Ischemic stroke is a pathological process
manifested as blockage (cramps, blood clots, embolism, etc.)
cerebral vessels and leading to a violation of its full
blood supply. The vessels remain intact.
This is a severe pathology, the mortality of which reaches 20% of all
about 50-60% of cases after stroke
severe disabling effects and only a few succeed
survive brain infarction without residual effects.
What is ischemic stroke?
Ischemic stroke is an acute cerebral disorder.
blood circulation, a consequence of blood supply deficiency, accompanied
омертвением участка the brain. Another name for ischemic stroke is
�”Brain infarction” also reflects the essence of pathogenesis in the brain
The word ischemia means lack of blood supply at a certain,
localized area of human tissue or organ. Under stroke
понимается недостаточное кровообращение головного the brain. If also
vascular rupture or ischemia occurs
головного the brain.
Tissue destruction occurs gradually, in waves and the process is not
stops even after the resumption of normal blood flow.
Therefore, it is very important to provide the injured
help and rehabilitate the patient. One aspects of therapy
is to prevent the development of complications after ischemic
инфаркта the brain.
Features of development at different ages:
- Slow development of the disease is characteristic of older persons with
severe sclerosis. They have symptoms that appear, then disappear in
for a week. Cerebrovascular accident can occur
suddenly or have a short period of forerunners.
- Sudden development is characteristic of young people due to
vascular embolism. Symptoms appear on the background of physical activity,
strong cough, when performing operations on the lungs, during
caisson underwater work.
Cerebral arteries are divided into two vascular pools:
vertebrobasilar and carotid. Vertebrobasilar strokes
Basin include lesions in the posterior cerebral and basilar system
arteries. In case of impaired blood flow in the anterior or middle system
cerebral artery talk about stroke carotid pool.
On the side of the lesion, ischemic stroke can be
left or right.
There is a classification by lesion:
- Transient ischemic attack (TIA). Astonished minor
участок the brain. Symptoms disappear within 24 hours.
- Small – recovery of functions occurs within 21
of the day
- Ischemic stroke is progressive
gradual development of current focal and cerebral
symptoms that can occur like within a few hours,
and days. Recovery of functions after this occurs in
incomplete – the patient usually has some
neurological symptoms of minimal manifestation;
- Total (ie complete) ischemic stroke –
implies a brain infarction with actual
incomplete or stably regressing deficit.
In the classification of ischemic stroke are the following types
- Атеротромботический обычно поражает во время ночного сна.
May develop slowly and affects large and medium vessels.
by blocking the movement of blood by cholesterol plaques.
- Cardioembolic form. It starts suddenly. More often
возникает в области кровоснабжения средней артерии the brain. By size
the lesion may be medium or large.
- Lacunar form of ischemic stroke. Small ones are affected
perforating arteries. Brain stem stroke develops
not right away. The dimensions of the lesions do not exceed 15 mm.
- Ischemic type caused by rare disorders diagnose
more difficult. The cause of cerebral infarction may be increased
blood clotting, pathological changes in the walls of blood vessels and
- Ischemic brain damage may not have causes. For such
condition is characteristic or there are several reasons for the development
ischemic brain damage or lack of opportunity for
finding out the cause of pathology.
There are also several periods of ischemic stroke:
- the most acute period is the first 3 days. Of these, the first three hours
got the definition of “therapeutic window” when there is
the possibility of using thrombolytic drugs for systemic
introduction. In case of regress of symptoms during the first day
диагностируют транзиторную ишемическую атаку;
- acute period – up to 4 weeks;
- early recovery period – up to six months;
- late recovery period – up to 2 years;
- period of residual effects – after 2 years.
The starting factor for the development of ischemic stroke is
stopping the flow of blood to a specific area of the brain due to
impaired patency of the feeding arteries or hemodynamic changes,
what is its fundamental difference from hemorrhagic
stroke when a vessel breaks with subsequent
These medical statistics are alarming: from ischemic
stroke dies in the acute period a third of patients, in 40%
extensive brain infarction develops, 8 out of ten people remain
Provocative factors can also be:
- Heart defects and blood vessels;
- Aortic aneurysm;
- Elderly age;
- Hormonal contraception;
- Unilateral headache (migraine);
- Bad habits;
- Increased blood viscosity;
- The use of trans fats.
If several factors are combined at once, this is
a serious reason to worry about your health,
be extremely attentive and know the smallest signs of pathology.
In women under 30 and after 80 years the risk of ischemic development
stroke is significantly higher than in men of the same age, and from 30 to
80 years in men more causes of stroke. This statement
refers to different age and gender groups that do not have
history of chronic diseases proven to affect the brain
blood flow. A number of researchers have proven high marital
предрасположенность к инфарктам the brain.
Symptoms of ischemic cerebral stroke
Signs of acute cerebrovascular accident – a reason for
treatment of a person for medical assistance.
Determine the relatives of the patient, in his appearance, behavior,
- disturbances of consciousness (from mild lethargy to coma);
- decrease / loss of pain sensitivity of body parts;
- decrease / loss of motor, voice functions;
- головная боль, рвота.
Cholesterol plaque and thrombus blocking the artery at
Suspect acute vascular pathology
помогут общемозговые симптомы ишемического инсульта,
which can be represented as follows and they naturally
will depend on the affected area and the severity of the condition:
- Often there is a loss of consciousness sometimes with short-term
- Headache, pain in the eyes and, especially, when eye movement
- Stunned and disorientated space;
- Nausea and vomiting.
При обширном ischemic stroke правого полушария головного
brain will be observed this picture:
- partial memory impairment. In this speech, which
is administered by the left hemisphere, may be normal. because of
this problem diagnosis can be very difficult;
- numbness and paralysis of the body will touch exclusively left
- facial muscles will be paralyzed and deprived
sensitivity is exactly on the left side;
- the patient’s mental state will be accompanied by lethargy and
The following symptoms are characteristic of a left-sided stroke:
- paralysis of the right side of the body of varying severity;
- violation of the sensitivity of the right side of the body;
- visual impairment, hearing, smell, until the complete loss
the ability to perceive the appropriate stimuli. When heavy
поражениях расстройство может захватывать обе parties;
- imbalance and balance of movement;
- speech disorders.
Depending on the degree of violation of cerebral blood flow are possible
The following options for the manifestation of stroke:
- acute onset: the rapid onset of neurological symptoms and
deficiency, the patient can clearly indicate the time of onset of the disease.
Such a course is characteristic of an embolic stroke.
(the patient has atrial fibrillation);
- undulating onset: symptoms of lesion are flickering
character, gradually increasing in time;
- tumor-like onset: ischemia increases for a long time, affecting
main vessels of the brain, which ultimately leads to
unfolded stroke with a large focus of brain damage
Disturbing signs of ischemic stroke:
- sudden numbness of limbs or any other area
- loss of control over your body – a person cannot understand that
what happens to him where he is;
- speech disorders (words incoherent, the victim does not understand
speech addressed to him);
- blurred vision, double vision, loss of field
- twisted face, drooping of the corners of the mouth, if asked
the victim to smile – he will not succeed;
- paralysis of any limb – impossible to lift or move
hand or foot;
- when sticking out the tongue from the mouth, it deviates from the middle in
- cerebral disorders – loss of consciousness, convulsions, nausea,
For patients, the prognosis of the disease is of great importance.
since the consequences of a stroke inevitably affect the level
life and human performance. In most cases, patients
face persistent neurological disorders for example
vestibular disorders, changes in speech, paralysis.
Implications for chelówek
The effects of ischemic stroke are directly dependent on the size.
affected area of the brain and timeliness of care. When
assistance provided in a timely manner and appropriate treatment assigned,
possible full or at least partial restoration of functions.
Sometimes, despite the prescribed treatment, the symptoms increase,
This can lead to serious consequences.
Select the following types complications:
- infectious complications (occur due to a long stay
in a supine position in the complex by the addition of infection that
leads to infections of the urinary system, pneumonia, bedsores and
- deep vein thrombosis of the lower leg;
- pulmonary thromboembolism;
- swelling of the brain;
- cognitive impairment;
- violation of defecation, urination;
- эпилепсия (развивается порядка в 20% случаев);
- movement disorders (unilateral, bilateral),
severe weakness and paralysis;
- mental disorders (changeable moods,
раздражительность, депрессии и etc.);
- pain syndrome.
Consequences with different brain damage: right and
Left and right hemisphere of the human brain
Consequences of ischemic stroke of the right side of the head
the brain. In addition to the usual stroke disorders as a person’s asymmetry,
hypertonus on the left side (upturned corner of the lips), smoothed
nasolabial fold on the right, paralysis and paresis of the left half of the body,
There are other features.
- Loss of memory on recent events, with saved
memories of the distant past (such as from childhood).
- Disturbed concentration of attention.
- Speech impairment.
Consequences of ischemic stroke of the left side:
- Pronounced mental disorders – the patient is not oriented
time and space, does not recognize loved ones, a feature
is positioning oneself as a healthy person.
The most common causes of death of ischemic stroke on
first week are:
- отек головного мозга и дислокация очага некроза ствола
brain with respiratory and cardiovascular centers,
- hemorrhagic transformation of cerebral infarction with the formation
- вторичная ишемия ствола головного мозга с
the formation of foci of infarction.
Timely and accurate diagnosis of this disease allows
provide proper assistance in the most acute period, start adequate
treatment and prevent terrible complications, including lethal
Basic diagnostic methods:
- When collecting the history, you must decide on the beginning of violations
cerebral circulation set sequence and speed
progression of certain symptoms. For ischemic stroke
a sudden onset of neurological symptoms is typical.
- In addition, attention should be paid to possible risk factors.
the occurrence of ischemic stroke (diabetes mellitus, arterial
hypertension, atrial fibrillation, atherosclerosis,
- Laboratory tests – biochemical blood test,
lipid spectrum, coagulogram.
- Blood pressure measurement. ECG. MRI or CT scan of the head
brain can determine the location of the lesion, its
size, prescription of its formation.
- If necessary, perform CT angiography to detect
exact location of the occlusion of the vessel.
If a patient’s ischemic stroke is suspected
hospitalized in specialized departments. In that case,
if the disease is less than 6 hours old – in block
intensive care of the same departments. Transportation must
be carried out only when the position is raised to 30 degrees
head of the patient.
A very important aspect when choosing a method of treatment is
differentiation of ischemic and hemorrhagic stroke.
The best way to do this can help CT or MRI, only these methods
studies provide accurate data on the type of stroke. In his absence
in the hospital, the doctor will evaluate a number of clinical syndromes,
development of the disease, may use a number of other diagnostic
methods, for example, lumbar puncture, to establish exactly
If the patient is lucky and the doctor can manage to diagnose
stroke in the first 60 minutes of symptoms, then there will be
assigned to thrombolytic therapy, which allows you to dissolve
thrombus that caused the stroke and restore normal
blood flow in the affected vessel.
In this case, the consequences of ischemic stroke for the patient
will be minimal and it will begin to recover quickly, its functions
the body will begin to return to normal.
Basic treatment includes activities that provide
maintenance of vital functions and somatic prevention
- Normalization of external respiratory function;
- Maintaining cardiovascular activity with
correction of blood pressure;
- Regulation of homeostasis (water-salt balance, acid-base
balance, glucose level);
- Maintaining the patient’s body temperature, which should not
exceed 37.5 degrees;
- Reduced swelling of the brain;
- Symptomatic treatment depending on clinical
- Профилактику пневмонии, уроинфекций, пролежней, тромбозов
нижних конечностей и ТЭЛА (тромбоэмболия легочной артерии),
переломов конечностей и пептических язв желудка и
Within 3-6 hours from the beginning of a stroke, it is possible
conducting drug thrombolysis. Upon successful elimination
thrombus possible restoration of functioning viable
cells located in the area of the so-called shadow stroke. Most
common drug thrombolysis – Aktilize.
Drug-induced thrombus liquefaction has many
contraindications and is associated with the risk of bleeding, including
cerebral hemorrhage and the development of hemorrhagic stroke.
The main drugs for the treatment of ischemic stroke
- Anticoagulants – heparin, fragmin, nadroparin.
- Blood thinners – aspirin, cardiomagnyl.
- Vasoactive drugs – pentoxifylline, vinpocetine, trental,
- Antiplatelet agents – Plavix, tiklid.
- Angioprotectors – etamzilat, prodectin.
- Neurotrophies – piracetam, cerebrolysin, nootropin, glycine.
- Antioxidants – vitamin E, vitamin C, mildronate.
Treatment ишемического инсульта правой стороны не отличается от
treatment of the left side, but in therapy there must be an individual
approach and various combinations of drugs that
appointed by a doctor only.
Rehabilitation после ишемического инсульта подразумевает комплекс
activities aimed at returning the patient to the usual
of life. For this purpose, apply:
- special preparations
- patients are prescribed diet food,
- Exercise therapy,
- mud therapy
- various physiotherapy.
Speech therapists work with people who have had an ischemic attack.
experts in the field of neurology who help to restore
speech function of the patient.
Duration, like the types of remedial measures,
determined by the doctor.
Prognosis for life after ischemic stroke
The main factors affecting the forecast is age
the patient, the localization of the lesion, the causes that provoked thrombosis,
form of pathology and the initial severity of violations. On the outcome
situations will affect the timeliness of medical care in the hospital,
adequacy of prescriptions, the presence of chronic diseases, mental
abnormalities, the addition of complications of the neurological type,
delayed rehabilitation and re-stroke.
Forecast regarding the degree of restoration of impaired functions
- with extensive stem and hemispheric heart attacks with persistent
paresis and paralysis, impaired coordination of movement, swallowing and
- in severe condition of general hemodynamics in
cardiovascular diseases in the stage of decompensation;
- with limited possibilities of collateral circulation in
connection with the defeat of both vascular basins.
Prediction for recovery improves:
- with limited brain infarction;
- in young patients;
- in satisfactory condition of the heart and blood vessels;
- with the defeat of one extracranial vessel.
Characteristic prognosis for ischemic stroke
- Favorable outlook. After losing a person loses
some features. But, thanks to the correctly defined
rehabilitation and timeliness of primary care,
lost functions are gradually restored
- Average. Not entirely favorable prediction may be
associated with additional accompanying diseases (sugar
diabetes, gastrointestinal dysfunction, pneumonia). So you can
to observe, then improvement, then deterioration of the human condition.
- Неблагоприятный прогноз для of life. Brain damage
takes place on a large plot. There is a possibility of relapse,
that ends in death.
It should not be forgotten that the prognosis of extensive ischemic
stroke of the right brain can be different in
each specific case. There are a number of factors to consider:
the degree of extensiveness of tissue damage, the presence or absence of other
diseases, the overall resistance of the organism to diseases.
Mortality from ischemic stroke is 1.23 cases per
1000 people per year. About 25% of patients die in the first month.
It is noted that the more pronounced the neurological deficit is
the first month of illness, the less chance of recovery
качества of life. Within 5 years of recurrent ischemic stroke
noted in a third of patients.