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Stroke: a view from the inside
Let me introduce myself, I work in the department of cardiology for patients with acute stroke. Subject stroke and other cardiovascular diseases is acute in systems currently worldwide. And I decided to hold a small educational program.
What is a stroke? This acute ischemic stroke.
Acute - develops suddenly, but sometimes dream that prevents him in time zametitNarushenie - everything ponyatnoMozgovogo - damaged cerebral sosudyKrovoobrascheniya - also all ponyatnoKakoy is a stroke?
Ischemic - when there is a blockage of the vessel plaque, thrombus ... blood supply is disrupted and there is ischemia (lack of oxygen) in the area of the brain, which he supplies. Hemorrhagic - rupture an artery that leads to hemorrhage. Blood in the cerebrospinal fluid (fluid around the brain and its ventricular system) is dangerous because even one drop can cause a sharp spasm of cerebral (brain) blood vessels and cause ischemia mozga.Osnovnye all causes of ischemic stroke:
Hypertensive heart disease (untreated) - Treatment involves not dropper 2 times a year, and regular use of antihypertensive preparatov.Mertsatelnaya arrhythmia - heart rhythm disturbance, a 2-fold increased risk of cerebral vessels insulta.Ateroskleroz - you need to watch your cholesterol, the good, if not take the free clinic, the analysis costs about 500 rubles (lipid) In atrial fibrillation, reception needs special preparations - anticoagulants (not aspirin and others like him).
There are 2 types of anticoagulants:
Warfarin - cheap, proven, but it requires a diet, regular monitoring of blood coagulation (INR) .Novye anticoagulants (ksarelto, pradaksa) - require only the reception are from 3k a month, at the level of effectiveness of warfarin or vyshe.Esli you or your loved ones arrhythmia - be sure to discuss with your doctor cardiologist anticoagulation and decide in favor of one of them.
The main causes of hemorrhagic stroke:
Hypertensive heart disease (no treatment) Malformations - an aneurysm in the brain arteriyah.Plyus huge influence: smoking, alcohol intake, passive lifestyle, obesity, diabetes.
As you can see most of the factors or modifiable, or it can be manageable.
Particularly dangerous aneurysm of cerebral arteries - razmitiya abnormalities of cerebral blood vessels in the form of its expansion with a thin wall - a ticking time bomb that could explode at any moment. About a month ago she came 23 years after the birth, rupture of a large aneurysm, intracerebral hematoma large volume (not operable), 6 hours later died. To exclude the aneurysm has a fairly simple and safe method - MRI angiography, right in the clinic of your choice no one will appoint - no evidence. Performed independently once in a lifetime, worth about 5k rubles. I think once in your life you can not afford to be sure that there are no mines?
As suspected stroke?
Very simple! That junk littered polinterneta, but by the example of our center, only 10% of stroke patients arrive within 3 hours, when there is a chance to help.
Signs of stroke:
Violation rechiPoterya orientation in time, place, unusual povedenieNarushenie motor activity - can not raise their hand, leg, his gait ... Violation of facial expressions - just ask the person to smile, blink and inflate cheeks. Sharp headache in an "hammer blow" If something of the above appear suddenly or after sleep urgent need to call 03, and not to shout, "Come quickly, there's a man dies," and clearly describe exactly what happened. This will allow the operator to find their way and send a specialized team.
Man will be delivered to the emergency room, most likely in local vascular center (check where it is in advance), we all understand that there are incompetent professionals in any profession.
The hospital will be performed CT and set the type of stroke.
Further treatment depends on the type of stroke.
Ischemic stroke
On admission to the hospital within 3 hours after stroke onset may thrombolysis. This introduction of a special drug that can dissolve clots in blood vessels and part of brain tissue. Unfortunately, this method has many contraindications, but its efficiency is very high and proven by clinical studies.
Further recovery depends on the capabilities of the human body, family - with the patient need to talk, to do, to look after. Most of stroke patients die from infections join, bedsores and neglect. Staff who are unable to provide. Unfortunately very few nurses willing to go to work for money 3 times smaller than it would receive in a stall. The main concern lies with the relatives. There are tons of cases where patients with severe stroke recovered and began to walk (relatives were on watch constantly, talked with him and doing) and with respect to a mild - died from pressure sores.
With regard to the wonder drugs pokapatsya: Cavintonum, Cerebrolysin, chereton - just expensive water. For these drugs, with all their space cost was not implemented any research that would show their effectiveness.
Hemorrhagic stroke
Tactics determined by the size and location of hemorrhage.
Danger of blood in the cerebrospinal fluid that even a drop of blood can cause spasm of cerebral vessels. for the prevention of a special drug Nimotop. This drug should be administered during the first hours in the injectable form. It is expensive and often do not have it either in the hospital, or you can write in a drugstore, but in the morning / after the weekend. Immediately ask the presence of his doctor. If not, then ask to buy - at a run to the pharmacy, take the receipt. The money spent will return in the fund MLA later, now no time to lose.
What to do after a stroke?
First need rehabilitation, patients are now sent to the special sanatorium, where they worked as a rehab, logopevty that allow them to adapt to life with motor or speech defect, can reduce its manifestation. The brain itself gradually rebuilds communication and movement and it will improve. It is necessary that the patient and the family did not give up, and continued to work and after treatment.
Further, the prevention of recurrent stroke. The most dangerous period for recurrent stroke - the first year, then slowly decreases the risk. All drugs prescribed by a doctor to be taken continuously, daily, at the same time, unless otherwise stated.
As can be seen, treated, and most importantly effectively treat stroke is very difficult. That is why, in my opinion, the program of construction of vascular centers, though good, but we need to influence the cause, not the consequence.
So prevention, prevention and again prevention
Finally some figures.
The prevalence of about 460-560 cases per 100 thousand. GodSmertnost population during the first month of ischemic stroke about 15%, hemorrhagic - 33% to 20% of stroke survivors require constant uhodaokolo 50% can not return to his previous job
Source:
What is a stroke? This acute ischemic stroke.
Acute - develops suddenly, but sometimes dream that prevents him in time zametitNarushenie - everything ponyatnoMozgovogo - damaged cerebral sosudyKrovoobrascheniya - also all ponyatnoKakoy is a stroke?
Ischemic - when there is a blockage of the vessel plaque, thrombus ... blood supply is disrupted and there is ischemia (lack of oxygen) in the area of the brain, which he supplies. Hemorrhagic - rupture an artery that leads to hemorrhage. Blood in the cerebrospinal fluid (fluid around the brain and its ventricular system) is dangerous because even one drop can cause a sharp spasm of cerebral (brain) blood vessels and cause ischemia mozga.Osnovnye all causes of ischemic stroke:
Hypertensive heart disease (untreated) - Treatment involves not dropper 2 times a year, and regular use of antihypertensive preparatov.Mertsatelnaya arrhythmia - heart rhythm disturbance, a 2-fold increased risk of cerebral vessels insulta.Ateroskleroz - you need to watch your cholesterol, the good, if not take the free clinic, the analysis costs about 500 rubles (lipid) In atrial fibrillation, reception needs special preparations - anticoagulants (not aspirin and others like him).
There are 2 types of anticoagulants:
Warfarin - cheap, proven, but it requires a diet, regular monitoring of blood coagulation (INR) .Novye anticoagulants (ksarelto, pradaksa) - require only the reception are from 3k a month, at the level of effectiveness of warfarin or vyshe.Esli you or your loved ones arrhythmia - be sure to discuss with your doctor cardiologist anticoagulation and decide in favor of one of them.
The main causes of hemorrhagic stroke:
Hypertensive heart disease (no treatment) Malformations - an aneurysm in the brain arteriyah.Plyus huge influence: smoking, alcohol intake, passive lifestyle, obesity, diabetes.
As you can see most of the factors or modifiable, or it can be manageable.
Particularly dangerous aneurysm of cerebral arteries - razmitiya abnormalities of cerebral blood vessels in the form of its expansion with a thin wall - a ticking time bomb that could explode at any moment. About a month ago she came 23 years after the birth, rupture of a large aneurysm, intracerebral hematoma large volume (not operable), 6 hours later died. To exclude the aneurysm has a fairly simple and safe method - MRI angiography, right in the clinic of your choice no one will appoint - no evidence. Performed independently once in a lifetime, worth about 5k rubles. I think once in your life you can not afford to be sure that there are no mines?
As suspected stroke?
Very simple! That junk littered polinterneta, but by the example of our center, only 10% of stroke patients arrive within 3 hours, when there is a chance to help.
Signs of stroke:
Violation rechiPoterya orientation in time, place, unusual povedenieNarushenie motor activity - can not raise their hand, leg, his gait ... Violation of facial expressions - just ask the person to smile, blink and inflate cheeks. Sharp headache in an "hammer blow" If something of the above appear suddenly or after sleep urgent need to call 03, and not to shout, "Come quickly, there's a man dies," and clearly describe exactly what happened. This will allow the operator to find their way and send a specialized team.
Man will be delivered to the emergency room, most likely in local vascular center (check where it is in advance), we all understand that there are incompetent professionals in any profession.
The hospital will be performed CT and set the type of stroke.
Further treatment depends on the type of stroke.
Ischemic stroke
On admission to the hospital within 3 hours after stroke onset may thrombolysis. This introduction of a special drug that can dissolve clots in blood vessels and part of brain tissue. Unfortunately, this method has many contraindications, but its efficiency is very high and proven by clinical studies.
Further recovery depends on the capabilities of the human body, family - with the patient need to talk, to do, to look after. Most of stroke patients die from infections join, bedsores and neglect. Staff who are unable to provide. Unfortunately very few nurses willing to go to work for money 3 times smaller than it would receive in a stall. The main concern lies with the relatives. There are tons of cases where patients with severe stroke recovered and began to walk (relatives were on watch constantly, talked with him and doing) and with respect to a mild - died from pressure sores.
With regard to the wonder drugs pokapatsya: Cavintonum, Cerebrolysin, chereton - just expensive water. For these drugs, with all their space cost was not implemented any research that would show their effectiveness.
Hemorrhagic stroke
Tactics determined by the size and location of hemorrhage.
Danger of blood in the cerebrospinal fluid that even a drop of blood can cause spasm of cerebral vessels. for the prevention of a special drug Nimotop. This drug should be administered during the first hours in the injectable form. It is expensive and often do not have it either in the hospital, or you can write in a drugstore, but in the morning / after the weekend. Immediately ask the presence of his doctor. If not, then ask to buy - at a run to the pharmacy, take the receipt. The money spent will return in the fund MLA later, now no time to lose.
What to do after a stroke?
First need rehabilitation, patients are now sent to the special sanatorium, where they worked as a rehab, logopevty that allow them to adapt to life with motor or speech defect, can reduce its manifestation. The brain itself gradually rebuilds communication and movement and it will improve. It is necessary that the patient and the family did not give up, and continued to work and after treatment.
Further, the prevention of recurrent stroke. The most dangerous period for recurrent stroke - the first year, then slowly decreases the risk. All drugs prescribed by a doctor to be taken continuously, daily, at the same time, unless otherwise stated.
As can be seen, treated, and most importantly effectively treat stroke is very difficult. That is why, in my opinion, the program of construction of vascular centers, though good, but we need to influence the cause, not the consequence.
So prevention, prevention and again prevention
Finally some figures.
The prevalence of about 460-560 cases per 100 thousand. GodSmertnost population during the first month of ischemic stroke about 15%, hemorrhagic - 33% to 20% of stroke survivors require constant uhodaokolo 50% can not return to his previous job
Source:
