Stroke in the elderly

Stroke in the elderly is an acute disorder of cerebral circulation with damage to brain tissue and a disorder of its functions.

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

Causes of the stroke in the elderly

Depending on the nature of the pathological process, stroke in the elderly is divided into hemorrhagic and ischemic.

To hemorrhagic stroke include hemorrhages in the substance of the brain (parenchymal) and the membranes of the brain (subarachnoid, subdural, epidural).

Ischemic stroke in the elderly is due to the difficulty or cessation of blood flow to a particular part of the brain and is accompanied by a softening of the area of the brain tissue - a cerebral infarction.

The most common cause of stroke in the elderly is hypertension due to hypertension, kidney disease, pheochromocytoma, and certain endocrine disorders; atherosclerosis, affecting the main vessels of the brain on the neck. The cause of the stroke can also be:

• rheumatism,
• various vasculitis (syphilitic, allergic, obliterating thromboangiitis, Takayasu's disease),
• diabetes,
• aneurysms of cerebral vessels,
• blood diseases (aplastic anemia, erythremia, leukemia, thrombocytopenic purpura),
• acute infections,
• poisoning with carbon monoxide, heart defects, myocardial infarction.

[6], [7]

Forms

Hemorrhagic stroke in the elderly

Most often develops at the age of 45-60 years. Appears suddenly after another excitement or sudden overwork. The initial symptoms are headache, vomiting, mental disorders, rapid breathing, bradycardia or tachycardia, hemiplegia, or hemiparesis.

In elderly and elderly people, hemorrhages proceed less violently than in young people, often without accompanied by severe cerebral symptoms, often without a temperature reaction and changes in blood counts.

On the fundus of the hemorrhagic stroke, hemorrhages in the retina, a picture of hypertensive retinopathy with edema and hemorrhages can be detected. In the general blood test, leukocytosis is revealed with a shift of the leukocyte formula to the left, an increase in ESR, as well as an increase in blood viscosity, increased fibrinolytic activity, hyperglycemia, azotemia, bilirubinemia, a decrease in potassium content. In the study of cerebrospinal fluid, an admixture of blood is found in the cerebrospinal fluid. Electroencephalography reveals gross diffuse changes in brain bioelectric activity, sometimes with interhemispheric asymmetry. Angiography can detect the displacement of intracerebral vessels or the presence of a so-called avascular zone.

[8], [9]

Ischemic stroke in the elderly

In geriatric practice, ischemic brain damage predominates.

The development of an ischemic stroke is often preceded by transient disorders of the cerebral circulation, which are the result of a short-term deficiency in the blood supply to the brain in the area in which the infarction later develops.

When thrombosis of cerebral vessels in patients there are dizziness, short-term disorders of consciousness (semi-fainting condition), darkening in the eyes. Ischemic stroke in the elderly can develop at any time of the day, but more often it occurs in the morning or at night. In elderly and old people, ischemic stroke often develops after myocardial infarction. Characteristically bedded (for several hours, and sometimes even days) the increase in focal neurological symptoms (impaired vision, paresis, paralysis). In this case, more often there is a wavy expression of the symptoms - it is amplified, then weakened again. In embolic ischemic stroke, neurologic symptoms occur simultaneously and are immediately expressed as much as possible.

The peculiarity of ischemic stroke is the predominance of focal symptoms over cerebral infarction. More reliable information is obtained with angiography, computed tomography and magnetic resonance imaging of the brain.

Treatment of the stroke in the elderly

Treatment of patients with cerebral stroke should be performed in a hospital. Hospital conditions significantly expand the therapeutic possibilities and provide constant monitoring of the patient's condition. Transportation to the hospital from the home is not subject to patients with a deep coma with gross disruption of vital functions, it is also inadvisable to be hospitalized in cases of repeated violations of cerebral circulation with the presence of dementia and other mental disorders, patients with incurable medical illnesses.

The general principles of stroke treatment are:

1. Effects on the activity of the cardiovascular system - the use of cardiac glycosides when! A marked decrease in the contractility of the myocardium, hypotensive agents (calcium antagonists (nifedipine), beta-blockers (obzidan and diuretics (lasix), respiratory analeptics (cordiamin, sulfocamphocaine).
2. Correction of homeostasis by the introduction of solutions of electrolytes (solution of glucose 5%, 0.9% solution of sodium chloride, Ringer's solution, 4% sodium bicarbonate solution, polarizing mixture in the total volume up to 2p), low-molecular dextrans (reopolyglucin to 400 ml), correction of hypokalemia, hypochloremia .
3. Control of cerebral edema: 10 ml of 2.4% euphyllin, 1 ml of Lasix, if necessary - mannitol, urea; antihistamine preparations (diphenhydramine, pipolphen), novocaine; can apply hydrocortisone, dexamethasone, prednisolone, glycerin - inside.

Elimination of vegetative disorders: with hyperthermia, they are prescribed "lytic" mixtures, including dimedrol, novocaine, analgin; neurovegetative blockade is carried out with the help of droperidol, dimedrol, and aminazine; it is recommended to rub the body of the patient with alcohol reddish, which increases heat transfer, regional hypothermia of large vessels (cooling of the carotid artery, axillary and inguinal regions), wrapping in wet sheets.

When hemorrhagic stroke - increase the coagulation properties of blood and reduce the permeability of the vascular wall, using calcium preparations (10 ml of 10% solution of calcium chloride intravenously or calcium gluconate intramuscularly), vikasop (2 ml of 1%), 5-10 ml of 3% solution of ascorbic acid, gelatin 10% - 20-50 ml intravenously, rutin, rutamine, e-aminocaproic acid (5% to 100 ml), dicinone (2 ml - 250 mg) intravenously or intramuscularly; possible surgical treatment - puncture stereotaxic removal of lateral hematoma after CT, various methods of surgical treatment of aneurysms of cerebral vessels.

With ischemic stroke: increase the flow of blood to the brain by expanding regional cerebral blood vessels and reducing vasospasm, improving collateral circulation, using vasodilators (10 ml of 2.4% euphyllin solution intravenously), nicotinic acid (1% solution 1-2 ml intravenously), stugeron, trental, etc .; improve venous outflow by administration of cocarboxylase (50 mg) and diethiphene (10 mg); normalize the coagulation and rheological properties of blood with heparin (5,000-10000 ED intravenously or intramuscularly for 3 days), phenylline and other indirect anticoagulants (up to 2-3 months), acetylsalicylic acid, komplamin, prodectin, trental, etc.

Increasing the resistance of the brain tissue to hypoxia and improving brain metabolism by using tissue metabolism inhibitors (neuroleptics, regional hypothermia) ATP, vitamins and amino acids (cocarboxylase, glutamic acid, glycine, B vitamins, vitamin E), nootropics (aminalon, pyracetam), cerebrolysin , actovegin, hyperbaric oxygenation.

When caring for a patient with a stroke, it is necessary:

• every 1-2 hours to monitor the parameters of hemodynamics, the nature and frequency of respiratory movements;
• Monitor the skin condition and determine the water balance on a daily basis;
• ensure compliance with bed rest with the implementation of all measures for caring for the seriously ill;
• to prevent pneumonia, constipation, urosepsis, thromboembolic complications;
• prevent the development of contractures;
• when speech is violated, determine the way to communicate with the patient and perform speech therapy exercises;
• when swallowing is impaired - provide parenteral feeding and feeding through the probe;
• in the presence of hyperthermia - to care for the patient as in the second period of fever.