Consequences and recovery after a second stroke

An acute condition caused by complete or partial cessation of blood flow in 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 managed to recover safely after a stroke, however, retained the body's propensity to form blood clots, cholesterol plaques, uncontrolled rise in blood pressure. In addition, they usually have a history of other serious chronic pathologies - neurological, endocrinological, cardiovascular, renal, often in a fairly severe neglected form. Reserves of their body that can avoid recurrence of a stroke are very small. And patients who come out of a fight with a dangerous disease winners, sometimes make mistakes about their real capabilities, which leads to a recurrence of a vascular accident.

[1], [2], [3], [4], [5], [6]

Epidemiology

World statistics puts the death rate from stroke to second place after the lethality due to coronary heart disease. Annually, with acute disorders of cerebral circulation hospitalize from 460 to 560 people out of every 100 thousand people on the planet, a third of cases - repeated. Survival statistics after the second stroke are disappointing: if after the first stroke an average of 2/3 patients survive in the world, then after the second one, not more than 30% survive, and the quality of their life should not be discussed, since the stroke is in the first place in world among the causes of primary disability.

[7], [8], [9], [10]

Causes of the second stroke

To date, clarification of the initial causes of repeated episodes of acute cerebrovascular pathologies remains one of the promising areas of angioneurology. So far, the mechanism of their development, clinical manifestations and morphology of strokes have not been sufficiently studied, a unified approach and terminology have not been developed. Even the concept of a second stroke is interpreted ambiguously, since in some studies, cases of acute vascular disorders in another arterial system or in areas of the brain whose blood supply is carried out by different blood vessels are listed. In other studies, they are excluded, so the data of different authors are sometimes incommensurable. In this connection, in most of the studies, factors that increase the risk of repetition of the impact and affect its course and the probability of survival are especially noted.

The main provocateurs of acute violation of cerebral circulation, both for the first time and in the next, are the presence of high blood pressure in the patient (and not necessarily the numbers must "go off scale"), atherosclerosis (especially dangerous combination of them), hypertrophic changes in the left ventricle of the heart. If the patient is a diabetic, an avid smoker or a drink lover, the risk of a stroke rises many times. The combination of even the above two factors significantly increases the likelihood of an unfavorable outcome.

Doctors have long noticed the following peculiarity: a repeated vascular catastrophe catches up, basically, those who, almost completely recovering their health after a stroke, returned to their former way of life, ceased to be cautious and guided by preventive recommendations. The quality of life of a person who has suffered a stroke determines to the full the possibility of a repetition of the situation.

[11], [12], [13], [14], [15], [16]

Risk factors

The risk factors of the second stroke, not directly causing the pathological changes in the cerebral arteries, lower the adaptive potentials of hemodynamics and create conditions for disrupting compensation of blood circulation in the arteries of the brain. This group includes mental and physical overstrain, inadequate rest (even labor, which gives pleasure, it is necessary to dose); the abundance of stressful situations, both negative and positive; far from useful habits - smoking, drinking alcohol and / or drugs, taking medications without prescribing a doctor; the absence of feasible physical loads, usually in combination with malnutrition and, as a consequence, excessive weight.

There is a high probability of a second stroke in people who do not control their blood pressure, blood viscosity, carelessly refer to existing chronic diseases. The increased risk of a second stroke is combined not only with hypertension, but also with low blood pressure, metabolic disorders and hypercoagulable blood. A repeated stroke often happens in people with functional impairment of the heart muscle, atrial fibrillation, myocardial infarction in the anamnesis.

For women of fertile age, hormonal contraception is a threat of recurrent stroke, especially smoking and with hypertension.

Another major risk group is people who have undergone short-term cerebral circulatory disorders-pinpoint hemorrhages (micro strokes as they are also called) that lead to minimal necrotic changes in the brain tissues, as well as transient ischemic attacks (reversible blood flow disturbance in any part of the brain) . The insidiousness of such events, for the most part remaining unnoticed or forgotten, is that the probability of a true stroke in such people is much higher.

These factors can be corrected medically, after having completed adequate treatment and ordering their way of life.

The uncorrectable factors for the likelihood of stroke generally include: the age limit of 65 years - of three strokes every two occur in individuals older than this age; Sexual accessory - the male population of 30 to 69 years is more susceptible to acute cerebrovascular pathologies; hereditary predisposition and ethnicity (the highest probability of stroke, it is estimated, in African Americans). This includes random stressful situations. However, the specialists do not associate the possibility of a repeated stroke with either gender, age group, or pathological type of the previous vascular accident. The main reason for its recurrence is the patient's frivolous attitude to his health and unwillingness to adhere to certain restrictions.

The vast majority of all acute disorders of the cerebral circulation develops in the type of ischemia (about 8-9 out of 10), hemorrhages are only 10-15%, however, they are characterized by more severe course and high mortality.

[17]

Pathogenesis

The pathogenesis of ischemic stroke is currently seen as the result of a lesion:

• Atherosclerosis of the main arteries (primarily sow-bones) before entering the cranial cavity, which accounts for the majority (up to 40%) of all primary and secondary vascular disasters of this type;
• small arteries localized within the brain, due to increased arterial pressure, combined with atherosclerotic changes in intracranial vessels (approximately 35% of ischemic strokes);
• occlusion of the middle cerebral artery with fat or air embolus formed in the heart (left divisions), from about 15% of ischemic strokes to 20.

In other cases, the pathogenetic links of ischemic strokes were disorders of blood clotting (thromboembolism), degeneration of vascular membranes caused by diseases not directly associated with cerebral vessels, for example, diabetes mellitus, vasculitis, erythremia.

The presence of atherosclerotic angiopathy is the main cause of development of the majority of ischemic strokes, including repeated ones. This is the most significant risk factor. Atherosclerotic changes in the walls of the vessels are considered as a chronic proliferative-inflammatory process, against the background of the development of which blood clots form, due to the 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 the arteries. With the patient's age, the penetration of low-density proteins circulating in the plasma in the arterial membrane increases, forming first cholesterol spots that eventually turn into outgrowths on the walls of arteries-atheromatous plaques. Sealing or, conversely, loosening plaques crack, ulcerate, in their thickness there are small hemorrhages, later fibrous, which increases the size of the formation and, accordingly, the lumen arteries narrows, the endothelial membrane is damaged. The thrombore resistance of the vessel decreases and in this place the formation of a parietal thrombus gradually takes place. Its structural disorders (loosening, cracks, fibrosis) give rise to intravascular substrates (emboli), transported by blood flow to the cerebral arteries.

Pathogenetic processes develop and increase approximately during the first three weeks, and especially intensively it occurs in the first minutes and hours of the disease. When the artery is blocked, the blood flow stops at some part of the brain and the so-called "ischemic cascade" rapidly develops, causing oxygen starvation and oxidation of the brain tissues, disturbance of fat and carbohydrate metabolism, inhibition of neurotransmitter production and a sharp decrease in their number in the synaptic cleft. This process is accompanied by the formation of a hearth infarct, which is formed literally from five to eight minutes. The area of tissue damage left without oxygen and nutrition increases at a tremendous rate (in 1.5 hours - by 50%, in six hours, called the period of the "therapeutic window" - by 80%). Without treatment, this area expands in a geometric progression, the secondary widespread edema of the brain develops. This lasts from three to five days, then the dead neurons are subjected to necrosis and the process is partially localized. In the future, neurological symptoms develop and grow.

A repeated stroke develops in the same scenario, but the presence of an ischemic zone, the consequences of the previous lesion, should be taken into account. The focus of softening of the brain tissue damages a larger area, positive dynamics at the end of the acute period is much less frequent. Sometimes developing ischemia develops into a hemorrhagic form, which makes diagnosis difficult, aggravates the situation and worsens the prognosis.

The mechanism of the development of hemorrhagic stroke in the vast majority of cases is due to rupture of the cerebral arteries and impregnation of blood in the parenchyma of the brain and / or the formation of an intracerebral hematoma, in a cavity formed in the brain tissues, expanded under blood pressure. This causes destruction or compression of the brain tissue, its dislocation, disrupted the outflow of venous blood and cerebrospinal fluid, which leads to brain edema and squeezing its trunk. Dimensions hemorrhagic focus have a diverse range - from small to spread to the entire hemisphere, sometimes develop multiple hemorrhages. On this site, the ischemia region develops, and the cascade of pathogenetic processes described above is triggered. If the patient remains alive, then the cyst is formed in the place of the hematoma with time.

More than four out of five hemorrhagic strokes occur at the time of a sharp jump in blood pressure, sometimes the cause of cerebral hemorrhage is the rupture of an aneurysm (arterial malformation) and other intracerebral hemorrhages. The background for the development of cerebral hemorrhage is a stressful situation or physical overstrain. The risk of hemorrhagic catastrophe is increased in patients with lipid metabolism disorders, overweight, diabetes mellitus, cardiac pathologies and sickle cell anemia, which are not parted with bad habits.

[18], [19], [20], [21], [22], [23]

Symptoms of the second stroke

A person who has already managed to recover from a stroke, his symptoms should be remembered and treated with care, so as not to miss the precursors of a new catastrophe.

The first signs, which speak of its possible approximation:

• unilateral short-term visual impairment;
• sudden attacks of memory loss - a person for a while seems to "fall out" of reality or can not assess his location;
• transient speech dysfunctions - indistinctness, inhibition;
• one-sided paresis of the extremities and / or a decrease in their sensitivity;
• meteorological dependence, manifested as dizziness, weakness, pre-stupor, and headache.

At occurrence of even two of the listed signs to the person who has transferred already one stroke, it is necessary to address urgently to the doctor and to pass a course of treatment to prevent repetition of blow.

If the misfortune still happened, then the success of treatment depends, first of all, on the speed of reaction of others and the professionalism of the arrived ambulance team. Symptoms of the second stroke, the same as in the first case - dizziness, nausea, stunned or excited state. The patient suddenly paralyzes one side of the body, there may be vomiting, an attack of diarrhea, hyperthermia. The patient can not raise both hands, the hand does not rise from the paralyzed side, her shaking is almost not felt. The face becomes asymmetric (on one side the angle of the mouth drops and the eye does not close), the smile is a curve, it is not possible to clearly say a few words of the patient.

Stages

The severity of post-stroke coma is assessed according to the Glasgow scale:

1. The first is determined in patients with some consciousness, although contacts with them cause difficulties, but they are able to swallow, flip themselves in the prone position, perform simple movements, although the symptoms of stun and decay are noticeable, the patient is drowsy, the reactions are belated, even for pain, hypertonic musculature; pupils react to light, sometimes notice excesses of divergence (divergent strabismus). For this variant of coma, the most favorable prognosis and the least complications are characteristic.
2. The second - the patient is not contact, is in a state of sopor, occasionally you can see chaotic muscle contractions that can not be attributed to controlled movements, physiological dispensations are performed involuntarily, mostly patients do not control them, pharyngeal reflexes remain at this stage, the pupils of the patient are severely narrowed and practically not react to light, noisy pathological breathing, characteristic of oxygen starvation of the brain, muscle weakness, its spontaneous wave-like contractions. Survival is unlikely, especially after the second stroke.
3. The third (atonic) - the patient is unconscious, without reacting to pain stimuli and touching the cornea, the photosensitivity of the pupils is completely absent, the pharyngeal reflexes are very weak sometimes; muscular tonus is significantly reduced, muscle cramps can occur in any place or wave throughout the body, hypotension, hypothermia, a rhythm of breathing. The likelihood of survival, especially after the second stroke, tends to zero.
4. The fourth - already essentially the patient does not give signs of life, every second breath can stop.
5. The fifth is the agony and death of the patient.

Stages of stroke development are determined as follows:

• the first 24 hours are called the most acute stage of the disease;
• followed by a sharp, which can last an average of three weeks;
• the next three months are considered a subacute stage;
• then the early (from three months to six months) and the late (up to a year from the moment of impact) recovery phases are isolated;
• the stage of the distant consequences of a stroke begins after the expiry of the year.

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

Types of primary and repeated stroke are not always the same, common for them are usually the zones and brain structures in which the final destructive processes occurred, pathogenesis is often quite different.

A second ischemic stroke usually develops suddenly (although occasionally clinical symptoms may increase gradually), more often at night or in the morning, in a dream (arterial thrombosis) or during the day (a non-thrombotic stroke). Characteristic one-sided defeat. The state of consciousness depends on the location and extent of damage, as well as the consequences of the first stroke. With insignificant changes, consciousness can be preserved or disturbed insignificantly. Neurological symptoms of acute stage are manifested by violations of the pronunciation of individual words or more significant speech distortions, asthenia and ataxia, unilateral visual impairment, and on the same side - numbness of the extremities. Sometimes there may be urinary incontinence. Epileptic seizures are not typical.

Massive (extensive) ischemic stroke is characterized by a gradual increase in symptoms, lack of consciousness, a serious neurologic deficit: vomiting, severe headache, oculomotor and speech disorders, paresis and paralysis, coma. Extensive repeated strokes often end fatal.

The second hemorrhagic stroke in the overwhelming 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 hemorrhage - the compression of the brain tissue layers the formation of an extensive ischemic region. It usually develops during the day and is the result of a stressful situation and / or physical stress. The possibility of an early hemorrhage is predicted 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 wrapped in a red veil; periodic loss of balance control; aphasia. The face before a stroke is often red, sometimes the temperature rises, there is a hoarse, bubbling breath, sometimes epileptic seizures occur.

The symptomatology of hemorrhagic stroke corresponds to dislocations of the brain substance with respect to the normal location. If the patient has not lost consciousness, he usually has a severe headache, photophobia, nausea and vomiting, tachycardia, speech and movement disorders.

The unconscious state can be observed in varying degrees - from stunned to comatose. It is typical for most patients with hemorrhagic stroke. In addition to the disturbance of consciousness, the patient can observe: rhythmic movements with the eyes (nystagmus), the inability to follow the moving subject, the absence or decrease in the photosensitivity of the pupil, the absence of muscle tone, respiratory and cardiac arrhythmia, hypotension, the absence of a pharyngeal reflex, different pupil size, bulbar dysarthria, causeless tears or laughter, delay or incontinence of urine. Seizures similar to epileptic seizures may occur.

In this type of stroke, the highest mortality of patients is observed on the second to fourth day after the onset of the disease (due to the onset of the development of the pathological process), and also on days 10-12 (due to complications).

The most severe is hemorrhage in the cerebral cortex: almost always there are gross violations of consciousness and serious neurological deficits: paralysis, gross verbal disorders, loss of sensitivity, loss of orientation. External symptomatology resembles blockage of the middle cerebral artery.

In thalamic hemorrhages, there is also the likelihood of coma, the symptomatology is characterized by the predominance of sensory disorders (oculomotor, strabismus, visual field limitation) before the impairment of motor function.

Early comatose with a hemorrhage in the varioly bridge, characterized by a lack of response to light and pupils in the form of a point, 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 motion, inability to walk and stand, with the paresis of the eye muscles in the presence of consciousness, however, compression of the brainstem can provoke a fatal outcome.

Subarachnoid hemorrhage, mainly occurs when rupture of the protrusion of the inner elastic wall of the artery (aneurysm). This type of hemorrhagic stroke is characteristic for the age group from 35 to 65 years. A momentary severe headache is characteristic. In pain, the patient may even faint, which occasionally passes into a coma, however, in most cases the consciousness returns and the patient is only somewhat deafened. Sometimes a syncope precedes a headache. Hemorrhage develops usually with physical exertion or is its immediate consequence. The focus can be localized only under the arachnoid membrane or spread further. When blood enters the brain substance, symptoms of focal hemorrhage appear.

[24], [25]

Complications and consequences

The consequences of a second stroke are usually much harder - in most cases, it ends in death. Coma after the second stroke happens in 2/3 of the patients, and it is possible to get out of it alive. At a coma, a deep fainting occurs, the patient has completely or partially no reflexes and a response to external stimuli. However, depending on the depth of the coma, the patient can react to the irritation of the cornea by involuntary opening of the eyelids or by disorderly movements, sometimes grimacing, lacrimation, and unreasonable laughter. Comatose state occurs with intracerebral hemorrhage, extensive ischemia, edema and toxic damage to brain tissue, concomitant systemic diseases, for example, connective tissue diseases.

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

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

Nevertheless, if the brain tissue has been insignificantly damaged for the first and second time, there is a possibility of maintaining work capacity. There are cases when a person experienced several strokes, however, each time the probability of a quality life decreases.

Post-stroke complications become stable the second time, the edema of the brain and coma develops more often. Even the surviving patient is guaranteed complete or partial movement disorders, speech, vision, and dementia.

Paresis of limbs significantly restrict the possibility of movement. Paralysis chains the patient to a bed or a wheelchair. The easiest degree of paralysis is monoplegia, when only one limb loses its ability to move. There is a one-sided immobility of limbs (hemiplegia) and real estate of both twin extremities (paraplegia).

With the inability to fully move, often blindness is combined into one eye, verbal disorders - indistinct and incoherent speech, decreased intelligence.

[26], [27], [28], [29], [30], [31], [32]

Diagnostics of the second stroke

Primary diagnosis is the prerogative of others, the patient himself, usually, can not help himself and call an ambulance.

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

A patient with an acute attack is hospitalized. In the hospital, he carries out blood test, including - on the level of sugar and cholesterol, assesses the effectiveness of the mechanism of blood clotting, the general analysis of urine. In case of impossibility to make a tomography - examine the cerebrospinal fluid.

The neurological deficit is determined by different methods, the most famous scale of the National Institutes of Health of the USA (NIHSS), the Scandinavian stroke scale and the Glasgow coma scale are also applied.

An accurate representation of the localization and spread of vascular lesions is provided by modern instrumental diagnostics - computer and / or magnetic resonance tomography, angiography with and without contrast, ultrasound dopplerography, electroencephalogram. Usually, cardiac muscle work is evaluated using an electrocardiogram, ultrasound examination of the heart can be prescribed.

[33], [34], [35], [36], [37], [38], [39], [40]

Differential diagnosis

Differential diagnosis is carried out with a strong migraine attack, coma with diabetes, brain tumors, sudden paresis of another etiology, intracerebral hematoma, exfoliating carotid artery aneurysm and some other diseases similar in symptomatology.

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

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

[41], [42], [43], [44], [45], [46], [47], [48]

Treatment of the second stroke

The prognosis for survival in the second vascular accident depends on many factors, one of which is the speed: the faster the patient gets into the hands of specialists and the resuscitation measures begin, the more chances he has to survive with minimal consequences.

What to do in the second stroke? To call an ambulance. While waiting for the brigade to arrive, it is necessary to help the patient to lie down (sit down), providing an elevated position of the head (try not to move the patient any more). Measure (if possible) blood pressure and give the antihypertensive medication available with it. To help get rid of dentures, contact lenses, remove glasses, unbutton the collar, loosen the belt.

If the patient has lost consciousness, they turn their heads to one side and slightly open their mouths, watch the breath, avoiding the stumbling of the tongue, which can block the flow of air into the respiratory tract. Do not try to bring the patient back to life. It is advisable to put a cold compress or ice on the forehead.

Usually a specialized brigade comes to the patient with a sharp stroke, who can provide the necessary help at home and on the road. You can use the services of a paid ambulance, then it will be guaranteed that the patient will be transported reliably after the second stroke. Therapy after the second acute attack is no different from the previous time. Entered by an ambulance with a repeated vascular accident is usually sent to the intensive care unit or resuscitation. Make the necessary diagnostics to determine the type of lesion.

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

• the maximum restoration of the ability of the arteries to transport blood to the brain tissues through drip infusions of saline solutions;
• use of thrombolytics, to reduce blood viscosity, dilute it and activate microcirculation;
• protection of neurons and prevention of cerebral edema.

In the first hours, they try to restore blood flow, using vasodilating drugs, thus removing the spasm of blood vessels and forcing the work of spare collateral arteries. Intravenously injected No-shpu, drugs based on nicotinic acid and others.

But-spa, the active ingredient of which drotaverina hydrochloride has the ability to reduce the concentration of calcium ions in cells, permanently inhibiting contractile activity and relaxing the musculature of the arteries, thereby widening the blood vessels and increasing blood flow in them. The mechanism of its action is based on inhibition of the enzymatic activity of phosphodiesterase IV, with no effect on the activity of the same type of enzymes of type III and V, which releases No-shpu from spasm of cerebral vessels from other antispasmodics by the absence of a significant therapeutic effect on the activity of the heart muscle.

Nicotinic acid is an enzymatic agent that transports to the tissues and organs of hydrogen and participates in oxidation and reduction reactions. It has the ability to expand blood vessels, lowers the content of lipoproteins in the blood. Intravenously, nicotinic acid preparations are administered very slowly, as it causes painful sensations. Preference is given to Nicotinat sodium or nicotinamide as not causing irritating effect. The recommended dose is 1 ml of a 1% solution.

The anti-shock solution of Reopoliglyukin is injected drip to restore capillary blood flow.

If the patient is conscious and is able to take pills, he may be prescribed the following anticoagulants: Ticlopidine, Warfarin, Clopidogrel and all known Aspirin. The dosage of these drugs is determined by the doctor according to the symptoms, since the situation is urgent. If the patient has taken medications that dilute the blood, relatives should inform the doctor about this, as the dosing will be adjusted.

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

Warfarin refers to indirect anticoagulants. It inhibits the action of vitamin K, thereby preventing the process of blood clotting and the formation of blood clots.

Clopidogrel is a selective inhibitor of the binding process of ADP with the same receptor of platelets. The drug has an irreversible effect by blocking the ADP-receptors of blood cells, so coagulability is restored after discontinuation of admission after platelet renewal (about a week).

Patients who are in an unconscious state are prescribed drip infusions of Heparin. Has a direct effect preventing blood clotting, as it is a natural component that provides fluidity of blood. In addition, it inhibits the enzymatic activity of hyaluronidase, prevents the formation of thrombi, activates the blood flow in the coronary artery. Heparin activates the cleavage of lipids, reducing their content in the blood serum. With intravenous administration it acts instantaneously, but for a short time, from four to five hours.

This preparation is usually combined with enzymatic fibrinolytics, for example, fibrinolysin or plasmin derived from human blood plasma, or streptodecase, which activates the transformation of plasminogen into a natural plasmine blood ingredient. These drugs provide the dissolution of fibrous fibrin protein, the clots of which are the basis of thrombus. Their deficiency is systemic action and the possibility of bleeding.

The most effective for today in ischemic stroke is the drug Aktilisse, a second-generation thrombolytic that is used during the "therapeutic window" and has the ability to destroy the blood clot that clogged the artery. The so-called tissue plasminogen activator, introduced in the first hours after a stroke, is fully capable of restoring blood supply to the ischemic site. Actilize selectively only converts fibrinogen, which is related to the formed thrombus, without having a systemic effect. This drug is intended for intravenous administration. It is recommended to inject no more than 90 mg, first a jet intravenous injection is made in the amount of 10% of the dose prescribed by the doctor, the rest is injected into the drip for an hour.

The treatment regimen followed by the use of heparin (intravenous) and acetylsalicylic acid (orally) has not been studied enough, therefore, especially in the first day of treatment with Actylize, it should not be used. In cases where it is necessary to use Heparin (because of other pathologies), it is administered subcutaneously and no more than 10,000. 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, it is recommended to transfuse fresh whole blood (freshly frozen plasma) or use synthetic antifibrinolytic agents.

If the resuscitation measures were successful and positive dynamics was noted, Cavinton was appointed to restore vascular tone. The vegetable alkaloid derivative corrects mental and neurological post-stroke disorders. Under the action of the drug, the cerebral arteries expand, the blood flow increases and the amount of oxygen in the brain tissues increases, glucose metabolism improves. Inhibiting the enzymatic activity of phosphodiesterase, Cavinton promotes the accumulation in the tissues of cyclic adenosine monophosphate, a universal mediator that transmits signals of certain hormones to neurons. Also, the drug has an antiaggregant effect, preventing the formation of thrombi, increases the plasticity of red blood cells. Cavinton does not have a significant hypotonic effect.

In neurological practice, the drip introduction of the drug is used, then they switch to taking the tablets. They are taken continuously for one or two units three times a day.

Emergency measures for repeated hemorrhagic stroke are primarily aimed at stopping bleeding and reducing the pressure of hematoma and displaced brain areas 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.

Normalization of blood pressure, stop taking vasodilating and antiaggregant drugs (if they are the cause of hemorrhage), use haemostatic agents. The second hemorrhagic stroke is rarely subject to therapeutic treatment, however, in these cases, injections of antihypertensive medications and diuretics are used to reduce pressure. For this, different drugs are used: β-blockers (Atenolol, Bisoprolol, Nebivolol, Anaprilin, Timolol), antispasmodics (No-sppa, Otilonium bromide, Atropine, Buskopan), calcium antagonists (Corinfar, Anipamil, Clentiazem), drugs inhibiting enzymatic activity angiotensin (Benazepril, Captopril, Enalapril, Fosinopril).

Emotional lability is stopped by sedatives - Elenium, Diazepam. Often appoint Phenobarbital, because it has an anticonvulsant effect, not more than 90 mg per day, divided into three doses.

Laxatives are used to prevent hampered bowel movements, for example, Pikolax drops that stimulate the peristalsis of the large intestine and move to the exit of stool. Take once a day, in the evening, from 13 to 27 drops.

Drugs that stop bleeding:

• Dicinone - accelerates the formation of tissue thromboplastin, which helps stop hemorrhage, inhibits the enzymatic activity of hyaluronidase, blocking the metabolism of mucopolysaccharides, which increases the strength of the vascular walls. However, this ability does not affect the duration of the prothrombin period, nor does the drug cause hypercoagulability. From the time of parenteral administration to the onset of action, a period of time from five minutes to a quarter of an hour passes, from ingestion - an hour or two. Provides a four-six-hour effect. The recommended dose for a four-time application is 250 mg.
• Gordoks (aprotinin) - well tolerated by most patients with a primary use of a hemostatic drug for drip infusions. Oppresses the enzymatic activity of proteases, promotes the activation of the coagulation process and reduces the fluidity of the blood. Assign four droppers per day, each for 100 000 units. In the secondary course within half a year 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 not more than 30 g, in droppers 100-150 ml (5% solution). It can be combined with a small amount of Reopoliglyukin, which improves blood circulation in the capillaries.

The appearance of the symptoms of the penetration of the brain substance into the openings of the cranium of different locations, the patient's inhibition requires anti-edematous therapy - the appointment of osmotic diuretics. Usually prescribed drugs with the active substance mannitol (Aerosmosol, Mannitol, Mannistol, Osmosal, Renitol and eponymous drug). 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.

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

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

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

When the acute period has passed and the bleeding is safely stopped, further therapy is performed symptomatically. The patient must necessarily adhere to bed rest and diet.

Vitamins and vitamin-mineral preparations reduce the permeability of vascular membranes, make them elastic and durable. Ascorbic acid and rutozide are indispensable in this respect, especially their combination in many vegetables and fruits, as well as in the Ascorutin preparation. Patients after the second stroke to strengthen blood vessels are recommended calcium preparations:

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

Vitamin-mineral complex Berokka Plus contains eight vitamins of group B (thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxine hydrochloride, biotin, folic acid, cyanocobalamin), vitamin C, calcium, magnesium and zinc. It is indispensable for healing the vessels, normalizing the process of hematopoiesis and the functions of the central nervous system. Take one tablet a day.

Restore the body after the second stroke will help physiotherapy. Ultrasound therapy can be prescribed already in an acute period in ischemic stroke, and also during rehabilitation to reduce muscle tone or vice versa in muscular dystrophy, treatment of concomitant pathologies. With hemorrhages, ultrasound treatment is prescribed after at least two months from the onset of the disease.

Post-stroke patients are shown electroprocedures - amplipulse therapy; electrophoresis; darsonvalization; diadynamic therapy; electrosleep. With the help of such procedures, metabolic processes are activated, the trophism of the vessels improves, the ischemic areas and edema decrease, the motor activity of the parietal muscles increases. Procedures are appointed already in the early recovery period (from the third week).

Magnetotherapy promotes a smooth decrease in blood pressure, improves the rheological properties of the blood.

Low-intensity laser irradiation improves the quality of erythrocytes - blood cells transporting oxygen to the neurons of the brain, as a result of the destruction of thrombi and reduces the likelihood of new ones.

Thermotherapy - paraffin and ozocerite applications, white light phototherapy, hydromassage and vacuum massage are recommended for patients with postinsult arthropathies.

Alternative treatment

To treat a stroke at home is life-threatening, especially the second, in this case urgent intensive therapy with the use of modern diagnostic equipment and medicines is required. But within the framework of restorative measures and as preventive measures, the recommendations of alternative healers can be included in the therapeutic scheme, after consultation with the attending physician.

To treat the consequences of stroke and prevent a recurrence, alternative medicine suggests using pine and fir cones. For therapeutic purposes, young cones with seeds are used. They need to be torn only from trees growing in the forest away from the main roads. Broken bumps are cleaned from damaged insects, necrotic parts. Pine is best collected in March, in extreme cases until the end of April, the collection of spruce begins on June 5.

Tincture of pine cones on vodka is taken twice or thrice a day in a teaspoon for three weeks, then a week break is made and the course of administration is repeated twice more. The next time this treatment can be done no earlier than six months.

Preparation of tincture: bumps rinse under running water and put in a clean one-liter jar, filling it to the top. Pour vodka, cover and insist in a closed locker or pantry for two or three weeks before getting a thick dark red color. Strain through gauze, folded twice. The infusion is ready for use.

An alternative non-alcoholic variant - a decoction of pine cones is prepared as follows: cut five young pine cones into smaller pieces, put them in an enamel saucepan, pour ½ liters of hot water and boil five minutes on a small flame. This broth is drunk about a quarter of a glass after eating one to three times a day.

Spirituous tincture of fir cones with apple (grape) vinegar. Five cones are rinsed, cut and poured with alcohol (vodka) in a volume of 250 ml. Within a decade, the mixture is left for infusion in a closed locker or pantry. Then filter well and add a teaspoon of vinegar (preferably home-made). Use, adding tea a teaspoon of tincture, for six months, then take a break.

Water infusion of spruce cones is used in a daily volume of not more than 30 ml, it is drunk several times a day. For cooking rinse the cones, cut and fill them in a three-liter jar to half the volume, pour over the cooled boiled water to the top and leave to infuse in the dark place for ten days. Then, after draining the liquid, fill the jar with water again. A week later, the medicine is ready. The entire prepared portion is drunk on the course and a break is taken.

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

Alternative medicine extensively practices herbal treatment of the effects of stroke. Paralyzed in whole or in part of the body is recommended to rub with alcohol tincture of thyme (50g of crushed dry vegetable raw material insist on a week for alcohol or vodka with a capacity of 500ml) or alcohol or ether mixed with vegetable oil in a ratio of 1: 2.

You can do a bath every two days with decoction from the roots of dog rose, the course is supposed to make from 20 to 30 baths.

The root of bryony (paralyzed herbs) in the volume of one tablespoon insists a week on vodka (300ml) in a warm place, filter. Tincture is taken inside in the morning and in the evening, dropping 25 drops in a quarter of a glass of water.

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

You can also normalize the pressure without medication. To do this, recommend in the morning before breakfast to drink half a glass of mint tea (you can of melissa). For its preparation, a teaspoon of grass is boiled with 200ml of boiling water, after half an hour, it is filtered and drunk. After waiting another half hour, you need to drink half a glass of pre-brewed infusion of two herbs - immortelle and yarrow. Taking a pinch of each herb, brew it with boiling water and leave to cool, then strain.

Prevent thrombosis and reduce the viscosity of the blood will help the following remedy:

• Corvalol (10 ml);

Pharmaceutical tinctures for alcohol

• echinacea (10ml);
• eucalyptus (40ml);
• peppermint (40ml);
• motherwort (125ml);
• pion (125 ml);
• valerian (125ml);
• hawthorn (125 ml each).

Add to this mix eight mashed to powder state buds carnations (meaning the seasoning). Shake and put in a closed locker. A week later the product is ready. Every day in the morning, at lunch and in the evening dilute a teaspoon of medicine in ten milliliters of water and drink.

Alcohol-free composition, blood thinning and preventing the formation of blood clots: in the evening in a liter thermos, four tablespoons of boiling water are brewed with two tablespoons of herbal extract from mint, sage and the root of elecampane mixed in equal proportions. The next morning, strain and drink before eating 200 ml four times a day. Treatment lasts three weeks. The next course can be done by making an interval of at least a month.

[49], [50], [51], [52], [53], [54], [55]

Homeopathy

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

The use of complex homeopathic remedies of the brand "Heel" can be included in the scheme of therapy practically at any stage of the disease. Injection of drugs to stimulate the respiratory function of cells Coenzyme compositum and Ubiquinone compositum can provide adequate oxygenation of neurons of the brain, strengthening immunity, restoring trophic and lost functions. They can be used simultaneously with other drugs that are used in emergency therapy and recovery period. As a rule, the catalysts for tissue respiration are prescribed alternately every other day by a course of 10-15 injections. Producers recommend, in some cases, to achieve greater efficiency, use drugs in combination with each other.

Parenteral cerebral protection 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 that occur in them. When it is used, the body's immune status is increased, the strength of the vascular wall increases, its elasticity, and the blood flow becomes active. The drug is able to slightly dilate the blood vessels and eliminate spasms, activate metabolic processes and eliminate toxins. After the course of treatment, memory improves, neurological deficit decreases. Appointed one ampoule after one to three days. You can inject in any way, and also use it orally, having drunk within 24 hours, dissolving the contents of the ampoule into 50 ml of pure water.

The action stimulating the restoration of the nervous system is provided by injections of the placenta compositum, the complex of which expands the arteries and facilitates blood flow, tones and eliminates spasmodic phenomena, improves tissue nutrition and respiration. Normalization of blood circulation in the limbs is provided by components - organ preparations from placental tissue and embryonic tissue, which also contribute to cellular renewal and recovery. The state of the internal vascular membrane is positively influenced by organ preparations from the tissues of the artery, veins and umbilical cord. Stabilizes the pituitary and endocrine disorders of the organ ingredient from the pituitary gland, and the regulation of metabolic processes is corrected by sodium pyruvicum and muscle lactic acid. Herbal ingredients reduce the permeability of the walls of arteries, veins and capillaries, provide blood flow to the skin, have an anticonvulsant effect, eliminate paresthesia. Barium carbonate, copper sulfate and lead iodide clean the vascular walls and prevent the spread of cholesterol plaques. Dosage is similar to the previous preparation.

Stabilize the condition after a stroke and compensate for cerebral insufficiency by using oral drops
Eskulius compositum, taking them 10 drops under the tongue three times a day before meals for half an hour or diluting them in a tablespoon of water. Do not use the drug for various disorders of immunity, neoplasms, collagenoses, multiple sclerosis.

Nervocheel - stabilizes the nervous system, has antidepressant and anticonvulsant properties. It consists of Ignacy, Sepia, Potassium bromide which are used to normalize cerebral circulation as monopreparations, Phosphoric acid, which is called homeopathic nootropic. Tablets dissolve under the tongue, dosing: for patients from the age of three - one unit per reception three times a day. Acute seizures are cured by resorption of 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.

Monopreparations, appointed by a specialist individually, will most effectively work.

With left-sided symptoms: Arnica (Arnica) - the most effective remedy for regenerating remedy, can be used to provide emergency care; Lachesis (Lachezis) - normalizes blood circulation in small arteries, works well for hemorrhages.

Right-sided lesions well restores Bothrops (Bottrops) - thrombolytic, improves blood circulation, regenerates paralyzed muscles;

Bufo rana (Bufo rana) - speech defects, bulbar syndrome, aphasia, aggressive reaction in case of misunderstanding.

Ambra Grisea (Ambra griseya) and Phosphorus (Phosphorus) - homeopathic nootropics, effectively restore cognitive functions.

Lathyrus sativus - the post-stroke patient walks, but with difficulty (drags his legs, knees, feet are bent).

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

Helleborus niger (Hlebborus niger) - is used to treat apathetic patients with inhibited reactions or their absence.

Nux vomica (male vomica) is a male drug used for paresthesias, seizures, motor ataxia.

Baryta carbonica and Baryta iodata are mainly prescribed after ischemic stroke, selectively has a positive effect on cerebral vessels, it removes the oppressed state, forgetfulness, and improves the concentration of attention.

Aurum iodatum (Aurum iodatum) - normalizes blood pressure, suppresses hypertensive crises and cerebrovascular disease, is effective in atherosclerotic vascular changes.

Conium (Conium) - effectively cures neurological symptoms, speech disorders, paresis and paralysis of the lower limbs.

Crataegus (Krategus) - is indispensable in the prevention of strokes, has soothing, vasodilating, strengthening their wall properties.

Surgery

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 state whose lethality is estimated from 90% to 100%. These are patients with medial hemorrhages, the size of which does not matter, and staying in a deep coma with impaired stem functions.

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

Surgical treatment is performed to reduce pressure on the medulla and to minimize its dislocation, as well as to reduce intracranial pressure, local and total, and the number of neurotoxins released from the hematoma.

Classical open microsurgery is used in about a quarter of cases of hemorrhage, when the hematoma is localized near the surface. In this case, the possibility of causing additional brain injury to the patient is minimized. Also, open surgery can be performed according to vital indications in patients with deep cerebellar hematomas, or hemorrhages localized in the cerebral hemispheres and causing severe neurologic symptoms.

Minimally invasive endoscopic surgery is performed by most patients: a small diameter instrument (from two to seven millimeters) is inserted into a blood clot and then it is removed by aspiration. Operations are carried out under the control of a computer and modern navigation technology using ultrasonic, infrared or electromagnetic radiation.

In ischemic stroke, thrombus removal or treatment of a damaged artery is performed with the help of special medical minimally invasive procedures, which, strictly speaking, are not yet related to surgery, but also conservative treatment, too, because catheter penetration in the brain to the place of thrombosis through the femoral artery and delivery thrombolysis directly to the thrombus. Intraarterial selective thrombolysis is a rather complicated procedure that is carried out in stroke centers with modern equipment and round the clock access to angiography of cerebral vessels. This procedure is performed by patients with a severe form of acute cerebrovascular accident of the ischemic type within the time of the "therapeutic window" or with ischemia developed in the vertebrobasilar basin during the first 12 hours. Infusion of thrombolytics is carried out long enough, 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.

Prophylactic surgical procedures - carotid endarterectomy (removal of atherosclerotic formations) on the walls of the carotid artery, and also - stenting and angioplasty, as a result of which the lumen of the artery increases and the blood flow is activated. With atherosclerosis, such procedures reduce the risk of developing a second vascular accident of an ischemic type.

Rehabilitation after a second stroke

The main restoration of all the functions that were present in the patient before a repeated vascular accident occurs in the first two to three months - they are considered peak for neurologic recovery. At this time, half of the basic functions are restored, then by the end of the year - the second half. The evaluation of the quality of recovery includes indicators characterizing the return of self-service skills, motor and cognitive functions.

Often the consequence of the second stroke is a disorder of motor functions, so the activation of the post-stroke patient begins as soon as the patient's condition stabilizes. In general, the ability to move in paralyzed limbs is restored in the first six months.

The patient, who is still on bed rest, starts to activate for the prevention of muscular contracture in the joints of the paralyzed limbs - to do static exercises, i.e. Give the hands and feet positions that the patient himself is not yet able to take. For example, unbend the arm in the elbow joint, laying it on the chair, which is attached to the bed, while opening the wrist and maximally flexing the fingers. The leg is bent at the knee joint at an acute angle, the foot is bent. Fix the limbs in the desired position with rollers, pillows, towels, pouches with sand for at least two hours every day.

In addition passive gymnastics is carried out by paralyzed limbs. First, the exercises are performed by a specialist in curative physical education. At the same time there are close patients who have studied the sequence of exercises will continue to do them on their own after discharge. Passive gymnastics is supplemented by breathing exercises. Gradually, the pace and number of exercises are increasing.

Physical recovery of the post-stroke patient begins with giving it a semi-sitting position under the supervision of medical staff with pulse and blood pressure measurement, and assessing the subjective feelings of the patient who gradually learns to sit, then stand and move with support in the ward. The patient is supported from the paralyzed side, substituting the shoulder for the paretic limb. Then the patient begins to use the support of special devices - walkers. At the same time, they restore their everyday habits - they suggest taking items with a paralyzed hand, dressing themselves unaided, fastening, tying shoelaces and the like.

In addition to physiotherapy exercises, the patient is given a massage. It should be done by a specialist who is familiar with the peculiarities of carrying out this procedure to post-stroke patients, since lack of qualification can lead to complications after massage in the form of muscle spasms, contractures. With expressed spasms of the musculature, the patient is prescribed muscle relaxants whose treatment regimen is prescribed by the doctor in each specific case. Warn the occurrence of movement restrictions in the joint acupressure, physiotherapy procedures, acupuncture.

Special activating massage is also used with reduced muscle tone in paralyzed arms and legs, drugs are prescribed that activate muscle contractions, facial devices.

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

Speech disorders are most effectively corrected during systematic sessions with a speech therapist-aphasiologist. At first these sessions are short-lived, not more than a quarter of an hour. Over time, relatives can actively participate in the restoration of speech, writing, reading skills, dealing with the patient at home. Usually, the patient is assigned nootropics that help restore speech and other cognitive functions.

The diet should contain vegetable products, cereals, cereals, lean meat and fish. Oily, fried foods, smoked products, pickles, cakes, cakes, baked pastries should be excluded. Dishes nedosalivayut. The daily caloric content of the diet should be 2000-2500 kcal. Food is taken in small portions, 5-6 times a day.

A second stroke leads to the death of a significant number of neurons. Therefore, a full rehabilitation is very doubtful, in many cases, recovery takes a long time, requires modern and effective medicines, and the application of greater efforts by the medical staff, the patient and the people close to him. A huge role in this is played by the patient's positive attitude toward recovery.

Prevention

First of all, a person who has suffered a vascular catastrophe must comply with all preventive recommendations:

• not to resume bad habits - smoking, alcohol, drugs;
• Do not take medicines without doctor's advice;

• have a home-based blood pressure monitor and monitor your blood pressure, in case of an increase, not even very significant, to take prescribed anti-hypertensive medications;
• to make an examination of the cerebral vessels for the presence of an aneurysm and in case of its detection it is desirable to remove it;
• try to stop the development of atherosclerosis - monitor your diet, excluding from it "dangerous" foods (liver, egg yolks, fatty meat, sausages, sweets, spicy and salty foods), if necessary, take medications that reduce cholesterol;
• conduct antithrombotic treatment;
• moderate physical activity - therapeutic gymnastics, walking in the fresh air;
• Try to avoid stress, increase stress resistance (auto-training, yoga);
• regularly undergo medical examination.

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

• headache, not associated with increased blood pressure, not localized in any one place, resulting from fatigue or caused by sudden changes in weather conditions;
• periodic or constant noise in the ears;
• dizziness, which suddenly appears in a state of rest, the strengthening of which is associated with a change in the spatial position of the body;
• the loss of recent events;
• decrease in the usual efficiency of performing any work;
• difficulties with falling asleep, insomnia, drowsiness during working hours.

If a person has answered at least two questions positively, he should immediately consult a doctor, take a survey and get recommendations for treatment. The second stroke is just the case when the disease is easier to prevent than recover from it.

[56], [57], [58], [59], [60]

Forecast

Predict the favorable completion of the second vascular accident, no one will undertake, most such events end in the cemetery.

Are they surviving after a second stroke? Yes. Survive very rarely and after the third, and even after the fourth, but how? The prognosis for a full recovery is more a myth, not a reality. Even after the first strike, many remain disabled.

People who have a loved one overtaken by a second stroke often wonder how many live after the second stroke. If, after the first stroke, under the most favorable circumstances, a person can live for about ten years, then after the second stroke, not even five, but two or three years, is released.

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

The prognosis for life in the elderly with the second stroke is unfavorable. The older the patient, the more severe the course of the disease and the greater the rate of damage to brain cells. People older than 70 years often develop coma, they are more difficult to deliver to the hospital, they have a "bouquet" of concomitant diseases. Even if the aged patient managed to survive, it is usually not possible to fully recover. A full life after the second stroke in elderly patients, especially over 80 years, experts do not predict. In general, they develop serious neurological deficiencies and all the short period of time they have released, these patients are bedridden. However, there are no rules without exception, medical science does not stand still, modern drugs and treatment in specialized hospitals increase the chances of survival even in age patients.

Is disability due to a second stroke?

In itself, the fact of the transfer of a second stroke is not a basis for recognizing a person as an invalid. The medical and social expert commission (MSEC) establishes the fact of disability. Specialists of this commission will conduct an expert examination of the patient and determine the group of disability, depending on the degree of disability. Sends the patient to the examination of the attending physician-neurologist.

[61], [62], [63], [64], [65], [66]