Ischemic stroke

Description:

The ischemic stroke is the clinical syndrome which is shown an acute disorder of local functions of a brain which proceeds more than 24 hours, or leading to death, can be caused or insufficiency of blood supply in a certain zone of a brain as a result of the decrease in a brain blood-groove, thrombosis or an embolism connected with diseases of vessels, hearts or blood.

Symptoms of the Ischemic stroke:

The clinical picture of an ischemic stroke is presented by symptoms of sudden loss of function of a certain department of a brain. They are defined by that department of a brain which is struck with ischemia, damage volume. In most cases symptoms which arise at patients are disturbances of the speech, motive and sensitive functions, sight on one party.

    * Motive disturbances. Weakness or awkwardness of movements on one side of a body, full or partial (hemiparesis). Simultaneous bilateral development of weakness in extremities (a paraparesis, tetraparesis). Swallowing disturbances (dysphagy). Lacks of coordination (ataxy).

    * Disturbances of the speech. Disturbances of understanding or use of the speech (aphasia). Disturbances of reading (alexia) and letters (agraphia). Disturbances of the account (acalculia). Smazannost of the speech (dysarthtia).

    * Sensitive disturbances. Somatosensory changes of sensitivity on one side of a body, full or partial (gemigipesteziya). Visual - decrease in sight on one eye, full or partial (a passing monocular blindness). Losses of the right or left half (or quadrant) fields of vision (hemianopsia, quadrant hemianopsia). Bilateral blindness. Doubling before eyes (diplopia).

    * Vestibular. Feeling of rotation of objects (rotatory vertigo).

    * Behavior disorder and cognitive functions. It is difficult to put on, brush the hair, to brush teeth, etc.; disturbance of orientation in space; disturbances of copying of drawings, for example, hours, a flower or the crossed cubes (disturbance of visual and space perception). Disturbances of memory (amnesia).

Reasons of the Ischemic stroke:

Among the major etiological factors leading to development of the ischemic stroke (IS) it should be noted atherosclerosis, arterial hypertension and their combination. Also the role of the factors promoting increase in coagulant properties of blood and increase in aggregation of its uniform elements is extremely important. The risk of emergence of AI increases in the presence of a diabetes mellitus, diseases of a myocardium which are especially followed by frustration of a cordial rhythm.

Treatment of the Ischemic stroke:

In treatment of a stroke it is accepted to allocate the basic and differentiated therapy. Basic therapy does not depend on the nature of a stroke (ischemic or hemorrhagic). The differentiated therapy, on the contrary, is defined by the nature of a stroke.

Basic therapy of an ischemic stroke.

Basic therapy of a stroke is directed, in fact, to maintenance of the main vital functions of an organism. Basic therapy includes ensuring adequate breath, blood circulation maintenance, control and correction of water and electrolytic disturbances, reduction of wet brain, prevention and treatment of pneumonia.

The differentiated therapy in the acute period.

Epidemiological researches demonstrate that not less than 70% of ischemic strokes are connected with thrombosis or a thrombembolia of cerebral arteries. In these cases the most modern method of treatment is the so-called thrombolysis which is reached by intravenous or intra arterial administration of the activator of fabric plasminogen.

So far beneficial effect of a thrombolysis for the outcome of an ischemic stroke it is proved both within the controlled researches, and in daily clinical practice.

For the purpose of improvement of rheological properties of blood in the acute period hemodilution in the form of intravenous injections is widely applied. Empirically widely use so-called vasoactive drugs (пентоксифиллин, инстенон, a Vinpocetine, blockers of calcium channels) though confirmation of their clinical performance is not available now.

Maintaining patients in the recovery period of an ischemic stroke

As a rule, at the favorable course of an ischemic stroke, after acute emergence of neurologic symptomatology, there occurs its stabilization and gradual regress. It is supposed that process of "retraining" of neurons as a result of which intact departments of a brain undertake functions of affected departments is the cornerstone of reduction of expressiveness of neurologic symptomatology.

Does not raise doubts that active motive, speech and cognitive rehabilitation in the recovery period of an ischemic stroke favorably influences process of "retraining" of neurons and improves an outcome. Rehabilitation actions should be begun as soon as possible and to carry out systematically, at least, within the first 6-12 months after an ischemic stroke. In these terms rate of recovery of the lost functions is maximum. However it is shown that rehabilitation actions render positive effect and in later terms.

At any pathogenetic option from the first hours of manifestation of clinical symptoms it is necessary to appoint antithrombocytic drugs that reduces risk of repeated ischemic events by 20-25%.

Further prevention of repeated ischemic strokes has to be aimed at correction of major factors of risk of cerebral ischemia. It is necessary to carry out adequate anti-hypertensive therapy, to induce the patient to stop smoking or to reduce quantity of the smoked cigarettes, to carry out correction of exchange disturbances (a gipergikemiya, a lipidemia), to fight against the excess weight and a hypodynamia.

The course of recovery treatment of the patients who had a stroke includes remedial gymnastics, occupations on exercise machines for passive and active rehabilitation, a baby sling exercise machines for an ergoterapiya, massage, hardware verticalization and locomotory occupations (walking recovery), physiotherapy, stimulation treatment, selection of prosthetic orthopedic devices.