Currently, extensive cerebral stroke is one of the leading causes of mortality. Even with a relatively favorable outcome, serious consequences occur. Recovery and rehabilitation require many months and even years, and not all patients manage to return to a full life. From our article you will learn what a major stroke is, what symptoms it is accompanied by, and what are the chances of survival for the victim.
Causes of major stroke
As a rule, a stroke occurs for two reasons - due to ischemia (deterioration of blood circulation in the brain) and due to hemorrhage. The first type of stroke is called ischemic. The second is hemorrhagic.
Extensive ischemic stroke is caused by prolonged spasm, compression or blockage of the main branches of the great vessels - the carotid arteries.
Hemorrhagic disorders are caused by rupture of arterial walls and subsequent saturation of brain tissue with blood. Hemorrhage can develop against the background of a sharp jump in blood pressure, with congenital pathologies and acquired diseases of the cerebral vessels, as well as with open and closed craniocerebral injuries.
Provoking factors for extensive cerebral stroke can be:
- atherosclerotic damage to cerebral vessels;
- hypertension (especially in the absence of adequate treatment);
- blood pathologies associated with an increased risk of thrombosis;
- heart diseases (CHD);
- metabolic disorders (in particular, overweight and obesity);
- endocrinopathies (including diabetes mellitus);
- asymptomatic stenosis of the carotid arteries.
Please note: The likelihood of acute cerebrovascular accident is significantly higher in patients with a history of panic attacks.
Signs and photos
Signs of the disease with such a deviation are typical for a heart attack. The patient complains of compression and burning behind the sternum, shortness of breath, rhythm disturbances and pressure surges. But with a large heart attack, I almost always observed pronounced clinical symptoms. And laboratory tests of markers (ALT, AST, troponins, myoglobin and CK) will be significantly higher than with a minor lesion.
In the attached figure you can see an example of damage to a large area of the heart when an artery is blocked by a thrombus in the area of atherosclerotic plaque.
The photo below shows an anatomical section of the myocardium of a patient who died as a result of an extensive transmural infarction. Necrotic changes are clearly visible on it.
Difference between left-sided and right-sided lesions
If extensive cerebral circulation disorder is located in the right hemisphere, the following are observed:
- left-sided paralysis;
- paralysis of facial muscles on the left side;
- passivity and general depressed state of the victim;
- memory impairment.
Important: In some cases, speech dysfunction is minor, which makes it difficult to make a correct diagnosis.
If the focus of the pathology is located in the left hemisphere, the following comes to the fore:
- right-sided paralysis;
- serious mental disorders;
- speech disorders;
- pronounced problems with logical thinking.
Characteristic symptoms
Clinical manifestations of extensive damage to brain tissue are always pronounced. If they appear, you should call an ambulance as quickly as possible, since the patient needs urgent hospitalization. His life depends on how quickly adequate treatment is started.
Characteristic symptoms:
- intense headache;
- dizziness;
- impaired coordination of movements;
- instability in a vertical position;
- loss of orientation in space;
- nausea and vomiting;
- hyperemia of the facial area;
- cold sweat;
- dry mouth;
- cardiopalmus;
- disorders of visual, auditory or olfactory perception;
- loss of consciousness;
- speech disorders (indistinct pronunciation of words and individual sounds);
- muscle spasms (cramps);
- paralysis and paresthesia of half the body;
- memory losses.
In cases where the victim is unconscious, it is advisable to conduct a pupillary test. One of the important signs of a stroke is the lack of reaction (constriction) of one pupil to a light stimulus.
Consequences (complications)
The sooner therapy is started, the greater the patient’s chances for the most complete restoration of body functions.
Consequences of a major stroke:
- hemiplegia (paralysis of half the body);
- complete paralysis (if both hemispheres are affected);
- problems with speech (with an extensive lesion in the left hemisphere);
- cognitive impairment (difficulty perceiving and processing information);
- amnesia (partial memory loss);
- hearing and (or) vision impairment;
- decreased tactile and pain sensitivity;
- loss of ability to concentrate.
Often the possibility of full rehabilitation is excluded, and severe consequences persist for the rest of your life.
Coma as a consequence of a stroke. Principles of treatment
A comatose state is characterized by a complete lack of consciousness and lack of reactions. It can develop rapidly, but often (in approximately every fourth case) the cause is untimely provision of assistance.
Coma with a major stroke, as a rule, lasts from several hours to 1-1.5 weeks, but can drag on for months and even years. According to statistics, the chances of partial recovery after several months in this condition are less than 15%. The mortality rate for this complication is very high. Even if the patient manages to emerge from a long coma, there can be no talk of complete rehabilitation.
The danger of this condition is that not only brain functions are affected; there is often no control of breathing and cardiac activity, and therefore the patient must be connected to a life support system. In this condition, the likelihood of repeated acute cerebral circulation disorders remains high.
The first signs of coma:
- incoherent, quiet speech;
- rave;
- lethargy;
- confusion;
- body lethargy;
- weak pulse filling;
- tachypnea (rapid breathing).
Falling into a coma is accompanied by a lack of control over the functions of the pelvic organs (involuntary urination and defecation are noted).
In the first degree, reflexes are generally preserved (skin ones are weakened), and muscle tone is increased. In the second case, there is no reaction to external stimuli; the victim is in a state of deep sleep. The third degree is characteristic of extensive hemorrhage and is characterized by the absence of basic reflexes and the reaction of the pupils to light. In the fourth, against the background of suppressed reflexes, there is a sharp decrease in pressure and depression of respiratory function.
The prognosis for life in a coma after a second stroke is disappointing, especially when it comes to the hemorrhagic type. After ischemia, the chances of recovery from this condition and partial recovery are significantly higher.
Measures must be taken to combat brain swelling, seizures and the risk of infections. The victim requires constant care. Prevention of bedsores is of great importance. Treatment also includes vitamin therapy and general massage.
Chances of survival and prognosis
Many patients who come to see me ask about how long they live after developing a massive heart attack. It is difficult to answer this question unambiguously. I believe that everything depends not only on competent and timely assistance, but also on the person himself, who must follow all recommendations for successful treatment and recovery.
Hospital mortality during prolonged myocardial hypoxia is 14%; of the total number of patients, about 40% die on the first day after the onset of the attack. The main reason for this is the occurrence of early and late complications. The possibility of stenting and other X-ray endovascular interventions in large cardiac intensive care centers participating in the “vascular program” reduces the likelihood of patient death during hospital stay to 6%.
At the same time, life expectancy depends on the presence of factors and diseases that worsen coronary circulation and increase the load on the heart:
- diabetes;
- hypertension;
- obesity;
- elderly age;
- smoking;
- atherosclerosis and high levels of low-density cholesterol;
- hereditary predisposition to cardiovascular diseases.
Statistics show that in men of working age, death from a major heart attack occurs 7-8 times more often than in women, but after 50 years this figure levels out.
First aid
Irreversible changes in the brain begin within a few hours after the first signs of a major stroke appear. There is the concept of a “therapeutic window” - a period of 4.5 hours, during which it is still possible to prevent the death of a critical number of nerve cells. In practice, doctors have significantly less time to carry out a set of measures - on average, about one and a half hours.
If symptoms appear that indicate an acute circulatory disorder, you need to call a medical team without wasting a minute. Before their arrival, it is necessary to calm the victim and help him take a semi-lying or horizontal position with his head raised. If the patient is unconscious, the head should be turned to the side to prevent aspiration of vomit. The shirt collar should be unbuttoned, the trouser belt should be loosened, and other clothing that may restrict breathing should be removed. To ensure the flow of fresh air, it is recommended to open a window or vent.
If the attack began against the background of a hypertensive crisis, to improve the outflow of blood from the brain, you can lower the patient’s legs into a basin of hot water.
Important: It is strictly forbidden to give vasodilators, as well as give water and food to the patient! You should not take him to the hospital on your own, especially by public transport!
Relatives or friends need to accompany him to the hospital by ambulance, so that they can then describe the symptoms in detail to the doctors. This will help specialists objectively assess the situation and quickly make the correct diagnosis.
If necessary, the ambulance team can perform mechanical ventilation and tracheal intubation, as well as administer drugs to lower blood pressure and begin correcting the water and electrolyte balance by placing a drip with saline solution. The basic principle that guides transportation is “delivery with the least possible deterioration in condition.”
Treatment and rehabilitation after a major stroke
The treatment plan is drawn up taking into account the diagnostic results. The type of stroke, location and probable size of the lesion are taken into account. Diagnostic procedures include blood pressure measurement, computed tomography, electrocardiogram, Doppler ultrasound, chest x-ray and laboratory blood tests - general and biochemical.
The patient is admitted to the intensive care unit. For any type of disruption of the blood supply to the brain, control of breathing, heart function and swallowing function is necessary.
For ischemic stroke, anticoagulants, vasodilators and angioprotectors are indicated. Thrombolytics are effective within the first 6 hours.
Hemorrhagic stroke may require surgical removal of the hematoma.
As the patient’s condition stabilizes, he is transferred from the intensive care unit to the intensive care unit, where he stays for an average of 2-3 weeks.
In the post-stroke period, long-term and carefully planned rehabilitation is required. It is desirable that it be carried out in a specialized medical center. Some victims remain bedridden, while others have to be re-taught basic skills. A lot of time and effort needs to be spent on restoring speech functions. For this purpose, classes are held with a speech therapist.
Caring for seriously ill patients requires certain skills. The most important activities in the recovery period are hygiene procedures, prevention of bedsores, physical therapy, adherence to the prescribed diet and socio-psychological adaptation.
Features of rehabilitation
Rehabilitation of patients with a large heart attack consists of taking medications, the patient’s participation in programs that allow them to restore their psycho-emotional background, quit smoking, and ensure proper nutrition. How long can such a period last? The duration of active patient management in the clinic after discharge ranges from 5-6 months to one year.
Motor rehabilitation is mandatory; it begins in the first days after an attack and consists of performing breathing exercises with a gradual expansion of motor activity. Restorative measures also include a light massage of the cervical-collar area and the area of the projection of the heart onto the anterior wall of the chest. This should be done very carefully, taking into account the general condition, the presence of complications and concomitant diseases.
With a large heart attack, it will take a long time for the patient to be able to perform normal activities again and tolerate stress normally. If it is necessary to switch to easier working conditions or if the ability to self-care is limited, the patient is assigned a disability.
After conducting research, it turned out that in the post-infarction period, mortality among experiment participants decreased by 25% if they followed the principles of proper nutrition. The use of whole grains in the diet had a particularly beneficial effect.
