Stroke

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Pathomechanism of stroke

Blood reaches the brain through two internal carotid arteries and two vertebral arteries. The arteries of the brain coming from the internal carotid and vertebral arteries are a system of connections, securing the blood supply to particularly hypoxic brain cells. This is the arterial wheel of the brain known as the Willis wheel. The functioning of this circle can be disturbed due to the formation of atherosclerotic plaques that narrow the lumen of the blood vessels.          

Stands out :

• hemorrhagic strokes
• ischemic strokes, accounting for approximately 80% of all strokes.
  
  
  Differentiation of the most common types of stroke is possible through the use of computed tomography, magnetic resonance imaging or angiography, which explains and distinguishes hemorrhagic stroke and cerebral infarction (ischemic stroke).

Causes of strokes

The main causes of stroke are: high blood pressure and atherosclerotic changes that occur in the blood vessels. In addition, stroke can be caused by heart conditions such as:- heart defects, in particular mitral valve disease,
- myocardial infarction.
The amount of blood flow through the cerebral arteries is important to the proper functioning of the brain because the brain uses a lot of oxygen. The brain uses about 20% of the oxygen supplied to the body.

Hemorrhagic stroke - causes

A hemorrhagic stroke occurs in the course of a rupture of the cerebral artery wall. Due to the outflow of blood outside the cerebral vessel, the blood does not reach the brain tissues in the area supplied by the ruptured artery. The blood destroys the surrounding nervous tissue, causing an increase in intracranial pressure.

Hemorrhagic stroke symptoms

The main symptoms of a hemorrhagic stroke include:- Headache
- nausea
- vomiting
- loss of consciousness
- numbness of the face with a noticeable curve of the mouth 

Types of hemorrhagic strokes

There are intracranial hemorrhages such as:
- subdural hemorrhage,
- epidural hemorrhage,
- intraventricular hemorrhage,
- subarachnoid hemorrhage,
- hemorrhagic presentation of ischemic stroke,
- venous haemorrhage from venous or sinus thrombosis and intracerebral haemorrhage.

Treatment and rehabilitation of patients after hemorrhagic stroke

 In the treatment of hemorrhagic stroke, agents are used to reduce brain swelling, as well as drugs that regulate arterial blood pressure. Rehabilitation involves the use of physiotherapy treatments and improvement exercises, carried out in cooperation with a neurologist, neurosurgeon and physiotherapist,

Major risk factors for strokes

The risk factors include:a) inappropriate lifestyle and environment:
- long-term nicotinism,
- alcoholism,
- taking drugs,
- age (the risk of developing a stroke increases twice every 20 years),
male gender,
genetic factors,
family factors.

1. b) comorbidities:
   
    - hypertension,
   - heart diseases,
   - already had a stroke or a TIA,
   - high hematocrit,
   - diabetes,
   - high fibrinogen

Likely factors include:

1. a) incorrect lifestyle and environment:
   
   -contraceptives,
   - a diet with lots of animal fats,
   - obesity,
   - abnormal lipid values,
   - too little physical activity,
   - early death of the mother due to vascular diseases,
   - geographic location (Japan),
   - poor socio-economic conditions.

1. b) comorbidities
   
   - increased uric acid,
   - gout
   - migraine
   - Hypothyroidism,
   - narrowing of the arteries, e.g. carotid stenosis
   - large difference in blood pressure in the upper limbs,
   - the occurrence of an aneurysm
   - the presence of arteriovenous deformities,
   - fibromuscular dysplasia.
   

Ischemic stroke causes

 Cerebral ischemia can be caused by many factors. Hemodynamic ischemic stroke occurs as a result of impairment of normal cerebral perfusion resulting from critical vasoconstriction or occlusion. The main risk factors are: atherosclerosis, embolism, hypertension. The cerebral circulation in patients with cerebral vasoconstriction is maintained by cerebral autoregulation, which maintains perfusion over a wide range of pressures, and by circulation of blood in the Willis wheel.

Ischemic stroke symptoms

 Ischemic stroke is of special social importance as it is the main cause of severe and chronic disability. They lead to disability of patients more often than death, with enormous costs, including health care expenses and loss of production capacity. Ischemic strokes account for approximately 80-88% of all strokes, the remaining 12-20% are haemorrhagic strokes.

Symptoms of a stroke

 Symptoms of a stroke include:- prickly headache
- weakness in the limbs, on one side
- difficulty pronouncing words, speech disorders
- blurred vision
- unsteady gait

How to recognize an ischemic stroke

The following are distinguished among ischemic strokes (cerebral infarctions):- TIA, transient ischemic stroke, symptoms are not clearly marked and pass within 24 hours.
- RIND - the symptoms of a stroke last more than 24 hours, they disappear after a few days.
- CS - completed ischemic stroke causes permanent defect symptoms (in the form of neuronal death).

Treatment and rehabilitation of patients after ischemic stroke

In the treatment of ischemic stroke, it is important to use therapy to improve cerebral perfusion in the ischemic area and to reduce the effects of stroke. Therefore, it is justified to use procedures aimed at opening blood vessels: vasodilation, lowering blood viscosity and anticoagulant therapy.

Managing a patient after ischemic and hemorrhagic stroke

         In this disease, secondary prophylaxis becomes necessary, i.e. preventing relapses and improving psychomotor functions. For this purpose, drugs are used to reduce blood clotting and improve circulation to the brain, and to prevent arterial hypertension.Medical rehabilitation is an important step in the treatment process as patients have varying degrees of neurological deficit. Therefore, rehabilitation should be incorporated into the treatment of stroke patients as soon as possible.Comprehensive rehabilitation in the acute period of stroke is aimed at reducing mortality in the first month of the disease by preventing life-threatening neurostimulation in the rehabilitation of speech disorders and their positive effect on the improvement of speech. Nursing care in the first phase of the stay is focused on preventing complications typical for patients with urticaria, i.e. pneumonia, contractures, bedsores and various infections. Rehabilitation supports the use of the compensation possibilities of the central nervous system, which will reduce the future neurological deficit, the risk of life-threatening complications (pressure ulcers, as well as aspirin pneumonia, deep vein thrombosis and pulmonary obstruction) and reduces the costs associated with the treatment of stroke

Source:

• Kwolek, A. Szydełko, Granice przeciwskazań do rehabilitacji po udarze mózgu, Udar Mózgu, 2005, t.7, nr,1, s. 31-37
• Bejer, A. Kwolek,Assessmentof qualityof life amongelderly strokepatients-preliminary report,Physiotheraphy2008, nr.16, 1, s..61-62
• J. Piskorz, G. Wójcik, Wczesna rehabilitacja pacjentów po udarze niedokrwiennym mózgu, Medycyna ogólna i nauka o zdrowiu, , 2014, t.20, nr.4,s.352-354
• G. Magoń, A. Bejer, Wpływ depresji na postepy rehabilitcaji u pacjentów po przebytym udarze mózgu- doniesienia wstępne, Postepy Rehabilitacji, 2005, nr.1 , s.41-46
• K. Adamczyk, Pielęgniarstwo neurologiczne, Wyd. Czelej, Lublin 2000, s. 43-57
• Szczudlik, Udar mózgu, Wyd. Uniwersytetu Jagiellońskiego, Kraków 2007, s. 202