First aid for stroke

Stroke, or apoplexy, is a condition associated with a violation of the normal activity of the vascular system of the human body. It is also called a disease, although, in fact, a stroke is precisely an acute condition, a pathological violation of blood circulation in the brain. This pathology is characterized by the sudden appearance of certain neurological symptoms, which may have a focal distribution, or affect the entire organ. The clinical picture of symptoms persists for up to several days, gradually disappearing, or causes the death of the patient in a short time, if he was not provided with medical care.

Stroke is the second leading cause of death among all pathologies of the cardiovascular system, right after coronary heart disease.

Causes of formation and mechanism of development of pathology

Brain damage by stroke, today, is one of the most common causes of disability in the population – this is evidenced by the data of the World Health Organization. Approximately 70-80% of people who have had a stroke become disabled, of which 20-30% require constant care from the outside.

Men and women are approximately equally susceptible to the development of pathology, and the likelihood of a stroke increases as a person reaches the age of 30-35 years and older.

Why can a stroke develop? The general principle of the development of pathology is the presence of disturbances in the work of the vascular system, which directly affect the blood circulation in the brain. A significant role in the development of stroke is played by factors such as arterial hypertension, vascular atherosclerosis, coronary heart disease – against the background of these diseases, apoplexy can develop if this is facilitated by malnutrition, smoking, alcohol consumption, frequent stress, taking hormonal contraceptives, dyslipidemia. Moreover, stress and the use of contraceptives negatively affect the female body. For women, obesity is also dangerous, for men, the problem of alcoholism is more relevant. If relatives have a history of stroke, this also increases the likelihood of brain damage.

As for the mechanism of stroke development, each of the types of pathology known to medicine is formed in different ways. Thus, ischemic and hemorrhagic stroke are characterized by fundamentally different mechanisms of occurrence. The ischemic type of damage occurs about 4 times more often than hemorrhagic.

Ischemic stroke is also called a cerebral infarction – it develops as a result of impaired patency of the cerebral arteries. Due to insufficient blood supply, a person develops prolonged ischemia of the brain, after which irreversible changes begin in the tissues of the organ, affecting the area of ​​blood exchange of the affected artery.

Hemorrhagic stroke is formed in a slightly different way – as a result of an atraumatic rupture of the cerebral vessel, a hemorrhage occurs in the brain tissue.

Ischemic strokes are more common in people over the age of 55, while hemorrhagic type of pathology also occurs in younger individuals.

Varieties of brain strokes

All manifestations of pathology, its characteristic features, pathogenesis and etiology determine the division of the concept of “stroke” into several types:

• ischemic;
• hemorrhagic;
• lacunar;
• extensive;
• spinal;
• acute;
• repeated.

What is ischemic stroke

This type of lesion is formed as a result of a violation of the flow of blood through the blood vessels in the brain. In this case, intracranial and extracranial vascular subsystems may be affected. So, in 30% of cases of ischemic stroke, it develops due to occlusion of the carotid arteries.

A sharp deterioration in blood supply can be formed due to the presence of vascular spasm, thromboembolism. The formation of emboli occurs against the background of pathologies in the work of the heart:

• after a heart attack;
• with atrial fibrillation;
• due to acquired or congenital heart valve defects;
• in the myocardium, endocardium;
• with rheumatism.

Blood clots that form in the region of the heart, due to the blood flow, move into the cavity of the cerebral vessels, clogging them. In this case, part of an atherosclerotic plaque, which breaks away from the vascular wall, can act as an embolus. Getting into a narrow cerebral vessel, it provokes its occlusion.

What pathogenetic varieties can have ischemic stroke? Physicians distinguish:

• cardioembolic, which is formed due to arrhythmia of the heart, the presence of valvular disease, a previous heart attack;
• atherothrombotic: its root causes are atherosclerosis of large arteries and arterio-arterial embolism;
• lacunar: develops due to occlusion of small arteries;
• of unknown origin, which include pathologies with an unknown cause of appearance, when an accurate diagnosis cannot be established.

More rarely, another type of ischemic apoplexy occurs, caused by hypercoagulability of the blood, non-atherosclerotic vasculopathies, and dissection of the arterial wall.

Periods of development of ischemic type of brain damage

Ischemic stroke can occur due to the following diseases:

• atherosclerosis;
• amyloidosis;
• collagenosis;
• systemic vasculitis;
• angiitis;
• drug addiction.

The usual course of the disease involves a person passing through several periods:

• the most acute, which is observed in the patient during the first three days. In this case, the first five hours are considered the so-called “therapeutic window”, during which it is advisable to use thrombolytic drugs;
• acute, which lasts up to 4 weeks after the attack;
• early recovery – up to 6 months;
• late recovery – about 2 years after the onset of pathology.

After the rehabilitation period ends, the residual effects of a stroke can manifest themselves throughout the rest of life.

Hemorrhagic stroke: what is it, why does it appear

This type of brain damage is associated with diffuse or isolated cerebral vascular pathology of the brain. The vascular wall becomes thinner, loses elasticity.

Often hemorrhagic stroke occurs against the background of uncorrected arterial hypertension, hypertensive crisis. With a sharp increase in pressure, the pressure on the vessel wall increases – it bursts. Blood is poured into the surrounding tissues.

Provocative moments are:

• stress;
• lack of sleep;
• hyperthyroidism;
• adrenal pathology.

Other factors provoking the appearance of pathology are developmental anomalies, arteriovenous malformation of the brain. This process leads to the formation of an aneurysm, that is, a protrusion of the arterial wall. In this place, the vascular wall becomes very thinned, therefore it is easily ruptured due to an increase in blood pressure.

Hemorrhagic strokes can occur due to a violation of blood clotting, as well as with inadequate drug therapy, which affects coagulation parameters.

It is considered the most severe form of stroke – death occurs in about 70% of all cases.

There are such stages in the formation of hemorrhagic strokes:

• ruptures of the walls of blood vessels lead to the accumulation of a blood clot, the formation of necrosis in the tissues;
• a hematoma is formed, which mechanically compresses the brain tissue;
• an ischemic zone is formed in the clamped area;
• the combination of hematoma and ischemia triggers a chain of irreversible processes of brain damage in the organ;
• under the pressure of a hematoma, parts of the brain can shift, which is a life-threatening condition.

Characteristics of other types of strokes

Extensive

This category characterizes the so-called massive strokes – severe lesions with severe cerebral manifestations:

• depressed state of consciousness;
• swelling of the brain;
• paresis of gaze towards the paralyzed side of the body;
• hemiparesis;
• speech disorder;
• loss of part of the field of view;
• vegetative disorders;
• trophic disorders that occur after a year or two on the side of the lesion;
• a change in the size of the pupil, a weakening of the reaction of the pupil to light;
• strabismus.

In addition, the patient has spasms of tonic muscles. The extensor muscles may have a pronounced increase in tone.

A massive stroke is a lesion that often leads to the death of a person or complete disability.

lacunar

It stands out in a separate variety. In the process of life and development, a person develops a limited lesion of the perforating arteries of the brain – small vessels (up to 2 millimeters in diameter, no more than 10 centimeters in length). They connect larger vessels together. At the site of the infarction, a round-shaped cavity appears, which contains cerebrospinal fluid. The lacunar variety represents approximately 30% of all ischemic strokes. It is characterized by:

• violation of body coordination on the one hand;
• violation of clarity, intelligibility of speech;
• the disappearance or disorder of the motor activity of one arm or leg.

The most common cause of this type of lesion is a combination of atherosclerosis and high blood pressure. In addition, lacunar stroke can be of an embolic nature – such a pathology is more difficult for the patient, since a significant part of the brain is involved in the lesion mechanism.

Spinal

It is a violation of blood circulation in the spinal cord, which is formed against the background of a typical stroke of the brain or an infectious process, tumor, metastases, autoimmune diseases. Spinal stroke is usually localized in the cervical or lumbar thickening, namely in the arteries of large diameter, as well as in small reticulo-medullary arteries. Such a lesion is more often manifested in older people, whose body is hard to cope with the state of impaired blood supply to the brain.

How to determine the formation of a spinal type of pathology in a person? Doctors pay attention to the presence of such signs:

• unexplained pain in different parts of the body;
• chronic spinal insufficiency;
• severe pain in the head that is permanent;
• the presence of noise and a feeling of heaviness in the head;
• loss of consciousness when trying to get up;
• feelings of dizziness;
• memory loss;
• increased fatigue;
• sleep disorders.

A person, due to a long walk, feels numbness in the legs, while there are no pain feelings in the limbs. Discomfort disappears after rest.

Acute

Acute stroke is the initial period of development of the pathological condition. On average, it lasts for three weeks. The patient has an increase in the pathogenetic process in the brain, especially in the first 6 hours.

Acute stroke goes through several stages:

• after damage to the cells of the organ, the core of the brain infarction is formed;
• around it the area of ​​metabolic changes increases (by about 80% in 6 hours);
• the beginning of the death of organ cells (necrosis);
• the spread of a neurological disorder in the form of generalized and focal manifestations.

Repeated

It appears due to cerebrovascular diseases, dementia disorders, against the background of disturbed heart rhythm, arterial hypertension, diabetes mellitus, after a previously diagnosed stroke of the brain.

Symptoms and signs of stroke: clinical picture

All clinical manifestations of pathology are divided into several groups:

• cerebral;
• meningeal;
• focal.

The hemorrhagic variant of the pathology has a characteristic manifestation, rapidly progressive course. The ischemic type of lesion develops somewhat more slowly.

The first thing that can be noticed in a victim with ischemic pathology is focal manifestations, while cerebral symptoms are less pronounced, and meningeal symptoms are often absent. With hemorrhagic stroke, it develops according to a different pattern – cerebral manifestations make their debut, then focal symptoms increase. Meningeal syndrome is characterized by subarachnoid hemorrhage, localized between the pia mater and arachnoid.

Typical manifestations of cerebral lesions in hemorrhagic stroke:

• headache;
• nausea and vomiting;
• state of stupor, clouding of consciousness;
• coma.

Up to 10% of those affected may develop an epileptic attack. Due to the increasing swelling of the brain, a sharp intracranial hypertension is formed in a person, a dislocation syndrome and compression of the brain stem may develop.

Focal symptoms manifest themselves in different ways – depending on the location of the lesion. If a hemorrhage occurs in the basin of the carotid arteries, a person has a complete loss of muscle tone of one half of the body, the appearance of pathological foot signs.

The muscles of the face in the half that corresponds to the immobilized half of the body are paralyzed. A person has a skewed facial expression, the corner of the mouth drops, while the nasolabial fold is smoothed out. An attempt to smile will immediately give out the lag of the damaged side from the healthy one, or it may even remain motionless, due to which a skewed grin appears. Raising both eyebrows is also not possible.

Limbs with reduced muscle tone lose sensitivity. Both eyes lose half of the visual field. The patient may develop visual hallucinations and photopsia, visual-spatial agnosia. It should be noted that the half of the body and face in which such signs are noted is often opposite to the damaged half of the brain.

A stroke in the vertebrobasilar basin of the vascular system of the brain is accompanied by dizziness, vestibular ataxia, diplopia, eye visual field defect, cerebellar ataxia, hearing impairment, dysphagia, dysarthria. The patient cannot move his eyeballs normally.

Stroke: how to recognize and identify brain damage

Doctors focus on the fact that in the first three to six hours after the onset of a hemorrhage, the most effective treatment and withdrawal of a person from a deadly state is possible. Every second is precious, and this is not an exaggeration – that is why it is very important to know and be able to determine if a person has a stroke in order to immediately take him to the hospital, or call an ambulance.

Suspicion should be caused by such sensations and complaints:

• sudden weakness in the limbs;
• numbness in the arm and leg on one side;
• a sharp violation of speech;
• clouding or loss of consciousness;
• impaired perception of the speech of people around;
• loss of coordination, balance;
• feeling dizzy;
• sharp and sudden headache after a stressful condition or strong physical exertion;
• numbness of the lips, half of the face, distortion of the facial muscles;
• violation of pressure indicators – a sharp decrease or increase.

What to do if a person nearby becomes ill, and how to understand if he has a stroke? There are 4 tips that help to almost accurately determine that the deterioration in well-being occurred precisely against the background of this pathology:

1. Ask to smile – if he was struck by a stroke, then the patient will not be able to do this or he will have a crooked grin on one side, while the other corner of the mouth will remain motionless or will react retarded.
2. Ask to answer a simple question – what day is it or what is his name. A person will not be able to pronounce a simple sentence of several words, his speech will be slowed down, words and letters will change places. Or the response to the request will not come at all.
3. The patient is asked to raise both hands up – he will not succeed either, his hands will only partially rise. On the side of the lesion, muscle weakness is noted.
4. Ask to stick out the tongue. If it is curved, then this may be a sign of pathology.

If a person with a suspected stroke has problems performing at least one of the listed simple tasks, he urgently needs to be taken to the hospital, or an ambulance team should be called.

Other obvious symptoms that the victim complains about are severe headaches, the appearance of flickering “flies” before the eyes, numbness of the limbs and loss of sensitivity. The person should be asked to move the left and right limbs together, most likely, it will be extremely difficult for him to do this.

Nausea, vomiting, and dizziness are common; vision is lost, coordination of movements is disturbed. The patient cannot stand on his feet, falls, loses consciousness.

First aid for stroke: an algorithm of actions

The rules for first aid at the first sign of damage require that an emergency medical team be called immediately. The service dispatcher needs to describe in detail all the signs and symptoms of the pathology so that a specialized team is sent to the call.

Apoplexy is a pathology that requires mandatory medical care, and it is impossible to cope with it at home. The patient should be hospitalized in the vascular center, to conduct examinations – computed or magnetic resonance imaging. Only in a hospital setting is it possible to make a diagnosis, determine the cause of the formation of pathology, prescribe the correct treatment and therapy for the recovery period of the patient.

Before the arrival of doctors, the patient must be given first aid. He is laid with his head on high pillows, while the head end of the body should be located at an angle of 30 degrees above the body. It is necessary to provide fresh air access to the room, open windows, while avoiding strong drafts.

Clothing that constrains the body must be removed, the shirt, belts and belts should be unbuttoned.

Next, you need to measure the patient’s blood pressure. With an ischemic stroke, the pressure is reduced, with a hemorrhagic stroke, this is strictly prohibited, since the brain tissue will be left without nutrition. Therefore, in cases where there is no certainty in the nature of the pathology, it is better to leave this question to specialists.

In the event of vomiting, the victim’s head should be turned on its side to prevent vomit from entering the respiratory tract. Under the lower jaw enclose a tray or bowl for vomiting. The oral cavity must be cleaned of saliva and accumulation of vomit – this is done with a finger, which can be wrapped in gauze or a clean cloth.

On the Internet, you can find advice – to bleed a person with apoplexy in order to protect the capillaries in the brain from damage. For these purposes, it is advised to use a syringe for injection, a needle or a pin. They need to be sterilized, and then the tips of all ten fingers on the hands should be pierced, at a distance of about 1-2 millimeters from the nail. Further, the recommendations say that it is also necessary to pierce the earlobes before the blood.

Under no circumstances should this be done! All doctors call such advice, to put it mildly, harmful, since bloodletting a patient with a stroke will not help in any way, but will easily harm. The main help in case of defeat is to call an ambulance, if it is not possible, to deliver the victim to the hospital.

A stroke is a deadly brain injury. Even in cases where the patient survives, he has a high chance of remaining disabled, unable to care for himself. That is why doctors focus on the fact that it is easier to pay attention to the prevention of pathology than to treat its results later. You should not forget about dosed sports loads, a balanced diet without harmful foods and fast food, introduce nuts, vegetables, fruits, fish, honey into your diet.

If a person is overweight, he automatically falls into the risk group for pathology, so the issue of losing weight plays an important role in the method of stroke prevention.

Avoiding alcohol and smoking reduces the chance of a stroke, as does getting a good night’s rest. It is imperative to monitor your blood pressure, in the presence of hypertension – do not let this condition take its course, but deal with its treatment.

Another health criterion that you need to pay attention to is the amount of cholesterol in the blood. People over the age of 20 need to take a blood test for fat levels at least once every 3-5 years.

An unhealthy lifestyle, smoking, eating junk food, overweight, congenital and acquired cardiovascular diseases contribute to the fact that pathology has dramatically “younger” in the last 20 years, that is, it has begun to affect younger people more and more often.

The first aid algorithm for a stroke involves the creation of rest conditions for the patient, under which he can survive until the arrival of doctors. The first 3-6 hours in this case are critical – if you do not go to the hospital at this time, in the future the treatment of a stroke will be longer and more difficult, and its consequences will be more severe and extensive.