Reduced blood flow to the brain. Poor blood circulation to the brain, symptoms of pathology

For normal operation brain required large number blood, which is a natural oxygen transporter. Damage to the main arteries, venous and jugular veins, due to the development of thrombosis, embolism, aneurysms, etc. leads to serious oxygen deficiency, tissue death and loss of certain vital functions for the body. Poor blood circulation in the brain is a serious pathology that requires urgent treatment.

Features of blood supply to the brain

According to the most rough estimates, the human brain contains about 25 billion nerve cells. There is a hard and soft shell, gray and white matter.

The brain consists of five main sections: terminal, posterior, intermediate, middle and medulla, each of which performs its own necessary function. Obstructed blood supply to the brain leads to disruptions in coordinated work departments, death of nerve cells. As a result, the brain loses certain functions.

Signs of circulatory problems in the head

Initially, symptoms of poor circulation are of low intensity or not observed at all. But as the disorders develop, clinical manifestations become more and more obvious.

Symptoms of the disease include:

If the blood circulation of the brain is impaired, oxygen starvation occurs, causing a gradual increase in the intensity of symptoms. Each of the manifestations may indicate a number of other diseases and requires mandatory contact with a neurologist.

Causes of obstructed blood supply to the brain

The anatomy of the blood supply has complex structure. Transport of oxygen and other nutrients is carried out through four arteries: vertebral and internal.

For normal functioning, the brain needs to receive about 25-30% of the oxygen supplied to the body. The supply system comprises about 15% of the total blood volume found in the human body.

Insufficient blood circulation has symptoms that make it possible to determine the presence of certain disorders.

The cause of the development of pathology is:

Whatever the cause of circulatory failure, the consequences of the disorders are reflected not only in the activity of the brain itself, but also in the functioning of the internal organs. Treatment outcome is influenced by accuracy established cause- catalyst and timely elimination of violations.

What are the dangers of poor blood flow problems in the brain?

A severe disruption of the blood circulation in the brain leads to serious complications. The consequences of an attack can be:

• Ischemic stroke – accompanied by nausea and vomiting. At focal lesion affects the functioning of individual internal organs. Affects motor and speech function.
• Hemorrhagic stroke - disorders are provoked by blood entering the brain area. As a result of increased pressure, the brain is compressed, and tissue is wedged into the foramen magnum. The high speed of blood flow in the vessels of the brain leads to a rapid deterioration of the patient's condition. Hemorrhagic stroke leads in the number of deaths.
• Transient ischemic attack is a temporary lesion. Blood circulation can be restored with the help of medications that improve brain activity and stimulate hematopoiesis.
  A transient attack is observed mainly in elderly patients. The attack is accompanied by motor and visual function, numbness and paralysis of the limbs, drowsiness and other symptoms.

Depletion of peripheral blood flow is most often observed in the old age of the patient and leads to the development of chronic insufficiency of blood supply to the brain. As a result, the patient's mental activity is inhibited. A decrease in intelligence and abilities is diagnosed. The pathology is accompanied by absent-mindedness, irritability, and extremely aggressive behavior.

Cerebral blood flow disorders in children

For children minimum indicators blood flow in the arteries, sufficient for normal brain function, is 50% higher than in adults. For every 100 gr. brain tissue requires about 75 ml. blood per minute.

A change in the total indicator of cerebral blood flow of more than 10% is critical. In this case, there is a change in the tension of oxygen and carbon dioxide, which leads to serious disturbances in brain activity.

In both adults and children, the brain is supplied with blood by several main arteries and vessels:

• The middle cerebral artery supplies blood deep sections brain and eyeball. The internal one is responsible for nourishing the cervical region, scalp and face.
• The posterior cerebral artery supplies blood to the occipital lobes of the hemispheres. This task is helped by small blood vessels that directly supply the deep parts of the brain: gray and white matter.
• Peripheral circulation - controls the collection of venous blood from the gray and white matter.

Essentially, cerebral blood flow is special system blood circulation and transfer of nutrients and oxygen to brain tissue. The system contains carotid, cerebral and vertebral arteries, as well as jugular veins and the blood-brain barrier. The blood supply areas of the cerebral arteries are distributed in such a way as to abundantly supply each area of ​​soft tissue with oxygen.

Control over the operation of the system is carried out thanks to a complex regulatory mechanism. As brain tissue continues to develop after birth, new synapses and neural connections, any disturbances in the blood circulation of the brain in a newborn affect his mental and physical development. Hypoxia is fraught with complications at a later age.

When solving a mathematical problem or any other mental load, an increase in the speed parameters of blood flow through the cerebral arteries is observed. Thus, the regulation process responds to the emerging need for more glucose and oxygen.

Why do newborns have problems with blood supply to the brain?

Among the many reasons due to which disturbances in the blood supply to the brain develop, only two main ones can be identified:

Why is impaired blood supply to the head dangerous for a baby?

For the normal development of a child, the volume of incoming blood in relation to brain tissue is required to be 50% greater than that of an adult. Deviations from the norm affect mental development.

The complexity of therapy lies in the fact that when prescribing drugs that improve blood circulation in the vessels of the brain, the doctor must take into account the effect of drugs on the still fragile structures of the child’s life: the gastrointestinal tract, nervous system etc.

The consequence of a lack of blood supply is:

1. Poor concentration.
2. Problems in learning.
3. Borderline intellectual disability.
4. Development of hydrocephalus and cerebral edema.
5. Epilepsy.

Treatment of cerebral circulation begins from the first days of life. There is a possibility of death. Hypoxia negatively affects the functionality of the brain and internal organs.

How to check the blood supply to the brain

Suspicions of insufficient blood supply to brain tissue arise when there is neurological symptoms and violations. To determine the factors of damage and prescribe the necessary therapy, additional examination is carried out using instrumental methods for studying blood circulation:

Any drugs, tablets, injections and other medications are prescribed only after a complete examination of the patient and identification of the problem that has affected the deterioration of blood supply to the brain.

How and how to improve cerebral circulation

Based on the results diagnostic study are selected medications, making cerebral circulation better. Since the cause of disorders is a variety of factors, the course of therapy for one patient may not coincide with what is prescribed for another patient.

What improves blood circulation, what medications

There is no one medicine to improve blood circulation in the brain that can eliminate disorders. For any deviation, a course of therapy is prescribed, including one or more drugs from the following groups:

Some drugs have a special purpose. Thus, Cortexin, in the form of intramuscular injections, is recommended for use during pregnancy and after the birth of a child with pronounced encephalopathy. Emoxipine is used for internal bleeding. Available in the form of intravenous injections.

New generation drugs are constantly appearing that have fewer negative side effects. side effects. Appoints drug therapy exclusively the attending physician. Self-medication is strictly prohibited!

How to improve blood flow without drugs

At the initial stage, it is possible to improve blood supply to the brain without the help of medications. There are several ways to influence a person’s well-being:

It would be useful to include in your therapy the intake of vitamins E and C, which increase blood flow, and also to visit a nutritionist in order to select an effective therapeutic diet.

Folk remedies for improving blood supply to the brain

Treatment of cerebral circulatory disorders with folk remedies does not eliminate the need to receive professional medical care. Unconventional methods therapy effectively relieves symptoms of disorders:

Herbs that improve blood flow may cause bleeding. Before taking herbal tinctures, it is recommended to consult with your doctor.

Breathing exercises to improve blood circulation

The set of exercises is aimed at enriching the blood with oxygen. There are several types of breathing exercises.

Like any effective remedy, exercise without proper supervision and preparation can be dangerous. The first lessons should be conducted together with an instructor.

Breathing exercises are present in yoga and other eastern gymnastics. Effective methods were also developed by compatriots. Thus, Streltsova’s method deserves special mention, as it allows you to quickly restore lost brain functions.

Exercises and gymnastics

Exercise therapy to improve the patient’s well-being is aimed at the source-catalyst of the problem. During exercise, blood pressure and the functioning of the cardiovascular system are normalized.

The following types of gymnastics are optimal:

1. Yoga.
2. Qigong.
3. Pilates.
4. Classes in the pool, swimming.

Caution when prescribing exercises should be observed in the presence of blood clots or high blood pressure.

Diet for poor cerebral circulation

We are what we eat! Life itself proves the truth of this statement. A person’s diet and eating habits have a negative or positive effect on the blood supply to the brain.

What foods improve blood flow

Products that improve blood counts include:

1. Fatty fish.
2. Seafood.
3. Dairy products.
4. Vegetables and fruits, especially rich in iron vitamins.

The diet must include herbal remedies that improve blood circulation: oils (sunflower and olive). Plant food, foods containing zinc are also necessary to restore blood circulation.

Foods that are harmful to the blood supply to the brain

If blood circulation is poor, you should avoid rich and saturated foods. fatty acids products.

The following are prohibited:

1. Sugar.
2. Sweets and baked goods.
3. Smoked and fatty foods.
4. Flavorings and synthetic seasonings.
5. Carbonated and alcoholic drinks.

A complete list of harmful and healthy products can be obtained from a neurologist who treats disorders of the blood supply to the brain.

Alcohol and cerebral circulation

Moderate doses of alcohol have a beneficial effect on the blood supply to the brain, preventing blockage of blood vessels. We are talking about small or moderate portions.

Alcohol abuse is harmful to humans. With prolonged abuse, there is a high probability of developing hemorrhagic stroke, which can be fatal.

According to a recent study published in Stroke: Journal of the American Heart Association, moderate consumption improves blood circulation, while excessive consumption leads to brain cell atrophy.

IN recent years the mortality rate from pathological lesions cerebral vessels, which were previously associated with the aging of the body and were diagnosed only in elderly people (after 60 years). Today, the symptoms of cerebrovascular accident have become younger. And people under 40 often die from strokes. Therefore, it is important to know the causes and mechanism of their development, so that diagnostic and therapeutic measures gave the most effective results.

What are cerebrovascular accidents (CVA)

The vessels of the brain have a unique, perfect structure that ideally regulates blood flow, ensuring the stability of blood circulation. They are designed in such a way that when the flow of blood into the coronary vessels increases approximately 10 times during physical activity, the amount of circulating blood in the brain, with increasing mental activity, remains at the same level. That is, a redistribution of blood flow occurs. Some of the blood from parts of the brain with less load is redirected to areas with increased brain activity.

However, this perfect circulatory process is disrupted if the amount of blood entering the brain does not satisfy its need for it. It should be noted that its redistribution across brain regions is necessary not only for its normal functionality. It also occurs when various pathologies occur, for example, (narrowing) or obstruction (closure). As a result of impaired self-regulation, the speed of blood movement slows down in certain areas of the brain and their.

Types of MC violations

There are the following categories of blood flow disorders in the brain:

1. Acute (stroke), which occurs suddenly with a long course, and transient, the main symptoms of which (visual impairment, loss of speech, etc.) last no more than a day.
2. Chronic, caused by. They are divided into two types: origin and caused.

Acute cerebrovascular accidents (ACI)

Acute cerebrovascular accident causes persistent disorders brain activity. It comes in two types: and (it is also called cerebral infarction).

Hemorrhagic

Etiology

Hemorrhage (hemorrhagic disturbance of blood flow) can be caused by various arterial hypertension, congenital, etc.

Pathogenesis

As a result of an increase in blood pressure, plasma and the proteins contained in it are released, which leads to plasma saturation of the walls of blood vessels, causing their destruction. A peculiar hyaline-like specific substance (a protein whose structure resembles cartilage) is deposited on the vascular walls, which leads to the development of hyalinosis. The vessels resemble glass tubes, lose their elasticity and ability to maintain blood pressure. In addition, the permeability of the vascular wall increases and blood can freely pass through it, soaking the nerve fibers (diapedetic bleeding). The result of such transformations can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. Thus, hemorrhage occurs as a result of:

• Plasmic impregnation of the walls of blood vessels of the white medulla or visual thalamus;
• Diapedetic bleeding;
• Microaneurysm formations.

Hemorrhage in acute period characterized by the development of hematomas due to wedging and deformation of the brain stem into the tentorial foramen. In this case, the brain swells and extensive edema develops. Secondary hemorrhages occur, smaller ones.

Clinical manifestations

Usually occurs during the day, during physical activity. Suddenly your head starts to hurt and you feel nauseous. Consciousness is confused, the person breathes quickly and whistlingly, it occurs, accompanied by hemiplegia (one-sided paralysis of the limbs) or hemiparesis (weakening of motor functions). Basic reflexes are lost. The gaze becomes motionless (paresis), anisocoria (pupils of different sizes) or divergent strabismus occurs.

Treatment

Treatment of cerebrovascular accidents of this type includes intensive therapy, the main goal of which is to reduce blood pressure, restore vital (automatic perception of the outside world) functions, stop bleeding and eliminate cerebral edema. The following medications are used:

1. Reducing - ganlioblockers ( Arfonad, Benzohexanium, Pentamin).
2. To reduce the permeability of vascular walls and increase blood clotting - Dicynone, vitamin C, Vikasol, Calcium gluconate.
3. To increase blood rheology (fluidity) - Trental, Vinkaton, Cavinton, Eufillin, Cinnarizin.
4. Inhibiting fibrinolytic activity - ACC(aminocaproic acid).
5. Decongestant - Lasix.
6. Sedatives.
7. To reduce intracranial pressure, a spinal puncture is prescribed.
8. All drugs are administered by injection.

Ischemic

Etiology

ischemic cerebrovascular accident due to atherosclerotic plaque

Ischemic circulatory disorders are most often caused by atherosclerosis. Its development can be provoked by severe anxiety (stress, etc.) or excessive physical activity. May occur during night sleep or immediately upon awakening. Often accompanies a pre-infarction state or.

Symptoms

They may appear suddenly or grow gradually. They manifest themselves in the form of headaches, hemiparesis on the side opposite to the lesion. Impaired motor coordination, as well as visual and speech disorders.

Pathogenesis

An ischemic disorder occurs when a specific area of ​​the brain receives sufficient quantity blood. In this case, a focus of hypoxia arises, in which necrotic formations develop. This process is accompanied by disruption of basic brain functions.

Therapy

Treatment uses injections of medications to restore normal functioning. cardiovascular system. These include: Korglykon, Strophanthin, Sulphocamphocaine, Reopoliklyukin, Cardiamin. Intracranial pressure decreases Mannitol or Lasix.

Transient cerebrovascular accident

Transient cerebrovascular accident (TCI) occurs against the background of arterial hypertension or atherosclerosis. Sometimes the reason for its development is their combination. The main symptoms of PNMK are as follows:

• If the focus of the pathology is located in the carotid vessels, the patient becomes numb in half of the body (on the side opposite to the lesion) and part of the face around the lips, paralysis or short-term paresis of the limbs is possible. Speech is impaired and an epileptic seizure may occur.
• If the patient's blood circulation is impaired, the patient's legs and arms become weak, it is difficult for him to swallow and pronounce sounds, and photopsia occurs (the appearance of luminous spots, sparks, etc. in the eyes) or diplopia (doubling of visible objects). He becomes disorientated and has memory lapses.
• Signs of cerebrovascular accident due to hypertension are as follows: a severe headache and eyeballs, the person experiences drowsiness, he experiences ear congestion (like on an airplane during takeoff or landing) and nausea. The face turns red and sweating increases. Unlike strokes, all these symptoms disappear within 24 hours. For this they received the name.

Treatment of PNMK is carried out with antihypertensive, tonic and cardiotonic drugs. Antispasmodics are used, and. The following medications are prescribed:

Dibazol, Trental, Clonidine, Vincamine, Euphyllin, Cinnarizine, Cavinton, Furasemide, beta blockers. Alcohol tinctures of ginseng and Schisandra chinensis are used as tonics.

Chronic cerebrovascular accidents

Chronic cerebrovascular accident (CVA), unlike acute forms develops gradually. There are three stages of the disease:

1. At the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person gets tired quickly, his sleep is disturbed, he often hurts and feels dizzy. He becomes hot-tempered and absent-minded. His mood often changes. He forgets some minor points.
2. At the second stage, chronic cerebrovascular accident is accompanied by significant memory deterioration, and minor motor dysfunctions develop, causing unsteadiness of gait. It appears in my head constant noise. A person perceives information poorly, having difficulty concentrating his attention on it. He is gradually deteriorating as a person. Becomes irritable and unconfident, loses intelligence, reacts inadequately to criticism, and often becomes depressed. He constantly feels dizzy and has a headache. He always wants to sleep. Efficiency is reduced. He adapts poorly to socially.
3. In the third stage, all symptoms intensify. Personality degradation turns into memory loss. Having left home alone, such a person will never find his way back. Motor functions are impaired. This manifests itself in hand tremors and stiffness of movements. Speech impairment and uncoordinated movements are noticeable.

Cerebrovascular accident is dangerous because if treatment is not carried out in the early stages, neurons die - the main units of the brain structure, which cannot be resurrected. Therefore, diagnosing the disease in the early stages is so important. It includes:

• Identification of vascular diseases that contribute to the development of cerebrovascular accidents.
• Making a diagnosis based on patient complaints.
• Conducting a neuropsychological examination using the MMSE scale. It allows you to detect cognitive impairment by testing. The absence of violations is indicated by 30 points scored by the patient.
• Duplex scanning to detect damage to cerebral vessels due to atherosclerosis and other diseases.
• Magnetic resonance imaging, which allows identifying small hypodense (with pathological changes) foci in the brain.
• Clinical blood tests: complete blood count, lipid spectrum, coagulogram, glucose.

Etiology

The main causes of cerebrovascular accident are as follows:

1. Age. They mainly occur in people who have entered their fifth decade.
2. Genetic predisposition.
3. Traumatic brain injuries.
4. Overweight. Obese people often suffer from hypercholesterolemia.
5. Physical inactivity and increased emotionality (stress, etc.).
6. Bad habits.
7. Diseases: diabetes mellitus (insulin-dependent) and atherosclerosis.
8. Hypertension. High blood pressure- the most common cause of strokes.
9. In old age, problems with blood flow in the brain can result from:
   • ciliated,
   • various diseases of the hematopoietic organs and blood,
   • chronic,

Treatment

For chronic disorders of blood flow in the brain all therapeutic measures are aimed at protecting brain neurons from death as a result of hypoxia, stimulate metabolism at the neuronal level, normalize blood flow in brain tissue. Medicines for each patient are selected individually. They should be taken in a strictly prescribed dosage, constantly monitoring blood pressure.

In addition, for cerebral circulatory disorders accompanied by neurological manifestations, antioxidants, vasodilators, drugs that increase blood microcirculation, sedatives and multivitamins are used.

Chronic cerebrovascular accident can also be treated using traditional medicine, using various herbal teas and herbal teas. Particularly useful is an infusion of hawthorn flowers and a collection that includes chamomile, cudweed and motherwort. But they should be used as an additional treatment course that enhances the main drug therapy.

People with increased weight who are at risk for developing atherosclerosis due to diabetes need to pay attention to nutrition. There are for them special diets, which you can learn about from a nutritionist who monitors the organization of nutrition for patients undergoing treatment in an inpatient department of any hospital. Dietary products include everything of plant origin, seafood and fish. But milk products, on the contrary, should be low in fat.

If cholesterolemia is significant and the diet does not give the necessary results, medications included in the group are prescribed: Liprimar, Atorvakar, Vabarin, Torvacard, Simvatin. With a large degree of narrowing of the lumen between the walls carotid arteries(more than 70%) requires carotid ( surgical operation), which is executed only in specialized clinics. For stenosis less than 60%, conservative treatment is sufficient.

Rehabilitation after acute cerebrovascular accident

Drug therapy can stop the progression of the disease. But she is unable to regain the ability to move. Only special gymnastic exercises can help with this. You need to be prepared for the fact that this process is quite long and be patient. The patient’s relatives must learn to perform massage and therapeutic exercises, since they will have to do them for him for six months or more.

Kinesiotherapy is indicated as the basis for early rehabilitation after dynamic cerebrovascular accident in order to fully restore motor functions. It is especially necessary in the restoration of motor skills, as it contributes to the creation of a new model of the hierarchy of the nervous system for the physiological control of the motor functions of the body. The following techniques are used in kinesitherapy:

1. Gymnastics “Balance”, aimed at restoring coordination of movements;
2. Feldenkrais reflex exercise system.
3. The Voight system, aimed at restoring motor activity by stimulating reflexes;
4. Microkenisotherapy.

Passive gymnastics “Balance” is prescribed to every patient with cerebrovascular accidents as soon as consciousness returns to him. Usually, relatives help the patient perform it. It includes kneading the fingers and toes, flexing and straightening the limbs. Exercises begin to be performed from the lower extremities, gradually moving upward. The complex also includes kneading the head and cervical regions. Before starting the exercises and finishing the gymnastics, you should use light massaging movements. It is imperative to monitor the patient's condition. Gymnastics should not cause him to become overtired. The patient can independently perform eye exercises (squinting, rotating, fixing the gaze at one point, and some others). Gradually, with improvement general condition the patient's load is increased. An individual recovery method is selected for each patient, taking into account the characteristics of the course of the disease.

Photo: basic passive gymnastics exercises

Feldenkrais Method is a therapy that has a gentle effect on the human nervous system. It promotes the complete restoration of mental abilities, motor activity and sensuality. It includes exercises that require smooth movement when performed. The patient must focus on their coordination, making each movement meaningfully (consciously). This technique forces one to divert attention from the existing health problem and concentrate it on new achievements. As a result, the brain begins to “remember” previous stereotypes and returns to them. The patient constantly studies his body and its capabilities. This allows you to find quick ways to get him moving.

The technique is based on three principles:

• All exercises should be easy to learn and remember.
• Each exercise must be performed smoothly, without overstraining the muscles.
• While performing the exercise, the sick person should enjoy the movement.

But most importantly, you should never divide your achievements into high and low.

Additional rehabilitation measures

Widely practiced breathing exercises, which not only normalizes blood circulation, but also relieves muscle tension arising under the influence of gymnastic and massage loads. In addition, it regulates respiratory process after performing therapeutic exercises and gives a relaxing effect.

In case of cerebrovascular accidents, the patient is prescribed bed rest for a long time. This can lead to various complications, for example, disruption of natural ventilation of the lungs, the appearance of bedsores and contractures (mobility in the joint is limited). Prevention of bedsores involves frequent changes of position of the patient. It is recommended to turn him over on his stomach. At the same time, the feet hang down, the shins are located on soft pillows, and under the knees there are cotton wool discs covered with gauze.

1. Place the patient's body in a special position. In the first days, he is transferred from one position to another by his relatives caring for him. This is done every two or three hours. After stabilizing blood pressure and improving the general condition of the patient, they are taught to do this on their own. Getting the patient into bed early (if well-being allows) will prevent contractures from developing.
2. Perform the massage necessary to maintain normal muscle tone. The first days it includes light stroking (if muscle tone is increased) or kneading (if muscle tone is decreased) and lasts only a few minutes. In the future massage movements are intensifying. Rubbing is allowed. The duration of massage procedures also increases. By the end of the first half of the year, they can be completed within an hour.
3. Perform exercise therapy exercises, which, among other things, effectively combat synkinesis ( involuntary contractions muscles).
4. A good effect is achieved by vibration stimulation of paralyzed parts of the body with an oscillation frequency of 10 to 100 Hz. Depending on the patient’s condition, the duration of this procedure can vary from 2 to 10 minutes. It is recommended to carry out no more than 15 procedures.

For cerebrovascular accidents, it is also used alternative methods treatment:

• Reflexology, including:
  1. Treatment with odors (aromatherapy);
  2. classic version of acupuncture;
  3. acupuncture at reflex points located on the ears (auricolotherapy);
  4. acupuncture biologically active points on the hands (su-Jack);
• Pine baths with the addition of sea salt;
• Oxygen baths.

Video: rehabilitation after a stroke, program “Live Healthy!”

Read more about comprehensive rehabilitation after strokes and ischemic attacks.

Consequences of NMC

Acute cerebrovascular accident has severe consequences. In 30 cases out of a hundred, people who have suffered this disease become completely helpless.

1. He cannot eat or perform independently hygiene procedures, getting dressed, etc. Such people have a completely impaired ability to think. They lose track of time and have absolutely no orientation in space.
2. Some people retain the ability to move. But there are many people who, after a cerebrovascular accident, remain bedridden forever. Many of them maintain a clear mind, understand what is happening around them, but are speechless and cannot express their desires and feelings in words.

Disability is a sad result of acute and in many cases chronic cerebrovascular accident. About 20% of acute cerebrovascular accidents are fatal.

But there is an opportunity to protect yourself from this serious illness, regardless of which category of classification it belongs to. Although many people neglect it. This - attentive attitude to your health and all the changes occurring in the body.

• Agree that healthy person There should be no headaches. And if you suddenly feel dizzy, it means that some kind of deviation has arisen in the functioning of the systems responsible for this organ.
• Evidence of problems in the body is elevated temperature. But many people go to work when it is 37°C, considering it normal.
• Is there a short term? Most people rub them without asking the question: why is this happening?

Meanwhile, these are the companions of the first minor changes in the blood flow system. Often an acute cerebrovascular accident is preceded by a transient one. But since its symptoms go away within 24 hours, not every person rushes to see a doctor to undergo an examination and receive the necessary drug treatment.

Today, doctors have effective drugs -. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one “but”. To achieve maximum effect, they must be administered to the patient within three hours after the first symptoms of a stroke appear. Unfortunately, in most cases, seeking medical help is too late, when the disease has reached a severe stage and the use of thrombolytics is no longer useful.

Video: blood supply to the brain and the consequences of stroke

The spinal cord and brain are responsible for the most important processes in the body; failure in their work leads to the development of various diseases. The cause of many pathologies can be a violation of cerebral circulation. What are the reasons for this process, and what therapeutic measures should be taken to eliminate it? This and much more will be discussed in this article.

Head and spinal cord The human body is penetrated by many blood vessels through which blood circulates at a certain speed and pressure. It carries oxygen and nutrients, allowing a person to fully perform many vital functions.

Poor blood circulation in the brain occurs when there is insufficient blood supply to its areas. This process is accompanied unpleasant symptoms, untimely treatment leads to serious complications (oxygen starvation, etc.).

Main causes of the disease

Scientists have identified the main risk factors that provoke cerebral circulatory failure:

• genetic inheritance;
• congenital or acquired thin and fragile blood vessels;
• vascular diseases (atherosclerosis, etc.);
• increased blood viscosity;
• disturbances in the functioning of the heart (defects, changes in its rhythm, etc.);
• increased blood pressure;
• disorders in the musculoskeletal system;
• diabetes mellitus;
• overweight;
• excessive abuse of alcohol and tobacco products;
• taking a specific group of medications ( hormonal contraceptives or drugs that change the rheological properties of blood);
• nervous tension or stress;
• duration of adherence to depleting diets.

Cerebrovascular accidents occur equally among men and women. However, in older people this pathology is diagnosed much more often. This is due to the appearance chronic diseases, which cause disruption of natural blood circulation.

• Transient disorders;
• Complete or partial blockage of blood vessels;
• Rupture of blood vessels and severe hemorrhage in the brain.

It is very important to recognize a cerebrovascular accident early stage, this will help reduce the risk of developing concomitant diseases and complications.

The classification of cerebrovascular disorders can be based on the nature of the pathological processes. Possible:

• Acute stage. In this case, the patient most often experiences a stroke. It occurs suddenly, is characterized by a long course and development negative consequences(visual impairment, speech impairment, etc.);
• Chronic cerebrovascular accident. Most often it appears as a result of atherosclerosis or persistent arterial hypertension.

Vascular genesis of the brain acute type is divided into two main groups:

• ischemic stroke, which is characterized by the formation of blood clots in the vessels of the brain, as a result of which a sufficient amount of blood does not flow to it. There is an acute lack of oxygen and the death of some areas of neurons;
• hemorrhagic stroke, which is accompanied by rupture of a blood vessel and the release of a blood clot.

Chronic cerebrovascular accidents develop gradually and do not always have severe symptoms. There are three main stages, which are accompanied by various symptoms.

Symptoms of the disease

Symptoms of cerebrovascular accident depend on its type and stage. On acute phase arise: severe and sudden headache, nausea and vomiting, increased breathing and heart rate, problems with speech and coordination, paralysis of limbs or part of the face, double vision, slight squint.

Severe nervous shock often leads to the development of ischemic stroke, which manifests itself against the background of existing atherosclerosis. In this case, the patient experiences severe headache, deterioration in speech and coordination of movements. All symptoms appear spontaneously and gradually intensify.

The intermediate stage between acute and chronic brain failure is the transitional stage. In this case, cerebral circulatory disorders occur as a result of a combination of persistent arterial hypertension and atherosclerosis. The patient has the following symptoms:

• numbness of half the body or face, but in which foci of vascular origin are concentrated;
• —epilepsy attack—, partial paralysis;
• dizziness;
• increased photosensitivity (reaction of the pupils of the eyes to bright light);
• double vision;
• loss of orientation;
• partial memory loss.

With further progression, the disease becomes chronic stage. There are three main stages. Initial manifestations of cerebrovascular insufficiency, which are characterized by severe fatigue of the patient, dizziness and headaches. Often such people suffer from frequent mood swings or loss of concentration.

At the next stage, noise in the head, poor coordination of movements, inadequacy in reaction to various situations. In addition, the patient becomes drowsy, loses attentiveness, and his performance is significantly reduced.

At the last stage, an exacerbation of symptoms occurs. A person loses memory and self-control, trembling appears in the limbs.

If effective treatment is not carried out in a timely manner, then due to a lack of oxygen, brain neurons will begin to die, which will lead to serious complications. It is impossible to restore these cells and the person may remain disabled for the rest of his life.

When the first signs appear, you must immediately consult a doctor who will conduct a comprehensive diagnosis and determine the cause of this condition. Among the main studies are:

• cerebral vessels;
• ultrasound examination;
• consultation with a neurologist.

The first method is most often used; it allows you to most reliably determine the location of the blood circulation disorder. More modern techniques Magnetic resonance angiography is considered.

It is not carried out in all clinics and requires special equipment and highly qualified specialists. Using this type of study, it is possible to determine how well the cerebral circulation is functioning and to identify possible pathologies.

Today, the method of electroencephalography remains popular. It is performed for epileptic seizures, speech problems or brain injuries. Thanks to fluctuations in electronic potentials, the doctor can identify possible disorders.

By using computed tomography it is possible to establish the form of vascular origin (acquired or congenital), and also to study in detail the condition of the patient’s brain.

The difficulty of diagnosis lies in the absence of characteristic signs of the disease. The symptoms are very similar to other pathologies, so doctors need to conduct several studies simultaneously that allow them to obtain reliable data.

Basic treatment methods

After receiving the results comprehensive examination An individual treatment regimen is selected for the patient. As a rule, he is prescribed a certain course of medications that help stabilize blood circulation in the brain.

It is very important to determine the form and stage of cerebrovascular accident; the effectiveness of therapy directly depends on this.

Drug therapy

At acute disorder cerebral circulation of hemorrhagic type, the patient is prescribed drugs to lower blood pressure, stop bleeding and reduce swelling in the brain. The following medications are used for this:

• Arfonad, Pentamin etc. – help stabilize blood pressure;
• ascorbic acid, calcium gluconate– increase the permeability of the walls of blood vessels, improve the function of blood clotting;
• Kaviton, Tsinnarzin etc. – improve the rheological properties of blood;
• Lasix– helps relieve swelling.

In most cases, drugs are administered intravenously or intramuscularly. If intracranial pressure is elevated, the patient undergoes a puncture.

If chronic cerebral circulatory failure is diagnosed, antioxidants, ventotonics, neuroprotectors, and agents that improve blood circulation are used. Since this condition often develops against the background of severe nervous shock, the patient is prescribed mild sedatives And vitamin complexes. The course of treatment and dosage is selected by the attending physician individually.

If cerebrovascular accident is caused by atherosclerosis, then medications are used that promote the breakdown cholesterol plaques(Vabarbin, Simartin, etc.). If there is multiple blockage of blood vessels, surgery may be required.

Traditional medicine

You can improve cerebral circulation by using folk remedies. The most commonly used infusions or decoctions based on medicinal plants are: ginseng and Chinese lemongrass, hawthorn, chamomile, motherwort, etc.

These drugs must be used in conjunction with the main treatment regimen, otherwise the risk of complications increases. Before using traditional medicine, you should consult your doctor.

Proper nutrition

A balanced diet makes a difference big role in the treatment of circulatory dysfunction. People prone to obesity should avoid fatty, spicy, smoked foods. It is better to eat fresh fruits and vegetables in season, healthy cereals, fish, seafood and lean meats.

Dietary nutrition will help avoid the development of atherosclerosis and other diseases that cause impaired blood circulation in the vessels of the brain.

Drug therapy allows you to stop the progression of the disease, but does not return the patient to lost abilities (restoration of speech, movements, etc.). Therefore, it is important to consult a doctor in a timely manner, since the sooner changes are recorded, the easier they are to treat and have fewer negative consequences for the patient.

Prevention methods

Prevention of cerebrovascular accidents includes a healthy lifestyle and nutrition, walking fresh air, minimizing strong physical and emotional stress. Subject to availability genetic predisposition For such a disease, it is necessary to undergo regular examinations with a doctor.

To improve blood circulation, doctors recommend visiting saunas or steam baths 1-2 times a week.(in the absence of direct contraindications). This will help open clogged blood vessels and enrich the brain with the necessary amount of blood. In addition, it is recommended to regularly take complexes of vitamins and microelements, which help strengthen the walls of blood vessels.

Problems with blood circulation in the brain are quite common. They appear on various reasons and are subject to immediate treatment. Otherwise, the risk of developing irreversible consequences for the patient increases (speech and movement disorders, memory loss, etc.). For therapy, special medications are used, which are selected by the doctor, depending on the form and severity of the disease. Self-medication with such a diagnosis is unacceptable.

The brain is a “mystical” organ that can fill us with incredible sensations, show us our own “movie”, dreams, accumulate experience and wisdom that allows us to think. This is an organ that controls and regulates the functioning of the entire organism as a whole and each organ and system separately; providing the balance, protection, and compensatory reactions to disturbances necessary for our body. This small organ, weighing about 1400-1500 g (2% of body weight), has incredible abilities that have not yet been fully studied.

What does the brain need? Working without rest, day and night, he is in dire need of oxygen (the brain consumes 20% of all oxygen entering the body) and nutrients, without which he cannot live even for a few minutes. It is a known fact that oxygen reserves are not created in the brain, and there are no substances that can nourish it under anaerobic (in the absence of oxygen) conditions. That is, the nerve cells of the brain constantly need oxygen, glucose and “cleaning” (cleansing of cell waste products).

Excursion into physiology

The uninterrupted supply of substances necessary for the nerve cells of the brain and the cleansing of waste are carried out by the cerebral circulatory system, where arterial blood carries oxygen and nutrition to the brain, and venous blood removes toxins and metabolic products.

The vessels of the brain have a unique, perfect structure that ideally regulates blood flow, ensuring its stability. They are designed in such a way that with an increased flow of blood into large vessels, the strong pulse impulse of the blood coming from the heart is weakened due to numerous bends (siphons) of the vessels along the vascular bed, which contribute to the pressure drop and smoothing of the pulsating blood flow. Due to complex mechanisms regulation when total blood pressure increases, the pressure in the brain remains stable for a long time. Regulatory systems allow blood flow to be redistributed from parts of the brain with less load to areas with increased brain activity.

The brain has an autonomous regulatory system, which allows it to be in a healthy functional state and control the processes of continuous adaptation of the body to the constantly changing conditions of external and internal environment. In a state of functional rest, the brain receives 750 ml of blood per minute, which is 15% of cardiac output. In children, blood flow activity is 50-55% higher, and in the elderly it is 20% lower than in a person in adulthood.

It should be noted that the gray matter of the brain ( cell bodies neurons) is supplied with blood more intensively than white (conducting pathways), which is due to greater cell activity. Thus, during intense mental work, local blood flow in the cerebral cortex can increase 2-3 times compared to the resting state.

The brain has the richest capillary network. Nerve cells are not only intertwined, but also penetrated by capillaries. The vessels of the brain are connected to each other by collaterals (“bridges”). Arterial collateral circulation brain, important for maintaining normal blood flow, plays a particularly significant role in compensating for circulatory disorders when one of the cerebral arteries is blocked.

With high intensity of blood flow in the vessels of the brain, the blood pressure in them is maintained relatively constant. A complex chain of regulatory mechanisms protects the brain from a drop in blood pressure and hypoxia (decreased oxygen). Along the path of blood flow to the brain, there are many sensitive cells (pressoreceptors, chemoreceptors) that can respond to blood pressure and regulate heart rhythm and vascular tone.

The activity of the vasomotor centers of the brain is associated not only with nervous and humoral mechanisms regulation, but also with a system of autonomous regulation, which allows, despite significant fluctuations in total blood pressure, to maintain cerebral blood flow at a constant level.

Thus, cerebral circulation is provided with complex regulatory mechanisms that make it possible to maintain a constant supply of the substances it needs.

With excessive blood supply to the brain, excessive hydration (fluid accumulation) may occur, followed by the development of edema and damage to vital centers that are incompatible with life. The cause of excess blood supply can be, for example, an increase in systemic blood pressure to 160-170 mm Hg. Art. and higher.

In the problem of impaired blood supply to the brain, much attention is paid to arteries. But venous circulation is no less important. The veins carry out the removal of waste substances (toxins) with the blood - that is, cleansing the brain. Thanks to these vessels, constant intracranial pressure is maintained.

Violation of the venous outflow leads to stagnation of blood and accumulation of fluid in the brain, causes hydrocephalus with compression of the brain centers, and contributes to the occurrence of phlebitis and thrombophlebitis.

There is one more feature of the cerebral veins that must be taken into account. The wall of a venous vessel in the brain does not have a valve apparatus, unlike, for example, the veins of the extremities (valves help withstand loads by moving blood upward and preventing it from moving in the opposite direction). Therefore, venous blood in the vessels of the brain passes freely in both directions, depending on the pressure that arises. This creates a danger of rapid spread of infection from the sinuses and eye sockets, which is facilitated by the atomic structure of the nose and its paranasal sinuses, located in close proximity to the brain. When coughing, venous pressure increases, reverse venous flow, congestion, and brain hypoxia become possible. There are known cases of loss of consciousness during a coughing attack in the presence of a chronic disease respiratory tract and in small children, when they “go into a fit” of coughing when sick and crying and screaming until they cough.

Become clear why long-term violations from the respiratory system, accompanied by constant swelling and cough, can cause cerebrovascular accidents. Because they not only cause brain hypoxia, but also disrupt venous outflow and, being a constant source of infection, contribute to its penetration into the brain.

An ophthalmologist, for example, can observe manifestations of congestion in the brain (dilated, blood-filled vessels of the fundus). But this is also visible to the naked eye: red, puffy eyes after sleep (due to drinking alcohol the night before, overeating at night, lack of sleep) are a symptom of congestion in the brain.

After a brief excursion into physiology, it becomes clear that the reasons for the deterioration of cerebral circulation may be associated with disturbances in the flow of blood to the brain and the outflow of blood from the brain.

What happens when blood pressure rises?

At first, vascular tone is slowly disrupted. Over time, if elevated blood pressure (BP) persists, minor cerebral hemorrhages and strokes may occur.

As a result of a constant increase in blood pressure with hypertension plasma (part of the blood without formed elements) is released, which ultimately leads to the destruction of the walls of blood vessels.

How does this happen? A specific protein (hyaline-like substance, similar in structure to cartilage) is deposited on the walls of blood vessels, which leads to the development of hyalinosis. The vessels become like glass tubes, lose their elasticity and ability to hold blood pressure. In addition, the permeability of the vascular wall increases, and blood can freely pass through it, soaking the nerve fibers (diapedetic bleeding). The result of such transformations can be the formation of microaneurysms and rupture of the vessel with hemorrhage and blood entering the white medulla. The resulting swelling and hematomas lead to further hemorrhages (hemorrhagic stroke).

Atherosclerosis that accompanies hypertension, or exists without it (which is rare), contributes to cerebral ischemia - insufficient supply of nutrients and oxygen to the tissues (except for atherosclerotic plaques that narrow the lumen of the arteries, the blood itself can be thick and viscous).

Acute circulatory disorders are strokes (hemorrhagic and ischemic). But it all starts with transient cerebrovascular accidents against the background of hypertension and atherosclerosis, as well as obesity, diabetes mellitus, and respiratory diseases that often accompany them.

Symptoms of cerebrovascular accident

When a lesion forms in the brain with impaired blood supply, the patient may experience numbness in half of the body (on the side opposite to the lesion) and part of the face around the lips; short-term paresis of the limbs or other parts of the body and face is possible. Speech is impaired and an epileptic seizure may occur.

If there is a circulatory disorder, depending on the location of the lesion, the legs and arms may become weak, the head may become dizzy, the patient may have difficulty swallowing and pronouncing sounds, photopsia (appearance of luminous spots, sparks, etc. in the eyes) or diplopia (doubling of visible objects) may occur. . The person loses orientation and has memory lapses.

Signs of impaired cerebral circulation due to hypertension are manifested in the following: the head and eyeballs begin to hurt very much, the person experiences drowsiness, he experiences stuffiness in the ears (like on an airplane during takeoff or landing) and attacks of nausea. The face turns red and sweating increases.

Unlike strokes, all these symptoms, which are called “transient attacks,” disappear within 24 hours.

Chronic cerebrovascular accident (CVA), unlike acute forms, develops gradually. There are three stages of the disease:

1. At the first stage, the symptoms are vague. They are more like chronic fatigue syndrome. A person quickly gets tired, becomes hot-tempered and absent-minded, and forgets some minor points. His sleep is disturbed, his mood often changes, his head hurts and he feels dizzy.
2. At the second stage, chronic cerebrovascular accident is accompanied by significant memory deterioration, and minor motor dysfunctions develop, causing unsteadiness in gait. There is a constant noise in my head. A person perceives information poorly, having difficulty concentrating his attention on it. Becomes irritable and unconfident, loses intelligence, reacts inadequately to criticism, and often becomes depressed. He gradually degrades as a person and adapts poorly socially. He constantly feels dizzy and has a headache. He always wants to sleep. Performance is significantly reduced.
3. In the third stage, all symptoms intensify. Personality degradation turns into dementia, memory suffers. Having left home alone, such a person will never find his way back. Motor functions are impaired, which manifests itself in hand tremors and stiffness of movements. Speech impairment and uncoordinated movements are noticeable.

Consequences of cerebrovascular accidents

Disability is a sad result of acute and in many cases chronic cerebrovascular accident.

Acute cerebrovascular accident has serious consequences. In most cases, a person who has suffered a stroke becomes completely helpless. He cannot eat, perform hygiene procedures, dress, etc. on his own. Such people have a completely impaired ability to think. They lose track of time and have absolutely no orientation in space.

Some people retain the ability to move. But many people, after a cerebrovascular accident, remain bedridden forever. Many of them maintain a clear mind, understand what is happening around them, but are speechless and cannot express their desires and feelings in words.

How to prevent cerebrovascular accidents

The opportunity to protect yourself from this serious disease, regardless of what category it belongs to, exists. Only many people neglect it.

This is a careful attitude to your health and all the changes occurring in the body.

Agree that a healthy person should not have headaches. And if you suddenly feel dizzy, it means that there is some kind of deviation in the functioning of the systems responsible for this organ.

An increase in temperature is evidence of problems in the body. But many people go to work with a temperature of 37°C, considering it normal (explaining this by the fact that the tests did not reveal anything).

Do you experience short-term numbness in your limbs? Most people rub them without asking the question: why is this happening?

It is not normal to live on constant drug treatment for chronic diseases of the nose and respiratory tract, not to associate them with existing internal disorders and not to think about the consequences (because there is no time, because the ENT doctor will perform the procedure and it will become easier for a while).

It is not normal to live with obesity and diabetes without thinking about the consequences while indulging in your eating habits.

After all, all this is a companion to the first minor changes in the cerebral blood flow system.

Often an acute cerebrovascular accident is preceded by a transient one. But since its symptoms go away within 24 hours, not every person rushes to see a doctor to undergo an examination and receive the necessary drug treatment.

Today, doctors have effective drugs - thrombolytics. They literally work wonders, dissolving blood clots and restoring cerebral circulation. However, there is one “but”. To achieve maximum effect, they must be administered to the patient within three hours after the first symptoms of a stroke appear. Unfortunately, in most cases, seeking medical help is too late, when the disease has reached a severe stage and the use of thrombolytics is no longer useful. In case of chronic disorders, taking only thrombolytics and blood thinning drugs does not give the desired result, since it is necessary to identify and eliminate real reasons leading to these violations.

And here again we recall the instructions of the great Avicenna: “Establish nutrition, sleep, wakefulness... and the disease will recede.”

General information

The left hemisphere controls the functioning of the right half of the body and is responsible for all types of sensitivity, motor activity, vision, and hearing. Approximately 95% of humanity is right-handed, which means they are dominant. left hemisphere brain

It contains centers responsible for the use and perception of different types of speech, mathematical operations, logical, abstract, analytical thinking, the formation of dynamic stereotypes, and the perception of time.

Symptoms

The symptoms that appear depend on the location and size of the lesion. They are divided into general cerebral, vegetative and focal. With cerebral ischemia, general cerebral disorders are less pronounced than with hemorrhagic stroke, in some cases may be absent. The most common:

• a sudden attack of severe headache;
• dizziness;
• loss of consciousness when extensive lesions– coma to varying degrees heaviness;
• nausea and vomiting;
• convulsions.

Any form of stroke is accompanied by manifestations focal symptoms, and their combination and severity are determined by the functional characteristics of the affected area. Left-sided stroke is characterized by:

• paralysis right side bodies of varying degrees of severity;
• sensory disturbances on the right side of the body;
• impairment of vision, hearing, smell, up to complete loss of the ability to perceive relevant stimuli. With severe lesions, the disorder can affect both sides;
• impaired sense of balance and coordination of movements;
• speech disorders.

Suspicion of an attack and first aid

A stroke is an emergency; pathological changes in the lesion develop in a matter of minutes. The faster the patient is provided medical care, the greater the chance of a successful outcome.

If your attention is drawn to a person with a strange gait or an unnaturally asymmetrical face, you should:

• Talk to him. With a left-sided stroke, speech is unintelligible, the person is unable to name himself, place, time, does not understand the question or cannot utter a word.
• Ask to smile or stick out your tongue. The asymmetry of the face will increase; with lesions of the left hemisphere, the movements of the facial muscles of the right half of the face are greatly hampered.
• Ask for a show of hands. A stroke is indicated by impaired mobility of the right hand.

Identification of even one of the symptoms is sufficient grounds for an emergency call to the ambulance regarding a suspected stroke. Before the doctors arrive, you must:

• Lay the victim on his side, placing something soft under his head to protect the person in case of possible convulsions;
• Provide air flow;
• Unfasten, loosen, if possible, remove all parts of clothing that impede breathing;
• If it is possible, measure the pressure; an antihypertensive drug can be given only if the victim is conscious and has with him the medicine previously prescribed by the doctor;
• If convulsions develop, open the patient’s mouth;
• If breathing or heart stops, begin resuscitation.

We bring to your attention a video about what a stroke is and how to provide first aid during an attack:

Therapy

Treatment of ischemic stroke begins directly on site. Measures emergency assistance depend on the severity of the patient’s condition and are primarily aimed at stabilizing the condition for transportation to a specialized department.

Immediately after hospitalization, studies are carried out to determine the general physical condition patient, location and size of the lesion. Basic treatment for ischemic strokes is aimed at restoring blood circulation in the affected area, maintaining and restoring vital important functions body, preventing possible complications.

Within a few hours of the onset of the attack, the patient is given a thrombolytic drug to dissolve the clot. After this period, thrombosis can only be eliminated surgically. The patient is prescribed drugs that improve blood microcirculation and vascular-strengthening drugs to normalize blood circulation.

To restore and normalize metabolic processes in brain tissue, neurotrophics are prescribed.

As part of the prevention of thrombotic complications, antiplatelet agents, anticoagulants and drugs that improve blood flow are prescribed.

At the same time, treatment of the underlying disease and symptomatic treatment of possible complications from vital organs are carried out.

The most dangerous early consequences stroke are cerebral edema, coma and recurrent stroke, which are the most common cause of death in patients in the acute period.

The severity of residual neurological damage varies greatly, ranging from minor disturbances in speech and motor functions to complete loss of the ability to move and the ability to perform minimal self-care. After a stroke, mental disorders, memory disorders, and speech disorders are observed.

Forecast for life

The prognosis for stroke is generally rather unfavorable, possible consequences It is extremely difficult to predict each specific case, even after a complete examination of the patient. The prognosis worsens for older people, as well as in the presence of certain chronic diseases.

According to statistics early complications Ischemic strokes are the cause of death in approximately 25% of patients within a month after a stroke.

Approximately 60% continue to have disabling neurological disorders.

Survival rate within a year approaches 70%, within five years - about 50%, about 25% of surviving patients overcome the ten-year threshold. Recurrent strokes occur in approximately 30% of patients within five years of the first episode.

There are specially developed methods for assessing the risk of a second strike.

Recovery period

The recovery period after a stroke lasts up to three years. Patients are prescribed a diet depending on the condition and the presence of underlying diseases, massage courses, and therapeutic exercises. Shown spa treatment. Patients are prescribed maintenance therapy, often lifelong.

There is a lot of useful information about recovery from illness:

Acute ischemic cerebrovascular accident

Sudden changes in blood flow to the brain are classified as hemorrhagic (bleeding) and ischemic disorders. This division is important for the right choice method of therapy.

The classic abbreviated name for the pathology in acute cerebrovascular accident is “ischemic stroke.” If hemorrhage is confirmed, then it is considered hemorrhagic.

In ICD-10, ACME codes may vary, depending on the type of violation:

• G45 is an established designation for transient cerebral attacks;
• I63 - recommended for statistical registration of cerebral infarction;
• I64 - an option used for unknown differences between cerebral infarction and hemorrhage, used when a patient is admitted in an extremely serious condition, unsuccessful treatment and imminent death.

The frequency of ischemic strokes exceeds hemorrhagic strokes by 4 times, and is more associated with general diseases person. The problem of prevention and treatment is considered in programs at the state level, because 1/3 of patients who have suffered the disease die in the first month and 60% remain permanently disabled requiring social assistance.

Why does a lack of blood supply to the brain occur?

Acute ischemic cerebrovascular accident is often a secondary pathology and occurs against the background of existing diseases:

• arterial hypertension;
• widespread atherosclerotic vascular lesions (up to 55% of cases develop due to pronounced atherosclerotic changes or thromboembolism from plaques located in the aortic arch, brachiocephalic trunk or intracranial arteries);
• previous myocardial infarction;
• endocarditis;
• heart rhythm disturbances;
• changes in the valvular apparatus of the heart;
• vasculitis and angiopathy;
• vascular aneurysms and developmental anomalies;
• blood diseases;
• diabetes mellitus

Up to 90% of patients have changes in the heart and main arteries of the neck. The combination of these reasons sharply increases the risk of ischemia.

Transient attacks are most often caused by:

• spasm of the arterial brain stems or short-term compression of the carotid and vertebral arteries;
• embolization of small branches.

The following risk factors can provoke the disease:

• elderly and senile age;
• excess weight;
• the effect of nicotine on blood vessels (smoking);
• experienced stress.

The basis of the influencing factors is the narrowing of the lumen of the vessels through which blood flows to the brain cells. However, the consequences of such a malnutrition may vary according to:

• stamina,
• localization,
• prevalence,
• severity of vessel stenosis,
• gravity.

A combination of factors determines the form of the disease and clinical symptoms.

Pathogenesis of various forms of acute cerebral ischemia

Transient ischemic attack was previously called transient cerebrovascular accident. Highlighted in separate form, since it is characterized by reversible disorders, the focus of the infarction does not have time to form. Usually the diagnosis is made retrospectively (after the disappearance of the main symptoms), within a day. Before this, the patient is treated as if he had a stroke.

The main role in the development of hypertensive cerebral crises belongs to increased level venous and intracranial pressure with damage to the walls of blood vessels, release of fluid and protein into the intercellular space.

The feeding artery is necessarily involved in the development of ischemic stroke. The cessation of blood flow leads to oxygen deficiency in the focus formed in accordance with the boundaries of the basin of the affected vessel.

Local ischemia causes necrosis of an area of ​​brain tissue.

Depending on the pathogenesis ischemic changes There are different types of ischemic strokes:

• atherothrombotic - develops when the integrity of the atherosclerotic plaque is disrupted, which causes complete closure of the internal or external feeding arteries of the brain or their sharp narrowing;
• cardioembolic - the source of thrombosis is pathological growths on the endocardium or heart valves, fragments of a blood clot, they are delivered to the brain with the general blood flow (especially when the foramen ovale is not closed) after attacks of atrial fibrillation, tachyarrhythmia, atrial fibrillation in patients in the post-infarction period;
• lacunar - most often occurs when small intracerebral vessels are damaged during arterial hypertension, diabetes mellitus, characterized by the small size of the lesion (up to 15 mm) and relatively minor neurological disorders;
• hemodynamic - cerebral ischemia with a general decrease in blood circulation speed and a drop in pressure against the background of chronic heart diseases, cardiogenic shock.

It is worth explaining the variant of development of strokes of unknown etiology. This often happens when there are two or more reasons. For example, in a patient with carotid artery stenosis and fibrillation after an acute infarction. It should be taken into account that elderly patients already have stenosis of the carotid arteries on the side of the suspected disorder, caused by atherosclerosis, in the amount of up to half the lumen of the vessel.

Stages of cerebral infarction

The stages of pathological changes are distinguished conditionally; they are not necessarily present in every case:

• Stage I - hypoxia (oxygen deficiency) disrupts the process of permeability of the endothelium of small vessels in the lesion (capillaries and venules). This leads to the transfer of fluid and protein from the blood plasma into the brain tissue and the development of edema.
• Stage II - at the level of capillaries, pressure continues to decrease, which disrupts the functions of the cell membrane, the nerve receptors located on it, and electrolyte channels. It is important that all changes are reversible for now.
• Stage III - cell metabolism is disrupted, lactic acid accumulates, and a transition to energy synthesis occurs without the participation of oxygen molecules (anaerobic). This species does not allow maintaining the necessary level of life of neuron and astrocyte cells. Therefore, they swell and cause structural damage. Clinically expressed in the manifestation of focal neurological signs.

What is the reversibility of the pathology?

For timely diagnosis, it is important to establish a period of symptom reversibility. Morphologically, this means preserved neuronal functions. Brain cells are in a phase of functional paralysis (parabiosis), but retain their integrity and usefulness.

In the irreversible stage, it is possible to identify a zone of necrosis in which cells are dead and cannot be restored. Around it there is an ischemic zone. Treatment is aimed at supporting adequate nutrition of neurons in this area and at least partially restoring function.

Modern research has shown extensive connections between brain cells. A person does not use all reserves and opportunities in his life. Some cells are able to replace dead ones and provide their functions. This process is slow, so doctors believe that rehabilitation of a patient after an ischemic stroke should continue for at least three years.

Signs of transient cerebral circulatory disorders

Clinicians include the following in the group of transient cerebrovascular accidents:

• transient ischemic attacks (TIA);
• hypertensive cerebral crises.

Features of transient attacks:

• the duration ranges from several minutes to a day;
• every tenth patient after a TIA develops stroke of the ischemic type within a month;
• neurological manifestations are not grossly severe;
• mild manifestations of bulbar palsy (focus in the brain stem) with oculomotor disorders are possible;
• blurred vision in one eye combined with paresis (loss of sensation and weakness) in the limbs of the opposite side (often accompanied by incomplete narrowing of the internal carotid artery).

Features of hypertensive cerebral crises:

• the main manifestations are cerebral symptoms;
• focal signs occur rarely and are mild.

The patient complains of:

• sharp headache, often in the back of the head, temples or crown of the head;
• state of stupefaction, noise in the head, dizziness;
• nausea, vomiting.

People around note:

• temporary confusion;
• excited state;
• sometimes - a short-term attack with loss of consciousness, convulsions.

Signs of a cerebral stroke

Ischemic stroke means the occurrence of irreversible changes in brain cells. At the clinic, neurologists distinguish periods of the disease:

• acute - continues from the onset of symptoms for 2–5 days;
• acute - lasts up to 21 days;
• early recovery - up to six months after the elimination of acute symptoms;
• late recovery - takes from six months to two years;
• consequences and residual effects - over two years.

Some doctors continue to distinguish small forms of stroke or focal ones. They develop suddenly, the symptoms do not differ from cerebral crises, but last up to three weeks, then completely disappear. The diagnosis is also retrospective. During the examination, no organic deviations are not detected.

Cerebral ischemia, except common symptoms(headaches, nausea, vomiting, dizziness), manifests itself locally. Their nature depends on the artery that is “turned off” from the blood supply, the state of the collaterals, and the dominant hemisphere of the patient’s brain.

Let's consider the zonal signs of blockage of the cerebral and extracranial arteries.

If the internal carotid artery is damaged:

• vision is impaired on the side of the blocked vessel;
• the sensitivity of the skin on the limbs and face on the opposite side of the body changes;
• paralysis or muscle paresis is observed in the same area;
• possible loss of speech function;
• inability to realize one’s illness (if the focus is in the parietal and occipital lobes of the cortex);
• loss of orientation in parts of one’s own body;
• loss of visual fields.

Narrowing vertebral artery at neck level causes:

• hearing loss;
• nystagmus of the pupils (twitching when deviating to the side);
• double vision.

If the narrowing occurs at the confluence with the basilar artery, then the clinical symptoms are more severe, since cerebellar damage predominates:

• inability to move;
• impaired gesticulation;
• chanted speech;
• violation of joint movements of the trunk and limbs.

If there is insufficient blood flow in the basilar artery, manifestations of visual and brain stem disorders (impaired breathing and blood pressure) occur.

If the anterior cerebral artery is damaged:

• hemiparesis of the opposite side of the body (unilateral loss of sensation and movement), often in the leg;
• slowness of movements;
• increased tone of flexor muscles;
• loss of speech;
• inability to stand and walk.

Obstruction of the middle cerebral artery:

• when the main trunk is completely blocked, a deep coma occurs;
• lack of sensitivity and movement in half of the body;
• inability to fix the gaze on an object;
• loss of visual fields;
• loss of speech;
• inability to distinguish the left side from the right.

Obstruction of the posterior cerebral artery causes:

• blindness in one or both eyes;
• double vision;
• gaze paresis;
• seizures;
• large tremor;
• impaired swallowing;
• paralysis on one or both sides;
• respiratory and blood pressure disturbances;
• cerebral coma

When the optic geniculate artery is blocked, the following appears:

• loss of sensation in the opposite side of the body, face;
• heavy painful sensations when touching the skin;
• inability to localize the stimulus;
• perverted perceptions of light, knocking;
• “thalamic hand” syndrome - the shoulder and forearm are bent, the fingers are extended at the terminal phalanges and bent at the base.

Impaired blood circulation in the area of ​​the visual thalamus is caused by:

• sweeping movements;
• large tremor;
• loss of coordination;
• impaired sensitivity in half of the body;
• sweating;
• early bedsores.

In what cases can acute stroke be suspected?

The above clinical forms and manifestations require careful examination, sometimes not by one, but by a group of doctors of different specialties.

Cerebrovascular accident is very likely if the patient exhibits the following changes:

• sudden loss of sensation, weakness in the limbs, face, especially one-sided;
• acute loss of vision, the occurrence of blindness (in one eye or both);
• difficulty in pronunciation, understanding words and phrases, composing sentences;
• dizziness, loss of balance, impaired coordination of movements;
• confusion;
• lack of movement in the limbs;
• intense headache.

Additional examination allows us to establish the exact cause of the pathology, the level and location of the vessel lesion.

Purpose of diagnosis

Diagnosis is important for choosing a treatment method. To do this you need:

• confirm the diagnosis of stroke and its form;
• identify structural changes in brain tissue, focal area, affected vessel;
• clearly distinguish between ischemic and hemorrhagic form stroke;
• based on pathogenesis, establish the type of ischemia for starting specific therapy in the first 3–6 in order to get into the “therapeutic window”;
• assess indications and contraindications for drug thrombolysis.

It is practically important to use diagnostic methods on an emergency basis. But not all hospitals have enough medical equipment to operate around the clock. Application of echoencephaloscopy and research cerebrospinal fluid give up to 20% errors and cannot be used to resolve the issue of thrombolysis. The most reliable methods should be used in diagnosis.

Computed and magnetic resonance imaging allows you to:

• distinguish a stroke from space-occupying processes in the brain (tumors, aneurysms);
• accurately determine the size and location of the pathological focus;
• determine the degree of edema, disturbances in the structure of the ventricles of the brain;
• identify extracranial locations of stenosis;
• diagnose vascular diseases that contribute to stenosis (arteritis, aneurysm, dysplasia, vein thrombosis).

Computed tomography is more accessible and has advantages in studying bone structures. And magnetic resonance imaging better diagnoses changes in the parenchyma of brain tissue and the size of edema.

Echoencephaloscopy can only reveal signs of displacement of the median structures with a massive tumor or hemorrhage.

During ischemia, cerebrospinal fluid rarely shows slight lymphocytosis with increased protein. Most often no change. If the patient has a hemorrhage, blood may appear. And with meningitis - inflammatory elements.

Ultrasound examination of blood vessels - Dopplerography method of the arteries of the neck indicates:

• development of early atherosclerosis;
• stenosis of extracranial vessels;
• sufficiency of collateral connections;
• the presence and movement of an embolus.

Duplex sonography can determine the condition of the atherosclerotic plaque and artery walls.

Cerebral angiography is performed if technically possible for emergency indications. Typically, the method is considered more sensitive in identifying aneurysms and foci of subarachnoid hemorrhage. Allows you to clarify the diagnosis of pathology identified on tomography.

Cardiac ultrasound is performed to detect cardioembolic ischemia in heart disease.

Examination algorithm

The examination algorithm for suspected acute stroke proceeds according to the following plan:

1. examination by a specialist in the first 30-60 minutes after the patient’s admission to the hospital, examination of the neurological status, clarification of the medical history;
2. taking blood and studying its coagulability, glucose, electrolytes, enzymes for myocardial infarction, and the level of hypoxia;
3. if it is not possible to conduct MRI and CT, do an ultrasound of the brain;
4. spinal puncture to exclude hemorrhage.

Treatment

The most important importance in the treatment of cerebral ischemia belongs to the urgency and intensity in the first hours of admission. 6 hours from start clinical manifestations called the “therapeutic window”. This is the time for the most effective use of the thrombolysis technique to dissolve a blood clot in a vessel and restore impaired functions.

Regardless of the type and form of stroke, the following are carried out in the hospital:

• increased oxygenation (filling with oxygen) of the lungs and normalization of respiratory function (if necessary, through transfer and mechanical ventilation);
• correction of impaired blood circulation (heart rhythm, blood pressure);
• normalization of electrolyte composition, acid-base balance;
• reducing cerebral edema by administering diuretics and magnesium;
• relief of agitation and seizures with special antipsychotic drugs.

A semi-liquid diet is prescribed for the patient's nutrition; if swallowing is impossible, parenteral therapy is prescribed. The patient is provided with constant care, prevention of bedsores, massage and passive exercises.

This allows you to get rid of negative consequences in the form of:

• muscle contractures;
• congestive pneumonia;
• DIC syndrome;
• pulmonary embolism;
• damage to the stomach and intestines.

Thrombolysis is a specific therapy for stroke of ischemic type. The method allows you to preserve the viability of neurons around the necrosis zone, returning all weakened cells to life.

You can read more about the indications and methods of thrombolysis in this article.

The administration of anticoagulants begins with Heparin derivatives (in the first 3–4 days). Drugs of this group are contraindicated for:

• high blood pressure;
• peptic ulcer;
• diabetic retinopathy;
• bleeding;
• impossibility of organizing regular monitoring of blood clotting.

After 10 days they switch to indirect anticoagulants.

Drugs that improve metabolism in neurons include Glycine, Cortexin, Cerebrolysin, Mexidol. Although they are not listed as effective in the evidence-based medicine database, their use leads to improvement in the condition.

Patients may need symptomatic treatment depending on the specific manifestations: anticonvulsants, sedatives, painkillers.

Antibacterial agents are prescribed to prevent kidney infection and pneumonia.

Forecast

Data on prognosis are available only for ischemic infarction; other changes represent precursors indicating increased risk stroke.

Atherothrombotic and cardioembolic types of ischemia have the most dangerous mortality rate: during the first month of the disease, from 15 to 25% of patients die. Lacunar stroke is fatal in only 2% of patients. The most common causes of death:

• in the first 7 days - cerebral edema with compression of vital centers;
• up to 40% of all deaths occur in the first month;
• after 2 weeks - pulmonary embolism, congestive pneumonia, cardiac pathology.

Patient survival time:

• 1 year - up to 70%;
• 5 years - 50%;
• 10 years - 25%.

After this period, 16% die per year.

The following have signs of disability:

• after a month - up to 70% of patients;
• six months later - 40%;
• by the second year - 30%.

The rate of recovery is most noticeable in the first three months by an increase in the range of movements, while the functions of the legs return faster than the arms. Remaining immobility in the hands after a month is an unfavorable sign. Speech is restored after years.

The rehabilitation process is most effective with the volitional efforts of the patient and the support of loved ones. Complicating factors include old age, heart disease. Seeing a doctor during the phase of reversible changes will help avoid serious consequences.

Instructions for use Indapamide, at what pressure should it be taken?

"Indapamide" is antihypertensive, which is used for hypertension and edema caused by heart failure. But you can take this drug only after consulting a doctor, a full examination and passing the necessary tests, since it has many contraindications. Self-medication is strictly prohibited. You can read a detailed description of Indapamide in our article.

Indapamide: what is the drug prescribed for?

General characteristics of the drug

Indapamide is a white, round, film-coated tablet with convex surfaces. The cut clearly shows 2 layers medicinal substance. Inner layer yellow. This drug belongs to a group related to thiazide diuretics, having moderate hypotensive and diuretic properties. The drug is preferred because it causes fewer side effects and has fewer contraindications. More suitable for long-term treatment than for acute conditions. Maximum effect observed after daily use"Indapamide" for at least 8 weeks.

Mechanism of action on the body

The use of 2.5 mg of Indapamide per day leads to a pronounced and prolonged hypotensive effect with a mild diuretic effect. Increasing the dose will not enhance the hypotensive effect, but will enhance the diuretic effect. "Indapamide" leads to weakening of the muscle layer of blood vessels, which causes blood pressure to decrease. It also inhibits the reabsorption of primary urine, and diuresis increases.

Pharmacological effect on the body

"Indapamide" inhibits ion exchange, as a result of which the level of catecholamines in the blood increases. This leads to a decrease in the force of contraction of the muscle fibers of the medial tunic of the arteries. As vascular tone decreases, blood pressure (BP) decreases. In addition to the pronounced hypotensive effect, there is also a diuretic effect. The drug acts on the proximal and distal tubules of the loop of Henle, where the reabsorption of water, proteins, glucose, sodium, potassium, chlorine and much more occurs, due to which the reabsorption of sodium, chlorine and water is inhibited. Thus, more secondary urine is produced from primary urine.

Indapamide, a drug for high blood pressure

The degree of change in the tubules is directly proportional to the dosage of the medicine, that is, the more you take, the greater the diuretic effect. The drug does not penetrate the blood-brain barrier, resulting in no central effect and fewer side effects. Indapamide can be taken by patients with renal failure, because it does not affect the condition of the glomeruli of the kidneys and does not increase the load on the kidneys.

Why is Indapamide prescribed?

Since the drug has a moderate effect, it is prescribed for continuous use. If an emergency occurs, such as a hypertensive crisis, it is better to use more effective means. This drug is ideal for the treatment of hypertension. The patient himself will be able to regulate the effectiveness: if the diuretic effect is not needed, simply reduce the daily dose to 1.25 mg. It is also good for patients with hypervolemia. Kidney diseases are often complicated by pathologies such as renal arterial hypertension. And here the appointment of "Indapamide" will be very appropriate.

Therapy of arterial hypertension with Indapamide

The method of using Indapamide will depend on the degree of complexity of hypertension. If a hypertensive crisis occurs, you need to take a larger dose, because the diuretic effect in this case will help cope with the preload on the heart and reduce the volume of circulating blood. In addition, it must be combined with other antihypertensive drugs. And if the pressure is moderately increased, then you can limit yourself to one drug and a minimum daily dose of 2.5 mg.

How to take Indapamide

What effect should you expect when combined with other drugs?

• When combined with antiarrhythmic drugs, arrhythmogenicity increases, especially with Quinidine, Disopyramide and Amiodarone.
• Non-steroidal anti-inflammatory drugs, glucocorticoids and sympathomimetics eliminate the hypotensive effect of Indapamide, and Baclofen enhances it.
• Carrying agents, cardiac glycosides and mineralocorticoids increase the likelihood of developing hypokalemia. Therefore, it is necessary to monitor potassium levels.
• X-ray contrast agents containing large amounts of iodine increase the likelihood of dehydration.
• "Indapamide" enhances the effect of muscle relaxants.
• Cyclosporine increases the level of creatinine in the blood.

Contraindications:

1. individual hypersensitivity to individual components of the drug;
2. decompensated diabetes mellitus;
3. acute cerebrovascular accident;
4. gout;
5. pregnancy;
6. lactation period;
7. low potassium;
8. liver diseases;
9. use before adulthood.

Instructions for use Indapamide

"Indapamide" during pregnancy

During pregnancy and breastfeeding, taking Indapamide is not recommended, since the effectiveness and safety have not been established. This drug can slow down the growth and development of the fetus in the womb and lead to its malnutrition. And since it is excreted along with milk, use during lactation is not recommended. In cases where treatment is necessary, it is better to refrain from breastfeeding.

Side effect:

1. Immune reactions - urticaria, dermatoses, anaphylactic shock, Quincke's edema.
2. From the side of the central nervous system - dizziness, headaches, weakness, aches throughout the body, paresthesia.
3. The effect on the gastrointestinal tract is manifested by nausea, vomiting, dry mouth, constipation.
4. From the cardiovascular system - arrhythmia, prolongation of QT waves on the ECG, orthostatic arterial hypotension.
5. From the respiratory system - cough, rhinitis, sinusitis.
6. Changes in tests - low platelet count, anemia, leukopenia, agranulocytosis, increased amount calcium, decreased potassium and sodium, increased urea and creatinine.

Effect of the drug on the ability to work with machinery and drive a car

Indapamide drug for hypertensive patients

The drug lowers blood pressure, which means hypotension is possible. Due to the diuretic effect, long-term use may cause EBV disruption. Both conditions can impair the ability to operate machinery and drive a car.

Analogs of a drug for the treatment of hypertension

If side effects occur, the medicine can be changed. It is best to use another representative of the thiazide-like diuretics. Do not select medications on your own; you need to consult a specialist.

List of drugs:
"Arifon"
"Vazopamide"
"Indapamide Sr",
"Ypres Long"
"Xipogama"
"Ravel Sr",
"Softensif."

"Indapamide" is a mild drug with dual action, due to which it is often used for various pathologies. Mostly patients leave positive reviews. You cannot start treatment on your own, only after consulting a doctor. Before taking the drug, be sure to read the contraindications and if you find at least one point that bothers you, then it is better to abandon this drug. If side effects occur during long-term use, you should stop treatment. Consult a specialist and he may prescribe a similar drug.

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