Stroke (lat. insulto – jump, jump) – an acute violation of cerebral circulation (hemorrhage, etc.), causing the death of brain tissue.

Causes of a stroke

It is caused by blockage (ischemia) or rupture (hemorrhage – hemorrhage) of one or another vessel that feeds part of the brain, or hemorrhage in the meninges.

Types of strokes

Thus, there are two types of stroke: hemorrhagic type stroke, hemorrhagic (vessel rupture and hemorrhage) and ischemic type stroke, ischemic (vessel blockage). Most often, both hemorrhagic stroke and ischemic stroke develop against the background of hypertension, heart disease (atrial fibrillation, defects, paroxysmal tachycardia), heart failure, cerebral atherosclerosis.

In ischemic stroke, the most common cause of blockage is: pieces that come off atherosclerotic plaques in large vessels of the neck or thrombotic overlays on the heart valves; blood clots that form on large plaques in places of vasoconstriction, vasospasm for a long time also cause ischemic stroke.

Stroke Symptoms

A hemorrhagic stroke differs from an ischemic stroke in that the rupture of the vessel occurs at high blood pressure, since the wall of the artery in atherosclerosis is unevenly thinned. With such a stroke, blood under high pressure pushes the brain tissue apart and fills the resulting cavity, so a blood tumor, or intracerebral hematoma, occurs. Or, with a hemorrhagic stroke, a hemorrhage occurs when a saccular formation on the vessel wall, called an aneurysm, ruptures, such a hemorrhage often occurs in the meninges and is called subarachnoid (SAH). There is such a hemorrhage more often up to 40 years. Suddenly there is a feeling of a blow to the head (sometimes it is compared with a dagger in the head), a severe headache (with all this, a person screams in pain and then loses consciousness), there may be convulsions, but consciousness, usually recovers. The patient is drowsy, lethargic, groans in pain, holds his head with his hands, vomiting, nausea are frequent. But, unlike a stroke with hemorrhage and with the formation of a cerebral hematoma, such a patient does not have paralysis.

However, ischemic stroke is more insidious than hemorrhagic stroke, sometimes the signs of ischemic stroke are indistinct, increase gradually or “flicker”. With a hemorrhagic stroke in the cerebral hemisphere with the formation of an intracerebral hematoma, the manifestations are violent: against the background of a hypertensive crisis, a headache occurs or significantly intensifies, often in one half of the head, then the patient loses consciousness, the face becomes gray or red, hoarse breathing, often there is repeated vomiting . After some time, with such a stroke, a seizure may develop with a predominance of seizures on one half of the body, the pupil on the side of the stroke expands. If the patient regains consciousness, then his limbs are paralyzed, if on the right, then speech disorders (aphasia) are noted, if on the left, then the sick person has pronounced mental deviations (does not know how old he is, where he is, does not recognize his relatives, considers himself completely healthy, etc.). With such an ischemic stroke, stiff neck muscles are always observed: it is unbelievable to bend the head in front so that the chin touches the chest (due to the pronounced tension of the neck muscles) and stiffness of the leg muscles: it is incredible to raise the straight leg behind the heel (also due to the pronounced tension of the leg muscles) – signs of irritation of the meninges with blood, the so-called. meningeal syndrome. With hemorrhagic stroke in the brainstem, patients do not live more than 2 days and die without regaining consciousness. With subarachnoid hemorrhage from an aneurysm, stroke often occurs as a result of physical activity: lifting weights, trying to break a stick through the knee, nervous stress,

Transient disorders of cerebral circulation (TIMC) are the most insidious. Depending on the side and location of the brain lesion, weakness occurs in the arm or arm and leg on one side, often accompanied by speech disorders – “porridge in the mouth”, or “verbal okroshka” (aphasia), sometimes blindness develops in half of the visual field or complete. These phenomena disappear after a few minutes or less than hours, but during the day they can be repeated more than once. An ambulance doctor who came to the call can already see a “healthy person”, although 10-15 minutes ago the patient could not say a word or move his hand. At this time, the relatives have calmed down and the doctor is not particularly worried, the patient stays at home, and wakes up in the morning with total aphasia and half paralyzed. The presence of PNMK is a 100% indication for hospitalization by ambulance,

Recognition of acute cerebrovascular accident is not difficult when there are gross paralysis, disorders of consciousness and speech, it is more difficult with transient disorders, but the tactic must be the same – hospitalization by ambulance, if the patient is not very old and not in a coma.

First aid for stroke

First of all, the sick person will need to be comfortably laid on the bed and unfasten clothing that makes it difficult to breathe, to give a sufficient supply of fresh air. Remove dentures, vomit from the mouth. The head, shoulders should lie on the pillow so that there is no flexion of the neck and deterioration of blood flow through the vertebral arteries. With the development of a stroke, the first minutes and hours of the disease are the most expensive, it is at this time that medical care can be most effective.

A patient with a stroke is always transportable lying down, only if it is not a coma of the 3rd stage. Patients do not often die directly from a stroke, pneumonia and bedsores most often join a stroke, which requires constant care, turning from side to side, changing wet linen, feeding, cleansing the intestines, and vibromassage of the chest.

Stroke treatment

Stroke treatment includes a course of vascular therapy, the use of products that improve brain metabolism, oxygen therapy, restorative treatment or rehabilitation (physiotherapy exercises, physiotherapy, massage).

Rehabilitation after a stroke

First of all, it will be necessary to monitor the indicators of blood pressure, the pulse of the patient and monitor the severity of the recommended medication products. An important point in care is to control body temperature, the amount of urine excreted and the regularity of the stool. To do this, it is necessary to have a special notebook, in which it is necessary to carefully reflect the dynamics of changes in these vital signs, since this is important for correcting the therapy. If the stool is delayed for more than three days, you will need to do a cleansing enema. In case of urinary retention and fever, you will need to immediately inform your doctor about this.

The room in which the patient is located must be bright, protected from noise. Indoors, it is desirable to carry out wet cleaning 1-2 times every day, regularly ventilate, while avoiding drafts. The optimum air temperature is +18-22°С.

The bed on which the patient lies should not bend. The most hygienic and comfortable foam mattress. If the patient does not control his physiological functions, put an oilcloth on the mattress, under the sheet, or put a diaper on the patient. When changing bed linen, which must be done as needed, the sick person is carefully turned to the edge of the bed, the old sheet is folded like a bandage, and a fresh one is laid on the vacated part of the bed, where the sick person is “rolled”.

It is advisable to carry out breathing exercises with patients several times every day. The simplest of the breathing exercises, performed even by weakened patients, is inflating balloons, rubber toys. In order to prevent bedsores and congestion in the lungs, patients will need to be turned over in bed after 2-3 hours, massaged with light tapping with a cup-shaped bent palm on the lateral sections of the chest and under the shoulder blades.

If the patient is not likely to move independently, it will be necessary to regularly, 2-3 times every day, wash the sick person, carefully monitor the condition of the visible mucous membranes and skin, regularly wipe the body of the sick person with a damp towel dipped in a mild soapy solution with further wiping dry. You should also have a bedpan and a urinal. Particular attention should be paid to the toilet of the oral cavity and the perineum. For the prevention of conjunctivitis, it is recommended to instill a solution of albucid into the eyes 2-3 times a week.

You should know that in patients who have had a stroke, the characterological features of the personality are sharpened. They can become whiny and passive or, conversely, rude and irritable. Memory suffers significantly, patients remember current events especially poorly, many have speech impairment. It is necessary to treat these manifestations of the disease with understanding, but not to indulge the patient in his whims and whims, at the same time avoid conflicts, be sure to follow the regimen. It is good to tell the patient about yourself, loved ones, try to communicate with him on various topics, ask him to talk about his desires, name the surrounding objects, correctly pronouncing syllables and sounds. Read newspapers, books to patients, ask them to retell what they have read. A healthy psychological climate in the family is the key to successful restoration of lost functions.

An important point of rehabilitation is the proper feeding of the sick. The calorie content of the diet should be reduced to 2200-2500 kcal per day, mainly due to carbohydrates and animal fats, the consumption of flour products, sugar should be sharply reduced, try to give more vegetables and fruits, exclude salty, spicy, fried foods from the diet. It is advisable to feed the sick person 4-5 times every day with the main calorie load in the morning and afternoon hours.

In any case, if a stroke occurs, it should be remembered that part of the brain cells, neurons, died, and the question of the complete restoration of lost functions, despite the high compensatory probabilities of the brain, is very problematic. Restoring lost skills most often takes a long period of time and requires, along with the use of appropriate medications, competent patient care and his own desire to live a full life. The success of rehabilitation treatment is related to the learning process, therefore, as in school, there may be capable and less capable, active and passive patients. Helping the patient in learning is the main task of the medical staff and socially significant persons, but it must be remembered that only the active life position of the patient himself,

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