Cerebral infarction caused by cerebral embolism. Cerebral infarction - what is it and how dangerous is it, how to identify and cure it in a short time

Ischemic stroke is a violation of the blood supply to the brain due to the narrowing of the supply arteries, another name is “brain infarction”. The disease often occurs in people over 60 years of age, but in recent years it has spread to a younger age.

In the first three weeks (acute period), death occurs in 1/3 of patients. Stroke on the right side of the brain is considered less favorable in prognostic terms. This is associated with a better ability of cells in the left hemisphere to survive.

Why does cerebral ischemia occur?

The main causes of ischemia or oxygen starvation of the brain are divided into:

• atherosclerosis of cerebral vessels (about 40% of cases);
• hypertension with a crisis course (about 30%);
• embolism of the main vessels of the brain in diseases of the heart (about 25%);
• the remaining cases (1/10) are due to diseases associated with increased blood clotting, systemic damage to small capillaries.

A right-sided stroke may be the result of the same pathological changes not in the cerebral vessels, but along the course of the right carotid and vertebral arteries, which are oxygen suppliers for the cerebral arteries.

Depending on the mechanism of occurrence, ischemic strokes are divided into:

• thromboembolic - caused by a thrombus or vessel embolism;
• hemodynamic - associated with circulatory disorders (increase or decrease in blood pressure, anatomical defects in the structure of the heart);
• lacunar - occur when small arteries passing through the medulla are affected, they are prone to loss of tone and the formation of small cavities (lacunae) up to two cm in diameter.

Most often there is a mixed type. Since lacunar strokes occur with hypertension, they may not give any symptoms for a long time.

Features of the manifestation of a right-sided stroke

The right hemisphere of the brain provides a sense of your body in space, analysis of incoming information, sensitive perception of the environment. Left-handers have the center of speech on the right.

In the acute period of a right-sided stroke, the following symptoms are observed:

• paresis or paralysis of the left half of the body (with paresis, movements are partially preserved);
• changes in the face (on the right, smoothness of the nasolabial fold, drooping down the corner of the mouth, “sailing” movement of the lips during breathing);
• the inability to determine the size of objects, to assess the position of one's body;
• loss of memory for recent events while maintaining the ability to recall the past;
• left-handers have a speech disorder;
• lack of ability to concentrate.

During the recovery period, in addition to impaired motor functions, mental symptoms and emotional manifestations of the disease become important: a depressive state is replaced by cheerfulness, stupid behavior, lack of a sense of proportion and tact.

With extensive damage to the right hemisphere, clinical manifestations occur rapidly against the background of cerebral symptoms (severe headache, nausea, vomiting, dizziness, movement disorders, loss of consciousness). A characteristic change in the face appears, immobility of the left half of the body increases. Swallowing and speech difficulties may occur.

Right-sided lacunar ischemic stroke develops gradually in patients with hypertension and diabetes, in young people with vascular diseases. Cerebral manifestations are poorly expressed.

• In half of the cases, weakness develops in the left arm and leg, loss of sensation in the left side of the face.
• In 35% of patients, there is a loss of pain sensitivity, the ability to distinguish the shape and temperature of an object by touch.
• In every tenth patient, lacunar stroke is manifested by severe dizziness. Inability to move independently (ataxia).

Symptoms of ischemic right-sided stroke in children and adolescents

Vascular diseases of the brain in childhood cause mortality up to 16%. The growth of this pathology is associated with an increased prevalence of congenital heart defects in children, endocrine diseases, systemic vasculitis, and hereditary blood diseases. More often there are small lacunar strokes.

Symptoms are focal in nature:

• impaired movement in the left arm or leg;
• loss of sensation in the left half of the face;
• difficulty in pronouncing certain sounds;
• hyperkinesis - extra movements, trembling in the hands;
• cramps in arms and legs.

Timely detection and treatment of this disease in children leads to a complete restoration of brain function.

Treatment

People suffering from hypertension should be critical of their disease, control blood pressure, blood cholesterol levels, carry fast-acting drugs to reduce pressure. This also applies to patients with diabetes mellitus, coronary heart disease, rheumatic patients.

Treatment of ischemic stroke should begin long before the onset of brain symptoms. If there are "harbingers" in the form of frequent crises, headaches, dizziness, decreased strength in the limbs, you need to tell your doctor about this and start taking medications. The main thing is not to waste time, not to allow irreversible changes to develop.

Inpatient treatment includes obligatory fibrinolytic mixtures in the first six hours, maintaining blood pressure at a normal level, administering drugs that dilate the vessels of the brain and improve cell nutrition.

Patients with right-sided cerebral stroke require patient and attentive care. Loss of orientation and memory makes them look like children. The degree of recovery depends on the prevalence of the lesion, the replacement abilities of other cerebral vessels.

Rehabilitation

Complete restoration of all functions of the right hemisphere of the brain is difficult to achieve. However, it is necessary to achieve the return of the patient to an active life, to inspire him with faith in improvement, to accustom him to new behavior and opportunities.

The patient must comply with the diet. Spicy dishes, all foods containing "bad" cholesterol, alcoholic beverages, coffee and strong tea are contraindicated. It is recommended to eat more often than usual, but in small portions.

The motor mode includes daily gymnastics, walks in the air, exercises that train small movements of the hands. Limb massage is performed to restore sensitivity and muscle tone.

Communication with the patient should be built taking into account the learning of lost skills. Family members are calmly obliged to tell the patient about the forgotten events of his life. Changes in the psyche can be partially corrected only with a benevolent and patient attitude.

Profile spa treatment can significantly reduce the negative consequences of the disease, connect acupuncture, baths and showers, physiotherapy procedures to the treatment.

Useful video about life after ischemic stroke:

Forecast

The consequences of a right-sided ischemic stroke depend on the size of the lesion. Full recovery occurs with small lacunar changes, timely treatment. For other patients, the ability to independently serve themselves, to walk with a cane, is considered success. 80% get permanent disability. There can be no question of returning to the previous work. People with a strong will find themselves in quieter professions.

The support of loved ones and the supervision of a doctor help to maintain an active life.

cerebral infarction- This is a clinical syndrome, which is expressed in an acute violation of local brain functions. It lasts more than 24 hours, or leads to the death of a person during this time. Acute circulatory disorders in cerebral infarction occur due to blockage of its arteries, which provokes the death of neurons in the area that feeds on these arteries.

Also called cerebral infarction. This problem is very relevant in the modern world, since a huge number of people die every year due to cerebral infarction. Mortality in ischemic stroke is 25%, another 20% of patients die within a year, and 25% of the survivors remain disabled.

The symptoms of a cerebral infarction depend on where the lesion is located.

However, there are common symptoms of this pathological process, including:

Loss of consciousness, sometimes coma may develop;

Violations of the functioning of the pelvic organs;

Pain in the eyeballs;

feeling of heat;

dry mouth;

Nausea and vomiting against the background of severe headache;

Vascular diseases (pathologies of their development, Takayasu's disease, leukemia, malignant tumors).

In addition, do not forget about the risk factors that increase the likelihood of a cerebral infarction, among them:

Age (every ten years of life increases the risk of developing a cerebral infarction by 5-8 times);

hereditary predisposition;

Hypodynamia;

Excess weight;

Smoking (if this bad habit is supplemented by taking oral contraceptives, then smoking becomes a leading risk factor for developing cerebral infarction);

alcohol abuse;

Acute stress, or prolonged psycho-emotional stress.

The consequences of a cerebral infarction can be very serious and often pose a direct threat to human life, among them are:

Bedsores from lying in bed for a long time.

In addition to the consequences of cerebral infarction that develop in early dates, and long-term complications can be distinguished, among which:

Violation of the motor function of the limbs;

Decreased sensation in the arms, legs, and face;

speech problems;

Deterioration of mental abilities;

Mental disorders;

Difficulty swallowing food;

Loss of coordination when walking, during turns;

Epileptic seizures (up to 10% of people who have had a cerebral infarction are susceptible to them);

Malfunctions of the pelvic organs (suffer bladder, kidneys, intestines, reproductive organs).

How is a heart attack different from a stroke?

With a cerebral infarction, there is a violation of its blood supply, as a result of which the tissues of the affected area begin to die. Insufficient blood flow to the brain occurs due to atherosclerotic plaques that prevent its normal flow, due to heart rhythm disturbances, or due to problems with the blood coagulation system.

With a hemorrhagic stroke of the brain, on the contrary, the blood flow to it increases, which causes a rupture of the artery. The cause is vascular pathology or hypertensive crisis.

There are differences in the course of the disease. So, a cerebral infarction develops gradually, over several hours or even days, and a hemorrhagic stroke occurs almost instantly.

Treatment of cerebral infarction is primarily based on thrombolytic therapy. It is important that the patient is admitted to the neurological department within the first three hours of the onset of an attack. It is necessary to transport the patient in an elevated position. The head should be 30°C higher than the body. If a thrombolytic is administered to the patient at the specified time, the drug will very quickly dissolve the existing thrombus, which is most often the cause of impaired blood supply to the brain. The effect can often be seen almost instantly, in the first seconds of drug administration.

If thrombolytic therapy is not carried out in the first three hours from the onset of cerebral infarction, then it no longer makes sense to carry it out further. There will be changes in the brain, the nature of which is irreversible.

It should be borne in mind that thrombolysis is performed only when the doctor has made sure that the patient has a cerebral infarction, and not a hemorrhagic stroke. In the latter case, such therapy will lead to death.

If it is not possible to administer a thrombolytic, then the following measures are indicated:

Decreased blood pressure;

Taking antiplatelet agents (Aspirin) or anticoagulants (Clexane, Fraxiparin, Heparin);

Purpose medicines aimed at improving cerebral blood supply (Trental, Piracetam, Cavinton).

Also, patients are prescribed vitamins of group B, they carry out rehabilitation treatment, they are engaged in the prevention of bedsores. Self-medication is unacceptable, at the first sign of a cerebral infarction, it is necessary to call an ambulance. It is worth remembering that at home it is impossible to distinguish a cerebral infarction from a hemorrhagic stroke.

Surgical treatment of cerebral infarction is surgical decompression aimed at reducing intracranial pressure. This method allows to reduce the percentage of mortality in cerebral infarction from 80 to 30%.

An important component of the general scheme for the treatment of cerebral infarction is competent restorative therapy, which is called "neurorehabilitation".

You need to start it from the first days of the disease:

Movement disorders are corrected with the help of physiotherapy exercises, massage and physiotherapy methods. At the moment, there are special simulators that help people recover after a cerebral infarction;

Speech disorders are corrected during individual sessions with a speech therapist;

Swallowing dysfunctions are leveled by special devices that stimulate the work of the laryngeal and pharyngeal muscles;

Classes on the stabiloplatform help to cope with coordination problems;

Equally important is the psychological assistance to the sick. A psychotherapist helps to cope with emotional problems;

| PhD surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the educational and scientific medical center for the administration of the President of the Russian Federation.

Often recurring symptoms indicate the development of pathology. The root cause of circulatory disorders of the brain can be a number of diseases. Such diseases include atherosclerosis, arterial hypertension or hypotension, inflammation of the walls of blood vessels (rheumatic, syphilitic, etc.), diseases of the hematopoietic system.

The disease is divided into:

• acute (stroke, hypertensive encephalopathy);
• chronic (dyscirculatory encephalopathy);
• transient ischemic attacks.

Transient circulatory disorders

Transient cerebrovascular accident occurs as a result of an ischemic attack. A characteristic sign of pathology is the acute development of neurological symptoms and their subsidence during the day. Pathology is caused by a temporary blockage of cerebral vessels by a detached thrombus that has formed in the heart or in a large vessel of the brain. In rare cases, transient strokes occur as a result of severe narrowing of large vessels. This condition usually occurs when there is a sudden drop in blood pressure.

Thus, transient disorders of cerebral circulation occur for three main reasons:

The main symptoms in violation of blood flow in the basin of the carotid artery:

• paralysis of half of the body;
• violation of the sensitivity of half of the body;
• impaired speech and vision.

All pathological processes occur on the opposite side of the lesion. That is, if there are violations of the cerebral circulation on the right side, the left side of the body suffers. A patient with transient ischemic attacks may experience other signs:

This symptomatology is due to pathology in the vertebrobasilar basin.

The duration of symptoms in transient attacks rarely exceeds several tens of minutes. With a hypertensive crisis, the patient has a sharp headache, stunning, tinnitus and pain in the eyes. In rare cases, there may be epileptic seizures or psychomotor agitation. With ischemic attacks against the background of a hypertensive crisis, the patient's face turns red, there is increased sweating.

Causes of ischemic attack may be related to degenerative diseases of the spine. The main factor is a violation of blood flow in the vertebral arteries. With a pathology such as osteochondrosis, any prolonged uncomfortable position or a sharp turn of the head can cause a short-term violation of cerebral circulation.

Later, body functions are restored, but small foci of loss of nerve cells or areas of necrosis remain. However, this condition suggests that the patient may soon experience a myocardial infarction or stroke. With an untimely visit to a doctor and the absence of a diagnosis, a subsequent ischemic attack can result in a dangerous brain catastrophe (stroke).

brain stroke

Stroke, or acute cerebrovascular accident, occurs suddenly with the development of persistent neurological symptoms. In the course of the pathology, progressive and completed strokes are distinguished. For a progressive course, an increase in symptoms is characteristic. Completed strokes of the brain are characterized by stabilization of symptoms after the peak of their development.

Hemorrhagic stroke

Otherwise, a hemorrhagic stroke is called a hemorrhage into the substance or into the membranes of the brain. According to statistics, hemorrhagic stroke in 90% of cases occurs in the cerebral hemispheres. The remaining 10% are in the brain stem and cerebellum. There are also mixed forms of hemorrhages. The main causes of hemorrhage are hypertension and aneurysm rupture. In rare cases, the pathology develops against the background of leukemia, blood diseases, infections (endocarditis), and brain tumors.

Often during a hemorrhage, when a vessel ruptures, a cavity filled with blood is formed. The appearance of such a cavity leads to compression of neighboring areas of the brain, a change in the size of the furrows, and a flattening of the gyri. In rare cases, hemorrhages occur by the type of blood soaking the entire substance of the brain. A characteristic difference of such a pathology is the absence of borders and the merging of many small foci.

Symptoms of cerebrovascular accident as a result of hemorrhage occur mainly during the day, when a person is in an active state. Often before a stroke, a person physically exerts himself, is in a state of stress, or experiences strong emotions. Such reasons contribute to an increase in blood pressure.

With a hemorrhage, the patient suddenly loses consciousness and falls. In cases where a person remains conscious, he complains of a severe headache. Vomiting may occur within the first minute after a stroke. The patient's face becomes red, breathing is disturbed, the pulse in most cases is slowed down.

Violations of cerebral circulation lead to hemiparesis and hemiplegia. The degree of brain damage in this case is much greater than in ischemic strokes. The clinical picture depends on such factors:

• the size of the hematoma;
• localization;
• the degree of cerebral edema;
• involvement in the pathological process of other brain structures.

In most cases, hemorrhage leads to a coma. The patient has dysfunction of vital organs. With a shallow coma, the patient retains the reaction of the pupils to light, tendon and pharyngeal reflexes, pathological reflexes, and changes in muscle tone are observed. Deep coma usually ends in death.

Ischemic stroke

Ischemic disorders of cerebral circulation cause thrombosis and embolism of cerebral vessels. A stroke caused by blood clots occurs more often at night, during sleep. The patient wakes up in the morning already with neurological pathologies (speech disorder, paresis). With the development of pathology in the daytime, a gradual progression of neurological symptoms is observed. Often, ischemic stroke is preceded by transient cerebrovascular accidents.

In embolic stroke, neurological symptoms develop rapidly. The patient has a headache, loss of consciousness, paresis. The clinical picture depends on which part of the brain is affected. The main signs of damage to the carotid artery pool:

• limb weakness;
• drooping corner of the mouth;
• displacement of the tongue to the paralyzed side.

Patients may experience disorientation in space and speech, severe paralysis and paresis. The defeat of the occipital lobes is accompanied by visual impairment, blindness, hypersensitivity. With ischemia of the brain stem, difficulty swallowing, double vision, strabismus, paresis are observed. Blockage of the basilar artery leads to the development of coma.

In cases of blockage of small vessels that feed the deep tissues of the brain, a slow increase in the following symptoms is observed:

• hemiparesis;
• violation of coordinated movements;
• speech disorder.

Patients may experience cerebral edema on the 3rd day after a stroke. The increase in symptoms may be associated with hemorrhage in the infarction zone, organ dysfunctions, infectious complications of the excretory and respiratory systems. Approximately a quarter of patients after an ischemic stroke die within a month. In 90% of surviving patients become disabled.

Therapeutic measures

Patients are treated in a hospital. In severe cases, in violation of the function of important organs, swallowing disorders, epileptic status, the patient is hospitalized in the intensive care unit. Acute cerebrovascular accidents are treated according to the degree of brain damage.

The tasks of basic therapy are:

1. Maintaining breath.
2. Maintaining hemodynamic parameters (blood pressure, pulse).
3. Cerebral edema warning.
4. Maintaining water and electrolyte balance.
5. Maintenance normal level blood sugar.
6. Prevention of infectious complications.
7. Maintaining body temperature.

In addition to drug therapy, complex treatment includes the prevention of bedsores, muscle contractures and nutrition. If swallowing is disturbed in patients, nutrition is carried out through a tube. In case of violation of the motility of the gastrointestinal tract, parenteral nutrition is carried out. From the first day of a stroke, the patient's skin is treated with disinfectants. Skin folds are smeared with zinc pastes (Desitin, Sudocrem).

An important role in the rehabilitation of patients is played by measures to prevent contractures. In the acute period, treatment is carried out by position. From the second day, passive movements and specialized massage are introduced. After normalization of the condition, it is recommended (in the absence of contraindications) the mobilization of the patient. Adequate therapy and early rehabilitation measures improve the outcome of cerebral strokes. After discharge home, you can carry out treatment with folk remedies.

Treatment of transient disorders

Transient disorders of cerebral circulation begin to be treated after determining the underlying cause of the pathology. In the interictal period, patients prone to low blood pressure are prescribed tonic drugs in the morning. You can be treated with folk remedies - tincture of magnolia vine, eleutherococcus or ginseng. With hypotension, they are allowed to drink a cup of coffee in the morning.

If a patient is diagnosed with arterial hypertension, the treatment of a transient violation of the head blood flow consists in prescribing drugs that stabilize blood pressure and antispasmodics. The main task is not only to reduce pressure, but also to prevent its sharp drop. If patients have increased blood clotting, there is a predisposition to thrombosis, antiplatelet agents and anticoagulants (Fenilin, Sinkumar) are prescribed under the control of blood clotting.

In the treatment of cerebral blood flow disorders caused by atherosclerosis, drugs for vasodilatation are not prescribed. Conservative therapy consists in prescribing anticoagulants. With a weakening of cardiac activity, Korglikon or Strofantin is used. According to indications appoint Kordiamin, Camphor. With a sharp drop in pressure, Caffeine, Mezaton are administered. Treatment is selected strictly individually for each patient.

When transient disorders are not amenable to drug therapy, the question of surgery is raised to restore blood flow and eliminate the source of thromboembolism. Such surgeries are preventive in nature. Surgery is indicated for patients without persistent focal neurological symptoms.

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Cerebral infarction caused by thrombosis of the cerebral arteries

in Heart attackViews

Cerebral infarction is one of the most difficult, both in terms of treatment and later life person, disease. Violation of parts of the brain can lead to irreversible consequences. Provocateurs of such a heart attack are many factors, and the main one is vascular thrombosis.

Symptoms

The following:

• weakness or numbness of half of the body;
• loss of sensation in the limbs;
• intense headache;
• difficult speech;
• disorientation in time and space;
• slight stupor;
• drowsiness;
• unsteadiness;
• dizziness with vomiting and nausea.

A person who has had a stroke turns pale, his blood pressure drops. Its sharp increase is rarely observed, mainly if a brain infarction occurred in its trunk. The body temperature remains normal, the pulse quickens, but becomes less full.

With a heart attack in the right hemisphere of the brain, if they have already occurred in the patient before, his mental health may suffer, which is initially characterized by mild confusion, and then develops into dementia. Even after the restoration of consciousness, symptoms of asthenia, psychosis, depression, delirium and hallucinations of varying severity are observed.

Occasionally (in case of blockage of the carotid artery) the patient falls into a coma. These symptoms allow you to independently determine a cerebral infarction and take the necessary measures.

If the patient is provided with timely medical care, the stroke may not lead to disability. Catastrophic consequences develop during the first hour and a half, so the greatest effect treatment reaches in the first two hours.

The symptoms accompanying a cerebral infarction are divided into three types.

• Acute type - begins with neurological manifestations, which is typical for coronary heart disease, accompanied by arrhythmia.
• Undulating (wave-like) type - these are the symptoms of the initial stage, the intensity of which increases over several hours.
• Tumor-like type - neurological symptoms that increase over time, indicating cerebral edema and high intracranial pressure.

Cerebral edema in children

Causes

The main reason for the death of a section of brain tissue is blockage of the artery resulting from thromboembolism. Thrombosis leads to changes in the structure of the vascular wall and a decrease in the rheological properties of the blood, causing an increase in its coagulability, and as a result, a slowdown in blood flow. The cause of the blockage cerebral arteries most often are:

• destroyed atherosclerotic plaques of vessels, both of the brain itself and of other anatomical regions;
• blood clots formed in the atria during rhythm disturbances;
• fat embolism resulting from fractures of large bones;
• fragments formed during the decay of tumors;
• separation of a blood clot with thrombophlebitis of the lower extremities;
• air embolism in chest and neck injuries.

Ischemic infarction can also develop with prolonged spasm of the cerebral arteries. Due to hemodynamic disturbances, there is a discrepancy between the intake of nutrients and the need for them in the brain, which leads to the development of irreversible ischemic changes. As a rule, this condition develops with persistent spasm of cerebral vessels against the background of hypertension. Sometimes there may be a violation of the integrity of the vessel, resulting in the development of a hemorrhagic infarction, in other words, there is a hemorrhage in the brain. The risk of developing a cerebral infarction is much higher in people with a history of:

• widespread atherosclerosis of vessels, with damage to the arteries of the brain, heart and kidneys;
• hypertension stage II and III;
• diseases of the cardiovascular system (ischemic disease, severe arrhythmias, pathology of the heart valves);
• long-term smoking and alcohol abuse;
• diseases of the endocrine system (diabetes mellitus, hyperthyroidism, diseases of the adrenal glands);
• systemic connective tissue diseases (rheumatism, lupus, rheumatoid arthritis).

Treatment

A cerebral infarction is an emergency condition requiring urgent hospitalization of the patient.

In the hospital, the main tasks of treatment will be the restoration of cerebral circulation and the protection of nerve fibers from further damage. For this purpose, from the first hours of the development of the condition, thrombolytics are prescribed - agents that dissolve blood clots. They are also very effective in the treatment of myocardial infarction. By dissolving the clot, these drugs prevent new damage to nerve cells, significantly reducing the size of the lesion.

However, drugs are indicated only for a strictly defined group of patients and are used in the early stages of the development of ischemic stroke.

Anticoagulant drugs help to slow down the growth of existing blood clots and prevent the emergence of new ones. In addition, they reduce blood clotting.

Another group of drugs that change the properties of the blood is called antiplatelet agents. They inhibit the aggregation (gluing) of platelets. Antiplatelet agents are included in the standard drugs for the treatment of stroke caused by cerebral atherosclerosis or various blood diseases with a tendency to clot formation due to platelet agglutination. These drugs are also used to prevent the development of recurrent stroke.

It must be understood that, without receiving oxygen and nutrients, brain cells begin to die. At the same time, a number of biochemical reactions are launched, which can be stopped by protective drugs - neuroprotectors, or cytoprotectors. At the same time, neuroprotectors help the cells that surround already dead ones survive such “stress” by increasing their activity. And they force the "uninvolved" cells to take on the duties of the dead.

There are also surgical methods for the treatment of cerebral infarction, such as carotid endarterectomy, an operation aimed at eliminating the inner wall of the carotid artery, which is affected by an atherosclerotic plaque when the artery is destroyed or narrowed. Such an intervention is the method of choice when the cause of a stroke is stenosis or blockage of the carotid artery through an atherosclerotic plaque. It is also used to prevent the occurrence of stroke, including repeated. However, there are clear indications and contraindications for this operation.

People who have had a cerebral infarction have a good chance of recovery, including a full recovery. The main thing is to have a clear focus on a positive result, courage and patience in achieving the goal!

Effects

The consequences of a massive stroke are reversible and irreversible. It depends on the area of ​​the lesion and the size of the area, as well as how quickly the treatment began. They are divided into several categories: motor, mental, vestibular, hearing, speech, vision, swallowing. Among the most common complications:

• paralysis of the right or left side of the body;
• paralysis of the limbs;
• speech, hearing and vision disorders;
• impaired coordination of movements and loss of orientation in space;
• complete or partial loss of smell, pain and tactile sensations;
• impaired memory and attention;
• difficulties with the perception of information;
• coma, which can occur with significant damage to brain tissue.

Stroke is the most common movement problem. As a rule, these are unilateral paralysis (complete absence of voluntary movements) or paresis (weakening of muscle movements). According to statistics, paralysis is observed in violation of cerebral circulation in 80% of cases.

With motor disorders after a cerebral stroke, pathological reflexes are observed, in some muscles an increased tone often develops.

With a stroke, mental pathologies are not uncommon. These include frontal syndrome and psychopathological. Frontal syndrome is associated with circulatory disorders in the region of the anterior cerebral artery. At the same time, irritability, partial loss of self-control, self-centeredness, lethargy, decreased intelligence and memory are noted. A psychopathological syndrome caused by a lesion of the middle cerebral artery is observed with a stroke of the right hemisphere and is characterized by forgetfulness, loss of orientation in space, and a decrease in intelligence.

In addition, people who have had a stroke of the brain may develop psychosis and depression. Long-term consequences include post-traumatic epilepsy, which may appear after recovery and lead to pathologies of consciousness after a few years.

They are associated with changes in the region of the posterior artery of the brain. Most often there is double vision, strabismus, half blindness. With a stroke in the right hemisphere of the brain, the field of vision drops out on the left side. If the brain stem was affected, then motor eye disorders are observed.

Such consequences occur with damage to the left hemisphere and are due to pathology of blood circulation in the region of the middle artery of the brain. In this case, motor or sensory aphasia is possible. With motor aphasia, the patient can neither write nor speak, but understands someone else's speech. With sensory, the patient does not understand others, while he himself speaks, although his speech is meaningless. With the first stroke, speech function is most often restored, but this may not happen with a second one.

The consequences of this kind are associated with a lesion in the region of the brainstem, pyramid of the brain or cerebellum. Vestibular disorders are characterized by dizziness, loss of balance, rapid movements of the eyeballs. With a cerebellar stroke, nausea, vomiting, decreased muscle tone, and problems with coordinating voluntary movements appear. In addition, sweating, flushing of the face, changes in blood pressure, respiratory rate (RR) and heart rate (HR) are possible.

Prevention

Preventive measures include the exclusion or reduction of exposure to factors that negatively affect the state of the vascular system of the brain.

• Treatment of arterial hypertension - allows you to halve the risk of developing a cerebral infarction. To do this, every day you need to take drugs that prevent high blood pressure. Often, a doctor prescribes a combination of medications. The goal of this therapy is to maintain blood pressure at a level not higher than 140/90 mm Hg. Art.
• To give up smoking. This habit significantly accelerates the progression of atherosclerosis and provokes the formation of blood clots in the vessels of the brain and heart. That is why people who smoke are twice as likely to develop a heart attack. Quitting smoking reduces the risk of this disease.
• Treatment of heart failure, coronary heart disease, heart defects. The presence of these diseases significantly increases the risk of cerebral infarction. The detection and treatment of these diseases, in particular the use of antithrombotic drugs, will help prevent the development of brain catastrophes.
• Treatment of diabetes. People who suffer from this disease often develop atherosclerosis. Compliance with a diet that involves limiting the intake of easily digestible carbohydrates, the use of hypoglycemic drugs and control of blood glucose levels reduces the risk of developing vascular complications.
• Cholesterol control. High level cholesterol increases the likelihood of developing atherosclerosis of the coronary and carotid arteries. Prolonged use of special drugs not only helps to reduce the concentration of cholesterol, but also to prevent the development of cerebral infarction. The use of these drugs in order to prevent this disease is indicated for patients with diabetes mellitus, arterial hypertension, impaired renal function.
• Refusal of alcoholic beverages. Alcohol abuse leads to an increase in blood pressure, aggravates the course of arterial hypertension, contributes to the development of cardiomyopathy and cardiac arrhythmias. All this increases the risk of developing a cerebral infarction.
• Refusal to take oral contraceptives. The risk of developing this disease increases against the background of the use of oral contraceptives by smoking women with a history of migraine, arterial hypertension. Therefore, the use of these funds without consulting a doctor is unacceptable.

Cerebral infarction is a very complex and dangerous disease which often has the most serious consequences for human health. Therapeutic measures are most effective in the first hours after an attack has occurred. Therefore, when the first signs of a cerebral infarction appear, you must urgently consult a doctor - this will help you save not only health, but also life.

Diagnostics

Diagnosis of the disease includes the following methods:

• Computed tomography - this method helps to distinguish a cerebral infarction from a hemorrhage;
• Magnetic resonance imaging. With it, you can get an image of the vessels of the brain;
• brain MRI
• Liquor research. If an ischemic stroke occurs, there will be no blood in the cerebrospinal fluid;
• Examination of the carotid arteries - this includes duplex scanning and Doppler ultrasonography (transcranial Doppler is a new ultrasound technique that can assess blood flow velocity in certain intracranial arteries);
• Cerebral angiography - this method is especially indispensable if surgery is needed; however, it requires special care, as a stroke may occur or an artery may be damaged.

Forecast

The prognosis for extensive cerebral infarction is determined by the location, size of the damaged area, concomitant diseases. The prognosis is worse, the larger the affected area and the later the person began treatment. In severe cases, especially if the patient has suffered a coma, it is very difficult to restore coordination of movements, memory, and speech. Every day spent in a coma reduces the chance of recovery by 15%. About 25% of people who have had a massive heart attack die within the first month.

Lethal outcome in the first month in 15-25% of patients (mainly with atherothrombotic and cardioembolic types). With lacunar stroke, the mortality rate is 2%. Causes of death:

• In the first week: more often - swelling and dislocation of the brain with damage to the vital centers (40% of all deaths in the first 30 days), less often - cardiac pathology.
• At 2-4 weeks: pulmonary embolism, pneumonia, acute heart failure.

• by the end of the first year 60 – 70%
• after 5 years - 50% (poor prognostic signs: advanced age, myocardial infarction, atrial fibrillation, heart failure)
• after 10 years - 25%
• In the future, mortality is 16 - 18% per year.

• by the end of the first month in 60 - 70% of patients
• after 6 months in 40%
• one year later in 30% of patients

• most noticeable in the first 3 months.
• paresis in the leg often recovers better than in the arm
• hemiplegia by the end of the 1st month, plegia in the arm - unfavorable prognostic signs

Low probability of regression of neurological deficit after a year or more (exceptions are in patients with aphasia - speech is restored for several years).

Hemorrhagic

It is most often found in combination of hypertension with atherosclerosis and in cardiogenic or arterio-arterial embolisms, as well as in pathological tortuosity of the carotid arteries.

Clinical manifestations are similar to white heart attack and cerebral hemorrhage. The onset of the disease is apoplectiform, often against the background of elevated blood pressure. With embolic stroke in the first 2 days. there is a regression of cerebral and focal symptoms.

Then, on the 3-4th day, cerebral and focal symptoms gradually increase again, consciousness becomes somnal and soporous. Neuroimaging studies reveal hemorrhagic impregnation of the cerebral cortex in the pool of the embolized vessel. Contributes to the development of hemorrhagic infarction taking an effective dose of anticoagulants against the background of elevated blood pressure (more than 160-180 mm Hg). Treatment is symptomatic.

Primary prevention provides for a "mass strategy", including a broad health education work aimed at increasing the knowledge of the population about the risk factors for stroke (smoking, high blood pressure, diabetes mellitus, hypercholesterolemia, excessive consumption of table salt, alcohol abuse, stress, physical inactivity, etc.) and about measures to prevent it; and a “high-risk group strategy”, which includes the identification of groups of individuals at high risk of developing a stroke based on a special algorithm. Such patients undergo planned preventive courses of treatment under the supervision of a local therapist and a neurologist.

The main methods of prevention: antihypertensive therapy with constant control of blood pressure, antiplatelet agents, lipid-lowering therapy, carotid endarterectomy, angioplasty.

Secondary prevention of stroke is carried out at the outpatient and sanatorium stages of rehabilitation of post-stroke patients. The ultimate goal is to reduce the patient's dependence on others in everyday life, and in some cases, return to work, as well as reduce the risk of recurrent stroke, myocardial infarction, and other diseases of the cardiovascular system. Such patients periodically undergo drug therapy (vasoactive drugs, antiplatelet agents, nootropic, neuroprotective, anti-sclerotic drugs, vitamins, etc.), massage, exercise therapy, psychotherapy.

The criterion for determining the degree of disability after a cerebral stroke is the severity of brain function disorders (speech, cognitive, visual, motor, coordinating, pelvic organs, etc.).

In case of speech impairment, pronounced motor disorders and the function of the sphincters of the pelvic organs, patients need outside help, and they are assigned I group of disability.

If the patient, due to severe paresis or speech impairment, cannot perform any work, but does not need constant outside care, a disability group II is established.

With mild paresis and slight limitation of movements by paretic limbs, the issue of working capacity is decided taking into account the profession, and either a third disability group is established, or patients are recognized as able-bodied, subject to rational employment. Such patients can be recommended to work that is not associated with significant psycho-emotional and physical stress, without staying in conditions of high or low temperature and humidity, without contact with vascular and neurotropic poisons.

Ischemic

Ischemic cerebral infarction is a clinical syndrome manifested by an acute disturbance of local brain functions lasting more than a day, or leading to death during this period. Ischemic stroke can be caused by insufficient blood supply to a certain area of ​​the brain due to a decrease in cerebral blood flow, thrombosis or embolism associated with diseases of the vessels, heart or blood.

Ischemic stroke (cerebral infarction) develops with a significant decrease in cerebral blood flow. Among the diseases leading to the development of cerebral infarction, the first place is occupied by atherosclerosis, which affects the main vessels of the brain in the neck or intracranial vessels, or both. Often there is a combination of atherosclerosis with hypertension or arterial hypertension.

Often, atherosclerosis is also combined with diabetes mellitus, which contributes to the development of atherosclerosis. Less commonly, the main disease is hypertension, even more rarely - rheumatism, various arteritis (syphilitic, thromboangiitis obliterans, Takayashi's disease, etc.), blood diseases (erythremia, leukemia), congenital heart defects in the stage of decompensation, myocardial infarction, acute infectious diseases, intoxication , injuries of the main vessels in the neck, etc. The "resolving" role in the development of ischemic stroke often belongs to mental and physical overstrain.

Most often, ischemic stroke occurs in the elderly - from 50 to 60 years and older, but sometimes in younger people. The focal necrosis of the brain that develops with it - heart attacks - can occur in various parts of the brain, most often they are found in the basin of the middle cerebral artery. There are white (or gray), red and mixed cerebral infarcts; white heart attacks are more common.

Pathogenetic mechanisms leading to the development of cerebral infarction are diverse: thrombosis of the cerebral vessels, the so-called cerebrovascular insufficiency (ischemia of the brain tissue in the area of ​​an atherosclerotically altered vessel, resulting from the adverse effect of any extracranial factor), embolism and spasm of cerebral vessels. In about half of the cases of cerebral infarction observed in atherosclerosis, an important role in the mechanism of its development is played by the pathology of the extracranial parts of the carotid and vertebral arteries.

The development of ischemic stroke is often preceded by transient disorders of cerebral circulation, often called transient ischemic attacks, which are manifested by unstable focal symptoms (paresthesia, paresis, speech disorders, etc.). They are usually the result of a short-term shortage of blood supply to the brain in the area in which a heart attack later develops. In some patients, there is an increase in transient ischemic attacks immediately before the development of cerebral infarction, in such cases they constitute the clinic of the "prodrome" of ischemic stroke. Sometimes there are signs of general discomfort, a sharp headache.

Cerebral infarction - what is it and how dangerous is it, how to identify and cure it in a short time

The human brain is a truly unique organ. All life processes are controlled by him.

But, unfortunately, the brain is very vulnerable to any kind of damage, and even seemingly minor changes in its work can lead to serious and irreversible consequences.

Let's talk about cerebral infarction - what it is and how ischemic stroke manifests itself.

Description

The human brain consists of a highly specific tissue that has a constant need for in large numbers oxygen, the lack of which causes negative changes.

Cerebral infarction (or ischemic stroke) is called ischemic damage to areas of the medulla that occur subsequently due to circulatory disorders. There is also a hemorrhagic cerebral infarction, but we will talk about it in another article.

Prevalence

Ischemic cerebral infarction is one of the most common diseases in the world. Under the age of 40, it is rare, on average it happens 4 times per 100 people. After 40, this figure increases significantly and is already 15 percent of the population.

People who have crossed the fifth decade, even more often suffer from the consequences of this disease - 30%. After 60 years, cerebral infarction occurs in 50% of people.

Classification and differences

Depending on the causes that led to a cerebral infarction, experts usually distinguish between several of its forms:

• atherothrombotic;
• Cardioembolic;
• Hemodynamic;
• Lacunar;
• Hemorheological.

Let's consider each of the varieties.

atherothrombotic

Atherothrombotic form of ischemic stroke develops with atherosclerosis of large or medium cerebral arteries.

This form of cerebral infarction is characterized by gradual development. Symptoms of the disease are slowly but surely increasing. From the onset of the development of the disease to the onset of the manifestation of pronounced symptoms, quite a few days can pass.

Cardioembolic

This form of stroke occurs against the background of partial or complete blockage of arteries by blood clots. Often this situation occurs with a number of cardiac lesions that occur when parietal blood clots form in the heart cavity.

Unlike the previous form, cerebral infarction caused by thrombosis of the cerebral arteries occurs unexpectedly, while the patient is awake.

The most typical affected area of ​​this type of disease is the area of ​​blood supply to the middle artery of the brain.

Hemodynamic

It happens against the background of a sharp decrease in pressure or as a result of a sudden decrease in the minute volume of the cardiac cavities. An attack of hemodynamic stroke can begin both abruptly and progressively.

lacunar

Occurs under the condition of lesions of the middle perforating arteries. It is believed that lacunar stroke often occurs when the patient's blood pressure is high.

The lesions are localized mainly in the subcortical structures of the brain.

Hemorheological

This form of stroke develops against the background of changes in normal blood clotting parameters.

Depending on the severity of the patient's condition, stroke is classified into three degrees:

Infarcts are also divided into classification according to the area of ​​localization of the affected area. The patient may have damage:

• in the area of ​​the inner side of the carotid artery;
• in the main artery, as well as in various vertebrates and their outgoing branches;
• in the region of the arteries of the brain: anterior, middle or posterior.

stages

Official medicine distinguishes 4 stages of the course of the disease.

The first stage is the acute course of the disease. The acute phase of a stroke lasts three weeks from the moment of the stroke. Fresh necrosis changes in the brain are formed the first five days after the attack.

The first stage is the most acute of all existing. During this period, the cytoplasm and karyoplasm shrink, symptoms of perifocal edema are noted.

The second stage is the early recovery period. The duration of this phase is up to six months, during which pannecrotic changes in cells occur.

Often there is a recurrent process of neurologic deficiency. Near the localization of the affected focus, blood circulation begins to improve.

The third stage is the late recovery period. Lasts from six months to a year after a cerebral infarction. During this time, glial scars or various cystic defects develop in the patient's brain.

The fourth stage is the period of residual manifestations of a heart attack. It starts 12 months after the stroke and can last until the end of the patient's life.

Causes

In fact, the reasons why this or that form of cerebral infarction develops are to a greater extent the consequences of various pathological conditions of the human body.

But among the main causes of stroke stand out:

• atherosclerotic changes;
• the presence of thrombosis in the veins;
• systematic hypotension;
• temporal arteritis disease;
• damage to large intracranial arteries (Moya-Moya disease);
• chronic subcortical encephalopathy.

Smoking provokes thrombosis, so a bad habit must be forgotten if health problems are suspected.

Taking hormonal contraceptives also slightly increases the risk of cerebral infarction.

Watch the video, which tells about the main causes of the disease:

Danger and Consequences

The disease is extremely dangerous. In 40% of cases, it ends in death in the first hours after the attack. However, with the timely provision of first emergency aid, the patient is able not only to survive, but also subsequently to lead a normal life.

The consequences of a cerebral infarction can be very different, ranging from numbness of the limbs, ending with complete paralysis and even death.

Here we will talk about all the stages of rehabilitation of patients who have had myocardial infarction.

Whether or not they give a disability group for myocardial infarction, you will learn separately.

Symptoms and signs

In the vast majority of cases, a stroke immediately makes itself felt: a person suddenly begins unbearable headaches, which most often affect only one side, the skin of the face during an attack acquires a pronounced red tint, convulsions and vomiting begin, breathing becomes hoarse.

Remarkably, the seizures affect the same side of the body as the side of the brain that was affected by the stroke. That is, if the location of the lesion is on the right side, then the convulsions will be more pronounced on the right side of the body and vice versa.

However, there are cases when an attack as such is absent at all, and only some time after a stroke, which the patient might not have suspected, numbness of the cheeks or hands (some one) is felt, the quality of speech changes, visual acuity decreases.

Then the person begins to complain of weakness in the muscles, nausea, migraines. In this case, a stroke can be suspected in the presence of stiff neck, as well as excessive muscle tension in the legs.

How is the diagnosis carried out

To establish an accurate diagnosis and prescribe effective treatment, several studies are used: MRI, CT, EEC, CTG, dopplerography of the carotid artery.

In addition, the patient is assigned to take an analysis for the biochemical composition of the blood, as well as a blood test for its coagulability (coagulogram).

First aid

The first measures to prevent irreversible consequences and death should begin in the very first minutes after the attack.

• Help the patient lie down on a bed or any other plane so that the head and shoulders are slightly above the level of the body. It is extremely important not to tug at the person who was hit too hard.
• Get rid of all items of clothing squeezing the body.
• Provide maximum oxygen, open windows.
• Make a cold compress on the head.
• With the help of heating pads or mustard plasters, support blood circulation in the limbs.
• deliver oral cavity from excess saliva and vomit.
• If the limbs are paralyzed, then they should be rubbed with solutions based on oil and alcohol.

Video about cerebral infarction and the importance of providing proper first aid:

Treatment tactics

A cerebral infarction is an emergency condition that requires immediate hospitalization.

In a hospital setting, the main goal of treatment is to restore blood circulation in the brain, as well as to prevent possible cell damage. In the first hours after the onset of the development of pathology, the patient is prescribed special drugs, the action of which is aimed at dissolving blood clots.

In order to inhibit the growth of existing blood clots and prevent the appearance of new ones, anticoagulants are used, which reduce the degree of blood clotting.

Another group of drugs that are effective in the treatment of stroke are antiplatelet agents. Their action is aimed at gluing platelets. The same medicines are also used to prevent recurrent attacks.

What is the prognosis?

People who have suffered a cerebral infarction have a good chance of recovering and even fully recovering. If within 60 days after the attack the patient's condition remains stable, then this suggests that he will be able to return to normal life in a year.

In order for this disease not to affect you, you must adhere to a proper lifestyle, nutrition, exercise, avoid stressful situations, monitor body weight, and give up bad habits.

Heart Treatment

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Cerebral infarction caused by cerebral artery embolism

Many people are familiar with the concept of "heart attack", but few people understand what a cerebral infarction caused by thrombosis of the cerebral arteries is.

This serious disease, which is not always completely treatable, can significantly impair brain function, negatively change a person’s quality of life, and even cause death.

A heart attack is tissue necrosis, that is, their irreversible death. The most common cause of cerebral infarction is a complete blockage of the arteries that provide a constant flow of blood and oxygen to the cells of the organ. Tissues that have ceased to receive nutrition begin to experience starvation, after which they die.

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• Only a DOCTOR can make an EXACT DIAGNOSIS!
• We kindly ask you DO NOT self-medicate, but make an appointment with a specialist!
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The disease is mainly affected by the elderly. The older the person, the greater the risk of developing a cerebral infarction.

Etiology

The cause of the disease is acute vascular insufficiency caused by blockage of the lumen of the cerebral extracranial and intracranial vessels by a thrombus. Most often, the disease occurs in people who suffer from chronic atherosclerosis.

Pathogenesis

Blood cannot pass through the arteries, therefore, leaking through the walls of blood vessels, and more often, tearing them, enters the brain tissue. At the same time, intracranial pressure increases, parts of the brain are displaced or infringed, its membranes are destroyed, and organ edema occurs.

The following factors influence the development of the disease:

• paralysis of the intracerebral arteries caused by spasm and disruption of the nervous regulation of blood vessels;
• embolism - overlapping of the vascular lumen with particles formed from thrombotic deposits;
• circulatory failure in the collateral (lateral or bypass) blood flow;
• a general disorder in the movement of blood through the vessels (hemodynamics), caused by uneven pressure in different parts of the circulatory system;
• change in physical, biological and chemical properties blood.

At risk are also elderly people suffering from chronic heart disease, arterial hypertension, with a history of diabetes, abusing smoking, alcohol and women who have been taking hormonal contraceptives for a long time.

Clinical picture

A few days before blockage, patients may experience headache, numbness of the limbs, dizziness. The condition continues to worsen, aphasia is observed - a violation or absence of speech, paralysis of the limbs occurs.

Tendon reflexes decrease, pathological reflexes unusual for a healthy person may appear, muscles weaken, swelling occurs, joint tissue degeneration (arthropathy) occurs, accompanied by severe pain, flexion or extension of the limbs is often difficult (contracture).

Diagnosis of cerebral infarction caused by cerebral artery thrombosis

It is important to notice the onset of the disease in order to prevent irreversible consequences in the brain as soon as possible.

There are first signs indicating the formation of a blood clot in the vessels of the brain and impaired blood flow:

• paralysis of the limbs;
• involuntary movements;
• uncontrolled facial expressions;
• impaired or absent speech;
• an increase in one pupil on the affected side;
• dullness or absence of pain.

Emergency diagnosis is most effective when using computed tomography, which allows you to identify a heart attack, to distinguish it from a hemorrhage.

Magnetic resonance therapy is also used, which makes it possible to examine the vessels.

Successful elimination of thrombosis by more than 70% reduces the likelihood of recurrent heart attacks

In the absence of modern diagnostic devices, a puncture is performed spinal cord and cerebrospinal fluid (CSF) is taken for analysis. The presence of impurities in her blood means that there was a hemorrhage in the brain.

Dopplerography or duplex scanning is used to examine the carotid arteries. The most effective method is angiography of the cerebral arteries - examination of blood vessels by introducing a radiopaque substance into them, which allows you to detect the localization of thrombosis, assess the degree of blockage of the lumen.

The last diagnostic method is used strictly according to indications. There is always a risk of damage to the blood vessels through the catheter through which the substance is injected, which can lead to a stroke.

Treatment

A cerebral infarction caused by thrombosis of the cerebral arteries requires emergency hospitalization of the patient. Therapy must be started within the first hours after the attack - this significantly increases the chances of saving the patient's life.

Reducing the ability of blood to clot in the first two hours, the use of blood thinners can significantly reduce the risk of paralysis, as well as other serious complications. However, with cerebral hemorrhages, the introduction of these drugs is contraindicated.

Treatment consists in systematic therapy:

• stabilization of the acid-base balance of the blood;
• restoration of blood circulation of the brain;
• oxygen saturation of the blood, through the use of antihypoxic drugs;
• elimination of respiratory failure;
• lowering blood pressure.

If indicated, surgical treatment may be required. Blockage of the carotid artery is an indication for surgery.

In some cases, surgery is needed to lower intracranial pressure, normalize cerebral blood flow, increase perfusion pressure, and increase oxygen supply to brain cells.

Dehydration drugs, diuretics are prescribed to eliminate excess water from the body. Be sure to carry out therapy with anticoagulants - drugs that reduce blood clotting, use fibrinolytic drugs that promote the resorption of blood clots, preventing their formation.

The patient continues to take medication to reduce swelling for several days.

The most important step after emergency care and normalization of blood flow is the recovery period.

Rehabilitation consists of the following actions:

• control of the stable functioning of the gastrointestinal tract, urinary system, heart rate;
• maintaining the stability of blood pressure, heart rate, respiration;
• restoration of speech;
• return of muscle tone;
• gradual return motor activity sick.

Moral support of family members is also needed, which will prevent a person from falling into depression and losing the meaning of life.

If necessary, it is better to use the help of a specialist - a psychologist who, using professional methods, will help restore the patient's positive attitude and faith in a successful recovery.

Prevention

Prevention of cerebral infarction and vascular thrombosis should be started in adulthood, trying to healthy lifestyle life, as well as reduce the effect of all negative factors affecting the effective functioning of the cardiovascular system.

The preventive measures are as follows:

The brain is the most important organ responsible for all processes in the body. The irreversible consequences of a heart attack can completely deprive a person of a full life, the ability to move, walk, talk, which can cause serious nervous disorders and depression, deprive the craving for life.

Cerebral infarction caused by thrombosis of the cerebral arteries is a disease that requires immediate treatment. The effectiveness of subsequent therapy and rehabilitation measures directly depends on the provision of first aid within two hours after the onset of a heart attack.

Emergency therapy will increase the chances of not only returning to a person all the joys of life, but also the opportunity to live for many more years.

The human body, in fact, is a fragile thing and danger to its life can lie in wait at every corner. So, if some injuries in themselves are not dangerous, then their complications can lead to serious pathologies. One of these is cerebral embolism.

Features of the disease

A cerebral embolism is a sudden occlusion of cerebral vessels by an embolus, which is sometimes a consequence of the development of an ischemic stroke. The condition is dangerous because it may not manifest itself in the first days, and if it is not diagnosed in time, it leads to internal bleeding, cerebral hemorrhage and death.

Classification

Embolism can be single or multiple, as it can be caused by one or more thrombi. The most common embolic material is a thrombus that clogs the vessels of the brain. A thrombus can be of different sizes, but in any case they speak of a cardiogenic embolism (eg, cerebral vessels) or thromboembolism. According to the same principle, the disease is classified into:

• Adipose. In this case, the lipid drop enters the bloodstream and blocks the capillaries, gradually being transferred to the brain.
• Air. Blockage of blood vessels causes an air bubble.
• Gas. Similar to air in all respects, however, a blockage is caused by a gas bubble.
• Cellular. Pieces of tissue enter the bloodstream, which disrupt it.
• Microbial. It is caused by microbes settling on the walls of the capillaries, which causes abscesses that block blood flow.
• Mechanical. In this case, the blockage is provoked by a foreign body, such as a bullet.

Depending on the type, the causes and some treatment regimens differ. We will talk about the causes of cerebral embolism later.

Causes

The common cause for all forms of embolism is vascular trauma, for example, in accidents or surgical interventions. In this case, not the brain itself may be injured: even childbirth in some cases can be complicated by embolism.

The most common causes of embolism:

1. fracture and wound of a tubular bone;
2. traumatization of subcutaneous fat;
3. the introduction of drugs with an oil base;
4. pneumothorax;
5. abortion intervention;
6. carrying out caisson works;
7. fast decompression;
8. anaerobic gangrene;
9. pathological processes that provoke tissue destruction;
10. severe microbial inflammation.

Also, embolism can be caused by mechanical factors. This happens when you are injured by fragments of bombs and bullets: a foreign body blocks blood circulation.

About what symptoms are characteristic of cerebral artery embolism, read on.

Symptoms of cerebral embolism

The clinical picture of cerebral embolism is the severity of neurological infarction. Depending on the type and location of the blockage, symptoms may vary. The main symptoms are:

In some young patients, embolism may not appear immediately, but make itself felt after stress and physical. loads.

Diagnostics

The condition is diagnosed by examination and hardware studies. First, the doctor collects an anamnesis of life and complaints, and also conducts a physical examination for cyanosis of the skin, other signs of embolism. An accurate diagnosis can be made by CT of the brain, which allows you to determine the lesion and the possible localization of the blockage.

For additional diagnostics, which allows to identify the causes and concomitant pathologies, appoint:

The most accurate study is MRI, however, diagnosing with it is expensive, and not every hospital has the necessary equipment.

Treatment

Treatment should be resorted to immediately after diagnosis, since any delay is fatal. The main therapeutic measure is drug therapy, which can be carried out in conjunction with surgical and therapeutic methods.

Note! It is strictly contraindicated to treat embolism with folk remedies! This can eliminate some of its manifestations, which will aggravate control over the patient's condition. On the advice of a doctor, you can take some herbal remedies, but it is forbidden to prescribe them to yourself.

Therapeutic

Patients with embolism are shown complete rest. If the patient feels well, then therapeutic measures can be carried out at home, however, it is better to transport the patient to a hospital. The hospital is also indicated when the patient's condition worsens.

When transporting, it is necessary to use a stretcher, while keeping the head above the legs, while monitoring the condition so that foamy saliva does not get into the respiratory tract and does not lead to suffocation. After delivery to the hospital, the person must be carefully undressed and freed from tight clothing, and then the oral cavity should be cleaned from vomit, and mucus should be sucked out of the respiratory tract.

If there is an increase in blood pressure, you can resort to bloodletting (ml at a time). It is also important to follow a diet, so vegetable fatty foods are shown only on the 2nd day after feeling better, and until that time it is better to limit yourself to teas and light meals.

Medical

Drug therapy is prescribed depending on the manifestations of embolism:

• With a pronounced ischemic status, i.e., reduced blood pressure and a weakened pulse, cardiovascular agents such as camphor and caffeine are prescribed.
• For respiratory disorders, injections of lobelin and cytitonin are used.
• With reduced prothrombin, they give vikasol and vitamin K. With increased prothrombin, it is optimal to drink anticoagulants like dicoumarin, pelentan, phenylin and heparin.
• Patients with thrombopenia are shown vitamin C, blood transfusion and calcium chloride.
• During a thrombotic stroke, thrombolytic drugs are indicated.
• Pachycarpine is prescribed for ischemic stroke.
• Patients with tachyarrhythmia and atrial fibrillation should take Medinal or Novocainamide with Novocaine.
• Patients with pulmonary edema are given antifoam agents, for example, antifomsilan.

Other drugs may also be used, depending on symptoms and response to treatment.

Operation

Surgical intervention is indicated when breathing stops. During this condition, the patient undergoes a tracheostomy, that is, an incision is made in this area, after which a temporary anastomosis of the trachea and the environment is constructed.

Patients with a tracheostomy need to be given oxygen through a tube, after removing mucus and sputum from there.

Prevention

Prevention of cardiac embolism is to avoid conditions that can lead to it. Often, this is unrealistic, since the list of these states is very wide. During surgical intervention, the doctor must monitor the quality of blockage of blood vessels, that is, their cauterization, bandaging of wounds, etc. You can reduce the risk of developing an embolism if you monitor your health and fully comply with the requirements of doctors.

Other types of operations aimed at restoring normal blood circulation may also be used.

Complications

Embolism is a serious condition that is often complicated by:

1. internal bleeding;
2. hemorrhage in the brain;
3. cerebral edema;
4. circulatory disorders;
5. cardiac arrhythmias.

The most serious complication of cerebral embolism is respiratory arrest, which can be fatal if first aid is not provided in time.

Forecast

The prognosis for the treatment of embolism depends entirely on its timely diagnosis. There are no exact statistics, but in most cases, when an embolism affects a person outside the hospital, the patient dies because they do not immediately go to the doctor.

With early diagnosis and proper treatment, there is a high chance of a full recovery. Sometimes patients may have residual effects such as paresis, circulatory disorders and concomitant diseases.

Cerebral infarction (ischemic stroke) is a dangerous pathology that develops as a result of a serious circulatory disorder. As a result, there is a rather rapid death of nerve cells, which leads to irreversible consequences for the human body. The danger of this disease is explained by the structure of the brain. It consists of specific tissues that have a high demand for oxygen and are extremely sensitive to its deficiency. When blood circulation is disturbed, irreversible changes are observed in the brain. They lead to a violation of the basic functions that provoke all the negative phenomena associated with this disease.

The most dangerous consequence of a cerebral infarction is the death of a person, which occurs in 25% of cases during the first day. 40% of patients die a little later - within 20 days. Also, 50% of all surviving patients remain permanently disabled. In this case, there is a high risk of death over 5 years.

What causes ischemic stroke?

The causes that cause impaired blood flow in the brain are specific. These include:

• atherosclerosis. This pathology most often provokes a cerebral infarction in combination with other aggravating problems, which include arterial hypertension. This factor is found in 70% of patients. It increases the risk of stroke by 12 times. Also, a heart attack in combination with atherosclerosis can be caused by diabetes mellitus, syphilis, various pathologies of the blood, heart (congenital malformation, myocardial infarction), blood vessels, after serious injuries, if infectious diseases different types, etc. The presence of several factors at once aggravates the human condition. Very often there are cases when the causes of blockage of cerebral vessels are precisely secondary causes;
• the presence of serious pathologies in the structure of the vertebral or carotid arteries. In the presence of this factor, cerebral infarction develops as a result of stenosis (narrowing of the lumen) or vascular thrombosis;

• after fracture of large bones. In this case, a stroke is provoked by a fat embolism that develops in this condition;
• surgical intervention. It very rarely happens that during certain operations (most often on the open heart), an air bubble can enter the bloodstream. It impedes normal blood circulation, which leads to a stroke;
• blockage of the artery by blood clots, which are formed during thrombophlebitis of the lower extremities;

• development of an air embolism. It develops when the chest or neck is injured;
• prolonged smoking, alcohol abuse, exposure to narcotic substances;
• blockage of blood vessels can occur as a result of the accumulation of decay products of various tumors;
• prolonged use of oral contraceptives (especially in combination with smoking), which leads to thrombosis;
• psycho-emotional or physical stress.

Given all the factors that lead to the development of the disease, it is clear that people over the age of 50 are most affected by this disease. However, we should not forget that stroke can also develop in young people with certain health problems.

Signs of the disease

Blockage of blood vessels, which is caused by certain negative factors, or any other violation of cerebral circulation leads to a gradual or sharp increase in various neurological signs. The characteristic symptoms of a heart attack can actively develop over several hours or even days. A feature of a stroke is that its symptoms may increase or, conversely, weaken over time.

In most cases, the symptoms of a cerebral infarction are as follows:

• complete absence of pain. Stroke symptoms rule this out because there are no pain receptors in the brain;
• complete or partial paralysis. A person cannot make many movements, there is numbness of any part of the body or half of it;
• appearance of involuntary movements. This is due to the activity of the segmental apparatus of the spinal cord;
• difficulty in speech or its complete loss. These symptoms are much less common in women than in men. This is due to the fact that the fair sex has one speech center in each of the cerebral hemispheres;

• mime disorder. The person cannot smile, move their lips normally, or make other similar movements;
• pupillary dilatation is uneven. This can happen when the blood flow disturbance occurs in only one of the hemispheres of the brain. In this case, an enlarged pupil will be detected in one eye, and a normal pupil in the other;
• impaired consciousness, which often has different manifestations. A person may feel some kind of muffledness or fall into a coma. Most often there is a short-term loss of consciousness;

• dizziness, which is often accompanied by vomiting, nausea;
• the appearance of autonomic disorders - increased sweating, dry mucous membranes, tachycardia, etc.;
• temporary hearing loss, deafness;
• drowsiness;
• pallor of the skin;
• a sharp decrease in blood pressure.

The symptoms of a heart attack are largely determined by the area of ​​the brain where there is insufficient blood supply. Based on the developing signs, a preliminary diagnosis can be made and a problem area can be identified.

Disease classification

Cerebral infarction is divided into several types:

• atherothrombotic stroke. This pathology develops as a result of the concomitant course of hypertension, coronary heart disease, etc. This type of cerebral infarction is caused by thrombosis of the cerebral arteries and most often occurs in the morning or during sleep. In this case, tissue damage occurs on a different scale. A person's condition can deteriorate rapidly (or short-term episodes of improvement are observed).

• Cardioembolic stroke. Occurs when arteries are blocked by emboli of cardiac origin. With the development of this type of cerebral infarction, an acute onset is observed. The causes of this pathology are various heart diseases. Also, an aggravating factor leading to this problem is considered emotional or physical overstrain.

• Lacunar stroke. This is a pathology caused by damage to small vessels that supply blood to the deep structures of the brain. In this case, there is an increase in blood pressure, but there are no signs of a violation of higher nervous activity. This disease rarely lasts longer than 3 weeks, and may not even be detected during brain imaging.

• hemodynamic stroke. In this case, insufficient blood supply to the brain tissues is explained by a sharp decrease in pressure indicators. This type of cerebral infarction most often occurs in older people with severe atherosclerosis of the vessels. A feature of this pathology is that it can develop gradually or suddenly.

• Hemorheological stroke. In this case, a cerebral infarction occurs due to a clear violation of blood flow. This can occur against the background of heart disease, with the use of hormonal contraceptives, diuretics, drinking excessive amounts of coffee, alcohol, and for other reasons.

Diagnosis of cerebral infarction

Cerebral infarction can be detected using the following diagnostic procedures:

• CT scan. With the help of this study, one can easily distinguish a hemorrhage from a cerebral infarction;
• MRI (magnetic resonance imaging). With the help of such a diagnostic procedure, it is possible to determine the state of the vessels of the brain;
• liquor research. With a cerebral infarction, blood is not detected in the cerebrospinal fluid;
• duplex scanning, dopplerography to study the condition of the carotid arteries;
• cerebral angiography. Modern Method x-ray examination of blood vessels located in the brain. This diagnostic method is indispensable if surgery is necessary, but can be dangerous due to the high risk of vascular rupture.

Cerebral infarction is a disease that requires urgent hospitalization of the patient. The sooner therapeutic measures are taken, the higher the likelihood of a favorable outcome. It is best when medical assistance is provided within 2 hours after the onset of the development of symptoms of the disease.

In a hospital, treatment is used that is aimed at restoring cerebral circulation, at protecting tissues from further destruction.

Most often this happens with the help of the following means:

• thrombolytics. Means are used that allow you to dissolve blood clots, leading to blockage of the arteries;
• anticoagulants. Prevent the appearance of new blood clots, reduce blood clotting;
• antiplatelet agents. Preparations of this group slow down the adhesion of platelets;
• neuroprotectors. They help stop the biochemical reactions that are triggered by the death of damaged brain cells.

Also, the treatment of cerebral infarction can occur in an operative way. Most often, a carotid endarterectomy is performed, which allows you to remove the inner wall of the carotid artery, which is affected by atherosclerotic plaques. Surgery has its own indications and contraindications, which must be taken into account in order to obtain the desired effect.

Cerebral infarction is a clinical syndrome, which is expressed in an acute violation of local brain functions. It lasts more than 24 hours, or leads to the death of a person during this time. Acute circulatory disorders in cerebral infarction occur due to blockage of its arteries, which provokes the death of neurons in the area that feeds on these arteries.

A cerebral infarction is also called an ischemic stroke. This problem is very relevant in the modern world, since a huge number of people die every year due to cerebral infarction. Mortality in ischemic stroke is 25%, another 20% of patients die within a year, and 25% of the survivors remain disabled.

• Symptoms of a cerebral infarction
• Treatment of cerebral infarction

Symptoms of a cerebral infarction

The symptoms of a cerebral infarction depend on where the lesion is located.

However, there are common symptoms of this pathological process, including:

Loss of consciousness, sometimes coma may develop;

Violations of the functioning of the pelvic organs;

Pain in the eyeballs;

Nausea and vomiting against the background of severe headache;

Seizures (not always present).

If the focus of cerebral infarction is localized in the right hemisphere, then the following clinical picture is characteristic:

Complete immobility (hemiparesis) or a significant decrease in strength (hemiplegia) of the left limbs;

Sensitivity in the left half of the body and face disappears or sharply decreases;

Speech disorders will be observed in left-handers. In right-handers, speech disorders develop exclusively with damage to the left hemisphere. The patient cannot reproduce words, but conscious gestures and facial expressions are preserved;

The face becomes asymmetric: the left corner of the mouth goes down, the nasolabial fold is smoothed out.

Depending on which half of the brain is damaged, the symptoms of a cerebral infarction will be observed on the opposite side. That is, if the lesion is located in the left hemisphere, then the right half of the body will suffer.

If a cerebral infarction develops in the vertebrobasilar vascular pool, then the patient's symptoms are as follows:

Dizziness, which increases when the head is thrown back;

Coordination suffers, static disorders are observed;

There are violations of the movement of the eyeballs, vision deteriorates;

A person pronounces individual letters with difficulty;

There are problems with swallowing food;

Paralysis, paresis, impaired sensitivity of the limbs will be observed from the side opposite to the lesion.

It is worth considering separately the symptoms of a cerebral infarction, depending on which particular cerebral artery is damaged:

Anterior cerebral artery - incomplete paralysis of the legs, the occurrence of grasping reflexes, eye movement disorders, motor aphasia;

Middle cerebral artery - incomplete paralysis and disorder of the sensitivity of the hands, as well as the lower half of the face, sensory and motor aphasia, laterofixation of the head;

Posterior cerebral artery - visual disturbances, the patient understands the speech of another person, he can speak himself, but he forgets most of the words.

In severe cases, consciousness is depressed and the person falls into a coma, which can occur when any part of the brain is damaged.

Causes of cerebral infarction

There are the following causes of cerebral infarction:

Atherosclerosis. It develops in men earlier than in women, since at a young age female vessels are protected from atherosclerotic lesions by sex hormones. First of all, the coronary arteries are affected, then the carotid, and subsequently the blood supply system of the brain;

Hypertension. Enhances atherosclerosis and disrupts the adaptive reactions of the arteries mild hypertension (pressure up to 150/100 mm Hg), which is the most dangerous;

Heart diseases. So, people who have had a myocardial infarction have a high risk of developing a cerebral infarction. In 8% of patients after myocardial infarction, an ischemic stroke will develop within the first month, and in 25% of patients within six months. The danger is also coronary heart disease, heart failure;

High blood viscosity;

Atrial fibrillation arrhythmias. They are the reason that blood clots form in the left atrial appendage, which are subsequently transferred to the brain;

Violations in the work of the endocrine system, first of all, it is diabetes mellitus;

Vascular diseases (pathologies of their development, Takayasu's disease, anemia, leukemia, malignant tumors).

In addition, do not forget about the risk factors that increase the likelihood of a cerebral infarction, among them:

Age (every ten years of life increases the risk of developing a cerebral infarction by 5-8 times);

Smoking (if this bad habit is supplemented by taking oral contraceptives, then smoking becomes a leading risk factor for developing cerebral infarction);

Acute stress, or prolonged psycho-emotional stress.

Sequelae of a cerebral infarction

The consequences of a cerebral infarction can be very serious and often pose a direct threat to human life, among them are:

Cerebral edema. It is this complication that develops more often than others and is the most common cause of death in the first week after an ischemic stroke;

Congestive pneumonia is the result of the patient being in a horizontal position for a long time. It develops most often 3-4 weeks after suffering a cerebral infarction;

Pulmonary embolism;

Acute heart failure;

Bedsores from lying in bed for a long time.

In addition to the listed consequences of cerebral infarction, which develop in the early stages, long-term complications can also be distinguished, including:

Violation of the motor function of the limbs;

Decreased sensation in the arms, legs, and face;

speech problems;

Deterioration of mental abilities;

Difficulty swallowing food;

Loss of coordination when walking, during turns;

Epileptic seizures (up to 10% of people who have had a cerebral infarction are susceptible to them);

Malfunctions of the pelvic organs (the bladder, kidneys, intestines, reproductive organs suffer).

How is a heart attack different from a stroke?

With a cerebral infarction, there is a violation of its blood supply, as a result of which the tissues of the affected area begin to die. Insufficient blood flow to the brain occurs due to atherosclerotic plaques that prevent its normal flow, due to heart rhythm disturbances, or due to problems with the blood coagulation system.

With a hemorrhagic stroke of the brain, on the contrary, the blood flow to it increases, which causes a rupture of the artery. The cause is vascular pathology or hypertensive crisis.

There are differences in the course of the disease. So, a cerebral infarction develops gradually, over several hours or even days, and a hemorrhagic stroke occurs almost instantly.

Treatment of cerebral infarction

Treatment of cerebral infarction is primarily based on thrombolytic therapy. It is important that the patient is admitted to the neurological department within the first three hours of the onset of an attack. It is necessary to transport the patient in an elevated position. The head should be 30 degrees higher than the body. If a thrombolytic is administered to the patient at the specified time, the drug will very quickly dissolve the existing thrombus, which is most often the cause of impaired blood supply to the brain. The effect can often be seen almost instantly, in the first seconds of drug administration.

If thrombolytic therapy is not carried out in the first three hours from the onset of cerebral infarction, then it no longer makes sense to carry it out further. There will be changes in the brain, the nature of which is irreversible.

It should be borne in mind that thrombolysis is performed only when the doctor has made sure that the patient has a cerebral infarction, and not a hemorrhagic stroke. In the latter case, such therapy will lead to death.

If it is not possible to administer a thrombolytic, then the following measures are indicated:

Decreased blood pressure;

Taking antiplatelet agents (Aspirin) or anticoagulants (Clexane, Fraxiparin, Heparin);

Appointment of drugs aimed at improving cerebral blood supply (Trental, Piracetam, Cavinton).

Also, patients are prescribed vitamins of group B, they carry out rehabilitation treatment, they are engaged in the prevention of bedsores. Self-medication is unacceptable, at the first sign of a cerebral infarction, it is necessary to call an ambulance. It is worth remembering that at home it is impossible to distinguish a cerebral infarction from a hemorrhagic stroke.

Surgical treatment of cerebral infarction is surgical decompression aimed at reducing intracranial pressure. This method allows to reduce the percentage of mortality in cerebral infarction from 80 to 30%.

An important component of the general scheme for the treatment of cerebral infarction is competent restorative therapy, which is called "neurorehabilitation".

You need to start it from the first days of the disease:

Movement disorders are corrected with the help of physiotherapy exercises, massage and physiotherapy methods. At the moment, there are special simulators that help people recover after a cerebral infarction;

Speech disorders are corrected during individual sessions with a speech therapist;

Swallowing dysfunctions are leveled by special devices that stimulate the work of the laryngeal and pharyngeal muscles;

Classes on the stabiloplatform help to cope with coordination problems;

Equally important is the psychological assistance to the sick. A psychotherapist helps to cope with emotional problems;

For life, a person is prescribed statins and Aspirin preparations;

To improve the functioning of the brain, it may be recommended to take medicines such as Cavinton, Tanakan, Bilobil, etc.

It is important for the patient himself to constantly monitor the level of blood pressure, blood sugar and cholesterol levels, as well as give up bad habits and lead a healthy lifestyle with the obligatory presence of moderate physical activity in it.

But, unfortunately, the brain is very vulnerable to any kind of damage, and even seemingly minor changes in its work can lead to serious and irreversible consequences.

Let's talk about cerebral infarction - what it is and how ischemic stroke manifests itself.

Description

The human brain consists of a highly specific tissue that has a constant need for a large amount of oxygen, the lack of which causes negative changes.

Cerebral infarction (or ischemic stroke) is called ischemic damage to areas of the medulla that occur subsequently due to circulatory disorders. There is also a hemorrhagic cerebral infarction, but we will talk about it in another article.

Prevalence

Ischemic cerebral infarction is one of the most common diseases in the world. Under the age of 40, it is rare, on average it happens 4 times per 100 people. After 40, this figure increases significantly and is already 15 percent of the population.

People who have crossed the fifth decade, even more often suffer from the consequences of this disease - 30%. After 60 years, cerebral infarction occurs in 50% of people.

Classification and differences

Depending on the causes that led to a cerebral infarction, experts usually distinguish between several of its forms:

• atherothrombotic;
• Cardioembolic;
• Hemodynamic;
• Lacunar;
• Hemorheological.

Let's consider each of the varieties.

atherothrombotic

Atherothrombotic form of ischemic stroke develops with atherosclerosis of large or medium cerebral arteries.

This form of cerebral infarction is characterized by gradual development. Symptoms of the disease are slowly but surely increasing. From the onset of the development of the disease to the onset of the manifestation of pronounced symptoms, quite a few days can pass.

Cardioembolic

This form of stroke occurs against the background of partial or complete blockage of arteries by blood clots. Often this situation occurs with a number of cardiac lesions that occur when parietal blood clots form in the heart cavity.

Unlike the previous form, cerebral infarction caused by thrombosis of the cerebral arteries occurs unexpectedly, while the patient is awake.

The most typical affected area of ​​this type of disease is the area of ​​blood supply to the middle artery of the brain.

Hemodynamic

It happens against the background of a sharp decrease in pressure or as a result of a sudden decrease in the minute volume of the cardiac cavities. An attack of hemodynamic stroke can begin both abruptly and progressively.

lacunar

Occurs under the condition of lesions of the middle perforating arteries. It is believed that lacunar stroke often occurs when the patient's blood pressure is high.

The lesions are localized mainly in the subcortical structures of the brain.

Hemorheological

This form of stroke develops against the background of changes in normal blood clotting parameters.

Depending on the severity of the patient's condition, stroke is classified into three degrees:

Infarcts are also divided into classification according to the area of ​​localization of the affected area. The patient may have damage:

• in the area of ​​the inner side of the carotid artery;
• in the main artery, as well as in various vertebrates and their outgoing branches;
• in the region of the arteries of the brain: anterior, middle or posterior.

stages

Official medicine distinguishes 4 stages of the course of the disease.

The first stage is the acute course of the disease. The acute phase of a stroke lasts three weeks from the moment of the stroke. Fresh necrosis changes in the brain are formed the first five days after the attack.

The first stage is the most acute of all existing. During this period, the cytoplasm and karyoplasm shrink, symptoms of perifocal edema are noted.

The second stage is the early recovery period. The duration of this phase is up to six months, during which pannecrotic changes in cells occur.

Often there is a recurrent process of neurologic deficiency. Near the localization of the affected focus, blood circulation begins to improve.

The third stage is the late recovery period. Lasts from six months to a year after a cerebral infarction. During this time, glial scars or various cystic defects develop in the patient's brain.

The fourth stage is the period of residual manifestations of a heart attack. It starts 12 months after the stroke and can last until the end of the patient's life.

Causes

In fact, the reasons why this or that form of cerebral infarction develops are to a greater extent the consequences of various pathological conditions of the human body.

But among the main causes of stroke stand out:

• atherosclerotic changes;
• the presence of thrombosis in the veins;
• systematic hypotension;
• temporal arteritis disease;
• damage to large intracranial arteries (Moya-Moya disease);
• chronic subcortical encephalopathy.

Smoking provokes thrombosis, so a bad habit must be forgotten if health problems are suspected.

Taking hormonal contraceptives also slightly increases the risk of cerebral infarction.

Watch the video, which tells about the main causes of the disease:

Danger and Consequences

The disease is extremely dangerous. In 40% of cases, it ends in death in the first hours after the attack. However, with the timely provision of first emergency aid, the patient is able not only to survive, but also subsequently to lead a normal life.

The consequences of a cerebral infarction can be very different, ranging from numbness of the limbs, ending with complete paralysis and even death.

Here we will talk about all the stages of rehabilitation of patients who have had myocardial infarction.

Whether or not they give a disability group for myocardial infarction, you will learn separately.

Symptoms and signs

In the vast majority of cases, a stroke immediately makes itself felt: a person suddenly begins unbearable headaches, which most often affect only one side, the skin of the face during an attack acquires a pronounced red tint, convulsions and vomiting begin, breathing becomes hoarse.

Remarkably, the seizures affect the same side of the body as the side of the brain that was affected by the stroke. That is, if the location of the lesion is on the right side, then the convulsions will be more pronounced on the right side of the body and vice versa.

However, there are cases when an attack as such is absent at all, and only some time after a stroke, which the patient might not have suspected, numbness of the cheeks or hands (some one) is felt, the quality of speech changes, visual acuity decreases.

Then the person begins to complain of weakness in the muscles, nausea, migraines. In this case, a stroke can be suspected in the presence of stiff neck, as well as excessive muscle tension in the legs.

How is the diagnosis carried out

To establish an accurate diagnosis and prescribe effective treatment, several studies are used: MRI, CT, EEC, CTG, dopplerography of the carotid artery.

In addition, the patient is assigned to take an analysis for the biochemical composition of the blood, as well as a blood test for its coagulability (coagulogram).

First aid

The first measures to prevent irreversible consequences and death should begin in the very first minutes after the attack.

• Help the patient lie down on a bed or any other plane so that the head and shoulders are slightly above the level of the body. It is extremely important not to tug at the person who was hit too hard.
• Get rid of all items of clothing squeezing the body.
• Provide maximum oxygen, open windows.
• Make a cold compress on the head.
• With the help of heating pads or mustard plasters, support blood circulation in the limbs.
• Rid the mouth of excess saliva and vomit.
• If the limbs are paralyzed, then they should be rubbed with solutions based on oil and alcohol.

Video about cerebral infarction and the importance of providing proper first aid:

Treatment tactics

A cerebral infarction is an emergency condition that requires immediate hospitalization.

In a hospital setting, the main goal of treatment is to restore blood circulation in the brain, as well as to prevent possible cell damage. In the first hours after the onset of the development of pathology, the patient is prescribed special drugs, the action of which is aimed at dissolving blood clots.

In order to inhibit the growth of existing blood clots and prevent the appearance of new ones, anticoagulants are used, which reduce the degree of blood clotting.

Another group of drugs that are effective in the treatment of stroke are antiplatelet agents. Their action is aimed at gluing platelets. The same medicines are also used to prevent recurrent attacks.

What is the prognosis?

People who have suffered a cerebral infarction have a good chance of recovering and even fully recovering. If within 60 days after the attack the patient's condition remains stable, then this suggests that he will be able to return to normal life in a year.

In order for this disease not to affect you, you must adhere to a proper lifestyle, nutrition, exercise, avoid stressful situations, monitor body weight, and give up bad habits.

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Many people are familiar with the concept of "heart attack", but few people understand what a cerebral infarction caused by thrombosis of the cerebral arteries is.

A heart attack is tissue necrosis, that is, their irreversible death. The most common cause of cerebral infarction is a complete blockage of the arteries that provide a constant flow of blood and oxygen to the cells of the organ. Tissues that have ceased to receive nutrition begin to experience starvation, after which they die.

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The disease is mainly affected by the elderly. The older the person, the greater the risk of developing a cerebral infarction.

Etiology

The cause of the disease is acute vascular insufficiency caused by blockage of the lumen of the cerebral extracranial and intracranial vessels by a thrombus. Most often, the disease occurs in people who suffer from chronic atherosclerosis.

Pathogenesis

Blood cannot pass through the arteries, therefore, leaking through the walls of blood vessels, and more often, tearing them, enters the brain tissue. At the same time, intracranial pressure increases, parts of the brain are displaced or infringed, its membranes are destroyed, and organ edema occurs.

The following factors influence the development of the disease:

• paralysis of the intracerebral arteries caused by spasm and disruption of the nervous regulation of blood vessels;
• embolism - overlapping of the vascular lumen with particles formed from thrombotic deposits;
• circulatory failure in the collateral (lateral or bypass) blood flow;
• a general disorder in the movement of blood through the vessels (hemodynamics), caused by uneven pressure in different parts of the circulatory system;
• changes in the physical, biological and chemical properties of blood.

At risk are also elderly people suffering from chronic heart disease, arterial hypertension, with a history of diabetes, abusing smoking, alcohol and women who have been taking hormonal contraceptives for a long time.

Clinical picture

A few days before blockage, patients may experience headache, numbness of the limbs, dizziness. The condition continues to worsen, aphasia is observed - a violation or absence of speech, paralysis of the limbs occurs.

Tendon reflexes decrease, pathological reflexes unusual for a healthy person may appear, muscles weaken, swelling occurs, joint tissue degeneration (arthropathy) occurs, accompanied by severe pain, flexion or extension of the limbs is often difficult (contracture).

Diagnosis of cerebral infarction caused by cerebral artery thrombosis

It is important to notice the onset of the disease in order to prevent irreversible consequences in the brain as soon as possible.

There are first signs indicating the formation of a blood clot in the vessels of the brain and impaired blood flow:

• paralysis of the limbs;
• involuntary movements;
• uncontrolled facial expressions;
• impaired or absent speech;
• an increase in one pupil on the affected side;
• dullness or absence of pain.

Emergency diagnosis is most effective when using computed tomography, which allows you to identify a heart attack, to distinguish it from a hemorrhage.

Magnetic resonance therapy is also used, which makes it possible to examine the vessels.

Successful elimination of thrombosis by more than 70% reduces the likelihood of recurrent heart attacks

In the absence of modern diagnostic devices, a spinal cord puncture is performed and cerebrospinal fluid (CSF) is taken for analysis. The presence of impurities in her blood means that there was a hemorrhage in the brain.

Dopplerography or duplex scanning is used to examine the carotid arteries. The most effective method is angiography of the cerebral arteries - examination of blood vessels by introducing a radiopaque substance into them, which allows you to detect the localization of thrombosis, assess the degree of blockage of the lumen.

The last diagnostic method is used strictly according to indications. There is always a risk of damage to the blood vessels through the catheter through which the substance is injected, which can lead to a stroke.

Treatment

A cerebral infarction caused by thrombosis of the cerebral arteries requires emergency hospitalization of the patient. Therapy must be started within the first hours after the attack - this significantly increases the chances of saving the patient's life.

Reducing the ability of blood to clot in the first two hours, the use of blood thinners can significantly reduce the risk of paralysis, as well as other serious complications. However, with cerebral hemorrhages, the introduction of these drugs is contraindicated.

Treatment consists in systematic therapy:

• stabilization of the acid-base balance of the blood;
• restoration of blood circulation of the brain;
• oxygen saturation of the blood, through the use of antihypoxic drugs;
• elimination of respiratory failure;
• lowering blood pressure.

The consequences of myocardial infarction in women of different ages are listed in this article.

If indicated, surgical treatment may be required. Blockage of the carotid artery is an indication for surgery.

In some cases, surgery is needed to lower intracranial pressure, normalize cerebral blood flow, increase perfusion pressure, and increase oxygen supply to brain cells.

Dehydration drugs, diuretics are prescribed to eliminate excess water from the body. Be sure to carry out therapy with anticoagulants - drugs that reduce blood clotting, use fibrinolytic drugs that promote the resorption of blood clots, preventing their formation.

The patient continues to take medication to reduce swelling for several days.

The most important step after emergency care and normalization of blood flow is the recovery period.

Rehabilitation consists of the following actions:

• control of the stable functioning of the gastrointestinal tract, urinary system, heart rate;
• maintaining the stability of blood pressure, heart rate, respiration;
• restoration of speech;
• return of muscle tone;
• gradual return of the patient's motor activity.

Moral support of family members is also needed, which will prevent a person from falling into depression and losing the meaning of life.

If necessary, it is better to use the help of a specialist - a psychologist who, using professional methods, will help restore the patient's positive attitude and faith in a successful recovery.

Prevention

Prevention of cerebral infarction and vascular thrombosis should be started even in adulthood, trying to lead a healthy lifestyle, as well as reduce the effect of all negative factors that affect the effective functioning of the cardiovascular system.

The preventive measures are as follows:

The brain is the most important organ responsible for all processes in the body. The irreversible consequences of a heart attack can completely deprive a person of a full life, the ability to move, walk, talk, which can cause serious nervous disorders and depression, and deprive him of his desire for life.

Cerebral infarction caused by thrombosis of the cerebral arteries is a disease that requires immediate treatment. The effectiveness of subsequent therapy and rehabilitation measures directly depends on the provision of first aid within two hours after the onset of a heart attack.

Signs of death from myocardial infarction and its symptoms are described here.

Description of focal myocardial infarction and its consequences can be found here.

Emergency therapy will increase the chances of not only returning to a person all the joys of life, but also the opportunity to live for many more years.

Cerebral infarction caused by thrombosis of the cerebral arteries

Varieties and treatment of circulatory disorders of the brain

Violation of cerebral circulation refers to vascular diseases, the initial manifestations of which are memory impairment, headache, tinnitus and dizziness. Often recurring symptoms indicate the development of pathology. The root cause of circulatory disorders of the brain can be a number of diseases. Such diseases include atherosclerosis, arterial hypertension or hypotension, inflammation of the walls of blood vessels (rheumatic, syphilitic, etc.), diseases of the hematopoietic system.

The disease is divided into:

• acute (stroke, hypertensive encephalopathy);
• chronic (dyscirculatory encephalopathy);
• transient ischemic attacks.

Transient circulatory disorders

Transient cerebrovascular accident occurs as a result of an ischemic attack. A characteristic sign of pathology is the acute development of neurological symptoms and their subsidence during the day. Pathology is caused by a temporary blockage of cerebral vessels by a detached thrombus that has formed in the heart or in a large vessel of the brain. In rare cases, transient strokes occur as a result of severe narrowing of large vessels. This condition usually occurs when there is a sudden drop in blood pressure.

Thus, transient disorders of cerebral circulation occur for three main reasons:

The main symptoms in violation of blood flow in the basin of the carotid artery:

• paralysis of half of the body;
• violation of the sensitivity of half of the body;
• impaired speech and vision.

All pathological processes occur on the opposite side of the lesion. That is, if there are violations of the cerebral circulation on the right side, the left side of the body suffers. A patient with transient ischemic attacks may experience other signs:

This symptomatology is due to pathology in the vertebrobasilar basin.

The duration of symptoms in transient attacks rarely exceeds several tens of minutes. With a hypertensive crisis, the patient has a sharp headache, stunning, tinnitus and pain in the eyes. In rare cases, there may be epileptic seizures or psychomotor agitation. With ischemic attacks against the background of a hypertensive crisis, the patient's face turns red, there is increased sweating.

Causes of ischemic attack may be related to degenerative diseases of the spine. The main factor is a violation of blood flow in the vertebral arteries. With a pathology such as osteochondrosis, any prolonged uncomfortable position or a sharp turn of the head can cause a short-term violation of cerebral circulation.

Later, body functions are restored, but small foci of loss of nerve cells or areas of necrosis remain. However, this condition suggests that the patient may soon experience a myocardial infarction or stroke. With an untimely visit to a doctor and the absence of a diagnosis, a subsequent ischemic attack can result in a dangerous brain catastrophe (stroke).

brain stroke

Stroke, or acute cerebrovascular accident, occurs suddenly with the development of persistent neurological symptoms. In the course of the pathology, progressive and completed strokes are distinguished. For a progressive course, an increase in symptoms is characteristic. Completed strokes of the brain are characterized by stabilization of symptoms after the peak of their development.

Hemorrhagic stroke

Otherwise, a hemorrhagic stroke is called a hemorrhage into the substance or into the membranes of the brain. According to statistics, hemorrhagic stroke in 90% of cases occurs in the cerebral hemispheres. The remaining 10% are in the brain stem and cerebellum. There are also mixed forms of hemorrhages. The main causes of hemorrhage are hypertension and aneurysm rupture. In rare cases, the pathology develops against the background of leukemia, blood diseases, infections (endocarditis), and brain tumors.

Often during a hemorrhage, when a vessel ruptures, a cavity filled with blood is formed. The appearance of such a cavity leads to compression of neighboring areas of the brain, a change in the size of the furrows, and a flattening of the gyri. In rare cases, hemorrhages occur by the type of blood soaking the entire substance of the brain. A characteristic difference of such a pathology is the absence of borders and the merging of many small foci.

Symptoms of cerebrovascular accident as a result of hemorrhage occur mainly during the day, when a person is in an active state. Often before a stroke, a person physically exerts himself, is in a state of stress, or experiences strong emotions. Such reasons contribute to an increase in blood pressure.

With a hemorrhage, the patient suddenly loses consciousness and falls. In cases where a person remains conscious, he complains of a severe headache. Vomiting may occur within the first minute after a stroke. The patient's face becomes red, breathing is disturbed, the pulse in most cases is slowed down.

Violations of cerebral circulation lead to hemiparesis and hemiplegia. The degree of brain damage in this case is much greater than in ischemic strokes. The clinical picture depends on such factors:

• the size of the hematoma;
• localization;
• the degree of cerebral edema;
• involvement in the pathological process of other brain structures.

In most cases, hemorrhage leads to a coma. The patient has dysfunction of vital organs. With a shallow coma, the patient retains the reaction of the pupils to light, tendon and pharyngeal reflexes, pathological reflexes, and changes in muscle tone are observed. Deep coma usually ends in death.

Ischemic stroke

Ischemic disorders of cerebral circulation cause thrombosis and embolism of cerebral vessels. A stroke caused by blood clots occurs more often at night, during sleep. The patient wakes up in the morning already with neurological pathologies (speech disorder, paresis). With the development of pathology in the daytime, a gradual progression of neurological symptoms is observed. Often, ischemic stroke is preceded by transient cerebrovascular accidents.

In embolic stroke, neurological symptoms develop rapidly. The patient has a headache, loss of consciousness, paresis. The clinical picture depends on which part of the brain is affected. The main signs of damage to the carotid artery pool:

• limb weakness;
• drooping corner of the mouth;
• displacement of the tongue to the paralyzed side.

Patients may experience disorientation in space and speech, severe paralysis and paresis. The defeat of the occipital lobes is accompanied by visual impairment, blindness, hypersensitivity. With ischemia of the brain stem, difficulty swallowing, double vision, strabismus, paresis are observed. Blockage of the basilar artery leads to the development of coma.

In cases of blockage of small vessels that feed the deep tissues of the brain, a slow increase in the following symptoms is observed:

• hemiparesis;
• violation of coordinated movements;
• speech disorder.

Patients may experience cerebral edema on the 3rd day after a stroke. The increase in symptoms may be associated with hemorrhage in the infarction zone, organ dysfunctions, infectious complications of the excretory and respiratory systems. Approximately a quarter of patients after an ischemic stroke die within a month. In 90% of surviving patients become disabled.

Therapeutic measures

Patients are treated in a hospital. In severe cases, in violation of the function of important organs, swallowing disorders, epileptic status, the patient is hospitalized in the intensive care unit. Acute cerebrovascular accidents are treated according to the degree of brain damage.

The tasks of basic therapy are:

1. Maintaining breath.
2. Maintaining hemodynamic parameters (blood pressure, pulse).
3. Cerebral edema warning.
4. Maintaining water and electrolyte balance.
5. Maintain normal blood sugar levels.
6. Prevention of infectious complications.
7. Maintaining body temperature.

In addition to drug therapy, complex treatment includes the prevention of bedsores, muscle contractures and nutrition. If swallowing is disturbed in patients, nutrition is carried out through a tube. In case of violation of the motility of the gastrointestinal tract, parenteral nutrition is carried out. From the first day of a stroke, the patient's skin is treated with disinfectants. Skin folds are smeared with zinc pastes (Desitin, Sudocrem).

An important role in the rehabilitation of patients is played by measures to prevent contractures. In the acute period, treatment is carried out by position. From the second day, passive movements and specialized massage are introduced. After normalization of the condition, it is recommended (in the absence of contraindications) the mobilization of the patient. Adequate therapy and early rehabilitation measures improve the outcome of cerebral strokes. After discharge home, you can carry out treatment with folk remedies.

Treatment of transient disorders

Transient disorders of cerebral circulation begin to be treated after determining the underlying cause of the pathology. In the interictal period, patients prone to low blood pressure are prescribed tonic drugs in the morning. You can be treated with folk remedies - tincture of magnolia vine, eleutherococcus or ginseng. With hypotension, they are allowed to drink a cup of coffee in the morning.

If a patient is diagnosed with arterial hypertension, the treatment of a transient violation of the head blood flow consists in prescribing drugs that stabilize blood pressure and antispasmodics. The main task is not only to reduce pressure, but also to prevent its sharp drop. If patients have increased blood clotting, there is a predisposition to thrombosis, antiplatelet agents and anticoagulants (Fenilin, Sinkumar) are prescribed under the control of blood clotting.

In the treatment of cerebral blood flow disorders caused by atherosclerosis, drugs for vasodilatation are not prescribed. Conservative therapy consists in prescribing anticoagulants. With a weakening of cardiac activity, Korglikon or Strofantin is used. According to indications appoint Kordiamin, Camphor. With a sharp drop in pressure, Caffeine, Mezaton are administered. Treatment is selected strictly individually for each patient.

When transient disorders are not amenable to drug therapy, the question of surgery is raised to restore blood flow and eliminate the source of thromboembolism. Such surgeries are preventive in nature. Surgery is indicated for patients without persistent focal neurological symptoms.

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Cerebrovascular disease in the early stages is manifested by a decrease in working capacity, increased fatigue, a decrease in mood background, sleep disturbances, when the patient wakes up in the middle of the night and then cannot fall asleep. Then the symptoms of cognitive impairments join, i.e. memory decreases, thinking slows down, mental counting becomes difficult, excessive fussiness appears. In the future, persistent headaches, tinnitus, dizziness join. Brain crises develop periodically, which proceed with a gross violation of the functions of the brain and are manifested by the development of weakness in the limbs on the one hand, speech, sensitivity, and vision disorders. If these symptoms disappear within 48 hours, then they speak of a transient cerebrovascular accident. If the symptoms persist for longer, then it is a stroke. In this case, gross dysfunctions of the nervous system can persist until the end of life, making the patient disabled. A stroke can be ischemic, in case of closure of the lumen of the vessel by an atherosclerotic plaque or thrombus, or hemorrhagic, when the integrity of the vascular wall is violated and a cerebral hemorrhage occurs.