Stroke - this is a very difficult and dangerous disease, with the defeat of the vessel, and then the central nervous system.The word « stroke » is derived from the Latin insulto - «gallop, jump" and stands for "attack, stroke, assault."And according to the WHO definition: Stroke - a rapidly growing global or focal brain damage, lasting more than 24 hours or leading to death, to the exclusion of any other origin of the disease.Under stroke
understand clinical syndrome characterized by the sudden loss of local cerebral symptoms, and sometimes of brain functions (confirmed or not the data computed tomography), lasting more than 24 hours resulting in death without other apparent cause other than vascular disease.The reasons that lead to disruption of the blood delivery can be such as rupture of the blood vessel when the blood flows into the brain tissue.The gap is due to the sharp fluctuations in blood pressure and diseased vascular wall.There is a violation of adequate blood flow, which leads to a det
There are two types of strokes:
are three main nosological forms - ischemic (thrombotic, netrombotichesky, embolic) stroke, cerebral hemorrhage, subarachnoid hemorrhage.In addition, there may be subarachnoid-parenchymal, parenchymal, subarachnoid hemorrhage, and "mixed" strokes.
In hemorrhagic stroke blood coming out of the ruptured vessel under high pressure pushes the brain tissue, forming a hematoma (blood tumor), and infiltrates the part of the brain.
This gap is due to the sharp blood pressure oscillations in the diseased vessel wall atherosclerotic process - 50% of cases.10% of cases occur in the diseased vessel wall tumor drug intake, contributing to increase the blood flow and 20% of cases - to all other causes of hemorrhagic stroke.
There are cracks on the inner wall of the vessel.Through them is soaking the walls of the blood vessel.Thereafter
vessel wall develops a necrotic process - failure within the vessel walls.
Science has proven that such changes occur in the blood vessels with a sharp increase in blood pressure - hypertensive crisis.While this process is inside the vessel, external pathology is not observed.
But when a vessel ruptures, blood enters the substance of the brain, destroying its fabric is formed hemorrhage or hematoma.They constitute 85% of intracerebral hemorrhage.When hypertension is the most severe changes are subject to the carotid vessels.
Artery atheromatous plaques destroyed.
heaviest - bleeding in the brain stem, where the vital centers, it leads to instant death.Symptoms and bleeding in the brain also depend on their location, as will be discussed in stroke clinic.See also a detailed and clear article about the symptoms, diagnosis, treatment and recovery from hemorrhagic stroke.Learn how to ensure a successful rehabilitation, maintain the ability to work, to prevent recurrent stroke.
hemorrhagic stroke more often develops between the ages of 45-60 years, mostly with the same frequency in men and women.There is a sudden, in the afternoon, usually after a sharp agitation or overwork.Sometimes a stroke is preceded by rush of blood to the face headache, vision objects in the red, vomiting, disturbance of consciousness, rapid breathing, slowing heart rate, or vice versa, palpitations.Sometimes there are dilated pupil on the affected side, the divergence of the eyeballs, abduction of the eyeballs towards (paresis of the eye, drooping corner of the mouth and venting off the cheek-side paralysis (a symptom of the sail) on the side opposite the fireplace, often found symptom of hemiplegia -. Foot turned outwards,hand fell like a log. Often there is a pulsation of vessels in the neck, hoarse breathing with difficulty inhaling or exhaling. The skin is cold, pulse tense, blood pressure in the majority of cases increased, a disorder of swallowing, urinary retention or urinary incontinence. When hemorrhage in the brain stem violated vital functionsand may occur sudden death.
to hemorrhage in the cerebellum characterized by dizziness with a sensation of rotation of objects, sharp pain in the back of the head and neck, vomiting, narrowing the pupils, it is broken, tension neck.
acute form of stroke is characterized by development within a few minutes of deepcoma.Death occurs quickly, within a few hours, the same pattern is observed in extensive hemorrhage in the cerebral hemispheres, cerebellum, pons, or blood in the ventricles of the brain break and defeat vital centers of the medulla oblongata.
subacute form is characterized by a slowly progressive increase of symptoms or acute onset followed by a short-term improvement and a new deterioration.Individuals elderly hemorrhages occur less rapidly than in the young, often appearing cerebral symptoms.In case of violation of cerebral circulation disorder possible recognition of objects by touch, hearing is preserved, but the patient does not recognize familiar voices, guided poorly in the space, sees, but does not know from past experience objects.This occurs in lesions of various parts of the cerebral cortex.
Clinic lesion of the temporal lobe disorder characterized by speech, auditory, gustatory hallucinations, dizziness, vestibular disorders.
Hemorrhage in the frontal lobe, it is characterized by the violation of the letter, seizures with the rotation of the head and eyes in the opposite direction.
When you touch the palm of the patient is shown grasping reflex, there is a violation of the psyche, a tendency to flat jokes, depression, impaired walking.The patient frantically clutching at the bed, the wall and other objects, afraid to fall.
Most ischemic strokes (60%) arises due to atherosclerosis.An important role in their development plays a pathology of extracranial carotid and vertebral artery.
most often localized compression of the artery in their division - the cervical spine.Because these areas are more prone to traumatic spinal canal with the back wall owing to degenerative or inflammatory changes in the intervertebral joints.Perhaps, and vascular compression due to abnormalities of the cervical spine.
• Full closure of the vessel may occur due to blood clots, or thrombus isolation - embolism, or at the close of the atherosclerotic plaque.
Blood clots usually form in the field of cholesterol plaques.The material for embolization of thrombi may be particles of cardiac thrombi and fragments ranging from plaque in the aortic arch and carotid artery.Cerebral ischemia can occur without vascular occlusion - when it is narrowing (stenosis) or bend.Here are important fluctuations in blood pressure, worsening of cardiac activity, blood loss, etc.the type of cerebrovascular insufficiency.Ischemic strokes are different in size and location.Dimensions of stroke depend on the level of vascular lesions.Read more instructions about the symptoms, diagnosis, treatment and recovery after ischemic stroke.It is written in plain language.Learn how to ensure a successful rehabilitation, to maintain a high quality of life, to prevent recurrent stroke.
ischemic stroke (cerebral infarction) occurs most often in middle-aged and elderly persons sometimes possible and at a young age;men indicated slightly more often than women.Ischemic stroke is often preceded by transient ischemic attacks, which appear unstable lesions of limbs, speech disorders, etc.Normally they are a consequence of deficiency of blood supply to the brain region in which later develops infarction.In some patients, more frequent and recurrent ischemic attack occurs just before the development of cerebral infarction.Thrombosis (blood clots) of cerebral vessels are frequent precursors of ischemic stroke - dizziness, transient disturbance of consciousness (faint and dizzy), darkening of the eyes.Ischemic stroke can occur at any time of the day.Most often it occurs in the morning or at night.Sometimes the connection is established the initial manifestations of stroke with the previous increased physical activity, the impact of emotional factors, alcohol consumption, taking a hot bath, blood loss or any disease, particularly infectious.
ischemic stroke often develops after myocardial infarction.Characterized by a gradual increase of focal neurological symptoms - for hours, sometimes days 2-3, at least for a longer time.
acute ischemic stroke may occur in thrombosis of the internal carotid artery or acute occlusion of a large intracranial arteries.Approximately 1/6 of the observations of cerebral infarction (stroke) develops slowly - over several weeks or even months.Pathological symptoms determined by the localization of cerebral infarction (stroke), vascular and circulatory conditions of the district.For blockage extracranial portion of the internal carotid artery is characterized by a period of ongoing visual impairment in one eye in combination with short-term paralysis and sensory disturbances on the opposite side of the body.Later develop persistent visual impairment, with atrophy of the optic nerve on the side of artery blockage and paralysis on the opposite side;under occlusion of the left carotid artery often have speech disorder, epileptiform seizures, a symptom of blockage of vertebral and basilar arteries outside the skull, in the region of the cervical spine manifested systemic vertigo, staggering when walking, jerking of the eyeballs (nystagmus), noise in the ear, hearing loss and impairedvision in both eyes.Sometimes developing coma, paralysis, reduced muscle tone.
When cerebral infarction in the region of the vertebrobasilar region most affected brain stem - is a very dangerous area.
In ischemic lesions in the blood brain patients the increased cholesterol, increased blood clotting, increased prothrombin, changes in the EEG, reovazogramme, CT.An ultrasonic Doppler method yields information about the state of the blood circulation.
Mortality in hemorrhagic stroke is high, varies between 60-90%.Most patients die within the first two days, of which a large part - in the first day.Ishemichekom stroke mortality observed within 20% of cases.When recurrent ischemic stroke developed progressive mental disorder.
ischemic stroke - the most common form of stroke.They constitute about 80% of the total number of strokes.
term "ischemic stroke" reflects only the fact of the disease, caused by a decrease in blood flow to a certain area of the brain and is characterized by the formation of a limited stroke.Cerebral infarction - a necrotic zone, formed as a result of gross, persistent metabolic disorders neuronal and glial structures resulting from insufficient krovoobespecheniya due to stenosis (occlusion) of the main arteries of the head or brain arteries, leading to a deficiency of perfusion pressure, or due to thrombosis orembolic cerebral arteries.Thus, all the remedial measures are directed at relief or compensation of pathological changes in the brain caused by developed myocardial.
Modern methods of instrumental studies (CT and nuclear magnetic resonance imaging, proton emission tomography, transcranial Doppler, duplex scanning, subtraction angiography) allow to classify acute cerebral ischemia in view of the four principles:
1) Taking into account the duration of the existence of neurological deficitrelease:
2) classification, characterizes the degree of severity of the condition patients.It provides:
3) Classification based on the localization of cerebral infarction, based on the characteristics under topical focal neurological symptoms specific blood pools: medium, front, posterior cerebral artery;the main artery and distal branches.
4) pathogenetic classification includes:
cerebral infarction Etiopathogenesis most justified to consider taking into account the heterogeneity of the concept of ischemic stroke.
NV Vereshchagin described the role of the pathology of the main arteries of the head, a variety of cardiac lesions, disorders of the central and cerebral hemodynamics in the etiopathogenesis of ischemic stroke.It proved the importance of the characteristic changes of hypertension intracerebral arteries of small caliber underlying lacunar infarcts.In addition, defines the role of changes in the rheological properties of blood and coagulation, thrombotic changes in endothelial-link and biomechanics of blood flow as the etiopathogenic causes of cerebral infarction.
EI Gusev detail characterized pathobiochemical changes in brain structures, leading to the formation of cerebral infarction and identify measures for their correction.
patokineza Adaptation to the definition of the concept of cerebral infarction Development Mechanism allows to specify conditions that predispose to its occurrence, and the immediate causes of ischemic stroke.
Among the conditions that predispose to the development of cerebral infarction, rightly highlight the local and systemic factors.
most common local factors are the atherosclerotic lesions of cerebral arteries and arteries of the brain - stenosis (occlusion), and conjugated with them the local thrombus formation;Various heart disease as a source of cardioembolic cerebral infarctions;degenerativnodistroficheskie changes in the cervical spine, causing compression of the extracranial vertebral artery.For relatively rare local factors include cranio-vertebral anomalies, fibromuscular dysplasia, kinking of the main arteries of the head, dilatatornaya arteriopathy, arteritis.
include disorders of the central and cerebral hemodynamics, coagulopathy, polycythemia and polycythemia, oppression gas transport properties of blood Systemic factors.
Local and systemic factors are interrelated and interdependent, often inaccessible recognition and evaluation.
Atherosclerosis .As the progression of atherosclerosis due to the accumulation of cholesterol takes place a thickening of the intima-media, gradually formed atheromatous plaques in the trunk and cerebral arteries.Morphological structure of plaque is different.Soft, loosened plaques are embologenic substrate, and dense plaques contribute to stenosis (occlusion) arterial trunks, sharply restricting blood flow.
Having one or multiple (echelon) stenosis causes a number of adverse effects.Substantially impair the dynamic properties of blood - volume and viscosity.Very limited level of cerebral blood flow - its reduction to 60% is critical to the development of cerebral infarction.
only multiple (echelon) extra- and intracranial stenosis of the arteries have an independent role in the pathogenesis of ischemic stroke.In other cases, acute cerebral ischemia occur in decompensation of cerebral blood flow due to severe disturbance of the central hemodynamics.
experimental and clinical and instrumental studies have shown that hypertension promotes and aggravates atherosclerotic lesions of the arterial system.
Furthermore, stenosis (occlusion) creates the preconditions for serious thrombotic events.
thrombosis. main stages of thrombosis are: endothelial damage due to intimal atheromatosis;Art.