As it turns out, cerebral ischemic stroke in the elderly, as well as in young patients, is not a disease, but a clinical syndrome. In plain language, we can say that this is a combination of certain signs and symptoms with a common etiology. Let's find out what this condition is, how it is characterized and how therapy is carried out.
The concept of stroke and its consequences
What is an ischemic stroke, and how it affects later life, know the relatives of those who have encountered this problem. You can expect anything from paralysis to death.
From the point of view of medicine, such a syndrome is typical for the onset of a cerebral infarction due to a number of reasons. The secondary cause is called a decrease in cerebral blood flow. But what are the root causes, you should understand in each case.
Because of what happens
Regardless of the age of the patient, ischemic cerebral stroke in the elderly or young people has several causes:
- Hypertension or diabetes can lead to a lacunar attack. In this case, circulatory disorders occur in small arteries located in the hemispheres and the cerebral cortex.
- Atherosclerosis of the middle or large central artery causes an atherothrombotic attack. In this case, symptoms develop gradually and peak during sleep.
- Clogging of the middle artery of the brain with an embolus, that is, blocking the lumen of the vessel, leads to a cardioembolic attack.
- In rare cases, a stroke occurs due to dissection of the artery wall, a high degree of blood clotting, existing vascular pathologies (not related to atherosclerotic), blood diseases.
- Due to a drop in blood pressure, both during exercise and at rest, a hemodynamic attack can develop.
It also happens that the cause cannot be determined. However, it is known that the risk of stroke increases in smokers and patients suffering from obesity and hypertension.
Symptomatics
What is an ischemic stroke and its consequences, you can find out if you analyze what are the main signs of the syndrome. After all, the recovery period also depends on the severity of the disease. But it is equally important to understand what symptoms indicate a stroke. Among the most notable and most common, experts note:
- loss of consciousness;
- impossibilitymove one or more limbs;
- disorientation;
- speech problems;
- difficulty swallowing;
- nausea and vomiting;
- pain and dizziness;
- heat;
- sweating;
- memory problems.
How pathology is detected
It is known that early stroke therapy allows not only to save life, but also to alleviate its consequences. What is an ischemic stroke and how to diagnose it, both neurologists, paramedics and emergency doctors know.
When visiting a patient at home, the doctor examines him and determines the need for admission to the hospital. If a stroke is suspected, the patient is advised to go to the emergency room of the neurological department. In a hospital setting, basic studies are first carried out, including a general and biochemical blood test, an electrocardiogram, after which the doctor decides on further examinations. The most informative methods are MRI and CT. They will help to identify the site of the lesion, the capacity of the vessels going to it, as well as the area of the infarct and the damage done to the brain.
Types of ischemic stroke
Classification in this case is carried out according to several criteria:
- According to localization, ischemia is distinguished: carotid, basilar, vertebral artery, branches of arteries and brain.
- Severity: mild, moderate and severe. In mild stroke, neurologicalsymptoms are mild, recovery occurs as soon as possible. The average type does not disturb consciousness, the symptoms are characteristic of a focal lesion. In the case of a severe degree, depression of consciousness is noticeable, and treatment after an ischemic stroke of this type is long, with the obligatory passage of a rehabilitation course.
- According to the speed of development: transient attack, small, progressive and total stroke. Transient ischemic attack is the mildest type, developing during the day. However, the attack itself lasts no more than an hour. It cannot be fully called a stroke, since a heart attack is not recorded here, and therefore, irreversible damage to a part of the brain is not detected. Usually, patients do not go to doctors, therefore they do not receive the necessary medicines, which can lead to total brain damage in the future. A minor stroke is characterized by an acute impairment of cerebral circulation. You can recover from the manifestation of such a syndrome within a month. It should be noted that even long-term and high-quality rehabilitation after progressive ischemic stroke does not guarantee full restoration of functions. The total type of pathology leads to the death of the meninges and most often to death.
- Depending on the area of damage, there are left-sided, right-sided, stem, cerebellar and extensive strokes.
How to identify the affected part of the brain
Right-sided type of ischemic stroke is expressed in paralysis of the left side of the body. Also canspeech disorders appear. If the left side was damaged, then there are problems with the right half of the body. Paralysis is not all the consequences. With a left-sided stroke, a serious impairment of speech and the ability to perceive what others are saying is noticeable.
Stem stroke is the most common cause of death, because it is there that the centers that regulate the heart and respiratory systems are located. The main signs of such a lesion are nausea, vomiting, loss of orientation in space, inability to coordinate their movements.
The cerebellar appearance is also manifested by problems with coordination and dizziness. In this case, a coma is possible, from which only a part of patients manage to get out.
Extensive brain damage manifests itself in the rapid development of all possible symptoms, from headache to loss of consciousness.
Consequences requiring serious rehabilitation
Often, the condition after a stroke is complicated by the occurrence of aphasia. This is a speech disorder that is caused by damage to certain brain cells. It manifests itself in the form of both partial and complete loss of the ability to use speech. Understanding reversed speech can also be a sign of aphasia. Doctors diagnose this condition in four ways:
- Loss in the dominant hemisphere of Broca's center, located in the frontal inferior gyrus, causes motor aphasia, when the patient cannot speak, but understands speech. In this case, paralysis of the speech muscles is not diagnosed.
- Violation inthe upper temporal lobe of the main hemisphere of the Wernicke center leads to a sensory type, when the patient himself cannot form sentences, and does not understand the speech of others.
- Losses at the border of the parietal, occipital and temporal lobes of the dominant hemisphere, which can cause forgetfulness with normal understanding of speech and the ability to communicate, is called amnestic aphasia.
- Destruction in the parietal lobe and the difficulty of perceiving whole sentences is called a pathology of the semantic type.
Dysarthria after a stroke is expressed by defects in the pronunciation of sounds and words. In this case, experts talk about the disruption of the work of precisely those muscles that contribute to speech. The patient perfectly understands what they are talking about, is able to write and read to himself. This condition appears when there is a lesion in the frontal lobes of the posterior sections and the death of part of the subcortical structures.
Therapy for aphasia and dysarthria
These are the longest-running but usually modifiable disorders diagnosed as a result of a stroke. As neurologists say, its reversible consequences. What is an ischemic stroke and how to achieve a complete cure in these cases, we will describe further.
Dysarthria requires patience and perseverance from others. Day after day it is necessary to teach the patient to pronounce sounds, and then put them into words. It must be borne in mind that a person perfectly understands what they want from him, he hears everything and even remembers how he spoke before. However, his mandibular and oral muscles have lost their skills. A special charger will help, includingthe following exercises:
- protruding from the mouth alternately relaxed and tense tongue;
- circular movements of the tongue and emphasis on the teeth;
- training the articulation of the entire face, i.e. lips, facial muscles and lower jaw.
It is advisable to visit a speech therapist who will help restore swallowing function. Medical treatment is also mandatory as prescribed by a specialist who observed the patient in the hospital. And after undergoing this kind of therapy, you need to contact a doctor at the place of residence, who will give recommendations on the further behavior of the patient and the adoption of appropriate medications.
The state of aphasia is much more difficult to correct, since there is no full contact with the patient. He either does not understand speech at all, or this function is seriously impaired. Again, it is important to take some time each day to help the stroke victim.
You should talk to him, listen to what he is trying to say. In no case should you interrupt the patient, correct his phrases and instead of him finish the sentences he started.
In case of sensory aphasia, it is recommended to start with pictures of household items. Therapy of motor aphasia involves the construction of speech series. Here you can set up a person to pronounce the days of the week, months, seasons, numbers of the first ten. Amnestic and semantic types of lesions require frequent communication with simple questions, the answers to which will not make a person at the first stage confused and will allow him to believe intheir strength.
Facial symmetry disorder
Sometimes the very first symptom and difficult to treat later is a distorted face. After a stroke, this defect will be corrected. However, it should be understood that such a condition can be caused by both the defeat of mimic wrinkles and the central nerve.
If the doctor diagnoses a stroke, and not possible in the case of the same defect, neuritis of the facial nerve, then the distorted side indicates a damaged hemisphere. The lowering of the corner of the mouth on the left indicates damage to the right hemisphere and vice versa.
Restoring a face is possible in some cases, but the result is not always predictable. Removing asymmetry is difficult. Additional drugs are used, that is, funds other than those that treat the general condition of the body. In addition to following the doctor's recommendations regarding the use of medications, it is imperative to perform special exercises. This is the only way to return facial expressions and its normal expression.
Usually, the doctor prescribes funds to restore blood circulation, relieve inflammation, normalize intracranial pressure, get rid of muscle paralysis and reduce swelling. They also conduct a course of massage, physiotherapy and recommend performing facial gymnastics. The special complex includes the following exercises:
- Raise and lower the eyebrows, then relax the muscles and repeat the movement.
- Move brow ridges.
- Frown and wrinkle nose at the same time.
- Smile with your mouth openclose it, relax the muscles and repeat the exercise.
- Smile with pinstriped lips.
- Pip your lips.
- Close your mouth, puff out your cheeks and try to smile.
- Sing vowels for as long as possible.
- Move your jaw in a circle.
- Try to reach your nose and chin with your tongue.
- Pushing the jaw to the left, hold it in this position, and then repeat the exercise in the other direction.
However, you should not start such movements on your own. It is better to consult a doctor. Some patients can start gymnastics a week after the crisis, others should wait a month. In addition, the number of repetitions should also be recommended by the doctor, taking into account the patient's he alth condition.
What to expect
In the first few days, neuroscientists prefer not to make predictions. Ischemic stroke in the elderly, as well as in young people, can cause a whole range of conditions that are often impossible to cure. Most often, difficulties arise with paralysis. Violation of the sensitivity of half of the body, if it passes, then by no means immediately. Long-term rehabilitation is required. It is known that with paralysis of the right side, the prognosis is more favorable, since a smaller number of vital organs are located here. However, well-being can also be difficult, and a person can be on the verge. A return to a full life, if resuscitation ended with a way out of a crisis state, is possible after completing a rehabilitation course, including:
- Identification of the root cause and the appointment of therapeutic measures that can stabilize the condition. This refers to lifelong medication, for example, maintenance for hypertension, atherosclerosis, kidney failure, coronary heart disease.
- Taking drugs to thin the blood and prevent vasospasm. For this purpose, various medications are used that help normalize blood flow.
- Prescribing drugs to bring the walls of blood vessels and their tone into line.
- Monitoring and stabilizing blood pressure.
- The use of diuretics, which not only reduce blood pressure, but also prevent cerebral edema.
In addition to these measures, additional drugs are often prescribed to improve heart function and lower blood cholesterol levels. Also, therapy should include strict adherence to diet and lifestyle adjustments.
After the crisis passes, the patient's relatives wonder how long they live after an ischemic stroke. The answer is far from clear. The statistics say this:
- The number of deaths is 75%.
- 40% of older patients live more than a year.
- 65% of all patients are able to live beyond five years.
- 25% overcome all problems, successfully rehabilitate and die in old age.
It should be noted that the severity of the post-stroke condition and the patient's quality of life is directly related to the lifestyle he led before the tragedy. Undoubtedly the influenceand chronic diseases, and rehabilitation measures, and proper drug therapy. Physical activity and the desire to physically work on yourself will help increase the chances of a full recovery.
What drugs help recovery
There are a number of classic remedies for ischemic stroke. The most commonly prescribed medicines of the following groups:
- Thrombolytics: Dipyridamole, Ticlopidin, Clopidogrel, Pentoxifylline.
- Nootropics: Cerebrolysin, Piracetam, Picamilon, Aminalon.
- Anticoagulants and antiplatelet agents: Aspirin, Enoxaparin sodium, Phenylin, Warfarin, Nadroparin calcium.
- To improve the rheological properties of blood: plasma, albumin, rheopolyglucin.
- Calcium antagonists: Nicergoline, Vinpocetine, Aminophylline, Instenon, Cinnarizine, Vasobral.
- To improve metabolism: lipoic acid, Actovegin, Diavitol, Solcoseryl, Cytochrome.
Sometimes a special chamber is used in which the patient is placed to enrich his body with oxygen.
The patient's relatives need to know that the process of recovery and subsequent rehabilitation is complex, it takes time and effort. To make significant improvements, you needseveral months and sometimes a whole year. The only recommendation for the inner circle is the obligatory adherence to the prescriptions of the attending physician and the absence of any initiative. If you want to help the victim, it is better to coordinate any therapy with the doctor. This advice applies to both medical and folk methods of treating stroke, of which there are a great many on the Internet.
