Stroke (synonym - acute cerebrovascular accident) is the death of a part of the brain associated with the cessation of its blood supply.

Causes of stroke

If the reason for the cessation of blood supply is blockage of the artery by atherosclerotic plaque and/or thrombus, it is said ischemic stroke .

If the cause is a rupture of the artery and hemorrhage, they speak of hemorrhagic stroke . The most common causes of hemorrhagic stroke are rupture of a dilated section of an artery (a congenital pathology of the vessel called an aneurysm) or rupture of an artery due to high blood pressure.

When brain cells in a certain area of ​​the brain die, the functions for which that area of ​​the brain was responsible are disrupted or completely lost. Typically, a stroke occurs in one half of the brain and loss of function occurs on the opposite half of the human body (due to the crossing of nerve pathways from the brain to the human body). For example, when the right side of the brain is damaged, there is a decrease in strength and sensitivity in the left side of the body. In addition, it is necessary to remember that in humans the left half of the brain is responsible for mental functions and speech. If a stroke occurs in the left half, this leads to a severe impairment of the patient’s speech (slurred speech or its complete absence) and understanding of the speech of others.

The brain consists of several parts: on top, the cerebral cortex, which is responsible for thinking, feelings, speech, and muscle movements of a person. The subcortical part of the brain is responsible for basic functions: breathing, heart function, maintaining blood pressure, etc. In addition, in the posterior parts of the brain there is the cerebellum, which is responsible for the coordination of movements. Depending on the affected area, certain functions are impaired. The cerebral cortex is most often affected.

Symptoms of a stroke:

• Movement violations, especially in the limbs. Decreased strength or complete cessation of movement in the arms or legs
• Sensory disorders: decrease or loss of perception of pain, temperature, etc. usually most noticeable in the extremities
• Visual impairment. For example, half of the vision (left or right) of one eye may be lost
• Speech disorders: slurred, unclear speech, complete inability to speak or understand speech
• Standing disorders: when standing, the patient sways and may fall
• Impaired consciousness: from drowsiness to complete loss of consciousness.
• Less important symptoms, often found in other diseases, are: headache (may occur with migraine), dizziness (often occurs with ear disease), muscle cramps (epilepsy).

If a person suddenly develops the symptoms described above, it is necessary to suspect the development of a stroke and urgently consult a doctor.

Video about the signs of a stroke and what to do if you suspect a stroke:

If you find yourself next to a person who you suspect is developing a stroke, you need to make him lie down comfortably and urgently call an ambulance. There is no need to give the patient any medications. If the patient is unconscious, he should not be left lying on his back! An unconscious person has reduced muscle strength and the tongue can close the windpipe and the person will die from suffocation. An unconscious person should always be kept on their side, so that saliva can flow from the mouth and the tongue cannot obstruct breathing.

In approximately three out of four cases, the symptoms of a stroke are mild and disappear within 24 hours. This is a transient disorder of cerebral circulation (another name is transient ischemic attack). Name " microstroke ” is not currently used by doctors.

Such short-term transient strokes or micro-strokes serve as a warning. The risk of developing major strokes with severe consequences after them is very high, so planned treatment is required to prevent the development of a recurrent stroke.

Stroke treatment

Regardless of the nature of the stroke, emergency hospitalization in a hospital is indicated, and in severe cases, observation in an intensive care unit. Refusal to hospitalize a patient with a stroke due to old age (usually over 70-80 years of age) is a grave mistake. In this situation, the persistence of the patient's relatives is necessary.

Treatment of stroke depends on the nature of the brain damage (type of stroke): hemorrhage or ischemia (closure of a vessel).

To confirm the diagnosis and determine the nature of the stroke, a computed tomography of the brain (CT brain) or magnetic resonance imaging of the brain (MRI of the brain) is performed. These are the most informative methods that allow you to make an accurate diagnosis and determine the prognosis of the disease.

Hemorrhagic stroke (bleeding) is usually more severe than ischemic stroke. In case of hemorrhage, a consultation with a neurosurgeon is required and a decision on a possible neurosurgical operation to remove the bloody area (hematoma) or clamp the bleeding vessel is required. Neurosurgical operations are often necessary, but involve a high risk for the patient.

Ischemic stroke does not require neurosurgical treatment. Early hospitalization, regardless of the patient’s age (!), observation in a hospital setting, attentive care for the patient and symptomatic therapy determine the outcome of the disease. Already in the first days of the disease, with a stable course, activation of the patient with physical therapy is indicated.

It must be remembered that there are no effective medications to treat stroke. Medicines are prescribed to prevent recurrent strokes and to combat complications of the disease. Careful monitoring of the patient and symptomatic therapy to maintain optimal blood pressure numbers, combating complications, as well as prescribing medications to prevent stroke recurrences are the basis of treatment!

Treatment after a stroke includes

conducting a course of vascular therapy,

the use of drugs that improve brain metabolism,

oxygen therapy,

restorative treatment or rehabilitation (therapeutic exercise, physiotherapy, massage).

In case of a stroke, call emergency medical help immediately! Failure to provide immediate assistance will result in the death of the patient! With stroke treatment and rehabilitation, some effects of a stroke can be alleviated and others completely eliminated. For many people, however, some physical or neurological disabilities remain for the rest of their lives.

After a stroke

Symptoms after a stroke depend on which area of ​​the brain is affected. Accordingly, the functions controlled by this area are disrupted. After a stroke, you may experience loss of muscle control over any part of the body or greater weakness and paralysis on one side of the body. The ability to speak and understand speech may be impaired. People affected by a stroke often show confusion, helplessness, and emotional instability.

What to do immediately after a stroke: first aid

If symptoms of acute cerebrovascular accident appear, be sure to immediately call emergency help in order to begin treatment as early as possible.

In the first hours of the development of the disease, it is impossible to predict its further course: whether the symptoms regress in 24 hours, or in a month, or in a year. TIA and minor stroke are, of course, more favorable, but still do not give reason for joy and relief. These types of cerebral circulatory disorders are the “first call”, which may be followed by a more serious outcome. That is why it is necessary not only to start treatment early, but also after restoration of lost functions, to begin secondary prevention of stroke.

Why is hospitalization necessary immediately after a stroke?

If the doctor has diagnosed a stroke, then there is no need to refuse the proposed hospitalization, as patients often do. Often the refusal is motivated by the need to stay at home due to family problems that require the active participation of the sick person. Sometimes people show distrust of inpatient treatment, asking the doctor questions: “What will they do there?” Other reasons are also cited. This behavior is wrong.

On the first day, a patient with a stroke should be hospitalized for examination and treatment. During the first 3 days, it is recommended to conduct ultrasound examinations that will show the condition of the vessels responsible for cerebral circulation. They include duplex scanning of the main arteries of the head (DS), transcranial Doppler ultrasound (TCD). A heart examination is required: ECG, echocardiography and study of hemorheological properties of blood (hematocrit, viscosity, fibrinogen level, platelet aggregation, erythrocytes, etc.)

An accurate diagnosis, which reflects the location and nature of the stroke (ischemic or hemorrhagic), is established during computed tomography of the brain or magnetic resonance imaging. If necessary, the examination plan may include cerebral angiography, Holter ECG monitoring, 24-hour blood pressure monitoring and other methods that take into account the individual characteristics of the patient.

As a result of a comprehensive clinical, instrumental and laboratory examination, it is possible to reveal the main cause and mechanisms of stroke in a particular patient. This is necessary to know in order to carry out the correct treatment, which takes into account the subtype of stroke. Researchers at the Research Institute of Neurology of the Russian Academy of Medical Sciences have identified five subtypes of ischemic stroke and their diagnostic criteria, which determines the treatment option in each specific case. We do not go into professional difficulties here; this is the task of special medical literature. Our task is to teach people who respect their health to correctly assess an acute situation and wisely manage their chance to survive.

Nutrition immediately after a stroke

Stroke is a serious disease that requires a lot of energy from the patient. But often patients are weakened and cannot eat normally or have impaired swallowing. In these cases, therapeutic nutrition with special protein mixtures is required: nutrizon, berlamin-modular, etc. These mixtures can be administered through a special tube installed through the nose into the stomach (nasogastric tube) if the patient does not swallow, or given as the main food or added to another food. The packaging of the drug must indicate: for feeding by mouth or nasogastric tube. In pharmacies, the drug nitridrink is available for sale in 200 ml, 5 different flavors. To fully provide the patient with nutrition, it is enough to slowly drink (it is better to suck through the attached straw, this promotes better absorption of nutrition) 3-4 packets of nutridrink per day.

Gradually, as far as possible, during the rehabilitation process the patient is transferred to regular food.

Recovery after a stroke

The recovery period after a stroke begins on the first day (usually after a few days) of the illness.

The most important components of the early recovery period are physical therapy. It is especially important to exercise with affected limbs. If an arm or leg does not move, passive flexion of the limb at the joints and early initiation of light massage (stroking) are necessary.

In a more distant recovery period (1-2 weeks from the onset of the disease), it is necessary to teach the patient self-care. Visual and auditory stress is required: music, conversations with relatives, watching TV, walking outside in a sitting chair. More active physical therapy and therapeutic massage continues, especially of the affected limbs. It is very important to prevent immobilization of the affected limbs in the joints (so-called contracture): foot drop, flexion of the hand, etc.

Patients who have had a stroke may have urinary or stool incontinence or, conversely, difficulty urinating or stool retention. This needs to be monitored carefully. In addition, it is necessary to explain to the patient that the changes are temporary and teach correct behavior (wearing diapers, enemas, etc.).

For rehabilitation to be effective, the patient's desire to participate in rehabilitation is necessary. The patient must have sufficient mental capacity to follow at least simple commands and also be able to remember rehabilitation exercises. In a patient also suffering from coronary artery disease (angina pectoris, post-infarction cardiosclerosis, arrhythmia), a neurological rehabilitation program should be carried out in conjunction with a cardiological one.

Frequency: twice a day, every day, in a hospital setting. At home every day. The likelihood of improvement in motor functions in paralyzed limbs is greatest in the first 6 months. Speech improvement can continue for up to 2 years. Movement in the arm is usually restored worse than in the leg. The absence of any movements in the arm within 4 weeks after stroke is a poor prognostic sign for the restoration of motor function. According to statistics, 50% of patients who have suffered an ischemic stroke manage to achieve good effects from rehabilitation. For patients who have suffered a hemorrhagic stroke, this figure is lower. About a third of patients who have suffered stroke and survived remain dependent on outside help for a year. This proportion remains stable 5 years after the stroke.

If a stroke occurs, early hospitalization and initiation of treatment, as well as subsequent full rehabilitation of the patient, are the key to the most favorable outcome of the disease.

Rehabilitation after stroke

Rehabilitation after a stroke is one of the most important tasks of modern medicine. The basic principles of rehabilitation after a stroke are early, timely start, systematicity and duration of rehabilitation treatment.

A cerebrovascular accident leads to the formation of a pathological focus in the brain. The core of the lesion consists of dead nerve cells, and the cells near it are in a state of reduced activity or complete inhibition. Timely treatment measures can restore their activity.

It is necessary to begin rehabilitation in the first month after a stroke, that is, during the patient’s stay in the hospital. A lot depends on the psychological mood of the patient. Optimism, the desire to achieve a set goal, and an active attitude towards life help to overcome the disease. After discharge from the hospital, the rehabilitation process should continue. The work of specialists in the recovery of a patient after a stroke is coordinated by a neurologist or rehabilitation specialist.

Recovery after a stroke includes drug support, active non-drug treatment (according to indications depending on the type of disorder: physiotherapy, exercise therapy, massage, psychotherapy) and teaching the patient skills impaired or lost due to a stroke.

In patients who have suffered a mini-stroke, all functions are usually restored within a month. But a micro-stroke is just a warning that the blood supply system to the brain in this person is far from being in the best condition. That is, a stroke can recur at any time and lead to more devastating consequences. What to do?

There is a unique modern approach to rehabilitation: to fight the root cause of strokes - changes in the composition of the blood at the cellular and molecular level. This approach is unique: doctors change his own blood through various physical, chemical and biological manipulations. Returned to the body, it becomes a medicine, devoid of side effects and extremely effective. New techniques have become a real miracle for those who suffer from atherosclerosis, coronary heart disease, atherosclerosis of the blood vessels of the brain, kidneys, lower extremities or hypertension.

The patient's own blood plasma, properly prepared by surgeons, dissolves cholesterol plaques. Then harmful substances are again removed from the blood - and so on until a lasting result is achieved. After a course of treatment, the lumen of blood vessels and their elasticity are restored, the risk of heart attack or stroke is reduced, and blood pressure is normalized. “Rejuvenation” of blood vessels naturally leads to the restoration of all body functions. Lipid metabolism and hormonal levels are normalized, the appearance of the skin, complexion, and the condition of hair and nails are improved. Painless procedures (from 2 to 10 depending on the severity of the disease and the technique selected by doctors) are carried out on an outpatient basis, once every two days, and take no more than three hours.

Thus, timely and properly organized rehabilitation of patients after a stroke helps restore their health, return to a full life and reduces the risk of relapse.

Caring for a stroke patient at home.

First of all, you should properly organize those places in the house that will become the patient’s main living areas for some time.

The bed needs to be moved away from the wall so that you can approach it from any side. This will greatly facilitate patient care. It is better to raise the head of the bed so that it is easier for the patient to sit, leaning on pillows. The mattress must be firm and even. The blanket - or rather its heaviness, which we, healthy people, do not notice - can contribute to the formation of bedsores in a sick person who is forced to lie motionless. It is necessary to make a special frame out of cardboard and attach it to the bed so that the blanket rests on the frame.

The room should be warm - after all, a person lying motionless becomes hypothermic very quickly. However, the room must be ventilated several times a day.

The patient should be able to call you from another room or from the kitchen at any moment. You can place a bell near the bed or agree on some other signal that means that the patient urgently needs your attention.

If the patient can already stand up on his own, it is necessary to ensure that there is a comfortable chair near the bed. It should be low (to make it easier to stand up), with a hard seat and fairly wide armrests. You can attach a homemade table to the chair - it will serve as support for a paralyzed arm. In addition, such a table will be convenient for eating and various other activities - reading, restorative exercises.

At first, when the patient begins to move around the apartment, he, who still does not know how to fully control his body, will probably fall. Therefore, it is necessary to carefully inspect the apartment and remove everything that could cause falls (rugs, wires) and become a source of increased danger (heating devices).

It is necessary to ensure that the entire apartment is well lit.

After returning home from the hospital, the patient’s rehabilitation should initially be carried out under the supervision of a neurologist. Sometimes the disorders caused by a stroke go away quickly, and after a few months the person can resume his previous job.

In other cases, restoration of impaired functions is delayed. You must be prepared for the fact that therapeutic exercises and speech restoration classes will be carried out for a long time and necessarily systematically. It is especially important to exercise in the first 2-3 months after a stroke. It is necessary to do the exercises, not miss a day, gradually increasing the load.

Physical therapy exercises should be agreed with your doctor. Specialized centers or rehabilitation departments can provide significant assistance. Programs have been developed for step-by-step rehabilitation of a person who has suffered a stroke, which can be used at home. By following it, you can help the patient gradually return to a normal, active life.

The process of recovery after a stroke is reminiscent of how a baby develops in the first months and years of life: first he learns to coordinate the movements of his limbs, then roll over, sit down, stand up, and walk. At the same time, control over the body’s excretory functions is enhanced. Social skills are formed: speech develops, a person learns to eat, dress, wash independently, masters the telephone, door locks, electrical appliances, and settles into the apartment space.

In almost the same way, a patient who has suffered a stroke learns to live again. And just like a small child, he needs support and love, the approval of his loved ones. If a patient is constantly spoken to kindly, if he feels that those around him are confident in his recovery, this adds strength and optimism to him.

It must be remembered that despite the need for independent activity, a person who has suffered a stroke will not be able to recover without outside help.

If you are almost at the limit - rest!!!

Many people neglect this simple rule, not giving themselves a break until fatigue literally knocks them off their feet. Meanwhile, rest breaks significantly increase efficiency in any type of activity, and not just in such physically and psychologically difficult work as caring for an immobile patient.

Don't hesitate to ask other people for help.

Help comes in a variety of forms - a neighbor or friend can sit with the patient while you rest or go to the store or pharmacy. Find ways to distract yourself from painful thoughts and improve your mood. When a difficult situation drags on for months, the ability to enjoy the little things in life is especially important. Give yourself small gifts, go to visit - this will help you hold out. Use traditional ways to relieve stress. Among them are walking, a variety of water treatments, sports, and aromatherapy. Use self-hypnosis and auto-training techniques.

Create a healthy eating program for yourself with the maximum content of vitamins, minerals and other beneficial nutrients. And most importantly: NEVER LOSE OPTIMISM!

A reminder for a person who has suffered a stroke.

Even if you are paralyzed, you still shouldn’t lose hope. Remember: the main and most effective method of restoring motor function is therapeutic exercises; general strengthening and breathing exercises are especially recommended.

Motor and speech disorders resulting from a stroke are better amenable to rehabilitation treatment in the first months.

Physical activity stimulates the ability of nerve cells to “relearn” and, to a certain extent, take on the responsibilities of the dead and compensate for their inaction.

The basic rule of physical activity is a gradual increase in loads.

It is necessary to constantly monitor blood pressure levels.

During the first year after a stroke, you must stop drinking alcoholic beverages, smoking, drinking coffee and other tonic drinks.

Do not lose optimism, avoid stressful situations, follow all doctor’s orders.

Try to be as active as possible and do everything you can yourself.

Complications and consequences of stroke

Treatment of a patient in the acute period of stroke is necessary in a specialized neurological department, which allows, through accurate diagnosis of the nature of the stroke, intensive treatment and early rehabilitation, to reduce mortality and disability among patients.

In the treatment of patients who have suffered a stroke, two main directions can be distinguished:
treatment of stroke consequences,
prevention of recurrent stroke and other diseases of the cardiovascular system.

Movement disorders– one of the most common and severe consequences of a stroke. Recovery of lost movements is maximum within two to three months after the stroke, it continues throughout the year and is most significant in the first six months. Restoration of the ability to move independently is observed even in patients in whom a stroke leads to a complete absence of movement in the limbs on one side (hemiplegia). With adequate physical therapy, most of these patients begin to stand and walk independently at least 3-6 months after the disease, which is one of the main goals of rehabilitation for severe motor disorders.

Therapeutic exercises should be carried out already in the first days after a stroke in the absence of contraindications to physical activity (for example, myocardial infarction or cerebral artery aneurysm). Movements in paralyzed limbs should be carried out for several (10-20) minutes at least three times a day, special attention should be paid to the joints (shoulder, elbow, hip and ankle), in which early and significant development of inflammation and limitation of mobility is possible. Active movements in paretic limbs must be trained immediately after their appearance, gradually increasing the load. In the absence of contraindications, patients should sit up in bed 2-3 days after the development of an ischemic stroke and one to two weeks after the occurrence of intracerebral hemorrhage. Then, if they sit confidently in bed, patients can sit in a chair or chair and learn to stand and use a wheelchair. In the future, patients should be taught to walk, using first special devices and then a stick. When conducting physical therapy, a gradual increase in physical activity is necessary. If the patient has a heart pathology (for example, arrhythmia or angina), then the rehabilitation program is coordinated with a cardiologist.

To reduce pain before gymnastics, you can use local anesthetic ointments or compresses with novocaine and dimexide, massage and reflexology.

If a patient after a stroke has speech disorders, speech therapy sessions are recommended. The patient must hear the speech of other people, radio, television and be able to communicate with others. It is necessary to encourage the patient to speak independently, even with a severe degree of impairment. Reading aloud, writing, drawing and other activities that stimulate speech functions are of great importance. The effectiveness of restoration of speech functions is largely determined by the patient’s motivation and his active participation in the rehabilitation process, therefore positive comments from the doctor and people around the patient about his success in classes are of great importance.

Decrease in memory and intelligence observed in a significant proportion of patients after a stroke. In order to improve memory and intelligence in patients who have suffered a stroke, you can use drugs that increase metabolic processes and blood supply to the brain. Treatment is often carried out in courses over one month, 2-4 times a year. Piracetam is used orally at 1.2-4.8 g/day. Gliatilin is prescribed orally at 0.8-2.4 g/day. Nimodipine is prescribed orally at a dose of 30-60 mg 3-4 times a day. Vinpocetine is administered orally at a dose of 5 mg 3 times a day. Nicergoline is used orally at a dose of 5 mg 3-4 times a day. Cinnarizine is prescribed orally at a dose of 25 mg 3-4 times a day. Nicardipine is used orally at a dose of 20 mg 2 times a day.

Depression occurs in more than half of patients after a stroke. It significantly complicates the process of rehabilitation of the patient, complicates his care and his contact with other people. Depression can manifest itself as headaches and other neurological disorders, which are sometimes mistakenly regarded as the progression of vascular damage to the brain in a patient who has suffered a stroke. Psychotherapy is used to treat depressive syndrome. It is advisable to tell the patient that many people who suffered a stroke were able to gradually restore lost abilities, everyday skills, and even return to their previous professional activities.

Stroke Prevention

Stroke is one of those diseases that is easier to prevent than to treat. It can be prevented with the help of rational organization of work and rest regimes, proper nutrition, sleep regulation, normal psychological climate, limiting sodium salt in the diet, timely treatment of cardiovascular diseases: coronary heart disease, hypertension.

The best way to avoid a stroke is to prevent atherosclerosis and other cardiovascular diseases. Monitoring your blood pressure and checking for diabetes are important here.

If necessary, take medications that improve microcirculation of blood vessels in the brain, and it is also possible to take medications that prevent a lack of oxygen (hypoxia) in the brain as prescribed by a doctor.

Prevention of recurrent stroke

One of the important areas of treatment for patients who have suffered a stroke is the prevention of recurrent stroke. The risk of recurrent stroke is increased in the presence of arterial hypertension, arrhythmia, heart valve pathology, congestive heart failure, and diabetes mellitus.

Prevention of recurrent stroke should begin as soon as possible and continue for at least 4 years. Maintaining a healthy lifestyle is important, which includes quitting smoking or reducing the number of cigarettes you smoke, avoiding drug use and alcohol abuse, adequate physical activity, and losing excess weight. It is advisable to reduce the consumption of foods containing large amounts of cholesterol (butter, eggs, fatty cottage cheese, etc.) and increase the amount of fresh vegetables and fruits in the diet. Women who have had a stroke are not recommended to use oral contraceptives.

Arterial hypertension is the most important correctable risk factor for stroke.

Patients who have had a stroke and have arterial hypertension may be advised to reduce their dietary salt intake, as this can lower blood pressure and therefore reduce the dose of antihypertensive drugs, which can cause unwanted side effects. If the patient is overweight, then it is recommended to achieve and maintain ideal body weight, which requires reducing the total calorie content of food and regular physical activity (therapeutic exercises, walking), the intensity of which is individual.

To prevent a recurrent stroke, patients who have suffered an ischemic stroke are recommended to take antiplatelet agents for 1-2 years or continuously: acetylsalicylic acid, dipyridamole, ticlopidine or clopidogrel. Acetylsalicylic acid is usually used in small doses (80-300 mg/day). To reduce the irritating effect of the drug on the stomach, a form of acetylsalicylic acid that does not dissolve in the stomach is used.

If a patient who has suffered an ischemic stroke has hyperlipidemia (increased levels of total cholesterol more than 6.5 mmol/l, triglycerides more than 2 mmol/l and phospholipids more than 3 mmol/l, decreased levels of high-density lipoproteins less than 0.9 mmol/l) , a low-cholesterol diet is recommended to prevent the progression of atherosclerosis.

Antidepressants prolong life after stroke

February 2011 Treatment with antidepressants for 12 weeks after a stroke improves patients' condition regardless of whether they suffer from depression.

Given the relationship between depression after stroke and mortality, an obvious question is whether appropriate antidepressant treatment would reduce mortality, write Ricardo E. Jorge and colleagues from the University of Iowa College of Medicine, USA.

During stroke recovery, 104 patients were recruited to receive a 12-week course of nortriptyline, fluoxetine, or placebo. The groups were homogeneous in stroke severity, cognitive decline, and therapy received. Of the 104 patients, 48.1% died within 9 years. Of the 53 patients who received antidepressants, 67.9% lived longer compared to 35.7% who received a placebo.

Treatment with antidepressants after stroke significantly increased survival in both depressed and nondepressed patients. This may mean that the pathophysiological processes that determine the increased risk of mortality associated with post-stroke depression can be corrected by antidepressants.

"Our data suggest that all patients who have experienced acute stroke should be treated with antidepressants if they are likely to prolong their life," the authors conclude in The American Journal of Psychiatry.

A new drug will save you from the consequences of a stroke

February 2011. Regulation of programmed cell death may be the key to creating a new effective treatment for stroke.

American scientists have successfully tested a substance on mice that has already found use in other areas of medicine. It turned out that its administration to animals reduces the neurological consequences of stroke by 91%.

As the authors of the work from the University of Rochester and the Scripps Research Institute in California explained, much of the brain damage after a stroke occurs not in the first hours, when cells are left without oxygen, but much later, when the damaged cell “decides” what is for the good of the body. need to die. This process is called apoptosis.

Scientists have found that activated protein C, used for example in severe sepsis, can reduce programmed cell death. Through cellular receptors, it reduces the content of p53 molecules, a protein that is at the center of death processes due to hypoxia. In addition, the content of substances that interfere with this process increases.

In experiments with laboratory mice reported in the journal Nature Medicine, Berislav Zlokovic and John H. Griffin found that activated protein C preserved up to 65 percent of the cells that typically die as a result of a stroke. Overall, neurological impairment after stroke was reduced by 91 percent.

Scientists hope that their discovery will help create a medicine that will be effective not only in the first hours of a stroke, but will also help those patients who end up in the hospital later.

Navigation

In recent years, stroke has become an increasingly common pathology among people of different sexes and ages; every 4 patients out of 1000 are susceptible to a brain catastrophe. 80% of all registered cases are ischemic brain lesions, the remaining 20% ​​are a hemorrhagic type of stroke. It is almost impossible to predict the crisis of the disease and its peak (the hemorrhage itself), just as it is difficult to answer the question of how many days the patient will remain in intensive care after a stroke.

The nature of the pathology is unique for each individual patient, and there are no people whose recovery period is the same. Therefore, the number of days spent in hospital depends on several factors, which will be discussed further. In general, therapy for a stroke condition consists of three periods: the pre-hospital stage, the patient’s stay in the intensive care unit (resuscitation department) and therapy in the general ward.

Staying in intensive care

How long do patients who have suffered a cerebral hemorrhage stay in the hospital is the question most often asked to the doctor by the patient’s relatives. The question is logical, because no one, including the patient himself, imagined that an attack of ischemia would occur at this very moment, and loved ones are not allowed into the intensive care ward. General standards of treatment require a three-week course of inpatient therapy for those patients who do not experience loss or serious impairment of vital functions after a stroke, and a 30-day course of treatment for patients with serious impairment.

These terms are approved by the Ministry of Health, but in cases requiring longer treatment, an examination is carried out, during which it may be decided that the patient needs an individual rehabilitation program.

The patient is usually kept in the intensive care unit for no longer than 21 days. This period is set aside for doctors to better monitor the patient’s condition and to prevent dangerous consequences that may arise due to disturbances in the functioning of the brain.

Every patient who has suffered an ischemic or hemorrhagic stroke is required to stay in the intensive care unit, and the duration of treatment depends on several criteria:

• the size of the lesion and its location in the brain tissue (with extensive treatment, the treatment process takes longer);
• severity of clinical manifestations of pathology;
• whether there is depression of consciousness in the patient or a state of coma - in this case, the patient with a stroke will be in the intensive care unit until signs of positive dynamics appear;
• dysfunction of vital organs and systems of the body - breathing, swallowing and others;
• high probability of recurrent hemorrhage, which requires additional monitoring of the patient’s condition;
• serious concomitant pathologies that can negatively affect the general condition of a stroke patient.

Based on the listed factors, we can say that the time spent by the patient after surgery in the intensive care unit is an individual indicator that is not the same for everyone.

Course of therapy in the intensive care unit

Intensive therapy for a stroke condition involves the elimination of primary dysfunctions of the vital systems of the body; the treatment itself is divided into two stages.

The first stage is basic treatment, it consists of the following activities:

• elimination of disorders of the respiratory system, if any;
• hemodynamic correction;
• combating fever, psychomotor impairment and brain swelling;
• and caring for it.

Next comes the stage of differentiated therapy, its course depends on the type of stroke. With a hemorrhagic form of damage, doctors set themselves the task of removing swelling of the brain and adjusting the level of pressure, arterial and intracranial. Also at this stage, the possibility of surgical intervention is assessed; it is most often performed after 2 days spent in the intensive care unit.

If the patient has experienced an ischemic stroke, the main emphasis in therapy is on restoring full blood circulation in the brain, improving metabolism and relieving signs of hypoxia (oxygen starvation of brain tissue).

It is difficult to make any prediction about what day the patient will be transferred to the general ward and how long the treatment may take. Young patients have much higher compensatory abilities than older people, so they usually recover faster. The larger the lesion in the brain structures, the longer and more difficult the rehabilitation process will be.

Coma

Loss of consciousness during cerebral hemorrhage is observed in only 10% of all cases of pathology. In whom the patient is falls with lightning-fast dissection of a deep vessel of the brain; in such a development of events, the duration of therapy cannot be predicted even by a qualified doctor. A patient who has fallen into a comatose state should receive rapid resuscitation assistance and constant monitoring of changes in condition during resuscitation procedures.

Diagnosis and correction of the condition is carried out as follows:

• control over vital signs is provided by equipment connected to the patient - it monitors pulse and blood pressure levels;
• in a coma, the patient is forced to lie down around the clock, which requires the use of anti-bedsore mattresses and turning the patient over every few hours;
• Feeding a comatose patient is carried out through a tube, food includes fruit juices and mixtures, medical nutrition - everything must be ground and heated before feeding.

If the doctor assesses the patient's condition as serious, he may be put into an artificial coma, which is necessary for urgent brain surgery.

Recovery from a coma is the body’s fight against the consequences of a stroke, in which intensive therapy is regarded as auxiliary. If the patient feels better, his vision, hearing, speech and clear thinking return, the recovery period will go much faster.

At this stage, the patient receives not only vital support for the main functions (breathing, feeding), but also prevention of immobility. For this purpose, verticalizers, devices for developing the muscles of the arms and legs are used, and measures are also taken to prevent joint atrophy.

Staying in a general ward

The criteria for transferring a patient to the general department are the following facts:

• absence of pressure and pulse surges within an hour of continuous monitoring;
• spontaneous breathing, without the support of a ventilator;
• return of consciousness to the patient, his ability to perceive and understand speech well, and communicate with the doctor;
• exclusion of recurrent hemorrhage.

Only if the listed criteria are met and positive changes in the dynamics of treatment can the doctor decide to transfer the patient to the general department. Rehabilitation in a hospital setting is carried out in the neurology department, treatment includes medication, and if the patient’s motor activity is preserved, the first rehabilitation exercises.

After completing the full course of treatment (in a general ward this is a three-week period), the patient is sent home to continue outpatient therapy. Working patients are required to be issued a certificate of incapacity for work, and the length of sick leave depends on the level of brain damage and the disorders resulting from the stroke. So, after a minor stroke, the patient will be able to start work after 3 months, after a moderate hemorrhage - after 4 months (while he remains in the hospital for 30 days).

Severe cases of hemorrhage, with a long recovery period, require a medical and social examination, which will determine the need to extend sick leave after 3-4 months of outpatient treatment. Patients who underwent emergency surgery after an aneurysm rupture are in the hospital for at least 60 days, after which they are given a sick leave certificate for 4 months, with the right to extend without undergoing an examination (if there are prerequisites for relapse of the pathology).

As you can see, the recovery time and hospital stay are individual for each person. Only the attending physician can give a prognosis for successful rehabilitation, and therefore questions about the dynamics of treatment, the patient’s condition and possible recommendations should be asked to a specialist who is treating a particular patient.

Unfortunately for doctors, the need for constant health care has not been formed in the minds of our compatriots. More often, when signs of illness appear, people think that the symptoms will disappear on their own, nothing will happen to them, and the disease will recede. It will go away on its own. There are probably many reasons for this behavior. But what it leads to is reflected in the dry language of statistics. Kazan doctors conducted a study of the causes of mortality in strokes.

Stroke kills many people

The results were horrifying:

• Half of patients with strokes are admitted to the hospital more than 6 hours after the onset of the disease. What is 6 hours in ordinary life? Not enough even for sleep. But not to save the patient’s life. This period is called the “therapeutic window”. The time during which treatment gives the maximum result and allows you to relieve a person from disability or save his life.
• More than half of such patients are not hospitalized! Not because they are refused. They do not go to the hospital or refuse hospitalization suggested by emergency doctors. The mortality rate in this group is 97%.

What can you do to avoid adding your life to the dry statistical lines of stroke mortality? Just understand what signs of a change in well-being should promptly consult a doctor. So to speak, recognize the enemy by sight.

What is a stroke and what types of stroke are there?

The word “stroke” refers to acute disruptions in the blood supply to the brain, which develop in an ischemic (decreased or lack of blood circulation) or hemorrhagic (hemorrhage) type. For cerebral ischemia, there is also a short-term condition called transient ischemic attack. Learn more about each of these conditions.

Strokes are divided into 2 large groups: ischemic and hemorrhagic.

Transient ischemic attack

A microstroke or transient ischemic attack is an acute transient disruption of the blood supply to a small part of the brain that does not cause irreversible changes in cells. But this condition is not as harmless as it might seem. In people who have suffered a TIA, in 20% of cases a full-fledged stroke develops a week later, in another 45% in the first year after the attack. This is a wake-up call that you need to take more care of yourself and urgently call a doctor as soon as the following appear:

• Changes in sensitivity in the face or limbs: numbness or a feeling of “goosebumps” running across the skin.
• Limitation of movements.
• Difficulties in perceiving the speech of others.
• Partial loss of hearing, touch or vision.
• Double vision.
• Dizziness.
• There may be a disorder in coordination of movements and gait.
• Loss of speech.
• Blurred consciousness or brief fainting.

In this case, call a doctor immediately! Despite the transience of TIA, timely examination and treatment can prevent a life-threatening condition.

Ischemic stroke

Ischemic stroke due to vessel thrombosis

Number 3 cause of death in the world. A disease that changes a person forever. Deprives him of speech, movements, and the ability to think. A condition that confines a person to bed for months. And despite this, people continue to hope for “maybe.” Tell yourself: “maybe it will pass.” During ischemia, some neurocytes stop receiving oxygen. If you don't give them back the ability to “breathe,” they die.

And the death of brain cells can be prevented in the first 6 hours from the onset of ischemia.

You just need to deliver the patient to the hospital as soon as possible. Signs of cerebral ischemia:

• Speech disturbances and difficulties in pronouncing words clearly appear.
• Severe headache, sometimes accompanied by vomiting.
• Facial asymmetry: the corner of the mouth or eye on one side is lowered, the smile appears crooked.
• Muscle weakness in the leg and arm on one side. Trying to raise both arms at the same time may not be successful.
• Blurred consciousness, loss of orientation, fainting.

These symptoms signal the development of ischemia. The person needs immediate help:

• Call an ambulance. It’s better to tell what happened over the phone, because there are specialized “stroke” teams at the stations.
• Be sure to help him lie down. Either on the floor or on the table. Doesn't matter. The main thing is the horizontal position.
• Do not try to bring the patient back to consciousness. Doctors will do this.

If you take measures to quickly start treatment, the chances of returning to health after an illness reach 50%. Not just to survive, but to restore the ability to live actively.

Hemorrhagic stroke

Cerebral hemorrhages occur 4 times less frequently than ischemia. Only the prognosis for their outcome is much worse. Apoplexy ends in death in 45% of people in the first week from the onset of the stroke. A condition that should not be treated on its own or wait for it to go away on its own. The insidiousness of hemorrhages lies in the fact that the blood pouring out of the vessels remains inside the skull and compresses the brain. The signs of hemorrhage are accompanied by symptoms of secondary ischemia from the effects of spilled blood. Signs of apoplexy:

• The condition develops unexpectedly, against the background of high emotional or physical stress.
• May be accompanied by a rush of blood to the face.
• My head starts to hurt badly.
• Consciousness becomes confused.
• Nausea appears and vomiting may develop.
• Sometimes seizures occur.

First aid in this case is the same as for cerebral ischemia:

• Put the person down.
• Call an ambulance.

Woman calling an ambulance

Stroke goes away on its own

Of course, like any disease, a stroke can go away on its own. In two cases: if a person becomes disabled or dies. Take care of your health and consult a doctor on time.

A stroke is an acute disorder of cerebral circulation, resulting in damage and death of nerve cells.

Stroke is an insidious disease that can appear suddenly, for no apparent reason.

The main thing that worries the patient’s relatives in this difficult situation is how many days they spend in the hospital after a stroke.

First aid at the prehospital stage is determined by the type of stroke:

For ischemic stroke you should:

• lay the patient on his back (the head can be in the same plane as the body or slightly above it; the main thing is not to raise it too high);
• monitor the condition of the respiratory tract and oral cavity (prevent saliva, mucus, and vomit from entering the respiratory tract);
• do not try to bring the victim to his senses using improvised means: ammonia and other medications (such actions can lead to the opposite effect and aggravate the patient’s condition);
• release the neck from constricting objects, ensure access of oxygen to the room;
• massage/rub paralyzed arms and legs (you can do this using a semi-alcohol solution);
• prohibit the patient from taking any tableted drugs and drinking water;
• monitor basic vital parameters.

For hemorrhagic stroke it is necessary:

• lay the patient on his back, raise his head;
• free your neck from any accessories and objects that may squeeze it (unbutton your shirt, remove your tie, etc.);
• remove removable dentures from the patient’s mouth;
• open the windows in the room where the victim is located to ensure the flow of fresh air;
• turn your head to the side if there are no signs of consciousness (this will make sure that saliva and mucus do not enter the respiratory tract);
• if the patient has vomited, clean the mouth from vomit;
• apply a heating pad/bottle with ice water or a bag of ice pieces to the head (the ice must be applied to the side opposite the side of the lesion);
• cover the victim with a warm blanket;
• perform resuscitation measures if the heart has stopped, there are no signs of breathing, the pupils have dilated (resuscitation measures include artificial respiration and chest compressions);
• Constantly monitor heart rate, breathing, and blood pressure.

And finally, the most important thing that needs to be done at the pre-hospital stage is to contact the doctors as soon as possible by calling “03”. The faster a person is taken to a medical facility, the sooner doctors will be able to help him.

In the general ward department, further rehabilitation of the person is carried out, including the implementation of measures to restore lost functions.

Thus, the length of stay of a stroke patient in hospital varies from case to case. To find out the approximate length of a person’s stay in the institution, you need to talk with his attending physician.

Video on the topic

One of the serious diseases that often occurs as a result of hypertension, as well as cerebral atherosclerosis, is stroke. Treatment of this disease, if successful, can prolong a person's life activity. The danger of a stroke lies in the high probability of negative consequences, because Quite often the consequence is disability.

Among older people, stroke is the most frequently reported cause of death.

A stroke is characterized by an acute circulatory disorder of the cerebral cortex, which results in damage and death of nerve cells.

Stroke is a number of other pathological conditions, including:

• Brain hemorrhage;
• Cerebral infarction;
• Subarachnoid hemorrhage.

There are two types of strokes:

• Ischemic;
• Hemorrhagic.

Not only do they differ in origin, but each of them is treated according to a different scheme.

Peculiarity ischemic A stroke is a disruption of the blood supply to certain areas in the cerebral cortex due to blockage of an artery by a thrombus or atherosclerotic plaque.

Hemorrhagic A stroke occurs when an artery ruptures and subsequent hemorrhage occurs. The cause of this type of disease is a rupture in an enlarged section of the artery due to a congenital pathology of the vessel, called an aneurysm, or a rupture of the artery, the background of which may be high blood pressure.

Types of strokes

A stroke of any kind requires immediate action, medical attention and treatment. The clinical picture of hemorrhage develops so rapidly that the ability to cure the disease is limited by time. Only with timely provision of qualified assistance can brain damage be minimized, preventing complications from occurring in the future.

Stages of treatment

In order to know how to treat a stroke, it is necessary to imagine the sequence of the main stages of this process, consisting of:

• Emergency care;
• Inpatient treatment;
• Rehabilitation or sanatorium therapy.

Signs of a stroke

In order to recognize the symptoms of a dangerous illness in a person in time, it is necessary to firmly remember them.

Signs of a stroke are:

• Sudden weakness;
• Paralysis or partial numbness of the muscles of the face or limbs (most often only on one side);
• Speech disorders;
• Deterioration of vision;
• The appearance of a strong and sharp headache;
• Dizziness;
• Loss of balance and coordination, gait disturbances.

A stroke often takes a person by surprise and at this moment it is very important that people around them show attention and provide first aid.

If you notice a passerby on the street behaving unnaturally, you should not think that he is drunk before a stroke check is performed according to the following plan:

Actions before the ambulance arrives

If there is a suspicion of a stroke, which can occur at any time - at home or on the street, You should do the following as quickly as possible:

• Place the patient on his back, try not to touch his head;
• Provide free access to fresh air, the source of which may be an open window or a fan. For the same purpose, it is necessary to exclude any compression of the body from a tight tie or collar or belt;
• If the patient shows signs of vomiting, it is necessary turn his head in any direction to avoid vomit getting into the bronchi area;
• If possible a cold compress will help, placed on the head or a heating pad with ice;
• The patient, if he is conscious, can ask about his hypertension and give him a pill under the tongue (often hypertensive patients hold the necessary medicines in the pocket);
• Preliminary blood pressure measurement- one of the useful actions that can be performed with a special apparatus at hand;
• A distraction procedure that can be performed at home is placement of mustard plasters in the calf area on the legs.

Help and first actions of medical workers

In the first minutes after arriving at the location of a person suffering from a stroke, the ambulance team specialists assess the severity of the patient’s condition. Their main task is to transport the patient to a hospital equipped with an intensive care unit.

During transportation the following is carried out:

• Blood pressure measurements;
• Administration of drugs that correct the functioning of the cardiac and respiratory systems.

We do not transport patients who:

• They were found in a coma;
• If they have circulatory disorders in the brain in terminal conditions of various pathologies of internal organs or tumors.

Patients with such deviations are provided with symptomatic care, after which the call is transferred to the clinic.

Which department are they admitted to for a stroke?

After hospitalization of the victim, treatment of cerebral stroke in hospital begins with his placement in the intensive care unit or intensive care unit. This requires the presence of an appropriate department in the clinic, equipped with special equipment and qualified personnel.

Patients are examined by a neurologist. Consultation with a neurosurgeon may be required. The treatment regimen, as well as which department the patient will be in, is determined by the doctor depending on the established type and severity of the disease. The main tasks of a hospital depend on the type of disease.

Treatment in a hospital. Drugs.

Treatment for hemorrhagic stroke.

To treat the brain with the development of hemorrhagic stroke, therapy should include a number of specific tasks, these are:

• Elimination of swelling in brain tissue;
• Reduced intracranial and blood pressure;
• Treatment aimed at increasing blood clotting and the density of vascular walls.

During all actions of the medical staff, a certain position of the patient on the bed is observed. For this, a functional bed with a raised headboard is used. Ice is placed on the patient's head and warming pads are placed on the patient's feet. Relaxing the muscles will help ensure that the popliteal bend is created. For the same purpose, you can place a cushion under your knees.

Drug treatment includes the use of the following drugs for intravenous drip use:

• Magnesium sulfate;
• Dibazol;
• Aminazine;
• Pentamin.

Due to the increased risk of decreased blood clotting, medications that activate thrombosis in blood vessels can be administered. This type of therapy should be carried out under the supervision of a laboratory blood test for a coagulogram.

In the first 2-3 days the following are prescribed:

• Calcium chloride;
• Vikasol;
• Aminocaproic acid.

In cases where on the third day after a stroke there are pronounced signs of atherosclerosis and subarachnoid hemorrhage, proteolytic enzymes can be prescribed:

• Gordoks;
• Contrikal.

One of the effective modern drugs used in the treatment of cerebral stroke is Etamsilate. It allows you to stop blood loss, improve microcirculation in damaged areas of the brain, and normalize vascular permeability. At the same time it serves as an excellent antioxidant.

If cerebral edema has pronounced meningeal symptoms, a spinal puncture should be performed with caution, during which cerebrospinal fluid is extracted in small quantities.

Treatment for ischemic stroke

In case of the second type of brain stroke, the actions of specialists will be aimed at solving the following problems:

• Improving blood supply to tissues;
• Formation of increased resistance to oxygen deficiency;
• Introduction of drugs to improve metabolism in surviving cells.

The patient's position in bed should be comfortable, but his head should not be raised as high as it should be for a hemorrhagic stroke.

For ischemic stroke, treatment must necessarily include vasodilators. To a greater extent, collaterals are used, which are auxiliary capillaries that can partially replace natural ones.

For this purpose, the following products are used in the form of solutions for intravenous drip:

• Eufillin;
• No-shpa;
• Papaverine;
• A nicotinic acid;
• Complamin.

Used medicine to improve hemodilution - Reopoliglucin, which improves blood supply by reducing blood clotting.

Medical monitoring and treatment includes careful measurement of the volume of fluid administered, which in excess amounts can pose a risk of increased tissue swelling. The use of diuretics also requires caution, especially if you have hypertension.

Anticoagulants are used simultaneously with fibrinolytic agents. The important term “golden hour” is used in stroke therapy. It serves as an indicator of the maximum effectiveness of administering medications to reduce blood clotting, as well as for prognosis of the disease.

Due to too long transportation to the clinic, it becomes difficult to determine the difference between different types of stroke and provide the correct assistance in treatment, and its optimal time is missed.

On the first day, ischemic stroke is treated by administering a solution of Fibrinolysin with Heparin.

After this, the treatment regimen includes:

• Intramuscular injection of Heparin;
• After 3-5 days, it is recommended to switch to Phenilin and Dicoumarin.

When treating young patients and middle-aged people, Pentoxifylline is used, which helps improve blood density.

Elderly patients are prescribed for treatment:

• Parmidine;
• Xanthinol nicotinate;
• Anaprilin (with existing tachycardia);
• Cavinton, Cinnarizine (allows you to improve vascular tone).

Medicine has found that in case of ischemic stroke, the combined use of Curantil and Aspirin will help reduce the risk of re-development of the pathology.

The patient's agitation syndrome can be cured by prescribing barbiturates. Metabolic failure should be treated with drugs of the metabolite class (Piracetam, Aminalon, Cerebrolysin), which also help to increase the resistance of cells to a lack of oxygen.

Surgical methods

Sometimes a stroke can be overcome with surgery. If a patient has been diagnosed with a hemorrhagic stroke, then surgical treatment methods can only be used if they are young or middle-aged, and also if lateral hematomas and hemorrhages in the cerebellar area have been diagnosed.

Indications for the operation are:

• Impossibility of relieving cerebral edema by other means;
• The appearance of signs of compression by a hematoma;
• Suspicions of the possibility of repeated hemorrhage in the area of ​​the brainstem or hemispheres.

The best time for surgery is 1-2 days. The hematoma is opened and removed. If ruptures of a cerebral aneurysm are detected, the vessel is ligated.

Surgical treatments for ischemia are used in rare cases. Indications for surgery are the diagnosis of narrowing of the carotid, vertebral or subclavian arteries causing pathology.

Patient care

In order to recover from a stroke, it is very important to provide proper care to the patient.

Care measures during inpatient treatment include:

• A certain diet, including juices, liquid high-calorie meals;
• In a comatose state, nutrition is provided using a tube;
• Prevention of congestion in the lungs and bedsores, for which the patient is turned over every 2-3 hours, a rubber circle is placed in the sacral area, and dense rings are placed under the heels;
• Monitor the cleanliness of bed linen and prevent high humidity;
• The skin should be treated with a weak solution of manganese, camphor alcohol or solcoseryl ointment;
• The oral cavity is treated with boric acid;
• A catheter is used to drain urine, and for constipation, laxatives are given and an enema is performed.

Rehabilitation

The consequences of a stroke can be safely eliminated with well-organized rehabilitation.

Help for a brain stroke survivor should include the following measures and actions:

• Gentle massage of the limbs from the second week of illness;
• Therapeutic exercise, promoting the restoration of motor functions with a gradual increase in intensity.
• Kinesiotherapy, developing fine hand movements, helping the patient with self-care in new conditions;
• Water procedures aimed at stretching muscles, oxygen baths, hydromassage.

With correctly taken therapeutic measures for stroke, as well as well-organized rehabilitation, up to 70% of people who have suffered a cerebral stroke return to independent life.

The best period for rehabilitation measures and assistance is the first three years, during which you need to be patient and have faith in success.

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