Consequences and recovery after a second stroke

An acute condition caused by complete or partial cessation of blood flow in the cerebral vessels, provoked by their occlusion or stenosis (ischemic stroke) or rupture of intracerebral arteries with subsequent bleeding from them into the cranial cavity (hemorrhagic stroke) is very dangerous and leads to the death of the patient much more often than myocardial infarction.

Patients who have successfully recovered from a stroke, however, retain the body's tendency to form blood clots, cholesterol plaques, and uncontrolled increases in blood pressure. In addition, they usually have other serious chronic pathologies in their medical history - neurological, endocrinological, cardiovascular, renal, often in a rather severe advanced form. The reserves of their body, which can allow them to avoid a second stroke, are very small. And patients who have emerged victorious from the battle with a dangerous disease sometimes make mistakes about their real capabilities, which leads to a repeat of the vascular catastrophe.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Epidemiology

World statistics puts stroke mortality in second place after mortality due to ischemic heart disease. Every year, 460 to 560 people out of every 100 thousand inhabitants of the planet are hospitalized with acute cerebrovascular accidents, a third of cases are repeated. Survival statistics after a second stroke are disappointing: if after the first stroke, on average, 2/3 of patients survive in the world, then after the second stroke, no more than 30% remain alive, and it is not worth talking about their quality of life, since stroke is the first cause of primary disability in the world.

[ 6 ], [ 7 ], [ 8 ]

Causes of a second stroke

Today, identifying the initial causes of repeated episodes of acute cerebrovascular pathologies remains one of the promising areas of angioneurology. The mechanism of their development, clinical manifestations and morphology of strokes have not yet been sufficiently studied, and a unified approach and terminology have not been developed. Even the concept of a repeated stroke is interpreted ambiguously, since some studies include cases of acute vascular disorders in another arterial system or in areas of the brain supplied with blood by different vessels. Other studies exclude them, so the data of different authors are sometimes incomparable. In this regard, most studies specifically note factors that increase the risk of a repeated stroke and affect its course and the likelihood of survival.

The main provocateurs of acute cerebrovascular accident, both the first time and the next, are considered to be the presence of high blood pressure in the patient (and the numbers do not necessarily have to be “off the charts”), atherosclerosis (their combination is especially dangerous), hypertrophic changes in the left ventricle of the heart. If the patient is a diabetic, a heavy smoker or a drinker, the risk of stroke increases several times. A combination of even two of the above factors significantly increases the likelihood of an unfavorable outcome.

Doctors have long noted the following feature - a repeated vascular catastrophe mainly affects those who, having almost completely restored their health after a stroke, returned to their previous way of life, stopped being careful and following preventive recommendations. The quality of life of a person who has suffered a stroke fully determines the possibility of a recurrence of the situation.

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ]

Risk factors

Risk factors for a second stroke, without being the direct cause of pathological changes in the cerebral arteries, reduce the adaptive potential of hemodynamics and create conditions for disruption of compensation of blood circulation in the cerebral arteries. This group includes mental and physical overstrain, insufficient rest (even work that brings pleasure must be dosed); an abundance of stressful situations, both negative and positive; far from healthy habits - smoking, drinking alcohol and/or drugs, taking medications without a doctor's prescription; lack of feasible physical activity, usually in combination with poor nutrition and, as a result, excess weight.

The probability of a second stroke is high in people who do not control their blood pressure, blood viscosity, and are careless about existing chronic diseases. An increased risk of a second stroke is associated not only with hypertension, but also with low blood pressure, metabolic disorders, and blood hypercoagulation. A repeated stroke often occurs in people with functional disorders of the heart muscle, atrial fibrillation, and a history of myocardial infarction.

For women of childbearing age, hormonal contraception poses a risk of recurrent stroke, with smokers and those with hypertension at particular risk.

Another large risk group consists of people who have suffered short-term cerebrovascular accidents – pinpoint hemorrhages (microstrokes as they are also called), which lead to minimal necrotic changes in brain tissue, as well as transient ischemic attacks (reversible disruption of blood supply in some part of the brain). The insidiousness of such events, which mostly remain unnoticed or forgotten, is that the probability of a true stroke in such people is much higher.

These factors can be corrected with medication, by undergoing a course of adequate treatment and by organizing your lifestyle.

Non-modifiable factors of stroke probability in general include: age limit of 65 years – out of three strokes, every two occur in people older than this age; gender – the male population from 30 to 69 years is more susceptible to acute cerebrovascular pathologies; hereditary predisposition and ethnicity (the highest probability of stroke, according to estimates, is in African Americans). Random stressful situations are also included here. However, experts do not associate the probability of a repeated stroke with either gender, or age group, or the pathological type of the previous vascular catastrophe. The main reason for its recurrence is said to be the patient's frivolous attitude to their health and unwillingness to adhere to certain restrictions.

The overwhelming majority of all acute cerebrovascular accidents develop as ischemia (approximately 8-9 out of ten), hemorrhages account for only 10-15%, however, they are characterized by a more severe course and high mortality.

[ 15 ]

Pathogenesis

The pathogenesis of ischemic stroke is currently considered to be the result of damage to:

• atherosclerosis of the main arteries (primarily the carotid arteries) before entering the cranial cavity, which causes the majority (up to 40%) of all primary and secondary vascular catastrophes of this type;
• small arteries located inside the brain, due to increased blood pressure, combined with atherosclerotic changes in the intracranial vessels (approximately 35% of ischemic strokes);
• occlusion of the middle cerebral artery by a fat or air embolus formed in the heart (left sections), approximately 15% of ischemic strokes to 20.

In other cases, the pathogenetic links of ischemic strokes were blood clotting disorders (thromboembolism), degeneration of the vascular membranes caused by diseases not directly related to cerebral vessels, such as diabetes mellitus, vasculitis, and erythremia.

The presence of atherosclerotic angiopathy is the main cause of the development of most ischemic strokes, including repeated ones. This is the most significant risk factor. Atherosclerotic changes in the vessel walls are considered a chronic proliferative-inflammatory process, against the background of which thrombi are formed due to an increase in blood viscosity, often provoked by hypertension, and lipid metabolism disorders.

A significant role in the pathogenesis of this process is given to the interaction of low-density lipoproteins with the walls of arteries. With the age of the patient, the penetration of low-density proteins circulating in the plasma into the arterial membrane increases, initially forming cholesterol spots, which over time turn into growths on the walls of the arteries - atheromatous plaques. Thickening or, conversely, loosening, the plaques crack, ulcerate, small hemorrhages occur in their thickness, later fibrosing, which increases the size of the formation and, accordingly, the lumen of the artery narrows, the endothelial membrane is damaged. The thromboresistance of the vessel decreases and a mural thrombus gradually forms in this place. Its structural disorders (loosening, cracks, fibrosis) generate intravascular substrates (emboli), moved by the blood flow to the cerebral arteries.

Pathogenetic processes develop and increase over approximately the first three weeks, and this occurs especially intensively in the first minutes and hours of the disease. When an artery is blocked, blood flow in some part of the brain stops and the so-called "ischemic cascade" rapidly develops, causing oxygen starvation and oxidation of brain tissue, disruption of fat and carbohydrate metabolism, inhibition of the production of neurotransmitters and a sharp decrease in their number in the synaptic cleft. This process is accompanied by the formation of an infarction focus, which forms literally from five to eight minutes. The area of tissue damage left without oxygen and nutrition increases at an enormous rate (in 1.5 hours - by 50%, in six hours, called the "therapeutic window" period - by 80%). Without treatment, this area expands exponentially, secondary widespread cerebral edema develops. This continues for three to five days, then the dead neurons undergo necrosis and the process is partially localized. Neurological symptoms are subsequently formed and increase.

A repeated stroke develops according to the same scenario, but it is necessary to take into account the presence of an ischemic zone - the consequences of the previous lesion. The focus of softening of the brain tissue damages a larger zone, positive dynamics at the end of the acute period are observed much less often. Sometimes developing ischemia develops into a hemorrhagic form, which complicates diagnosis, aggravates the situation and worsens the prognosis.

The mechanism of development of hemorrhagic stroke in the vast majority of cases is caused by rupture of cerebral arteries and blood saturation of the brain parenchyma area and/or formation of intracerebral hematoma in the cavity formed in the brain tissues, pushed apart by blood pressure. This causes destruction or compression of brain tissue, its dislocation, disruption of venous blood and cerebrospinal fluid outflow, which leads to cerebral edema and compression of its trunk. The size of the hemorrhagic focus has a diverse range - from small to spreading to the entire hemisphere, sometimes multiple hemorrhages develop. In this area, an area of ischemia develops, and a cascade of pathogenetic processes described above is launched. If the patient remains alive, then over time a cyst forms at the site of the hematoma.

More than four out of five hemorrhagic strokes occur at the moment of a sharp jump in blood pressure, sometimes the cause of cerebral hemorrhage is a ruptured aneurysm (arterial malformation) and other intracerebral hemorrhages. The background for the development of cerebral hemorrhage is a stressful situation or physical overexertion. The risk of hemorrhagic catastrophe increases in patients with lipid metabolism disorders, excess weight, diabetes, heart disease and sickle cell anemia, who have not parted with bad habits.

[ 16 ], [ 17 ], [ 18 ]

Symptoms of a second stroke

A person who has already managed to recover from a blow should remember its symptoms and treat himself carefully so as not to miss the harbingers of a new catastrophe.

The first signs that indicate its possible approach:

• unilateral short-term visual impairment;
• sudden attacks of memory loss - a person seems to “fall out” of reality for a while or cannot assess his location;
• transient speech dysfunctions - slurring, inhibition;
• unilateral paresis of the limbs and/or decreased sensitivity;
• weather dependence, manifested as dizziness, weakness, pre-fainting condition, headache.

If at least two of the listed symptoms appear, a person who has already suffered one stroke must immediately consult a doctor and undergo a course of treatment to prevent a recurrence of the stroke.

If an accident does occur, the success of treatment depends, first of all, on the speed of reaction of those around and the professionalism of the ambulance team that arrives. The symptoms of a second stroke are the same as in the first case - dizziness, nausea, stunned or excited state. The patient suddenly becomes paralyzed on one side of the body, vomiting, diarrhea, hyperthermia may be observed. The patient cannot raise both arms, the hand on the paralyzed side does not rise, its grip is almost not felt. The face becomes asymmetrical (the corner of the mouth drops on one side and the eye does not close), the smile is crooked, the patient is unable to clearly pronounce several words.

Stages

The severity of post-stroke coma is assessed using the Glasgow Coma Scale:

1. The first is determined in patients with some presence of consciousness, although contacts with them cause difficulties, but they are able to swallow, turn over independently in a lying position, perform simple movements, although the symptoms of stupor and inhibition are noticeable, the patient is drowsy, reactions are delayed, even to pain, hypertonicity of the muscles is observed; pupils react to light, sometimes an excess of divergence (divergent strabismus) is noted. This variant of coma is characterized by the most favorable prognosis and the least complications.
2. The second - the patient is uncommunicative, is in a state of stupor, occasionally chaotic contractions of the muscles can be observed, which cannot be attributed to controlled movements, physiological functions are performed involuntarily, patients generally do not control them, pharyngeal reflexes are preserved at this stage, the patient's pupils are strongly constricted and practically do not react to light, noisy pathological breathing, characteristic of oxygen starvation of the brain, weakness of the muscles, their spontaneous wave-like contractions. Survival is unlikely, especially after a second stroke.
3. The third (atonic) - the patient is unconscious, does not respond to painful stimuli and touching the cornea, the pupils are completely light-sensitive, the pharyngeal reflexes are very weak and occasionally present; muscle tone is significantly reduced, muscle cramps may appear in some place or in waves throughout the body, hypotension, hypothermia, and respiratory rhythm disturbances. The probability of survival, especially after a second stroke, tends to zero.
4. The fourth stage is when the patient essentially shows no signs of life; breathing may stop at any second.
5. The fifth is the agony and death of the patient.

The stages of stroke development are defined as follows:

• The first 24 hours are called the acute stage of the disease;
• it is followed by an acute phase, which can last on average up to three weeks;
• the next three months are considered as a subacute stage;
• then early (from three months to six months) and late (up to a year from the moment of impact) recovery stages are distinguished;
• The stage of late consequences of a stroke begins after a year.

Depending on the nature of the vascular damage, there are two main types of strokes. Four out of five acute cerebral circulatory disorders are caused by blockage or stenosis of large or small arteries, causing a complete or partial cessation of arterial blood flow to the brain tissue (ischemic stroke). Only a fifth of acute cerebral pathologies are hemorrhagic strokes, however, they are much more severe, more than 80% of hemorrhages end in the death of the patient.

The types of primary and recurrent strokes do not always coincide; what they have in common are usually the zones and brain structures in which the final destructive processes occurred, but the pathogenesis is often completely different.

The second ischemic stroke usually develops suddenly (although occasionally clinical symptoms may increase gradually), more often at night or in the early morning, during sleep (arterial thrombosis) or during the day (non-thrombotic stroke). Unilateral damage is typical. The state of consciousness depends on the location and extent of damage, as well as the consequences of the first stroke. With minor changes, consciousness may be preserved or slightly impaired. Neurological symptoms of the acute stage are manifested by impaired pronunciation of individual words or more significant speech distortions, asthenia and ataxia, unilateral visual impairment, and numbness of the limbs on the same side. Sometimes there may be urinary incontinence. Seizures similar to epileptic ones are not typical.

Massive (extensive) ischemic stroke is characterized by a gradual increase in symptoms, loss of consciousness, serious neurological deficit: vomiting, severe headache, oculomotor and speech disorders, paresis and paralysis, comatose state. Extensive repeated strokes most often end in death.

The second hemorrhagic stroke in the vast majority of cases leads to the death of the patient or complete disability. The main danger of this type of stroke is that the mechanical effect of the hemorrhage - compression of brain tissue is superimposed by the formation of an extensive ischemic area. It usually develops during the day and is the result of a stressful situation and / or physical exertion. The possibility of an imminent hemorrhage is foreshadowed by the following symptoms: unilateral facial paresthesia; flushes of blood to the face; sharp pain in the eye (sometimes in both), short-term blindness, the field of vision is often covered with a red veil; periodic loss of balance control; aphasia. The face before the stroke is often red, sometimes the temperature rises, hoarse gurgling breathing appears, sometimes seizures of the epileptic type occur.

The symptoms of hemorrhagic stroke correspond to the dislocation of the brain tissue relative to its normal location. If the patient has not lost consciousness, he usually has a severe headache, photophobia, nausea and vomiting, tachycardia, speech and movement disorders.

Unconsciousness may vary in degree, from stupefied to comatose. It is typical for most patients with hemorrhagic stroke. In addition to impaired consciousness, the patient may experience: rhythmic eye movements (nystagmus), inability to follow a moving object with the gaze, absence or decreased pupil sensitivity to light, absence of muscle tone, respiratory and cardiac arrhythmia, hypotension, absence of the pharyngeal reflex, different pupil sizes, bulbar dysarthria, unprovoked tears or laughter, urinary retention or incontinence. Seizures similar to epileptic seizures may be observed.

With this type of stroke, the highest mortality rate of patients is observed on the second to fourth day from the onset of the disease (associated with the onset of the development of the pathological process), as well as on the 10th to 12th day (due to the addition of complications).

The most severe is a hemorrhage into the cerebral cortex: almost always there are severe disturbances of consciousness and serious neurological deficits: paralysis, severe speech disorders, loss of sensitivity, loss of orientation. External symptoms resemble blockage of the middle cerebral artery.

With thalamic hemorrhages there is also a possibility of coma, the symptoms are characterized by the predominance of sensory disorders (oculomotor, strabismus, limitation of the visual field) over impaired motor function.

A comatose state develops early with hemorrhage into the pons, characterized by a lack of reaction to light and pupils in the shape of a dot, as well as a sharp bilateral increase in muscle tone.

Cerebellar localization is characterized by the appearance of sudden dizziness, accompanied by vomiting, impaired coordination of movement, inability to walk and stand, paresis of the eye muscles in the presence of consciousness, however, compression of the brainstem can provoke a fatal outcome.

Subarachnoid hemorrhage usually occurs when a bulge in the internal elastic membrane of the artery wall (aneurysm) ruptures. This type of hemorrhagic stroke is typical for the age group from 35 to 65 years. It is characterized by an immediate severe headache. The pain may even cause the patient to faint, which occasionally turns into a coma, however, in most cases consciousness returns and the patient experiences only some confusion. Sometimes fainting precedes headache. Hemorrhage usually develops during physical exertion or is its immediate consequence. The lesion may be localized only under the arachnoid membrane or spread further. When blood enters the brain tissue, symptoms of focal hemorrhage appear.

[ 19 ], [ 20 ]

Complications and consequences

The consequences of a second stroke are usually much more severe – in most cases, it ends in death. Coma after a second stroke occurs in 2/3 of patients, and only a few manage to come out of it alive. During a coma, a deep faint occurs, the patient completely or partially lacks reflexes and response to external stimuli. However, depending on the depth of the coma, the patient can respond to irritation of the cornea by involuntary opening of the eyelids or chaotic movements, sometimes grimacing, lacrimation, causeless laughter are observed. A comatose state occurs with intracerebral hemorrhage, extensive ischemia, edema and toxic damage to brain tissue, concomitant systemic diseases, for example, diseases of connective tissue.

People who have experienced one vascular accident should not relax, without proper preventive measures it can happen again and with much more serious consequences. The prognosis of the disease largely depends on the size of the cerebral artery affected by the pathological process, its location, the extent of damage and the consequences of the first stroke. In addition, the age and physical condition of the patient, as well as how quickly he received professional help, play an important role.

What is the danger of a second stroke? Medical statistics state that most patients (about 70%) do not survive a second stroke.

However, if the brain tissue was slightly damaged the first and second time, there is a chance to maintain working capacity. There are known cases when a person experienced several strokes, however, with each time the probability of a quality life decreases.

Post-stroke complications become persistent the second time, cerebral edema and coma develop more often. Even a surviving patient is guaranteed complete or partial motor disorders, speech and vision impairments, and the development of dementia.

Paresis of the limbs significantly limits the ability to move. Paralysis confines the patient to bed or a wheelchair. The mildest degree of paralysis is monoplegia, when only one limb loses the ability to move. There is unilateral immobility of the limbs (hemiplegia) and immobility of both paired limbs (paraplegia).

The inability to move fully is often combined with blindness in one eye, speech disorders - slurred and incoherent speech, and decreased intelligence.

[ 21 ], [ 22 ], [ 23 ], [ 24 ]

Diagnostics of a second stroke

Primary diagnosis is the prerogative of those around; the patient himself, usually, cannot provide assistance to himself or call an ambulance.

If you suspect a stroke of any serial number, you can test a conscious person by asking him to smile, raise his hands and say something. He will not be able to cope with these tasks: the smile will be crooked, the hand on the affected side will not rise, the words will be pronounced unclearly. If the person is unconscious, then an urgent call to an ambulance is mandatory.

A patient with an acute attack is hospitalized. In the hospital, he undergoes blood tests, including sugar and cholesterol levels, the effectiveness of the blood clotting mechanism is assessed, and a general urine analysis is performed. If it is impossible to do a tomography, the cerebrospinal fluid is examined.

Neurological deficit is determined by various methods, the most well-known is the scale of the National Institutes of Health (NIHSS), the Scandinavian Stroke Scale and the Glasgow Coma Scale are also used.

Modern instrumental diagnostics – computer and/or magnetic resonance tomography, angiography with and without contrast, ultrasound Dopplerography, electroencephalogram – provide an accurate idea of the localization and spread of vascular lesions. The work of the heart muscle is usually assessed using an electrocardiogram; an ultrasound examination of the heart may be prescribed.

[ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ]

Differential diagnosis

Differential diagnostics are carried out with a severe migraine attack, coma in diabetes mellitus, brain tumors, sudden paresis of other etiologies, intracerebral hematoma, dissecting aneurysm of the carotid artery and some other diseases with similar symptoms.

Differentiation of the type of stroke is carried out based on the data of a survey of relatives or the patient (if possible) and on the examination data. The most informative in this regard are the tomogram data. Characteristic differences of hemorrhagic stroke - when examining the fundus, hemorrhages in the retina are usually found; blood in the cerebrospinal fluid, the color of which is yellow-brown or greenish, the pressure is increased; leukocytes are increased, prothrombin is normal or decreased; erythrocytes, occasionally glucose and protein are found in the urine.

In the thrombotic form of recurrent ischemic stroke, examination of the fundus shows narrowed and uneven vessels; the punctured fluid is transparent, its pressure is normal (in non-thrombotic form, it may be elevated); the blood is viscous, the prothrombin index is elevated; the specific gravity of urine is low

[ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ]

Treatment of a second stroke

The prognosis for survival in a second vascular accident depends on many factors, one of which is speed: the sooner the patient gets into the hands of specialists and resuscitation measures begin, the greater his chances of surviving with minimal consequences.

What to do in case of a second stroke? Call an ambulance. While waiting for the team to arrive, help the patient lie down (sit up), ensuring that the head is elevated (try not to move the patient anymore). Measure (if possible) blood pressure and give the patient any hypotensive medication he has. Help remove dentures, contact lenses, remove glasses, unbutton the collar, loosen the belt.

If the patient has lost consciousness, turn his head to the side and slightly open his mouth, monitor his breathing, not allowing the tongue to fall back, which can block the flow of air into the respiratory tract. There is no need to try to bring the patient to his senses. It is advisable to put a cold compress or ice on the forehead.

Usually, a specialized team arrives to a patient with an acute stroke, which can provide the necessary assistance at home and on the road. You can use the services of a paid ambulance, then gentle transportation of a bedridden patient after a second stroke is guaranteed. Therapy after a second acute attack is no different from the previous time. A patient admitted by ambulance with a repeated vascular catastrophe is usually sent to the intensive care unit or resuscitation. The necessary diagnostics are made to determine the type of damage.

In the first hours of ischemic stroke, the efforts of medical personnel are focused on performing the following tasks:

• maximum restoration of the ability of arteries to transport blood to brain tissue through drip infusions of saline solutions;
• the use of thrombolytics to reduce blood viscosity, thin it and activate microcirculation;
• protecting neurons and preventing cerebral edema.

In the first hours, they try to restore blood flow by using vasodilators, thus relieving vascular spasm and forcing spare collateral arteries to work. No-shpa, nicotinic acid-based drugs, and others are administered intravenously.

No-shpa, the active ingredient of which is drotaverine hydrochloride, has the ability to reduce the concentration of calcium ions in cells, inhibiting contractile activity for a long time and relaxing the muscles of the arteries, thereby expanding the vessels and increasing blood flow in them. Its mechanism of action is based on the inhibition of the enzymatic activity of phosphodiesterase IV, while it does not have any effect on the activity of the same enzymes of type III and V, which distinguishes No-shpa from other antispasmodics for spasms of the cerebral vessels by the absence of a significant therapeutic effect on the activity of the heart muscle.

Nicotinic acid is an enzymatic agent that transports hydrogen to tissues and organs and participates in oxidation and reduction reactions. It has the ability to dilate blood vessels and reduces the content of lipoproteins in the blood. Nicotinic acid preparations are administered intravenously very slowly, since it causes painful sensations. Preference is given to sodium nicotinate or nicotinamide as they do not cause an irritating effect. The recommended dose is 1 ml of a one percent solution.

The anti-shock solution Rheopolyglucin is administered intravenously to restore capillary blood flow.

If the patient is conscious and able to take pills, the following anticoagulants may be prescribed: Ticlopidine, Warfarin, Clopidogrel and the well-known Aspirin. The dosage of these drugs is determined by the doctor based on the symptoms, since the situation is urgent. If the patient has taken blood thinners, relatives should inform the doctor about this, since the dosage will be adjusted.

Ticlopidine - inhibits the process of "sticking" platelets caused by ADP (adenosine diphosphate), adrenaline, collagen, arachidonic acid, thrombin and platelet activating factor. Once in the body, the drug causes dysfunction of the platelet cell membranes to bind, thinning the blood and prolonging bleeding time.

Warfarin is an indirect anticoagulant. It inhibits the action of vitamin K, thereby preventing the blood clotting process and the formation of blood clots.

Clopidogrel is a selective inhibitor of the process of binding ADP to the same receptors of platelets. The drug has an irreversible effect, blocking the ADP receptors of blood cells, so coagulation is restored after stopping the intake after the renewal of platelets (in about a week).

Unconscious patients are given Heparin drip infusions. It has a direct effect, preventing blood clotting, as it is a natural component that ensures blood fluidity. In addition, it inhibits the enzymatic activity of hyaluronidase, prevents the formation of blood clots, and activates blood flow in the coronary artery. Heparin activates the breakdown of lipids, reducing their content in the blood serum. When administered intravenously, it acts instantly, but for a short time, from four to five hours.

This drug is usually combined with enzymatic fibrinolytics, such as Fibrinolysin or plasmin, obtained from human blood plasma, or Streptodecase, which activates the conversion of plasminogen into the natural blood ingredient plasmin. These drugs ensure the dissolution of the fibrous protein fibrin, the clots of which are the basis of the thrombus. Their disadvantage is the systemic effect and the possibility of bleeding.

The most effective drug for ischemic stroke to date is Actilyse, a second-generation thrombolytic used during the "therapeutic window" and capable of destroying a thrombus that has blocked an artery. The so-called tissue plasminogen activator, administered in the first hours after a stroke, is fully capable of restoring blood supply to the ischemic area. Actilyse selectively converts only fibrinogen related to the thrombus that has formed, without having a systemic effect. This drug is intended for intravenous administration. It is recommended to administer no more than 90 mg, first a jet intravenous injection is made in a volume of 10% of the dose prescribed by the doctor, the rest is administered by drip over the course of an hour.

The treatment regimen with subsequent use of Heparin (intravenously) and acetylsalicylic acid (orally) has not been sufficiently studied, therefore, especially in the first day of treatment with Actilyse, it should not be used. In cases where it is necessary to use Heparin (due to other pathologies), it is administered subcutaneously and no more than 10 thousand IU per day.

The most dangerous consequence of thrombolytic therapy is bleeding and/or hemorrhage in any part of the body, including life-threatening. In this case, transfusion of fresh whole blood (fresh frozen plasma) or the use of synthetic antifibrinolytics is recommended.

If resuscitation measures have been successful and positive dynamics are observed, Cavinton is prescribed to restore vascular tone. A derivative of a plant alkaloid corrects mental and neurological post-stroke disorders. Under the influence of the drug, cerebral arteries expand, blood flow is activated and the amount of oxygen in brain tissue increases, glucose metabolism improves. By inhibiting the enzymatic activity of phosphodiesterase, Cavinton promotes the accumulation of cyclic adenosine monophosphate in tissues, a universal mediator that transmits signals of some hormones to neurons. The drug also has an antiplatelet effect, preventing the formation of blood clots, and increases the plasticity of red blood cells. Cavinton does not have a significant hypotonic effect.

In neurological practice, the drug is administered by drip, then they switch to taking tablets. They are taken for a long time, one or two units three times a day.

Emergency measures in case of repeated hemorrhagic stroke are aimed, first of all, at stopping the bleeding and reducing the pressure of the hematoma and displaced areas of the brain on its trunk. Conservative treatment of hemorrhages is carried out only in the most uncomplicated cases with small hemorrhages. The patient is provided with conditions that limit noise and light.

Blood pressure is normalized, vasodilators and antiplatelet drugs are discontinued (if they caused the hemorrhage), hemostatic agents are used. The second hemorrhagic stroke is rarely amenable to therapeutic treatment, however, in these cases, injections of antihypertensive drugs and diuretics are used to reduce blood pressure. Various drugs are used for this: β-blockers (Atenolol, Bisoprolol, Nebivolol, Anaprilin, Timolol), antispasmodics (No-shpa, Otilonium bromide, Atropine, Buscopan), calcium antagonists (Corinfar, Anipamil, Klentiazem), drugs that inhibit the enzymatic activity of angiotensin (Benazepril, Captopril, Enalapril, Fosinopril).

Emotional lability is relieved by sedatives - Elenium, Diazepam. Phenobarbital is often prescribed, since it has an anticonvulsant effect, no more than 90 mg per day, divided into three doses.

Laxatives are used to prevent difficult bowel movements, for example, Picolax drops, which stimulate peristalsis of the large intestine and the movement of feces to the exit. Take once a day, in the evening, from 13 to 27 drops.

Medicines that stop bleeding:

• Dicynone accelerates the formation of tissue thromboplastin, which helps stop hemorrhage, inhibits the enzymatic activity of hyaluronidase, blocking the metabolism of mucopolysaccharides, as a result of which the strength of the vascular walls increases. However, this ability does not affect the duration of the prothrombin period, the drug also does not cause hypercoagulation. From the moment of parenteral administration to the onset of action, a period of time from five minutes to a quarter of an hour passes, from oral administration - an hour or two. A four-six-hour effect is provided. The recommended dose for four times a day is 250 mg.
• Gordox (aprotinin) is a hemostatic drug for drip infusions that is well tolerated by most patients during initial use. It inhibits the enzymatic activity of proteases, promotes activation of the coagulation process and decreases blood fluidity. Four drips are prescribed per day, each at 100,000 U. During the secondary course for six months, the probability of anaphylaxis or allergy is 5%.
• Γ-aminocaproic acid – stimulates blood clotting processes by inhibiting the action of enzymes that catalyze fibrinolysis. In addition, it has an antiallergic effect. The daily dose is no more than 30 g, in droppers of 100-150 ml (5% solution). Can be combined with a small amount of Rheopolyglucin, which improves blood circulation in the capillaries.

The appearance of symptoms of wedging of brain matter into the cranial openings of various localizations, the patient's inhibition requires anti-edematous therapy - the prescription of osmotic diuretics. Usually, drugs with the active substance mannitol are prescribed (Aerosmosol, Mannitol, Mannistol, Osmosal, Renitol and the drug of the same name). This is a very effective diuretic, its action is accompanied by significant losses of water and sodium chloride. It is injected intravenously, calculating the dose per kilogram of the patient's weight from 500 to 1500 mg, preparing a 10-20% isotonic solution.

Or a furosemide-based drug - Lasix, which five minutes after intravenous administration quickly reduces blood pressure and has a pronounced diuretic effect. Forced diuresis with this drug is carried out twice a day, adding 20-40 mg to the dropper. Then, taking into account the water-electrolyte balance and the patient's condition, the dosage is adjusted.

Intravenous injections of hormonal drugs (Dexamethasone) may be prescribed.

In case of symptoms of cerebral artery spasms (approximately on the seventh day), calcium antagonists are prescribed, for example, drip infusions of Nimoton (10 mg) against the background of correction of dosages of drugs that lower blood pressure.

When the acute period has passed and the bleeding has been successfully stopped, further therapy is carried out symptomatically. The patient must adhere to bed rest and a dietary regimen.

Vitamins and vitamin-mineral preparations reduce the permeability of the vascular membranes, making them elastic and strong. Ascorbic acid and rutoside are irreplaceable in this regard, especially their combination in many vegetables and fruits, as well as in the drug Ascorutin. Patients after a second stroke are recommended calcium preparations to strengthen blood vessels:

• calcium pantothenate – relieves intoxication, participates in the metabolism of fats and carbohydrates, the production of cholesterol, steroid hormones, acetylcholine, indicated for patients with neurological deficit and weak fragile vessels;
• intramuscular injections of calcium gluconate;
• intravenous - calcium chloride, which, in addition to strengthening blood vessels, has an anti-allergic effect.

The vitamin and mineral complex Berocca Plus contains eight B vitamins (thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxine hydrochloride, biotin, folic acid, cyanocobalamin), vitamin C, calcium, magnesium and zinc. Indispensable for improving blood vessels, normalizing the process of hematopoiesis and the functions of the central nervous system. Take one tablet per day.

Physiotherapy will help restore body functions after a second stroke. Ultrasound therapy can be prescribed already in the acute period of ischemic stroke, as well as during the rehabilitation period to reduce muscle tone or vice versa in muscular dystrophy, treatment of concomitant pathologies. In case of hemorrhages, ultrasound treatment is prescribed after at least two months from the onset of the disease.

Post-stroke patients are prescribed electrical procedures - amplipulse therapy; electrophoresis; darsonvalization; diadynamic therapy; electrosleep. With the help of such procedures, metabolic processes are activated, vascular trophism is improved, ischemic areas and edema are reduced, and the motor activity of paretic muscles is increased. The procedures are prescribed already in the early recovery period (from the third week).

Magnetic therapy promotes a gradual reduction in blood pressure and improves the rheological properties of the blood.

Low-intensity laser irradiation improves the quality of red blood cells – blood cells that transport oxygen to neurons in the brain, resulting in the destruction of blood clots and a reduced likelihood of new ones forming.

Heat therapy – paraffin and ozokerite applications, white light phototherapy, hydromassage and vacuum massage are recommended for patients with post-stroke arthropathies.

Folk remedies

Treating a stroke at home is life-threatening, especially the second one, in which case urgent intensive therapy with modern diagnostic equipment and medications is required. But as part of rehabilitation measures and as preventive measures, recommendations of traditional healers can be included in the therapeutic scheme, after consulting with the attending physician.

Traditional medicine suggests using pine and spruce cones to treat the consequences of a stroke and prevent a relapse. Young cones with seeds are used for medicinal purposes. They should be picked only from trees growing in the forest far from main roads. The picked cones are cleared of insect-damaged and dead parts. Pine cones are best collected in March, or at least until the end of April, while spruce cones are picked starting on June 5.

The tincture of pine cones on vodka is taken twice or three times a day, one teaspoon at a time, for three weeks, then a week's break is taken and the course of treatment is repeated twice more. The next time such treatment can be carried out no earlier than in six months.

Preparation of the tincture: rinse the cones under running water and place them in a clean liter jar, filling it to the top. Pour in vodka, cover and leave in a closed cupboard or pantry for two or three weeks until a thick dark red color is obtained. Strain through cheesecloth folded in half. The tincture is ready for use.

An alternative non-alcoholic option is a decoction of pine cones, prepared as follows: cut five young pine cones into small pieces, place in an enamel saucepan, pour in ½ liter of hot water and boil for five minutes over low heat. Drink a quarter of a glass of this decoction after meals one to three times a day.

Alcohol tincture of spruce cones with apple (grape) vinegar. Five cones are rinsed, cut and filled with alcohol (vodka) in a volume of 250 ml. For ten days, the mixture is left to infuse in a closed cupboard or pantry. Then it is filtered well and a teaspoon of vinegar is added (preferably homemade). It is consumed by adding a teaspoon of tincture to tea for six months, then a break is taken.

The water infusion of spruce cones is used in a daily volume of no more than 30 ml, drink it several times a day. To prepare, rinse the cones, cut them and pour them into a three-liter jar to half the volume, pour cooled boiled water to the top and leave to infuse in a place protected from light for ten days. Then, drain the liquid, fill the jar with water again. In a week, the medicine is ready. For the course, drink the entire prepared portion and take a break.

After the second stroke, folk healers recommend rinsing the mouth with a 3% solution of hydrogen peroxide with water in proportions of 1:1 after meals for about a minute. This procedure normalizes metabolic processes and disinfects the oral cavity after eating.

Traditional medicine widely practices herbal treatment of stroke consequences. It is recommended to rub completely or partially paralyzed body parts with thyme alcohol tincture (50 g of crushed dry plant material is infused for a week in alcohol or vodka in a capacity of 500 ml) or alcohol or ether mixed with vegetable oil in a ratio of 1:2.

You can take baths with a decoction of rosehip roots every two days; the course requires 20 to 30 baths.

One tablespoon of bryony root (paralysis grass) is infused for a week in vodka (300 ml) in a warm place, filtered. The tincture is taken orally in the morning and evening, dripping 25 drops into a quarter glass of water.

It is recommended to add black elderberries to tea or brew them instead of tea.

You can also normalize your blood pressure without medication. To do this, it is recommended to drink half a glass of mint tea (you can use lemon balm) in the morning before breakfast. To prepare it, brew a teaspoon of the herb in 200 ml of boiling water, strain it after half an hour and drink. After waiting another half hour, you need to drink half a glass of a pre-brewed infusion of two herbs - immortelle and yarrow. Take a pinch of each herb, brew it with boiling water and leave until it cools, then strain.

The following remedy will help prevent blood clots and reduce blood viscosity:

• Corvalol (10 ml);

Pharmacy tinctures on alcohol

• Echinacea (10ml);
• eucalyptus (40ml);
• peppermint (40ml);
• motherwort (125ml);
• peony (125ml);
• valerian (125 ml);
• hawthorn (125 ml each).

Add eight cloves (meaning the spice) ground to powder to this mix. Shake and put in a closed cupboard. After a week, the remedy is ready. Every day, morning, lunch and evening, dilute a teaspoon of the medicine in ten milliliters of water and drink.

An alcohol-free composition that thins the blood and prevents the formation of blood clots: in the evening, in a liter thermos, brew two tablespoons of an herbal mixture of mint, sage and elecampane root, mixed in equal proportions, with four glasses of boiling water. In the morning, strain and drink 200 ml four times a day before meals. The treatment lasts three weeks. The next course can be carried out with an interval of at least a month.

[ 37 ], [ 38 ], [ 39 ], [ 40 ], [ 41 ]

Homeopathy

The effect of homeopathic preparations has not been sufficiently studied by evidence-based medicine; they are not yet used in the acute period of the disease. However, during the rehabilitation period and the elimination of complications and consequences, homeopathic remedies can achieve very noticeable success in eliminating ischemic phenomena and the consequences of oxygen starvation of the brain, and cope with what synthetic drugs cannot cope with due to side effects and damaging effects on tissue. The use of homeopathy sometimes leads to a significant improvement in the physical condition after a stroke, and a person returns to a full life.

The use of complex homeopathic remedies of the Heel brand can be included in the treatment regimen at almost any stage of the disease. Injections of drugs to stimulate the respiratory function of cells Coenzyme compositum and Ubiquinone compositum can ensure adequate oxygenation of neurons in the brain, strengthening of the immune system, restoration of trophism and lost functions. They can be used simultaneously with other drugs that are used in emergency therapy and the recovery period. As a rule, tissue respiration catalysts are prescribed alternately every other day in a course of 10-15 injections. Manufacturers recommend in some cases to use drugs in combination with each other to achieve greater efficiency.

Parenteral cerebroprotector Cerebrum compositum can also be included in the treatment regimen at any stage and for preventive purposes. The drug has a variety of effects, covering all parts of the brain and the processes occurring in them. When used, the immune status of the body increases, the strength of the vascular wall increases, its elasticity increases, blood flow is activated. The drug is able to slightly expand blood vessels and eliminate spasms, activate metabolic processes and remove toxins. After a course of treatment, memory improves, neurological deficit decreases. Prescribed one ampoule every one to three days. Injections can be done in any way, as well as used orally, drinking during the day, dissolving the contents of the ampoule in 50 ml of clean water.

The effect stimulating the restoration of the nervous system is provided by injections of Placenta compositum, the complex of components of which dilates arteries and facilitates blood flow, tones and eliminates spasmodic phenomena, improves tissue nutrition and respiration. Normalization of blood circulation in the extremities is provided by components - organ preparations from placental tissue and embryonic tissue, which also promote cellular renewal and restoration. Organ preparations from arterial, venous and umbilical cord tissues have a positive effect on the condition of the inner vascular membrane. The organ ingredient from pituitary tissue stabilizes pituitary and endocrine disorders, and Sodium pyruvate and muscle lactic acid correct the regulation of metabolic processes. Plant ingredients reduce the permeability of the walls of arteries, veins and capillaries, ensure blood flow to the skin, have an anticonvulsant effect, eliminate paresthesia. Barium carbonate, copper sulfate and lead iodide cleanse the vascular walls and prevent the spread of cholesterol plaques. The dosage is similar to the previous drug.

You can stabilize the condition after a stroke and compensate for cerebral insufficiency with the help of oral drops
of Aesculus compositum, taking 10 drops under the tongue three times a day half an hour before meals or diluting them in a tablespoon of water. You should not use the drug in case of various immune disorders, neoplasms, collagenoses, multiple sclerosis.

Nervoheel - stabilizes the nervous system, has antidepressant and anticonvulsant properties. It contains Ignatia, Sepia, Potassium bromide, which are used to normalize cerebral circulation as monodrugs, Phosphoric acid, which is called a homeopathic nootropic. The tablets are dissolved under the tongue, dosing: for patients from three years of age - one unit per dose three times a day. Acute attacks are stopped by dissolving a single dose every quarter of an hour, while you can take no more than eight single doses.

The duration of therapy with complex homeopathic preparations can last up to several months.

The most effective are single-drug treatments prescribed by a specialist individually.

For left-sided symptoms: Arnica is the most effective regenerating agent, can be used to provide emergency care; Lachesis normalizes blood circulation in small arteries, works well for hemorrhages.

Right-sided lesions are well restored by Bothrops (Botrops) - a thrombolytic, improves blood circulation, regenerates paralyzed muscles;

Bufo rana (Bufo rana) – speech defects, bulbar syndrome, aphasia, aggressive response when not understood.

Ambra Grisea (Amber Grisea) and Phosphorus (Phosphorus) are homeopathic nootropics that effectively restore cognitive functions.

Lathyrus sativus (Lathyrus sativus) – a post-stroke patient walks, but with difficulty (dragging legs, knees and feet bend poorly).

Gingko biloba (Ginkgo biloba) is effective in the aftermath of hemorrhages, restores vascular patency, compensates for neurological insufficiency.

Helleborus niger (Helleborus niger) - used to treat apathetic patients with slow or absent reactions.

Nux vomica (Nux vomica) is a male drug used for paresthesia, convulsions, and motor ataxia.

Baryta carbonica (Baryta carbonica) and Baryta iodata (Baryta iodate) are mainly prescribed after ischemic stroke, have a selective positive effect on cerebral vessels, eliminate depression, forgetfulness, and improve concentration.

Aurum iodatum (Aurum iodatum) – normalizes blood pressure, relieves hypertensive crises and manifestations of cerebrovascular disease, effective in atherosclerotic changes in blood vessels.

Conium (Conium) – effectively relieves neurological symptoms, speech disorders, paresis and paralysis of the lower extremities.

Crataegus (Crategus) is irreplaceable in the prevention of strokes, has calming, vasodilatory, and vascular strengthening properties.

Surgical treatment

Patients with a second hemorrhagic stroke are most often subject to surgical treatment. The exception is patients with small volumes of hemorrhages and in a condition with a mortality rate estimated at 90% to 100%. These are patients with medial hemorrhages, the size of which is irrelevant, and those in a deep coma with impaired stem functions.

Indications for surgical intervention are lateral, the most common localization (about 40% of cases), and lobar hemorrhages, large and medium in volume (more than 20-30 ml); negative dynamics of successive tomograms; brainstem and cerebellar hemorrhages, accompanied by severe neurological deficit.

Surgical treatment is performed to reduce pressure on the brain substance and minimize its dislocation, as well as to reduce intracranial pressure, local and general, and the amount of neurotoxins released from the hematoma.

Classical open microsurgery is used in about a quarter of hemorrhage cases, when the hematoma is localized near the surface. In this case, the possibility of causing additional trauma to the patient's brain tissue is minimized. Open operations can also be performed for vital indications in patients with deep cerebellar hematomas, or hemorrhages localized in the cerebral hemispheres and causing severe neurological symptoms.

Minimally invasive endoscopic surgeries are performed on most patients: a small-diameter instrument (from two to seven millimeters) is inserted into the blood clot and then immediately removed by aspiration. The surgeries are performed under computer control and modern navigation technology using ultrasound, infrared or electromagnetic radiation.

In case of ischemic stroke, thrombus removal or treatment of the damaged artery is performed using special medical minimally invasive procedures, which, strictly speaking, are not yet related to surgery, but are not conservative treatment either, since catheter penetration into the brain to the site of thrombosis is performed through the femoral artery and thrombolytic agent is delivered directly to the thrombus. Intra-arterial selective thrombolysis is a rather complicated procedure, which is performed in stroke centers with modern equipment and round-the-clock access to cerebral angiography. This procedure is performed on patients with severe acute cerebrovascular accident of the ischemic type within the time of the "therapeutic window" or with ischemia that has developed in the vertebrobasilar basin during the first 12 hours. Infusion of thrombolytics is performed for a fairly long time, approximately up to two hours under the control of angiographic equipment.

Similarly, mechanical removal of the thrombus can be performed when it is captured by a special device inserted into the carotid artery and removed.

Preventive surgical procedures – carotid endarterectomy (removal of atherosclerotic formations) on the walls of the carotid artery, as well as stenting and angioplasty, which increase the lumen of the artery and activate blood flow. In atherosclerosis, such procedures reduce the risk of developing a second vascular catastrophe of the ischemic type.

Rehabilitation after the second stroke

The main recovery of all functions that the patient had before the repeated vascular catastrophe occurs in the first two to three months – they are considered the peak for neurological recovery. During this time, half of the main functions are restored, then by the end of the year – the second half. The assessment of the quality of recovery includes indicators characterizing the return of self-care skills, motor and cognitive functions.

Often, the consequence of a second stroke is a disorder of motor functions, so the activation of a post-stroke patient begins in the hospital immediately after his condition has stabilized. Basically, the ability to move in paralyzed limbs is restored in the first six months.

The patient, who is still on bed rest, is activated to prevent muscle contracture in the joints of the paralyzed limbs - doing static exercises, i.e. putting the arms and legs in positions that the patient himself is not yet able to take. For example, the arm is straightened at the elbow joint, placing it on a chair placed next to the bed, opening the hand and straightening the fingers as much as possible. The leg is bent at the knee joint at an acute angle, the foot is bent. The limbs are fixed in the desired position with the help of rollers, pillows, towels, sandbags for at least two hours daily.

Additionally, passive gymnastics is performed with paralyzed limbs. At first, the exercises are performed by a specialist in therapeutic exercise. The patient's relatives are present, who, having studied the sequence of exercises, will continue to do them independently after discharge. Passive gymnastics is supplemented by breathing exercises. The pace and number of exercises performed are gradually increased.

Physical rehabilitation of a post-stroke patient begins with placing him in a semi-sitting position under the supervision of medical personnel with pulse and blood pressure measurements and assessment of the patient's subjective sensations, who gradually learns to sit, then stand and move around the ward with support. The patient is supported from the paralyzed side, placing the shoulder under the paretic limb. Then the patient begins to use the support of special devices - walkers. In parallel, they restore everyday skills - they offer to take objects with the paralyzed hand, dress without assistance, button up, tie shoelaces, etc.

In addition to physiotherapy, the patient is prescribed a massage. It should be done by a specialist familiar with the specifics of this procedure for post-stroke patients, since lack of qualifications can lead to complications after the massage in the form of muscle spasms and contractures. In case of severe muscle spasms, the patient is prescribed muscle relaxants, the treatment regimen for which is prescribed by the doctor in each specific case. Point massage, physiotherapy procedures, and acupuncture prevent the occurrence of movement restrictions in the joint.

A special activating massage is also used for decreased muscle tone in paralyzed arms and legs; drugs that activate muscle contractions and physical therapy are prescribed.

If relatives have the opportunity to place a post-stroke patient in a specialized rehabilitation center, then qualified specialists there will quickly restore all functions that can be restored.

Speech disorders are most effectively corrected with systematic sessions with a speech therapist-aphasiologist. At first, these sessions are short in duration, no more than a quarter of an hour. Over time, relatives can also actively participate in restoring speech, writing, and reading skills, working with the patient at home. Usually, the patient is prescribed nootropics that help restore speech and other cognitive functions.

The diet must necessarily contain plant products, cereals, porridges, lean meat and fish. Fatty, fried food, smoked meats, pickles, cakes, pastries, and rich pastries must be excluded. Dishes are undersalted. The daily caloric content of the diet should be 2000-2500 kcal. Food is taken in small portions, 5-6 times a day.

The second stroke leads to the death of a significant number of neurons. Therefore, full rehabilitation is very doubtful, in many cases recovery takes a long time, requires modern and effective medications, and great efforts of both the medical staff and the patient himself and his loved ones. A huge role in this is played by the patient's positive attitude towards recovery.

Prevention

First of all, a person who has suffered a vascular accident must follow all preventive recommendations:

• do not resume bad habits – smoking, alcohol, drugs;
• do not take medications without a doctor's recommendation;

• have a tonometer at home and monitor your blood pressure; if it increases, even if not very significantly, take the antihypertensive medications prescribed by your doctor;
• conduct an examination of the cerebral vessels for the presence of an aneurysm and, if one is detected, it is advisable to remove it;
• try to stop the development of atherosclerosis - monitor your diet, excluding “dangerous” foods (liver, egg yolks, fatty meats, sausages, sweets, spicy and salty foods), if necessary, take medications that lower cholesterol;
• carry out antithrombotic treatment;
• moderate physical activity – therapeutic exercises, walks in the fresh air;
• try to avoid stress, increase stress resistance (auto-training, yoga);
• undergo regular medical examinations.

A person who does not want to experience another vascular catastrophe should be extremely attentive to his or her health. For self-diagnosis, you can periodically answer questions about the presence of the following symptoms that have been repeated at least once a week over the past three months:

• headaches not associated with high blood pressure, not localized in any one place, resulting from overwork or caused by a sudden change in weather conditions;
• intermittent or persistent tinnitus;
• dizziness that appears suddenly in a state of rest, the intensification of which is associated with a change in the spatial position of the body;
• loss of memory of recent events;
• a decrease in the usual efficiency in performing any work;
• difficulty falling asleep, insomnia, sleepiness during working hours.

If a person answers at least two questions positively, he should immediately contact a doctor, undergo an examination and receive recommendations for treatment. A second stroke is exactly the case when it is easier to prevent a disease than to recover from it.

[ 42 ], [ 43 ], [ 44 ]

Forecast

No one will undertake to predict a favorable outcome of the second vascular catastrophe; most such events end in the cemetery.

Do people survive a second stroke? Yes. They very rarely survive a third or even a fourth, but how? The prognosis for a full recovery is more a myth than a reality. Even after the first stroke, many remain disabled.

People whose loved one has suffered a second stroke are often interested in how long people live after a second stroke. If after the first stroke, under the most favorable circumstances, a person can live about ten years, then after the second one, he is given not even five, but two or three years.

The prognosis depends on many circumstances - the patient's age, his state of health after the first stroke, concomitant diseases. Stroke becomes the main cause of death for people who have already suffered it once.

The prognosis for life in old age after a second stroke is unfavorable. The older the patient, the more severe the course of the disease and the higher the rate of damage to brain cells. People over 70 years of age are more likely to develop a coma, it is more difficult to take them to the hospital, they have a "bouquet" of concomitant diseases. Even if an elderly patient managed to survive, then it is usually not possible to fully recover. Specialists do not predict a full life after a second stroke in elderly patients, especially over 80 years old. Basically, they develop serious neurological deficits and are bedridden for the entire short period of time allotted to them. However, there are no rules without exceptions, medical science does not stand still, modern drugs and treatment in specialized hospitals increase the chances of survival even in elderly patients.

Is disability provided for a second stroke?

The fact of having suffered a repeated stroke is not in itself a reason to recognize a person as disabled. The fact of disability is established by the medical and social expert commission (MSEC). The specialists of this commission will conduct an expert examination of the patient and determine the disability group depending on the degree of limitation of life activities. The attending neurologist refers the patient for examination.

[ 45 ], [ 46 ]