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Post-stroke state

 
, medical expert
Last reviewed: 25.06.2018
 
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Acute disorders of cerebral circulation, characterized by the rapid emergence of focal and / or cerebral neurological symptoms, physicians call a stroke. The severity of this disease does not cause anyone the slightest doubt. Its consequences - the post-stroke state - can remain with the patient until the end of his days. Medical statistics are inexorable, according to her information, only a third of patients who have suffered a stroke can fully restore their brain functions. The rest remain disabled for life.

trusted-source[1], [2], [3], [4], [5], [6]

Causes of the post-stroke state

With age, many people are increasingly confronted with problems associated with the physiological characteristics of the cardiovascular system. Such changes can be expressed differently and have different degrees of severity, individually manifested in the state of the human body.

However, a stroke always happens suddenly, dramatically changing the life of the victim to "before" and "after". And the way this "after" will largely depend on the effectiveness of the rehabilitation period.

Completely to the end the mechanism of manifestation of pathological symptoms that occurs after a stroke has not been fully revealed, but some reasons for the post-stroke state of the physician still sound in the state.

To the considered clinical picture lead:

  • Swelling of brain areas.
  • Problems with the blood flow.
  • Violation of venous blood outflow.
  • Failures in the normal nutrition of tissues by oxygen, which is associated with a violation of a number of blood vessels.
  • Depressive psychoemotional mood.
  • Violation of the reflex links of the affected area.
  • Pain symptomatology of tension, which appears in a lying patient with an incorrect position of the body.
  • Practically all patients who survived an apoplexy strike begin to sharply feel the change in meteorological conditions, becoming meteodependent.
  • The reason for the discomforting condition can be the large rehabilitation loads imposed on the patient during the recovery period.
  • This can be the response of the affected organism to medicines used in secondary prevention of the disease.

trusted-source[7], [8], [9], [10]

Symptoms of the post-stroke state

Immediately after the onset of the attack, the patient enters the intensive care unit, where he receives first aid.

In the first days after apoplexy, the most dangerous manifestation of an attack is cerebral edema, a reaction to which becomes a high temperature index of the patient's body.

This factor is a bad harbinger, which can indicate the development of a number of quite dangerous not only for health, but also for life complications:

  • Puffiness and appearance of foci of necrosis of the head cells.
  • Localization of stroke lesions is located in the trunk region and extends to the center of thermoregulation.
  • Infectious process develops in the organism of the victim.

That is, the occurrence of high fever may indicate a high risk of recurrence or death.

It should be noted and other symptoms of the post-stroke state, which occur in the first hours and days after the "stroke".

  • Cramps can be observed, which are mainly diagnosed in the lower extremities.
  • Paresis - partial paralysis of the musculature of the body or mimic activity, as a result of which some part of it ceases to perform the usual functions.
  • Complete paralysis.
  • Aphasia is a speech disorder that occurs with local lesions of the cortex of the left hemisphere of the brain (in righties) and the right hemisphere (in left-handers).
  • There may be problems with swallowing reflexology.
  • There are headaches that can be expressed in different ways and be:
    • Periodic or permanent.
    • Intensive (they suffer about 7% of the victims, they are called the term neuropathic pains) and moderate.
    • Have accompanying symptoms (noises in the ears and the head itself, midges before the eyes and so on). Such a clinic indicates a poor state of the vascular system, which does not exclude the possibility of a repeat attack.
  • Dizziness.
  • Depressive mood.

If any of the above symptoms occur, especially with regard to pain symptoms and temperature indicators, you should immediately notify your attending physician - neurologist. He will conduct an additional examination and schedule the appropriate therapy.

But you should warn the patient and his relatives, to become the reason for contacting a specialist, they must be forced not only by strong, but also weak, rarely appearing, painful symptoms.

Diagnostics of the post-stroke state

The recovery period after a stroke is a very complex and lengthy process that can continue throughout the rest of a person's life.

Therefore, the diagnosis of the post-stroke state in such a patient has a sufficiently significant role in preventing repeated "strokes".

This activity includes the analysis of a number of characteristics of the patient.

  • This is his age. As it is not strange, for example, severe headaches are more common for young people.
  • The sex of the patient. Headaches in the post-stroke period are more likely to persecute women than representatives of the strong half of humanity.
  • In most cases, the pathology associated with the brain already appears in the outpatient card of such a patient.
  • Blood pressure level. Thus the neurologist tries to receive its or his change in dynamics or changes. It is necessary to prevent developing hypertension.
  • A study is made of the blood condition of the victim. The analysis of sugar indicators (in dynamics) and the ratio of its values with the manifestation of pain are analyzed.
  • An echocardiogram is mandatory, which allows to evaluate the characteristics of the vessels of the heart and brain.
  • Magnetic resonance imaging - allows you to get a more complete picture of the violations affecting the organ of interest to us.
  • Checking the patency of venous poles and smaller vessels in the neck region.
  • If necessary, the attending physician can appoint a consultation of other specialists, for example, a psychotherapist, if the patient has a depressed mood.

Based on the results of the conducted studies, the doctor makes his verdict and appoints the most appropriate therapy.

trusted-source[11], [12], [13], [14]

Who to contact?

Treatment of the post-stroke state

The attack significantly changes the life of such people. All of them subsequently need a long and competent therapy. Treatment of the post-stroke state, depending on the severity of the pathology, can be carried out, both in the walls of the hospital and at home.

The length of rehabilitation, and its effectiveness, depends on the degree of brain damage, age and individual characteristics of a person.

When diagnosing the disease in question, the patient is assigned a full complex of comprehensively directed treatment.

In the prescribed manner, drug therapy is carried out with nootropic, medicinal products, the action of which is aimed at optimizing metabolic processes in the central nervous system in order to restore its cognitive and motor functions. Among such preparations it is necessary to allocate: vinpotropil, nootobril, kombitropil, nootropil, vinpocetin, amminosar, aktovegin, pikamilon, stamin,  mexikor, fenotropil, cereton and many others.

Mandatory in the protocol for the therapy of such patients are injected with antihypertensive drugs. They are assigned to control blood pressure. They are: anaprilin, nevotenz, minoxidil, lorist, nifedipine, magnesium sulfate, aminazine, barboval, veracard, papaverine, kapoten and others.

An important role in the rehabilitation process is played by vasotonics as well - vasostimulants, which stimulate the vascular tone. It can be: horse chestnut, Asian centa.

Appointed as drugs with antispasmodic characteristics that reduce the tone of the smooth muscles of blood vessels and internal organs. They also have a vasodilating and analgesic effect. These include: barboval, aminophylline, spasmalgon, drotaverin, aprofen, vesicar, atropine sulfate, baralgin, papaverine hydrochloride, spasmalgine, dibazol, rinalgan, influben, magnesium sulfate and others.

Such a patient necessarily takes and decongestants: imunret, diacarb, hydrocortisone, lyoton 1000, indomethacin, diclobene, lipril, lokoid, rinoprint and others.

Attributed and antiaggregants that have a depressing effect on the process of blood clotting, which is important in the process of recovery. These are arvin, heparinolide, syncumar, papaverine, neodicumarin, carbocroment, dicumarin, heparin, nafarin, phenylin, calcium heparinate, parmidine, omepine, indomethacin, imizine, anturane, butadione and others. They reduce blood density, preventing the re-formation of blood clots, which also reduces the likelihood of a second stroke. These drugs can reduce the risk of recurrence of the disease by an order of magnitude. They effectively normalize the cerebral blood flow.

In the treatment of post-stroke status, motor rehabilitation is not the last place, designed to correct motor disorders. These techniques include exercises exercise therapy, respiratory gymnastics, massages, sessions of physiotherapy. These techniques help restore muscle tone, preventing the development of contractures in the joints and trophic tissue.

Among the physiotherapy procedures, magnetotherapy, phonophoresis, pressotherapy, laser therapy, microwave and ultrasound therapy, lymph drainage, amplipulse therapy and UHF are very popular.

The selection of these funds is purely individual.

Most of these patients have to undergo speech rehabilitation, since this function is often damaged. Here the lessons are conducted by a specially trained speech therapist, who begins the activity from simple to complex.

Many people who survive a stroke, need the help of a qualified psychologist and psychological support of relatives.

Nvps neuronal reductant in post-stroke states Combined drug nvps - neuronal reductant in post-stroke states - in its pharmacodynamics refers to drugs nootropic action.

This medicine allows:

  • It is more effective to restore motor activity and sensitivity of nerve impulses, which accordingly reduces the area of foci of necrotic cells and vascular disorders.
  • Helps to normalize the coordination of movement.
  • Improves cerebral blood flow.
  • Significantly reduces the area of secondary damage.
  • Normalizes the viscosity of the blood.
  • Increases the quality of oxygen absorption by brain cells.
  • Improves all functions of the brain, memory and speech centers.

Convenient and form of the drug is a spray quickly absorbed by the oral mucosa, which is especially important for such patients.

Nvps is applied in a dosage corresponding to five oral injections, four to five times a day. The duration of treatment depends on the severity of the patient and can range from three months to a year.

Strongly active tablets in post-stroke state

Without fail, the complex therapy includes, in the post-stroke state, potent pills. One of these is nootropic drugs, whose action is aimed at optimizing metabolic processes in the central nervous system in order to restore its cognitive and motor functions. Among such preparations it is necessary to allocate: vinpotropil, nootobril, kombitropil, nootropil, vinpocetin, amminosar, aktovegin, pikamilon, stamin,  mexikor, fenotropil, cereton and many others.

Actovegin is prescribed by a dosage corresponding to the severity of the pathology. This figure is selected by the doctor individually for each patient.

In the form of injection, the drug is taken both intravenously and intramuscularly. The starting dose is 10 - 20 ml. The medicine is administered, at the discretion of the doctor, daily or several times a week.

The dosage of the drug can be adjusted during the treatment. The rate of administration of the drug solution should be approximately 2 ml / min.

Contraindication to the administration of the drug in the treatment protocol may be pulmonary edema, decompensated heart failure, individual intolerance of the constituents of the drug, pathology associated with fluid retention in the body, anuria, oliguria.

The hood is taken inside, starting with the minimum doses, gradually selecting an individual amount of the drug.

Starting can start with 6 ml three times a day, mostly in most cases maintaining a daily dosage equal to - 25 mg two to three times throughout the day.

The maximum permissible dose taken for one day is 150 mg. In case of signs of hypotension, the amount of medication administered should be reduced.

Contraindication to the administration of the drug in question is Quincke's edema, severe kidney and / or liver dysfunction, increased intolerance of constituent components, hyperkalemia, stenosis of the aortic and renal arteries, problems with blood outflow, period after kidney transplantation, pregnancy and lactation.

Dibazol is injected into the patient's body orally for a couple of hours before or after a meal. The drug is taken 20 - 50 mg twice - three times a day for three to four weeks. Maximum allowable dosage: daily - 150 mg, single dose - 50 mg.

The agent in question is not admitted to admission if a history of the patient has an arterial hypotension or an individual intolerance to the component composition of the drug.

Such a patient necessarily takes and decongestants: imunret, diacarb, hydrocortisone, lyoton 1000, indomethacin, diclobene, lipril, lokoid, rinoprint and others.

Many patients after a stroke fall into a state of depression, such people are prescribed antidepressants. To this group of drugs are attributed, of different strength of impact: moclobemide, befol, toloxaton, pyrazidol, imipramine, amitriptyline, anafranil, pantofran, trimipramine, azaphene, maprotiline, mianserin, fluoxetine, feravin, citalopram, sertraline, paroxetine, simbalta and others. Such drugs dull the feeling of fear, panic and anxiety, stabilizing the psychological characteristics of the patient.

Pyrazidol is an effective domestic preparation, taken at a starting dosage of 50 - 75 mg twice a day. If therapeutic effectiveness is not observed, the amount of administered pyrazidol can be increased by the doctor, up to 150-300 mg daily. Then the dosage gradually decreases.

Contraindication to the use of the drug is hypersensitivity to the components of pyrazidol, acute hepatitis or severe blood damage (eg, infection).

Appointed and antiaggregants that have a depressing effect on the process of blood clotting, which is important in the process of recovery. These are arvin, heparinolide, syncumar, papaverine, neodicumarin, carbocroment, dicumarin, heparin, nafarin, phenylin, calcium heparinate, parmidine, omepine, indomethacin, imizine, anturane, butadione and others. They reduce the density of the blood fluid, preventing the re-formation of blood clots. This reduces the risk of developing a secondary stroke. These drugs can reduce the likelihood of recurrence of the disease by an order of magnitude. They effectively normalize the cerebral blood flow.

Heparin is injected or infusion into a vein. Supportive therapy is indicated by an amount of 20,000 - 40,000 IU per diem. The preparation immediately before the procedure is diluted with 1 liter of isotonic NaCl solution. If necessary, injections are conducted every four to six hours, but a specialist can choose another input mode.

Do not use heparin in acute leukemia, diathesis and other pathologies associated with poor blood coagulability, bleeding of any genesis, inflammatory processes in the internal cavity of the heart, embolic lung infarction or kidney, with severe renal and / or liver dysfunction any form of anemia, venous gangrene and similar physiology.

Motherwort in post-stroke state

A simple philistine perceives this medicinal plant as a sedative. But, as the long-term observations show, the motherwort is quite effective in hypertension, allowing to lower the indications of arterial pressure, and also its reception favorably affects the work of the central and peripheral nervous system of man. And, surprisingly, the studies found a clear reduction in the amount of "bad" cholesterol in the blood of the person taking the medicine.

In the light of the above, the motherwort in the post-stroke state is a good solution to a number of pathological problems that arise after a heart attack.

The composition of this gift of nature is very impressive. These are flavonoids, saponins, organic acids, glycosides, alkaloids, vitamins C, A and E, tannic and sugary substances, as well as numerous macro- and microelements.

The motherwort tincture, which is easily purchased in any pharmacy, is administered to the victim for 30 to 50 droplets (can be diluted with a small amount of water), making three to four approaches per day.

Motherwort calms, normalizes sleep and heart function, and also has moderate hypotensive, antispasmodic and diuretic characteristics.

The motherwort extract is released in the form of tablets and is taken in the amount of three to four pieces per day, immediately before meals.

In this case, the medicine of plant origin is well tolerated by the body, but it should be limited or excluded from the treatment protocol if the patient has a history of hypotension (low blood pressure), as well as slow heart rate and hypersensitivity to the product itself.

More information of the treatment

Prevention

It should be noted right away that the prevention of post-stroke status largely depends on the severity of the disease transferred to the victim, belonging to a certain age category, the nature of the neurological changes affecting the brain tissue and the "bouquet" of other pathologies in the patient's history.

Not the last place in the recovery process is the psychological attitude of the patient. Therefore, it is very important to support his family and friends. If necessary, the attending physician can connect the psychological training of a specialist.

Much depends, of course, on the experience of doctors who lead this pathology.

You can not do without proper nutrition. In the diet of such a patient must be present a sufficient number of polyunsaturated fatty acids. From his diet should disappear products of modern supermarkets, which in their composition have stabilizers, emulsifiers, various dyes and flavor enhancers.

The patient also has to forget about bad habits. Alcohol, nicotine, drugs are death for the affected brain.

Walking on fresh air, moderate physical activity. All this can also be attributed to preventive measures.

trusted-source[15], [16], [17], [18], [19], [20]

Forecast

Many, probably, know that a stroke is a disease aggravated by a high percentage of deaths. But the essence of the problem is not only in this fact. The prognosis of the post-stroke state is rather vague. After all, as statistics show, only 10 percent of patients can fully recover after an apoplexy, about a third only partially regain their former mobility, speaking and thinking abilities. The rest, those who are tired to survive the attack, remain disabled for the rest of their days. At the same time the severity of their disability varies from mild degree to complete paralysis and coma.

And this finale is observed even against the background of innovative technologies that come to the aid of modern medicine.

Nevertheless, as recent studies have shown, an important factor in a satisfactory prediction is the rehabilitation period, which is burdened or not by other pathologies and complications.

Doctors say that the most difficult and fateful are the first six to ten months after the stroke. It is during this period that the quality of the later life of a sick person is decided. Although it is possible to understand the relatives of a recumbent patient, when they understand what awaits them in a given period of time.

Close people of this patient are panic-stricken, they do not know how to cope in this situation. Here the advice of doctors is the same. At least part of the worries about the patient shift to an experienced nurse who can professionally take care of the patient, helping to overcome the post-stroke period more effectively.

Stroke - this diagnosis in the memory of many sounds like a sentence. But despair and fold your hands should not be. If you or your loved one are lucky enough to survive after an apoplexy, you should make the most of your efforts and faith, so that the post-stroke state, determined after the attack, had a favorable prognosis. In such a situation, the disease can be overcome only by joint efforts. The desire for a full life in the patient, the help and support of relatives and the professionalism of doctors is a pledge that the disease will be defeated, and the person will return to normal full-fledged life in society.

trusted-source[21], [22], [23]

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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