Stroke in women and men - types, causes, signs, symptoms and consequences of stroke

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Stroke in women and men - types, causes, signs, symptoms and consequences of stroke
Stroke in women and men - types, causes, signs, symptoms and consequences of stroke
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Causes, types, signs and consequences of a stroke

stroke
stroke

Strokes are characterized by a variety of causes that cause the disease. It has been proven that the etiology of stroke in women and men in some cases differs. The causes of stroke in women mainly lie in the plane of the pathophysiology of the fertile period and menopause, in men they are more often due to occupational risks and bad habits. Differences in the pathogenesis and consequences of stroke in gender groups are associated with the same features.

What is a stroke?

A stroke is an acute cerebrovascular accident (ACA) resulting from one of two causes:

  • Narrowing or blockage of blood vessels in the brain - ischemic stroke;
  • Hemorrhages in the brain or in its membranes - hemorrhagic stroke.

Strokes occur in people in a wide age range: from 20-25 years to old age.

Strokes in young and middle-aged people

Ischemic stroke - has common etiological factors for women and men, (arterial hypertension and atherosclerosis).

Gender predisposing factors for ischemic stroke:

  • Women have rheumatism of the heart in combination with cardiogenic cerebral embolism (blockage of the middle cerebral artery by a fatty or air embolus formed in the left side of the heart);
  • In men - traumatic occlusion of the vessels of the neck (trauma and subsequent blockage of the carotid artery located in the muscles of the neck).

Hemorrhagic stroke - has common etiological factors for women and men (arterial aneurysms, arterial hypertension, arteriovenous aneurysms).

Gender predisposed factors for hemorrhagic stroke:

  • Women have hypertension;
  • In men - arterial aneurysm, post-traumatic dissection of the arteries, subarachnoid hemorrhage.

Young women during gestation (carrying a fetus) develop hemorrhagic stroke eight to nine times more often than men of the same age.

Features of the clinical course and consequences of strokes in young people vary greatly. In ischemic stroke, the disease often occurs in the presence of clear consciousness and develops against a background of moderate neurological deficit. Severe forms of stroke in women develop according to the type of cardiogenic cerebral embolism, in men according to the type of atherosclerosis and thrombosis of the main arteries.

Strokes in the elderly

At the age of 65 to 79 years, strokes are more common in men, and after 80 years, in women.

Main causes of stroke in the elderly:

  • Men have arterial hypertension, elevated blood cholesterol levels;
  • Women - atrial fibrillation, carotid artery stenosis, coronary heart disease, cardiovascular failure.

Features of the clinical course and consequences of strokes in the elderly do not depend much on gender. The disease usually occurs against the background of a pronounced neurological deficit with a high level of disability. This is due to the difficult state of he alth before a stroke: chronic diseases, age-related changes in brain structures. Patients over 65 years of age have a threefold increased risk of recurrent stroke compared with those who had a stroke at a young age.

How long do people live after a stroke?

How many years do you live after a stroke?
How many years do you live after a stroke?

There is no single answer to this question. Death can occur immediately after a stroke. However, a long, relatively full life for decades is also possible.

Meanwhile, it has been established that mortality after strokes is:

  • During the first month - 35%;
  • During the first year - about 50%.

Prognosis of stroke outcome depends on many factors, including:

  • Age of the patient;
  • He alth conditions before stroke;
  • Quality of life before and after stroke;
  • Compliance with the regime of the rehabilitation period;
  • Complete elimination of causes of stroke;
  • Presence of concomitant chronic diseases;
  • Presence of stressors.

Main risk factors for stroke (the ''death quintet''):

  1. Hypertension;
  2. Hypercholesterolemia;
  3. Diabetes;
  4. Smoking
  5. Hypertrophy of the left ventricle of the heart.

The combination of 2-3 of these factors significantly increases the risk of an adverse outcome of the disease.

Stroke mortality statistics

Every year, 5 to 6 million strokes are diagnosed in the world, up to 450 thousand in Russia. For this reason, 29% of men and 39% of women die. 3.2 people per 10,000 become disabled. During the first month, up to 35% die, and by the end of the year - up to 50%. Recurrent strokes are dangerous. In the first year, relapse develops in 5-25%, within three years - in 20-30%, within five years - in 30-40% of those who have been ill. The highest risk of stroke in people over 65 years of age, the incidence in this age segment is up to 90% of all cases. At the same age, the highest number of deaths. Up to 80% of strokes develop as ischemic brain pathologies with a mortality rate of up to 37%. The remaining 20% of patients with hemorrhagic stroke have a mortality rate of up to 82%.

The reason for the high mortality from stroke in Russia is the rapid aging of the population, late delivery to a medical institution, poor educational work and insufficient stroke prevention measures. Recent statistics show that 39.5% of people at risk of stroke do not think about its danger.

Stroke rarely occurs without previous symptoms - the initial manifestations of insufficiency of the blood supply to the brain (NPNKM) in the form of transient attacks or hypertensive crises in individuals at risk. The risk group for NPCM includes people with hypertension, heart rhythm disturbances, chronic stress, a history of chronic diseases, smoking, a tendency to aggregation of blood cells, and overweight.

Causes of stroke

Causes of a stroke
Causes of a stroke

The causes of stroke include ischemia (impaired blood supply), embolism (blockage of blood vessels by an embolus), thrombosis, atheroma (degenerative change in the walls of blood vessels) and intracerebral hemorrhage. Thrombosis is the process of formation of blood clots. If a clot occurs in a blood vessel that feeds the brain, it leads to swelling of the brain tissue.

Thrombosis often develops in the morning or at night after surgery or a heart attack. It is thrombosis that causes most strokes that occur in older people. Most often, thrombosis occurs in people who are overweight, in those who abuse smoking, and in women who are protected by oral hormonal contraceptives. At the moment, thrombosis can also develop in very young people who take cocaine.

When a hemorrhage occurs, the artery of the brain ruptures. This type of stroke can happen at any age. Hemorrhage occurs with high blood pressure. This type of stroke can occur with hardening of the arteries, arrhythmias, diabetes, low or sudden high blood pressure, sedentary lifestyle, smoking, use of oral contraceptives.

When an embolism occurs, a clot of fatty substances (an embolus) forms in a blood vessel. Getting stuck in the vessels, the embolus blocks the blood flow. This type of stroke can occur after heart surgery or an arrhythmia.

Stroke symptoms

Signs of the disease, identified by doctors on the basis of general clinical, instrumental and laboratory studies of the patient in order to make a diagnosis, are called symptoms. The first symptoms of a stroke are determined by a doctor or paramedic on scales (GCS / FAST). Based on many years of research, the most common symptoms of stroke have been identified, which are divided into two conditional groups.

  • Cerebral symptoms characteristic of many pathologies associated with brain damage are dizziness, lightheadedness, stupor or agitation.
  • Focal symptoms - sudden paresis, paralysis, loss of vision or change in the position of the pupil, uncertain speech, impaired coordination of movement, rigidity (abnormal tension) of the muscles of the neck.

First symptoms of a stroke

A patient with a suspected stroke is admitted to the neurological department or intensive care unit. Hope for a favorable outcome (maximum rehabilitation of the patient) is possible during the first three to six hours from the onset of a stroke to the start of intensive care or resuscitation. The first symptoms that reliably indicate a certain type of stroke:

  • Hemorrhagic stroke - hemorrhage (hemorrhage) in the tissues of the brain;
  • Ischemic stroke is an area of infarction (necrosis) in brain tissues.

These signs are detected using CT, MRI, EEG. link

Symptoms of cerebral or focal lesions of the brain, obtained by publicly available methods, are not always the result of a stroke. Work on the classification of vascular lesions of the brain began in 1971 by E. N. Schmidt, in the final version proposed by him in 1985.

Signs of stroke in women and men

Signs of a stroke in women and men
Signs of a stroke in women and men

Signs of a stroke are a subjective (personal) feeling of a person or an objective (obvious) description of the disease by an outside observer, which serves as a reason for the patient to seek help from a medical institution.

Signs of a stroke should be known to all people, regardless of medical education. These symptoms are primarily associated with a violation of the innervation of the muscles of the head and body, so if you suspect a stroke, ask the person to perform three simple actions: smile, raise their hands, say any word or sentence.

If a person has a stroke, this simple test will show the following results:

  • The smile looks unnatural, the corners of the lips are located on a different line, which is associated with a limitation or complete impossibility of facial muscle contraction;
  • Raising hands looks like an asymmetrical action, the hand on the affected side has no power, that is, spontaneously lowers, the handshake is weak;
  • Pronunciation of words or phrases due to paresis or paralysis of facial muscles is difficult.

There are other similar tests. Unfortunately, the detection of signs of a stroke means a statement (confirmation) of the onset of irreversible consequences in the brain. The sooner qualified assistance is provided to the patient, the greater the chance of eliminating the consequences of a stroke.

Signs of some types of stroke (ischemic) appear before the development of changes in brain tissues. Such signs are called the initial manifestations of insufficiency of blood supply to the brain (NPNKM), they consist in transient (passing) ischemic attacks or hypertensive crises. Their timely detection is recommended to prevent the development of clinical forms of stroke.

NNKM is easy to determine at home using the questionnaire L. S. Manvelov. One positive answer (+) is equal to one point. To confirm the diagnosis, you must answer at least twice (+) questions about the presence of the following sensations at least once a week or constantly during the last three months:

  • Headache without a clear localization, not due to hypertension, often associated with overwork and weather changes: (+) or (-);
  • Dizziness that increases with a change in body position in space: (+) or (-);
  • Head noise permanent or transient: (+) or (-);
  • Memory disturbance that extends to current events, logical memory is generally not affected: (+) or (-);
  • Disturbance of sleep and/or performance: (+) or (-).

If the examined person scored two or more points, this means that he has prerequisites for the imminent development of a stroke. You should contact your local physician to get a referral to a neurologist for laboratory and instrumental examinations and treatment.

A stroke does not always have signs visible to strangers. Sometimes they are only apparent based on personal experience when performing habitual activities, such as those that are female-only or male-only.

First aid at the first sign of a stroke

First aid at the first signs of a stroke
First aid at the first signs of a stroke

After identifying signs of a stroke, you must do the following:

  1. Call an ambulance, the call is free:

    • call from landline 03;
    • call from mobile phone 112 or 03.
  2. The patient should take a horizontal position on the bed, the head is slightly higher than the body:

    • if you have dentures, eye lenses, glasses - remove;
    • if the patient is unconscious, help him open his mouth slightly, tilt his head slightly to one side, monitor his breathing.
  3. Before the ambulance arrives:

    • write down the names, dosage and frequency of medications taken by the patient;
    • write down the names of medicines intolerable to patients (if any);
    • prepare a passport, he alth insurance policy, outpatient card if the patient has one.
  4. Tell the emergency doctor known information about the patient.
  5. If possible, accompany the patient to the emergency room of the hospital.

Aid to a patient in a hospital is provided in accordance with the standards of medical care for patients with stroke, approved by Order of the Ministry of He alth and Social Development of the Russian Federation of 2007-01-08 N 513.

Temperature during stroke

A number of scientific publications show the negative impact of high temperature on the outcome of stroke. At the same time, the use of low temperature (hypothermia and normothermia) in the neuroprotection of brain cells during the treatment of cerebrovascular accidents has been reported.

The pathogenesis of strokes is largely determined by the state of the patient's thermoregulation. One of the causes of a patient's coma during a stroke is a violation of thermoregulation.

Hyperthermia is diagnosed in 40-70% of patients with hemorrhagic stroke and 18-60% with ischemic stroke.

  • The leading cause of hyperthermia in stroke is purulent-inflammatory processes in the body that developed as complications of pneumonia, urinary tract infections, bedsores.
  • The second cause of hyperthermia is supratentorial brain tumors. An increase in temperature with them does not depend on purulent processes in the body.

The method of hypothermia to preserve brain structures damaged as a result of a stroke was widely used until the 70-80s of the last century. The promising method was abandoned due to numerous complications. Currently, with the discovery of new tools and methods in biology and medicine, the use of hypothermia in stroke is again widely discussed with the aim of neuroprotection of neurons from the cascade of pathological reactions in the brain during stroke in the first stage.

Classification and types of stroke:

Types of ischemic stroke
Types of ischemic stroke

Ischemic stroke

Ischemic stroke (IS) – is the most common form of stroke. According to various sources, up to 80% of all strokes are ischemic. AI has another name - cerebral infarction, that is, a focus of necrosis formed on the periphery of the site of blood flow delay. Necrosis in IS is the result of metabolic disorders in brain cells with blood stagnation in the area of the nervous tissue.

Causes of stagnation of blood in the blood vessels of neuronal and glial tissues of the brain:

  • Stenosis (narrowing) or occlusion (blockage) of large arterial vessels of the brain;
  • Thrombosis - blockage of an arterial vessel by a thrombus (thrombus - a clot of blood cells);
  • Embolism - blockage of an arterial vessel by an embolus (an embolus is a clot of fat cells that are not normally present in the bloodstream).

Hemorrhagic stroke

Hemorrhagic stroke (HI) is the most dangerous form of stroke. According to various sources, the lethal outcome of GI is up to 82% of cases. GI is the result of a rupture of a blood vessel and the formation of a blood clot in this place and then a site of necrosis. The more severe pathogenesis of HI compared to IS is explained by the development of a focus of hemorrhagic stroke and layering of ischemia.

The development of hemorrhagic stroke at the first stage occurs in the following sequence:

  1. Hematoma causes direct mechanical compression of brain tissues,
  2. The ischemic zone is being formed in this area;
  3. Hematoma and ischemia around it trigger a cascade of pathogenetic processes.

The volume of hematoma in GI is several times less than extensive ischemia around the focus of hemorrhagic stroke.

Major stroke

Massive stroke is a generalized name for massive strokes. According to the classification of acute cerebral ischemia (E. I. Gusev, 1962), OI corresponds to a severe stroke with pronounced cerebral symptoms:

  • Depression of consciousness;
  • Edema of the brain;
  • Hemiparesis or hemiplegia on the opposite side of the lesion;
  • Paresis of gaze towards paralyzed limbs;
  • Disorder of consciousness in the form of hemispheric damage (aphasia - speech disorder, geminopsia - loss of half of the field of vision, anosognosia - lack of understanding by patients of their condition);
  • Vegetative disorders - disorders of the nervous regulation of the internal organs and systems of the body.
  • Trophic disorders - nerve conduction disorders that manifest as skin ulcers.

Massive strokes are complicated by secondary-type stem syndrome in the form of impaired consciousness and oculomotor disorders:

  • Anisocoria - changes in the size of the pupil, it is enlarged on the side of the affected hemisphere;
  • Ophthalmoplegia - weakening or lack of pupillary response to light;
  • Squint and strobism (pendulum movements of the eyeballs);
  • Hormetonia - generalized disorders in the form of muscle spasm of tonic muscles;
  • Decerebrate rigidity - increased tone of the extensor muscles,

In terms of localization, extensive strokes correspond to lesions in the basins of large precerebral and cerebral main arteries (classification by E. V. Schmidt, 1985 and ICD-10).

Comparison of major stroke rates in men or women was not found. Major strokes are a common cause of death or long-term (lifelong) disability.

Lacunar stroke (LI)

Lacunar stroke
Lacunar stroke

Lacunar stroke is a type of ischemic cerebral infarction. LI is characterized by a limited lesion of one of the small perforating arteries. Perforating arteries are small vessels ranging in size from fractions to 2 mm, with a length of up to 10 cm, connecting the larger deep and superficial arteries. The name "lacunar stroke" was obtained in connection with the formation of round-shaped cavities (lacunae) (less than 1.5 cm in diameter) filled with liquid contents - cerebrospinal fluid at the site of the infarction.

The incidence (occurrence) of lacunar stroke averages 20% of all ischemic strokes. They are not characterized by cerebral and meningeal symptoms.

Lacunar stroke is identified by focal symptoms:

  • Atactic hemiparesis - impaired coordination of half of the body;
  • Dysarthria - a violation of the clear pronunciation of words;
  • Monoparesis is a violation of the motor activity of one arm or leg.

Of the group of patients diagnosed with lacunar stroke, women account for approximately 54%, men - 46%. Average age of patients diagnosed with LI: 48 to 73 years.

The most common cause of lacunar stroke is atherosclerosis associated with arterial hypertension. The embolic nature of LI has also been proven; in this case, the disease is more severe for patients due to the involvement of a larger area of the brain in the pathogenesis after blockage of the vessel by an embolus. The prognosis of lacunar stroke depends on the location of the lesion and the time of initiation of treatment.

Spinal Stroke

Spinal stroke – is an acute circulatory disorder in the spinal cord. The causes of spinal stroke can be ischemic or hemorrhagic stroke of the brain. The usual location of a spinal stroke is in the large arteries of the cervical and lumbar thickening or small branches of the reticulo-medullary arteries.

SI is more common in older people. Differences in the pathogenesis of spinal strokes in men and women have not been identified.

There are no exact data on the prevalence of spinal strokes. This is probably due to the difficulty of differential diagnosis. More accurate diagnosis has become possible with the widespread introduction of CT, MRI and selective spinal angiography.

Some sources indicate the following harbingers of a spinal stroke:

  • Radicular syndrome - pains of different localization (neck, arms, legs, lower back);
  • Chronic cerebrovascular insufficiency (CVS);
  • Recurrent severe headaches;
  • Noise and heaviness in the head;
  • Short-term dizziness;
  • Fatigue and sleep disturbance;
  • Memory deterioration;
  • Myelogenous intermittent claudication syndrome - a feeling of numbness in the legs when walking for a long time with a rapid disappearance after rest, there is no pain in the legs.

The clinical picture of SI is varied, it depends on the location of the stroke focus in the spinal column.

Ten spinal ischemic syndromes:

  • Ventral half of the spinal cord or obstruction of the anterior spinal artery or Transfiguration syndrome;
  • Anterior Poliomyelopathy;
  • Brown-Sekara;
  • Centromedullary stenosis;
  • The marginal zone of the anterior and lateral cords;
  • Amyotrophic Lateral Sclerosis;
  • Dorsal part of the diameter of the spinal cord (Williamson's syndrome);
  • The diameter of the spinal cord;
  • Cervical artery occlusion;
  • Turn off the artery of the lumbar enlargement.

Diagnosis and differential diagnosis of SI is carried out using instrumental methods.

Acute stroke

Acute stroke
Acute stroke

This is the initial period of stroke development. It lasts an average of twenty-one days, sometimes less. During this period, there is an increase in pathogenetic processes in the brain tissues, especially intensively during the first six hours of the disease.

The following stages of OI are distinguished:

  • Formation of a nucleus from damaged brain cells - 5-8 minutes;
  • Increased penumbra (areas of metabolic changes around the core of the brain infarction):
  • by 50% within 1 hour 30 minutes;
  • up to 80% within 6 hours.

Six hours is the ''therapeutic window'', when therapeutic interventions can be carried out with maximum effect. From the first minutes, a pathogenetic cascade is activated, which at the cellular level begins with the cessation of blood flow and ends with apoptosis (death) of the brain cell. In the absence of treatment, cell apoptosis expands exponentially. On days 3-5, damaged brain cells undergo necrosis, and partial localization of the process occurs.

Next, the formation and / or increase of neurological disorders in the form of cerebral and focal symptoms.

Intensive care during the ''therapeutic window'' includes:

  1. Improvement of the hemodynamics of brain tissues due to the drip of physiological solutions;
  2. Neuroprotection (protection) of brain cells.
  3. Improvement of rheological (viscosity) and coagulation (clotting) properties of blood;
  4. Improve blood microcirculation.
  5. Prevention of cerebral edema.

Microstroke

It is also called a small stroke (MI). The name is given because of the relatively rapid (2-21 days) disappearance of symptoms of neurological deficit.

Neurological deficit syndrome is accompanied by two to three or more of the following:

  • Uncertain gait;
  • Muscle hypertonicity;
  • Mono or hemiparesis;
  • Paralysis of the eye or head;
  • Aphasia/anosmia;
  • Seizures/epilepsy;
  • Unreasonable fun/rage.

With a microstroke, foci of cell necrosis are formed and persist in the brain. The symptoms of MI are similar to transient ischemic attacks (TIAs).

The fundamental difference between a microstroke and transient ischemic attacks is that with TIA:

  • Symptoms of a neurological deficit;
  • CT/MTR does not detect necrosis (ischemia) in the brain.

The development of a small stroke is observed in the age group from 25 to 45 years. No sex correlation established.

The causes of MI are a combination of several of the following factors:

  • Hypertension;
  • Regular use of oral contraceptives and other drugs that increase blood viscosity;
  • Venous thrombosis;
  • Systemic blood diseases;
  • Migraine;
  • Drugs, alcohol;
  • Head and neck injuries.

Microstroke is a risk factor for the development of one of the types of completed stroke. Frequently repeated MI is the reason for the decline in intelligence and dementia.

Repeated stroke

Repeated stroke
Repeated stroke

The main cause of recurrent strokes is previous cerebrovascular disease (CVD). It should be considered that CVD is strokes and TIA. During the first year, people with major strokes may develop:

  • Repeated strokes;
  • Dement disorders (acquired decrease in intelligence to varying degrees);
  • Fatal.

Influencing risk factors is a real chance of preventing recurrent strokes. Prevention must be consistent and continuous.

The standard algorithm for influencing risk factors in secondary stroke has the designation - A-B-C therapy (A - antihypertensive, B - blockers, C - statins). For the prevention of recurrent strokes apply:

  • Antihypertensive drugs (Micardis, Agrenox);
  • Clot blockers (aspirin, warfarin, agrenox, clopidogrel);
  • Statins to counteract the formation of cholesterol. Drugs from the statin group are used to block the enzyme (HGM-CoA) involved in the production of cholesterol. For this purpose, lovastatin, fluvastatin, atorvastatin, rosuvastatin and others are prescribed.

Risk factors for stroke

Smoking
Smoking
  • Smoking and drinking alcohol are among the main risk factors for stroke, especially in older people. Smoking and alcohol together increase the risk of developing cardiovascular disease many times over, in addition, drinking alcohol contributes to weight gain.
  • Taking certain medications without a doctor's prescription puts you at risk of developing heart and blood disorders, which can lead to stroke. The likelihood of developing a stroke is significantly increased with the use of oral contraceptives containing estrogens. This risk is increased when oral contraceptives are used by women who smoke and have high blood pressure.
  • It is necessary to monitor the level of cholesterol in the blood, as its high content is one of the risk factors for stroke. Incorrect (supersaturated fat) and irregular nutrition leads to an increase in cholesterol levels.
  • Many times increases the risk of stroke arterial hypertension, especially in combination with all of the above factors. Pregnant women suffering from arterial hypertension and women taking oral contraceptives should be more careful.
  • One of the reasons for the development of cardiovascular diseases is physical inactivity (sedentary lifestyle). It is necessary to do exercises daily, jogging and walking in the fresh air. The implementation of these recommendations has a beneficial effect on the content of sugar in the blood and helps to lower blood pressure. The risk of stroke in people with high weight is huge, even in the absence of other risk factors. Heavy weight contributes to the development of high blood pressure, diabetes and creates an increased load on the heart muscle.
  • The risk of stroke increases in people with diabetes. A huge percentage of people with diabetes die from the consequences of a stroke.
  • The mental state of a person plays a huge role in the occurrence of a stroke. Stress, anxiety, nervous stress increase the risk of developing the disease, especially for people who have already had a stroke.

Consequences of a stroke

Consequences of a stroke
Consequences of a stroke

Excluding deaths, some patients return to normal or partially limited work activity. With a slow recovery of body functions and the impossibility of returning to work within 3-3.5 months, the patient is sent for a medical and social examination (MSE). The medical commission (MC) decides whether to continue treatment on a sick leave or whether it is necessary to determine the III or II disability group. When considering the grounds for disability, the VC takes into account the persistence and duration of the consequences of a stroke:

  • Pyramidal defects (motor disorders - paresis, paralysis);
  • Extrapyramidal motor (speech disorder, slow movements of the acting side of the body, inability to self-service);
  • Extrapyramidal hyperkinesis (decrease in motor functions, inability to maintain a certain posture);
  • Atactic violations;
  • Disorders of visual functions in the form of partial or complete loss of vision;
  • Brain dysfunction in the form of aphasia;
  • Epileptic seizures;
  • Inhibition of mental functions (dementia);
  • Complications from the cardiovascular system (peripheral edema, weakness).

Swelling of the legs after a stroke

Edema refers to the long-term consequences of a stroke, caused by the insufficiency of the cardiovascular system of the body. Edema is characterized by:

  • Slow development and persistence for hours;
  • Located on limbs, spreading from bottom to top and symmetrical;
  • Dense consistency, when pressed, a hole remains.

From the available means of preventing swelling of the legs, it is allowed to use diuretic drugs of plant origin (canephron, cystone), medicinal herbs or fees that have a diuretic effect. Carefully apply ointments and liquids as rubbing, skin injury may occur.

Edema of the brain in stroke

Cerebral edema in stroke
Cerebral edema in stroke

This complication can develop at any stage of a stroke, more often during the first hours of pathogenesis. Cerebral edema is an increase in intracranial pressure due to pathological swelling of the glial tissue of the brain. Cerebral edema in stroke is a consequence of cerebrovascular accident caused by blockage of a large vessel of the brain and its pool and effusion of the liquid part of the blood outside the vascular bed.

Prevention of cerebral edema is an essential part of the treatment of the initial period of a stroke, regardless of the presence of symptoms.

Events are carried out by a specialized team authorized to treat critically ill patients.

The team performs the following actions.

  • Maintains stable hemodynamics;
  • Selectively controls blood pressure (only with hypertension and / or with the simultaneous development of pulmonary edema, some other conditions), clonidine, captopril, atenolol, labetalol, benzohexonium and others are indicated, blood pressure cannot be reduced by more than 15% of the original level;
  • Prevents swelling of the brain and lungs, artificial ventilation and drug therapy are indicated;
  • Reduces psychomotor agitation syndrome and / or convulsive syndrome, benzodiazepine drugs are indicated, non-narcotic dose of sodium oxybutyrate;
  • Temperature above 37.5°C, it is advisable to reduce, paracetamol and physical methods are shown;
  • Controls blood glucose levels. In hyperglycemia, short-acting insulin is indicated. Intravenous administration of glucose is contraindicated. Not recommended: dibazol, nifedipine, eufillin, vinpocetine, nicergoline, papaverine, furosemide and mannitol without monitoring blood osmolarity.

Paralysis after stroke

Motor activity disorders of varying degrees of regression are frequent companions of strokes.

Usually, disorders manifest as paresis (partial loss of movement) and paralysis (complete loss of motor activity).

When strokes are observed:

  • Monoplegia - paralysis of one limb (arm or leg);
  • Hemiplegia - paralysis of the arms and legs of one side of the body;
  • Paraplegia - paralysis of two arms or legs.

Peripheral paralysis is characterized by a complete lack of motor activity in the affected area of the body.

Central paralysis is characterized by synkinesis - friendly movement. In synkinesis, the paralyzed arm or leg does not act independently, but when the he althy arm or leg is raised, the paralyzed limb performs a similar movement.

Simultaneously with paralysis, speech disorders occur in the form of aphasia or difficulty in pronouncing words, as well as misunderstanding of one's own speech errors.

Coma after stroke

Coma after stroke
Coma after stroke

Coma after stroke – Depression of the central nervous system as a result of secondary cerebrovascular accidents, or apoplectiform coma. It develops against the background of stroke and an increase in body temperature, as a result of necrotic processes in the brain and purulent pathologies (complications in the form of bedsores and others).

Coma is characterized by stages, begins with precoma - confusion.

Regression of reflexes manifests itself in four stages:

  • Stun - Stage 1;
  • Deep sleep (sopor) - stage 2;
  • Loss of corneal and ocular reflexes - stage 3;
  • Loss of deep reflexes, muscle atony - stage 4.

How long does a coma last after a stroke?

The duration of a coma after a stroke is from several hours to several weeks.

The duration of the coma depends on:

  • Its depths - at the 1-2 stages it is possible to withdraw from a coma, at the 3-4 stage the prognosis is unfavorable;
  • General condition of the patient's body;
  • Completeness of measures to support the life of the patient;
  • Caring for the unconscious patient (pressure ulcer prevention).

Coma grade 3

The third degree is also called atonic coma.

Signs of grade III coma appear:

  1. Absence:

    • pain response;
    • corneal reflexes (eye closing in response to corneal irritation);
    • pupil reactions (lack of reaction to eye illumination).
  2. Decrease:

    • pharyngeal reflex;
    • tendon reflexes;
    • muscle tone;
    • blood pressure;
    • body temperature;
    • breathing rhythm.
  3. Involuntary actions:

    • paralytic miosis (permanently dilated pupil);
    • local or generalized convulsions;
    • acts of urination and defecation.

Forecast

Prognosis of stroke outcome in stage III coma (atonic coma) is ''poor'' or ''lethal''. The basis of the medical decision is the absence of vital signs of the patient's habitus.

Lethal prognosis of the outcome of a stroke can also be in the case of:

  • Extensive bleeding with severe hormetonic syndrome (attacks of increased muscle tone in the initial stages of coma);
  • Severe respiratory failure;
  • Hyperthermia above 40-42 °C;
  • Repeated stroke with severe residual effects (paralysis, dementia disorders);
  • Stroke on the background of oncology in an incurable (hopeless) stage.

A favorable outcome is possible with:

  • Transient ischemic attacks (pre-stroke state);
  • Small strokes (microstrokes);
  • Timely treatment of certain types of stroke in the period earlier than 3-6 hours after the onset of the first signs of the disease.

What to do, how to recover from a stroke?

how to recover after a stroke
how to recover after a stroke

The recovery period for men and women takes about the same time. Adaptation depends on the individual characteristics of the organism. The recovery period after a microstroke passes quickly, patients return to a relatively normal existence within two to three months. With extensive strokes, rehabilitation is long or lifelong.

It is desirable to involve specialists in the field of neurology, massage, manual therapy, speech therapists, nutritionists for rehabilitation. Separate stages of rehabilitation are possible both in a hospital, outpatient clinic and sanatorium, as well as at home.

During the rehabilitation period, patients who have had a massive stroke are shown:

  • Electrical stimulation with sinusoidal currents;
  • Magnetotherapy;
  • Electrophoresis with oculo-occipital electrodes;
  • Ozokeritotherapy.

To normalize motor and sensory functions, a combination of massage, manual therapy and acupuncture is recommended. Restoration of neuropsychological functions takes place in the classroom on an outpatient / home basis with an individual speech therapist or a group method, it takes a year or more.

To the topic: rehabilitation and recovery after a stroke at home

During the rehabilitation period, the following medicines are indicated:

  • In ischemic stroke - actovegin, berlition, instenon, gliatilin;
  • With hemorrhagic stroke - actovegin and gliatilin;
  • For the correction of muscle tone - mydocalm and sirdalud;
  • As antidepressants - trittiko, coaxil, stimuloton.

Foods for Stroke Prevention

The world's population as of July 2011 was already more than 7 billion, of which about a billion are at risk for stroke. For every six seconds, one person dies from a stroke on the planet.

Hearing this data, you have to think about whether it is possible to reduce the number of deaths from stroke. Although the number of strokes is on the rise, researchers point out that in 85% of such cases, it is possible to prevent a stroke by making changes to your daily lifestyle and diet. You must not abuse alcohol, include in your daily menu fresh vegetables and fruits, preferably homemade, which do not contain various chemical additives, and you should also exercise regularly.

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