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Ischemic stroke - Overview of information

 
Last reviewed by: Aleksey Portnov , medical expert, on 24.06.2018
 

Ischemic stroke is a pathological condition that is not a separate and special disease, but an episode that develops as part of a progressive general or local vascular lesion in various diseases of the cardiovascular system. Patients with ischemic stroke usually have a common vascular disease: atherosclerosis, arterial hypertension, heart disease (coronary heart disease, rheumatic fever, rhythm disturbances), diabetes mellitus and other forms of pathology with vascular lesions.

Strokes include acute disorders of cerebral circulation characterized by sudden (within minutes, less often hours) the appearance of focal neurologic and / or cerebral symptoms lasting more than 24 hours or leading to the death of the patient in a shorter period of time due to the cause of cerebrovascular origin. With ischemic stroke, the cause of the development of a pathological condition is acute focal ischemia of the brain. If the neurologic symptoms regress within the first 24 hours, the pathological condition is defined as a transient ischemic attack and is not attributed to ischemic stroke, but together with the latter it is classified as an acute ischemic type of cerebral circulatory disorder.

ICD-10 codes:

  • 163.0. Brain infarction due to thrombosis of precerebral arteries.
  • 163.1. Cerebral infarction due to embolism of the precerebral arteries.
  • 163.2. Brain infarction due to unspecified obstruction or stenosis of precerebral arteries.
  • 163.3. Cerebral infarction due to thrombosis of the cerebral arteries.
  • 163.4. Cerebral infarction due to embolism of cerebral vessels.
  • 163.5. A cerebral infarction due to an unspecified occlusion or stenosis of the cerebral arteries.
  • 163.6. Cerebral infarction due to vein thrombosis of the brain, non-pyogenic.
  • 163.8. Another cerebral infarction.
  • 163.9. Cerebral infarction, unspecified.
  • 164. Stroke, unspecified as a hemorrhage or a heart attack.

Epidemiology of ischemic stroke

Isolate primary (development in this patient for the first time in life) and secondary (development of a patient who had previously suffered an ischemic stroke) cases of stroke. There is also a fatal and nonfatal ischemic stroke. As a time interval for such assessments, an acute period of a stroke has now been taken - 28 days after the onset of neurologic symptoms (previously 21 days). Repeated worsening and death in the specified period of time is considered as a primary case and a fatal ischemic stroke. If the patient has experienced an acute period (more than 28 days), the stroke is considered as non-fatal, and with the new development of ischemic stroke the latter is defined as repeated.

Causes of Ischemic Stroke

The cause of ischemic stroke is the reduction of cerebral blood flow as a result of lesions of the main vessels of the neck and artery of the brain in the form of stenosis and occlusive lesions.

The main etiological factors that lead to a decrease in blood flow are:

  • Atherosclerotic and atherothrombotic stenoses and occlusions of the zkrastrakranialnyh arteries of the neck and large arteries of the base of the brain;
  • arterio-arterial embolism from thrombotic layers on the surface of an atherosclerotic plaque or resulting from its disintegration, which leads to occlusion of the intracranial arteries with atheromatous emboli;
  • cardiogenic embolism (in the presence of artificial heart valves, atrial fibrillation, dilated cardiac iopathy, myocardial infarction, etc.);
  • hyalinosis of small arteries, which leads to the development of microangiopathy and the formation of lacunar cerebral infarction;
  • stratification of the walls of the main arteries of the neck;
  • hemorheological changes in the blood (with vasculitis, coagulopathy).

Significantly less often, the cause of disturbance of carotid patency is cicatricial traumatic and external inflammatory vascular lesions, fibro-muscular dysplasia, as well as pathological bends, and vascular loops.

Occlusion of vertebral arteries in most cases is observed in a place from walking them from the subclavian arteries.

In addition to the sclerotic process, the cause of stenosis of vertebral arteries is often osteophytes, which are formed in the osteochondrosis of the cervical spine.

Stenosis and thrombosis of the anterior and middle cerebral arteries occur, as a rule, on the site of branching of the internal carotid artery.

When the vessels of the carotid artery system are affected, cerebral infarction often develops, and in the vertebro-basilar basin - mainly transient disorders of cerebral circulation.

Ischemic stroke - Causes and pathogenesis

Symptoms of ischemic stroke

Symptoms of ischemic stroke of the brain depend on the localization of the lesion, and the severity and persistence of the symptoms - on the size and condition of the collateral systems. The peculiarities of the collateral circulation are such that situations can arise when, when one or more trunk vessels are blocked, there is no or minimal disruption of the brain function, and on the contrary, with a stenosis of one vessel, a softening focus can be formed, followed by the development of persistent symptoms of brain damage. Ischemic stroke can occur at any time of the day, but more often it occurs at night, during sleep. Quite often, there is a gradual development of ischemic stroke, mainly with a predominance of focal symptoms. In general, the manifestations of stroke are due to the location of the cerebral infarction, which leads to a violation of the corresponding brain functions.

Ischemic stroke - Symptoms

Diagnosis of ischemic stroke

Patients with stroke should perform a clinical blood test (including platelet count), biochemical analysis (glucose, creatinine, urea, bilirubin, total protein, electrolytes, CK), coagulogram (fibrinogen content, activated partial thromboplastin time, international normalized ratio), total Analysis of urine.

Ischemic stroke - Diagnosis

Who to contact?

Treatment of ischemic stroke

The main tasks of the medical measures (medical, surgical, rehabilitation) are to restore the damaged neurological functions, prevent complications and combat them, secondary prevention of repeated violations of the cerebral circulation.

Non-drug treatment of patients with stroke includes measures for the care of patients, evaluation and correction of swallowing function, prevention and treatment of infectious complications (bedsores, pneumonia, urinary tract infections, etc.).

Treatment of ischemic stroke is most effective in a specialized vascular setting with a coordinated multidisciplinary approach to the treatment of the patient. In the structure of the hospital, which has a specialized department for the treatment of patients with stroke, it is necessary to have an intensive care unit (block) with the possibility of round-the-clock CT, ECG and chest radiography, clinical and biochemical blood tests, ultrasound vascular studies.

Ischemic stroke - Treatment

Prevention of stroke

The main goal of the stroke prevention system is to reduce the overall morbidity and reduce the frequency of deaths. Measures aimed at primary prevention of stroke are based on the population social strategy of prevention of cerebrovascular diseases at the state level (mass strategy) and medical prevention (high risk strategy).

A massive strategy is to achieve positive changes in each person in the general population through exposure to modifiable risk factors. The high-risk strategy provides early detection of patients from high-risk groups for the development of a stroke (for example, with arterial hypertension or hemodynamically significant stenosis of the internal carotid artery) followed by a preventive medication and (if necessary) vascular surgery that reduces the incidence of stroke by 50%. Prevention of stroke should be individual and include non-drug measures, targeted medical or angiosurgical treatment.

Ischemic stroke - How to prevent?

What is the prognosis of ischemic stroke?

The prognosis depends on many factors, first of all on the volume and localization of the lesion of the brain, the severity of the concomitant pathology, the age of the patient. Mortality in ischemic stroke is 15-20%. The greatest severity of the condition is noted in the first 3-5 days, which is due to the increase in cerebral edema in the area of the lesion. Then follows a period of stabilization or improvement with a gradual restoration of impaired functions.

It is important to know!

To date, a microinsult or ischemic attack is defined as a condition that arises from a temporary (transient) impairment of blood flow in any part of the brain and is accompanied by signs of focal neurological dysfunction, as is the case with stroke. 

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