Symptoms of stroke and first aid

Stroke is an acutely developing deflection of the cerebral circulation, which is caused by spasms, sudden rupture, clotting with a thrombus or embolus of the cerebral vessels, leads to disruption of the work or integrity of the cerebral vessels, a significant disruption of the functioning of brain tissue or hemorrhage in them. As a result of such disorders, the affected area of ​​the brain suffers from oxygen starvation and its tissues are destroyed and killed.

In the future, such changes lead to disability, and in severe cases, death can occur. Therefore, each of us should be able to recognize the first signs of a stroke and provide first aid to such a patient.

Fig.1 - The asymmetry of the face with a smile is one of the obvious signs of a stroke.

According to statistics, it is men who are more prone to stroke - it comes at an earlier age( after 40 years).In general, before the age of 45, the risk of its development in the stronger sex is 30% higher than in women, but at the age of over 65 the likelihood of developing a stroke becomes the same. His symptoms in men are not as pronounced as in women, and the onset of the disease can be less pronounced.

The main reason for the development of stroke in the stronger sex is the damage to the cerebral vessels, which is caused by actively progressive disorders in the functioning of coronary vessels in hypertension, myocardial infarction and other cardiac pathologies, accompanied by endocrine, infectious and concomitant somatic diseases. According to statistics in men, the lethal outcome of a stroke occurs less frequently than in women.

Risk factors

In most cases, a stroke occurs in men aged 40-60 years. The trigger mechanisms for its development often become such predisposing factors:

• age is more than 40 years;
• genetic predisposition;
• frequent stresses, ambitiousness and impulsiveness;
• irrational food;
• sedentary lifestyle;
• atherosclerosis;
• susceptibility to thrombosis;
• hypertension;
• ischemic attacks and vegetovascular dystonia;
• smoking and drinking;
• lack of adequate treatment of diseases of the cardiovascular or endocrine system.

The first signs of a stroke and its further manifestation

The precursors of a stroke

The development of many diseases can be suspected by the appearance of their earliest signs - precursors. With the development of a stroke, they can appear several hours or days before the attack.

The first alarming precursors of stroke in men can become:

• frequent and sudden headaches;
• nausea;
• dizziness;
• is not justified weakness;
• sharp mood swings.

In addition to these most frequent precursors of a stroke, the following symptoms may appear:

• a rare pulse;
• numbness of the extremities( usually on one side);
• redness of face due to sudden blood flow;
• sweating;
• hearing impairment;
• visual impairment in one eye or both;
• speech and movement disorders;
• blurred vision.

The aforementioned precursors of a stroke are brief and pass on their own after a certain period of time. At occurrence of such episodes of deterioration of state of health to the man it is necessary to address to the doctor and to pass additional inspections. This step in many cases can prevent the further development of the disease and the onset of cerebral hemorrhage.

Symptoms of stroke

The first signs of the onset of stroke in men become such symptoms:

• sudden and intense headache;
• confusion;
• dizziness;
• sharp weakness.

A little later, he may have such symptoms:

• nausea and multiple vomiting;
• numbness in the face, hands, or feet;
• sharp deterioration of visual acuity;
• bradycardia;
• violation of orientation in space and coordination of movements;
• reduced sensitivity;
• violation or loss of speech;
• involuntary urination or defecation;
• convulsive seizures;
• increased sweating;
• blood flow to the face;
• temperature increase.

Test

The severity and variability of these or other symptoms may be different, but everyone must know the main signs of this dangerous disease. To determine the signs of a stroke, a person near the sick person can conduct an easy test of the ( smile, talk to the patient, try to raise his left and right arm):

1. U - ask the affected person to smile and analyze the symmetry of the smile. When a stroke occurs, it will be asymmetrical( one of the corners of the lips will be raised in a smile, and the other - lowered down( see Figure 1)).Z - try to talk to the victim. With stroke, there is difficulty in understanding or reproducing speech. When you try to show the language, it is skewed one way.
2. P - ask the patient to simultaneously raise his left and right arm and hold them in this position for 10 seconds. In stroke, one arm will rise much more slowly than the other, and the patient will not be able to hold his hands in this position.

In some cases, a stroke may be accompanied by seizures, fainting or coma.

Fig.2 - A simple test for signs of a stroke.

Severity of stroke

By severity, strokes can be:

• lung;
• of medium gravity;
• heavy.

For mild stroke, treatment consists of intensive care for 20 days and in most cases, the lost functions of the brain tissue are restored. As a rule, after the completion of the rehabilitation period, the patient does not have paralysis or verbal disorders.

In moderate or severe episodes, the outcome of a stroke is disappointing - about 80% of patients become disabled, and 20% die.

Stroke types

At the site of localization of the lesion, the stroke can be:

• right-sided - the defeat of the right hemisphere leads to the appearance of pain on the left side of the body;
• left-sided - lesion of the left hemisphere leads to the appearance of pains on the right side of the body.

By the nature of the lesion, the stroke can be:

1. Ischemic - occurs due to blockage or sharp narrowing of the cerebral vessel. Symptoms grow slowly and are preceded by precursors. When the stroke occurs, the symptoms of precursors become more pronounced, and the loss of movements in the leg and arm occurs. With ischemic stroke, in most cases, loss of consciousness is not observed. The patient has a confusion and vomiting. In some cases, the affected area of ​​the brain stops spreading and the patient may have a temporary improvement in his state of health.
2. Hemorrhagic - occurs due to the rupture of the vessel, which occurs against the background of a sharp increase in blood pressure, and hemorrhage to the brain, as a result of the patient comes disability or death. Hemorrhagic stroke always begins suddenly. Many patients describe their condition as a sensation of a sudden blow to the head - there is dizziness, sensation of pain and heaviness in the head. After that, the victim loses consciousness, his eyeballs are diverted to the side of the affected area( or in rare cases in the opposite direction), the skin of the face becomes red and the breath is hoarse and noisy. Many patients experience involuntary bowel movement or urination and convulsions. After the victim comes to consciousness, he has nausea, vomiting, severe headache and a state of inhibition.

Fig.3 - Types of stroke - ischemic and hemorrhagic.

First Aid Assistance

If the first signs of a stroke or suspected onset occur, immediately call an ambulance and provide the dispatcher with information about the alleged diagnosis. Prior to the arrival of the doctor, it is necessary to conduct such first aid measures:

1. Provide the patient with complete peace, calm him and lay him on the horizontal surface on his back, lifting his head so that it is above the level of the legs. The victim should not rise or make sharp movements, since these actions will lead to a sharp deterioration in his condition. Before the arrival of doctors, the patient is not recommended to drink and eat, because this can aggravate vomiting and general condition.
2. Remove from the patient clothing that makes breathing difficult, and ensure fresh air.
3. To the nape of the neck attach a bubble with ice, and to the feet - a hot water bottle.
4. If the patient can take the pill, then give him under the tongue 10 tablets of glycine.
5. Measure pulse and blood pressure, remember these measures to inform their physician. At high pressure, give the patient an antihypertensive drug, which he usually takes. Spasmolytic drugs or cardiac drugs can not be used for this purpose. At high pressure, it should not be sharply reduced, giving the patient a second dose of the antihypertensive drug. The indicators of blood pressure can be reduced only by 15-20%, depending on the initial.
6. When paralysis of legs and hands before the arrival of a doctor, they should be ground with a mixture of alcohol and vegetable oil( 1: 2).
7. In case of loss of consciousness, the upper part of the body should be raised by 30 degrees and dentures removed from the mouth, if any. The head of the patient should be turned on its side and constantly monitored, so that when vomiting, it does not choke vomit. When vomiting occurs, clean the oral cavity of the remaining vomit remnants with a piece of cotton cloth.
8. When breathing is stopped, artificial respiration is required.

After the arrival of the medical team, it is necessary to provide them with information on how rapidly the signs of a stroke developed and what preparations the patient took.

Further treatment for stroke

An ambulance doctor evaluates the general condition of the patient and decides to transport him to the intensive care unit. During transportation to the intensive care the patient is constantly measured blood pressure and injected medicines to correct respiratory and cardiac activity. Hospitalization is not available only to those patients who were found at the site of an attack in a coma or when serious complications of internal organs are detected. Such patients receive emergency medical help and transfer information about such a patient to the polyclinic for further treatment.

After receiving the patient in the intensive care unit, he is examined by a neurologist and, if necessary, a neurosurgeon. The further tactics of treatment depends on the type of stroke and its severity.

Bed rest

The duration of bed rest for stroke is determined by the general condition of the patient - the type of stroke, the stability of vital signs and neurological disorders. The duration of bed rest with hemorrhagic stroke can range from 1-2 weeks to 4-6 weeks, and for ischemic stroke, which is not accompanied by the progression of neurologic symptoms, it is 3-5 days. In other cases with ischemic stroke, the duration of the patient's movement limitation is no more than 2 weeks.

For prophylaxis of deep vein thrombosis, which can occur with prolonged bed rest, patients are advised to wear compression stockings or tight bandaging of the legs with elastic bandages and lifting legs at 6-10 degrees. With the development of thrombosis, heparin is administered - first intravenous, and then subcutaneous. Anticoagulant therapy is carried out for 7-10 days.

After activation of the patient, his physical activity should expand gradually.

Treatment for hemorrhagic stroke

The main goals of treatment for hemorrhagic stroke are directed to:

• elimination of edema of the brain tissues;
• increase in the density of the walls of blood vessels and blood coagulation;
• decreased intracranial pressure.

The patient is placed on the functional bed and raised its head end. A bubble with ice is applied to the head, warmers to the feet. To relax the muscles under the knees, rollers are inserted or a necessary popliteal bend is made using a functional bed.

With increased pressure, the patient is prescribed antihypertensive drugs( Dibazol, Etamsilate, Magnesia, Labetalol, Pentamine, Aminazine).To activate the thrombosis of damaged cerebral vessels, drugs are added to increase blood coagulability( Vikasol, Calcium Chloride, Aminocapronic acid solution).

Three days later, for the prevention of thromboembolism in the presence of severe signs of subarachnoid hemorrhage and atherosclerosis, the patient is assigned proteolytic enzymes( Contrikal, Gordoks) in combination with Heparin. To eliminate cerebral edema, hyperventilation of the lungs is performed and such drugs as Mannitol, Glycerol or Dexamethasone are prescribed. If this therapy is ineffective, diuretics are prescribed in addition to these drugs( Lasix, Furosemide).If these measures are also ineffective, then it is possible to prescribe a surgical operation for decompression of the brain.

For the elimination of headaches, non-narcotic analgesics( Paracetamol) are prescribed to the patient, and for frequently recurring vomiting - Haloperidol and Metoclopramide. When psychomotor agitation occurs, the appointment of sodium oxybutyrate, diazepam and haloperidol is recommended. And in the case of the development of recurring epipriplets, anticonvulsant preparations with long-term action( carbamazepine) are prescribed.

In violation of the creation and mental disorders, it is necessary to organize control of the pelvic organs, adequate care for the patient's body and nutrition( if necessary, feeding through the probe).

Treatment for ischemic stroke

The main goals of treatment for ischemic stroke are directed to:

• normalization of the blood supply to the brain tissue;
• formation of tissue resistance to oxygen deficiency;
• improvement in metabolic processes in intact cells.

The patient should occupy a comfortable position in bed, but the head end of the bed should not be raised as in a hemorrhagic stroke, it is not necessary. Drug therapy includes the administration of vasodilators( Papaverin, Euphyllin, Complin, Nicotinic acid, No-shpy).To improve blood circulation in the affected area of ​​the brain and reduce blood clotting is introduced Reopoligyukin.

During the treatment, constant monitoring of the injected volume of fluid is carried out, since the introduction of excessive volumes of solutions can lead to increased edema of the brain. To reduce it with caution, diuretics are prescribed.

On the first day after the attack, the patient is administered anticoagulant solutions of Fibrinolysin and Heparin, and in 3-5 days Dikumarin or Phenylinum is administered.

For the improvement of blood density, patients of young and middle age are prescribed Pentoxifylline, and the elderly - Xanthinal nicotinate, Parmidin. To normalize the tone of the vascular walls, Cavinton and Cinnarizin are appointed.

When a patient develops psychomotor agitation, barbiturates are introduced.

When the brain region is ischemic, cells need to increase their resistance to oxygen starvation. For this, metabolites are used( Cerebrolysin, Piracetam, Aminalon).To prevent the development of repeated violations of cerebral circulation, the simultaneous administration of Curantil and antiplatelet agents( Aspirin, Cardiomagnol, Trombo Ass) is shown. Naloxone, Emoxipine can be used as antioxidants.

Surgical treatment of stroke

Table 1 - Surgical treatment of hemorrhagic and ischemic stroke.

Type of surgical intervention for stroke and the timing of its implementation are determined individually.

Rehabilitation after a stroke

In case of extensive strokes, the purpose of such rehabilitation drug therapy is indicated:

• preparations for improving blood flow and vasodilation - Cavinton, Nicoshpan, Cinnarizin;
• preparations for the prevention of blood clots and antiaggregants - Aspirin, Cardiomagnolo, Curantil, Tiklid;
• preparations to improve brain activity - Cerebrolysin, Actovegin, Nootropil, Karnitsyn, Laticin.

For rehabilitation after a stroke, the patient is prescribed therapeutic exercises and kinesitherapy. If the speech center is damaged, sessions with a speech therapist are recommended. Such patients should, if possible, read and listen more often to someone else's speech( communication with loved ones, radio, TV).

In the future the patient can be shown sanatorium treatment in specialized sanatoriums, in which support procedures can be performed: massage, therapeutic gymnastics, physiotherapy, mud and medical baths.

Patients with stroke need rehabilitation in everyday life and society, which will be accompanied by constant moral support from relatives and friends. As a rule, motor functions are restored 6 months after the stroke, and for significant improvement in balance, speech functions, professional and household skills, it may take about 2 years or more.

Cardiologist Petrova Yu.

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