A stroke is an acute disorder of cerebral circulation, the symptoms of which persist for more than one day.
There are three types of stroke:
- ischemic stroke
- hemorrhagic stroke
- subarachnoid hemorrhage.
- Ischemic stroke most often develops when the arteries that carry blood to the brain are narrowed or blocked. Brain cells die without getting the oxygen and nutrients they need. This type of stroke is also called cerebral infarction, by analogy with myocardial infarction.
The reasons for the blockage of the vessel can be different. The vessel can be closed by an embolus with a piece of an intracardiac thrombus that occurs in some heart diseases or an atherosclerotic plaque located on the wall of a large vessel. The cause of the vessel blockage may be thrombosis, the formation of a blood clot. A thrombus usually forms on the surface of an atherosclerotic plaque. Thrombosis is facilitated by an increase in blood clotting and an increased ability of platelets to stick together.
With frequent rises in blood pressure, changes can develop in the walls of small vessels that feed the brain’s deep structures. These changes lead to narrowing and often to the closure of these vessels. Sometimes, after another sharp rise in blood pressure in the circulation of such a vessel, a small heart attack develops.
Ischemic stroke occurs four times more often than other types of hemorrhagic stroke.
- Hemorrhagic stroke most often develops when arteries rupture. The poured blood soaks part of the brain, so this type of stroke is also called a cerebral hemorrhage. Most often, hemorrhagic stroke occurs in persons suffering from arterial hypertension and develops against the background of an increase in blood pressure. At some point, the vascular wall cannot withstand a sharp rise in blood and ruptures. A more rare cause of hemorrhagic stroke is a ruptured aneurysm. An arterial aneurysm is usually a congenital saccular protrusion on the vessel wall. The wall of such a protrusion is thinner than the wall of the vessel itself, and a slight rise in blood pressure in stressful situations or during physical exertion is often sufficient to rupture it.
- A ruptured vessel on the brain’s surface causes blood to enter the space surrounding the brain (subarachnoid space). This type of stroke is called a subarachnoid hemorrhage. Its most common cause is a ruptured aneurysm.
Acute neurology itself proceeds quickly enough from several minutes to several hours. The time after a stroke is conventionally divided into acute, recovery, and residual periods. In the acute period, both pathological processes and processes that contribute to recovery occur.
Very rarely, acute neurological disorder or stroke is asymptomatic. When the first symptoms appear, an urgent need to consult a doctor; after all, a stroke is brain damage.
Prevention of an acute neurological disorder
- Monitor your blood pressure. Statistics show that out of 100 patients with hypertension, only half know about their high blood pressure. And only 10-15 people out of 100 keep it, so to speak, in check with daily monitoring and taking medications.
If you suffer from arterial hypertension, regularly monitor your blood pressure; you should have a blood pressure monitor at work and home.
According to the World Health Organization criteria, pressure over 140/90 mm Hg is recognized as arterial hypertension. However, it is worth knowing that there are no set numbers, and one cannot adhere to this guideline. If a person has had a pressure of 90/60 all their life, if it then increases to 130/80, it is often seen as a hypertensive crisis. On the other hand, it would be illiterate to bring down the pressure to 130/80 for those who had it at 170/100 for a long time because sharp fluctuations are extremely dangerous. However, in any case, the 140/90 pass is a reason to see a doctor and take special medications.
- Reduce the number of cigarettes you smoke per day if you smoke, and in the future, completely give up this bad habit.
- Drink alcohol in moderation (no more than two glasses of wine a day or 50 ml of spirits).
- It is necessary to be aware of any cardiac arrhythmias’ presence or absence to avoid an acute neurological disorder. It is enough to take an ECG once every six months to maintain awareness. The main direction of preventing stroke in atrial fibrillation is to reduce the likelihood of blood clots in the heart’s cavities, which is achieved by taking medications.
- Find out your blood cholesterol level. If you increase it, see your doctor. Follow all of his cholesterol management guidelines.
- If you have diabetes, follow your doctor’s advice and keep your blood sugar levels high.
- Get exercise. Lead an active lifestyle. Physical activity should be chosen according to age, health, and on the advice of a specialist.
- Eat a balanced diet, avoiding salty and spicy foods, especially at night to avoid acute neurology.
- Maintain emotional balance. If you are acutely reacting to events, feel very worried or angry, do a simple thing, try to squeeze a tennis ball. Not only will you throw out unnecessary emotions, but you will not be able to get angry anymore because you have already psychologically switched over.
- If you experience the first symptoms of a stroke or acute neurological disorder, see your doctor immediately.
Risk factors for stroke
Risk factors for stroke can be divided into controllable (those that the doctor can influence by issuing recommendations or the patient himself by changing the lifestyle) and uncontrolled (which cannot be influenced, but they must be considered).
Controlled (adjustable) risk factors:
- high blood pressure (above 140/90 mm Hg)
- smoking cigarettes
- alcohol abuse
- atrial fibrillation and other heart diseases
- lifestyle factors (overweight, physical inactivity, malnutrition, and stressors)
- increased blood cholesterol
- prior transient ischemic attacks (TIA) and stroke
- oral contraceptive use
Uncontrolled (unregulated) risk factors:
Principles of acute neurology and stroke treatment
- Basic therapy, regardless of the nature of the acute neurological disorder, is aimed at ensuring the optimal level of functioning of physiological systems for the prevention and treatment of respiratory disorders, relief of central hemodynamic disorders with monitoring and correction of the level of oxygenation. It can also maintain adequate blood pressure, cardiac activity, the main parameters of homeostasis, and can monitor swallowing, the condition of the bladder, and intestines. Therapy can relieve seizures, help with skincare, offer nutritional support, passive gymnastics, and massage.
- Treatment of concurrent neurological disorders, cerebral edema, acute occlusive hydrocephalus, hemorrhage in the infarction zone, dislocation, and angiospasm.
- Special treatment methods of different types of strokes, systemic or selective thrombolytic therapy, thrombextraction, surgical methods.
- Rehabilitation measures (starting with the neuroresuscitation unit).
- Prevention and therapy of visceral complications, pulmonary embolism, deep vein thromboembolism of the lower extremities.
- Individual secondary prevention of vascular events, medical and surgical.
Neuroprotective therapy for acute neurology should be carried out in the first 3 hours after the onset of stroke, which may determine its effectiveness.
Neuroprotective therapy has specific goals:
- Reducing the size of cerebral infarction
- Prolongation of the therapeutic window period, expanding the possibilities for thrombolytic therapy
- Protection against reperfusion injury.
Pathogenetic therapy is divided into primary and secondary neuroprotection.