Extensive stroke ischemic and hemorrhagic: causes, symptoms, prognosis
The content of the article:
- What is a stroke?
- Who is affected by stroke?
- Major stroke symptoms
- The consequences of a massive stroke
- Coma after a stroke
- Diagnostics
- Treatment and recovery
- Forecast
- Video
A massive stroke is called so because it affects the basin of the large vessels of the brain, which carry the greatest amount of blood to the brain structures. The focus of the disease extends to most of the tissues, it is possible to include the whole hemisphere in the pathological process. Such a dangerous ailment requires the most serious approach to prevention, treatment and recovery.
What is a stroke?
A stroke is an acute circulatory disorder in which, for a number of reasons, blood stops flowing to the structures of the brain. The brain tissue is most sensitive to hypoxia, i.e. oxygen starvation, therefore it very quickly loses its functions. This explains the rapid course of the disease. Both small capillaries (in this case, they speak of a microstroke, or transient ischemic attack), and large vessels (extensive damage occurs) can be affected.
With a stroke, even more extensive, it is critical that medical attention is provided in the first three hours
The mechanism of development in which blood circulation stops due to squeezing of a vessel or its blockage by a thrombus (or embolus) is called ischemic. This is the most common type of stroke and it occurs in older people (after 60 years).
There is also a hemorrhagic stroke, which is associated with a cerebral hemorrhage with subsequent dysfunction of the blood-carrying vessel and squeezing of the brain tissue that has flowed out. It occurs less frequently and, as a rule, in younger patients.
Circulatory disorders can occur in the carotid (the area supplied by the internal carotid artery and its branches) and vertebrobasillar (the main artery is the vertebral) basins. Depending on the location, stroke is divided into right-sided and left-sided.
Depending on the affected structures, various disorders of the activity of organs and systems develop. This, as well as delayed complications, can be life-threatening for the patient.
Who is affected by stroke?
An extensive cerebral stroke can develop as a primary disease, and be a complication of other pathologies.
Factors that statistically significantly increase the risk of stroke include:
- arterial hypertension - a persistent increase in blood pressure has a detrimental effect on blood vessels, causes dystrophic changes in the walls of veins and arteries. The vessel under constant pressure loses its elasticity, becomes weaker and often ruptures;
- atherosclerosis - the deposition of cholesterol and trans fats in the endothelium of the vessels of the brain is called the cerebral form of atherosclerosis. When an atherosclerotic plaque begins to expand into the lumen of the blood tube, it blocks the flow of blood, and the brain area lacks nutrition;
- thromboembolism - blood clots that form in the vessels due to trauma or pathologies of the blood coagulation system, can at any time come off under the action of blood flow, clog the vessel and cause acute ischemia of the tissue fed by this vessel;
- congenital vascular anomalies - some vessels are defective from birth, so they do not fully fulfill their functions and are easily affected;
- age - patients over 50 are much more susceptible to acute cerebrovascular accident due to degeneration of collagen and elastin in the body, including the vascular wall. The vessels in the elderly are less resistant to changes in blood pressure. Patients aged 70-80 years have the highest likelihood of stroke.
Diabetes mellitus, obesity, unhealthy diet, a sedentary lifestyle, smoking, high blood pressure as a result of kidney disease, and other factors increase the risk of major ischemic stroke.
Major stroke symptoms
Depending on the area of the brain affected, the following symptoms may develop:
- a sharp headache that is not relieved by analgesics is a hallmark of hemorrhagic stroke; in ischemic stroke, headache may also be present, but it usually develops gradually and is less pronounced. The focus of pain is usually localized in the occipital and parietal lobes;
- dizziness, lack of coordination;
- paralysis and numbness of the facial muscles on one side of the face - lesions in stroke are of a mirror nature, that is, with a focus of destruction in the left hemisphere, the right half of the face suffers, and with damage to the centers in the right hemisphere, the left;
- paralysis and numbness of the limbs, muscle weakness in one half of the body;
- violation of mental functions;
- blackouts, disorientation in space;
- speech disorders indicate damage to the speech center. The patient stumbles, his articulation is indistinct (speech is like that of a drunk), and the sequence of words in a sentence is often incorrect.
Cramps, sweating, heart palpitations, loss of consciousness are also possible. To check the condition of a patient with suspected stroke, you should ask him:
- raise both arms up - a person cannot raise both limbs evenly, or one deviates, lags behind;
- smile - a patient with a stroke will not be able to do this, since one side of the face loses sensitivity, the corner of the lips is lowered;
- answer a simple question such as "What is the weather today?" - the patient will not be able to collect his thoughts or clearly pronounce the phrase, he will mumble and get confused in words;
- stick out your tongue - it will deviate from the midline.
If suspicions are confirmed after the test, the patient needs urgent hospitalization.
The consequences of a massive stroke
Depending on the degree of damage, the size of the primary focus, as well as the depth of necrotic processes in the affected centers, a stroke can manifest itself in different ways. The degree of defeat, in turn, depends on how quickly the help was provided.
Tactile sensitivity, taste, and smell are often lost. If the motor centers are damaged, the patient loses the ability to move fully. Weakness in the limbs can develop, and in the worst case, complete paralysis.
The outcome of a stroke largely depends not only on the size of the lesion, but also on which area of the brain is affected
The functions of other analyzers are also impaired - there is a deterioration in vision and hearing, up to deafness and blindness. The most common disorder of speech functions (dysphasia or aphasia).
Thought processes suffer. There are problems with recognizing letters, composing words and sentences from them. The patient does not express his thoughts well, his memory deteriorates, the perception of colors and sounds may be impaired.
Visceral disorders include voluntary bowel movements and urination, digestive disorders, heart failure, hemodynamic disorders. In some cases, the patient may fall into a coma.
The restoration of the lost functions is long-term, it requires persistent training with a speech therapist, exercise therapy specialist, massage therapist, and a rehabilitation therapist. When the lesion is massive, complete recovery may not occur even after a rehabilitation course. Often, after a stroke, a person partially or completely loses the ability to work.
Coma after a stroke
This is a state when a person loses consciousness and the ability to perceive the world around him, while the organs and systems are functioning, but the life processes are significantly slowed down.
Coma is a formidable complication of a stroke, it occurs when deep subcortical centers are affected, most often this occurs in the absence of qualified and timely medical care, which should be provided in the first hours after the manifestation.
If a person cannot be brought out of a coma for a long time, the pathological condition progresses, and the longer a person is in it, the less chances of recovery. Over time, the defeat will affect the vital centers of respiration and heartbeat, after which life can only be supported by special devices.
Diagnostics
Diagnostics is carried out immediately after the patient is admitted to the hospital, and at the initial stage it is urgent. The neurologist assesses the general condition of the patient, his reflexes, for which he conducts several simple tests. When the patient's condition is stabilized, he is referred for instrumental examination.
The most informative and modern diagnostic methods include MRI (magnetic resonance imaging), MRA (magnetic resonance angiography), contrast-enhanced CT, ultrasound of the neck vessels, ECG.
It is necessary to establish in which area of the brain the stroke occurred, what is the volume of the affected tissue - treatment tactics and prognosis depend on this.
Treatment and recovery
After a stroke, the patient is hospitalized, in the hospital, drug treatment is carried out. It consists in taking anticoagulants, thrombolytics, antiplatelet agents - drugs that level pathological blood clotting and dissolve already formed blood clots in order to avoid relapse, better perfusion.
Prescribed infusion solutions in combination with forced diuresis, vasodilators, antioxidants. Nootropics are shown to restore cognitive functions. To protect the vascular wall, angioprotectors are prescribed.
Recovery at home includes the continuation of the course of angioprotectors, the use of moderate physical activity, classes with a speech therapist to restore speech, physiotherapy procedures, and control of diet and lifestyle.
Forecast
Mortality from stroke is quite high, but we must not forget that the main percentage is accounted for by late complications of the disease. A third of patients have recurrent ischemic stroke within five years.
The risk of death or the development of severe late complications increases rapidly if proper medical attention is not provided in the first three hours after a stroke. In the first month, about 25% of patients die - such numbers are not directly related to organic damage, they are due to improper care and untimely treatment.
About 60% of all patients retain signs of impairment of certain functions for life, even after the end of the rehabilitation period. This applies to both disorders of the nervous system and other organs.
To restore functions lost after a stroke, a rehabilitation program is being developed
How long do you live after a stroke? The answer to this question cannot be given unequivocally, however, with proper treatment and timely treatment, up to 40% of patients fully recover, return to normal life without visible restrictions, more than half of them do not experience relapse. Therefore, the chances of surviving the consequences of a massive stroke depend on how timely assistance was provided and how well rehabilitation was carried out.
Video
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Nikita Gaidukov About the author
Education: 4th year student of the Faculty of Medicine No. 1, specializing in General Medicine, Vinnitsa National Medical University. N. I. Pirogov.
Work experience: Nurse of the cardiology department of the Tyachiv Regional Hospital No. 1, geneticist / molecular biologist in the Polymerase Chain Reaction Laboratory at VNMU named after N. I. Pirogov.
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