Extensive stroke: there are chances for a favorable outcome

The human brain is the most fragile and least studied organ in the entire body. Any disturbances in the functioning of the brain can lead to unpredictable consequences. But perhaps the most dangerous changes in cerebral circulation occur precisely as a result of a major stroke.

This is due to the fact that due to acute circulatory disorders, areas of the brain responsible for vital functions can be damaged. The outcome of a major stroke can be anything: from the appearance of minor movement disorders to the onset of coma and death of the patient.

Risk factors for developing pathology

Like any other pathology that develops in the human body, stroke has its own causes. They are mainly associated with blockage of blood vessels, a decrease in blood flow in them and an insufficient supply of nutrients to the nerve cells of the brain, resulting in necrosis (death) of the cellular material of the central nervous system.

Risk factors for disruption of normal blood supply are:

arterial hypertension;
development of atrial fibrillation;
hereditary predisposition to diseases of the cardiovascular system;
defects (deviations from the norm) in the structure and development of blood vessels;
development of angina pectoris;
smoking;
alcohol abuse;
obesity and overweight;
development of diseases of the endocrine system, primarily diabetes mellitus;
development of vegetative-vascular dystonia and atherosclerosis processes.

If you have at least one risk factor for stroke, you should contact a specialized specialist for an examination. Providing timely professional medical care can save the patient not only health, but also prolong life.

Ischemic stroke: complications and disability

The ischemic type of change in cerebral blood supply is divided into 6 stages:

Acute – 3 days;
Acute – up to 4 weeks;
Subacute – up to 2 months;
Early – up to 1.5 years;
Late – up to 2 years;
Residual changes – up to 4 years.

At each of the above stages, different consequences of the disease are formed.

With acute ischemic changes, the risk of death is high. Due to blockage of a large artery by a blood clot or cholesterol plaque, a sudden cessation of cerebral blood supply leads to the death of a large number of cells, which is incompatible with life.

In the acute period, with adequate resuscitation measures and a small amount of damage to brain cells, a person’s life can be saved, but, as a rule, he remains disabled.

In the subacute period, ischemic stroke is characterized by complications from other organs. At this stage, congestive pneumonia may occur, which is formed due to difficulties in the functioning of the heart and the reflux of intestinal contents into the bronchi. At this stage, serious consequences may occur - acute heart failure and pulmonary embolism (blockage of a vessel with death).

At the early and late stages of the disease, bedsores form, leading to the formation of purulent foci on the skin. Stagnant changes in the skin over a long period of time are accompanied by bacterial infection of tissues and organs.

If the ischemic type of microcirculation has been observed in the human cerebellum for a long time, disturbances in coordination of movements appear. It makes it difficult to walk exactly along the line drawn on the floor.

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How does a stroke develop - causes and provoking factors?

You probably remember how, during an examination at an appointment with a neurologist, a specialist asks you to walk along a line on the floor. This is how it determines coordination disorders during ischemic changes or hemorrhage in the brain.

Usually, along with the pathology of coordination, paresis (loss of innervation) of the muscles on the side opposite to the focus of ischemic changes in the brain is observed.

If the respiratory and vasomotor control centers are damaged, there is a high risk of stopping blood supply and breathing, which are incompatible with life.

Prevalence of stroke by gender and age

Metabolic processes occurring in the body are primarily influenced by age-related changes and dietary habits. Over time, the biochemical composition of many products consumed by humanity has changed.

The increased content of nitrates, carcinogens, emulsifiers and other chemical compounds in food has complicated the processes of metabolism and removal of dangerous and harmful substances from the body. Stroke is increasingly being diagnosed in young people, although more recently it was classified as an age-related disease that mainly affects older patients.

Thus, among patients aged 20 to 40 years, stroke was diagnosed in 0.5% of cases of medical care; in patients aged 40 to 65 years, pathology was observed in 7-8%, but after reaching 65 years of age, stroke was diagnosed in 15% of cases .

The female body, due to the peculiarities of hormonal balance, is more susceptible to the development of pathology. Female mortality was observed in 43.4%, but men died in 36.6% of cases.

Main factors influencing the prognosis of ischemic stroke

The prognosis of ischemic stroke is determined by the clinical and functional outcome of the disease - the likelihood of death, the duration of the recovery period, the likelihood of complications, long-term neurological consequences and repeated cerebral infarction.

The main factors influencing the prognosis for life are the age of the patient, the location of the lesion, the cause, type and initial severity of the stroke. Subsequently, the outcome of a stroke is influenced by the timeliness of admission to the hospital, the adequacy of treatment, the presence of severe concomitant diseases, mental disorders, the addition of neurological complications (cerebral edema with damage to the brainstem or cerebellum, coma), late start of rehabilitation, and the development of a recurrent stroke.

Forecast for the development of a stroke situation

Premature death after a stroke can occur within a few hours, regardless of whether the patient is in rehabilitation or undergoing treatment. During this period, the supervision of a specialized specialist plays a fundamental role for the health and life of the patient. Qualified therapeutic measures can restore blood supply to the affected tissues of the central nervous system, reducing the phenomenon of necrosis and preserving brain function.

What is the danger of a stroke in the absence of medical care? First of all, the possible development of a coma in the patient! In this case, his chances of saving life are sharply reduced: in 90% of cases, coma is a consequence of serious damage to the central nervous system. In addition, if treatment is not timely, a protracted state of coma may occur, in which case it can cause the development of other complications that pose a threat to life:

congestive pneumonia;
pulmonary embolism;
sepsis;
renal failure;
general dehydration.

It is very important that medical care for a stroke is provided to the patient as quickly as possible. Timely, adequate therapy can increase the chances of survival.

Symptoms of a stroke

Symptoms of stroke are divided into general and focal. The first are expressed by the following states:

disturbance of consciousness;
state of stupefaction;
drowsiness or excitability;
unbearable headache;
loss of consciousness;
nausea and vomiting.

At the same time, the heartbeat quickens, the person sweats a lot, his consciousness is clouded, he does not orient himself in space, he feels hot, and his mouth is dry.

Focal symptoms indicate damage to the brain and depend on which part of it is affected: if the area responsible for movement is affected, a person may feel weakness in the limbs, loss of sensitivity, and with severe damage, paralysis may occur.

If any of these symptoms appear, you must take immediate action:

decreased vision in one eye;
loss of balance;
dizziness;
double vision, strabismus;
change in articulation, facial distortion.

How to reduce the likelihood of death

First of all, you should avoid stress, states of emotional overstrain and worries. In the most unusual situations it is necessary to remain calm.

The risk of premature death from stroke can be reduced by leading a healthy lifestyle, closely monitoring your health, and promptly treating inflammatory and other diseases.

To reduce the negative impact of environmental factors, difficult climatic conditions of existence should be avoided. It is also necessary to limit the consumption of salt and animal fats, and organize a proper and balanced diet. Smoking and drinking alcohol is unacceptable!

Causes of death in cerebral ischemia

Ischemic stroke firmly occupies a leading position among diseases leading to death. In Russia, every year almost 360 thousand people have a cerebral infarction, and 15% of these patients die on the first day.

Mortality in hospital in the acute period of ischemia

According to neurologists, in Russia, about 60% of patients with ischemic stroke are treated in a hospital, of which only 30% were admitted to a medical institution in the first 6 hours from the onset of the disease, when medical intervention could prevent the onset of complications or death.

Due to reluctance to consult doctors, inattention to their condition, and the habit of relying on “maybe”, people turn to doctors’ help so late that professionals can only throw up their hands. In our country, every third person with ischemic stroke is treated at home! Absurd, but true.

Patients are brought to doctors already in varying degrees of coma, and the mortality rate in this state is almost 100%.

If you suspect a stroke, you should urgently call an ambulance

The main causes leading to death in ischemic stroke in the acute period of the disease are:

late admission of patients to the hospital in serious condition, accompanied by disturbances of consciousness;
late hospitalization;
large size of the lesion;
concomitant somatic diseases in the stage of decompensation (angina pectoris, diabetes mellitus, hypertension);
elderly age;
gender of the patient (men survive more often).

Among the causes of death in the acute period of ischemia, late admission to the hospital is the leading one. A terrible indicator of inattention to one’s health and carelessness.

Risk factors

To prevent the development of cerebrovascular accidents, death from them or the onset of disability, you need to know what reasons make the likelihood of ischemia higher:

if blood pressure is above 140/90 mm Hg;
presence of atrial fibrillation;
complicated family history: there are relatives who had an ischemic stroke;
presence of diabetes mellitus of any type;
angina pectoris and other cardiac diseases.

Controllable and uncontrollable risk factors

These are the causes that provoke thrombosis of cerebral vessels, which a person cannot remove. In this case, you can only carefully monitor your health and consult a doctor in a timely manner. But among the risk factors there is a special group. These are those that a person can and must fight to avoid death from an ischemic stroke:

alcohol abuse;
overweight;
physical inactivity;
smoking.

Neurologists believe that in order to reduce the number of deaths from cerebrovascular accidents, it is necessary to create special programs for people who will talk about the first signs of this disease, how to provide first aid to a patient, what is the life expectancy after a stroke, and how dangerous it is not to consult a doctor in such a situation . Only in this way, through the joint efforts of doctors and ordinary people, can cerebral infarction be shifted from its leading place in the structure of mortality and disability, and life after cerebral ischemia be extended.

Causes influencing the outcome of stroke

With ischemia, as with any other brain injury, the prognosis for the next month from the onset of the disease is determined by:

location of the focus of cerebral infarction;
the vastness of this outbreak;
development of early complications.

Gross neuroimaging changes in the brain are unfavorable factors for stroke outcome

The most common cause of poor outcome in ischemia is extensive cerebral infarction. A condition that develops with thrombosis of large cerebral arteries. In this case, a large area of the brain remains without blood supply, and many nerve cells die. As a result, the vital functions of the body fade away.

The most life-threatening complication of the first days of the disease is swelling of the brain stem and the development of repeated strokes. Even with a small initial lesion, the development of repeated cerebral ischemia leads to death in 70% of cases. In addition to the above, death in the acute period of cerebral ischemia occurs from other complications:

development of congestive pneumonia;
the development of myocardial infarction due to increased formation of blood clots in the body;
against the background of septicemia;
development of acute renal failure.

All these conditions arise due to the fact that the mechanism of pathological thrombus formation by the body is launched, the first messenger is cerebral ischemia, and then thrombosis of other organs joins it.

Timely and adequate treatment plays a huge role in the outcome of stroke

Despite the unfavorable prognosis for the patient when such conditions develop, there are factors that favorably influence the outcome even in this case:

the patient's age is up to 70 years;
proper care;
adequate therapy.

In this case, a person has a chance to avoid death from complications of ischemic stroke.

Causes of death in the first year after ischemia

After the first ischemic stroke, if it has a successful outcome, many people begin to think that the threat to life has passed. But that's not true.

The reasons that provoked the first ischemia have not disappeared. It is very important during this period to follow all doctor’s orders and listen to their advice. First of all, constantly take medications that will prevent the development of repeated cerebral ischemia.

The development of recurrent stroke in the first year after the first stroke leads to death in 7 out of 10 patients.

For people who have developed paresis or paralysis of varying severity after the first ischemia, the main danger, in addition to repeated thrombosis, is:

development of congestive pneumonia;
the appearance of bedsores complicated by tissue necrosis and subsequent sepsis.

The last two complications, leading to death from cerebral ischemia, can be successfully combated by properly caring for the sick patient. This is a situation in which a lot depends on the attention of loved ones and their desire to help a sick person.

In conclusion, let us once again look at the reasons that worsen the prognosis and lead to death in ischemic stroke:

Late visit to doctors.
A disregard for one's own body: violation of diet and medication, ignoring the recommendations of the attending physician - can not only complicate recovery, but also lead to death from a stroke.
Absence or low degree of prevention of repeated ischemia, including violation of diet and taking medications that prevent the formation of blood clots.
Mood disorders that debilitate the nervous system and increase the risk of death from stroke.

Signs of death

In some cases, stroke damage to the central nervous system develops rapidly and causes irreversible death of brain cells in a short period of time, resulting in premature death. How to understand that a patient has died and determine the onset of his death, which can be biological and clinical?

Clinical death is a condition in which the brain is already dead, but the body retains vital functions for some time. Its main features are:

the presence of agonal breathing - superficial frequent contractions of the lungs, accompanied by hoarseness and foamy discharge from the mouth;
the appearance of seizures;
observation of the pupils' reaction to light;
There are no general signs of life.

Biological death is observed when vital functions completely stop; it manifests itself:

lack of pupillary reaction to light;
clouding of the corneas of the eyes;
lack of breathing;
lack of heartbeat and other signs of life;
drying of mucous membranes accessible for visual inspection;
decreased body temperature;
the formation of cadaveric spots from the drained mass of blood;
development of rigor mortis.

Unfortunately, resuscitation measures have a high chance of success only when observing the patient’s clinical death state. In this case, it is still possible to provide an effective therapeutic effect.

Combined stroke

Combined strokes are considered complex and are found in 5-23% of all deaths from stroke (acute cerebrovascular accident).

The most common causes of combined stroke are the presence of severe vasospasm, which is observed with subarachnoid hemorrhages and leads to the development of “delayed” cerebral infarctions. Also, a combined stroke develops with the formation of a secondary brainstem syndrome (the development of small hemorrhages in the brainstem and medulla oblongata), which are formed during extensive infarctions with pronounced perifocal edema with the development of an “upper” herniation in the form of protrusion of the mediobasal parts of the temporal lobe into the notch of the cerebellar tentorium.

Clinical features and prognosis for brainstem infarction

Infarctions of the brain stem (including the medulla oblongata, pons and mesencephalon) are more often lacunar and are manifested by a variety of cross (alternating) syndromes, which are characterized on one side by damage to the cranial nerves localized on the affected side and the development of hemiparesis and/or ataxia, hemihypesthesia and/or hyperkinesis on the side opposite to the focus of cerebral infarction.

The prognosis in the first hours after an ischemic stroke depends on the localization of the lesion (mainly on the possibility of damage to the vascular and respiratory centers, as well as the thermoregulation center), the size and number of microfoci (with multiple lacunar lesions, the transformation of cerebral infarction into a hemorrhagic stroke is possible) and the timeliness of the treatment started .

Clinically, ischemic stroke of the brainstem (without damage to vital centers) is manifested by paralysis of the facial nerve, soft palate, vocal cord and posterior pharynx with deviation of the tongue towards the lesion with central hemiparesis and/or hemitremor of the opposite limbs and possible lesions of the cerebellum (ataxia) on side of the lesion.

Features of stroke in older people

Age is one of the significant factors in the development of acute vascular pathologies of the brain that impair blood circulation. Diseases of the blood vessels in older people are much more severe than in young people. This is due to physiological changes in the body, and in particular in the central nervous system, such as:

reduction in brain volume and weight;
thinning of the leptomeningeal membranes;
senile neuronal atrophy;
degenerative changes in white matter;
decreased functional activity of neurons;
neuronal death caused by electrolyte imbalance;
reduction of the blood-brain barrier;
pathological changes in the cerebral ventricles.

About 80% of stroke cases are diagnosed in people over 70 years of age. And, unfortunately, the prognosis for recovery is very often unfavorable. The consequences of stroke in older people are difficult to predict, since it is difficult for such patients to choose effective therapy. However, it should be recognized that their chances of full recovery are extremely low. In addition, the likelihood of repeated hemorrhages is very high.

Fatigue

Representatives of the aging population (for example, those with a stroke after 80 years of age) often suffer greatly from drowsiness and fatigue.

What can be done to reduce fatigue in an old person:

adequate food intake;
healthy and balanced diet;
adequate fluid intake;
planning the day;
frequent short rest breaks;
short nap during the day;
massages to improve blood circulation;
moderate physical activity (walking);
accepting help for more complex tasks.

The first factor is a reduction in morbidity, which results from successful primary, and to a lesser extent, secondary prevention. Prevention has improved mainly due to a decrease in blood pressure, an increase in the proportion of effectively treated hypertension, and a decrease in total cholesterol.

Types of stroke

A sharp disruption of blood circulation in one of the regions of the brain in the absence of timely treatment is the cause of death of the patient. That is why, before starting therapy, doctors need to identify what type of illness a person is facing. In international medicine, the following types of stroke are classified:

hemorrhagic. It occurs due to rupture of a vessel and accumulation of blood in nearby tissues. With this type of damage, neurons are deformed, leading to their dysfunction;
ischemic. The reason for this deviation is blockage of the vessel by a thrombus. In the area where the blood clot is located, blood circulation stops, and oxygen reaches the tissues in insufficient quantities. As a result, brain cells begin to gradually die. Statistics show that this type of pathology is very common after 60 years of age;
subarachnoid. This type of hemorrhage occurs due to excessive accumulation of blood fibers in a certain area of the brain. The complication is caused by destruction of the integrity of the smallest blood vessels or rupture of the aneurysm.

Strokes are also classified according to the cause of their occurrence. Depending on which factor provoked the disease, the patient may be diagnosed with:

lacunar hemorrhage. Most often occurs in hypertension due to a sharp spasm of the blood capillary;
embolic. Along with the blood flow, small blood clots enter the thin capillaries, causing blockage of the arteries;
hemodynamic . Occurs due to a sharp drop in blood pressure and cessation of blood circulation.

Stroke is also divided into acute, subacute and chronic. It is necessary to understand that in old age it is extremely difficult for a person to recover from such a disease, so in every possible way one must try to prevent its occurrence.

Post-stroke complications

The development of neurological complications - movement disorders (paresis, paralysis, impaired coordination of movements), speech disorders, depression, memory impairment after a stroke changes the lives of patients and leads to permanent disability. The prognosis for life depends on the likelihood of their occurrence and the possibility of recovery.

With ischemic strokes of various locations, hemiparesis develops in 70-80% of cases, impaired coordination of movements and movement difficulties (70-80%), loss of visual fields occurs in 60-75% of cases, speech disorders (dysarthria) - 55% and aphasia in 25 -30% of cases, depression (40%), dysphagia (15-35%).

Nature and causes of the disease

Stroke in older adults is divided into two categories: ischemic and hemorrhagic.

Most often these are the consequences:

kidney problems;
diabetes mellitus;
heart disease;
thrombosis;
rheumatism;
diseases of the respiratory system;
excess weight;
excess salt in the body;
sedentary lifestyle.

Elderly people have poor blood circulation.

The reason for this is a sedentary lifestyle and vascular damage. The normal blood pressure is considered to be 120/80. During a stroke it increases. With a sharp jump in pressure upward, the vessels cannot cope with the abundant blood flow in the brain.

It is worth noting that blood pressure can be either high or low. It is not the indicators that are important, but the very fact of its sharp jump. This is especially dangerous for older people.

Statistics

Stroke survivors have a 5 to 14 percent rate of having another stroke within one year. Within five years, stroke recurs in 24% of women and 42% of men.

The relapse rate after a first stroke is:

from 3% to 10% within 30 days;
from 5 to 14% for up to one year;
from 25 to 40% over a five-year period.

Preventing recurrent stroke is also critical for those who have had transient ischemic attacks (TIAs) or mini-strokes. TIAs are short episodes of stroke-like symptoms that last anywhere from a few minutes to 24 hours.

TIAs usually do not cause permanent damage or disability, but they can be a serious warning sign of an impending stroke.

Restoring the consequences of a stroke

Also, the quality of life, everyday and social adaptation of patients after a cerebral infarction depends on the possibility of recovering from the consequences of an ischemic stroke after six months, because many patients have long-term neurological disorders and progression of severe somatic diseases. Disorders of the pelvic organs are observed in 7-11% of patients, and hemiparesis persists in 45-50%.

The ability to self-care is impaired in 35-40% of patients: they cannot eat on their own - 33%, take a bath - 49%, dress - 31% of patients, and 15% of patients cannot walk independently. Significant combined movement disorders and communication difficulties are experienced by 16% of patients.