Stroke: symptoms, types, causes, first aid, diagnosis, treatment and rehabilitation

Everyone should know about the symptoms of a stroke. Even if you do not consider yourself at risk, knowledge of the signs of this dangerous disease may help save someone's life. So what is a stroke?

In the ICD-10 of this pathology, a separate code is allocated in the section “Cerebrovascular diseases” I60-I64. This disease in the predominant number of cases leads to death or disability. Everyone knows that acute cerebrovascular accident is an incredibly life-threatening condition. The consequence of a stroke is damage to the central nervous system, death of nerve cells. A threat to the health of a patient with this disease lies in his spontaneous and rapid development. If you do not start treatment in a timely manner, do not help at the first sign of a stroke, women and men have practically no chance of survival.

At the first symptoms of cerebrovascular accident, emergency medical attention must be called up! This is the only way to save a person’s life and minimize the likelihood of irreversible complications.

About the reasons

Acute cerebrovascular accident is localized in a separate area of ​​one of the hemispheres. Symptoms of a stroke result from thrombosis or rupture of a blood vessel. What provokes this violation, as a trigger mechanism, is difficult to answer. But something is known about the factors that increase the likelihood of a disease:

• arterial hypertension and frequent hypertensive crises;
• narrowing of the lumen of the carotid arteries;
• cerebral and neck vascular thrombosis;
• embolism;
• clotting problems;
• aneurysms;
• heart disease and heart rhythm disturbances;
• atherosclerosis;
• diabetes;
• alcohol abuse, drug use;
• sleep disturbances, including apnea;
• increased physical activity;
• head injuries;
• vasospasm caused by hypothermia;
• age-related changes in the walls of blood vessels.

Regardless of the causes of the disease, a “stroke” is extremely dangerous for a person’s life, therefore awareness of his signs and rules of first aid is of great importance.

Types of Stroke

A predominant number of patients diagnosed with ischemic stroke. The reason for its occurrence is the narrowing or blocking of the arteries of the brain, which leads to a stop in blood circulation and the inability of oxygen to access the cells of the brain.

Two-minute ischemia is enough for brain cells to die. The types of ischemic stroke include:

• Thrombotic - happens due to the formation of a blood clot in one of the arteries supplying the brain with blood. Most often occurs in patients suffering from atherosclerosis.
• Embolic - a blood clot forms on a portion of a blood vessel outside the brain due to irregular heartbeat.

The second group of acute cerebrovascular accidents is hemorrhagic strokes provoked by rupture of a blood vessel. The second name of this pathology is intracerebral hematoma. Hemorrhage can also be subarachnoid, i.e., occur in the space between the surface of the brain and the skull bone.

Transient ischemic attack

There is another type of acute cerebrovascular accident - a microstroke. In this case, a blood clot partially prevents the flow of blood, but does not cause serious damage, since blocking the vessel is short-term. A transient ischemic attack lasts no more than 5 minutes, however, the appearance of the same symptoms characteristic of a thrombotic stroke is characteristic of this episode.

Symptoms of a Stroke

In men and women, the manifestations of this disease do not have any differences and proceed according to a single scenario. The difference can only be in the causes of development and the characteristics of the course of the disease. Recognizing the signs of an acute violation of the blood supply to the brain, it is important to act immediately - urgently call a medical team and provide first aid to the patient before the doctors arrive.

Signs of a stroke in women and men look like this:

• spontaneous headache with dizziness, sometimes nausea and the urge to vomit;
• sudden numbness or tingling in the face, limbs;
• weakness in the limbs - legs and arms become "cottony";
• complete or partial loss of control over the muscles of the body;
• impaired speech and its perception (the inability to clearly and articulate pronounce words, to understand other people's spoken language);
• vision problems (short-term blindness, double vision);
• impaired consciousness of varying degrees, up to a coma;
• loss of coordination of movements and balance of the body;
• convulsive attacks;
• increase or decrease in heart rate, respiration;
• a sharp jump in blood pressure;
• violation of swallowing.

How to recognize a disease in another person

The behavior and condition of a person who has had a stroke may seem strange or resemble alcoholic intoxication from the outside. Brain hemorrhage or ischemia can be recognized in several ways:

• First, you should take a closer look at the person, ask if he needs help. Pay attention to how he answers the question: after a stroke, speech becomes difficult.
• Ask him to smile and do a simple test: if the corners of the mouth are at different levels, and the smile seems skewed, this is an undeniable symptom of a stroke.
• In this disease, the muscles are greatly weakened, and to verify this, it is enough to ask the patient to raise his hands up or shake hands with him. In both cases, the task will seem difficult to him.

First Aid Rules

Regardless of whether the patient is in an unconscious or conscious state, an ambulance must be called urgently. At the same time, it is extremely important not to lose precious time to save specialists before the arrival. Remember that every minute is important, so you need to clearly follow the algorithm of actions described below:

• The patient should be lying with his head raised about 30 °.
• If he has vomiting, it is necessary to turn his head and body on his side to avoid getting vomit in the respiratory system.
• It is important to empty the airways and clean the mouth if vomiting has already occurred.
• The victim should not be given water or food, as a person with a stroke often has respiratory tract spasms.
• The patient must ensure the supply of fresh air by opening a window or window. In this case, it is necessary to remove or unfasten tight clothing, loosen the belt, collar.

If there is a tonometer and a glucometer in the room where the patient is located, it is necessary to take measurements and record the indicators of blood pressure, blood sugar, and as soon as the team of doctors arrives, report the data. If the pressure is elevated, in no case can it be reduced by the use of drugs! In the first hours after a stroke, a symptom indicates adaptation of the brain. Antihypertensive drugs give the victim only a few hours after the incident.

In case of respiratory arrest and heart function, one must act without delay, perform an indirect heart massage and give the patient artificial respiration. Other rescue activities are the task of professionals.

Survey

Symptoms of a stroke, as a rule, are not in doubt among professionals, but in order to prescribe a suitable intensive care program, it is important to find out the type of disease and the degree of brain damage. In addition, it is necessary to differentiate a stroke with a malignant neoplasm.

After examining the patient and examining the medical history by the attending physician, a clinical diagnosis of stroke is carried out, which usually consists of several research procedures:

• blood tests;
• computed tomography (CT);
• magnetic resonance imaging (MRI);
• Ultrasound of the vessels of the neck and head, including carotid arteries;
• angiography;
• echocardiography.

The examination is carried out in a short time - no more than an hour should pass from the moment a patient enters the admission department until the start of intensive care measures. According to the results of emergency diagnosis of a stroke, medications and treatment procedures are prescribed.

The basic principles of treatment

Therapy for stroke takes place in several stages. First, the victim is given emergency medical care, which allows you to stop irreversible processes, save your life and prevent the development of repeated disturbance of cerebral circulation. The sooner therapy is started, the greater the patient's chances of preventing negative consequences and restoring health. Usually, a lot of medications are prescribed for the victim to treat a stroke, while self-medication without the advice of a doctor is unacceptable. In addition, the scheme of therapeutic measures will directly depend on the type of stroke.

In the following days, the patient is prescribed maintenance drugs, his health indicators are constantly monitored. To identify positive dynamics, a second examination can be prescribed, regardless of the severity of the symptoms of a stroke. After the course of treatment, the difficult stage of rehabilitation begins.

Emergency therapy for ischemic stroke

Treatment of this type of disease is fundamentally different from the principles of treatment of intracerebral hematoma. First of all, specialists select drugs that can dissolve a blood clot that has blocked the vessel. In addition, treatment should be aimed at preventing re-ischemic stroke. According to ICD-10, several varieties are distinguished, each of which is assigned a separate code. Among them, cerebral infarction of the pre-cerebral and cerebral arteries due to blockage or stenosis, as well as unspecified type of cerebral infarction.

Comprehensive treatment for acute cerebrovascular accident is the use of tablets, injectables and medical procedures. Special attention should be paid to drugs of tissue plasminogen activator (“Activase”, “Aktilize”). For the treatment of ischemic stroke, these drugs are the main ones, since their direct purpose is to dissolve blood clots. However, they can not always be used, as they have a number of contraindications and features:

• Firstly, they can be used no later than 3-4 hours after ischemia.
• Secondly, tissue plasminogen activator is not used to treat a second stroke and subsequent ones.
• Thirdly, these funds are not suitable for patients with diabetes mellitus, gastrointestinal ulcers, renal failure.

In addition to tissue plasminogen activator preparations, victims of ischemic stroke will be prescribed:

• antiplatelet agents (Aspirin, Tiklid, Pentoxifylline, Clopidrogel, Dipyridamole);
• anticoagulants (Warfarin, Dabigatran, Heparin, Calcium Nadroparin, Enoxaparin Sodium, Phenylin);
• statins (Atorvastatin, Atoris, Simvastatin).

Brain hemorrhage treatment options

Treatment of intracerebral hematoma is aimed at stopping hemorrhage as soon as possible and removing a blood clot from the artery, which puts pressure on the brain structures. Often with hemorrhagic stroke, patients have indications for neurosurgical intervention.

Drug therapy consists in the use of:

• antihypertensive drugs ("Enalapril", "Labetalol") or drugs that increase blood pressure ("Dopamine");
• selective beta-blockers ("Atenolol", "Bisaprolol");
• antipyretic drugs ("Paracetamol");
• broad-spectrum antibiotics for the prevention of congestive pneumonia and uroseptics in order to prevent urinary tract infections;
• diuretics ("Lasix", "Furosemide");
• decongestant medicines (Mannitol, Albumin);
• anticonvulsant, antiemetic drugs (Thiopental, Tserukal).

Medication after discharge

Caught in the native walls of the patient, the next stage awaits - rehabilitation after a stroke. At home, medication continues to be taken. In the recovery period, the patient is prescribed:

To eliminate the accompanying symptoms of a stroke in men and women (vomiting, nausea, irritability, fever, etc.), medicines are used in consultation with the doctor.

The consequences of cerebrovascular accident and prognosis

A normal life after a stroke is possible, but in order to recover from this disease you will have to go through a difficult rehabilitation path. Complications of an ischemic and hemorrhagic stroke are often:

• paralysis or paresis;
• violation of coherent speech, swallowing;
• amnesia;
• loss of existing self-care skills;
• body pain or numbness.

A person who has had a stroke especially needs the love and care of loved ones. It is important to understand that the forecast largely depends on the actions of persons caring for a person. A brain stroke in 2% of cases develops repeatedly - in this case, the chances of recovery decrease exponentially.

In general, the prognosis of the disease is unfavorable. With a hemorrhagic stroke with hemorrhage in the center of the brain, 90% of patients die within the first month. If the victim fell into a coma provoked by swelling in the brain, the probability of his recovery in the future, unfortunately, is close to zero. A repeated stroke, which occurred earlier than a month after the previous one, does not at all leave a single chance for recovery.

Rehabilitation exercises

Along with taking medications, restorative gymnastics after a stroke is of great importance . In the absence of the opportunity to go through a rehabilitation period in a specialized medical center, the patient expects stubborn, painstaking and lengthy work to restore lost functions and physical activity. When undergoing rehabilitation after a stroke at home, it is important to adhere to the recommendations of a physiotherapist and rehabilitologist. The effectiveness and duration of the course of therapeutic exercises depends on the area of ​​the damaged brain and the degree of damage.

Despite the variety of existing methods of exercise therapy for various types of stroke, all of them are based on common principles. So, the initial course of medical gymnastics, regardless of whether the patient suffered a hemorrhagic or ischemic stroke, includes passive movements of the limbs and massage, which is done taking into account the affected muscle. The extensors are massaged on the hands, and the legs and feet flexors are massaged on the legs. The transition from passive exercises to the active part of exercise therapy involves the gradual involvement of the muscles of the paralyzed part of the body. Exercises are performed at a slow pace, gently and smoothly, while they should not cause discomfort and pain in the patient.

Next, we dwell in more detail on one of the possible sets of exercises for physiotherapy after a stroke:

• Exercise No. 1. First performed with an unaffected hand, the elbow and wrist joints are involved. Repeat movement 4-5 times. Then do the same with a sick limb. If necessary, you need to help the patient make flexion movements.
• Exercise number 2. Inhale and exhale deeply, repeat 8-10 times.
• Exercise number 3. Try to raise and lower the shoulders. Exercise must be done rhythmically for 20-30 seconds.
• Exercise No. 4. Circular movements of the feet (first with a healthy foot, then paralyzed). Repeat at least 5-6 times.
• Exercise No. 5. With bent legs, take and bring the thigh. Exercise is done with both limbs 4-8 times.
• Exercise No. 6. Bend your back without lifting the pelvis, with partial tension. Repeat several times.
• Exercise number 7. Conduct minute breathing exercises.

As improvements occur, the exercise therapy complex becomes more complex in the late period of hemiparesis treatment. Further physiotherapy exercises are performed in reclining positions, sitting, standing. Also, gymnastics is supplemented by walking and self-service training.