home Audience 4 Extensive cerebral infarction of the right hemisphere. What causes cerebral infarction? Complications and consequences

Extensive cerebral infarction of the right hemisphere. What causes cerebral infarction? Complications and consequences

The human brain has two hemispheres, penetrated by a network of deep and superficial vessels.

Changes blood pressure directly affect the tension of large-caliber vessels, which leads to so-called cerebral infarctions.

This disease is determined when a large area of the cerebral cortex is affected. What is a massive heart attack?

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Risk group

As with other types of disease, there are risk groups for heart attack.

Most susceptible this disease people included in the main groups:

People suffering from high blood pressure are hypertensive.
People who have cardiac pathologies vascular system. This is associated with an increased risk of the formation of emboli and blood clots (prosthetic heart valves, acquired and birth defects hearts,).
People who have had transient ischemic attacks. These attacks are called micro-stroke. If proper treatment is not carried out, a massive heart attack will be provoked. Symptoms include local muscle numbness, sudden weakness, problems with balance, speech and vision, and severe headaches.
Population diagnosed with diabetes mellitus and high cholesterol blood.
Population diagnosed with stenosis carotid arteries.
People with nicotine and alcohol addiction, as well as using various psychotropic drugs.
People who are diagnosed different degrees obesity resulting from an unhealthy lifestyle.

Kinds

The impact of a large heart attack is taken by a fairly large area of nervous tissue, which subsequently (but not always) spreads to all two or one hemisphere. Accordingly, the affected part of the hemispheres loses all functions, which entails incompatibility with the full functioning of the body.

Extensive damage to the hemispheres is mainly caused by pathology of the main branches and the carotid arteries themselves. Most often this is observed in people with atherosclerotic narrowing of the vessels mentioned above. In most cases, such a narrowing occurs hidden and the person does not realize that he is susceptible to a heart attack almost every second.

Some patients suffer transient ischemic attacks, which are also harbingers of a major heart attack. These attacks are triggered by the formation of thrombotic masses on the plaques of the carotid arteries and their transfer by blood into the blood vessels, which leads to circulatory disturbances in the brain itself of a temporary and reversible nature.

It is important to examine the cervical and head vessels for people who have suffered at least one such attack. These include Dopplerography and ultrasound examination of blood vessels. If the examination reveals a significant narrowing, then it may be suggested to prevent a massive heart attack.

To determine the proportion of the lesion, it is necessary to conduct magnetic resonance and computed tomography

Extensive heart attack has two main types:

If the second type of heart attack leads to instant death, then the patient with cerebral ischemia can be saved.

An ischemic heart attack affects both sides of the brain - left and right. Speech function is affected by damage to the left lobe. There are a number of symptoms that help visually identify the lesion.

An extensive infarction of the right hemisphere of the brain can be determined by several symptoms:

depressed, passive state;
left-sided paralysis of the body and facial muscles;
speech and memory impairment - although in some cases speech will persist, which leads to difficulties during diagnosis.

With left-sided brain damage, the following is observed:

speech disorder and logical thinking;
right-sided paralysis of the body and facial muscles;
pronounced deviations in the patient’s psyche.

In cases of extensive infarction of certain areas, the patient loses certain functions. For example, if Broca's center in the brain has been damaged, the patient has speech function, but can only express himself in fits and starts, and can use and understand short sentences.

In addition to the left and right extensive infarction, five more main groups are distinguished, but short-term attacks and transient ischemic attacks are not taken into account:

Micro-occlusive infarction	Caused by a blood clotting disorder (fibrinolysis, hemostasis).
	Caused by blockage of arteries. A distinction is made between complete and partial.
Hemodynamic infarction	The most common type of heart attack associated with a sudden fall blood pressure. Affects most of the cerebral hemispheres.
Extensive	Causes a lingering clinical picture. It is caused by blockage of the vascular system and its other pathologies. This type of heart attack is predicted and predicted when a blood clot is detected in large vessels.
	It got its name from the cavities formed (lacunae). Arising as a result of damage to perforating vessels. The diameter of the lacunae varies between 0.05 – 5 mm. This heart attack develops gradually and can occur during sleep.

Causes

Our brain is fed by arterial vessels, and when they are compressed or undergo prolonged spasm, an ischemic infarction occurs. It occurs in more than 70% of cases. The formation of atherosclerotic plaques and blood clots leads to atherothrombotic infarction. Also among the causes of its occurrence are transient ischemic attacks.

Blockage of the arteries can be caused by emboli, which occur with arrhythmias, heart defects and other types of diseases. A heart attack caused by such a blockage is called cardioembolic.

More rarely, cases of extensive infarction caused by hemodynamic causes are observed. Such reasons include sharp drop blood pressure. A striking example a strong state of shock occurs.

Ischemic infarction is much more common than hemorrhagic infarction, but the latter has much more serious consequences. It is caused by a rupture of the primary blood vessel wall and extensive hemorrhage in the brain.

The reasons are:

Symptoms

Its symptoms depend on the type of heart attack and which hemisphere is affected. Most often, these cases have pronounced symptoms and are quite severe, so they can be diagnosed without much difficulty.

Among the main symptoms are:

changes in consciousness lead to stupor or coma of various stages;
dizziness or sharp pain(with a hemorrhage called subarachnoid, the patient feels a blow to the back of the head);
vomiting, fear of death, nausea, palpitations, dry mouth, shortness of breath, redness of the face and pale skin, cold sweat (these symptoms are called vegetative);
convulsions;
complete or partial paralysis of the muscles of the face and body (with an infarction of the left hemisphere, the right half of the body suffers, and, conversely, with the right, the left);
the occurrence of paresthesia and loss of sensitivity on the opposite side of the affected hemisphere of the brain;
the onset of aphasia (speech impairment) - occurs only when the left side of the brain is damaged;
impairment of human memory, so-called lapses;
problems with orientation, hearing, vision, smell;
disturbance of orientation and coordination;
disturbance of the patient's mental state.

The difficulty in recognizing a heart attack is caused by instant coma and loss of consciousness, because it is impossible to identify problems with vision, motor skills, sensitivity and speech.

A test of the pupils and their reaction to light will help - one pupil is wider than the other and does not narrow in the light.

The patient can survive and restore functions that were lost during a massive heart attack only with timely hospitalization. It takes only three hours from the onset of a heart attack for neurons to completely die.

If there is the slightest suspicion of a heart attack, a person should be placed on a hard surface and doctors should be called. It is also important to make the room in which the patient lies not stuffy and to ventilate it.

Direct treatment takes place under the strict supervision of doctors (neurosurgeons and neurologists) at the hospital. Among the medications, drugs that can reduce blood clotting are also used.

A decrease in blood glucose, which is caused by medications, is also necessary. Some cases require surgery.

Hemorrhagic stroke requires the administration of hemostatic drugs and drugs that can form blood clots. Sometimes the only salvation is a neurosurgical operation aimed at stopping heavy bleeding.

The treatment period for each person and in each case is individual and depends on the characteristics of the body and ending with the degree of damage

Consequences

If a person is lucky and receives full, timely medical care, the following consequences arise:

vegetative state caused by brain death;
various human mental disorders;
epileptic seizures;
balance and coordination disorders;
inability to formulate connections and conclusions, as well as lack of logical thinking (cognitive functions of the brain);
the patient loses the ability to assimilate information, and even memory;
paralyzes the muscles of the palate and bulbar syndrome(violation of the swallowing process);
varying degrees of hearing, vision and smell impairment;
motor and sensory aphasia – inability to understand speech and speak;
opposite loss of sensitivity - left-sided infarction - right side, and vice versa;
hemiparesis occurs on the left or right half of the face and body.

It is not possible to completely restore brain functionality. But by making maximum efforts during treatment, you can minimize the manifestations of the abnormalities that have arisen, but they cannot be completely cured.

Patient care

After crossing the threshold of death and dangerous period disease, the patient requires full care. In most cases, a person who survives a heart attack remains disabled and therefore needs constant care.

The patient can be cared for by both qualified health workers in rehabilitation centers and close relatives at home.

For a person who has suffered a major heart attack, the following care is necessary:

fight against soft tissue necrosis (bedsores);
prevention in the restoration and formation of muscle contracture;
specialized gymnastics for recovery;
respiratory gymnastics;
prevention of pneumonia (pneumonia);
prolonged immobilization leads to thromboembolic complications, so they must be prevented in time;
prevention to avoid a second wave of heart attack;
constant monitoring of blood pressure;
careful hygiene of the room in which the patient lies and the patient himself;
following a special diet;
timely reception of everyone medicines prescribed by a doctor;
speech restoration;
adaptation in society and psychological assistance.

A large heart attack is accompanied by severe disability and a high risk of death, so prevention is very important. This is especially true for people who fall into one of the risk groups.

First aid

The main thing is to diagnose the disease in time. If there is even the slightest suspicion of a heart attack, then you should immediately call an ambulance.

Before arrival qualified assistance the patient must be placed horizontally on a hard surface (floor, board, etc.) and fresh air must be supplied to the room. If possible, you should use an oxygen mask. Such methods will increase the patient’s chances of surviving and leading a normal life.

Unfortunately, the risk of disease is very high. Almost every third elderly person is susceptible to it. There are many reasons for this - poor nutrition, stress, poor environment and genetics, inactive way of life.

The risk of disease should be prevented in advance. But if a heart attack occurs, then the patient’s closest relatives need to have greater psychological endurance.

A lot of effort and energy is spent on providing timely, and most importantly proper treatment. And don’t forget about your mood, because it is transmitted to the patient.

A heart attack is a violation of blood circulation in the brain. Problems arise due to lack of blood supply. Wherein nerve cells the affected area of the brain may become dead. The disease is also called.

Such disorders often occur due to the formation of blood clots in circulatory system. The disease affects the human brain and causes disruption of the central nervous system.

As a result of such a disease, a person’s motor, speech and other natural functions of the body may be disrupted.

Causes of trouble

The main cause of necrosis of a part of the brain is considered to be blockage of an artery. The cause of thrombosis formation is the transformation vascular wall, as well as deterioration rheological properties.

Prolonged spasms of blood vessels in the brain can also cause ischemic cerebral infarction.

Irreversible changes can occur due to insufficient supply of essential nutrients to the brain.

Classification of violation

The following subtypes of cerebral infarction are distinguished by etiopathogenetic subtypes:

atherothrombotic;
cardioembolic;
lacunar;
hemodynamic;
hemorheological.

The disease can be localized in the following areas:

Clinical picture

The following symptoms of the disease are observed:

During an attack, a person begins to turn pale and blood pressure decreases. If a cerebral infarction occurs in the brainstem itself, a rapid increase in blood pressure is rarely observed. The pulse quickens, but becomes weaker.

With repeated heart attacks, it may be impaired mental condition sick. Symptoms can often be observed even after normalization of the mental state.

Establishing diagnosis

Diagnostic methods used:

CT scan;
Brain MRI;
examination of the carotid arteries;
study of cerebrospinal fluid;

Treatment approach

Cerebral infarction is considered emergency and always requires immediate hospitalization of the patient. Restoring the functioning of the circulatory system in the brain, preventing further possible damage nerve fibers are the main targets of inpatient treatment.

As soon as the condition ischemic stroke begins to develop, patients are prescribed special means, promoting the dissolution of blood clots:

Thrombolytics are very successfully used in the treatment of myocardial infarction. In addition to dissolving the resulting blood clot, these agents prevent subsequent damage to nerve tissue, significantly reducing the affected area. It should be borne in mind that such drugs can only be prescribed separate group sick and are used on different stages development of a heart attack.
Another group of drugs used to change the properties of blood is antiplatelet agents, preventing the process of platelet aggregation. Antiplatelet drugs are included in the list of common drugs to combat stroke caused by cerebral atherosclerosis or all kinds of blood infections that contribute to the formation of clots due to platelet aggregation. Similar medicines are also used to prevent the occurrence.
You need to understand that the formed elements of the brain tissue begin to gradually unlock without the supply of a sufficient amount of oxygen, as well as nutrients. This process is accompanied by a whole list of various biochemical reactions, the development of which is helped to be prevented. cytoprotectors or neuroprotectors. In addition, neuroprotectors help increase the activity of cells located next to already dead formed elements. Thus, neighboring cells are able to perform the functions of dead ones.

Also used are surgical methods treatments, such as carotid endarterectomy. Action required to remove inner wall near the carotid artery, damaged by an atherosclerotic plaque during deformation or narrowing of the blood vessel.

A similar method of intervention is also used for. Should be considered existing indications and contraindications before making a decision and carrying out such operations.

Patients who have suffered a cerebral infarction at one time have a fairly high chance of recovery, as well as a full recovery.

Recovery period

In order to be able to return to old life as soon as possible, it is recommended to undergo rehabilitation in special centers where comprehensive measures, promoting the treatment of strokes.

Basically, such processes are very long-lasting, but all cases of the disease are individual in nature, so the condition of some patients returns to normal later, and others faster.

Today there are a sufficient number of developed methods for restoring the functionality of the nervous system after illnesses. Specially designed therapeutic and physical training complexes have the greatest effect on the condition of patients.

The procedures help restore strength and motor functions of the affected side of the body within three months. Social and mental adaptation processes take much longer.

Set of preventive measures

Each day of this condition reduces the possibility of recovery by approximately 15%. It should be borne in mind that about 25% of citizens who have had a heart attack die in about a month.

If a patient experiences a lacunar stroke, the likelihood fatal outcome is about 2%.

Cerebral infarction or ischemic stroke (ICD-10 code I63) – irreversible ischemic lesion a certain area of the medulla, which occurs when there is a deficiency of arterial blood flow. The brain consists of highly specialized tissue that has a need for oxygen. The gray matter in the cerebral cortex is most sensitive to its lack, with oxygen starvation its cells die within minutes.

This condition, hypoxia, is very dangerous, since the damage large quantity areas leads to disruption of a certain number of functions that cannot be restored. In this case, irreversible changes occur in the brain tissue, shutting down the affected parts of the cerebral cortex. Providing first aid to the patient in case of a heart attack and timely medical assistance will help avoid tragedy - the stroke suffered can pass without serious complications and not lead to disability.

Catastrophic irreversible consequences develop within the first 1.5 hours, therefore greatest effect will bring treatment during this period of time.

Causes

Often, the cause of damage and death of a certain area of brain tissue is blockage of the arteries, which occurs as a result of thromboembolism. Thrombosis causes changes in the structure of the vascular wall, which leads to a decrease in rheological properties and blood viscosity. These factors lead to increased blood clotting, as well as slower blood flow in the body.

Causes of cerebral infarction:

Risk category

According to statistics, part of the population aged 40-50 years is susceptible to high blood pressure. Most people do not pay attention to the body's periodic alarm signals. In the future, these signs of the initial stage of the disease can provoke a heart attack, the symptoms of which cannot be ignored due to the irreversibility and severity of the consequences. Sometimes patients do not even suspect that the disease is already progressing asymptomatically and producing irreversible ischemic changes in the previously intact structure of arterial vessels.

Initially, the human brain suffers from them. An increase in pressure provokes a thickening of its arterioles and arteries, impregnation with plasma proteins occurs with changes in the structure, which can lead to necrosis of some areas of the vascular walls. Over time, the affected vessels become fragile and locally expand, and a sharp rise in blood pressure can lead to rupture of the arteries, as a result of which blood penetrates into the brain tissue. Also, damage to the walls of blood vessels often increases their permeability. In this case, blood can exit through them and penetrate into the nervous tissue or into the space between the vascular fibers and cells.

The risk of developing a stroke is much higher in some people who have a history of factors:

hypertonic disease Stages II or III;
vascular atherosclerosis, affecting the vessels of the brain, kidneys and heart;
connective tissue diseases – rheumatoid arthritis, rheumatism, lupus;
diseases associated with cardiovascular ischemic disease, pathology of heart valves, severe disturbances of its rhythm;
diseases endocrine system– hyperthyroidism, diabetes mellitus or adrenal disease;
prolonged smoking or alcohol abuse.

Symptoms

Characteristic symptoms cerebral infarction are:

numbness or weakness of half the body;
strong headache;
feeling of numbness in the limbs;
disturbance of the patient's orientation in time and space;
difficulty speaking;
feeling slightly stunned, lethargic and lethargic;
dizziness with nausea and vomiting;
unsteadiness, usually with dizziness;
difficulty swallowing;
dry mouth;
noise or congestion in the ears;
drowsiness.

A person who has had a cerebral infarction turns pale and their blood pressure usually drops. Sharp increase pressure is rarely observed, in isolated cases when an ischemic stroke occurred in the trunk. During a heart attack, the body temperature is normal, the pulse becomes much faster, but at the same time becomes less full.

A repeated stroke in the right hemisphere of the brain can affect the mental health of the patient. This initially manifests itself in mild confusion, but then develops into a more severe phase - dementia. After the patient’s consciousness is restored, symptoms of psychosis, asthenia, delirium, depression, and hallucinations of varying severity are observed. Sometimes, when a patient's carotid artery is blocked, he may fall into a coma. To prevent irreversible complications symptoms, first signs and other warning signs that the disease leads to must be accepted as hazardous factors by contacting immediately medical institution.

Consequences

Often, any type of cerebral infarction leads to disability. The consequences of the blow can be: loss of clarity of the patient’s thinking, rapid fatigue or dementia. If the affected area is small, then over time the neurological symptoms of the disease that appear may disappear. This occurs due to the fact that other, healthy parts of the brain take over all the functions of the affected parts.

Future life for a patient after a stroke, it can be difficult for him and the people around him, since the ability to work and some vital functions of the body may be lost forever. The patient, with the help of his family, will undergo long-term rehabilitation necessary to maintain the ability to full life and basic self-care.

Rehabilitation after a heart attack includes: physiotherapy, physical therapy, massage, oxygen therapy, taking medications to improve brain metabolism, a course of vascular therapy. In some cases, there is a need for a psychotherapist to work with the patient.

Treatment and first aid

According to statistics, the mortality rate from various diseases of cardio-vascular system. The manifestations of diseases are becoming younger every year, often affecting people under 40 years of age. Therefore, everyone needs to learn to recognize in practice the signs of an upcoming stroke and have an idea of how to properly provide first aid to a person suffering from an attack.

If signs indicating a possible heart attack are detected, the victim will need first aid sharp violation cerebral circulation. Until qualified emergency doctors arrive, the victim must be placed on his back. The head should be slightly raised and a low pillow or object that can replace it should be placed under it.

The patient must have the necessary air access. If it is in a closed room, you need to open the windows or a vent. Next important point- the victim’s clothing should be loose - take off a tie, belt or belt, unbutton buttons, etc.

If the patient vomits, his head must be turned to the side and the vomit removed. If there are dentures in the mouth, they must be removed. To avoid deterioration of the victim’s condition, if he loses consciousness, do not offer him to smell ammonia. If there is no breathing or heartbeat, the patient requires cardiopulmonary resuscitation.

If a person has a massive heart attack, the consequences of survival depend solely on the people around him and their actions. Identified on early stage diseases, signs of an upcoming heart attack and timely contact with specialized doctors will certainly make the treatment as effective as possible. The harmful consequences will be minimized.

Video on the topic

As we know, the structure of the human brain implies the presence of two hemispheres. Each of them is penetrated by both superficial and deep vessels. And among them there are both the smallest capillaries and large arteries of the brain, which, alas, are not alien to such a disease as a heart attack. Doctors call it extensive if the vessels suffer not in a specific area, but over a large area.

Extensive ischemic stroke - damage to large areas of the brain due to a phenomenon such as thrombosis or blockage of blood vessels and interruption of blood supply. The source of a major stroke is most often a blockage of the left or right carotid artery.

Even today, a large heart attack and its consequences are extremely difficult to cure, since during the existence of a large number of nerve cells without oxygen, vital functions are lost. In a considerable proportion of cases, such a stroke causes death.

Differences between left and right hemisphere strokes

In other words, an ischemic stroke can affect both left hemisphere, so right hemisphere brain. If affected left lobe, this is reflected in speech functions. Below are the main symptoms that can be used to visually identify the source of a major stroke.

Right hemisphere infarction:

Memory impairment and speech may persist, making diagnosis difficult.
Paralysis of the left side of the body.
Paralysis of the facial muscles on the left side.
Passive, depressed state.

Left hemisphere infarction:

Speech apparatus disorders.
Paralysis of the right half of the body.
Paralysis of facial muscles with right side.
Severe mental disorders.
Impaired logical thinking.

Sometimes, if a large stroke affects certain areas, a person loses only specific functions. Thus, with damage to Broca's center in the brain, the patient can speak, but cannot understand and use complex sentences and expresses himself in fragments.

Types of extensive ischemic stroke

Ischemic stroke is a consequence of blockage (thrombosis) or sharp spasm, narrowing of blood vessels in the brain. Unlike hemorrhagic, which involves open bleeding in the brain. In addition to the right and left hemispheres, there are five types of extensive ischemic stroke (main, not counting TIA and short-term attacks):

Lacunar infarction - when perforating vessels are damaged, a cavity, a lacuna, is formed around them, which can be from 0.05 to 4-5 mm in diameter. This type of stroke develops gradually and can even occur during sleep.
Atherothrombic infarction is a consequence of vascular disease, atherosclerosis and the appearance of blood clots. This stroke has a protracted clinical picture; its onset can be predicted by knowing about the presence of a blood clot in the brain.
Hemodynamic infarction is sudden, due to a sudden drop in blood pressure. Most often, a massive stroke happens just like this, cutting off the blood supply to a large location.
Cordioembolic infarction is a blockage of an artery, which can be complete or partial.
Micro occlusion is a violation of hemostasis and fibrinolysis in the blood.

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Prognosis of major stroke

Since for each type of disease the prognosis for stroke involves assessing the extent of the lesion, an extensive infarction gives disappointing results. It is important to take into account the condition of the body, the presence of additional chronic or acute forms diseases. Below are statistics for the CIS:

In approximately 25% of cases, the patient dies instantly or in the first 3-4 weeks after the attack.
Another 60% of patients gain visible signs disability, including nervous system disorders over the same period.
About 40% of people manage to get rid of the consequences of a major stroke. The rehabilitation period is more than a year, improvement noticeably begins to appear only after the first 6 months.
Only 60-70% of those who have suffered a major ischemic stroke survive to the second year, 30% live for more than 5 children.

It should be noted that if a person has suffered a local stroke, the probability of surviving a second attack is 30%. People who have had an extensive form and remain alive have no option to survive after a second attack.

However, there are also comforting statistics: about 37% of people remain alive and can restore at least vital body functions after rehabilitation.

Brainstem extensive ischemic stroke

This subtype is the most severe and virtually incurable, when a vascular infarction occurs within a bundle of nerves in the brain stem. The consequences of such a stroke are instant coma or death. Since all sense organs are affected simultaneously - hearing, vision, problems with breathing and speech, cardiac dysfunction. And as a result of neurosis, there is also tremors in the limbs, complete or partial paralysis of the body and bending of the vertebrae.

Only immediate resuscitation gives a chance for some kind of rehabilitation, at least partial.

Risk group

So, we can distinguish several groups of people who are endowed with risk factors for developing a major stroke. WITH a larger share probabilities are subject to it:

Hypertensive patients and people suffering from blood pressure;
Patients with diseases of the cardiovascular system;
Those who have experienced transient ischemic attacks, more than once; Transient ischemic attacks (TIAs) are a type of attack, in other words, micro-strokes, which, if left untreated, will provoke one large one. Signs include sudden weakness or local numbness of muscles, problems with vision, speech and balance, as well as sudden and causeless headaches.
Diabetics;
People diagnosed with asymptomatic carotid stenosis;
Smokers and alcoholics who abuse other psychotropic substances;
People who are overweight and lead an unhealthy lifestyle.

Symptoms that distinguish a major stroke

If even a couple of them occur, or one that progresses, you should immediately contact the clinic with suspicion of cerebral vascular infarction:

Sharp pain in the head and sudden dizziness;
Weakness, feeling of cottony limbs;
Paralysis or loss of sensation in the limbs;
Weakened vision, objects appear double;
Inability to think coherently, deterioration of speech.

The listed symptoms are considered to be a mild form of stroke. Often, a large ischemic stroke spreads over a large area of the brain and causes loss of consciousness and coma.

Extensive stroke: coma ensued

We call coma the onset of deep unconsciousness body and complete lack of response to the world. Coma can occur instantly, but in 20-25% of cases its appearance is caused by untimely medical care to the patient. Coma brings a disappointing result, as it speaks of deep, irreversible damage to the brain.

Prognosis supported by statistics: after 4 months of being in a coma without relief, the chances of partial recovery drop below 15%. There is no talk of completeness.

In a coma, a person loses not only higher functions brain, but often also control over heartbeat and breathing. It happens that the patient involuntarily opens his eyes, may even laugh or cry, change his facial expression, but does not understand what is happening and does not hear his relatives.

A poor prognosis for coma - the likelihood of death is determined by the following factors: recurrent stroke, non-standard reaction of the brain stem, lack of response to painful stimuli, and the patient’s age over 65 years.

Consequences of extensive cerebral stroke

If the outcome is favorable at the primary stage, i.e. If the vascular infarction is eliminated and the person is conscious, the following consequences are possible:

Weakness, dizziness, loss of spatial orientation;
Paralysis of one half of the body, distortion of the face, and if two hemispheres are affected by an extensive stroke at once, complete paralysis is possible;
Problems with the activity of the speech apparatus, especially in the area of large damage to the left hemisphere;
Problems with the perception of information, analysis, formation and presentation of thoughts;
Local amnesia;
Loss of concentration;
Impaired functioning of the organs of vision, hearing, smell, tactile and pain perception.

Opportunity complete rehabilitation practically excluded in cases of extensive brain damage.

Principles of treatment of extensive cerebral stroke. First aid.

Only immediate hospitalization gives a chance for the body to recover. After a stroke occurs, 3 hours are enough for the brain neurons to die irrevocably. If you want to provide normal life If a person is stricken by a seizure, call an ambulance. Before she arrives, ensure that she is lying down on a horizontal, hard surface. An influx of fresh air into the room or an oxygen mask is also necessary.

The patient must undergo inpatient treatment for ischemic stroke. Taking lump-thinning drugs is combined with intravenous or oral administration of drugs that lower blood sugar. It is also necessary to eliminate the focus of the lacuna or prevent hemorrhage in the brain. Sometimes surgical intervention is necessary.

The patient should immediately undergo examinations - MRI and CT scan of the brain to determine what caused the heart attack and how widespread it is. An ECG is done to analyze the functioning of the cardiovascular system. Further, general analysis blood and detection of inflammatory processes, blood sugar levels, etc. All this is combined with the non-drug rehabilitation programs described below.

The duration of treatment is uncertain; in each individual case, a major stroke is treated in a hospital from 2 weeks to several months.

Recovery and patient care

The most critical stage is the patient’s stay in a coma. At this point, the main thing is to provide all the conditions for normal recovery brain. Relatives should be patient, since extensive vascular infarction puts the patient in a vegetative state for a long time, and this period cannot be reliably predicted.

In a state of coma, hospital doctors should provide medical care, which includes not only taking blood thinning drugs, but also supporting functions respiratory system, saturation of blood with oxygen, regulation of heart activity. Complete sterility and protection against infection must be supported by maintaining physical condition the patient's body.

To avoid bedsores, paralyzed or immobilized vegetative state the patient must be turned over carefully every 2-3 hours, and therapeutic exercises must also be performed. When pain A conscious person can take painkillers only as prescribed by a doctor.

Recovery after the threat of dire consequences has passed can take from 3 months to a year or even several years. Extensive cerebral vascular infarction can be eliminated if the following principles are adhered to:

Physiotherapy – regular visits, possibly at a sanatorium-rehabilitation treatment or hospital;
Therapeutic gymnastics at home, with the help of relatives or independently, to consolidate the results of physiotherapy and correct orthopedic deformities;
Maintaining proper nutrition – atrophied at first gastrointestinal tract During the unconscious state, he will be able to digest only liquid gruel. Then other components are gradually introduced into the menu.

Patients who have suffered a massive cerebral infarction are prohibited from eating eggs, caviar, mayonnaise, margarine and other foods high in cholesterol. Avoid completely or limit intake of sweets, fatty foods, spicy food. The complete diet is prepared by the attending physician.

Refusal is not discussed bad habits. The best way to systematically restore the vital and neurological functions of the body is to stay at a sanatorium-rehabilitation treatment. Here the patient will be provided with professional and comprehensive care, and at the same time the relatives will have time to get used to the current situation in the family.

Home care, prevention of recurrent attacks

To provide a paralyzed or partially incapacitated person who has had a major stroke, home care, his relatives should have courage and patience. It is recommended to attend special training courses where they can teach you what to do in emergency situations how to behave with a patient and provide moral support.

Most main principle home rehabilitation is constant monitoring of the body’s condition. It is advisable to keep a diary of the patient, a kind of medical card, where daily readings of blood pressure, pulse, results of blood tests and MRI will be entered if they are repeated, as well as several notes about the patient’s behavior. In this form, it is possible to control the result of restoration of speech and motor functions.

At first the patient was prescribed bed rest. But you cannot linger at this stage for a long time; the more immobilized the muscles, the more less likely return them to partial functionality. Therefore, after a month to three, depending on how extensive the cerebral infarction was, the person must learn to move independently. First, use a walker to get out of bed, and gradually move on to walking with the support of an accompanying person.

But here are preventive measures that will help avoid such a disease as extensive ischemic stroke (infarction) of the cerebral vessels, even for those who have not encountered such a problem:

Regularly monitor your blood pressure, as the main cause of the disease. If you or a relative are elderly and prone to blood pressure fluctuations, it is recommended to keep records and measure blood pressure in the morning on an empty stomach and before bed.

Rule A: The blood pressure risk zone is in the range from 140-180 (upper range) and 105-140 (lower range). If such indicators appear consistently, consult a doctor immediately.

You should not take blood pressure medications or blood thinners without consulting your doctor. This way you can only harm yourself.
Physical exercise– this is good, but in moderation.

Rule B: It is recommended to give cardio exercise no more than 4 times a week to people aged 20 to 45 years, older - no more than 2-3 times.

Proper nutrition which excludes harmful, fried, fatty, sweet food, sharp components. Try to dilute the menu with fresh vegetables and fruits. For example, citrus fruits cleanse the blood well and stimulate brain function.
Even if your job involves a lot of stress, find time to relax. At least 10 minutes of gymnastics during a break will prolong your life and delay cerebral infarction.
It is recommended to spend time in the fresh air more often.
Stop smoking and drink alcohol in moderation.

Rule B: Quitting alcohol may leave you free to drink in moderation. A glass of dry red wine will be good for the stomach and heart. But no more.

You should control your weight. It has been proven that extensive heart attacks occurred more often in people with excess body weight due to obesity and vascular thrombosis.
Smile more often, enjoy life.

Rule D: if an extensive ischemic infarction has been registered in the family, this is the first alarm signal even for the younger generation. People may be genetically predisposed to this disease.

conclusions

Extensive heart attack - terrible disease, the risk of which hovers over every third elderly person in our country. There are enough reasons for this - bad genetics, ecology, constant stress, poor nutrition, sedentary lifestyle life. Since the consequences are often irreversible, it is better to prevent the risk of occurrence at this stage of your life. If a massive cerebral stroke does occur, the patient’s relatives need to have restraint, provide correct and timely treatment and care, and not lose optimism, which should be passed on to the patient.

You are at risk if:

experience sudden headaches, “flickering of spots” and dizziness;
pressure “jumps”;
feel weak and get tired quickly;
Are you irritated over trifles?

All these are harbingers of a stroke! E. Malysheva: “Timely noticed signs, as well as prevention, 80% help prevent stroke and avoid terrible consequences! To protect yourself and your loved ones you need to take a cheap remedy..."

Pushkareva Daria Sergeevna

Neurologist, website editor

Cerebral infarction is a condition that develops as a result of acute disorder cerebral circulation and leading to the appearance of various neurological symptoms. The disease can affect people of any age, but it most often affects older people. Recognizing the disease is usually simple, as patients present with typical, specific symptoms. Neurologists are treating him.

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Characteristics of cerebral infarction

Differences between ischemic and hemorrhagic stroke

Cerebral infarction is also called ischemic stroke. Central nervous system is well supplied with blood and reacts sharply to insufficient supply of oxygen, glucose and other food products.

By various reasons there may be a disruption in the flow of blood to certain areas of the brain, and this leads to the appearance typical symptoms diseases.

Ischemic stroke is often a complication of one or another pathology of the cardiovascular system. The classification of the disease includes the etiological factor of the disease, and depending on it, the following types of cerebral infarction are distinguished:

Atherothrombotic stroke. Occurs as a result of atherosclerotic damage to the blood vessels of the brain.
Cardioembolic stroke. It develops against the background of disturbances in the functioning of the heart - arrhythmias, valve defects, myocardial infarction.
Lacunar stroke. It develops as a result of damage to a small-caliber vessel.
Cerebral infarction caused by other causes. Among them are: vasculitis, hypercoagulable states of the blood, stratification of the vascular wall.
Idiopathic (unknown origin) ischemic stroke. In this case, it is not possible to establish the cause of the acute circulatory disorder.

A separate type is a transient state, or small stroke. It is characterized by the appearance of characteristic symptoms of cerebral infarction, but they disappear within a few hours or days.

Periods of illness

The stage of the course of cerebral infarction is very important, since if the time of onset of the disease is known, it is possible to decide on the use of certain methods of treatment and rehabilitation. During an ischemic stroke, several periods are distinguished:

The first period is the most acute. It lasts for three days. If symptoms disappear during this time, the diagnosis is interpreted as a transient ischemic attack.
The second period is acute. Lasts no more than four weeks. This is the time for the establishment and strengthening of characteristic symptoms.
The third period is early recovery. Its duration is up to six months. Acute symptoms begin to decrease and disturbances in the functioning of the neuromuscular system are established. At this time, it is necessary to use rehabilitation measures to the maximum.
The fourth period is late recovery. Its duration is no more than two years. The patients' condition improves, but persistent disorders of the neuromuscular system remain.
And the fifth period is of residual phenomena. All the time after two years. Patients are left with lifelong disabilities that cannot be rehabilitated.

Causes of ischemic stroke

Formation of ischemic stroke

In 90% of cases, stroke occurs as a result of atherosclerosis of cerebral arteries and vessels cervical region. It appears in the background arterial hypertension, cardiogenic embolism or diabetes mellitus.

The main factor in the development of the disease is atherosclerosis - a disease that affects the vessel wall and forms plaques on it. They not only reduce the lumen of the arteries, but can also come off from the wall and clog smaller vessels.

Often the atherosclerotic process is complicated by superficial thrombosis, since the body reacts to the presence of plaques as if it were damaged and platelets begin to apply to the site of the lesion. This connection of plaque with blood cells has an even greater risk of rupture and thrombosis of the arteries.

Against the background of thrombosis, ischemia of brain tissue develops. For some time this condition is compensated and there are no manifestations of diseases. Only in the case of complete occlusion (impaired patency) or a long-term decrease in perfusion (blood supply) does ischemia (insufficient blood supply) of nerve cells occur, which subsequently develops into softening and necrosis of brain tissue.

Predisposing and provoking factors of the disease are:

Having a history of transient ischemic attacks or strokes. It is noted that in 40% of cases, ischemic strokes develop in such patients within five years.
High blood pressure and hypertensive crises. The likelihood of developing a cerebral infarction in such patients is five times higher than in people with normal blood pressure.
Increased blood lipids (hypertriglyceridemia and hypercholesterolemia).
Age over 60 years. In older people, the risk of the disease is six times higher compared to patients 45-50 years old.
Atrial fibrillation.
Diabetes. Increases the risk of disease by four times.
Cardiac ischemia. The risk increases 2-4 times.
Obesity.
Bad habits. Smoking increases the risk of stroke fourfold.
Physical inactivity.
Use hormonal contraceptives also increases the risk of strokes.

Mechanism of disease development

The basis of the disease is a focal lesion of a region of the brain. This condition occurs when there is a decrease in blood flow to the nervous tissue. If per minute there is less than 10 ml of incoming blood per 100 g of nervous tissue, irreversible changes begin to develop - a heart attack. If this level of blood supply is maintained for 6-8 minutes, then a focus of necrosis forms in the brain.

Zones of the affected area of brain tissue during a stroke

A zone of ischimization (penumbra) always appears around the area of necrosis. Blood supply in this area is more than 10 ml, but significantly lower normal level, and nerve cells cannot perform their function fully, but remain viable for some time. If thrombolysis (dissolve blood clots) is not performed within three hours (maximum six) from the onset of the disease, then the ischemic zone turns into necrosis.

The clinic called these 3-6 hours the “therapeutic window.” This is the time during which nerve cells can maintain their vital activity, and the changes that have developed in them remain reversible.

The ischemic zone is followed by an oligemic zone, where blood supply is also reduced, but there is no risk of cell death.

Without timely assistance, inflammatory processes begin to develop in the area of the heart attack, which lead to swelling of the brain substance. The size of the edema will depend on the size of the ischemic stroke. The most dangerous and life-threatening complications of edema are dislocation of the brain and wedging of the trunk into the foramen magnum.

Manifestations of the disease

Symptoms of a stroke

Characteristic of cerebral infarction acute onset and rapid development of symptoms. It can be divided into two large groups - general cerebral and focal. Focal ones include:

The occurrence of central hemiparesis (impaired muscle strength and sensitivity in the limbs on one side).
Speech impairment.
Violation of facial symmetry.
Development sudden blindness on the right or left eye.
Changes in sensitivity in different parts of the body, more often - hemianesthesia (lack of sensitivity on one side of the body).
Asymmetrical language.
Nystagmus (twitching) eyeballs when looking to the side).
Anisocoria (differences in pupil size).

In the most acute and acute stage in the affected limbs there is a decrease muscle tone and tendon peflexes. But after a few days or weeks, stroke patients experience increased muscle tone. IN upper limbs Hypertonicity is more pronounced in the flexors, and in the lower ones - in the extensors.

Facial asymmetry - common symptom onset of cerebral infarction

Therefore, patients after a cerebral infarction have a characteristic appearance. The arm on the paralyzed side is bent at the elbow and brought towards the body, and the leg describes a semicircle when gait (“mower’s gait”).

General cerebral symptoms include:

disturbance of consciousness;
changes in memory and attention;
decreased intelligence;
mental disorders;
headache.

Patients with strokes in acute period very often they are not oriented in place and time. They do not recognize loved ones and cannot adequately assess the situation. They cannot name objects by name, although they know their purpose. They cease to understand heard or written speech, do not recognize ordinary objects by touch, etc.

A typical picture of the onset of a stroke:

In patients, against the background of absolute or relative well-being, severe weakness occurs or sensitivity disappears in the limbs, face and, most importantly, on any half of the body.
Vision impairment occurs on one side or both.
Severe dizziness appears.
Patients find it difficult to speak or cease to understand words spoken to them.
There is a loss of coordination and balance, most often this symptom is combined with other manifestations - impaired sensitivity, double vision, weakness, and so on.
A sharp development of disturbances of consciousness, combined with a decrease in muscle tone or a complete absence of movements in the limbs on one side of the body.

You need to be especially vigilant about the above symptoms if the patient has risk factors.

The severity and severity of disorders during strokes primarily depends on the location and extent of brain damage.

Treatment

Patients diagnosed with cerebral infarction must be urgently hospitalized in a neurological department or intensive care unit, where they are given thrombolysis in the first hours.

This method involves the administration of drugs that have the ability to resolve blood clots. To do this, patients are administered intravenously or intra-arterially with drugs such as Actilyse, streptokinase, etc. Treatment with these drugs is carried out under strict control, and the blood is tested every 2-3 hours for clotting ability. Thrombolysis is contraindicated in hemorrhagic stroke, so it is very important to differentiate these two similar conditions.

Basic therapy for cerebral infarction includes:

normalization of respiratory function and cardiovascular system;
regulation and control of homeostasis (levels of electrolytes, glucose, etc.);
monitoring and maintenance normal temperature bodies;
symptomatic therapy.

In case of breathing problems or absence, patients are given oxygen therapy. If patients are experiencing moderate shortness of breath, they are given oxygen mixtures through nasal cannulas or masks. If there is no breathing, intubation is performed and a ventilator is connected.

Nutrition plays an important role in the recovery of the patient. It must be started no later than two days from the onset of the disease. If the patient is unconscious, tube feeding is performed.

The consequences of strokes in the form of speech impairment, paresis and paralysis are eliminated with the help of therapeutic methods, as well as rehabilitation. It includes a set of therapeutic and preventive measures aimed at restoring lost motor and speech functions of a person. For this purpose, therapeutic and recreational activities are carried out, including physical therapy, massage, electrical muscle stimulation, mechanotherapy and other physiotherapeutic techniques. To restore speech function, rehabilitation is carried out by neurologists together with speech therapists or audiologists.

Drug treatment

In order to normalize the functioning of the cardiovascular system, hypo- or hypertensive therapy is carried out, which should be aimed at a gradual decrease or increase in blood pressure. To reduce blood pressure, medications such as labetalol, captopril, enalapril, and clonidine are prescribed. In patients with hypotension, administration infusion solutions sodium chloride, polyglucin, and dopamine or norepinephrine are also administered.

It is very important to regulate water and electrolyte metabolism in the first days of the disease. Depending on certain violations, various saline solutions(sodium chloride, potassium chloride, sodium bicarbonate, calcium chloride, etc.). Patients with diabetes mellitus Be sure to stabilize blood glucose levels. For this purpose, insulin and potassium are administered.