Ischemic cerebral stroke -effects and rehabilitation treatment

Update: October 2018

Ischemic stroke is an acute cerebral disorder.
circulation resulting from blockage of the arteries of the head
brain, in this regard, there is a death of neurons in a certain
the area of ​​the brain that was fed from this
arteries.

In modern times, ischemic stroke has become one of the main
causes of death of people. Most of those who survive after
suffered ischemic stroke, remain disabled. therefore
it is so important to talk about the consequences of this
заболевание и какие methods of rehabilitation
exist.

Let’s talk briefly about the etiology of the disease.

• Atherosclerosis of cerebral vessels. When cholesterol is deposited
  Atherosclerotic plaques form in the brain vessels. AT
  In this case, there may be two mechanisms of stroke:
  
  • The plaque will increase in size until
    will cause occlusion (complete blockage) of the vessel, which will stop
    blood flow.
  • Atherosclerotic plaque may be unstable, i.e.
    part of her can move freely and at some point come off,
    getting into the smaller arteries with blood, this piece of plaque
    clogs it and develops ischemic cerebral stroke
    (see how to reduce cholesterol without drugs).

• Atrial fibrillation. AT данном случае есть риск развития
  cardioembolic ischemic stroke. When atrial
  arrhythmias, especially when paroxysmal form, there are large
  the risk that during the next paroxysm small blood clots from the chambers
  hearts will get into the carotid arteries, and from there into smaller arteries,
  feeding the brain.

• Hypotension. This reason is quite rare, but about her
  should be mentioned. With a sharp drop in blood pressure
  decreases the volume of circulating blood in the brain, which leads to
  violation of its nutrition.

• Thrombus formation. Blood clots can form in any vessels.
  including in the vessels of the brain in violation of
  coagulation system, due to vasculitis, genetic abnormalities,
  and when taking oral contraceptives by women.

AT последнее время случаи тяжелых ишемических инсультов у молодых
women taking oral contraceptives have become more frequent
with the prevalence of this method of contraception.

Risk factors for ischemic stroke

• Hypertension and its improper treatment. Level
  артериального давления должен быть ниже 140/90 mm Hg! Reception
  drugs must be constant, otherwise jumps occur
  blood pressure, which creates the risk of stroke.
• Diabetes
• Old age (see how to determine
  risk of stroke and dementia in humans)
• Reception оральных контрацептивов. Especially in combination with age
  over 35 years old, smoking or hypertensive
• Smoking
• Obesity
• Hypercholesterolemia. Allowable cholesterol – no higher
  5.2 mmol / l (for more details, the norm of cholesterol in women and
  men)
• Arrhythmias

Clinical picture of ischemic stroke

Symptoms of ischemic stroke depend on the localization of the lesion.
lesions. There are also common symptoms that occur with any
localization of ischemic stroke. To them относятся головная боль,
disturbance of consciousness up to coma, dizziness,
violation of the functions of the pelvic organs.

When the lesion is located in the right hemisphere are observed
following symptoms:

• Left hemiplegia or hemiparesis – reduced force in the left
  limbs or their complete immobility.
• Left-side hemianesthesia or hemihypesthesia – reduction or
  total lack of sensitivity in the left limbs and the left
  half face.
• Left-handers have a speech disorder.
• Face asymmetry (smooth nasolabial fold and omission
  corner of the mouth to the left).

The first signs of a stroke. Click to enlarge.

• Right-sided hemiplegia or hemiparesis – a decrease in strength in
  правых limbs or their complete immobility.
• Right-sided hemianesthesia or hemihypesthesia – reduction or
  total lack of sensitivity in the right limbs and the right
  half face.
• Right-handed people – speech disorder, lack of understanding of speech, impossibility of speech
  reproduce.
• Asymmetry of the face on the right.

When the lesion is located in the cerebellum and the trunk:

• Disturbance of swallowing (choking with liquid and food).
• Coordination disorders.
• Dizziness.
• Disruption of the respiratory system.
• Nausea, vomiting, persistent hiccups.
• Dysarthria – impaired speech in which it is difficult to pronounce
  words, feeling like a man has a mess in his mouth.

Diagnosis of the disease

Basic diagnostic methods:

• Medical history, neurological examination, physical examination
  the patient. ATыявление сопутствующих заболеваний, имеющих важное
  value and affecting the development of ischemic stroke.
• Laboratory tests – biochemical blood test,
  lipid spectrum, coagulogram.
• Blood pressure measurement.
• ECG.
• MRI or CT scan of the brain allows you to determine the location
  the lesion, its size, the duration of its formation. With
  necessity spend CT angiography to identify the exact location
  vessel occlusion.

Sequelae of ischemic stroke

Such a serious disease can not pass for a person.
without a trace If he managed to survive, he will not do without
consequences. After an ischemic stroke, the patient may remain.
disabled for life, and may have minor problems with
which will quickly learn to live or completely get rid of as a result
rehabilitation treatment.

It should be remembered that affect the effects of ischemic
cerebral stroke is possible only in the first year after development
diseases. After a year from the development of the disease,
Rehabilitation treatment will become meaningless and ineffective.

ATероятные последствия ишемического инсульта:

1. Impaired motor function – strength in the limbs may
   not fully recover. Weakness in the leg will cause the patient
   use a cane, weakness in the hand makes it difficult to perform some
   household actions, up to dressing and holding a spoon.
2. Violation of sensitivity in the limbs and on the face.
   Sensitivity is always restored longer muscle strength in
   limbs. This is due to the fact that the nerve fibers that meet
   for the sensitivity and conduct of the corresponding nerve impulses,
   recovered much slower than the fibers responsible for
   movement.
3. Speech disorders – may not be all patients who have had
   ischemic stroke. Difficult communication of the patient with relatives, sometimes
   the patient can speak absolutely incoherent words and sentences
   sometimes it may just be hard for him to say something. Less often
   there are such violations in right-sided ischemic
   stroke
4. The consequences can manifest as cognitive impairment –
   a person can forget many things that are familiar to him
   phone numbers, your name, family name, address, it can behave like
   little child, underestimating the difficulty of the situation, he may be confused
   the time and place in which it is located.
5. Mental disorders – many stroke sufferers
   post-stroke depression appears. This is due to the fact that man
   can no longer be the same as before, he is afraid that he has become a burden for
   his family, afraid of what will remain disabled for life.
   Also могут появится изменения в поведении больного, он может стать
   aggressive, shy, disorganized, may be subject to
   frequent mood swings for no reason.
6. Swallowing disorders – the patient may choke as a liquid,
   and solid food, it can lead to aspiration pneumonia,
   and then fatal.
7. Coordination disorders manifest themselves in staggering when walking,
   dizziness, falling with sharp movements and turns.
8. Epilepsy – up to 10% of patients after ischemic stroke can
   suffer from epileptic seizures.
9. Dysfunction of the pelvic organs – not always the intestines and
   the bladder may continue to function normally after
   suffered ischemic stroke. AT связи с этим больному
   requires careful care by relatives or
   nurses.

Treatment methods for ischemic stroke

One of the most effective and modern methods are –
thrombolytic therapy. The main and most important condition for
The application of this method is admission to the neurological
separation earlier than 3 hours from the beginning of the appearance of the first
symptoms!

Thrombolysis is based on the fact that intravenous drip to the patient
a drug is injected (thrombolysis), which instantly begins
dissolve the resulting thrombus in the vessel that corked it. AT
resulting in normal blood flow to the arteries
brain. The effect is often felt, as they say, “on the needle,”
in the first minutes and even seconds, the drug was administered.

Withменение метода позднее 3 часов от начала ишемического
a stroke is meaningless, as it has already happened in the brain
irreversible changes and dissolution of a blood clot will not give any
positive effect. therefore особенно важно обращаться в скорую
help at the first sign of a stroke, otherwise you may not have time to get
into this “therapeutic window”. It must be remembered that in the hospital,
before starting thrombolytic therapy, the patient must
carefully examine, conduct a series of tests, exclude
hemorrhagic stroke, and it also takes a lot of time.

This method has a number of contraindications, the presence of which
find out the doctor before choosing a treatment strategy.

A very important aspect when choosing a method of treatment is
differentiation of ischemic and hemorrhagic stroke. It is better
CT scan or MRI can help with this, only these methods
studies provide accurate data on the type of stroke. With его отсутствии
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
diagnosis.

Thrombolysis is performed only if with 100% probability
it is established that this ischemic stroke, otherwise the introduction
thrombolysis will cause death. As with hemorrhagic
stroke hemorrhage occurs in the brain, and the “thinning” of blood
thrombolytic will cause severe bleeding and increase
hematoma formed.

If thrombolysis is not possible, treatment is carried out.
standard methods:

• • lowering blood pressure
  • antiplatelet agents (aspirin preparations) or anticoagulants (heparin,
    Fraxiparin, Clexane),
  • drugs that improve cerebral blood flow (cavinton, piracetam,
    trental)
  • B vitamins
  • methods of rehabilitation
  • bedsore prevention
  • control of blood pressure and excretory functions
  • among the folk remedies can be identified the use of pine
    stroke cones

as prophylaxis or in the recovery period

You can not self-medicate, so as to select a method
treatments need to know exactly the type of stroke, clinically they do not
are different. Being at home, a person cannot determine
hemorrhagic or ischemic stroke in him, therefore
self-medication can not only lead to
deterioration, but also to death.

Remedial treatment

Otherwise, it is called neurorehabilitation, which is best
produce in specialized rehabilitation centers (see
list of rehabilitation centers after a stroke in Russia). Start off
it should be from the first days of the disease. There are a number of techniques
allowing to significantly improve the quality of life of such patients (see
rehabilitation after stroke).

1. When movement disorders applied physical therapy,
   massage, gymnastics, physiotherapy. One of the new methods is PEMS.
   (programmable electromyostimulation), this method forces the muscles
   �“Remember” how she worked before this disease. Also
   various simulators are used that allow passive
   work affected limbs (motion performs simulator)
   then allows the muscles to be actively involved in the work.
2. For speech disorders, classes with a speech therapist are required, as well
   there are devices that stimulate the muscles of the larynx, pharynx,
   for example, “Vokastim.”
3. In case of a violation of swallowing, this apparatus and training also helps.
   swallowing, you need to gently feed and water the patient with
   spoons.
4. With the development of impaired coordination is necessary
   classes on a stabiloplatform, a special apparatus where possible
   train coordination and learn to keep balance
   redistribute body weight when trying to perform any
   motion.
5. Another important aspect of the rehabilitation of such patients –
   psychotherapy. They all experience psychological discomfort, in
   connection with the incident, no one can deal with it myself, in this
   he should be helped by a specialist psychotherapist.
6. To improve blood supply and brain function
   drugs like Tanakan, Cavinton, Cerebrolysin,
   Bilobil and others.

Ischemic Stroke Prevention

It is much easier to prevent the development of the disease than later
cure. Therefore, the issue of prevention is very acute.

• Blood pressure monitoring, keeping it at a level below
  140/90 mm Hg
• Blood sugar control is not higher than 5.5 mmol / l.
• Control of blood cholesterol level – not higher than 5.2 mml / l.
• Control of blood coagulation system – donated once a year
  coagulogram.
• Weight control.
• Refusal to smoke.
• Active lifestyle, moderate exercise.

Prevention of recurrent ischemic stroke

If the patient has already had ischemic stroke, then besides
listed prevention methods above are vital for him
are also the following:

• Acceptance of antiplatelet agents (aspirin drugs) for life !!! To them
  include: Thrombotic ass, Cardiomagnyl and others (see all about pills
  from cholesterol)
• In the presence of concomitant atrial fibrillation is assigned
  warfarin, in this case it is necessary to regularly monitor the INR and
  keep it on target level! Dose adjustment of this drug
  hold only a doctor! Independent, even insignificant,
  changing the dose of warfarin can lead to tragic
  consequences!
• Taking statins, cholesterol-lowering drugs –
  for life! Skipping the drug reduces all previous efforts to
  zero! To them относятся: Аторис, Липримар, Зокор, Мертинил и
  others.

Attention! The listed drugs in the article are not
the appointment and reception without consulting with your doctor
is forbidden!

Автор: Ревус Олеся Григорьевна врач-невролог