Venous discirculation of the brain. Vertebrobasilar insufficiency: occurrence, signs, diagnosis, complex treatment Subacute stage of ischemic stroke

Elderly people are familiar with such a disease, the name of which CVA - acute cerebrovascular accident Or just a stroke. Almost every older person has experienced this disease on himself. It is very important to understand the causes of stroke and the proper treatment of the disease.

What it is?

A stroke is a clinical symptom manifested by sharp failures in the normal operation of the existing options of the brain of the head, the duration of which is more than one day.

The main symptoms of CVA are:

1. The inability of the patient's body to move normally;
2. Disorders of the organs responsible for sensitivity;
3. Violations of the proper functioning of the speech apparatus;
4. The inability of the patient to make swallowing movements;
5. Frequent headache;
6. Loss of consciousness.

An unexpectedly appeared violation of the speech apparatus, loss of body sensitivity and problems with coordination of movement pass over the next day. Then they talk about transistor ischemic attack. This is not such a dangerous disease as a stroke, but also applies to stroke.

If the disease refers to disorders in the functioning of the circulatory system, then it is characterized as "stroke by the type of ischemia." In the case when bleeding is confirmed by a specialist, then the disease has the characteristic "CVA by hemorrhagic type".

A stroke that ends in a stroke is the stage when blood flow to some part of the brain stops. This phenomenon is caused by a decrease in the tone of the walls of the arteries of the brain and is accompanied by a disorder of the neurological system, which is a consequence of the destruction of part of the nerve tissue.

ONMK - code according to ICD-10

In the tenth international classification of diseases, stroke has several codes that differ from each other according to the disorders that caused the disease.

Prevention and treatment of this disease are considered at the state level, since stroke ends in death in a third of cases. Sixty percent of patients who have had the disease turn out to be disabled, who cannot do without social assistance.

Causes of stroke

CVA, related to the ischemic type, develops as a result of already existing pathologies in the patient's body.

These diseases include:

ACVE is found not only in the adult category of the population, but also in children. This is due to the fact that the vessels of the child's brain have any anomalies in their development. A high risk of developing stroke is observed in children who have congenital heart disease.

When stroke occurs, only 30% of children recover completely. About fifty percent have incurable disorders in the work of the neurological system. Twenty percent of cases of acute cerebral circulatory disorders in children end in death.

In what cases can CVD be suspected?

The diagnosis of stroke is made if the patient has the following disorders in the body:

1. A sharp lack of sensitivity in the limbs;
2. Loss of vision up to blindness;
3. Inability to recognize the opponent's speech;
4. loss of balance, problems with coordination;
5. Very severe headaches;
6. Clouding of consciousness.

An accurate diagnosis can be established only after the diagnosis.

Stages of cerebral infarction

ONMK has several stages of development. Let's consider each of them in more detail.

Stage number	Stage symptoms
First stage	There is a lack of oxygen, which leads to failures in the permeability of flat cells located on the surface of blood vessels. As a result, fluid and protein from the blood cells enter the brain tissue. Edema develops;
Second stage	At the capillary level, blood pressure continues to fall, which leads to disruption of the cell membrane. Nerve receptors and electrolyte channels also cease to function properly. At this stage, the disease can be prevented;
Third stage	There are disturbances in the work of cell metabolism, lactic acid accumulates in the tissues. Energy synthesis occurs, in which oxygen molecules do not participate. The anaerobic mode does not allow the tissues of neurons and astrocytes to maintain a normal level of vital activity. These cells increase in volume, causing malfunctions in the structure. The clinical picture is focal signs of a neurological nature.

Ischemic stroke

This type of stroke is accompanied by a complete cessation of blood flow delivery to specific areas of the brain tissue, which is accompanied by the destruction of brain cells and the cessation of its main functions.

Causes of ischemic stroke

A stroke of this plan is caused by obstruction of blood flow to any brain cell. As a result, the normal functioning of the brain stops. Plaque, consisting of cholesterol, can also become an obstacle to the normal flow of blood. This causes more than 80% of all diseases.

Risk group

CVA is most often manifested in the category of the population that have the following pathologies:

• Vascular disorders that are atherosclerotic in nature;
• A sharp increase in blood pressure;
• Previous myocardial infarction of an extensive nature;
• stretching of the artery;
• Heart defects that are acquired or congenital;
• Increased blood density caused by diabetes:
• Decreased blood flow rate, which is a consequence of cardiac insufficiency;
• Excess body weight;
• Transistor ischemic attacks previously transferred to the patient;
• Excessive consumption of alcohol and tobacco industry products;
• Reaching the age of sixty;
• The use of oral contraceptives that contribute to the occurrence of blood clots.

Symptoms of the disease

Neurologists distinguish several intervals in the development of ischemic stroke according to the severity of the disease:

1. The sharpest. Lasts up to five days;
2. Spicy. The duration is 21 days;
3. Recovery at an early stage. From the moment the acute symptoms are eliminated, it takes six months;
4. Late recovery. The rehabilitation period lasts for two years;
5. Eliminate traces. Over two years.

In addition to general symptoms, ischemic stroke of the brain is characterized by local symptoms. It depends on the area in which the disease occurred.

And so, if struck then the following symptoms appear:

• Disorder of the visual system in the direction where the blockage of the vessel occurred;
• The sensitivity of the extremities disappears on the opposite side of the focus of the disease;
• In the same area, paralysis of muscle tissue occurs;
• There are disorders in the work of the speech apparatus;
• The inability to recognize your illness;
• Problems with body orientation;
• Loss of field of view.

With narrowing of the artery of the spine, another symptomatology is noticeable:

• Hearing loss;
• Twitching of the pupils when moving in the opposite direction;
• Objects double in the eyes.

If the defeat happened on junction with an unpaired blood vessel, then the symptoms manifest themselves in a more severe form:

In case of defeat anterior cerebral artery:

• Loss of sensation in the opposite side, usually in the leg area;
• Slowness in movement;
• Increased tone of the musculoskeletal tissue;
• Lack of speech;
• The patient cannot stand or walk.

If failures interfere with normal patency of the middle artery of the brain:

• The result of a complete blockage of the main trunk is a state of severe coma;
• In half of the body there is a loss of sensitivity;
• Refuses the motor apparatus;
• The inability to fix the gaze on the subject;
• Fields of vision fall out;
• There is a failure of the speech apparatus;
• The patient is unable to distinguish the right limb from the opposite.

In case of violation patency of the posterior cerebral artery the following clinical picture is observed:

Obstruction of the optic geniculate artery accompanied by the following symptoms:

• Lack of tactile sensations from the opposite side of the face and body;
• If you touch the patient's skin, then he experiences severe pain;
• Incorrect perception of light and knock;
• Forearms and shoulder joints are bent. The fingers are also bent at the base.

Defeat on the site thalamus are characterized by the following symptoms:

• The movements of the patient have a wide scope;
• There is a strong tremor;
• There is a loss of coordination;
• Half of the body loses sensation;
• Severe sweating is characteristic;
• Bedsores occur.

The most severe case of stroke is the process of breakthrough intracerebral hematoma. Hemorrhage occurs in the cerebrospinal fluid, fills the cerebral stomachs with blood. This disease is called "ventricular tamponade."

This case of stroke is the most severe and in almost all cases ends in death. The explanation for this lies in the unhindered flow of blood into the patient's brain.

Treatment of stroke by ischemic type

The above symptoms may appear unexpectedly in a loved one. It is very important to provide the first first aid sick.

After calling an ambulance, it is necessary to alleviate the patient's condition using the following methods:

1. Put the patient on the side so that vomiting freely leaves the victim's oral cavity;
2. The head should be slightly raised;
3. If there is a tonometer, then it is necessary to measure blood pressure. If a sharp increase in pressure to critical values ​​\u200b\u200bis noticed, then a drug should be placed under the patient's tongue to reduce it;
4. Provide the patient with the necessary amount of fresh air;
5. Release the patient's neck from any squeezing things.

Treatment in a hospital

After arriving at the medical facility, the victim is placed in the ward intensive care. Next, the patient is prescribed a special diet, which focuses on the balance of all the necessary trace elements. Nutrition is adjusted so that fatty, spicy, salty foods are not observed in the diet.

Mayonnaise and other seasonings should also be excluded. Vegetables and fruits are limited only during the acute stage of the disease. If the patient's consciousness is absent, then food intake is carried out through a medical probe no earlier than two days later.

After confirmation of stroke, inpatient treatment continues for a month. The consequences after the transfer of this disease are extremely severe.

Severe loss of strength in muscle tissue on the opposite side of the brain, the area of ​​which was damaged. A certain category of patients practically learns to walk again and perform normal movements;

. The decrease in strength occurs only in the area of ​​the mouth, cheeks and lips. The patient is unable to properly eat and drink fluids;

Quite often there is a disrupted work of the speech apparatus. This is caused by damage to the speech center in the human brain. The patient either completely loses speech, or does not perceive the words of another person;

Movement coordination disorder It is caused by a lesion in the parts of the central nervous system that are responsible for the normal functioning of the human motor system. In severe cases, disturbances may persist for several months;

Malfunctions of the visual system are of a different nature and depend on the size and localization of the lesion with a stroke. Usually they are expressed in the loss of visual fields;

Sensory disturbance expressed in the loss pain sensations of heat and cold.

Rehabilitation

A very important stage on the path of recovery after stroke.

Quality therapy includes the following categories of treatment:

1. Physiotherapy. It is necessary to return the patient to normal movement of the limbs. A set of exercises is selected by the attending physician;
2. Visiting a speech pathologist. It is prescribed if the patient has speech and swallowing disorders;
3. Physiotherapy. The most affordable type of therapy, which is in every clinic;
4. Therapy with medicines. The main stage in the recovery process. Drugs mitigate complications after the disease and prevent the risk of relapse;
5. Mind training. It is desirable for the patient to read as much literature as possible, to memorize poems or excerpts from works.

CVA by hemorrhagic type

Components that have a nutritional effect, which include oxygen, enter the brain through the carotid arteries. Being in the box of the skull, they form a network of vessels, which is the root of the blood supply to the central nervous system. When arterial tissues are destroyed, the blood flow rushes to the brain.

Causes

A stroke of the hemorrhagic type occurs in the event of a hemorrhage into the brain from a vessel whose integrity has been compromised. As a result, a hematoma occurs in the patient's brain, which is limited to the brain tissue. Also, blood from a burst vessel can penetrate into the area surrounding the brain.

Risk group

Particular attention should be paid to the state of their health of the following category of citizens:

• Suffering from the expansion of blood vessels of a congenital nature;
• Having anomalies in the development of arteries and veins;
• Suffering from inflammatory diseases of the walls of blood vessels;
• With pathologies of connective tissues of a systemic nature;
• Having lesions of blood vessels, accompanied by a violation of protein metabolism;
• Abuse of drugs that stimulate the nervous system.

Symptoms

1. Acute headache;
2. Constant vomiting;
3. Frequent loss of consciousness over a long period;
4. In almost all cases, there is an increase in blood pressure;
5. Increasing sensations of weakness in the limbs;
6. A disorder in the functioning of the organs responsible for sensitivity or a complete loss of sensitivity;
7. Violation of the motor system;
8. Disorder of the visual system;
9. Strong nervous excitement;
10. When analyzed, a small amount of blood is observed in the cerebrospinal fluid;

Treatment of stroke by hemorrhagic type

Drug therapy consists in the use of drugs whose action is aimed at stopping bleeding, reducing the size of cerebral edema, and calming the nervous system. Antibiotics and beta-blockers are used.

Medications can cause stroke recurrence, so it is advisable to eliminate the problem through surgery. First of all, the neurosurgeon removes the lesion, and then eliminates the failure in the vessel.

Reversibility of pathology

During diagnostic studies, whether the symptoms of stroke are reversible is essential. When the stage is reversible, brain cells exist in the paralysis phase, but their integrity and full-fledged work are not disturbed.

If the stage is irreversible, then the brain cells have died and cannot be restored in any way. This area is called the ischemia zone. But therapeutic treatment in this case is possible.

Its meaning is to provide neurons with all the nutrients in the ischemic zone. With proper treatment, cell functions can be partially resuscitated.

It was found that a person does not use all the resources of his body in the course of his life, including not all brain cells are involved. Cells that are not involved in the work can replace the dead cells and ensure their full functioning. The process is rather slow, so full rehabilitation lasts for three years.

Transistor ischemic attack (TIA)

This disease is also a stroke, but unlike ischemic and hemorrhagic stroke, it is temporary. For a certain period of time, there is a sharp violation of blood flow in the large vessels of the brain, as a result of which its cells suffer from a lack of oxygen and nutrients. The symptoms of TIA - transistor ischemic attack last for days and are similar to the symptoms of a stroke.

If more than 24 hours have passed, but the disease has not receded, then most likely a stroke of an ischemic or hemorrhagic type has occurred.

Symptoms

Consider the symptoms of a transistorized ischemic attack:

• There is a decrease in sensitivity in one of the sides of the face, body, lower or upper extremities;
• Weakness in the body, which is mild or moderate;
• Violations in the work of the speech apparatus up to the complete absence of speech or problems with understanding the words of the opponent;
• Dizziness and incoordination;
• Sudden noise in the ears and head;
• Headache and heaviness.

These symptoms appear abruptly and disappear after 3-4 hours. The deadline that distinguishes a transistor ischemic attack from a stroke is no more than a day.

What diseases can cause TIA?

TIA can be caused by the following conditions:

1. Persistent increase in blood pressure, which is chronic;
2. Chronic cerebrovascular disease;
3. Changes in blood clotting;
4. sudden drop in blood pressure;
5. The impossibility of the normal flow of blood through the artery, caused by a mechanical obstruction;
6. Pathology of the structure of cerebral vessels.

Transistor ischemic attack can and should be treated! Despite the fact that its symptoms pass quite quickly, this ailment already signals a malfunction in the body and, in case of relapse, can turn into a stroke!

Risk group

Transistor ischemic attack is no less dangerous than a stroke. Up to 8% of patients who have had a TIA in the future suffer from a stroke that occurred within a month after the attack. In 12% of patients, a stroke occurs within a year and in 29% within the next five years.

Treatment of transistorized ischemic attack

It is carried out in a hospital.

Diagnostic studies include the following procedures:

1. Visiting a cardiologist, angiologist and ophthalmologist. The patient is assigned a consultation with a medical psychologist;
2. To conduct a laboratory analysis, the patient must pass a general blood and urine test, as well as blood for a biochemical analysis;
3. electrocardiography;
4. Computed tomography of the brain;
5. X-rays of light;
6. Regular blood pressure checks.

The victim is allowed to go home only if the recurrence of TIA is excluded or the patient has the opportunity to be immediately hospitalized in case of a recurrent attack.

The treatment of transistorized ischemic attack is to take the following oral medications:

• The action of which is aimed at thinning the blood;
• Vasodilating agents;
• Lowering cholesterol levels in the blood;
• Designed to normalize blood pressure.

It is good to combine drug therapy with balneotherapy and physiotherapy.

Prevention

To avoid the occurrence and recurrence of a transistor ischemic attack, a set of preventive measures should be observed:

1. Go in for sports, having previously drawn up a lesson plan together with your specialist;
2. Adjust the diet by reducing the amount of fatty, salty and spicy foods;
3. Reduce the use of alcohol and tobacco products;
4. Monitor your body weight.

Survey algorithm

It is possible to diagnose stroke by characteristic symptoms, but in order to determine the degree of the course of the disease, what type of stroke it belongs to,

It is necessary to undergo a series of diagnostic studies.

Examination by a specialist immediately after the patient enters the medical facility;

Taking blood for laboratory analysis, in order to assess the state of glucose levels, coagulation, enzymes;

CT scan in this case, allows you to get more complete information about the disease. In the first 24 hours after an ischemic disorder, it is not possible to find out the localization of the affected area.

This problem can be solved by conducting magnetic resonance imaging;

Angiography of cerebral vessels helps to determine with reliable accuracy the area where the lesion occurred or the level of narrowness of the artery. With this study, an aneurysm and a pathological connection between the veins and arteries of the brain can be diagnosed.

But the obtained results do not allow to correctly assess the amount of destruction of the nerve tissue. The solution to this problem is to combine vascular angiography with other diagnostic methods;

Collection of cerebrospinal fluid for laboratory research is a threat to the patient's life, but this study allows you to determine what type of stroke belongs to.

This diagnostic method is used mainly in medical institutions that lack more advanced equipment.

Forecast

A favorable outcome after the disease has a category of citizens who have experienced a small form of stroke. With few restrictions, these patients can normalize their life.

Statistics show that 40% of deaths occur within the first month after illness. 70% show signs of disability in the first month. Over the next 6 months, 40% become disabled. After two years, signs of disability are noticeable in 30% of patients.

Video: ONMK. Signs of a stroke.

Sudden changes in blood flow to the brain are classified as hemorrhagic (bleeding) and ischemic disorders. This division is important for right choice therapy method.

In abbreviated form, the classical name of the pathology in acute cerebrovascular accident looks like "CVA by ischemic type." If hemorrhage is confirmed, then - according to hemorrhagic.

In ICD-10, stroke codes may, depending on the type of violation, differ:

• G45 - established designation of transient cerebral attacks;
• I63 - recommended for statistical registration of cerebral infarction;
• I64 - a variant used for unspecified differences between cerebral infarction and hemorrhage, is used when a patient is admitted in an extremely serious condition, unsuccessful treatment and an imminent death.

By frequency ischemic strokes exceed hemorrhagic by 4 times, are more associated with general human diseases. The problem of prevention and treatment is considered in programs at the state level, because 1/3 of patients who have had a disease die in the first month and 60% remain permanently disabled requiring social assistance.

Why is there a lack of blood supply to the brain?

Acute cerebrovascular accident of the ischemic type is more often a secondary pathology, occurs against the background of existing diseases:

• arterial hypertension;
• widespread atherosclerotic vascular disease (up to 55% of cases develop due to severe atherosclerotic changes or thromboembolism from plaques located in the aortic arch, brachiocephalic trunk or intracranial arteries);
• transferred myocardial infarction;
• endocarditis;
• heart rhythm disturbances;
• changes in the valvular apparatus of the heart;
• vasculitis and angiopathy;
• vascular aneurysms and developmental anomalies;
• blood diseases;
• diabetes.

Up to 90% of patients have changes in the heart and the main arteries of the neck. The combination of these causes dramatically increases the risk of ischemia.

Possible compression of the vertebral artery by the processes of the vertebrae

The most common causes of transient attacks are:

• spasm of the arterial trunks of the brain or short-term compression of the carotid, vertebral arteries;
• embolization of small branches.

The following risk factors can provoke the disease:

• elderly and senile age;
• excess weight;
• the effect of nicotine on blood vessels (smoking);
• experienced stress.

The basis of the influencing factors is the narrowing of the lumen of the vessels through which blood flows to the brain cells. However, the consequences of such a malnutrition can be different in terms of:

• resilience
• localization,
• prevalence,
• severity of stenosis of the vessel,
• gravity.

A combination of factors determines the form of the disease and clinical symptoms.

Pathogenesis of different forms of acute cerebral ischemia

Transient ischemic attack was previously called transient cerebrovascular accident. It is singled out in a separate form, since it is characterized by reversible disorders, the focus of the infarction does not have time to form. Usually the diagnosis is made retrospectively (after the disappearance of the main symptoms), after a day. Prior to this, the patient is treated as with a stroke.

The main role in the development of hypertensive cerebral crises belongs to an increased level of venous and intracranial pressure with damage to the walls of blood vessels, the release of fluid and protein into the intercellular space.

Edema of the brain tissue in this case is called vasogenic

The feeding artery is necessarily involved in the development of ischemic stroke. The cessation of blood flow leads to oxygen deficiency in the focus, formed in accordance with the boundaries of the basin of the affected vessel.

Local ischemia causes necrosis of a portion of the brain tissue.

Depending on the pathogenesis of ischemic changes, there are types of ischemic strokes:

• atherothrombotic- develops when the integrity of the atherosclerotic plaque is violated, which causes complete blockage of the internal or external supplying arteries of the brain or their sharp narrowing;
• cardioembolic- the source of thrombosis is pathological growths on the endocardium or heart valves, thrombus fragments, they are delivered to the brain with the general blood flow (especially when the foramen ovale is not closed) after attacks of atrial fibrillation, tachyarrhythmia, atrial fibrillation in patients in the post-infarction period;
• lacunar - more often occurs when small intracerebral vessels are damaged in arterial hypertension, diabetes mellitus, it is distinguished by a small focus (up to 15 mm) and relatively small neurological disorders;
• hemodynamic- cerebral ischemia with a general decrease in blood circulation rate and a drop in pressure against the background of chronic heart disease, cardiogenic shock.

With hemodynamic disorders, blood flow in the vessels of the brain can decrease to a critical level and below

It is worth explaining the variant of the development of strokes of unknown etiology. This often happens when there are two or more causes. For example, in a patient with carotid stenosis and fibrillation after an acute infarction. It should be taken into account that elderly patients already have carotid artery stenosis on the side of the alleged disorder caused by atherosclerosis, up to half the lumen of the vessel.

Stages of cerebral infarction

The stages of pathological changes are allocated conditionally, they are not necessarily present in every case:

• Stage I - hypoxia (oxygen deficiency) disrupts the permeability of the endothelium of small vessels in the focus (capillaries and venules). This leads to the transition of fluid and protein in the blood plasma into the brain tissue, the development of edema.
• Stage II - at the level of capillaries, pressure continues to decrease, which disrupts the functions of the cell membrane, nerve receptors located on it, and electrolyte channels. It is important that all changes are still reversible.
• Stage III - cell metabolism is disturbed, lactic acid accumulates, there is a transition to energy synthesis without the participation of oxygen molecules (anaerobic). This type does not support required level cell life of neurons and astrocytes. Therefore, they swell, causing structural damage. Clinically expressed in the manifestation of focal neurological signs.

What is the reversibility of pathology?

For timely diagnosis, it is important to establish the period of reversibility of symptoms. Morphologically, this means the preserved functions of neurons. Brain cells are in the phase of functional paralysis (parabiosis), but retain their integrity and usefulness.

The zone of ischemia is much larger than the area of ​​necrosis, the neurons in it are still alive

In the irreversible stage, a zone of necrosis can be identified in which the cells are dead and cannot be restored. Around it is the zone of ischemia. Treatment is aimed at maintaining proper nutrition of neurons in this particular zone and at least partial restoration of function.

Modern research has shown extensive connections between brain cells. A person does not use all the reserves and opportunities in his life. Some cells are able to replace the dead and provide their functions. This process is slow, so doctors believe that the rehabilitation of a patient after an ischemic stroke should continue for at least three years.

Signs of transient circulatory disorders of the brain

In the group of transient disorders of cerebral circulation, clinicians include:

• transient ischemic attacks (TIA);
• hypertensive cerebral crises.

Features of transient attacks:

• by duration they fit in the period from several minutes to a day;
• every tenth patient after a TIA has an ischemic stroke within a month;
• neurological manifestations do not have a gross character of severe disorders;
• possible mild manifestations of bulbar paralysis (focus in the brain stem) with oculomotor disorders;
• blurred vision in one eye, combined with paresis (loss of sensation and weakness) in the limbs of the opposite side (often accompanied by incomplete narrowing of the internal carotid artery).

Features of hypertensive cerebral crises:

• the main manifestations are cerebral symptoms;
• focal signs are rare and mild.

The patient complains about:

• a sharp headache, often in the back of the head, temples or crown;
• state of stupor, noise in the head, dizziness;
• nausea, vomiting.

People around say:

• temporary confusion;
• excited state;
• sometimes - a short-term attack with loss of consciousness, convulsions.

Transient disorders are not accompanied by any abnormalities in computed tomography and magnetic resonance imaging, since they do not have organic changes.

Signs of a cerebral stroke

Ischemic stroke means the occurrence of irreversible changes in brain cells. In the clinic, neurologists distinguish periods of the disease:

• the most acute - lasts from the onset of manifestations for 2-5 days;
• acute - lasts up to 21 days;
• early recovery - up to six months after the elimination of acute symptoms;
• late recovery - takes from six months to two years;
• consequences and residual effects - over two years.

Some doctors continue to distinguish small forms of stroke or focal. They develop suddenly, the symptoms do not differ from cerebral crises, but last up to three weeks, then completely disappear. The diagnosis is also retrospective. Examination revealed no organic abnormalities.

Cerebral ischemia, in addition to general symptoms (headaches, nausea, vomiting, dizziness), is manifested locally. Their nature depends on the artery, which is "turned off" from the blood supply, the state of the collaterals, the dominant hemisphere of the brain in the patient.

Consider the zonal signs of blockage of the cerebral and extracranial arteries.

With damage to the internal carotid artery:

• impaired vision on the side of the blockage of the vessel;
• the sensitivity of the skin on the limbs, the face of the opposite side of the body changes;
• in the same area there is paralysis or paresis of muscles;
• the disappearance of the function of speech is possible;
• the inability to be aware of one's disease (if the focus is in the parietal and occipital lobes of the cortex);
• loss of orientation in parts of one's own body;
• loss of visual fields.

Narrowing of the vertebral artery at the level of the neck causes:

• hearing loss;
• nystagmus pupils (twitching when deviating to the side);
• double vision.

If contraction occurs at the confluence with the basilar artery, then the clinical symptoms are more severe, since the cerebellar lesion predominates:

• inability to move;
• disturbed gestures;
• scanned speech;
• violation of the joint movements of the trunk and limbs.

The possibility of developing compensatory collateral circulation is much higher with impaired patency of extracranial vessels, since there are connecting arteries for blood to flow from the other side of the body.

If there is insufficient blood flow in the basilar artery, there are manifestations of visual and stem disorders (impaired breathing and blood pressure).

With damage to the anterior cerebral artery:

• hemiparesis of the opposite side of the body (unilateral loss of sensation and movement) more often in the leg;
• slowness of movements;
• increased tone of flexor muscles;
• loss of speech;
• inability to stand and walk.

Blockage of the middle cerebral artery is characterized by symptoms depending on the defeat of the deep branches (nourish the subcortical nodes) or long (suitable for the cerebral cortex)

Violation of patency in the middle cerebral artery:

• with complete blockage of the main trunk, a deep coma occurs;
• lack of sensitivity and movements in half of the body;
• inability to fix the gaze on the subject;
• loss of visual fields;
• loss of speech;
• the inability to distinguish the left side from the right.

Violation of the patency of the posterior cerebral artery causes:

• blindness in one or both eyes;
• double vision;
• gaze paresis;
• convulsions;
• large tremor;
• impaired swallowing;
• paralysis on one or both sides;
• violation of breathing and pressure;
• brain coma.

When blockage of the optic geniculate artery appear:

• loss of sensation in the opposite side of the body, face;
• severe pain when touching the skin;
• inability to localize the stimulus;
• perverted perceptions of light, knocking;
• thalamic hand syndrome - the shoulder and forearm are bent, the fingers are unbent in the terminal phalanges and bent at the base.

Impaired blood circulation in the zone of the visual tubercle, thalamus is caused by:

• sweeping movements;
• large tremor;
• loss of coordination;
• impaired sensitivity in half of the body;
• sweating;
• early bedsores.

The combination of damage to several branches causes complex syndromes of loss of sensitivity, false sensations in the limbs. The possibilities of diagnosing ischemic changes depend primarily on the neurologist's knowledge of the clinical manifestations of vascular disorders.

In what cases can CVA be suspected?

The above clinical forms and manifestations require careful examination, sometimes not by one, but by a group of doctors of different specialties.

Violation of cerebral circulation is very likely if the patient has the following changes:

• sudden loss of sensation, weakness in the limbs, on the face, especially one-sided;
• acute loss of vision, the occurrence of blindness (in one eye or both);
• difficulty in pronunciation, understanding words and phrases, making sentences;
• dizziness, loss of balance, impaired coordination of movements;
• confusion;
• lack of movement in the limbs;
• intense headache.

An additional examination allows you to establish the exact cause of the pathology, the level and localization of the vascular lesion.

Purpose of diagnosis

Diagnosis is important for choosing a treatment method. For this you need:

• confirm the diagnosis of stroke and its form;
• identify structural changes in the brain tissue, the focus area, the affected vessel;
• clearly distinguish between ischemic and hemorrhagic forms of stroke;
• on the basis of pathogenesis, establish the type of ischemia to start specific therapy in the first 3-6 to get into the "therapeutic window";
• evaluate the indications and contraindications for medical thrombolysis.

It is practically important to use diagnostic methods on an emergency basis. But not all hospitals have enough medical equipment for round-the-clock work. The use of echoencephaloscopy and the study of cerebrospinal fluid give up to 20% errors and cannot be used to resolve the issue of thrombolysis. The most reliable methods should be used in the diagnosis.

Foci of softening on MRI allow differential diagnosis of hemorrhagic and ischemic strokes

Computed and magnetic resonance imaging allows:

• distinguish stroke from volume processes in the brain (tumors, aneurysms);
• accurately determine the size and localization of the pathological focus;
• determine the degree of edema, violations of the structure of the ventricles of the brain;
• identify extracranial localization of stenosis;
• to diagnose vascular diseases that contribute to stenosis (arteritis, aneurysm, dysplasia, vein thrombosis).

Computed tomography is more accessible, has advantages in the study of bone structures. And magnetic resonance imaging better diagnoses changes in the parenchyma of brain tissues, the size of the edema.

Echoencephaloscopy can only reveal signs of displacement of midline structures with a massive tumor or hemorrhage.

Cerebrospinal fluid rarely gives ischemia a slight lymphocytosis with an increase in protein. Most often no change. If the patient has a hemorrhage, then an admixture of blood may appear. And with meningitis - inflammatory elements.

Ultrasound examination of the vessels - the method of Dopplerography of the arteries of the neck indicates:

• development of early atherosclerosis;
• stenosis of extracranial vessels;
• sufficiency of collateral connections;
• the presence and movement of the embolus.

With duplex sonography, the condition of atherosclerotic plaque and artery walls can be determined.

Cerebral angiography is performed if there are technical possibilities for emergency indications. Usually, the method is considered more sensitive in determining aneurysms and foci of subarachnoid hemorrhage. Allows you to clarify the diagnosis of the pathology detected on the tomography.

Ultrasound of the heart is performed to detect cardioembolic ischemia in heart disease.

It is mandatory to study blood clotting: hematocrit, viscosity, prothrombin time, the level of platelet and erythrocyte aggregation, fibrinogen.

Survey algorithm

The examination algorithm for suspected stroke is carried out according to the following plan:

1. examination by a specialist in the first 30-60 minutes after the patient's admission to the hospital, examination of the neurological status, clarification of the anamnesis;
2. blood sampling and examination of its coagulability, glucose, electrolytes, enzymes for myocardial infarction, hypoxia level;
3. in the absence of the possibility of an MRI and CT scan, an ultrasound of the brain;
4. lumbar puncture to exclude hemorrhage.

Treatment

Most importance in the treatment of cerebral ischemia belongs to the urgency and intensity in the first hours of admission. 6 hours from the onset of clinical manifestations is called the "therapeutic window". This is the time of the most effective application of the thrombolysis technique for dissolving a blood clot in a vessel and restoring impaired functions.

Regardless of the type and form of stroke in the hospital, the following are carried out:

• increased oxygenation (filling with oxygen) of the lungs and normalization of respiratory function (if necessary, by translation and mechanical ventilation);
• correction of impaired blood circulation (heart rhythm, pressure);
• normalization of the electrolyte composition, acid-base balance;
• reduction of cerebral edema by the introduction of diuretics, magnesia;
• relief of excitation, convulsive seizures with special neuroleptic drugs.

To feed the patient, a semi-liquid table is prescribed, if swallowing is impossible, parenteral therapy is calculated. The patient is provided permanent care, prevention of bedsores, massage and passive gymnastics.

Rehabilitation starts from the first days

This allows you to get rid of the negative consequences in the form of:

• muscle contractures;
• congestive pneumonia;
• DIC;
• thromboembolism of the pulmonary artery;
• damage to the stomach and intestines.

Thrombolysis is a specific therapy for stroke of the ischemic type. The method allows preserving the viability of neurons around the necrosis zone, returning to life all weakened cells.

The introduction of anticoagulants begins with Heparin derivatives (in the first 3-4 days). This group of drugs is contraindicated in:

• high blood pressure;
• peptic ulcer;
• diabetic retinopathy;
• bleeding;
• the impossibility of organizing regular monitoring of blood clotting.

After 10 days, they switch to indirect anticoagulants.

Drugs that improve metabolism in neurons include Glycine, Cortexin, Cerebrolysin, Mexidol. Although they are not listed as effective in the evidence-based medicine database, the appointment leads to an improvement in the condition.

Decompression trepanation of the skull is performed in case of increasing edema in the region of the brain stem

Patients may need symptomatic treatments, depending on the specific manifestations: anticonvulsants, sedatives, painkillers.

Antibacterial agents are prescribed to prevent infection of the kidneys and pneumonia.

Forecast

Prediction data are only available for ischemic infarction, other changes are precursors indicating an increased risk of stroke.

Atherothrombotic and cardioembolic types of ischemia have the most dangerous mortality rate: from 15 to 25% of patients die during the first month of the disease. Lacunar stroke ends fatally in only 2% of patients. The most common causes of death:

• in the first 7 days - cerebral edema with compression of vital centers;
• up to 40% of all deaths occur in the first month;
• after 2 weeks - pulmonary embolism, congestive pneumonia, cardiac pathology.

Patient survival time:

• 1 year - up to 70%;
• 5 years - 50%;
• 10 years - 25%.

After this period, 16% per year die.

Only 15% of patients return to work

The presence of signs of disability have:

• in a month - up to 70% of patients;
• six months later - 40%;
• by the second year - 30%.

Most of all, the rate of recovery is noticeable in the first three months by increasing the range of motion, while the functions of the legs return faster than the hands. Remaining immobility in the hands after a month is an unfavorable sign. Speech is restored years later.

The rehabilitation process is most effective with the willful efforts of the patient, the support of loved ones. Complicating factors are advanced age and heart disease. Seeing a doctor in the phase of reversible changes will help to avoid serious consequences.

VIII pair - n.Vestibulocochlearis: hearing acuity for whispered and colloquial speech is preserved. Notes dizziness, tinnitus, during an attack of headache. Vestibular load tolerates well. He denies auditory hallucinations. Nystagmus is negative. Spoken language on the right = 4 m on the left = 6 m. Whispered speech on the right = 2m. left = 3m.

IX, X pairs - n.glossopfaringeus, n.vagus: the mobility of the soft palate is preserved. Swallowing and phonation are not disturbed. Palatal and pharyngeal reflexes are preserved. Taste sensitivity is normal.

XI pair - n. Accesorius: the contours of the trapezius, sternocleidomastoid muscles are unchanged. Raises arms outstretched to the side above the horizontal level. Raising the shoulder girdle, turning the head to the side, abducting the shoulder blades performs in full.

XII pair - n.hypoglossus: appearance the tongue is normal, there is no atrophy, no muscle twitches. The tongue protrudes along the midline, both halves of the tongue are symmetrical.

SENSITIVE SPHERE

There is a decrease in the surface sensitivity of the right half of the body, deep sensitivity on the right half is impaired. Superficial, deep sensitivity is preserved on the left half.

MOTOR FUNCTIONS

The gait is straight, stable and walks freely on the heels. The volume in the cervical, thoracic, lumbar spine is full. Movement in the joints of the upper and lower extremities of the right and left sides is complete.

Muscle strength:

The Bare test is positive, the muscle tone on the right limbs is reduced, on the left it is normal. There is a slight atrophy of the right limbs, there are no fasciculatory twitches. There are violations of coordination of movement: the test for adiodochokinesis is positive on the right hand, the heel-knee test on the right leg is performed unsatisfactorily, intentional tremor on the right hand. In a simple Romberg position, it is stable. In the complicated one, it staggers.

REFLEX SPHERE

Tendon periosteal reflexes from the biceps and triceps, knee Achilles reflexes are preserved on both sides. On the right above. Pathological reflexes: Rossolimo, Babinsky are positive on the right.

AUTONOMIC SYSTEM

Berner-Horner syndrome is negative. Skin color is normal, pigmentation, high body temperature, no sweating. The greasiness of the skin is within the normal range. Dermographism is red, strip width is 5 mm. It appears in 1 minute and disappears in 2-3 minutes. No trophic changes in the skin were found. The functions of the pelvic organs are not impaired.

HIGHER CORTICAL FUNCTIONS

Consciousness is clear, oriented in time and place, contacts with others. Crazy ideas, hallucinations, obsessive states denies. did not lag behind in development, this moment corresponds to the intelligence of his age. The patient adequately assesses her condition, specifically answers the questions posed. confidently repeats complex phrases. Understands the meaning of proverbs. He writes quite legibly, reads slowly, with meaning. Simple actions (fastens a button) perform well. With closed eyes, he correctly identifies objects with his left hand. Right-difficulty. (tactile-kinesthetic agnosia)

PLAN OF ADDITIONAL EXAMINATION METHODS

1. Complete blood count; for HIV, syphilis.

2. General analysis of urine.

5. Consultations of an ophthalmologist, physiotherapist, cardiologist.

1. Complete blood count (4.02.03.):

Hemoglobin - 117/l

Leukocytes - 4.4 * 10 9 / l

ESR- 10mm/h

E	mailbox	s / i	L	M
5	1	59	30	5

HIV is negative. Wasserman's reaction is negative.

2. General analysis of urine

Color - straw yellow

transparent

The reaction is sour

Protein negative.

Leukocytes 1-2

Red blood cells - 4-8

squamous epithelium – 2-4

Blood test for sugar (4.02.03.): 3.2 mmol/l

3. ECG. CONCLUSION: sinus rhythm, 75 beats per minute, there are signs of impaired conduction of the right atrium, left ventricular hypertrophy, impaired depolarization process. On the basis of ECG data, left ventricular hypertrophy, conduction disturbances and metabolic disorders in the myocardium are detected.

Optometrist's consultation

Fundus of the eye: angiopathy of retinal vessels.

The optic disc is pale pink in color. The boundaries are clear, sclerosis, veins are dilated I-II st.

Ds: retinal angiosclerosis.

Cardiologist's consultation

1. Enalapril 10 ml 2 times a day

2. Hypothiazide 12.5 ml per day

3. Atenolol 25 ml 2 times a day

4. BP control

TOPIC DIAGNOSIS

Based on neurological status: right-sided hemiparesis and hemihypoanesthesia, right-sided hypotension

Based on the conclusion of CT scan dated 03/12/08: we can conclude that the pathological focus is localized in the left half of the cerebral cortex.

CLINICAL DIAGNOSIS

Analyzing and comparing the results of additional research methods, as well as the patient's complaints: headaches in the temporal and parieto-occipital regions, aggravated in the evening, and also after sleep. The pains are acute in nature, and occur in the right temporal region, followed by a transition to the occipital and opposite temporal regions. Periodic dizziness, tinnitus, nausea, vomiting, numbness in the left arm, lower legs, general weakness, poor sleep (sleep 3-4 hours a day). The pain subsides in the position of the patient lying down, we can say that the nervous system, the circulatory system is involved in the pathological process. Based on the history of the disease and the topical diagnosis and additional examination methods, a clinical diagnosis can be made:

Acute cerebrovascular accident in the territory of the left MCA according to the ischemic type. Right-sided hemiparesis and hemihypoanesthesia. motor aphasia. GB III st, risk IV. Obesity II Art.

DIFFERENTIAL DIAGNOSIS

The differential diagnosis of ischemic stroke often requires the exclusion of hemorrhagic or neoplastic lesions of the brain. A hemorrhage into the tumor proceeds in a stroke-like manner, however, usually with a brain tumor it is possible to find out that the acute period was preceded by an increasing headache and focal symptoms. Significant assistance in the diagnosis is provided by the degree of displacement of the median structures on the echoencephalogram and the detection of space-occupying formations on CT, which are characteristic of tumors.

From the data given in the table, it follows that only ischemic strokes, brain atrophy are suitable for the described clinic.

ETIOLOGY

Etiology, pathogenesis. In most cases, strokes are a complication of hypertension and atherosclerosis, less often they are caused by diseases of the valvular apparatus of the heart, myocardial infarction, congenital anomalies of cerebral vessels, hemorrhagic syndromes and arteritis. Approximately 90% of stroke patients have some form of heart disease with symptoms of cardiovascular failure. The only exceptions are some variants of hemorrhagic strokes, for example, when an aneurysm ruptures in young people.

TREATMENT

For nosology:

Treatment should begin as early as possible (within the therapeutic window). Patients are shown hospitalization in a neurological or neurovascular hospital, and in the event of an extensive stroke, in the intensive care unit. Most patients require consultation with a cardiologist. Decide on the need and possibility of neurosurgical treatment.

Patients with PNMK need bed rest until the end of the acute period and stabilization of the condition. Inpatient treatment is indicated in the case of acute hypertensive encephalopathy, severe hypertensive crisis, repeated TIA, as well as the lack of effect of outpatient treatment, and exacerbation of concomitant diseases, in particular coronary artery disease.

There are 2 main areas of treatment:

Differentiated, depending on the nature of the stroke.

Undifferentiated, aimed at maintaining vital functions and correcting homeostasis.

Undifferentiated:

1. Correction of the activity of the CCC, aimed at controlling blood pressure.

Beta-blockers (anaprilin, atenolol)

Calcium channel blockers (nifedipine, amlodipine)

Diuretics (furosemide)

ACE inhibitors (captopril, enalapril)

With the development of hypotension - cardiotonic drugs (mezaton, cordiamin)

In the absence of effect - corticosteroids (hydrocortisone, dexamethasone)

2. Respiratory control:

Toilet mouth and nose. Removal of vomit and secretions from the upper respiratory tract with suction.

For severe stroke, broad-spectrum antibiotics (prevention of pneumonia)

Breathing exercises

3. Maintenance of hemostasis by the introduction of saline solutions

4. Corticosteroids to combat cerebral edema.

In recent years, 2 main pathogenetic variants of chronic cerebrovascular insufficiency have been considered. A large role in the development of chronic cerebrovascular insufficiency has recently been assigned to venous pathology, not only intracranial, but also extracranial.

The pathogenesis of cerebrovascular insufficiency in VBB can cover an extremely wide range of changes. Along with the pathology of the vessels of the vertebrobasilar system (stenosis and occlusion) due to atherosclerosis, extravasal factors are of great importance. Other causes also include pathological tortuosity, congenital developmental disorders in the form of hypo- and aplasia of the vertebral artery, and Kimmerli anomaly.

Mechanical compression of the vertebral artery at the level of the cervical spine, which underlies the development of archer's stroke. Treatment of vertebrobasilar insufficiency is one of the services offered by the multidisciplinary doctor clinic. Here you will find out what vertebrobasilar insufficiency is, how it is treated, the cost of the procedure.

Moreover, some of them, short-term and transient, are detected only during an attack, while others, long-term, may remain after an attack of circulatory disorders. In VBB, both transient ischemic attacks (TIA) and ischemic strokes and microstrokes can occur.

With such lesions, dizziness is often combined with tinnitus or hearing loss, is paroxysmal in nature, and lasts for several seconds. Such dizziness can be attributed to benign and quickly corrected conditions.

The main symptoms of circulatory disorders in the VBB:

Compression of blood vessels, both arterial and venous, can play a certain role in the formation of chronic cerebral ischemia. Low blood pressure adversely affects cerebral blood flow, especially in the elderly. This group of patients may develop damage to the small arteries of the head associated with senile arteriosclerosis. Quite often, chronic cerebrovascular insufficiency is detected in patients with diabetes mellitus, they develop not only micro-, but macroangiopathies of various localization.

In the presence of the main factors in the development of chronic cerebrovascular insufficiency, the rest of the variety of causes of this pathology can be interpreted as additional causes.

Cerebral blood flow depends on perfusion pressure (difference between systemic blood pressure and venous pressure at the level of the subarachnoid space) and cerebral vascular resistance. Adequate brain perfusion is maintained at the same time by an increase in vascular resistance, which in turn leads to an increase in the load on the heart.

Clinic (manifestations and symptoms):

Severe hypertensive crises are always a breakdown of autoregulation with the development of acute hypertensive encephalopathy, each time aggravating the phenomena of chronic cerebrovascular insufficiency. But cerebral blood flow depends not only on the severity of stenosis, but also on the state of collateral circulation, the ability of cerebral vessels to change their diameter.

However, even with hemodynamically insignificant stenosis, chronic cerebrovascular insufficiency will almost certainly develop. With damage to the main arteries of the head, cerebral blood flow becomes very dependent on systemic hemodynamic processes. They are based on morphological features - the nature of the damage and the predominant localization. At the same time, even a slight decrease in blood pressure can lead to ischemia in the end zones of the adjacent blood supply.

However, at the ultrastructural level around necrotic cells, cells with apoptosis-like reactions triggered in the acute period of stroke can persist.

Each vertebral artery (there are two in total, right and left) is conditionally divided into 4 segments:

The progression of cerebrovascular insufficiency becomes a risk factor for the development of recurrent stroke and vascular cognitive disorders up to dementia. core clinical picture Dyscirculatory encephalopathy has recently been recognized as cognitive impairment, detected already in stage I and progressively increasing to stage III. At stage I, the above complaints are combined with diffuse microfocal neurological symptoms in the form of anisoreflexia, convergence insufficiency, and coarse reflexes of oral automatism.

At this stage, there may be signs of a decrease in professional and social adaptation. The basis of all syndromes characteristic of dyscirculatory encephalopathy is the disconnection of connections due to diffuse anoxic-ischemic damage to the white matter. In the vestibulocerebellar (or vestibulo-atactic) syndrome, subjective complaints of dizziness and unsteadiness when walking are combined with nystagmus and coordination disorders.

The pyramidal syndrome in dyscirculatory encephalopathy is characterized by high tendon and positive pathological reflexes, often asymmetrical. Difficulties in turning while walking are manifested not only by stomping on the spot, but also by turning the whole body in violation of balance, which may be accompanied by a fall.

The genesis of these disorders is combined, due to damage to the pyramidal, extrapyramidal and cerebellar systems. To diagnose chronic cerebrovascular insufficiency, it is necessary to establish a relationship between clinical manifestations and pathology of cerebral vessels. Atherosclerotic stenoses usually develop in the initial segments of the internal carotid artery and in the bifurcation of the common carotid artery. The main direction of laboratory research is to clarify the causes of chronic cerebrovascular insufficiency and its pathogenetic mechanisms.

An important place is given to ultrasound research methods, which allow to detect both cerebral blood flow disorders and structural changes in the vascular wall, which are the cause of stenosis.

It is believed that chronic cerebrovascular insufficiency exists in 80% of patients with stenosing lesions of the main arteries of the head. Obviously, this indicator can reach an absolute value if an adequate clinical and instrumental examination is carried out to identify signs of chronic cerebral ischemia.

If the basis of chronic cerebrovascular insufficiency is only arterial hypertension, then the use of the term "hypertensive encephalopathy" is legitimate. As chronic cerebrovascular insufficiency progresses, there is an increasing decrease in protective sanogenetic mechanisms, including the antioxidant properties of plasma.

Dyscirculatory encephalopathy and its main symptoms

Dyscirculatory encephalopathy is a disease that is accompanied by organic changes in the nervous tissues. It is worth noting that in the absence of treatment, the disease progresses, leading to unpleasant and dangerous consequences. That is why it is so important to seek help from a specialist in time.

In most cases, the disease occurs against the background of chronic vascular insufficiency in the brain tissues. Due to impaired blood circulation and, accordingly, a lack of oxygen and nutrients, a change in structures is observed, which leads to serious disturbances in the functioning of the whole organism. The causes of vascular insufficiency can be different. Most often, dyscirculatory encephalopathy is the result of atherosclerosis (blockage) of cerebral vessels. But chronic hypertension, rheumatism and other problems can lead to the same result.

Dyscirculatory encephalopathy: symptoms

The main signs of the disease directly depend on the stage of its development. In modern medicine, it is customary to distinguish three main stages, each of which is accompanied by different symptoms:

At the first stage (stage of compensation), changes in the mental state and behavior of a sick person are mainly observed. As a rule, during this period, patients become emotionally unstable - they are too excitable, unrestrained and irritable. Often, this condition also affects the quality of sleep, which becomes disturbing, as a result of which a person simply cannot rest normally. Sometimes there are headaches and dizziness, as well as a decrease in memory and concentration.

The second stage is accompanied by more persistent organic changes in the brain tissues, which cannot but be reflected in the patient's condition. Periodic headaches become permanent. Increased excitability disappears - a person becomes lethargic, depressed, gets tired quickly, sleeps poorly. As the disease progresses, other disorders are observed, for example, some reflexes disappear, memory deteriorates significantly, hearing decreases, tremors appear in the limbs, as well as convulsive seizures.

Dyscirculatory encephalopathy in the third stage is accompanied by more pronounced symptoms, because during this period the morphological changes in the meninges are already easy to notice during tomography. All of the above symptoms remain, but become even more pronounced. In addition, other disorders appear, which depend on which particular area of ​​the brain was damaged. Often the disease is accompanied by paresis or paralysis, speech disorders and serious mental disorders are observed.

Therapy directly depends on the stage of the disease and the symptoms present. Patients are usually prescribed drugs that improve blood flow, as well as those drugs that strengthen the walls of blood vessels and eliminate their spasm. In some cases, drugs are used that regulate the activity of the brain. With increased excitability, sedatives are indicated, while with high blood pressure, antihypertensive drugs are used.

HNMK - chronic cerebrovascular accident

It is customary to single out the initial manifestations of cerebrovascular accident as an early stage of HNMK and DE (dyscirculatory encephalopathy) - a multifocal brain lesion caused by chronic circulatory failure.

In turn, the following forms of DE are distinguished:

Causes and pathogenesis of HNMK

As a rule, chronic cerebrovascular accident is a consequence of cardiovascular pathology. Usually HNMK develops against the background of:

• vegetative-vascular dystonia;
• atherosclerosis, hypertension;
• diabetes
• heart diseases of various etiologies;
• vasculitis;
• blood diseases accompanied by a violation of its rheological properties.

These pathologies change the general and cerebral hemodynamics and lead to a decrease in cerebral perfusion (less than ml / 100 g per minute). The most important factors involved in the pathogenesis of HNMK include:

• changes in the extra-, intracranial sections of the vessels of the head;
• insufficiency of collateral circulation;
• violation of autoregulation of blood circulation;
• violation of rheology.

Obesity, physical inactivity, alcohol abuse and smoking play a significant role in the progression of CNMC.

Symptoms of chronic cerebrovascular accident

In the early stages of HNMC, the picture is characterized by patient complaints of a feeling of heaviness in the head, mild dizziness, unsteadiness when walking, noise in the head, fatigue, decreased attention and memory, and sleep disturbance. The initial manifestations of circulatory failure occur after psycho-emotional and / or physical overstrain, against the background of alcohol consumption, under adverse meteorological conditions. Patients have signs of vegetative-vascular and emotional lability, some slowness of thinking processes, convergence insufficiency is possible. The progression of the initial manifestations of circulatory failure leads to the formation of the next stage - DE.

Depending on the severity of manifestations, there are three stages of chronic cerebrovascular accident. In stage I, the symptoms are mild, patients usually remain functional; in stage II, the symptoms are moderate, and in stage III, patients become disabled.

With atherosclerotic encephalopathy, i.e., with DE caused by atherosclerotic lesions of the vessels that provide blood supply to the brain, in stage I, a decrease in attention and memory is noted, especially for current events, it is difficult to memorize new information, it is difficult for the patient to switch from one activity to another. At the same time, mild cognitive impairments, as a rule, are compensated for by retained household and professional skills, as well as intellectual capabilities. Often, patients complain of increased fatigue and decreased performance, often there is emotional lability with a decrease in psycho-emotional background. Diffuse headaches, noise in the head are noted. Complaints of patients on instability when walking are characteristic. In the neurological status, minor scattered symptoms are detected in the form of moderate symptoms pseudobulbar syndrome, tendon hyperreflexia and anisoreflexia, and postural instability.

In stage II, clinical manifestations progress, cognitive impairment increases, working capacity decreases, patients become touchy and irritable. Narrowing of interests is noted, memory disorders are growing. Often there are dull headaches, dizziness, unsteadiness when walking. The neurological status reveals anisoreflexia, pseudobulbar symptoms, vestibulo-cerebellar disorders, and subcortical symptoms.

In stage III, there is a further aggravation of neurological manifestations. Patients show significant scattered neurological symptoms in the form of an increase in pyramidal insufficiency, pseudobulbar disorders, cerebellar and extrapyramidal symptoms, as well as impaired control of the pelvic organs. Epileptic seizures are possible. Stage III is characterized by pronounced violations of higher mental functions: significant cognitive impairment to dementia, probably the development of apatoabulic syndrome, pronounced emotional and personality changes. In the later stages, patients lose their self-care skills. For atherosclerotic encephalopathy, drowsiness after eating, Windscheid's triad, is typical. In stage III, Hackebush's disease, or a pseudo-Alzheimer's form of atherosclerosis, can be observed - a symptom complex, the main manifestation of which is dementia. At the same time, a decrease in memory, confabulation, a pronounced narrowing of the circle of interests, uncriticality, speech disorders, gnosis and praxis are noted. In addition, in the late stage of atherosclerotic encephalopathy, the formation of Demaje-Oppenheim syndrome is possible, which is characterized by gradually developing central tetraparesis.

Chronic hypertensive encephalopathy is a form of DE caused by arterial hypertension. Arterial hypertension leads to diffuse damage to the brain tissue, the disease progresses quite quickly with significant fluctuations in blood pressure, recurring hypertensive crises. The disease can manifest itself at a fairly young age, on average, at an early age. In the initial stages, the clinical picture of hypertensive encephalopathy is characterized by sufficient dynamism and reversibility of symptoms. Characteristic neurosis-like syndrome, frequent headaches, predominantly occipital localization, noise in the head. In the future, there may be signs of bilateral pyramidal insufficiency, elements of the akinetic-rigid syndrome, tremor, emotional-volitional disorders, decreased attention and memory, slow mental reactions. As the progression progresses, personality disorders occur, the range of interests narrows, speech intelligibility is impaired, anxiety increases, weakness is noted. Patients are characterized by disinhibition.

In the III stage of hypertensive encephalopathy in patients, as a rule, there is a pronounced atherosclerosis, the condition is characterized by features typical of atherosclerotic encephalopathy - developing dementia. In the advanced stage, patients lose the ability to self-service, control of pelvic functions, signs of apato-abulic or paranoid syndromes may appear.

A variant of hypertensive encephalopathy in combination with atherosclerotic brain damage is Binswanger's encephalopathy (progressive vascular leukoencephalopathy). It usually begins around the age of 50 and is characterized by memory loss, cognitive impairment, movement disorders with chronic cerebrovascular accident of the subcortical type. Sometimes there are epileptic seizures. As a rule, encephalopathy in chronic cerebrovascular accident develops gradually, although stepwise progression associated with vascular crises, fluctuations in blood pressure and cardiac disorders is also possible.

Venous DE is characterized by venous congestion in the skull, chronic hypoxia, and intracranial hypertension. Venous DE often develops in patients with cardiopulmonary diseases, as well as with arterial hypotension.

Diagnostic procedures for CNMC include taking an anamnesis, taking into account information about somatic pathology (especially about cardiovascular diseases), analyzing patient complaints, neurological, neuropsychological examination. Instrumental examination involves Doppler ultrasound (USDG), rheoencephalography, CT) or MRI, ophthalmoscopy and angiography. As a rule, it is necessary to examine the heart (electrocardiography - ECG, echocardiography), as well as a study of the rheological properties of the blood.

Treatment of chronic cerebrovascular accident

Arterial hypertension is one of the most important risk factors for CNMC, however, episodes of hypotension are also unfavorable for patients with DE. In the process of correction, it is advisable to maintain blood pressure at a stable level, slightly exceeding the "optimal" indicators: mm Hg. It is necessary to select medicines for chronic cerebrovascular accident, taking into account the characteristics of the patient, his reaction to prescribed drugs. In order to treat arterial hypertension, angiotensin-converting enzyme inhibitors - ACE inhibitors (captopril, perindopril, enalapril, enalaprilat), angiotensin II receptor antagonists (candesartan, eprosartan), β-blockers (in particular, atenolol, labetalol, metoprolol, propranolol, esmolol), agonists central α-adrenergic receptors (clonidine), slow calcium channel blockers (nifedipine). Diuretics as antihypertensive therapy are used only when indicated (for example, heart failure, ineffectiveness of other antihypertensive drugs) due to a possible deterioration in blood rheology.

Forecast

Usually, chronic cerebrovascular accident is characterized by a slowly progressive course, although a stepwise progression is also possible (usually after vascular crises). In stage I, the ability to work and everyday adaptation of patients in most cases is preserved, in stage II there is a slight or moderate decrease in working capacity, in stage III, patients are disabled, often unable to self-service.

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Chronic cerebrovascular accident (CCM): what is it?

1. Blood supply to the brain 2. Causes of the disease 3. Mechanisms of development 4. Clinical manifestations 5. Diagnosis 6. Treatment

Cerebrovascular pathology occupies a leading position among all neurological diseases. If the detection of acute hemodynamic disorders most often does not present difficulties due to vivid clinical manifestations, chronic dyscirculation may not be diagnosed for a considerable time. Such non-specific symptoms as recurrent headaches, fatigue, absent-mindedness are sometimes harbingers of a gradual increase in the disease. At the same time, chronic cerebrovascular accident (CIC) often leads to disability and significantly reduces the patient's quality of life.

CNMC is a gradually progressive disease of the brain, which is based on its diffuse dyscirculatory process, leading to ischemia of the nervous tissue. The impoverishment of cerebral blood flow changes the biochemical reactions in nerve cells, disrupts their nutrition and subsequently causes the death of neurons. With significant hemodynamic shifts, neurological symptoms appear associated with the lack of adequate blood supply to certain parts of the brain.

The term "chronic cerebrovascular insufficiency" is absent in the international classification of diseases ICD 10. Chronic ischemia of the brain (code I 67.9) and cerebrovascular disease not specified (code I 67.9) are considered the closest in terms of the clinical picture and pathogenesis of the disease. In addition, in ICD 10 you can find similar concepts - progressive vascular leukoencephalopathy, cerebral atherosclerosis and hypertensive encephalopathy.

Blood supply to the brain

The structures of the brain receive blood supply from the vertebrobasilar vascular basin (VBV) and the carotid system.

The carotid system gives rise to the anterior and middle cerebral arteries, which feed:

• frontal, parietal and temporal lobes;
• striopallidar subcortical structures;
• inner capsule.

Areas of blood supply of the vertebrobasilar basin:

Preferential discirculation in the vertebrobasilar system is often associated with the anatomical features of the vertebral arteries, which are located in the canal of the cervical vertebrae. Osteochondrosis of this department, neck injuries and displacement of the vertebrae deform the vessels and prevent adequate blood supply to the brain.

The two blood supply pools are connected by connecting arteries that close the circle of Willis. It is believed that such a closed system is a manifestation of the compensatory mechanisms required when one of the arteries is excluded from the blood flow. If the communicant vessels do not fully function or are completely absent, the circle of Willis is considered open or open.

Causes of the disease

Cerebrovascular insufficiency is mainly found in the elderly. However, recently there has been a sad trend towards the "rejuvenation" of the disease. Moreover, the causes of the development of the disease often do not depend on the age of the patient. The main predisposing factors include:

• instability of blood pressure (hypertension, hypotension);
• atherosclerosis;
• cardiac pathology;
• vasculitis;
• disorders of blood rheology;
• diabetes;
• chronic intoxication;
• hypodynamia;
• obesity;
• stressful situations.

The causes of the pathology may also be hidden in the genetic predisposition of a person to the development of the etiological components of the disease (hereditary forms of hypertension, diabetes mellitus, hyperlipidemia).

Development mechanisms

Insufficient cerebral blood flow provokes a number of morphological and functional disorders that play a major role in the development of the disease. Lack of adequate oxygen supply to cells:

• reduces the activity of redox processes;
• inhibits the synthesis of adenosine phosphate;
• inhibits the aerobic form of glycolysis;
• activates the anaerobic pathway for glucose utilization;
• disrupts the activity of ion transport through the cell wall.

These processes lead to the formation of small pinpoint foci of ischemia diffusely scattered in the brain tissue. The degree of hypoxic damage to the nervous tissue is determined by the causes of the pathological process, the severity of these factors, the duration of their exposure and the state of the body itself (acid-base balance, blood gas levels).

Clinical manifestations

The clinical picture of the disease depends on the duration of the disease and the vascular pool, where discirculation occurs predominantly. Due to the fact that ischemic foci are most often diffusely localized, the symptoms of the disease may include several components.

Currently, the gradation of chronic cerebrovascular pathology into three degrees is used. This division reflects the severity of the main manifestations and the severity of the disease.

For insufficiency of blood supply to the brain of the 1st degree, the presence of scattered neurological symptoms is characteristic, which does not allow to identify the leading neurological syndrome. As a rule, there is a small number of small foci of ischemia, which are not able to lead to pronounced functional disorders. Patients complain of general weakness, recurrent headaches, dizziness, absent-mindedness, memory loss, fatigue. Neurological examination reveals pyramidal insufficiency with asymmetry of tendon and periosteal reflexes, symptoms of mild dysfunction of the vestibulo-cerebellar system, autonomic manifestations.

II degree of chronic cerebrovascular pathology is diagnosed when a focal symptom complex of the disease is detected. At this stage, most often formed:

• cerebellar syndrome. Manifested by static and dynamic ataxia, instability in the Romberg position, dysmetria and impaired performance of coordinating tests.
• pyramidal disorders. They are detected in the presence of paresis of the limbs with the manifestation of pathological reflexes;
• striopallidar disorders. Most often, vascular parkinsonism is diagnosed with a specific tremor like "counting coins" or "pill rolling", increased muscle tone in the extrapyramidal variant and hypokinesia;
• sensory disturbance syndrome. Occurs when the cerebral conductors of superficial and deep sensitivity are damaged. Symptoms of hypesthesia, perversion of sensitivity, hyperpathy, and a decrease in two-dimensional-spatial feeling are formed.
• cognitive dysfunction. It manifests itself as a pathology of memory, attention, thinking. For grade II chronic cerebral ischemia, severe cognitive decline is not typical.

III degree of chronic brain insufficiency is diagnosed with severe cognitive pathology with the development of dementia. Patients are usually disoriented, not critical. During this period, symptoms of emotional disturbances in the form of apato-abulic syndrome and aggressive behavior are characteristic. Extensive areas of ischemia can act as an epileptic focus with the development of periodic somato-motor or somato-sensory paroxysms. Symptoms of the disease at this stage are practically not amenable to curation with medications. Her treatment is reduced to social rehabilitation and environmental adaptation of the patient.

Patients with chronic impairment of cerebral hemodynamics of the III degree need constant monitoring by relatives and doctors.

Cerebral blood flow is directly related to the quality of peripheral circulation. With a decrease in brain perfusion, a clinical manifestation of a symptom complex of vascular disorders in the periphery is possible. Thus, chronic forms of cerebral dyscirculation may be associated with the development of peripheral Raynaud's syndrome.

There is the concept of "initial manifestations of cerebrovascular insufficiency". Such a diagnosis is valid in the presence of subjective complaints typical of cerebral dyscirculation, in the presence of a normal neurological status.

Diagnostics

To confirm the diagnosis, a number of diagnostic procedures are required. On the one hand, this makes it possible to clarify the presence of the main morphological substrate of the disease (foci of ischemia), as well as to identify predisposing factors and the degree of their manifestations. On the other hand, additional instrumental examination methods can exclude other brain pathology that can manifest itself as a similar neurological deficit.

The standards for diagnosing chronic cerebrovascular insufficiency include:

• neuroimaging;
• angiography;
• ultrasound scanning of the vessels of the head and neck;
• daily monitoring of indicators of peripheral arterial pressure;
• electrocardiogram;
• x-ray examination of the cervical spine;
• blood lipid spectrum analysis;
• coagulogram;
• glycemic profile.

Treatment

Chronic forms of disorders of cerebral blood flow, as a rule, are subject to outpatient treatment. Decompensated types of pathology with an increased likelihood of developing acute cerebrovascular complications are hospitalized in the hospital.

Treatment of insufficient blood supply to the brain should correct the risk factors for the disease and prevent its progression. To do this, it is necessary to activate compensatory mechanisms aimed at restoring blood flow. The main treatment is aimed at the causes of the disease and the restoration of cerebral perfusion.

To normalize the background of the development of chronic cerebrovascular insufficiency, the following is prescribed:

• antihypertensive drugs;
• lipid-lowering treatment;
• antiplatelet agents.

Treatment with these drugs involves their constant use. Etiotropic therapy for chronic cerebral ischemia is not used as a course treatment.

To stabilize the patient's condition, use:

• antioxidants;
• neurotrophic;
• vascular protectors to improve both central and peripheral blood flow;
• nootropic drugs;
• metabolic agents.

Basic treatment is supplemented with symptomatic agents for leveling individual components of the clinical manifestations of the disease (analgesics, anticonvulsants).

The complex treatment of I and II degrees of chronic cerebrovascular pathology, as well as the initial manifestations of cerebral dyscirculation, includes physiotherapy, massage, psychotherapy, which allow to stop moderate symptoms of the disease.

Chronic cerebral ischemia is a serious neurological pathology that has adverse consequences without timely treatment. The prognosis directly depends on the duration of the disease, the degree of its progression and the adequacy of the prescribed therapy. To avoid the development of acute cerebrovascular disorders and vascular dementia, competent treatment and compliance with the basic rules of prevention (proper diet, moderate physical activity, regular medical check-ups).

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Hnmk in vbb what is it

One of the common causes of dizziness is cerebrovascular insufficiency in the vertebrobasilar basin (VBB), which can occur in the form of chronic ischemia, transient cerebrovascular accidents or strokes.

Pathogenesis. The main causes of ischemic changes in this pathology are factors that limit blood flow to the vertebrobasilar system or contribute to excessive outflow from it to other vascular pools. The pathogenesis of cerebrovascular insufficiency in VBB can cover an extremely wide range of changes. Along with the pathology of the vessels of the vertebrobasilar system (stenosis and occlusion) due to atherosclerosis, extravasal factors are of great importance. For example, thrombosis of the vertebral artery is possible due to dissection of the artery in case of a whiplash or other neck injury, inadequate manual manipulations on the cervical spine.

Other causes also include pathological tortuosity, congenital developmental disorders in the form of hypo- and aplasia of the vertebral artery, and Kimmerli anomaly. In the presence of the latter, when turning the head, bending and compression of the vertebral artery occur with its possible traumatization.

Also, pathological conditions such as Klippel-Feil-Sprengel anomaly, non-closure of the posterior arch of the atlas, saddle-shaped hyperplasia of the lateral masses of the atlas, underdevelopment of the articular processes of the cervical vertebrae, cervical ribs, “steal” syndrome ( subclavian-vertebral steal) and a number of others. In addition, there is often a blockage of blood vessels by a thrombus that has formed and migrated into the basin of the vertebral or basilar artery from the cavity of the heart.

However, it should be noted that most of the listed factors are significant specifically for acute vascular catastrophe, manifesting dizziness - transient cerebrovascular accidents or strokes. Systemic dizziness (i.e., when a person has a feeling of falling, moving in space, which is accompanied by nausea and vomiting) with chronic cerebrovascular insufficiency never happens, and anxiety, depression, orthostatic hypotension, metabolic disorders are most often masked under non-systemic ( hypo-, hyperglycemia), drug dizziness, impaired attention, vision, etc., which require adequate diagnosis and treatment.

Clinical manifestations. The core of the clinical picture in transient disorders of cerebral circulation in the vertebrobasilar basin are episodes of dizziness, often accompanied by nausea, vomiting, unsteadiness when walking and standing, noise, a feeling of congestion in the ears, autonomic disorders in the form of profuse sweat, tachycardia, blanching or, on the contrary, redness facial skin, lasting from several minutes to several hours. There may also be hearing impairment (mainly a decrease) and vision (“flies” before the eyes, “blurred vision”, “blurred picture”). Extremely dramatic for patients are sudden falls without loss of consciousness ("drop attacks", Unterharnscheidt's syndrome), which are acute circulatory disorders in the reticular formation of the brain stem and usually occur with sharp turns or tilting of the head.

Strokes in the vertebrobasilar basin are characterized by a rapid onset (no more than 5 minutes, usually less than 2 minutes, from the onset of the first symptoms to their maximum development), as well as the following neurological symptoms:

1. movement disorders: weakness, clumsiness of movements or paralysis of the limbs;
2. sensitivity disorders: loss of sensation or paresthesia of the limbs and face;
3. blurred vision in the form of double vision, loss of visual fields;
4. imbalance, imbalance
5. impaired swallowing and speech clarity.

A special form of acute cerebrovascular accident in VBB is a bowhunter's stroke, associated with mechanical compression of the vertebral artery at the level of the cervical spine during extreme turn of the head to the side.

Mechanical compression of the vertebral artery at the level of the cervical spine, which underlies the development of archer's stroke.

The mechanism of the development of such a stroke is explained by the tension of the artery when the head is turned, accompanied by tearing of the intima of the vessel (dissection), especially in patients with pathological changes in the arteries.

Diagnostics. When diagnosing cerebrovascular insufficiency in VBB, it must be taken into account that the symptoms of the disease are often nonspecific and may be the result of another neurological or other pathology, which requires careful collection of patient complaints, study of the disease history, physical and instrumental examinations to identify the main cause of its development. The leading role in the diagnosis of clinically significant changes in blood flow in the vertebrobasilar basin is currently played by neuroimaging methods for studying the brain (MRI and CT), as well as Doppler ultrasound and duplex scanning with color doppler, which make it possible to non-invasively and relatively cheaply assess the structure and patency of the vascular bed.

It is important to note that the differential diagnosis between vertigo caused by damage to the cerebellum and / or brainstem (central) and that occurs when the function of the vestibular apparatus or the vestibular nerve (peripheral) is impaired is not always simple. On the one hand, such conditions as benign paroxysmal positional vertigo are often mistaken for a stroke, at the same time, sometimes patients with acute vascular insufficiency in the VBB are mistakenly treated for “cervical osteochondrosis with vestibulopathic syndrome” by chiropractors and osteopaths with the development of appropriate complications .

Treatment. In case of an acute neurological deficit (alternating syndromes, cerebellar insufficiency, "negative" scotomas, etc.), the patient should be urgently hospitalized in the regional vascular center or neurological department to rule out a stroke in the VBB. If it is confirmed, treatment is carried out according to currently relevant guidelines and recommendations.

In case of dizziness against the background of chronic cerebrovascular insufficiency in the VBB, the main attention is paid to drugs that improve cerebral circulation due to vasodilating and rheopositive action (vinpocetine, cinnarizine, betahistine, etc.). Of great importance is adequate correction of blood pressure, prevention of thrombosis in various cardiac arrhythmias.

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CVA or acute cerebrovascular accident is a group of clinical syndromes that are the result of impaired blood flow to the brain. Pathology can be caused by a thrombus formed in the blood vessels of the brain or their damage, which leads to the death of a large number of blood and nerve cells. Allocate:

1. CVA by ischemic type (ischemic stroke).
2. CVA by hemorrhagic type ( hemorrhagic stroke). This diagnosis is made when a cerebral hemorrhage is confirmed.

The above classification is very important for the correct choice of treatment method.

A stroke provoked by damage to the brain tissue and critical disorders of the blood supply to its areas (ischemia) is called ischemic stroke.

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Reasons for the development of the disease

The main reason for the manifestation of pathology is a decrease in the amount of blood entering the brain. The following factors and diseases can lead to this:

• Persistent increase in blood pressure.
• Damage to the main arteries of the brain and neck vessels in the form of occlusion and stenosis.
• atherosclerotic changes.
• Inflammation of the connective tissue lining of the heart.
• Inflammatory processes or injuries of the carotid arteries, which significantly reduce blood flow through the vessels.
• Hemorheological changes in the cellular composition of the blood.
• Cardiogenic embolism.
• Change in the rhythm of heart contractions.
• Myocardial infarction.
• Various changes in the heart, as well as in the main arteries of the cervical region (observed in 91% of patients).
• Diabetes.
• Immunopathological vascular inflammation.
• Pathological violation of the tone of blood vessels.
• Thrombotic formations on the walls of blood vessels.
• The presence of artificial valves in the heart.
• Smoking.
• Overweight.
• Everyday stress.

At risk are the elderly (however, there are cases of illness in children) and patients suffering from osteochondrosis of the cervical spine, as this leads to significant squeezing of blood vessels.



Symptoms of pathology

The disease has a wide variety of symptoms. The general symptoms of stroke according to the ischemic type include sudden headaches, deterioration of speech and vision, impaired reflexes and coordination, nausea, vomiting, dizziness and disorientation of the patient in space, pain in eyeballs, paralysis of the face and limbs. Psychomotor agitation and short-term loss of consciousness, convulsions are also possible.



There are zonal signs of cerebral artery thrombosis. It is characterized by the following types of violations.

If the internal carotid artery is affected, the patient's vision deteriorates (fields of vision fall out), skin sensitivity and speech are disturbed, muscle paralysis and loss of orientation in one's own body occur.

Patency disorders in the middle cerebral artery cause sensory disturbances in half of the body, the inability to focus on a specific object, loss of visual fields and loss of speech. The patient is unable to distinguish the right side from the left.

If disorders occur in the posterior cerebral artery, blindness, seizures, complete or partial paralysis, respiratory failure, large tremors, and deterioration in swallowing function may occur. In the worst case, a cerebral coma occurs.

With damage to the anterior cerebral artery, one-sided loss of sensitivity, loss of speech is observed. The patient's movements slow down or there is no ability to walk and stand at all.

If the slightest symptoms of pathology are detected, it is necessary to carry out timely treatment of stroke.





Diagnostics

The purpose of diagnosis is to determine the necessary method of treatment. It is very important to conduct an examination with a specialist in the first hour after the patient arrives. The following procedures are followed:

• Blood sampling to determine blood clotting: viscosity, hematocrit, fibrinogen, electrolytes and antiphospholipid antibodies.
• CT and MRI. This is the most reliable method for detecting acute cerebrovascular accidents. It allows you to correctly determine the type of stroke, exclude tumors and aneurysms, determine the size and location of the focus, and diagnose vascular diseases.
• echoencephaloscopy. This technique is not very informative in the first hours of a stroke.
• X-ray examination of the vessels of the brain.
• ECG changes in blood pressure.
• brain ultrasound. It is used if there is no possibility of carrying out computer and magnetic resonance imaging.





Treatment of stroke by ischemic type

The main task is emergency and intensive treatment in the first minutes of the patient's arrival, since at this time the thrombolysis technique is effective. This will preserve the vitality of neurons near the zone of necrosis, as well as weakened cells. Further, in the hospital, upon confirmation of a stroke in a patient, the treatment is carried out in the following order:

1. 1. A general complex is being carried out to maintain the vital functions of the body.
2. 2. If necessary, antihypertensive agents, anticoagulants (if the patient has high blood pressure, ulcers, diabetes or bleeding), vasoactive and decongestants, antiplatelet agents and others are prescribed.
3. 3. To normalize breathing and saturate the lungs with oxygen, breathing exercises are performed. In extreme cases, perform artificial ventilation of the lungs.
4. 4. Restore blood circulation.
5. 5. With the help of diuretics, swelling of the brain is reduced.
6. 6. Antipsychotic drugs are prescribed to exclude the possibility of recurrent seizures.
7. 7. In case of violation of the swallowing function of the body, the patient is prescribed semi-liquid nutrition or parenteral therapy is carried out.

Consequences of the disease

Acute cerebrovascular accident of the ischemic type can lead to the following complications:

• paralysis or paresis of one side of the body;
• violations of pain sensitivity of any part of the body;
• loss of taste, hearing, sudden blindness or double vision;
• problems with speech (when talking, it is difficult for the patient to select and pronounce words);
• violations of complex, purposeful movements (apraxia);
• violations of the swallowing function of the body;
• loss of visual fields;
• spontaneous fainting;
• involuntary urination.



It should be noted that with proper treatment and regular rehabilitation sessions, it is possible to completely eliminate the above complications, as well as complete recovery of the patient's body. And after some time, a person can completely return to normal life.

First aid

If you have the slightest suspicion of stroke, you should immediately call an ambulance. The patient at this time should not be unreasonably disturbed (but it is best to isolate him) and put him in such a position that the upper body and head are raised. Next, you need to allow the patient to breathe freely. To do this, you need to perform a massage of the cervical-collar zone and provide fresh air access to the room.



If a person has gag reflexes, turn his head to the side and clean his mouth with a tissue or gauze. This will eliminate the risk of getting vomit into the respiratory tract.

Quite often, with stroke, an epileptic seizure occurs, which is accompanied by loss of consciousness and convulsions. In this case, the main thing is not to get confused. The patient should be placed on his side and a pillow placed under his head. Next, a pencil or pen should be placed in the mouth, for example, to prevent biting the tongue. In no case should you restrict the patient's movements (hold him by the arms and legs or press him down with your body), as this will only increase convulsions and the risk of a fracture or dislocation.

A common mistake is to use ammonia which can lead to respiratory arrest. If a person's heartbeat or breathing has disappeared, direct heart massage and artificial respiration can help.