How is a stroke treated in the hospital? Treatment for ischemic stroke. What is a stroke

Stroke is one of the most common pathologies of the cardiovascular system; its incidence is more than 2 times higher than the diagnosis of myocardial infarction. Every year, about 6 million people are hospitalized with this diagnosis.

The risk of stroke increases in old age, after 55 years, but, unfortunately, there is a tendency towards rejuvenation of the pathology and often a similar diagnosis is heard by people under 40 years of age.

The disease is characterized by acute disruption of blood circulation in the brain, which is accompanied by the death of nerve cells and the occurrence of problems with certain body functions.

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Hemorrhagic stroke

Depending on the cause of the disease, it is divided into two types:

• hemorrhagic;
• ischemic.

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds into the cavity. This type of stroke accounts for about 10-15% of all diagnosed cases.

There are many reasons for the manifestation of pathology, the main ones are:

• hypertension (high blood pressure);
• amyloid angiopathy;
• vasculitis;
• aneurysms (thin places in the walls of blood vessels that can rupture);
• thrombophilia, etc.

Along with various pathological processes that can cause the development of a stroke, hypertension accounts for nearly 70% of all cases, 20% is accompanied by an arterial aneurysm, and only the remaining 10% arise from a number of other changes.

Hemorrhagic stroke has two types of hemorrhage:

• intracerebral, in this case, blood from the vessels enters the surrounding tissues, the blood supply to the brain is disrupted, and accordingly its cells cease to function fully;
• subaranchoidal hemorrhage, this type involves the penetration of blood between the skull and the surface of the brain, its main cause is the rupture of an aneurysm.

The main symptoms of the pathology are:

• Strong headache;
• nausea accompanied by vomiting;
• dizziness up to loss of consciousness.

Focal manifestations depend on the location of the hematoma; the most commonly observed disorders are:

• memory;
• sensitivity of the limbs;
• speeches;
• mental disorders.

Ischemic stroke

This type of pathology occurs as a result of a clot blocking a blood vessel, which causes ischemia (insufficient blood flow to the brain). Impaired blood flow leads to an immediate lack of oxygen and irreversible processes in the brain cells begin to occur within a matter of minutes.

The ischemic type is diagnosed in most cases; in percentage terms it occurs in 85-90%.

Ischemic stroke also has its own types:

The main causes of the pathological process are considered:

• atherosclerotic and atherothrombotic stenoses;
• cardiogenic embolism;
• arterial embolism;
• dissection of arterial walls;
• less often scars and inflammatory processes in blood vessels.

Pre-hospital stage of treatment

The danger of a stroke lies in the lightning damage to the vital functions of the body and without timely medical care, the patient may become disabled, and even death is possible. For this reason, prehospital treatment is an important step in saving the patient's life.

Attention! The patient’s future life depends on the speed and effectiveness of first aid.

Step-by-step actions before the ambulance arrives:

• place the patient in a horizontal position, on his back, while making sure that the head remains without unnecessary movements;
• free a person from restrictive clothing, especially when it comes to shirt collars and trouser belts;
• ensure maximum flow of fresh air into the room;
• if the patient begins to vomit, carefully turn his head to the side so that the vomit does not enter the respiratory tract;
• measure the pressure, if it is elevated, give the patient medicine to reduce it when there is none at hand, immerse the legs in a basin of hot water.

Upon arrival of the medical team, the first thing they do is transport the patient to the hospital, intensive care unit or intensive care unit as quickly as possible. During transportation, it is important to prevent the patient from hesitating and causing shocks, for example, while driving.

All patients must be hospitalized; there are no official contraindications for this, but there are medical and social restrictions that the doctor can rely on:

• deep coma;
• previously expressed mental changes with repeated hemorrhage;
• terminal stage of cancer.

There are no other restrictions regarding age or late treatment after the first clinical symptoms appear!

The main goal of the prehospital stage is to stabilize impaired vital functions of the body until arrival at a medical facility.

Such functions include:

• restoration and maintenance of breathing;
• correction of intracranial pressure;
• maximum reduction of brain swelling;
• maintaining glucose metabolism.

Emergency diagnostics in a hospital setting

Among the diagnostic measures, computed tomography is performed urgently, Dopplerography is possible to assess the speed of blood movement through the vessels and identify the degree of stenosis.

In parallel with the treatment started, additional studies are carried out:

• complete blood count with mandatory platelet count;
• laboratory test for blood glucose levels;
• chest x-ray;
• biochemical blood test with determination of urea and creatinine levels.

Depending on the type of stroke, angiography may be additionally prescribed to determine the size of the hematoma and its exact location for further surgical intervention, as well as arteriography.

Intensive care phase

Treatment in intensive care usually takes place within the first three weeks. During this period, the main measures are aimed at preventing various somatic complications as a result of insufficient functioning of the brain.

Main events:

• maintaining sufficient oxygen supply;
• blood pressure control;
• correction of the cardiovascular system;
• control of homeostasis and swallowing function (for dysphagia, a probe is installed);
• monitoring the normal functioning of the bladder and gastrointestinal tract;
• limb massage.

If the patient is in an extremely serious condition, he is turned over from side to side every two hours, and the skin is wiped with camphor alcohol at least twice a day. The oral and nasal cavity is washed with chamomile infusion at least four times a day, and liquid is also injected into the body at the rate of thirty milliliters per kilogram of body weight.

Drug, basic therapy includes:

• Supply of an oxygen-carbohydrate mixture through the nose;
• Installing an air vent and eliminating possible tongue retraction;
• For high blood pressure, medications for inpatient stroke treatment should include: aminophylline, clonidine, magnesia;
• If the pressure is low, prescribe: mezatone, strophanthin, ephedrine. If these drugs are ineffective, the course of treatment is changed to taking dopamine in parallel with coricosteroid medications, for example, prednisolone or cordamine;
• To protect brain activity the following is used: Cerebrolysin, piracetam, macrodent and vitamin B6;
• To eliminate cerebral edema, the following is prescribed: glycerol, lasix, furosemide (diuretics are prescribed with extreme caution, strictly as prescribed by the doctor). Seduxen and corticosteroids (Dexon) to protect the brain membrane.

Differentiated treatment of stroke in hospital

Such treatment measures are used in parallel with basic treatment, but depend on the type of stroke. An individual approach is important here, since ischemic and hemorrhagic stroke have different causes, features of the course, and one type of treatment is not suitable for each of them.

For hemorrhagic stroke the following is prescribed:

With this type of pathology, surgical intervention is often resorted to, the purpose of which is to remove the hematoma. But the operation cannot be performed on all persons, but only on young and middle-aged people with lateral forms of hematomas.

Indications for surgical intervention are usually:

• compression of the brain by a hematoma;
• lack of proper results from conservative treatment;
• negative impact of hematoma on cerebral blood flow;
• danger of breakthrough of the hemorrhage focus.

The prices for inpatient stroke treatment directly depend on the complexity of the pathological process and the type of therapy required.

What to do after discharge?

The recovery period after a stroke upon arrival home is quite long and painstaking.

There are three options for continuing the rehabilitation period, it all depends on the financial capabilities of the patient’s family and the general condition of the patient:

Home recovery	This method requires a certain psychological attitude from all family members, so the structure of their lives will be forced to change radically. It is advisable to allocate a separate room for the patient, but it should not look like a ward from a medical institution. It should be filled with light, fresh air and contain positive emotions, for example, photographs of the patient’s loved ones, favorite paintings or flowers. In a word, the room should be cozy and comfortable. In addition to comfort, the patient requires daily care, which should include: hygiene procedures; prevention of bedsores if the patient is bedridden; specialized 4-5 meals a day; control of blood pressure, urination, bowel movements, etc.; massage with gradual elements of therapeutic exercises until mobility returns; classes with the patient to restore memory and the ability to speak, if these are impaired.
Rehabilitation center	According to doctors, a rehabilitation center is considered the best way out in this situation, since the patient is constantly under the control of qualified specialists and with the help of psycho-emotional support from them and their relatives, the patient recovers faster. The main condition for successful rehabilitation in this case is the correct choice of clinic. Read customer reviews, talk to families whose relatives are being treated there, find out about the medical staff and the general atmosphere in the institution. The resulting overall picture will help you make the right choice in favor of one institution or another.
Combined method	This method consists of a short-term, but so necessary for the patient, placement in a rehabilitation center, followed by continuation of restorative therapy at home. This option will help relatives learn the basic principles of assistance and recovery procedures for the patient and subsequently apply them at home.

Remember that a stroke is not a death sentence, and with timely treatment, further adequate rehabilitation and faith in a speedy recovery, the patient will definitely recover. The main task for all family members is to help him with this and believe in a positive result.

Now is the time for insurance medicine. A bed - a day - means money, and a lot of it: these are the costs of food, laundry, cleaning (in the wards), not to mention medicines and some other consumables. The number of bed days for all diseases has decreased, resulting in a greater load on outpatient services. For unreasonably exceeding the number of bed days, insurance companies fine hospitals, and seriously.

In fact, if you have a stroke, there is no point in staying in the hospital for a long time. Everything is decided by therapy in the FIRST HOURS after hemorrhage or ischemia. There are positive dynamics - they are consolidated, supported, and why keep it in the hospital? You can take care of him at home: give him pills, even give him injections. The only thing is that it’s difficult with IVs. Those who need to be “dug out” are kept in the hospital. Or if CT control is required or some other complex diagnostic measures are required over time. If this is not required, then there is NO point in keeping him in the hospital. Even if there is no dynamics, it won’t happen, unfortunately (time is lost). Maybe sometime later, in six months or a year, thanks to physical therapy and massage. etc. But no one will keep you in the hospital for six months or a year.

Minimum question. Maybe even 3 days. If you were admitted with a suspicion of a stroke, which was not confirmed: they did a CT scan after 3 days - no ischemic foci or hemorrhage appeared - they sent you home. If the stroke is confirmed, then, I think, at least 2 weeks (well, at least 10 days)

Neurologist Alexey Popov: “A patient who lies in one position for a long time may develop pneumonia”

The man had a stroke and was taken to the hospital by ambulance. Relatives are worried: will the patient be able to return to normal life? How quickly will he recover? What rehabilitation methods do doctors use? These and other questions from our readers were answered during the FACTS direct line by the head of the neurology department No. 2 of the Kyiv Regional Clinical Hospital, Alexey Popov.

— Hello, Alexey Vasilievich! You are worried about Olga Ivanovna from the city of Zhitomir. A neighbor had a stroke. He was admitted to hospital but discharged after 14 days. Is it possible to cope with the disease in such a short time?

— The duration of treatment in the hospital depends on the type of stroke. If an ischemic event occurs, in which an arm or leg is partially paralyzed, but the person cares for himself and his speech is not impaired, then two weeks of hospital stay is enough. The patient takes medications that improve blood supply and metabolic processes, relieve vascular spasm and swelling in the affected area, learn physical therapy exercises, undergo electrical stimulation, and receive a massage. But a person must clearly understand that treatment does not end after discharge from the hospital. At home, he needs to continue doing physical therapy and monitoring his blood pressure. Of course, you need to stop smoking, not abuse alcohol, and move more.

- "DATA"? Ivanna Lvovna is calling you from the Kyiv region. Dad suffered an ischemic stroke and is now in the hospital. When should recovery begin?

— For ischemic stroke, rehabilitation begins on the fourth or fifth day. But from the first hours of hospital stay, the patient is shown passive gymnastics. This is not so much gymnastics as positional treatment: it is necessary to correctly position the patient’s arms and legs and position the body.

- How do they do it?

- Using pillows and bolsters, the patient is made to sit half-sitting. This is similar to how an astronaut sits in a spacesuit: the arms are raised with pillows, and the legs, under which the bolsters are placed, are slightly turned out. The body position is changed every two hours. Also on the fourth or fifth day we begin to turn the patient on his side. You cannot stay in one position for a long time: this can cause congestion, pneumonia, and the appearance of bedsores. We slowly teach the patient simple movements so that the brain “remembers” how to control the body. An example is the behavior of an infant. What is the baby doing? Turns over on its side, on its stomach, and rises. A person plunges into childhood, and, repeating movements, develops and consolidates motor stereotypes. This speeds up recovery.

— Who conducts passive gymnastics?

- Either a physical therapy doctor or a kinesiotherapist. In the early rehabilitation ward, specialists work with the patient, and relatives observe and learn. The doctor shows: you need to start the massage with your fingers - stretch each joint several times, then the hand, elbow, shoulder... The sooner the patient starts performing simple movements, the faster he will move on to more complex ones: writing with a pen, dressing, washing. In case of a stroke, it is important to exercise the affected arm and leg to avoid restriction of joint mobility (pathological contracture). Due to malnutrition, inflammation, tissue degeneration, and arthrosis with contracture may begin in the joint. The joint hurts, the hand does not obey, and it is difficult to restore its former performance. To avoid complications, you need to massage and do exercises every day. More information about how to care for a patient who has suffered a stroke can be found in the neurology department No. 2, which is located in Kyiv, on Baggoutovskaya street, 1. Telephone 0 (44) 483−16−94 .

— Antonina Petrovna is calling from the city of Belaya Tserkov. Do you allow the patient's relatives to be in the room at all times?

- Yes. This is a huge support for the patient. In addition, in the ward, relatives learn how to care for the sick. We discharge a person home, and there the household must give him medicine, feed him, dress him, and do exercises with him. It is not simple. You need to know, for example, that you should start putting on a shirt with the injured hand, and take it off with the healthy one. Be able to change the bed - put the person on their side, and spread the rolled sheet on one side of the bed. Then turn the patient over the roller and straighten the sheet on the other side. You need to constantly communicate with a person, do it calmly and patiently. Often relatives come to me and complain that the patient is swearing, screaming... I explain that this is how the disease manifests itself. In the acute period, a person is irritated by everything: both the fact that you are nearby and the fact that you are away.

The patient recovers most intensively during the first three to four months after the stroke. Sometimes relatives feel that we recommend too frequent courses of treatment. One - immediately after a stroke, a second one - two to three weeks later. You will need three to four more courses in the first six to eight months. Then, at intervals of two to three months, another course of treatment. We want to make the most of the time favorable for rehabilitation.

— Valentina Vasilyevna from Mariupol is bothering you. I read in the newspaper that physiotherapy helps with strokes. Are they suitable for everyone?

— There are contraindications to physiotherapy. For example, electrical stimulation cannot be performed for those who suffer from cardiac arrhythmias, as well as with severe trophic disorders, thrombophlebitis. For others, this method will be very useful. Using electrical stimulation, we strengthen impulses from the receptors of the affected limbs to the brain and encourage neighboring areas to take over the lost function. There are programs for relaxing or stimulating muscles and activating nerve fibers. If muscle tone increases, we change the program to a relaxing one; if pain appears, we change to a painkiller.

Over the past five to seven years, we have been actively using magnetic laser therapy. This is a very effective method. Studies have proven that exposure to a strong magnetic field is beneficial for the brain: swelling goes away faster and blood microcirculation improves. Reflexology has proven itself well for strokes: by acting on certain points, we improve blood supply to the brain.

— Tatyana, Lviv region. It has been 23 years since my father suffered four ischemic strokes. What new can be done for such a patient?

— When did the strokes happen?

— The first at 39 years old, the last one a year later. All the strokes happened literally in a row. After the fourth, dad lost his speech.

— Stroke at a young age often occurs due to atrial fibrillation, an abnormal heart rhythm. If the heart beats irregularly, blood clots form and clog the blood vessels. I advise you to examine your father now to determine the condition of his heart and blood vessels. It is unlikely to return what is lost. It is important to prevent another stroke. To do this, the father needs to undergo treatment in a hospital twice a year. I think both medication support and physical therapy methods (as far as the cardiovascular system allows) will help improve his health.

— Tatyana Pavlovna from Kyiv is bothering you. My son (he is 35 years old) recently had a stroke. I'm wondering why young people get sick?

— Today, stroke at a young age is not uncommon. In the last two months we have had two young patients, a man and a woman. Both were 24 years old. A woman was recently treated: a month after giving birth, she developed a stroke. The fact that the disease is getting younger is most likely to blame for abnormalities in the vascular wall or the vessel itself. They cannot always be diagnosed, especially if they are small vessels. You need to pay attention to the sudden appearance of muscle weakness or numbness of a part of the face, arms, legs, speech impairment, or blurred vision. A person may suddenly lose balance, experience nausea and a severe headache for no apparent reason. With such signs, you should immediately consult a doctor.

- Hello! This is Alexey Anatolyevich from Poltava. I am 40 years old. A year ago I suffered an ischemic stroke. What can I do to prevent it from happening again?

- Monitor your blood pressure carefully. If you have hypertension, do not forget to take the pills prescribed by your doctor every day. Do physical therapy exercises, follow a diet - eat four times a day in small portions, avoid fried, fatty, spicy foods. Check your cholesterol and blood sugar levels. And if the indicators are elevated, contact specialists - a cardiologist, an endocrinologist, so that they can prescribe treatment.

—Where can I go for rehabilitation? My arm and leg still don’t work well...

- At the Poltava Medical Institute there is a clinic for nervous diseases with a rehabilitation department - you can go there. Or go to Mirgorod, to a sanatorium for patients who have suffered a stroke. Doctors will prescribe you physical therapy, massage, and physical therapy exercises, and this will help restore the functionality of your arms and legs.

— Nina Ivanovna, city of Brovary, Kyiv region. Mom had a mini-stroke, and she began to speak worse - she confuses words and stutters. Does she need help from a speech therapist?

- I think yes. Most often, a speech therapist works with patients who have had a stroke in the left hemisphere of the brain - where the speech center is located. The result is better if classes are started immediately after the stroke. We recently had a patient with a speech disorder who would not say anything other than “such and such.” And after working with a speech therapist, he slowly, with great tension, began to talk. In any case, the relatives understood what the patient wanted to say. We set him a task: until he says “Hello!” - We won’t let you go home. It helped.

“My grandmother also had a stroke. What can you advise me to prevent the disease?

— Treat pathologies that lead to stroke: sclerotic changes in blood vessels, hypertension. High blood pressure should not be taken lightly. Today at an appointment there was a patient who said: “My blood pressure is 210, but I have no time for treatment - I have to go to work.” I say: “If something happens to you, the job will remain, but you won’t be there.” The most unfavorable combination is when diabetes mellitus is added to atherosclerosis and hypertension. High blood sugar is dangerous for blood vessels - it damages their walls. Therefore, after 40 years, it is necessary to check your blood sugar and cholesterol levels annually.

- Doctor, Viktor Petrovich is bothering you. I am 88 years old and am currently caring for my daughter, who suffered an ischemic stroke a year ago. My daughter takes pills, periodically we give her massages, but nothing helps: her speech has not been restored, her right side does not work.

— I would recommend that you treat your daughter in a hospital at least twice a year. Taking pills is less effective than hospital care. Of course, my daughter had to be treated immediately, a couple of months after the stroke occurred, and then the course of treatment should have been repeated several times throughout the year. Now you should invite your local doctor, and he will call a neurologist, and you will clarify how to hospitalize your daughter.

— Elena Petrovna from the city of Chernivtsi. I am interested in what determines recovery after a stroke?

“Where the lesion is located and which centers are affected is of great importance. Sometimes a patient experiences a so-called hemispheric stroke, when the entire lobe of the brain is practically dead and there is nothing to replace its function. Of course, in this case one cannot count on a significant recovery. When the internal capsule of the brain, the collection of all pathways in the body, suffers, recovery also goes extremely poorly. But you should never stop fighting, even when it seems pointless. We are simply unaware of all the capabilities of the brain.

And there are cases when recovery is not necessary at all - with the so-called silent stroke. The MRI shows a fairly large lesion, but since the vital centers and pathways are not damaged, there are no symptoms. The person doesn’t even realize that he has suffered a stroke: he has a headache and that’s all. But such a patient still needs to take care of his health in order to prevent a recurrent stroke. You should take medications that reduce blood viscosity, keep cholesterol and blood pressure normal. Of course, it is impossible to influence sclerotic changes in blood vessels. But it is quite possible to ensure that atherosclerosis does not progress and the cardiovascular system copes with its work.

- Good afternoon! This is Natalia, from Kiev. My little and ring fingers on my left hand go numb, especially at night. Tell me which specialist to contact?

— You have signs of damage to the cervical spine. You need to see a neurologist, and the doctor will prescribe treatment for radicular manifestations. I think the specialist will definitely ask you to do an X-ray of your neck. It is dangerous to treat spinal pathology without an image. I know cases where, after visiting a chiropractor, people were overcome by paralysis. Recently, a man came in who had a destroyed vertebra. The patient suffered from multiple myeloma (a blood disease that affects the bones), which caused pain, and rushed to seek help from a chiropractor. And he undertook to treat without x-rays.

— Elena Vasilyevna is worried about the city of Vinnitsa. My eyelid twitches from time to time. What is this connected with?

— Nervous tic occurs due to overwork. Sleep more, relax, walk in the fresh air - and everything will pass. Every part of the body is represented in the cerebral cortex. The muscle begins to twitch when the cells are excited, generating and transmitting impulses to it. Also try to avoid stress. My grandmother, who lived to be 96 years old, said: some things must be perceived a meter from the heart. If you feel a health problem, take a break.

Prepared by Natalia SANDROVICH, FACTS

Mom has a stroke. Treatment and rehabilitation after stroke.

758. Guest | 17.07.2010, 17:24:07

like this in the presence of the head physician and a notary. Is this a power of attorney to receive a pension? Our power of attorney is simply expiring. and no one *notarizes it, because mom can’t answer the simplest questions. forgets who I am. and cannot name the place where she is. but the doctors say it’s not our concern.

On January 4, I had an ischemic stroke with paralysis of the left side, this became a terrible tragedy for me. I led an active lifestyle, I am an avid fisherman. As a result, I drove myself into post-stroke depression from which I still can’t get out. 8 months have passed already. the leg has recovered completely, the arm has not yet recovered. I am very worried that for some reason the arm has not recovered

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

Stroke kills many people

The results were horrifying:

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

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

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

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

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

Transient ischemic attack

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

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

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

Ischemic stroke

Ischemic stroke due to vessel thrombosis

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

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

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

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

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

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

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

Hemorrhagic stroke

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

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

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

• Put the person down.
• Call an ambulance.

Woman calling an ambulance

Stroke goes away on its own

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

Treatment of a stroke patient includes a prehospital stage, an intensive care stage in an intensive care unit or intensive care unit, a treatment stage in a neurological hospital, and then a suburban or rehabilitation outpatient department, and the final stage is a dispensary stage.

At the pre-hospital stage, before the ambulance doctors arrive, it is necessary to provide the patient with the following assistance:

1) be sure to place the patient on his back, without moving his head if possible;

2) open the window so that fresh air can enter the room; it is necessary to remove tight clothing from the patient, unbutton the shirt collar, tight belt or girdle;

3) at the first signs of vomiting, it is necessary to turn the patient’s head to one side so that the vomit does not enter the respiratory tract, and place a tray under the lower jaw; it is necessary to try to cleanse the oral cavity of vomit as thoroughly as possible;

4) it is important to measure blood pressure, if it is elevated, give the medicine that the patient usually takes in such cases; if this medicine is not at hand, immerse the patient’s feet in moderately hot water.

At the first – pre-hospital – stage, the patient must be provided with complete rest. The doctor must correctly assess the severity of the patient’s condition and ensure early hospitalization in a specialized neurological department or in a hospital that has a ward or intensive care unit. Only in a specialized neurological hospital, if necessary, surgical treatment and specialized resuscitation care are possible. Restrictions for hospitalization of patients at home are identified: deep coma with severe impairment of vital functions, pronounced psychoorganic changes in persons who have suffered repeated cerebrovascular accidents, as well as terminal stages of chronic somatic and oncological diseases.

All stroke patients require strict bed rest. The room in which the patient is located must be well ventilated. Strict caution must be observed when transporting a patient early. The patient should be carried while maintaining balance when going up and down the stairs and, if possible, avoiding jolts.

In the intensive care unit of a hospital, therapy is carried out aimed at eliminating vital disorders, regardless of the nature of the stroke - this is the so-called undifferentiated or basic therapy. Differentiated therapy is measures that are specifically taken depending on the nature of the stroke. These types of therapy must be carried out simultaneously.

Indications for basic therapy are the following conditions: the presence of epileptic seizures, mild disturbances of consciousness, a combination of stroke with heart rhythm disturbances, myocardial infarction, etc.

Basic therapy is a set of measures aimed at emergency correction of violations of vital functions: normalization of breathing disorders, hemodynamics, swallowing - all this includes the ABC program (Ak - “air”, ByuosS - “blood”, Cog - “heart”), changes homeostasis, combating cerebral edema, and, if necessary, correction of autonomic hyperreactions, hyperthermia, psychomotor agitation, vomiting, and persistent hiccups. This type of therapy also includes measures to care for the patient, normalize nutrition and prevent complications.

First of all, it is necessary to maintain the patency of the airways. If, after restoration of airway patency, ventilation of the lungs is insufficient, proceed to auxiliary artificial ventilation, the parameters of which are determined on the basis of clinical and biochemical data. The most commonly used mode is moderate hyperventilation. The use of respiratory stimulants for stroke of any type is contraindicated.

The most important stage is the relief of manifestations of violation of vital functions. This stage includes the following activities.

1. Normalization of respiratory function consists of restoring airway patency, sanitation of the oral cavity, insertion of an elastic air duct, tracheal intubation, and transfer to artificial ventilation. All these measures are necessary to prevent early complications of stroke, reduce cerebral hypoxia, and also prevent cerebral edema.

2. Maintaining optimal hemodynamic levels includes the choice of antihypertensive drugs. If there is a sharp increase in blood pressure after the development of a stroke, the choice of these drugs should be made taking into account 3 factors: the optimal level of heart function, determined by minute blood volume; circulating blood volume; level of linear blood flow velocity. For this purpose, the following drugs are used: nifedipine, Corinfar drops, captopril.

In the absence of the above-mentioned drugs, it is possible to use other drugs with similar properties.

The use of drugs that sharply force diuresis is prohibited immediately after the development of a stroke, these include furosemide and manitol, they have the ability to reduce minute blood volume, disrupt microcirculation and increase plasma osmolarity.

A separate category of patients with stenotic lesions of the arterial system, with signs of latent heart failure and cardiogenic hypodynamic syndrome, gradually adapted to high blood pressure numbers. Taking this into account, in such patients antihypertensive therapy should be carried out in such a way that blood pressure figures decrease by 20% from the initial level. For this purpose, drugs are used that have a predominant effect on peripheral vessels. Such drugs are calcium channel blockers, as well as angiotensin-converting enzyme inhibitors. In young and middle-aged patients without signs of hidden heart failure, systolic blood pressure should be reduced to a level exceeding only 10 mmHg. Art. "working numbers".

After the development of a stroke, severe arterial hypotension may appear, which may be caused by a simultaneously developing myocardial infarction or a sharp decompensation of cardiac activity. In this case, to increase blood pressure, the use of drugs such as dopamine, glucocorticoid hormones and gutron is indicated.

The development of a stroke may be accompanied by severe tachycardia, manifestations of circulatory failure of varying degrees, as well as atrial fibrillation. In this case, cardiac glycosides can be prescribed: strophanthin or cor-glycon in appropriate dosages. The drugs are used under the control of pulse and blood pressure.

Considering the fact that a stroke is not accompanied by hypovolemia, solutions that increase the volume of circulating blood are not used to lower blood pressure in this disease.

In the event of status epilepticus or a series of attacks, sodium hydroxybutyrate or seduxen are used to relieve them, which are diluted in isotonic sodium chlorine solution before use. If the use of these drugs does not lead to relief of seizures, then non-inhalation anesthesia with sodium thiopental is prescribed. If the required result is not achieved even after these measures, mechanical ventilation and intravenous administration of this drug are prescribed. If all these measures are ineffective, the patient in the intensive care unit must undergo inhalation anesthesia with a mixture of nitrous oxide and oxygen. If status epilepticus is long-lasting, then in order to prevent cerebral edema, glucocorticoids are prescribed intravenously.

In order to correct disorders of water-salt metabolism and acid-base status, including to combat cerebral edema, it is necessary to maintain optimal indicators of water-salt metabolism. This is ensured by rehydration, and when the first signs of cerebral edema appear, by dehydration. To do this, it is important to monitor osmolarity indicators and the content of cations in the blood serum, as well as the patient’s diuresis. It has been proven that with a hemorrhagic stroke, cerebral edema develops within 24–48 hours, and with an ischemic stroke, within 2–3 days. Taking these data into account, dehydration or rehydration of the body of a stroke patient is carried out.

The following drugs are widely prescribed for dehydration therapy: osmotic diuretics, saluretics, corticosteroid hormones, and in some cases artificial ventilation of the lungs is performed in the mode of moderate hyperventilation. In the initial stage of the formation of cerebral edema, an important role is played by stimulation of venous outflow from the cranial cavity, normalization of breathing and hemodynamics. Currently, neurosurgeons have developed methods of intraventricular drainage, which involve inserting a catheter into the anterior lateral ventricle. With the help of these measures, the possibility of controlled outflow of cerebrospinal fluid is achieved. In the intensive care unit, acid-base and electrolyte balances are normalized. All this is carried out under dynamic laboratory control.

To treat cerebral edema and increased intracranial pressure, a number of measures are carried out. General measures include the following: it is necessary to raise the head end and limit external irritants, limit the flow of free fluid, and do not use glucose solutions. The total volume of administered fluid should not exceed 1000 ml/m2 of the patient’s body surface per day. In some cases, if it is not possible to combat increased intracranial pressure by other methods, and the patient’s condition is threatening, they resort to a barbituric coma, which is carried out under constant monitoring of intracranial pressure.

The following measures taken for strokes are: correction of autonomic hyperreactions, psychomotor agitation, vomiting, and persistent hiccups. In strokes, hyperthermia is central in nature, that is, it is caused by the pathology of central thermoregulation. For this purpose, Voltaren, aspizole, reopirin, and lytic mixtures consisting of solutions of analgin, diphenhydramine, and haloperidol are actively used. Physical methods of cooling the patient's body are of great importance. To do this, ice packs are placed in the projection of large arteries and wrapped in 2 layers of towel. In addition to this method, you can rub the patient’s skin (torso and limbs) with a 20–30% solution of ethyl alcohol.

In case of vomiting and persistent hiccups, etaprazine, haloperidol (it must be taken into account that this drug is not compatible with sleeping pills and analgesics), seduxen, cerucal, as well as vitamin B6 and torekan are used. When prescribing all these drugs, it is necessary to take into account the concomitant pathology of the patient, since many of the listed drugs are contraindicated for gastric and duodenal ulcers.

Often, with acute cerebrovascular accidents, vestibular disorders develop. To relieve them, the following drugs are used: vasobral, which stops the aggregation and adhesion of erythrocytes and platelets, improves the rheological properties of blood and microcirculation, and betaserc, which acts on the histamine receptors of the vestibular nuclei of the brain stem and inner ear.

If pulmonary edema develops, the patient experiences a number of symptoms: suffocation; possible tachycardia; when examining the skin, acrocyanosis; tissue hyperhydration; When examining the respiratory organs, inspiratory shortness of breath, dry whistling, and then moist rales are revealed; copious and frothy sputum. This clinic is supported by a set of general measures, regardless of the level of blood pressure. First of all, oxygen therapy and defoaming are carried out. If the patient’s blood pressure remains at normal levels, then in addition to all the listed measures, lasix and diazepam are included in the therapy. For hypertension, it is additionally necessary to administer nifedipine. In case of developed hypotension, all of these prescriptions are supplemented with intravenous administration of lobutamine.

Nursing care is of great importance in the treatment of stroke patients. Adequate nutrition is an important component of the treatment of stroke patients; in some cases, tube feeding with nutritional mixtures is used. If the patient is conscious and the act of swallowing is not impaired, then on the first day he can be given sweet tea, fruit juices, and on the second day he is given easily digestible foods. Every 2–3 hours the patient must be turned on his side. This is necessary to prevent congestion in the lungs and the formation of bedsores. A rubber bed is also placed under the sacrum, and thick and soft rings are placed under the heels. If the patient does not have signs of heart failure, then he is given circular cupping and mustard plasters. To prevent contractures, the patient’s limbs are placed in a position opposite to the Wernicke-Mann position. To prevent congestive pneumonia, antibiotics and aspisol are prescribed. In case of hyperthermia, the patient’s skin is rubbed with a solution of equal parts of vinegar, water and vodka, and the temperature in the room where the patient is located should be no more than 18–20 °C. Be sure to perform oral hygiene every day: teeth and oral mucosa are wiped with a swab soaked in a solution of boric acid. If the functions of the pelvic organs are impaired - urinary incontinence, constipation - it is also possible to help the patient. In case of constipation, laxatives and, in some cases, oil enemas or hypertensive enemas are used.

In case of urinary incontinence, a heating pad is placed on the bladder area; if there is no effect, a catheter is placed 2 times a day.

If psychosis occurs, the patient is prescribed antipsychotic drugs and antidepressants; the doses of these drugs are selected strictly individually. Tranquilizers are rarely prescribed, especially to people over 60 years of age, since drugs in this group often cause muscle relaxation.

Differentiated treatment includes individual approaches to patients depending on the type of stroke: hemorrhagic or ischemic, since each of them has its own mechanism of occurrence and characteristics of the course.

Therapy for hemorrhagic stroke is mainly aimed at eliminating edema, reducing intracranial pressure, lowering blood pressure, and if it increases, increasing the coagulation properties of the blood and reducing vascular permeability.

Therapy for hemorrhagic strokes is carried out in neurology and neurological hospitals, but there is a category of patients whose treatment is carried out in neurosurgical departments.

The first stage of treatment for hemorrhagic stroke is the correct position of the patient in bed - the head should be in an elevated position. An ice pack is applied to the patient's head, and warm, but not hot, heating pads are applied to the patient's feet. With cerebral hemorrhage, blood pressure is often elevated, so special attention is paid to reducing it when prescribing treatment. First of all, dibazole and magnesium sulfate, which are used in a complex of basic therapy, have a hypotensive effect. If the effect of their action is not pronounced, then neuroleptics can be used, such as aminazine 2.5% solution in a dose of 0.5–1 ml, ganglion blockers - pentamin in a dose of 1 ml of a 5% solution. Antihypertensive therapy should be combined with ongoing dehydration therapy.

In hemorrhagic stroke, as a rule, fibrinolysis is activated and the coagulating properties of the blood are reduced, so drugs are prescribed that inhibit fibrinolysis and activate the formation of thromboplastin. To increase the rate of blood clotting, calcium gluconate or calcium chloride is prescribed in 10–20 ml of a 10% solution intravenously, Vicasol in 0.5–1.0 ml of a 1% solution intramuscularly, ascorbic acid and gelatin are also prescribed intramuscularly. Considering that the fibrinolytic activity of the blood is increased, aminocaproic acid is prescribed intravenously for 2–3 days under the control of blood coagulation parameters. In the next 3–5 days, proteolytic enzyme inhibitors, gordox and contrical, are included in the therapy. If there are clinical signs of concomitant atherosclerosis, then to prevent thrombosis, this therapy is combined with the use of small doses of heparin. This is most important in subarachnoid hemorrhages. An effective hemostatic agent is the drug etamzilat, which activates thromboplastin and improves microcirculation and normalizes the permeability of the vascular wall, and in addition is a strong antioxidant. In case of cerebral hemorrhage in patients with thrombocytopenia, they are prescribed intravenous administration of platelet mass. If a stroke develops as a complication of hemorrhagic diathesis, the patient is given intravenous vitamin K and plasma protein fractions. In case of hemorrhagic stroke development due to hemophilia, emergency replacement therapy with factor VIII concentrate or cryoprecipitate is necessary.

In case of manifestations of severe cerebral edema, meningeal signs, and also to clarify the diagnosis, a lumbar puncture is necessary. This procedure is carried out with precautions, without sharply turning the patient, using a mandrel to extract the cerebrospinal fluid in small portions of 5 ml. In deep coma, with severe disorders of stem functions in the form of disturbances in the activity of the heart and breathing, lumbar puncture is contraindicated.

Currently, surgical treatment is widely used to treat hemorrhagic stroke. But this type of treatment is not acceptable for all groups of patients; it is indicated for young and middle-aged people in the presence of lateral hematomas and hemorrhages in the cerebellum. The essence of the operation is to remove the hematoma.

In case of hemorrhagic stroke, the following factors are indications for surgery: conservative therapy has not achieved satisfactory results; compression of the brain by hematoma and/or progressive perifocal edema increases; the adverse effect of the hemorrhage focus on cerebral blood flow is determined, which worsens microcirculation and creates the possibility of developing secondary diapedetic hemorrhages in the brain stem and hemispheres. Important indications for surgical intervention are the reversibility of disorders that occur in the first day after a stroke and the danger of a hematoma breaking into the ventricular system of the brain. A subcortical hematoma or localized in the region of the subcortical nuclei, with a volume of more than 20 cm3 or a diameter of more than 3 cm, which is accompanied by a neurological deficit and leads to brain dislocation, is also an indication for surgical treatment. The last indicator for surgery is ventricular hemorrhage, which leads to occlusion of the CSF tract.

There are a number of factors, the presence of which suggests an unfavorable outcome of treatment for hemorrhagic stroke. These include the following: the patient’s age is over 60 years; depression of the patient's consciousness to the point of coma; the volume of ventricular hemorrhage is more than 20 cm3; the volume of intracerebral hematoma is more than 70 cm3; the appearance of signs of dislocation syndrome; high, uncontrolled blood pressure and severe concomitant pathology.

The best time for surgical intervention is 1–2 days after a stroke. The formed intracerebral hematoma is emptied by puncture aspiration of its liquid contents or by opening the cavity, during which, in addition to the liquid contents, blood clots are removed. If blood has broken into the ventricles, it is washed out through the hematoma cavity and a defect in the ventricular wall. In cases where surgery is performed for rupture of arterial and arteriovenous aneurysms, which is clinically manifested by intracerebral or subarachnoid hemorrhage, the surgeon’s actions are reduced to excluding the aneurysm from the brain’s circulation. In the first 3 days of the disease, surgical removal of the hematoma and clipping of the aneurysm are performed. If the patient has impaired consciousness, the operation is usually postponed until the patient's condition improves.

Treatment tactics for hemorrhagic stroke are determined individually in each specific case. The decision is made jointly by the neurosurgeon and neurologist. When hemorrhage is localized in the cerebellum, surgical treatment by drainage or removal of the hematoma is indicated. If the size of the hematoma is more than 8-10 mm3, then early surgical treatment is indicated. It is produced even before the development of clinical signs of compression of the brain stem. If the size of the hematoma is small and the patient is conscious, or if more than 7 days have passed since the hemorrhage, then conservative treatment is recommended. However, emergency surgical treatment is performed when symptoms of brain stem compression appear.

In some patients, medial localization of hemorrhage is detected; in this case, stereotactic drainage of the hematoma and subsequent fibrinolysis of the remnants of the blood clot can be used. This surgical treatment option will be the least traumatic in this situation. Sometimes, to save the life of a patient with obstructive hydrocephalus, a ventricular or external shunt is used.

If amyloid angiopathy is suspected in a patient with hemorrhagic stroke, surgical treatment is not recommended, since surgery can lead to re-hemorrhage.

Antifibrinolytic agents are used before surgery or for 4–6 weeks if surgery is not performed. Currently, there is an opinion about the need for their use only in cases of repeated or ongoing subarachnoid hemorrhage. E-aminocaproic acid is prescribed 30–36 g/day intravenously or orally every 3–6 hours, tranexamic acid is prescribed 1 g intravenously or 1.5 g orally every 4–6 hours. It has been proven that the use of antifibrinolytic drugs significantly reduces the likelihood of recurrent hemorrhage, but still significantly increases the risk of ischemic stroke, deep vein thrombosis of the lower extremities, as well as the likelihood of pulmonary embolism. It is believed that the use of a combination of calcium channel blockers and antifibrinolytic agents significantly reduces the risk of ischemic complications.

From the first hours of the disease, nimodipine is used intravenously at a dose of 15–30 mg/kg/h for 5–7 days, and then 30–60 mg nimodipine 6 times a day for 14–21 days.

When treating an ischemic stroke, as opposed to a hemorrhagic stroke, the patient should be placed horizontally in bed, and the head should be raised only slightly. Therapy for ischemic stroke is aimed at improving blood supply to the brain, increasing the degree of resistance of brain tissue to established hypoxia and improving metabolism. With proper treatment of ischemic stroke, there should be an improvement in cerebral circulation and the functioning conditions of cells that survived death. Timely and correctly chosen stroke treatment tactics are the prevention of deadly complications, such as pneumonia, bedsores, etc.

In the treatment of ischemic stroke, great importance is attached to aminophylline, since it not only reduces the severity of cerebral edema, but also has a positive effect on cerebral hemodynamics. The positive effect of aminophylline is that it only briefly dilates the blood vessels of the brain, affecting mainly the blood vessels as a vasoconstrictor factor. Its action is directed mainly at unaffected vascular beds, from which blood can move to the ischemic area. When using vasodilators, it can lead to the “steal” phenomenon, i.e., increased cerebral ischemia in the affected area. The drug must be administered very slowly; it is used in the form of a 2.4% solution of 10 ml intravenously. A solution of aminophylline with 10 ml of a 40% glucose solution or isotonic sodium chloride solution is used. The prescription of the drug can be repeated after 1-2 hours, and then used 1-2 times a day for the first 10 days. The effectiveness of aminophylline is primarily related to the period that has passed since the stroke; an excellent effect is noted if the drug was administered in the first minutes or hours after the onset of the stroke. By the end of the injection, the patient’s speech and movement are restored. Vasodilators are used only when vasospasms play a pathogenetic role. In this case, it is possible to prescribe no-shpa, nicotinic acid, papaverine, xavin, and complamin.

Currently, the hemodilution method is widely used for the treatment of ischemic stroke; for this purpose, polyglucin is administered intravenously or rheopolyglucin in a volume of 800-1200 ml. This method allows you to improve microcirculation and collateral circulation in the infarction area, as well as reduce the activity of the blood coagulation system.

When carrying out intensive therapy, ensuring normal water-salt metabolism is taken into account. This requires monitoring the moisture of the skin and tongue, skin turgor and blood counts. The latter include: the level of hematocrit and serum electrolytes. If violations are identified, they must be corrected. Fluid is limited and the rational use of diuretics is monitored, since their irrational use causes dehydration of the body, which increases blood clotting and lowers blood pressure. At the same time, excessive fluid administration during infusion therapy can lead to increased cerebral edema. Controlling glycemic levels and maintaining normo-glycemia are also important. This fact may contribute to changes in therapy in patients with diabetes. In this category of patients, they resort to a temporary switch to insulin and increase or decrease its dose.

Since it has been proven that ischemic stroke can occur against the background of an increase in the coagulating properties of the blood and a decrease in the activity of its fibrinolytic system, anticoagulants and antiplatelet agents are widely used in therapy.

If the diagnosis of ischemic stroke is made reliably and there are no contraindications from the kidneys, liver, gastric ulcer and duodenal ulcer, there are no malignant tumors, and blood pressure numbers are below 200/100 mm Hg. Art., anticoagulants are used. They are prescribed 1–2 days after a stroke under strict monitoring of blood coagulation parameters, i.e. coagulogram, thromboelastogram. If blockage of cerebral vessels by an embolus or thrombus is detected, they are combined with fibrinolytic drugs.

Anticoagulant therapy begins with heparin, which is a direct-acting anticoagulant. Heparin is prescribed in a dose of 5000-10000 units intravenously, intramuscularly or subcutaneously 4 times a day. Therapy with the drug is carried out under mandatory monitoring of blood clotting indicators for 3–5 days. In advance, 1–2 days before its cancellation, indirect anticoagulants, such as phenylin, neodicumarin, dicoumarin, are included in the therapy. Therapy with this group of drugs is carried out long-term, for 1–3 months, sometimes longer, under strict control of coagulogram, thromboelastogram and prothrombin index, the latter should not decrease less than 40–50%. Bleeding time during therapy with these drugs should increase by 1.5–2 times. Thrombolytic therapy includes the use of fibrinolysin in combination with heparin. Treatment begins in the first hours or days after the onset of the disease with the appointment of fibrinolysin at a dose of 20,000-30,000 units intravenously. The drug is pre-dissolved in 250–300 ml of isotonic sodium chloride solution with the addition of 10,000 units of heparin. The mixture is prescribed first once a day, and then every 6 hours. Heparin is administered intramuscularly at 5,000-10,000 units. Treatment with fibrinolysin continues for 2–3 days, and then anticoagulant therapy is continued according to the method proposed above. The following conditions are contraindications to the use of heparin: blood pressure above 180 mmHg. Art., a significant decrease in blood pressure, epileptic seizures, coma, severe liver disease, gastric and duodenal ulcers, chronic renal failure.

It was found that in young and middle-aged patients with severe signs of atherosclerosis or a combination of atherosclerosis with hypertension, pentoxifylline is more effective, as it does not have a pronounced effect on the blood coagulation system, but has a positive effect on its rheological properties.

For elderly patients without significant signs of pathology of the cardiovascular system, it is advisable to prescribe xanthinol nicotinate, parmidine, and indomethacin. If a patient has severe tachycardia and a persistent increase in blood pressure, then this is an indication for the prescription of anaprilin.

In the case of rapid withdrawal of antiplatelet drugs, patients experience withdrawal syndrome, which is characterized by a sharp increase in the rheological properties of the blood and a deterioration in the general condition of the patient. Given this fact, it is necessary to strictly adhere to the drug dose reduction regimen.

In case of ischemic stroke of the brain, it is preferable to prescribe Cavinton. In some cases, this drug may impair venous outflow from the cranial cavity and should not be used in combination with heparin. For brain stem infarction, it is better to prescribe cinnarizine. In some cases, acetylsalicylic acid can be used, which affects only the platelet component of hemostasis.

Acetylsalicylic acid in this case is used in a dose of 80-130 mg/day, the most commonly used is the administration of small doses of 80-325 mg/day, since this reduces the risk of complications from the gastrointestinal tract and inhibition of vascular wall prostacyclins, which have antithrombotic effect. In order to reduce the irritating effect of acetylsalicylic acid on the gastric mucosa, a form that does not dissolve in the stomach is used.

Curantil is used in a dose of 75 mg 3 times a day. According to the results of studies of the combined use of acetylsalicylic acid and chimes, the effectiveness of this combination for the prevention of stroke in patients with a history of transient ischemic attacks is proven, the risk of developing a recurrent stroke is also reduced, the risk of deep vein thrombosis and arterial occlusion in patients with vascular pathology is reduced. . One of the main characteristics of the drug is the possibility of using it in patients of different ages without laboratory monitoring of blood counts.

The drug ticlopidine is usually prescribed at a dose of 250 mg 2 times a day under the strict supervision of a general blood test. A blood test is taken for monitoring every 2 weeks during the first three months of treatment due to the risk of developing leukopenia.

Clopidrogel is prescribed at a dose of 75 mg/day and has much fewer side effects than acetylsalicylic acid and ticlopidine.

An important role in the treatment of ischemic stroke is played by metabolic therapy with the prescription of antihypoxic barbiturates, which inhibit brain metabolism, peripheral dilatation of intact vessels and vasogenic cerebral edema, which leads to redistribution of blood to the area of ​​local ischemia. The drugs in question are indicated primarily for patients with psychomotor agitation, the presence of convulsive readiness on the EEG, and paroxysmal changes in muscle tone. The most commonly used are thiopental - sodium or hexenal, phenobarbital. It has been proven that sodium hydroxybutyrate, or GHB, has a pronounced antihypoxic property, which differs from barbiturates in its ability to maintain oxidative processes in the brain at a sufficiently high level. Therapy with barbiturates and GHB is carried out under strict control of blood pressure, electrocardiography and echoencephalography.

Metabolic therapy includes drugs from the group of nootropics, which increase the brain’s resistance to hypoxia by stimulating cerebral metabolism and secondary enhancement of blood circulation, and also prevent the premature death of viable neurons near the source of the stroke (ischemic penumbra region). These drugs include piracetam, pyriditol and aminalon. Prescribing drugs from the nootropic group is advisable in the acute period in patients with mild cerebral symptoms and disorders of consciousness, as well as in all patients in the recovery period of the disease.

Cerebrolysin must be prescribed in large doses - 20–50 ml/day. This dose is administered 1 or 2 times, diluted in 100–200 ml of physiological solution, intravenously over 60–90 minutes, for a course of 10–15 days.

Piracetam is prescribed 4-12 mg/day intravenously, for a course of 10–15 days, and then the dose is reduced to 3.6–4.8 g/day. This dose can be prescribed to the patient from the beginning of treatment.

As drugs with an antioxidant effect, emoxipine can be prescribed at a dose of 300–600 mg intravenously, as well as naloxone at a dose of 20 mg intravenously (the drug must be administered slowly over 6 hours).

It is possible to carry out therapy not only with one drug, but also with a combination of them. The course of treatment is 1.5–2 months. Along with these drugs, glutamate and aspartate are prescribed. It is also recommended to use glycine sublingually at a dose of 1–2 mg per day in the first 5 days of a stroke.

Surgical treatment of ischemic stroke should be carried out in the presence of pathology of the great vessels, including the carotid and vertebral arteries. The surgical treatment itself may consist of brain surgery in the area of ​​the focus of the ischemic stroke and surgery on the great vessels, as a result of which damage arose and formed a heart attack. There are still no clearly formulated physiological justifications for surgical treatment. Given this fact, brain surgery for ischemic stroke is performed very rarely. The most common surgical interventions are performed on the carotid and vertebral arteries, brachiocephalic trunk, subclavian arteries, and much less frequently on the middle cerebral arteries. Indications for surgical treatment tactics on the carotid arteries are stenosis of the internal carotid artery, which is accompanied by transient circulatory disorders, persistent, but at the same time not severe neurological symptoms, symptoms of ongoing chronic cerebral ischemia; pathological tortuosity of the carotid arteries with impaired cerebral circulation; bilateral occlusive process in the carotid arteries. Indications for surgery on the vertebral arteries are atherosclerotic occlusion or stenosis, abnormal origin and compression in cervical osteochondrosis.

Immediately after the acute period of a stroke, a long and intense period of rehabilitation follows, during which partially or completely lost functions are restored. Vascular surgeons in our country successfully perform all types of surgical interventions on the carotid and vertebral arteries. A favorable outcome of the disease is guaranteed by the correct approach to indications, surgical technique and proper management of the postoperative period. In this case, the likelihood of developing life-threatening complications is minimized. It has been proven that timely surgical intervention reliably prevents the occurrence of recurrent and primary strokes, and also improves the restoration of functions lost as a result of a stroke.

Patients with impaired consciousness or mental disorders require special adequate treatment. This category of patients needs adequate nutrition, control of the vital functions of the pelvic organs, and care for the skin, eyes and oral cavity. It is advisable to use beds with a hydromassage mattress and side rails for such patients to prevent such a patient from falling. Nutrition in the first days is provided by intravenous administration of special nutrient solutions, and in subsequent days it is advisable to provide nutrition through a nasogastric tube. The nutrition of patients who are conscious and with normal swallowing begins with liquid food, and then moves on to receiving food in semi-liquid and regular form. If normal swallowing is not possible, the patient is fed through a tube. If the act of swallowing is not restored 1–2 weeks after the stroke, then it is necessary to decide on the application of a gastrostomy for further nutrition of the patient through it. In order to prevent constipation and straining of the patient during defecation, which is especially important for subarachnoid hemorrhage, patients are prescribed laxatives. If constipation nevertheless develops, then a cleansing enema is prescribed, but at least once a day with a sufficient amount of food. If there is urinary retention, then, if necessary, a permanent urethral catheter is installed. To prevent bedsores, in addition to turning the patient over, it is necessary to ensure dry skin, promptly change the patient’s bed and underwear, straighten folds and prevent urinary and fecal incontinence. In case of redness and maceration of the skin, it is treated with a 2–5% solution of potassium permanganate or sea buckthorn oil or solcoseryl ointment. If bedsores become infected, they are treated with antiseptic solutions.

Often a stroke occurs against the background of concomitant pathologies, such as arteritis, hematological diseases. The presence of this pathology aggravates the course of the stroke and, accordingly, requires special treatment.

For infectious arteritis, therapy is determined by the underlying disease. If a non-infectious nature of arteritis is detected in a patient, corticosteroids are prescribed, for example, prednisolone at a dose of 1 mg/kg/day, it is used either as independent therapy or in combination with cytostatics. If a patient is diagnosed with polycythemia, blood volume should be reduced using phlebotomy to maintain the hematocrit at 40–45%. In the case of concomitant thrombocytosis, myelosuppressants are used, such as radioactive phosphorus, etc. If the patient has thrombocytopenic purpura, plasmapheresis, administration of fresh frozen plasma and corticosteroids are indicated, for example, prednisolone is prescribed at a dose of 1–2 mg/kg/day. Repeated red blood cell transfusions are indicated for patients with sickle cell disease. If severe dysproteinemia is detected in blood tests, plasmapheresis is an effective treatment method. In patients with antiphospholipid syndrome, anticoagulants and antiplatelet agents are prescribed, plasma pheresis is possible and prednisolone is used at a dose of 1–1.5 mg/kg/day; if the patient is diagnosed with repeated ischemic attacks, then cytostatics are used. If leukemia is diagnosed, then it is advisable for the patient to be prescribed cytostatic drugs, and a bone marrow transplant is also indicated. In the treatment of patients with disseminated intravascular coagulation syndrome, sodium heparin is used, as in the treatment of the underlying disease. Sometimes ischemic strokes develop in young women. In this case, they are advised to stop taking oral contraceptives and alternative methods of contraception are prescribed.

In case of stenosis of the internal carotid artery after an acute period of stroke, the advisability of carotid endarterectomy is discussed. This method of treatment is prescribed when there is a pronounced narrowing of 70–99% of the diameter in patients who have suffered a transient ischemic attack. In some cases, it is performed when there is a moderate narrowing of 30–69% of the diameter of the internal carotid artery. This is indicated in patients who have suffered a minor stroke or have moderate neurological deficits after a stroke. Also, when choosing treatment tactics for patients with atherosclerosis of precerebral and cerebral vessels, the prevalence of the lesion, the severity of the pathology and the presence of concomitant pathology are taken into account.

One of the most common and severe complications of stroke is movement disorders. Restoration of impaired movements occurs within a maximum of 2–3 months from the moment a stroke patient is admitted to the hospital. Recovery continues throughout the year, with the first six months of treatment being the most important. Even in patients with lost ability to move independently, functions are restored. Patients who are unable to move independently due to hemiplegia can also fully restore their abilities. With adequate physical therapy, most of these patients become ambulatory at least 3–6 months after the onset of the disease.

While the patient is in the hospital, therapeutic exercises, massage, classes with a speech therapist, etc. are performed.

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Stroke is a disorder of cerebral circulation, which is accompanied by the appearance of neurological symptoms.

Causes of stroke

To understand the causes of stroke, you should know that there are two types of stroke: ischemic and hemorrhagic. They differ both in origin and in treatment methods.

Ischemic stroke occurs due to the formation of a blood clot or clot that clogs the arteries of the brain and disrupts the blood supply.

Hemorrhagic stroke appears due to a rupture of a brain vessel, as a result of which blood accumulates in neighboring tissues. The blood formed in large quantities puts high pressure on the brain tissue, as a result of which their work is disrupted.

In medicine, there are many reasons for the development of such a terrible disease as stroke. Among them are:

• high blood pressure - constant changes in blood pressure disrupt the elasticity of blood vessels and lead to their ruptures,
• frequent arrhythmias - interruptions in heart rhythm can lead to the formation of blood clots that impair blood circulation in the brain,
• exceeding the permissible level of cholesterol in the blood - increased cholesterol contributes to the formation of plaques that block blood vessels and lead to the development of a stroke,
• increased blood sugar causes fragility and fragility of the walls of blood vessels, as a result of which the likelihood of their rupture increases,
• formation of aneurysms on cerebral vessels,
• poor blood clotting leads to the formation of clots in blood vessels,
• overweight,
• alcohol consumption,
• smoking.

The most common causes of stroke are thrombosis, internal bleeding in the brain.

Thus, the main cause of stroke is damage to nerve cells, which are located in the brain and are responsible for all functions of the human body.

Symptoms of a stroke

In most cases, the symptoms that occur in patients with a stroke are:

• motor disorders. Weakness or clumsiness of movements, lack of coordination,
• speech disorders,
• sensory disorders
• behavioral and cognitive disorders. Difficulty getting dressed, combing your hair, brushing your teeth,
• memory impairment,
• severe headache, vomiting,
• increased breathing,
• disturbance of consciousness.

Stroke and its treatment

Treatment of a patient during a stroke should be carried out in the neurology department, which will ensure accurate diagnosis of stroke and intensive treatment, reduce mortality and disability among patients.

IN stroke treatment There are two main directions:

1. treatment of stroke consequences,
2. prevention of recurrent stroke.

Movement disorders are among the most common consequences of stroke. The patient's motor activity is restored within approximately two to three months from the moment of the stroke and can continue for a year.

Therapeutic exercises should be carried out in the first days after the diagnosis of a stroke, if there are no contraindications to physical activity. To reduce pain before gymnastics, you can use pain-relieving ointments or compresses.

If a patient has problems with speech after a stroke, you should consult a speech therapist. The patient must be in constant contact with people, listen to the radio, TV.

Big role in stroke treatment prevention plays a role. The risk of recurrent stroke exists in the presence of arterial hypertension, arrhythmia, heart valve pathology, heart failure, and diabetes mellitus. Preventive measures for recurrent stroke should begin as early as possible and last for less than 4 years.

In addition, maintaining a healthy lifestyle is of great importance. It is recommended to reduce the consumption of foods containing high amounts of cholesterol and increase the amount of fresh vegetables and fruits in the diet.

Rehabilitation course stroke treatment includes therapeutic exercises, exercise equipment, massage, physiotherapy, stimulation treatment.

Consequences of a stroke

Various conditions that begin to appear after a stroke depend on the location of the pathology, its size, and in the case of a cerebral hemorrhage, the resulting consequences depend on the size of the hematoma and how much it compresses the surrounding tissues and organs.

Possible consequences of a stroke:

• disturbances in movements that lead to paralysis. Motor functions are actively restored after a stroke in the first three months. Therapeutic gymnastics is of great importance in this process. Also important is the patient’s desire and desire to perform the prescribed set of exercises.
• speech disorders can persist for a long time. To eliminate such violations, constant sessions with a speech therapist and speech training are necessary.
• mental disorders, which most often manifest themselves as depression. The development of depressive conditions is caused by the severity of the disease and the loss of many opportunities for independent care. Manifestations of aggression and anxiety are possible. If the disorders do not recover on their own, medication may be taken.
• memory impairment, sometimes even memory loss. In most cases, memory is restored, but this requires regular training.
• disturbances in coordination of movements, which manifest themselves differently depending on the affected area. A good result for restoring coordination of movements is observed when taking medications.

Rehabilitation after stroke

The consequences of a stroke can only be eliminated by taking a number of measures for proper rehabilitation. Among them are the following procedures:

• light massage of the upper and lower extremities,
• physical therapy, which will help restore the patient’s motor activity,
• special exercises for developing fine motor skills of the hands,
• water massage, water procedures that stimulate muscle stretching.

Competent implementation of all treatment procedures aimed at rehabilitating the patient leads to the fact that the patient can return to independent life. As a rule, the rehabilitation period takes about 3 years.

Stroke Prevention

Strict adherence to doctor's prescriptions, as well as maintaining a healthy lifestyle will help you avoid developing a stroke. If you have suffered a stroke, then in order to avoid recurring cases, you should follow these recommendations:

• control your blood pressure. By lowering your blood pressure, you reduce the risk of another stroke.
• You should review your diet and eliminate foods rich in cholesterol and fat. This will reduce the formation of plaques on the walls of blood vessels. If you cannot eliminate these foods from your diet on your own, you need to see a doctor who will prescribe you special medications that will lower your cholesterol levels.
• quit smoking. The process of smoking or being surrounded by smokers leads to a stroke.
• Carry out drug treatment for diabetes if it is present, and also constantly monitor blood sugar levels. This will significantly reduce the risk of stroke.
• reduce excess weight, which contributes to the causes of stroke.
• Eat a diet rich in fresh fruits and vegetables.
• do physical exercise. Regular physical activity lowers blood pressure, reduces cholesterol levels in the blood, reduces body weight, and also improves the condition of your blood vessels. Which significantly reduces the risk of developing the disease.
• reduce the amount of alcohol consumption. Since alcohol increases blood pressure, which is the main cause of stroke.