Ischemic stroke is a serious disease in which blood flow to the brain is disrupted. The lumen in one of the arteries feeding the brain is closed. Usually the cause of this is blockage by a thrombus, less often a spasm. If there is no blood flow, then the brain tissues suffer due to the lack of oxygen and nutrients. Symptoms of ischemic stroke develop almost immediately. After 5 minutes, the cells begin to die if the blood flow is not restored. The disease can be more or less severe, depending on how large the artery is blocked and how important the parts of the brain it serves are. Read the article - learn about the causes, symptoms, diagnosis, treatment and consequences. Understand the methods of rehabilitation after a stroke. Learn about the restoration of speech and work, the optimal nutrition of the patient, the treatment of urinary and fecal incontinence.
Ischemic stroke: detailed article
The success of treatment is largely determined by how quickly the patient manages to get medical help. Ischemic stroke usually does not cause pain. This is more bad than good, because patients expect the symptoms to go away on their own and do not call a doctor. They lose valuable time while their brain tissue dies. Details on symptoms, diagnosis, and emergency care are provided below. It also provides information about treatment that patients and their loved ones need to know. Practical advice is given on rehabilitation after a stroke in a sanatorium and at home.
Ischemic stroke: a medical dictionary
Watch a video about the causes and treatment of stroke from the famous doctor Elena Malysheva. Take a tour of the institute in Moscow, which provides emergency care to patients with ischemic stroke, and then spend a long rehabilitation. Learn about modern rehabilitation methods that give the best results.
Ischemia is a process characterized by a lack of oxygen and nutrients. A heart attack is a possible outcome of this process. Sometimes cerebral ischemia does not last long. A heart attack does not have time to develop, because the blood flow is quickly restored. This is called a transient ischemic attack, popularly called a microstroke. In such cases, the symptoms of a stroke pass quickly, usually before the arrival of a doctor. However, if a transient ischemic attack occurs, the patient must be hospitalized and intensively treated to prevent a "real" ischemic stroke. Read the detailed article "". Take microstroke seriously.
Ischemic stroke: causes
The cause of ischemic stroke is usually that the patient did not pay attention to their risk factors and did not take measures to control them. Hypertension and atherosclerosis eventually lead to a stroke if the patient does not have time to die earlier from cardiovascular diseases. It is especially bad if hypertension is aggravated by smoking or diabetes. Additional risk factors are alcohol abuse, unhealthy diet, sedentary lifestyle, heart problems, in particular ventricular (atrial) fibrillation.
If you want to eliminate the causes that can cause blockage of blood circulation in the brain, then study the article "". Find out what are good pills for cholesterol and hypertension. To control risk factors, it is not necessary to sit on a "hungry" diet and hard labor in physical education. Leading a healthy lifestyle is easier than you think.
Typically, an ischemic stroke occurs when one of the arteries supplying the brain becomes blocked by a blood clot. If the carotid artery is significantly affected by atherosclerosis, then a blood clot can form in one of its problem areas. Such a stroke is called thrombotic. Sometimes a blood clot forms in another part of the body and then breaks off and travels with the blood. It eventually clogs one of the arteries that carry blood to the brain. Such a stroke is embolic. If a blood clot formed in the heart due to problems with valves or atrial fibrillation, then the stroke is cardioembolic.
Read also the detailed article "". Learn about all the possible causes of the disaster and how to reliably protect yourself from them.
Symptoms
Symptoms of ischemic stroke are individual, different patients are not similar. What they will be depends on how large the artery was blocked, and on the importance of the parts of the brain that it served. As a rule, signs of ischemic stroke are detected suddenly and abruptly. The most common of these are problems with pronunciation of words, as well as with understanding someone else's speech. All other symptoms are less common. There may be visual impairment, reduced mobility or complete paralysis of the arms, legs, muscle flabbiness on one half of the face.
Are you experiencing symptoms of a stroke in yourself or someone else? Urgently call an ambulance! Don't expect it to go away on its own. People who have had a cerebral infarction usually do not complain of pain, but they behave strangely - they slur words, the body does not obey them, they do not understand other people's speech well. Every minute of delay in treatment increases the patient's chances of remaining disabled.
In severe ischemic stroke, the patient may lose consciousness, but this does not happen often. Usually a person does not experience pain, but only confusion, dizziness. Others may guess that his condition is serious, even if the patient assures that there are no problems. Changes in character, urinary incontinence, difficulty swallowing are symptoms that do not appear immediately, but only after a few hours or days. Read the detailed article "". Find out how the signs differ in women and men. Learn to distinguish a stroke from other conditions that cause similar symptoms.
Watch the video in which the famous doctor Myasnikov talks about the prevention of ischemic stroke in an elderly person. Find out what symptoms warn that the risk of a cerebral infarction is increased.
Diagnostics
The doctor may suspect a stroke based on the results of a visual examination of the patient, if he cannot pronounce words, he has impaired coordination of movements and facial expressions. But an accurate diagnosis can only be made when doctors do tests and conduct examinations. The first step is computed tomography (CT). Therefore, ambulance workers are trying to quickly deliver patients with suspected stroke to a medical facility equipped with a CT scan machine. This examination allows you to accurately determine whether the patient had a stroke. And if it really is a stroke, then which one is ischemic or hemorrhagic.
Examining the patient at the scene, the doctor will ask him and the people around him when the unusual symptoms began and what they were expressed in. He will be interested in whether the patient has had a previous case of heart attack, head injury, stroke or microstroke (transient ischemic attack). With a stethoscope, your doctor will listen to your heart and carotid arteries in your neck. If these arteries are significantly affected by atherosclerosis, then there will be characteristic noises in the stethoscope. The doctor will measure the patient's blood pressure and ask what medications for hypertension he is taking. An ophthalmoscope can detect cholesterol deposits or blood clots in the vessels leading to the eyes.
Tests and examinations for the diagnosis of ischemic stroke
| Blood tests | The laboratory will give a report - how fast the patient's blood coagulates, what are the blood sugar levels, whether the electrolyte content is normal, whether there is an infection. Doctors will try to normalize those indicators that turn out to be problematic. |
| Computed tomography (CT) | During this examination, many x-rays are taken to get a complete picture of the brain. CT can detect hemorrhage, ischemic stroke, brain cancer and other diseases. |
| Magnetic resonance imaging (MRI) | They do not use X-rays, as in CT, but radio waves. MRI equipment is very expensive and therefore not available everywhere. The patient needs to lie still for a long time. MRI is worse than CT in distinguishing ischemic from hemorrhagic stroke. Therefore, it is recommended to do a CT scan first. |
| Ultrasound of the carotid arteries | Sound waves bounce off body tissues. The computer analyzes these reflections and draws a visual picture. Ultrasound of the carotid arteries allows you to find out how much the vessels are affected by atherosclerosis, whether an operation called carotid endarterectomy is needed. Ultrasound is a painless, harmless and affordable examination that provides important information. |
| Echocardiogram (EchoCG) | With the help of sound waves, a visual picture of the heart is obtained. An echocardiogram is prescribed if doctors suspect that the cause of an ischemic stroke was a blood clot that formed in the heart and then rose up with the blood. |
| Cerebral angiography | If you inject a dye into the blood, then x-rays will be much more informative. A catheter is inserted into an artery in the groin area, it is led through the vessels to the neck, then a dye is injected, the catheter is removed and pictures are taken. Cerebral angiography is a complex and unsafe examination. It is prescribed, as a rule, in severe cases. |
First of all, it is recommended to do a computed tomography to make sure that the stroke is ischemic and not hemorrhagic. Immediately after this, treatment begins, so as not to waste time. Other diagnostic procedures are performed in parallel with treatment. Read the article "". Learn more about differential diagnosis.
Ischemic stroke: treatment
First read the article " "to find out how the patient and the people around him should act before the arrival of the doctor. The main treatment of ischemic stroke is carried out in a medical institution. The sooner the patient is taken to the intensive care unit, the better the prognosis for him. Doctors will take measures to quickly dissolve the clot, restore normal blood supply to the brain and stop the death of its tissues. This goal is achieved with the help of drugs. Rarely used surgical methods.
The only drug approved for use in ischemic stroke to dissolve blood clots is called tissue plasminogen activator. It is administered intravenously. It is necessary to start treatment with this remedy no later than 3 hours after the stroke occurred. Unfortunately, tissue plasminogen activator has many contraindications and often causes side effects, even as severe as hemorrhagic stroke. Therefore, it is prescribed only to a small number of patients abroad, and even less frequently in Russian-speaking countries.
Treatment is most effective in the first 1-3 hours from the onset of the disease. It is possible to give aspirin or other tablets to the patient only after they are convinced that it was an ischemic stroke, and not a hemorrhagic one. The main drug is tissue plasminogen activator. Blood-thinning drugs are deadly for cerebral hemorrhage, which is similar in symptoms to clot blockage in the arteries that feed the brain.
First of all, the patient is given a CT scan. If her results show that the stroke is really ischemic and not hemorrhagic, aspirin is immediately given. This drug reduces the risk of another stroke. Unfortunately, it does not dissolve a clot that has already blocked an artery. At the scene of the incident, until the arrival of the doctor, the patient should not be given either aspirin or any other medicines! In well-equipped clinics, there is another way - to bring a small device through the vessels to the site of blockage of the artery in order to mechanically remove the clot. Or, with this device, you can inject tissue plasminogen activator directly into the right place. Unfortunately, research data refute the effectiveness of this treatment, so it is not used.
Carotid endarterectomy is a surgical procedure to remove atherosclerotic plaques from the carotid arteries. After the operation, the arteries are patched with patches, which are made from artificial material or from the patient's own veins. If the carotid arteries are significantly affected by atherosclerosis, then carotid endarterectomy may reduce the risk of recurrent cerebral infarction. Unfortunately, this operation itself carries a risk, albeit a small one. Instead of scraping the plaques out of the carotid arteries, you can widen the lumen in them with angioplasty or stenting. But large-scale studies have shown that alternative options for surgery carry no less risk.
Study the article "". Read all the details about the use of tissue plasminogen activator - indications for use, contraindications, possible side effects. Understand also the other drugs that are prescribed for ischemic stroke. These are antiplatelet agents, anticoagulants, blood pressure pills and statins for cholesterol. Find out what relatives need to do while the patient is in the hospital.
Rehabilitation
Rehabilitation is a long-term treatment that is carried out after the acute period of a stroke has ended. Its goals are to strengthen the strength of the patient, restore or compensate for lost functions, return a person to a full life, as far as possible. The rehabilitation program for each patient who has had a stroke, doctors make up individually. Its basis is physical therapy. You need to exercise with the maximum intensity that you can withstand, alternating classes with rest. Passive rehabilitation methods give questionable results, and physical education really helps.
Rehabilitation should begin as early as possible, even in the hospital, preferably in the first days after a stroke. Early initiation of rehabilitation has been shown to improve prognosis. After discharge from the hospital, it is advisable for the patient to spend some time in a rehabilitation center, and then be treated at home. In addition to a specialist in physical therapy, a speech therapist and, possibly, a counseling psychologist should work with a patient who has had a stroke. You will probably need to consult an ophthalmologist. There are also people who are engaged in the preparation of living space for people with disabilities.
Read detailed articles:
- how they can help in a rehabilitation center;
- how to make life easier at home;
- overcoming depression after a stroke;
- return to work.
Consequences
A micro-stroke or a mild ischemic stroke in young people can pass without leaving any consequences at all. But this rarely happens. Only 10-15% of people who have had a stroke can boast of ideal health. The rest of their lives struggle with the complications of this disease, which can be more or less severe.
Consequences of ischemic stroke:
- weakness or paralysis in the arms and legs, usually on one side of the body
- deterioration of skin sensitivity to touch and temperature;
- problems with pronunciation of words, understanding of speech, written text, numbers;
- visual impairment - partial blindness, double vision;
- weakening of memory and ability to concentrate;
- urinary or fecal incontinence, constipation;
- depression, anxiety, irritability, emotional instability;
- pain syndrome, especially often in the shoulders;
- intimate problems due to physiological and psychological reasons;
- sleep disorders.
People who have lost mobility due to a stroke face additional risks:
- bedsores;
- deep vein thrombosis;
- pneumonia.
Watch a video on how to care for a bedridden patient who has had a severe stroke.
Arms and legs that do not move for a long time can bend and harden so that they can no longer be straightened without damage. This is called contracture. To avoid them, you need to perform at least passive exercises for flexion and extension of the joints every few hours. Perhaps over time the brain will regain control over them. Read the detailed article "". Find out how the consequences of acute cerebrovascular accident that affected the right and left hemispheres differ.
Forecast
About 20% of people who have an ischemic stroke die in the first hours or later in the hospital. Another 40-50% remain disabled, more or less able to serve themselves. The older the patient, the higher the likelihood of an adverse outcome. 10% of people who have a cerebral infarction recover completely. Another 25% have visible signs that they have had a serious illness, but can lead a normal life.
The faster the patient is delivered to a medical institution, the more favorable the prognosis for him. Therefore, at the slightest suspicion of a stroke, immediately call an ambulance. Don't waste time! Do not be afraid to bother doctors in vain, pay for a false emergency call. The risk of severe consequences of ischemic or hemorrhagic stroke is so high that it outweighs all these dangers.
The prognosis after an ischemic stroke depends on the desire and ability of the patient to engage in physical therapy, as well as work on restoring speech. Many people manage to fully recover, as if they never had a stroke. To do this, you need to diligently perform rehabilitation exercises. For patients who rely on charlatan remedies, the prognosis is rather unfavorable.
Above are data from English-language sources. In Russian-speaking countries, the prognosis for patients is less favorable because ambulances travel slowly, intensive care units are poorly equipped, and their staff rarely receive training in stroke management. In Western countries, a lot of money is allocated for the long-term rehabilitation of patients. In Russian-speaking countries, the injured person and his family receive little help from the state and the people around them.
While a patient who has had a cerebral vascular accident is in the hospital, doctors are afraid to make predictions in the first few days. Only later does it become clear how the situation is developing. People who are paralyzed on one side of their body may hope that physical therapy will help them partially restore lost functions. This goal is achieved by 50% of patients - those who diligently exercise. Restoring the work of a paralyzed arm is usually more difficult than the legs. Physical limitations that have not disappeared 12 months after a stroke are likely to remain forever.
