"Like being hit with a dagger." Neurologist on how to recognize and prevent stroke

Vyacheslav Vashchilin, Deputy DIRECTOR for Medical Affairs of the Republican Scientific and Practical Center for Neurology and Neurosurgery, Chief Freelance Neurologist of the Ministry of HEALTH, Vyacheslav Vashchilin, spoke about the disease, in which every fourth patient is at risk of dying, in the project "In the subject" on the BelTA YouTube channel.

The development of stroke is influenced by non-modifiable and modifiable risk factors. The former include hereditary predisposition, gender (men are more likely to get sick) and age. Factors that can be corrected, or so-called modifiable, are arterial hypertension, hypercholesterolemia, diabetes mellitus, a sedentary lifestyle, ALCOHOL and tobacco abuse.

- A stroke is the outcome of some other processes. A person may not know about a disease (for example, myxoma of the heart) due to underexamination, sometimes these are casuistic processes. And then an acute violation of cerebral circulation develops, - said Vyacheslav Vashchilin.

He emphasized that a stroke is always a complication of a particular disease or the result of an existing predisposition, which, due to accumulated problems or acute decompensation, leads to impaired cerebral circulation.

- In any case, it is always a secondary state. To prevent it from developing, prevention is required.

Pre-stroke state is a household term. According to Vyacheslav Vashchilin, it means that a person has a very high risk of having a stroke. These are situations when there is unstable blood pressure with high values ​​at crisis thresholds, heart rhythm disturbance, which is highly likely to cause the development of cardioembolism and, as a result, cerebral ischemia, as well as a violation of the blood coagulation system.

- The presence of one or more causes increases the risk of stroke. With a very high probability, this can be called a pre-stroke state, the neurologist noted.

It is desirable to lay the patient with signs of a stroke in a horizontal position.

- Unless the person has had vomiting, seizures, another potentially dangerous cause of sudden death that requires intervention, it is best not to do anything until the ambulance arrives.

You can give it to drink if there is no vomiting, swallowing disorders, because of which a person can choke.

Headache, hearing and vision impairment

- When we talk about an acute violation of cerebral blood supply, we mean a number of problems. Acute violation of cerebral blood supply occurs due to subarachnoid, or intracerebral, hemorrhage, and due to a lesion like a brain infarction, Vyacheslav Vashchilin noted.

The specialist noted that pain syndrome is not typical for cerebral infarction:

- It can develop when the stroke is already regressing, and for various reasons, pain is possible in the post-stroke period, but in the acute period with cerebral infarction, it is not typical. And with subarachnoid hemorrhage, patients, as a rule, talk about acute headache (“as if hit with a dagger”), which occurs due to irritation of the meninges.

There may be other symptoms, such as severe hearing and visual impairment. In this case, most often it is an acute lesion. The task of the DOCTOR is to determine which localization of the vessels caused the problem.

- In any case, this is a clear reason to urgently seek medical help.

In general, the symptoms of a stroke can be very diverse. In medicine, two types are distinguished - cerebral (headache, nausea, vomiting, impaired consciousness) and focal (violation of strength in the limbs, sensitivity, speech, swallowing, loss of vision, facial asymmetry).

Preventive Research

Patients who have had covid-19 , if clinically indicated, are prescribed drugs that affect blood clotting.

- During the recovery period after an infection, these drugs, of course, should be taken. In the future, the need to control the coagulation system, the state of the vascular wall, or conduct ultrasound examinations of the heart is determined by possible risk factors in humans.

In preventive examinations of blood vessels, the age of a person is an indication.

- We know that from the age of 55, the risk of having a stroke doubles every 10 years. The fact of suffering from COVID-19 in the absence of other risk factors is not, in my opinion, fundamental. During the pandemic, almost everyone had a covid infection, some several times. Therefore, it is necessary to focus directly on clinical indications.

Unpleasant sensations in the region of the heart and disturbances in its rhythm, identified by ECG, high cholesterol or other symptoms are a reason to undergo an additional study of the cardiovascular system. It is desirable to do this as part of preventive dispensary observation for people over 55 years of age. The frequency of such a study depends on many factors, including the size of atherosclerotic plaques.

- If the plaque is more than 50% of the stenosing lumen of the vessels, it is advisable to be examined after 3-6 months. If 20 - 30%, then in a year.

In the future, the frequency of control of the condition of atherosclerotic plaques decreases, since they are usually stable.

Frequent symptoms

All over the world, a standard technique is used in primary diagnostics - the FAST test (Face Arms Speech Time). This English abbreviation stands for "face - hand - speech - time".

- Most often, speech is disturbed, there is weakness in the arm or leg, and facial asymmetry. These are the most noticeable and most frequent symptoms in the development of acute cerebrovascular accident.

He emphasized that a stroke is always an acute condition. In some subtypes of acute cerebrovascular accident, symptoms appear faster, in others they develop gradually.

- In any case, we are talking about minutes, about a period of up to an hour. According to statistics, from 20% to 30% of people seek medical help within the first three hours from the onset of symptoms. Everyone else is waiting: maybe it will pass.

In this regard, the percentage of patients with cerebral infarction who underwent thrombolytic therapy in Belarus is low, said the chief freelance neurologist. He added that such therapy has its own indications and contraindications, and possible complications.

In Belarus, the incidence of stroke is approximately 2.5-3 people per 1,000 population. In absolute figures, this is 25-30 thousand patients annually.

Every fourth patient is at risk of dying from acute cerebrovascular accident. In addition, a fatal outcome can develop within a year after the disease due to complications or repeated circulatory disorders.

| Photo by Maxim GUCHEK.

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