nutrition. The cerebral blood flow here is 20 ml/100 g in 1 minute.

This area is called penumbra or ischemic penumbra. In the cells of this area there is a metabolic disorder, due to it it loses its functionality due to a lack of nutrients.

Penumbra fabrics are very sensitive to any pressure disturbance. Incorrect action, elevation, improperly selected therapy for stroke increases the infarction zone. It is this area that becomes the target for urgent treatment. At the same time, edema develops, in severe cases, they cover the whole hemisphere. Metabolism worsens, the blood-brain barrier is destroyed.

Factors that affect the development of the disease are:

  • an artery involved in the process;
  • size of the affected area;
  • the moment of the beginning of resuscitation;
  • accompanying illnesses;
  • psychoemotional state of a person until the onset of the disease.

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Different causes provoke a heart attack of the right and left hemispheres of the brain. In some cases, however, they cannot be determined. This is especially true for patients under 50 years of age. In about 40% of cases, what caused the disease is impossible to establish.

The analysis identifies the correctable and non-correctable causes of ischemic stroke.

This group of reasons can be adjusted and largely depends on the person’s lifestyle, compliance with the doctor’s recommendations, and physical condition.

Most often, atherosclerosis and arterial hypertension leads to an attack.

The risks of vertebro-basilar syndrome with cervical osteochondrosis are increasing. Aggravates the situation of diabetes, smoking, overweight, alcoholism. In women – hormonal contraceptive pills.

In some cases, the disease develops for unclear, unspecified reasons.

This group includes reasons that cannot be adjusted. These are gender, age, heredity, as well as random factors.

So, if at the age of 20 one of three thousand people has a risk of a stroke, then at the age of 84, one in forty-five.

In older people with progressive sclerosis, ischemic stroke develops very slowly. Its symptoms may periodically appear and disappear during the week. Violation of the blood circulation can occur after a brief manifestation of the initial signs, or absolutely suddenly.

In young people, the sudden onset of the disease may be associated with vascular embolism. Symptoms can be expressed during severe physical exertion, during a severe attack of cough, during lung operations under general anesthesia, etc.

Risk factors for stroke include age older than 50 years, the presence of arterial hypertension, atherosclerosis, diabetes mellitus, chronic heart disease, transient ischemic attacks, as well as overweight, smoking, alcohol abuse, occupational hazards, and a genetic predisposition. Stroke is more often recorded in men.

There are two main forms of stroke: ischemic and hemorrhagic. The most commonly reported ischemic stroke (70-85% of patients). With this form of the disease, a blood vessel is blocked, as a result of which it ceases to fulfill its functions and the blood supply to the area that it feeds ceases.

In the hemorrhagic form of the disease, a blood vessel ruptures, as a result of which not only a certain area of ​​the brain ceases to be supplied with blood, but also blood flows into the brain, into the ventricles or under the meninges. This type of acute cerebrovascular accident is more severe, has more serious consequences and more often leads to death.

Depending on the development mechanism, ischemic stroke is divided into cardioembolic (with arrhythmias, endocarditis, heart defects), atherothromboembolic (with atherosclerosis of large-caliber arteries), lacunar (ischemia occurs when a small blood vessel is blocked), and also a stroke of another and unknown etiology.

Ischemic stroke of the left side of the brain is more common than the right – about 57% of the total number of registered cases of the disease account for the stroke of the left hemisphere. With this form of pathology, patients have motor and sensory disturbances in the right side of the body; in addition, speech, reading and writing skills often develop, and the patient’s communication with others may be limited.

Ischemic stroke of the right side of the brain is usually not manifested by speech abnormalities (they can occur in left-handed people). According to a number of studies, with a stroke in the right hemisphere, the diagnosis is often established later in comparison with damage to the left side of the brain, in which speech disorders are usually present.

In order to prevent the development of a stroke, rational nutrition, adequate night sleep, correction of overweight, adequate physical activity, abandonment of bad habits, avoidance of stress, timely treatment of diseases, the complication of which can be an acute violation of cerebral circulation, are recommended.

Development speed and age

The formation of a cerebral infarction provokes various factors. More often, the syndrome is diagnosed in older older smokers after 45 years. In young people, after an attack of ischemic stroke, the causes often remain undetected. The general conditions of the disease include the following:

  • Age – in young people about 20 years old, a similar disease occurs in only 0,03% of patients, and already at the age of 80 years this pathology is diagnosed in 2,22%.
  • Gender – statistics show that women are diagnosed with cerebral infarction more often than men.
  • Stressful situations.
  • Hereditary predisposition.
  • Osteochondrosis in the cervical spine.
  • Obesity.
  • Atherosclerosis – in 70% of cases is the cause of the disruption of the vascular system.
  • Alcohol abuse – when a large amount of alcohol enters the body, vasodilation occurs, followed by such a sharp narrowing of them, which can lead to a heart attack.

When the first signs of the disease occur, the patient should immediately provide first aid and deliver him to the hospital for treatment.

Development of ischemic stroke

The death of brain cells occurs due to blockage of the vessel, which is responsible for the delivery of blood to a specific area of ​​the brain, an embolus or thrombus. A history of pathologies such as arterial hypertension and TIA (transient ischemic attack) doubles the risk of stroke.

Provoking factors can also be:

  • Defects of the heart and blood vessels;
  • Aortic aneurysm;
  • IHD;
  • Elderly age;
  • Hormonal contraception;
  • Unilateral headache (migraine);
  • Bad habits;
  • Diabetes;
  • Increased blood viscosity;
  • The use of trans fats.

If several factors are combined at once, then this is a serious reason to worry about your health, to be extremely careful and to know the slightest signs of pathology.

Narrowing, complete overlap of the lumen of the cerebral arteries provoke a variety of reasons:

  • Atherosclerosis, thrombosis are two pathologies that most often lead to the development of ischemic stroke (about 50% of all cases).
  • Cardiogenic embolism is a blockage of cerebral vessels by thrombus particles formed in the cavity of the left ventricle, atrium of the heart. Thrombosis is caused by cardiac arrhythmias or organ diseases: atrial fibrillation, myocardial infarction, rheumatic heart disease, valve surgery. Cardiogenic embolism is responsible for 20% of brain strokes.
  • The narrowing of the carotid, vertebral arteries that carry blood to the brain. Stenosis can be congenital or acquired (spinal osteochondrosis, deforming spondylosis). A stroke is preceded by a sharp/pronounced drop in pressure.
  • Vascular diseases: Takayasu disease, Moyamoya, inflammation of the arteries of an infectious nature.

Acute ischemic stroke most often develops in people with the following risk factors (2):

  • older, older age (more than 55 years);
  • high blood pressure: the most significant risk factor, greatly increasing the likelihood of developing an attack;
  • diabetes mellitus (increases the chances of developing a heart attack by 4 times);
  • genetic predisposition, cases in immediate family;
  • obesity/overweight;
  • smoking;
  • alcohol abuse;
  • nutritional errors: a diet rich in saturated, trans fats;
  • lack of mobility;
  • addiction;
  • atherosclerosis of the vessels of the neck;
  • high blood cholesterol and/or homocysteine;
  • narrowing of the carotid arteries;
  • atrial fibrillation (15% of all cases of thromboembolic infarction).

The trigger for an ischemic stroke is the cessation of blood flow to one or more parts of the brain. It is a consequence of impaired vascular patency or malfunctions in the general hemodynamics of the body. The previous factors include:

  1. coronary heart disease;
  2. diabetes;
  3. migraines in the temporal, parietal and occipital areas of the head;
  4. heart disease;
  5. hormonal contraception;
  6. excessive consumption of fatty foods,
  7. bad habits;
  8. increased blood viscosity;
  9. heredity.

A combination of two or more factors increases the risk of ischemic stroke.

Signs and clinical symptoms

Everyone needs to know the following signs so that if they are found in a person (even an outsider), they should immediately take measures to quickly provide medical care.

Visible impaired consciousness. A person ceases to understand where he is and what surrounds him. His head starts to hurt a lot. There may also be a visible decrease in the rate of reactions, loss of ability to speak, fainting, coma.

Weakness and cramps

Decreased or complete loss of body sensitivity. A person suddenly ceases to feel pain or touching any part of the body.

Body paralysis, decreased or complete loss of motor function. Often manifested in violation of the mechanisms of the facial muscles: a person can not smile.

Additional symptoms may manifest in different ways, depending on the location of the pathology.

Signs of a stroke in the right cerebral hemisphere:

  • lethargy, inhibited reactions;
  • paralysis of the facial muscles on the left side;
  • numbness of the extremities and paralysis of the body on the left side.

Signs of a left hemisphere stroke:

  • speech impairment;
  • loss of coordination and confusion;
  • violation of the functions of the visual, olfactory and auditory organs.

Pathology has a different beginning, depending on the degree of circulatory dysfunction. The classification is as follows:

  1. Undulating beginning. Symptoms are reminiscent of outbreaks, which become more pronounced and prolonged over time.
  2. A sharp start. Symptoms are pronounced, manifest quickly.
  3. Tumor-like onset. Neurological symptoms increase gradually, and its result is an extensive stroke that affects a large number of brain tissue.

If you suspect a stroke, the patient may be asked to perform some action (for example, close your eyes and stretch your hands in front of you, palms up, raise both hands above your head, say a simple phrase, smile). So, in the presence of a stroke, the patient usually cannot raise his hands to the same height, he has speech defects, the smile is distorted. In this case, you should immediately call an ambulance and hospitalize the patient in a hospital.

If signs of a stroke are detected before the arrival of the ambulance crew, it is recommended that the patient be placed so that his head is raised about 30 ° above body level. It is necessary to ensure the influx of fresh air – open the window, if necessary, loosen tight clothing (collar, belt, bra).

During transportation of a patient with a stroke to a hospital, he is provided with the necessary medical assistance, which consists in normalizing blood pressure, restoring normal breathing, preventing the development of cerebral edema, seizures, etc.

In 80% of cases of pathology, the middle cerebral artery is affected, and the remaining 20% ​​are other vessels of the brain. Clinical symptoms usually occur at lightning speed, but sometimes manifestations can develop slowly with a gradual increase. In many ways, the manifestations depend on the area of ​​the lesion, for example, when a vessel located in the front of the neck is clogged, violations are as follows:

  • blindness in one eye;
  • paralysis of one limb from the side of the lesion;
  • poor perception of the speech of others and difficulties in selecting words in the dialogue.

When the lumen of the vessel is blocked in the back of the neck, other manifestations occur:

  • bifurcation in the eyes;
  • weakness on both sides of the body;
  • loss of coordination;
  • dizziness.

Symptoms and clinical manifestations

There are symptoms that worsen the overall prognosis of ischemic stroke for life:

  • depression of consciousness;
  • lack of ability to move independently (the patient can only open and close the eyelids), lack of speech, while understanding the patient’s situation can be maintained;
  • pronounced cognitive and emotional-volitional disorders;
  • dysphagia (difficulty swallowing);
  • persistent hyperthermia – speaks of the defeat of the center of thermoregulation and exacerbates ischemic damage to brain tissue. A decrease in body temperature by 1 ° C doubles the chances of a favorable outcome;
  • muscle hypertonicity, head tilting in one direction, convulsive twitching or prolonged epileptic seizures, lack of coordination of movements, loss of control over the body;
  • urinary incontinence;
  • persistent paralysis of the gaze, disturbance of eye movements (pendulum-like fluctuations or slow movements of the eyeballs, lack of synchronism of eye movements);
  • violation of hemodynamic parameters (severe heart rhythm disturbances, high blood pressure);
  • gross hemiparesis (weakening of the muscles of one side of the body);
  • somatic diseases in the stage of decompensation, severe infectious and inflammatory diseases;
  • pathological types of breathing: Kussmaul breathing (deep noisy inhalation and enhanced exhalation), Cheyne-Stokes breathing (alternating deep breaths and superficial respiratory movements, Biot breathing (long pauses between breaths);
  • coma – the chances of recovery after four months of cerebral coma caused by ischemic brain damage remain in only 10% of patients.

The cessation of blood supply leads to the death of neurons, as a result of which intercellular connections and brain functions are affected.

Start of development

Often people get confused about how ischemic stroke manifests itself. The fact is that it begins to develop in different ways. In an acute process, the brightness of the symptoms appears in one to two hours. During this time, a person falls into a coma. Usually, paralysis and other serious disorders develop subsequently. However, the symptoms of ischemic stroke of the brain can increase and wave-like.

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Tumor-like onset of the course of ischemic stroke is close in pace and nature of development. However, tissue edema and high blood pressure are considered the trigger of the process.

Many lose consciousness, while some patients develop a coma.

In some cases, convulsions are noted. There are motor, sensory disturbances.

Focal symptoms

Damage to the arteries of the brain is indicated by poor coordination, visual disturbances, dizziness, paralysis, speech impairment, and swallowing.

Damage to the anterior artery causes loss of ability to move, asynchronous movement of the eyes, inability to speak, grasping reflexes amplify.

Violation of the posterior artery leads to a narrowing of the breadth of vision, reducing its severity. The patient still has an understanding of the speech addressed to him, but he himself is lost, does not remember many words.

Extensive blockage of the middle artery causes paralysis, limits the sensitivity of the hands, face, lack of understanding of oral speech, inability to find the right words.

Cerebral symptoms of a stroke are characteristic of brain damage, as well as many diseases that are not related to it. Focal signs of a stroke are typical for the defeat of a specific area of ​​the brain; practically all patients have it; they are very diverse.

Cerebral signsFocal signs
  • stun
  • drowsiness/agitation;
  • short-term loss of consciousness;
  • dizziness;
  • mild or very severe headache (“it’s never been like this before”);
  • nausea, vomiting;
  • pain in the eyeballs, which intensifies with eye movement;
  • cramps (rarely);
  • sweating, feeling hot;
  • increased heart rate;
  • dry mouth.
  • weakness in the arm/leg, up to complete immobility. Paralysis can affect half of the body;
  • decrease/disappearance of pain, tactile sensitivity;
  • speech disorders (slurredness, inconsistency, inappropriateness, slowness);
  • loss/decrease in vision, most often one-sided;
  • unsteadiness of gait;
  • coordination disorders;
  • loss of balance;
  • loss of orientation in time, space.

Signs of a stroke can appear almost simultaneously or gradually: increase/supplement over several hours or days. A typical time for the first complaints to occur is the beginning of dawn, periods of daytime rest.

Prognosis for damage to different parts of the brain

There are a number of factors that influence the prognosis of ischemic stroke of the brain:

  • patient age – the prognosis for ischemic cerebral stroke in the elderly is worse;
  • localization and volume of the focus of necrosis of the brain substance – the larger the area of ​​damage to the brain, the higher the likelihood of damage to vital functions, intellectual and sensitive abilities. The likelihood of a fatal outcome increases if the ischemic focus is located in the area of ​​vital centers of the brain;
  • the causes and initial severity of the stroke – the prognosis is least favorable for ischemic strokes of atherosclerotic origin, accompanied by cerebral thrombosis;
  • the severity of the clinical picture – the probability of recovery can be determined by the severity of neurological disorders. A favorable criterion for the prognosis is the restoration of impaired motor functions in the first month after a stroke;
  • the development of complications and consequences – the causes of death and disability can be swelling of the brain, damage to the trunk or cerebellum, complete or partial paralysis, secondary cerebral ischemia, cardiac complications, depression of consciousness, falling into a coma, damage to the respiratory center, cognitive impairment, hemorrhagic transformation of ischemic heart attack.

big min - Prognosis for survivors of ischemic stroke

Among other things, the prognosis for life with an ischemic stroke depends on the timeliness of admission to the hospital and the beginning of resuscitation, the literacy of specialized medical care, and the early onset of rehabilitation.

Three main types of ischemic strokes are distinguished depending on the pathogenetic features of the manifestations.

  1. Thromboembolic – associated with a blockage of the lumen of the vessel by a thrombus. Thromboembolic stroke, in turn, is atherothrombotic and cardioembolic. With an atherothrombotic stroke of an ischemic type, arterial thrombosis occurs due to an atherosclerotic plaque that has come off. Cardioembolic ischemic stroke occurs when a blood clot formed in the cavities of the heart breaks off, and then with a blood flow brought into the arterial system of the brain. The thromboembolic type of stroke also includes hemodynamic cerebral infarction (another name for ischemic stroke), which occurs more often in elderly patients. This type of cerebrovascular accident develops as a result of a sharp decrease in blood pressure against a background of narrowing of the vessels of the brain and neck of an atherosclerotic nature.
  2. Rheological – caused by a violation of the rheological properties of blood. In this case, blood clots in the blood clots cause clotting disorders.
  3. Lacunar – is formed when small intracranial arteries are affected, it often provokes high blood pressure. The prognosis for lacunar stroke is favorable even for the elderly: as a rule, the restoration of impaired functions occurs, a fatal outcome is observed only in 2% of cases. Sometimes after the disease partial residual effects are observed. However, as a result of frequent relapses of arterial hypertension with damage to small penetrating arteries, the so-called lacunar state of the brain can develop, in which hemorrhages spread and the patient’s general condition worsens.

In ischemic stroke, the most unfavorable prognosis is atherothrombotic, cardioembolic or hemodynamic types of circulatory disorders of the brain. Thromboembolic stroke accounts for up to 75% of all ischemic strokes, and this type is considered one of the main causes of death from cerebral infarction: death during the first month is 20–25%.

With damage to the brain stem, a fatal outcome in 65% of cases occurs in the first two days from the onset of the disease. As a result of timely hospitalization and adequate therapy, the prognosis is somewhat improved. In the first few months after the development of disorders in the area of ​​the brain stem, doctors give a positive forecast for the restoration of impaired motor function, in the future the pace slows down. In some cases, motor function is partially restored within a year from the onset of the disease.

With an ischemic stroke of the cerebellum in the initial period, the likelihood of developing severe swelling of the affected area is high. If during the first day the patient was not provided with medical care, the edema begins to compress the stem structures, which can lead to irreversible damage to the brain stem, acute occlusive hydrocephalus, coma and death.

With a stroke in the occipital zone of the brain, a disorder of motor functions occurs on the side of the body opposite to the affected hemisphere. If the left hemisphere is affected, the person ceases to see what is in the right side of the field of vision, and vice versa. In most cases, after adequate treatment, the prognosis is positive, vision is restored within six months after the onset of the disease. Sometimes a person forever loses the ability to identify rarely observed objects and recognize unfamiliar people.

The prognosis for life after a coma is cautious. Coma develops with extensive damage to brain tissue. An extensive stroke is manifested by severe headaches, loss of vision, speech, facial sensitivity, damage to the thermoregulation center, respiratory center, and severe disorders of the cardiovascular system.

The possibility of successful rehabilitation directly depends on which areas of the brain were affected and what functions were impaired.

Speech function suffers when a stroke affects an area in the lower frontal lobe of the brain, which is called Brock’s center. This zone is responsible for the reproduction of speech, its damage leads to speech disorders, which are observed in 30% of people who have had a stroke. The speech becomes quiet, inarticulate, obscure.

Dysphagia is one of the main signs of stem infarction. Swallowing disorders threaten the development of life-threatening complications: aspiration pneumonia, exhaustion and dehydration. This violation is observed in the majority (up to 65%) of patients. The prognosis is uncertain, constant therapy is needed.

A stroke disrupts the movements of the arms and legs and their control, usually on the side opposite to the lesion. The prognosis is favorable in the first 2-3 months after a stroke, then the dynamics of recovery of motor functions decreases. After 6 months, full or partial restoration of movement is extremely rare.

Early signs of a stroke are dizziness, shaky gait, and poor coordination. Typically, these symptoms disappear during treatment and rehabilitation. The prognosis for the restoration of this function is generally favorable.

Disorder of respiratory function occurs in case of damage to the respiratory center of the brain stem. The patient loses the ability to breathe independently. In the future, such a stroke has an unfavorable prognosis: in most cases, patients become dependent on the artificial respiration apparatus. If the respiratory center of the brain is not completely destroyed, it is possible to restore respiratory function.

When the occipital zone of the head cortex is damaged, vision is impaired. Damage to the oculomotor center, which is located in the brain stem, causes impaired eye movements. The chances of restoration of visual functions with competent therapy are high.

The consequences of ischemic stroke directly depend on the size of the affected area of ​​the brain and the timeliness of care. When help is provided in a timely manner and adequate treatment is prescribed, full or at least partial restoration of functions is possible. Sometimes, despite the prescribed treatment, the symptoms increase, this can lead to serious consequences.

Headache

Headaches are the most common consequence of ischemic stroke, accompanying the patient throughout life.

Speech impairment

Speech disturbance is a common consequence of ischemic stroke. You can recognize the person who has had this disease by talking to him. When the left side of the brain is affected, speech impairment is a typical symptom of a disease.

Speech disorders can occur as:

  • Motor aphasia – is characterized by the fact that the patient clearly understands and perceives the spoken speech, but he is not able to formulate an answer. These patients are difficult to write and read.
  • Sensory aphasia – a person does not perceive spoken words, and his speech resembles incoherent, illegible phrases. Sensory aphasia greatly affects the emotional state of the patient.
  • Amnestic aphasia – the patient’s speech is free, but it is difficult for him to name objects.
  • The larger the affected area, the worse speech will be restored. The language is most actively restored in the first year after the disease, then the recovery process slows down. The patient should engage in special exercises with a speech therapist. Some defects still remain, but the person quickly adapts to them.

Cerebellar

Causes of the disease

  • violation of urination and defecation;
  • epilepsy;
  • cerebral paralysis;
  • thrombosis;
  • infectious complications caused by prolonged rehabilitation;
  • cognitive impairment;
  • disorders of the musculoskeletal system;
  • paralysis of the limbs and the whole body;
  • asymmetry of the face.

The consequences of a cerebral infarction may be different, depending on the location of the pathology. So, among the complications after an ischemic stroke of the right lobe of the brain, there are:

  • impaired concentration of attention;
  • speech impairment;
  • short-term memory loss.

Complications after a stroke of the left hemisphere:

  • pronounced mental deviations;
  • disorientation in time and space;
  • memory loss.

The most common diagnostic methods:

  • An anamnesis of the patient’s medical history in order to identify the origin of cerebral circulatory dysfunction, as well as to determine the rate of development and sequence of symptoms.
  • Consideration of all possible factors that could provoke an attack (cardiovascular disease, diabetes, aneurysms and others).
  • Conducting laboratory and instrumental studies, including coagulograms, biochemical analysis of blood and lipid spectrum.
  • ECG, MRI or CT scan of the brain in order to identify the focus of the disease, determine its location, size and prescription.
  • CT angiography, if necessary, to clarify the location of vessel occlusion.
  1. Recovery of vital functions after a cerebral infarction may be difficult due to complications:
  2. Postponed by extensive hemispheric or stem infarcts, accompanied by paralysis, paresis, impaired motor, swallowing and speech functions;
  3. Severe general hemodynamics of the body in diseases of the cardiovascular system in the stage of decompensation;
  4. The defeat of both vascular pools, the result of which is the limitation of the possibilities of collateral circulation.

Recovery from a stroke can be much easier and faster if:

  • The transferred ischemic stroke was localized in a small separate area;
  • Patient age less than 30 years;
  • The general condition of the heart and blood vessels is satisfactory;
  • During the course of the disease, only one extracranial vessel was affected.

The forecast is more influenced by the following factors:

  • The area and location of the focus of necrosis. If it is located in the area of ​​vital centers of the brain and affects a large number of tissues, the likelihood of an adverse outcome (up to death) is greatly increased.
  • The age of the patient. The older the person, the harder the disease goes and the greater the likelihood of complications.
  • The severity of neurological disorders. The more acute the stroke, the less likely the restoration of body functions.
  • The cause of the disease. For example, in the case when the cause of cerebral infarction is atherosclerosis or separation of a blood clot, the prognosis becomes less favorable.
  • The development of various complications. High mortality is recorded due to damage to the respiratory and cardiovascular centers, cerebral edema, the transition of ischemic stroke to hemorrhagic, etc.

Forecasts are divided into favorable, medium and unfavorable.

  • Favorable prognosis. It is given if, after the transferred pathology, one or more body functions were slightly impaired. As a rule, after high-quality rehabilitation and compliance with all medical recommendations, a crisis period of the disease begins, after which the patient fully returns to normal life.
  • The average forecast. The course of the disease was accompanied by gastrointestinal dysfunction, diabetes mellitus, pneumonia and other pathologies.
  • Unfavorable prognosis. It is given if an extensive area of ​​brain tissue is affected.

The brain stem contains a huge number of nerve bundles, a thermoregulation center, respiratory and vestibular centers. If a brain infarction affected one of the departments that play an important role in life support, then the likelihood of further normalization of its work is very small. That is why with necrotic lesions of the trunk it is often very difficult to make any predictions.

The cerebellum is anatomically located close to the trunk section, it is responsible for the coordination of movements. If this department was affected, a person ceases to feel his body, he loses his balance and orientation in space. With timely assistance, cerebellar function can be restored during the rehabilitation period.

The cerebral cortex is responsible for fixing and transforming information obtained through the optic nerves. When the right hemisphere is damaged, the patient loses the ability to see what is located on the left side of his field of vision and vice versa. A change in this part of the brain affects the perception of visual images in general, including familiar people and household items.

If several parts of the head organ have been affected at once, a cerebral coma may occur. This is the most severe variant of the course of the stroke, which is accompanied by extensive soft tissue necrosis. Coma is often accompanied by a loss of ability to breathe independently (regular shortness of breath) and a complete disruption of the cardiovascular system. The risk of death after a coma is very high, and with a favorable outcome, the chance to restore the previous functions of the body is less than 15%.

If there are suspicions of a violation of the blood supply, a special technique is used to determine ischemic stroke. If a person with an acute violation of cerebral circulation is conscious, his ability to speak, to hold his hands on his weight is checked. A characteristic sign of ischemic stroke is the omission of one of the corners of the mouth.

Angiography is indicated to determine the exact lesion site. An electrocardiogram is made to the patient, pressure is measured.

In order to diagnose ischemic stroke, blood tests are performed – general, for cholesterol, sugar, coagulability.

First, a quick examination of the patient is carried out, allowing the doctor to guess what he is dealing with, what kind of research the patient needs. Be sure to evaluate the quality of breathing, pulse, heart function. The presence of arrhythmia, cardiac murmur is the basis for the suspicion of a cardioembolic stroke; noise in the area of ​​branching of the carotid artery – stenosis; the difference in blood pressure, heart rate on both hands is a narrowing of the aortic arch or subclavian arteries.

IndicatorsHemorrhagicIschemic
AgeMost often average, senior – up to 60 yearsSenior, elderly – over 60 years
Symptom onset timeAfter intense physical exertion, intense emotional excitementDuring rest, after hot water procedures (baths, baths)
Disease onsetSwift, symptoms appear simultaneouslySymptoms appear gradually, the intensity of violations increases. Exception – extensive heart attack
HeadacheVery strongMore moderate
Nausea, vomitingOftenRarely
FaintingAlmost always, longRare, short
Blood pressureHeavily elevatedNormal, low, less often high
Heart tonesnormalDeaf, irregular
PulseHard, often slowWeak

From instrumental studies to the patient, first of all, an ECG, CT scan of the brain is performed. This helps to exclude the two most similar symptoms of the disease – myocardial infarction, hemorrhagic stroke. After their exclusion, they proceed to confirm the ischemic nature of the disorders. The most accurate method for diagnosing them is MRI: it even reveals tiny sections of necrosis that are invisible with other instruments.

Also, the patient is sent to:

  • duplex scanning of vessels of the neck, head;
  • Ultrasound of the heart;
  • biochemical, general blood test;
  • X-ray of the lungs (exclusion of pulmonary embolism);
  • lumbar puncture.

Cerebellar

The main methods for diagnosing ischemic cerebral stroke include the following:

  • collection of anamnesis from patient complaints, and observations of nearby people;
  • identification of other concomitant diseases;
  • blood chemistry;
  • blood pressure measurement;
  • ECG;
  • computed tomography (CT);
  • magnetic resonance imaging (MRI).

Using CT or MRI, the location and size of the lesion, as well as the time of its occurrence, are determined. Sometimes, CT angiography may be prescribed to a patient to accurately determine the area of ​​vessel occlusion.

In the process of diagnosing ischemic stroke, it is necessary to differentiate it from other possible pathologies of the brain, for example, a tumor, an infectious lesion of the membranes, epilepsy or hemorrhage.

Treatment of ischemic stroke and its consequences

Therapy for stroke consists of several stages:

  • pre-hospital – carried out by emergency doctors. Its main goal is to stabilize the patient;
  • Inpatient – takes several weeks. During the patient’s stay in the hospital, in addition to treatment, a comprehensive examination is carried out;
  • rehabilitation – the longest stage aimed at restoring lost functions, adapting to altered environmental conditions.

8aec257fb29f54db2ba8b27377add701 - Prognosis for survivors of ischemic stroke

Smile with a stroke.

  • stick out your tongue – it will be chamfered;
  • raise both hands at the same time – one will be motionless, insufficiently raised or quickly fall;
  • smile – one tip of the mouth will be lowered down;
  • answer any simple question – the answer resembles a drunken speech.

If at least one test is positive, call an ambulance. The prognosis for a stroke largely depends on the time of treatment initiation: the earlier it is started, the better the prognosis. Before the ambulance arrives, patients must:

  • provide complete peace;
  • give a half-sitting position, if there is vomiting – lateral;
  • unfasten the belt, bra, collar, cuffs, take off the tie;
  • if it’s difficult for a person to breathe, follow Safar’s technique: throw the victim’s head back a little, push the lower jaw forward, open his mouth;
  • to reassure, soothe.

Also, you cannot throw the injured one, even for a couple of minutes. Try to note any changes in the state of a person, to fix the time of their occurrence. This information is useful to visiting doctors.

The treatment regimen for all patients with stroke includes two components:

  • Basic therapy – various procedures, drugs that are prescribed before establishing the type, location, area of ​​the apoplexy stroke. Its main goal is to ensure the functioning of vital organs.
  • Specific therapy is a specialized treatment selected based on the subtype of pathology.
!  Vascular angiography indications examination process and procedure features

The main components of the basic treatment of ischemic stroke:

  • Breathing recovery. It is achieved by cleansing the respiratory tract, with severe disorders – intubation.
  • Normalization of the cardiovascular system. Depending on the existing disorders, antiarrhythmic drugs are administered to the patient (eliminate heart rhythm disturbances), nitrates (for angina attacks), cardiac glycosides (help the heart perform pumping function), antioxidants, and drugs that improve tissue metabolism.
  • Intravenous administration of solutions that normalize the water-salt, acid-base balance of the blood.
  • Neuroprotection – the use of drugs that improve the metabolic processes of brain tissue, increasing the resistance of neurons to the effects of adverse factors.
  • Reduction/elimination of cerebral edema. Usually, diuretics are prescribed for this purpose, which help to remove excess fluid from the body.
  • Symptomatic therapy – aimed at eliminating the existing symptoms: the introduction of anticonvulsants, analgesics.

Specific treatment for ischemic stroke may include:

  • Thrombolytic therapy – the introduction of drugs (usually tissue plasminogen activator) that contribute to the dissolution of the thrombus. Restoring blood flow with this method is possible only if no more than 6 hours have passed since the onset of the first symptoms.
  • Anticoagulants, antiplatelet agents (aspirin, clopidogrel) – drugs that prevent the formation of blood clots. This helps prevent a re-stroke.
  • Nootropics (cerebrolysin, piracetam) are drugs that theoretically stimulate the restoration of brain functions. In practice, many researchers doubt the appropriateness of their appointment.
  • Calcium antagonists (nimodipine, cinnarizine, diltiazem) – improve blood supply to damaged areas of the brain.
  • Drugs that improve viscosity, blood fluidity (pentoxifylline) are necessary for the prevention of relapse of the disease. The need for their appointment is controversial.

Surgery for stroke is used when it is necessary to resume passage of the artery in patients who are contraindicated thrombolytic therapy. There are several options for the operation:

  • Carotid endarterectomy – removal of an atherosclerotic plaque, thrombus from the lumen of the carotid artery. This type of intervention is performed if the pathology is caused by stenosis of the vessel.
  • The imposition of extra-intracranial microanastamosis is a complex operation, indicated for narrowing of the middle cerebral artery. So that blood can flow freely into the vessel, the surgeon connects the damaged vessel and the superficial temporal artery above the stenosis with an additional vascular prosthesis.
  • Angioplasty, stenting of arteries is a less traumatic operation, during which the doctor widens the lumen of the vessel with a microscopic balloon, establishes a framework (stent) that prevents repeated narrowing. All manipulations are carried out with miniature instruments that are inserted through a tiny incision in the inguinal vessel.

Folk remedies

The main reason why a stroke takes several times more lives of Russian patients than residents of Europe and the USA is late, inadequate medical care.

Folk remedies after a stroke are used only as an auxiliary treatment after the end of the acute, subacute period. They have the ability to improve cerebral circulation, heart function, normalize blood pressure, and cholesterol (3):

  • Ginseng – helps to restore memory, has a general strengthening effect. To prepare the tincture, pour 30 g of powder from the root of the plant with a liter of vodka. Put in a dark place, shake once/day. After 3-4 weeks, carefully strain the resulting liquid. Take 30 drops 1 time/day 30 minutes before meals.
  • Garlic – normalizes blood pressure, lowers cholesterol, prevents the formation of blood clots, atherosclerotic plaques. Best consumed raw.
  • Turmeric – prevents thrombosis, normalizes blood pressure, lowers cholesterol. This spice can be added to any unsweetened dishes.
  • Blueberries – normalizes cholesterol, blood glucose. In season, it is best to eat fresh berries, and then switch to preparations made from berry extract.
  • Cardiac motherwort – a perennial herb that has been used since ancient times to treat cardiovascular diseases. Animal experiments have shown that motherwort extract helps to reduce the area of ​​damage after a stroke, accelerates the restoration of lost functions, and protects brain cells from the effects of damaging factors. It is recommended to take motherwort in the form of a pharmacy setting according to the instructions.
  • Scutellaria baicalensis contains a large number of biologically active substances: baicalin, baicalein, coumarins, saponins, campesterol, stigmasterol. Beneficial effect on the work of the brain, heart, strengthens the vascular wall, slows the growth of tumors. To prepare the tincture, pour 20 g of the roots with 100 ml of 70% alcohol or vodka. Put in a dark place, shake periodically. After 14 days strain, squeeze out the remains of raw materials. Take 20-30 drops 3 times/day.
  • Ivan tea – has a calming effect, reduces blood pressure, increases the body’s resistance to infections. Fresh young leaves can be used as a basis for salad, and from dry leaves – to brew tea. To prepare a drink, pour a teaspoon of raw materials with a glass of boiling water, let it brew for 5 minutes. Drink 1 cup of tea daily before bedtime.

Before the arrival of the doctors, the patient is laid on a horizontal plane, the head is raised by 30 °, all the squeezing clothes are removed. Make a cold compress on the forehead.

Mustard plasters or a heating pad are placed on hands and feet, if they are paralyzed, rubbed with oil or alcohol solutions. It is important to ensure the flow of fresh air.

The first therapeutic measures with the use of drugs are performed immediately after confirmation of the diagnosis using CT, MRI. With a stroke, thrombolysis is performed. Drugs are introduced whose action is aimed at the resorption of the blood clot.

At this stage, it is important to understand that we are talking about ischemic stroke, not hemorrhagic.

Basic treatment for ischemic cerebral stroke includes:

  • Normalization of blood pressure. It is treated with drugs – diuretics, alpha and beta-blockers.
  • Reducing the risk of blood clots. Anticoagulants, antiplatelet tablets (Cavinton, Vazobral) are used.
  • A decrease in the volume of cerebral edema.
  • Regulation of homeostasis.
  • Prevention of concomitant diseases and complications. A person who has survived a stroke, especially atherothrombotic, has a high probability of pneumonia, thrombosis, and pressure sores.
  • Maintaining body temperature below 37,5 ° C.

Vitamin therapy is indicated. If necessary, with ischemic stroke, thrombolytic therapy is performed. Actiliz, Alteplaza is appointed.

b0b38090a4bca52ef9f90e694608f629 - Prognosis for survivors of ischemic stroke

Medicines prescribed for ischemic stroke of the right hemisphere are no different from the treatment of pathology of the left hemisphere.

As acute acute stroke symptoms disappear, the patient is advised to undergo restorative therapy. It includes exercise therapy, massage, physiotherapy methods. Recommended classes with a psychiatrist, speech therapist. To restore coordination, use a stable platform.

In ischemic stroke, drugs that improve brain function are used. Medications are prescribed that perform a neuroprotective function, for example, Nootropil, Nemotan.

After diagnosis of the disease and confirmation of the diagnosis, the patient is hospitalized in the appropriate department of the hospital. If less than six hours have passed since the onset of the disease, the patient is sent to the intensive care unit. In the case when the patient is in a coma, he is placed in the intensive care unit.

The first 3 hours are important

Complications

In the case of a large brain lesion, complications of ischemic stroke can cause complications from the first days of the course of the disease. Patients may experience severe disorders of motor activity, to the extent that they are not able to independently hold a spoon. Psycho-emotional disorders are also possible when patients cannot fully perceive everything that is happening around.

In the treatment of ischemic syndrome, patients often form pressure sores from the slightest irritation of the skin. If you do not notice the appearance of a small ulcer in a timely manner, then soon it can turn into a large non-healing wound. Therefore, patients must always be on a dry bed, while they regularly need to be turned over and lubricated with camphor alcohol.

One of the most serious complications is the occurrence of congestive pneumonia, which develops due to poor ventilation of the respiratory system during the second half of the first month of the course of the disease. The most severe and common complication is cerebral edema, which often causes a fatal outcome.

In ICD-10, the consequences of ischemic stroke are assigned code 169. If the diagnosis is incorrect and thrombolysis is carried out during an attack, the course of the latter may worsen.

Sensitivity suffers, and its restoration takes longer than normalization of motor activity.

In most patients, consequences such as disorders of the psycho-emotional sphere are noted. Ischemic stroke is characterized by a tendency to depression, emotional lability, and in many cases aggression, fears. Violations in the intellectual sphere with left-sided lesions lead to memory impairment, inability to analyze the situation, childishness, disorientation in space and time. With right-handed fantasy suffers.

Speech disorders are manifested by incoherent speech, repetitions of the same phrases or words. In left-handed people, they are noted in pathology of the right hemisphere.

In approximately 10% of cases, patients develop epilepsy. Often there is a risk of a second hit.

With cerebral ischemia, serious complications from the central nervous system can develop, which often end in death. These complications include:

  • cerebral edema;
  • dislocation and wedging;
  • secondary ischemia, covering the brain stem.

Also, concomitant chronic diseases, which in elderly patients, as a rule, are many, will negatively affect the prognosis. These include:

  • diabetes mellitus of the first or second type;
  • atherosclerosis;
  • cardiac ischemia;
  • a history of myocardial infarction;
  • arterial hypertension;
  • chronic renal and liver failure.

If the patient has these diseases, it is necessary to constantly monitor them and treat them. For example, with high blood pressure, a high risk of developing a second stroke.

The prognosis for patients who have an ischemic stroke depends on many factors. We can fight some of them, but not others. Proper care, timely treatment and rehabilitation give the patient a chance for a full recovery and quality life in the future.

d94c03c6c3029dcd1c7bc51981f7ae0b - Prognosis for survivors of ischemic stroke

However, much more often complete restoration of brain functions does not occur. The degree of disability from a stroke can be very different. Some people can live a full life, having slightly rebuilt the rhythm of life to the existing changes, while others need temporary or round-the-clock help from outsiders.

The problems that arise after an ischemic stroke depend on the location of the necrosis site. For example, if this part of the brain was responsible for coordinating movements or controlling the limb, the patient will not be able to fully/completely use it. With the death of neurons involved in the formation of speech – a person will experience problems with its perception, reproduction. There may also be impaired memory, thought processes, loss of orientation in time and/or space, visual impairment, hearing problems.

Most deaths are associated with complications of stroke, the most deadly of them:

  • cerebral edema (50%);
  • pneumonia;
  • heart disease;
  • pulmonary embolism;
  • kidney failure;
  • sepsis;
  • relapse of the attack.

Less dangerous but common complications include:

  • Pressure ulcers – local disturbance of blood circulation, innervation of soft tissues, which may result in their necrosis. They are typical for bedridden patients. To prevent the development of pressure sores, it is necessary to turn the patient over every few hours, put small pads under the protruding parts of the body.
  • Excretory tract infections are a common complication of stroke that occurs after the installation of a urinary catheter. To reduce the likelihood of infection, it is recommended to change the catheter only if it fails. Men can use an external urinal that resembles a condom in structure.
  • Convulsions are characteristic of extensive heart attacks. They arise due to the formation of a small area of ​​neurons with abnormal electrical activity.
  • Depression after a stroke is a complication that is ignored by many patients. Feeling of grief, loneliness, panic, powerlessness. However, if they do not pass, thoughts become mostly negative – you should consult a doctor. Depression is the same disease as pneumonia or infection. It does not need to be endured, it needs to be treated.
  • Deep vein thrombosis is a dangerous complication that develops in bedridden patients. Due to lack of movement, ideal conditions are created for the formation of blood clots in the large veins of the legs. If one of them comes off, there is a real threat of blockage of the lung vessel and the development of pulmonary embolism.

Rehabilitation of patients after ischemic stroke

  • neurological;
  • neurorehabilitation;
  • spa treatment;
  • outpatient monitoring.

The main objectives of the rehabilitation are:

  • restoration of lost opportunities;
  • psycho-emotional adaptation to the outside world;
  • prevention of possible complications.

The timing of the rehabilitation course depends on the severity of the stroke and the extent of brain damage.

Caring for a bedridden person helps to avoid many serious complications, which in the future can not only slow down recovery, but also lead to death. Without proper care, such a patient may develop such complications:

  1. Urinary infection. A urinary catheter is placed on a bedridden patient, or diapers for adults are put on. In this case, it is necessary to monitor hygiene, otherwise cystitis, or pyelonephritis, may develop.
  2. Pressure sores. They appear due to prolonged lying in one position. They form in places where the bones are closest to the skin, for example, on the tailbone and shoulder blades. In order to prevent them, it is necessary to change the patient’s position in the bed, knead these places, treat them with antiseptics, put special circles under them.
  3. Congestive pneumonia. This is a very common occurrence for bedridden patients. If they can, they need to be asked to inflate balloons to fully include the lungs in the work, and straighten them. You can also carry out other types of breathing exercises.

Rehabilitation measures are no less important for the health of a sick person. With their help, you can prevent such complications:

  1. Joint contractures. With a long absence of movements, the joints grow together, and it becomes impossible to restore the amplitude of movements in them. It is necessary to carry out passive flexion and extension of the joints, which the patient can not move. It is also necessary to tell the patient that he needs to move the active limbs on his own.
  2. Increased muscle tone. With paresis and strokes, the muscles are in hypertonicity. You can deal with it with the help of massages and special passive gymnastics.

Foto 2 8 - Prognosis for survivors of ischemic stroke

Active rehabilitation measures begin immediately after the end of the acute period. A rehabilitation scheme after a stroke is compiled individually for each patient, taking into account the state of health and existing disorders. The first recovery procedures are carried out in a hospital. One month after a stroke, most patients are transferred to the early rehabilitation unit. The course of treatment usually takes one month. The further direction depends on the severity of the consequences:

  • if there are pronounced motor, speech, cognitive problems – a rehabilitation center or a sanatorium;
  • there are no expressed violations – a neurological or cardiovascular sanatorium;
  • in the presence of contraindications for active rehabilitation, severe neurological disorders that are not resolved, they are transferred to home treatment.

Rehabilitation after a stroke is a long process, the minimum recovery time:

  • 6 months – motor functions;
  • 1 year – household skills, ability to work;
  • 2-3 years – speech functions.

The main methods of rehabilitation.

Type of violationPossible Solution
Motor function
  • kinesiotherapy;
  • walking training;
  • self-service skills training in the home;
  • neuro-muscle electrical stimulation;
  • elimination of spasticity: administration of drugs that relax muscles (muscle relaxants), massage, thermal procedures (paraffin, ozokerite), physiotherapy (electrophoresis, diadynamic therapy), acupuncture;
  • the use of mobility aids: canes, walkers, wheelchairs.
Speech Functions
  • specialized classes with a speech therapist-aphasiologist;
  • neuroprotectors (piracetam, cerebrolysin).
Cognitive functions (memory, thinking)
  • specialized classes with a specialist or independently;
  • neuroprotectors (piracetam, cerebrolysin).
Post-stroke pain syndrome
  • antidepressants (amitriptyline);
  • carbamazepine.
Psychological problems
  • psychotherapy;
  • taking antidepressants.

The recovery process after a disease is long enough. It includes a complex of various activities, the purpose of which is to return the patient to a familiar life. To achieve a positive result can be assigned:

  • mandatory diet and a certain diet;
  • drugs aimed at restoring vascular function;
  • Exercise therapy;
  • massage;
  • radiation therapy;
  • physiotherapy.

To restore the patient’s speech, first of all, specialists in the field of neurological diseases help, and then speech therapists. The duration of rehabilitation and the methods used depend on the severity of the disease and the individual characteristics of the patient.

Causes of stroke, the main forms of the disease and prevention

Preventive measures are aimed at preventing re-stroke and the development of complications. Patients are prescribed treatment for arterial hypertension, and they are examined in case of complaints of pain in the heart muscle. It is important to maintain a proper diet and give up bad habits, such as smoking and alcohol abuse.

You can prevent a stroke using simple rules:

  • reduce salt intake, increase potassium intake. Many minerals contain dried apricots, grapes, nuts, sunflower seeds, bananas, buckwheat, broccoli;
  • DASH diet. The basic principles are an increase in the consumption of vegetables, fruits, low-fat dairy products, and unsaturated fats. Limitation of saturated lipids (red meat, cream, fat cottage cheese, cheese, lard);
  • increase physical activity: at least 150 minutes/week of moderate intensity exercise or 75 minutes/week of intense aerobic exercise;
  • normalize weight;
  • stop smoking, including passive;
  • limit or exclude alcohol;
  • maintain blood pressure by taking medications, lifestyle changes at a level of less than 140 mm RT. Art. for systolic, 90 mmHg. Art. for diastolic pressure;
  • take aspirin (with a 10-year risk of stroke 6-10%);
  • regularly undergo an ECG for all patients over 65;
  • to control diseases that can cause a brain attack: atrial fibrillation, diabetes mellitus, congenital, acquired pathologies of the cardiovascular system;
  • lower cholesterol to healthy levels;
  • preventive operations with significant narrowing of large vessels.

In order to prevent the occurrence of pathology, you need to monitor your health and take into account the following rules:

  1. Monitor the state of blood pressure (especially to those people whose close relatives suffer from its differences) and prevent critical deviations from the norm.
  2. Do not hesitate to consult a doctor if there are unpleasant sensations from the cardiovascular system, regularly undergo medical examinations.
  3. Do not abuse fatty foods.
  4. Follow the basics of proper nutrition – this will help to keep cholesterol under control (to prevent the accumulation of plaques on the walls of blood vessels).
  5. Do not drink alcohol.
  6. Periodically take tincture of anise lofant.
  7. Do not smoke.
  8. Get enough sleep regularly (sleep should last at least 8 hours).
  9. Do not use uncontrolled drugs with a high content of hormones.

It is important to remember that a stroke can happen to everyone, especially in old age. Therefore, even minimal prevention can significantly reduce the risk of developing the disease.

Researchers are confident that the occurrence of ischemic cerebral infarction can be prevented. They have identified a number of preventive measures that can reduce the risk of the disease:

  • Treat hypertension. Normal pressure is 130/80. When rising to 140/90 and above, it is necessary to take medications to reduce it.
  • Follow medical advice in the presence of heart pathologies, drink prescribed medications.
  • Take measures to prevent diabetes, take prescribed medications. It is recommended to follow a diet, do not consume sugar, control glucose.
  • With a tendency to thrombosis, conduct thrombolysis. If blood clots are detected, a carotid endarterectomy is indicated.
  • Keep track of cholesterol. It increases the risk of plaque development in the coronary and carotid arteries. With instability of the lipid formation, a carotid endarterectomy is also performed.
  • Periodically do computed tomography.
  • Forget bad habits. Tobacco smoke increases the likelihood of atherosclerosis and thrombosis. The use of alcohol-containing drinks provokes an increase in blood pressure, the development of cardiac pathologies.
  • Do not use oral contraceptives. Researchers note that the likelihood of developing ischemic stroke increases if a woman takes hormonal drugs. The use of any drug should be agreed with the doctor.
  • Exercise regularly. Exercise, exercise, jogging every day is an excellent way to prevent ischemic stroke and other diseases.

Ignoring preventive measures leads to the appearance of repeated strokes.

Survival statistics

Brain infarction takes the third place in mortality in the world (after heart diseases and malignant tumors). According to research, in the first weeks of the disease 12-25% of patients die. The main cause of death is cerebral edema. In second and third place are pneumonia, obstruction of the pulmonary artery, followed by blood poisoning, respiratory tract dysfunction and renal failure.

About 40% of deaths occurring in the first three days are associated with extensive necrosis of brain tissue. Among patients who survived the disease, about 70% become disabled with disabilities due to neurological disorders. Over time, these disorders fade away, so that six months after rehabilitation, disorders remain in 40% of patients, and a year later – in 25%.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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