Ischemic stroke is a violation of cerebral circulation with damage to brain tissue, violation of its functions due to difficulty or cessation of blood flow to a particular Department. Accompanied by softening of the brain tissue-cerebral infarction. It may be due to insufficient blood supply to a certain area of the brain due to decreased cerebral blood flow, thrombosis or embolism associated with vascular, heart or blood diseases. It is one of the main causes of mortality among people.
The following risk factors contribute to the increased risk of ischemic stroke::
• Arterial hypertension
• Insulin resistance
• Abdominal obesity
* Lack of physical activity
* High-risk diet (e.g. high in saturated fat, TRANS fat and calories)
* Psychosocial stress (e.g. depression)
* Cardiac disorders (in particular, disorders that predispose to the development of embolisms, such as acute myocardial infarction, infectious endocarditis and atrial fibrillation)
* Use of certain drugs (e.g. cocaine, methamphetamine)
Irreversible risk factors include the following:
* History of stroke
• Old age
* Family history of stroke
Ischemia usually occurs due to thrombosis or embolism. Even such infarcts, which according to clinical criteria (morphology, size and localization) are lacunar, often develop as a result of thrombosis or embolism of small vessels.
Any factor that impairs the circulatory system (e.g. toxic exposure to carbon monoxide, severe anemia or hypoxia, polycythemia, hypotension) increases the risk of all types of ischemic strokes. Stroke can occur in border areas, between the blood flow of individual arteries; in such areas, blood supply is normally low, especially if patients suffer from hypotension and/or if the main cerebral arteries are narrowed.
Less often, ischemic stroke develops as a result of vascular spasm (eg, migraine, after subarachnoid hemorrhage, the use of sympathomimetic drugs or drugs such as cocaine or amphetamines) or venous sinus thrombosis (eg, intracranial infection, after surgery, childbirth, on the background of hypercoagulation).
Early diagnosis and differential diagnosis of ischemic, hemorrhagic strokes and subarachnoid hemorrhage are crucial for the choice of treatment tactics. Accurate diagnosis of stroke is clinically possible only in 70 % of cases.
Physical examination plays an important role in the diagnosis and determination of the patient's condition. The functions of respiration and cardiovascular system are evaluated (first of all, violations of Central hemodynamics for emergency correction), which in some cases allows to determine the pathogenetic nature of the stroke (the presence of arrhythmia and heart murmurs suggest cardioembolic stroke; systolic noise in the bifurcation of the common carotid artery indicates its stenosis; the difference in blood pressure and pulse on opposite sides indicates stenosis of the aortic arch and subclavian arteries).
During neurological examination, the state and level of consciousness are specified; topical diagnosis of focal brain injuries is carried out.
To obtain information about the cause of ischemic stroke, duplex and triplex ultrasound scans of the cerebral arteries of the head and cerebral arteries are performed. This method allows you to visualize the carotid arteries, examine the blood flow using spectral dopplerography. Transcranial Doppler can determine the state of some intracranial arteries, indirectly assess the speed of blood flow in them.
The most informative method of diagnosis is angiography, which allows you to detect narrowing of the lumen, aneurysms and other pathological changes in the arteries. Angiography, taking into account possible complications, should be used as indicated. Non — traumatic methods of diagnosing the state of cerebral vessels-Mr angiography or CT angiography-can also be used.
In addition to the above methods, it is necessary to conduct ECG and echocardiography to exclude concomitant cardiac pathology, x-ray examination of the lungs to diagnose pulmonary complications (aspiration pneumonia, PE, etc.), clinical, biochemical blood tests and other routine tests, coagulogram, blood gas composition. Consultation of the therapist and the ophthalmologist is obligatory.
* General measures for stroke treatment
* Antihypertensive therapy (only in some cases)
* Antiplatelet therapy
* In intensive care, sometimes use reperfusion recombinant tissue activator plasminogen [tPA] (intravenously or by local thrombolysis), and / or local thrombectomy
* In some cases, anticoagulation
* Long-term control of risk factors
• In some cases, carotid endarterectomy or stenting
In the treatment of stroke, it is customary to allocate basic and differentiated therapy. Basic therapy does not depend on the nature of the stroke (ischemic or hemorrhagic). Differentiated therapy, on the contrary, is determined by the nature of the stroke.
Basic therapy of ischemic stroke
Basic stroke therapy is aimed, in fact, to maintain the basic vital functions of the body. Basic therapy includes ensuring adequate breathing, maintaining blood circulation, control and correction of water-electrolyte disorders, reducing brain edema, prevention and treatment of pneumonia.
Differentiated therapy in the acute period
Epidemiological studies indicate that at least 70% of ischemic strokes are associated with thrombosis or thromboembolism of the cerebral arteries. In these cases, the most modern method of treatment is the so-called thrombolysis, which is achieved by intravenous or intra-arterial administration of a tissue plasminogen activator.
To date, the beneficial effect of thrombolysis on the outcome of ischemic stroke has been proven both in controlled studies and in everyday clinical practice.
In order to improve the rheological properties of blood in the acute period, hemodilution in the form of intravenous infusions is widely used. Empirically, so-called vasoactive drugs (pentoxifylline, instenone, vinpocetin, calcium channel blockers) are widely used, although confirmation of their clinical effectiveness is currently not available.
Management of patients in the recovery period of ischemic stroke
As a rule, with a favorable course of ischemic stroke, following the acute occurrence of neurological symptoms, its stabilization and gradual regression occurs. It is assumed that the basis of reducing the severity of neurological symptoms is the process of" retraining " of neurons, as a result of which intact parts of the brain take over the functions of the affected departments.
There is no doubt that active motor, speech and cognitive rehabilitation in the recovery period of ischemic stroke favorably affects the process of "retraining" of neurons and improves the outcome. Rehabilitation activities should be started as early as possible and systematically carried out at least during the first 6-12 months after ischemic stroke. In these terms, the rate of recovery of lost functions is maximum. However, it is shown that rehabilitation measures have a positive effect at a later date.
Secondary prevention of recurrent strokes
According to modern concepts, ischemic stroke is not an independent disease, but one of the complications of various diseases of the cardiovascular system. The development of ischemic stroke indicates a significant lesion of the blood supply to the brain. In the absence of adequate treatment of the underlying disease, the risk of recurrent strokes is very high. Therefore, one of the main objectives of the management of patients who have suffered an ischemic stroke is the secondary prevention of repeated disorders of cerebral circulation. Preventive measures should be started immediately from the first hours of manifestation of ischemic stroke.
In any pathogenetic variant, antiplatelet drugs should be prescribed from the first hours of manifestation of clinical symptoms, which reduces the risk of repeated ischemic events by 20-25%.
Further prevention of recurrent ischemic strokes should be aimed at correcting the main risk factors for cerebral ischemia. It is necessary to carry out adequate antihypertensive therapy, to induce the patient to stop Smoking or reduce the number of cigarettes smoked, to correct metabolic disorders (hypergicemia, hyperlipidemia), to fight excess weight and physical inactivity.
The course of rehabilitation treatment of stroke patients includes therapeutic gymnastics, classes on simulators for passive and active rehabilitation, sling simulators for ergotherapy, massage, hardware verticalization and locomotor classes (restoration of walking), physiotherapy, stimulation treatment, selection of prosthetic and orthopedic devices.
Tashkent clinic Gatling-med, equipped with the most modern medical equipment and highly qualified doctors, is ready to advise you and conduct proper treatment at a guaranteed high level.