Risk factors for stroke. Depression increases the risk of stroke. Exercise is good for the brain

Candidate of Medical Sciences Lev Manvelov, Scientific Center of Neurology of the Russian Academy of Medical Sciences

"Don't miss a single opportunity - life is short," said Stendhal. At the age of 59, the life of the great French writer was cut short: a stroke.

Computed tomography of the brain in a massive stroke. A light spot is a zone of circulatory disorders.

The risk of stroke depends on many factors. Their contribution can only be estimated approximately.

The carotid arteries are especially important for feeding the brain, narrowing their lumen or even completely closing it is very dangerous for the brain and can lead to a stroke.

When the plaque increases in size and slows down blood flow, platelets “stick” to it. This is how a thrombus is formed, which can cause occlusion - turn off the part of the cerebral blood supply from work.

obesity criteria.

Pulse rate during physical activity (60-70% of the maximum), depending on age.

Acute cerebrovascular accident, that is, a stroke, is the most severe vascular disease of the brain. In our country, more than 450 thousand cases of stroke are registered annually. In the first three weeks, up to 35% of patients die, and by the end of the first year, this sad figure rises to 50%. Only 20% of stroke survivors return to work. The rest are waiting for the hard fate of the disabled.

To prevent vascular diseases of the brain, you need to know what contributes to their development ...

For vascular diseases of the brain and vascular diseases of the heart, the risk factors are largely the same. They can be divided into internal and external. For example, obesity, diabetes mellitus, aggravated heredity (stroke, heart attack, hypertension in close relatives), gender, age are internal factors. Emotional stress, sedentary lifestyle, bad habits (alcohol abuse, smoking), adverse environmental conditions are external.

Risk factors can also be divided according to another feature: unregulated (age, gender, race) and amenable to influence (malnutrition, lack of physical activity, smoking, alcohol abuse).

Age and gender. The frequency of stroke depends on age, doubling in each subsequent decade compared to the previous one.
blowing. The elderly (60 years and older) are 17 times more likely to have a stroke than those under the age of 45. It has been proven that women develop strokes at an older age than men - 10-20 years later. Cerebral infarction in atherosclerosis in men occurs approximately 30% more often than in women.

Season and climate. Stroke and mortality from it depend on meteorological conditions and time of year. For people with cardiovascular diseases, the most unfavorable months are winter and spring. During this period, there is often a sharp change in weather, precipitation, significant fluctuations in atmospheric pressure, air temperature and oxygen content in the air. Violations of cerebral circulation become more frequent during periods of sudden changes in temperature.

arterial hypertension. Often, the immediate cause of the development of acute and chronic vascular diseases of the brain is arterial hypertension. But you can fight it.

Let us repeat the main rules for the treatment of hypertension (the attending physicians, of course, speak about them, but patients do not always follow their advice).

Treatment should begin with minimal doses of one drug. If the remedy is not effective enough, even with an increase in dose, the attending physician selects a drug from another group or, even better, prescribes a combined treatment. In case of side effects, the drug must also be replaced. It is better to use long-acting products, which, with a single application, give an effect for 24 hours.

The patient can control the effectiveness of the treatment, especially when choosing the dose of the drug, by measuring blood pressure at home. It is very important to periodically, at least twice a year, conduct daily monitoring of blood pressure in a hospital or on an outpatient basis. Salt should be limited - no more than 5 g per day.

Blood pressure lowering drugs should be taken every day, preferably at the same time. Adjust the dose of medication so that blood pressure does not drop too much. In case of serious vascular lesions of the brain, the level of systolic (upper) blood pressure should be maintained within 135-150 mm Hg. Art., to prevent deterioration of blood supply in the affected areas of the brain.

It should be taken into account that in chronic vascular diseases of the brain, the
autoregulation of cerebral blood flow towards higher blood pressure values. Vessels tolerate an increase in pressure better than a decrease in it. In this case, the reactivity of the cerebral vessels is disturbed, that is, the ability to expand or narrow, which is manifested by ultrasound after taking 0.25 mg of nitroglycerin under the tongue. A decrease in the reactivity of cerebral vessels often occurs over the age of 60 years.

Risk factors include irregular treatment of arterial hypertension with short-acting drugs (usually this is done in hypertensive crises); diffuse, focal changes in the substance of the brain and its edema, detected during computed or magnetic resonance imaging; hypertrophy (enlargement) of the left ventricle of the heart.

If the reactivity of cerebral vessels persists, then patients with chronic vascular diseases of the brain are recommended to reduce systolic (upper) blood pressure by 20% of the initial level, and diastolic (lower) - by 15%. With a pronounced violation of the system of regulation of cerebral blood flow, it is better to reduce systolic blood pressure by 15% of the initial level, and diastolic - by 10%.

The effectiveness of antihypertensive drugs of different classes in reducing the risk of stroke varies. Calcium antagonists and diuretics work better. Angiotensin-converting enzyme inhibitors and β-blockers are less effective compared to them.

It is believed that arterial hypertension increases the risk of stroke by 3-4 times. With properly selected treatment of arterial hypertension, the risk of stroke is reduced by 2 times.

Heart disease. Anything that impairs the functioning of the heart can lead to insufficient supply of oxygen and nutrients to the brain. This creates the prerequisites for the development of ischemic stroke.

Another cause of stroke in heart disease is thromboembolism. In these cases, clots are formed in the cavities of the heart - blood clots. They travel with the bloodstream and can clog arteries in the brain.

Heart failure is the cause of about a fifth of ischemic strokes, and coronary heart disease increases the risk of their development by about 2 times.

Myocardial infarction, coronary heart disease, heart valve disease, various arrhythmias, atherosclerosis of the aorta and the main arteries of the head (carotid and vertebral arteries), coronary arteries of the heart that supply it with blood can lead to the formation of blood clots. Blood clots can occur with cicatricial changes and calcification of the valves. With arrhythmias, the cardiac chambers of the atria and ventricles are not completely freed from blood pushed into large vessels. As a result, blood stagnates in the heart, which also leads to the formation of blood clots. The risk of stroke increases with hypertrophy of the left ventricle of the heart - a thickening of its wall, which is usually observed in arterial hypertension.

It has been proven that regular treatment of patients with diseases of the heart and blood vessels significantly reduces the likelihood of developing a stroke. To do this, first of all, you need to maintain an optimal level of blood pressure, monitor blood clotting, cholesterol and blood sugar, be physically active, follow a diet and take medications in accordance with medical recommendations.

Diabetes. With this disease, not only carbohydrate, but also fat and protein metabolism suffers, autoimmune and hormonal changes are noted, the rheological properties of the blood and the concentration of vital substances in the body change.

Diverse changes in cerebral vessels in diabetes mellitus include violations of vascular tone (dystonia), lesions of vessels of various calibers.

The risk of stroke in men with type 2 diabetes is 3 times, and in women 5 times higher than in those who did not have this disease. Patients need to follow a diet and take prescribed antidiabetic drugs. All persons over 40 years of age should have a blood sugar test, regardless of how they feel. Patients need to monitor their sugar levels with a special device and keep a diary in which the sugar level and treatment are recorded.

Smoking. This bad habit doubles the risk of cardiovascular disease. It is the cause of 60-85% of deaths from cancer of the lungs, digestive tract, and oral cavity. If parents smoke, the health of not only existing, but also future children deteriorates sharply.

Under the influence of nicotine, carbon monoxide and other substances (in total, smoke contains more than 3400 compounds), changes in the composition of the blood quickly occur. Blood pressure rises, heart rate increases.

The heart of a smoker per day makes 12-15 thousand more contractions than the heart of a non-smoker. Such an uneconomical mode of operation of the heart leads to its premature wear. Smokers are more prone to cardiac arrhythmias, up to atrial fibrillation, which can cause a stroke or sudden death. Nicotine can cause vasospasm, changes in the walls of the arteries.

Since smoking increases blood pressure, the risk of cerebral hemorrhage in smokers is 2.5 times higher than in non-smokers. American scientists have calculated that for people aged 60 who have smoked for 40 years, the risk of developing severe atherosclerosis increases by about 3.5 times compared to non-smokers.

The Committee of Experts of the World Health Organization believes that the dose of tobacco smoke can actually be reduced by smoking fewer cigarettes, inhaling shallowly, leaving large cigarette butts (because the concentration of the most harmful components of tobacco smoke increases as the cigarette is smoked), taking fewer puffs from each cigarette, removing mouth a cigarette after each puff.

Of course, it is best to stop smoking immediately. But it is possible, according to psychologists, to bring the smoker to the idea of ​​the need and possibility of parting with a destructive potion and gradually.

Drug treatment of smoking, first of all, is aimed at developing an aversion to tobacco smoke. For this purpose, astringents are used, rinsing the mouth before lighting a cigarette. In addition, substitution therapy is carried out, which allows you to remove nicotine withdrawal symptoms by introducing substances into the body that are similar in their action to nicotine, but do not have its harmful effect. Nicotine-based products (without other harmful substances contained in tobacco smoke), chewing gums and patches are also used.

“Governments have a key role to play in controlling tobacco use,” says one of the appeals to the World Health Organization. "The most effective actions to curb the tobacco epidemic are not taken in hospitals, but in government boardrooms."

Lipid metabolism disorders. The fact that lipid metabolism is disturbed can be judged by the content of cholesterol in the blood. Normal total cholesterol is 5.2 mmol/L (200 mg/dL) and below; border figures - 5.2-6.4 mmol / l (200-239 mg / dl); high level (hypercholesterolemia) - 6.5 mmol / l (240 mg / dl) and above. The normal level of low density lipoproteins, depending on age, ranges from 2 to 4-5 mmol / l, high density lipoproteins - 0.9-1.9 mmol / l, triglycerides - 0.5-2.1 mmol / l.

To normalize lipid metabolism, a diet is recommended that limits the consumption of fatty meat, sausages, margarine, white bread, muffins, sweets (sugar, jam, confectionery). The total calorie content should be up to 2000-2500 kcal / day for men, 1500-2000 kcal / day for women. The diet needs fresh vegetables and fruits and foods with hard-to-digest carbohydrates (wholemeal products, black and bran bread), containing large amounts of fiber, fish, sour-milk and seafood.

The diet should be especially rigid when lipid metabolism disorders are combined with coronary heart disease, atherosclerotic narrowing of the main vessels of the head (carotid and vertebral arteries) and early symptoms of vascular diseases of the brain. They are characterized by headache, dizziness, noise in the head, decreased memory, performance, etc.

Obesity. A convenient indicator for determining the degree of obesity - excessive accumulation of adipose tissue in the body - body mass index (BMI), or Quetelet index. This indicator, proposed by the Belgian mathematician Adolphe Quetelet back in the middle of the 19th century, is still considered the most accurate measure of the correspondence of body weight to height.

Normally, the index does not exceed 25 and is calculated by the formula: weight in kilograms divided by height in meters squared. Let's say the weight is 80 kg, and the height is 160 cm. Having made an arithmetic calculation, we find that the Quetelet index is 31.6, which indicates obesity.

Obesity (Quetelet index greater than 30) is detected in 20-25% of the population of most countries in Western Europe and the United States.

Another indicator that makes it possible to judge the presence of obesity is the coefficient by which the nature of the distribution of adipose tissue is determined. It is calculated by the formula: waist circumference / hip circumference (FROM / OB). The OT / OB index in men is more than 1.0 and in women more than 0.85 indicates the abdominal type of obesity.

The main causes of obesity are overeating, excessive consumption of fatty foods, combined with low physical activity with a hereditary predisposition. Obesity occurs as a result of a long-term energy imbalance, when the energy intake from food exceeds the energy expenditure of the body. Observation of some peoples of South Africa, eating mainly millet, fish, dates and nuts, showed that they do not have vascular diseases of the brain and heart, normal blood pressure, low cholesterol in the blood are determined. They remain physically strong and active into old age and die mainly from infectious diseases.

Insufficient physical activity. In economically developed countries, there are few types of work that require heavy physical exertion. Modern vehicles have saved a person from having to walk a lot, escalators and elevators - from climbing stairs, television "chained" people to soft and comfortable chairs. The sedentary lifestyle of the population has led to a sharp decrease in energy costs. As a result, obesity and decreased physical activity have become a mass phenomenon. Obesity, in turn, plays an important role in the development of arterial hypertension, diabetes mellitus, increased blood cholesterol levels, which increase the risk of acute cerebrovascular accidents.

A sedentary lifestyle changes the reactivity of the central nervous system, vascular tone, and creates a predisposition to stress. Physically active people are less likely to develop cerebrovascular disease. It is also known that the risk of developing a heart attack in physically inactive people increases by 1.5-2 times compared with physically active people.

If healthy people need physical activity to prevent diseases, then those who suffer from cardiovascular diseases need physiotherapy exercises. It contributes to the normalization of blood pressure, improves cardiac activity and cerebral circulation, reduces the manifestations of the disease, increases efficiency.

Thanks to systematic training, the body develops a calmer reaction of the cardiovascular system to the same physical activity: the increase in heart rate and blood pressure decreases, and oxygen consumption by the heart decreases.

Physical activity is classified by intensity and duration, depending on how much it increases the heart rate. For health purposes, as a rule, physical activity with a heart rate of no more than 85% of the maximum value is recommended. For burning fat and reducing excess body weight, the most effective exercise is at an intensity of 60-70% of the maximum heart rate.

For dosing physical activity, heart rate monitors are most often used, which continuously record the heart rate. They work on the same principle as the recorders of biopotentials of the heart on the surface of the chest when recording an electrocardiogram. The monitors continuously track the value of the heart rate and give an audible and visual alarm when the heart rate goes beyond the boundaries of a predetermined zone.

Alcohol. Drunkenness and alcoholism are one of the leading causes of mortality in Russia. Moreover, in recent years, the death rate from alcoholism among men has increased 2.5 times, and among women - even 3 times.

Strokes in young people often develop in a state of intoxication. The systematic use of alcohol increases the risk of both cerebral hemorrhages and cerebral infarctions. Individual sensitivity to alcohol plays a very important role in the development of cardiovascular diseases. It is known that in some people, even prolonged alcohol abuse may not cause serious complications, while in others, severe damage to the nervous and vascular systems, psyche, and internal organs manifests itself rather quickly and when alcohol is consumed in relatively smaller quantities.

Alcohol does not directly cause atherosclerosis, but acts in a more complex way, promotes changes in small vessels, disrupts their permeability. There are problems with blood circulation in all parts of the brain. Blood stagnates in the vessels of the brain and its membranes. The walls of blood vessels are impregnated with plasma, hemorrhages occur around them. There is a tendency to thrombosis. Alcohol and nicotine intoxication mutually reinforce each other.

emotional stress. Difficult economic situation, uncertainty about the future, increasing pace of life, high level of ambition, unsuccessful search for a suitable job, excessive workload, lack of information or, on the contrary, information overload, quarrels and conflicts at work and at home, plus the costs of urbanization and a deplorable state environment - all this causes an overstrain of the nervous system.

Under the influence of emotional stress, the biochemical composition of the blood, the content of electrolytes change, oxygen starvation of the vascular wall occurs, with its subsequent changes.

The contribution of emotional stress to the development of vascular diseases of the brain has been confirmed by large-scale epidemiological studies conducted in economically developed countries of the world. In cities, emotional stress is more common than in rural areas. More often than in the general population, it is found among people whose work is associated with great nervous tension: communication workers, journalists, workers in noisy workshops, drivers, etc. Arterial hypertension is detected in them much more often than in the general population. and its complications. Twice as often as in workers, this disease is found in people engaged in mental work.

When elucidating the role of emotional stress as a risk factor for the development of cardiovascular diseases, it was found that the type of personality is of some importance. Psychologists distinguish personality type A with the so-called haste syndrome, which is characterized by an energetic style of behavior, including the inability to relax, impatience, haste. These people are overly in control of themselves and others. They move and talk fast and eat fast. They can do different things at the same time.

Type A personalities are predisposed to create stressful situations and get into these situations. Angina pectoris, myocardial infarction, cerebrovascular accidents occur in them more often than in people of the opposite psychological type B. The occurrence of arterial hypertension is associated with such emotions as suppressed anger, irritability, aggressiveness.

It is not possible to completely eliminate emotional stress from life. Its impact can be reduced by strengthening the adaptive mechanisms of a person to stressful situations: physical and mental training, which allows you to “discharge” from unreacted emotions.

Stress can be social and individual, and not only negative, but also positive. It can help you react faster in different situations. In life, there are often small stresses that do not pose a serious danger. If the stressful situation persists for a long time, then this can lead to the development of new diseases: vegetovascular dystonia, arterial hypertension, neuroses and a number of others, or to the exacerbation of existing ones. Of course, short-term stresses, and even a single, but strong stress, provoked by tragic events, can be dangerous.

Even ancient philosophers considered it necessary for health to achieve mental harmony and vital wisdom. Democritus considered the ideal of "euthymia" - a calm, balanced life. “Ataraxia” - serenity and peace of mind was preached by Epicurus, and the outstanding teacher and thinker Jan Amos Comenius (1592-1670) wrote in the “Rules of Life”: “... in order to be more efficient, sometimes give yourself a rest or change the type of work. Where tension does not alternate with rest, there is no endurance. A drawn bow will burst." However, the task is not to try by all means to avoid difficulties by building life according to the idle, lazy, Oblomov model. You need to learn how to overcome obstacles on the path of life, create mental immunity to them.

Blood and blood vessels. A serious risk factor for stroke is atherosclerotic stenosis (narrowing) of the main vessels of the head, which can significantly impair the blood supply to the brain. Its first signs may be headaches, dizziness, unsteadiness and staggering when walking, noise in the head, memory loss. If long-term conservative treatment (medication, physiotherapy) is ineffective, then the issue of surgical intervention is decided.

Vascular diseases of the brain, even in the early stages, are accompanied by a violation of the rheological properties (fluidity) of the blood. The formation of aggregates of red blood cells and platelets can impair blood circulation in the vessels of the brain and contribute to the formation of blood clots. As a result, complete blockage of the arteries can occur.

Acetylsalicylic acid (aspirin) is widely used to improve the rheological properties of blood. Small doses are used - 1 mg per 1 kg of body weight (75-100 mg 1 time per day) to avoid complications (irritation of the gastrointestinal tract, bleeding). Based on acetylsalicylic acid, there are drugs with a milder effect on the gastrointestinal tract. It has been proven that their regular intake can prevent the development of ischemic stroke. It should be remembered that over time, resistance (immunity) to aspirin increases. Therefore, it is advisable to test the individual antiaggregatory effect of aspirin before starting treatment with aspirin and during its course (once every six months). Such a test system was developed at the Scientific Center of Neurology of the Russian Academy of Medical Sciences.

In addition to aspirin, other drugs are also used as antiplatelet agents: clopidogrel (Plavix), dipyridamole, pentoxifylline (trental, agapurine).

Preventive programs to combat arterial hypertension, conducted by research groups both in our country and abroad, made it possible to reduce the incidence of stroke by 45-50% within 5 years. The introduction of such programs in practical health care will save the health of many thousands of people.

The immediate cause of a stroke is a ruptured or blocked blood vessel. When a vessel ruptures, bleeding occurs in the brain (hemorrhagic stroke) or under its membranes (subarachnoid hemorrhage). But the most common type of stroke is ischemic, associated with blockage of cerebral vessels. Ischemic strokes are about four times more common than hemorrhagic strokes.

If someone becomes ill at home, do a simple test to help determine if the person has had a stroke. First ask the sick person to give their name, then ask them to smile, then raise their hands. If at least one task is not completed, then perhaps this is a sign of a stroke. Call an ambulance immediately.

In chronic vascular diseases of the brain, the autoregulation of cerebral blood flow is changed towards higher values ​​of arterial pressure - the vessels tolerate its increase better than its decrease. This should be taken into account when choosing the dose of drugs that reduce blood pressure.

Did you know that stroke is the third leading cause of early death? What's more, the most common type of stroke, called ischemic stroke, is often preventable. An ischemic stroke occurs when a blood clot forms in a blood vessel that carries blood and oxygen to the brain. When this happens, the life path to part of the brain is switched off.

This blockage can lead to loss of brain function in certain parts of the brain, or even death. And even if you survive a stroke, you can still live with varying degrees of disability. So, it is better to make sure that this does not happen!

You can reduce your risk of stroke through your lifestyle.

According to research discussed in Harvard Health, there are eight lifestyle habits that reduce the risk of stroke. In addition, these healthy lifestyle habits reduce the risk of developing cardiovascular disease. So, eight habits that will help avoid the dangers of a stroke.

Reduce Your Risk of Stroke: Quit Smoking

Smoking damages the inner walls of the arteries, the blood vessels that carry blood and oxygen from your heart to your organs. When the lining of an artery is damaged by smoking, it increases the chance of a blood clot forming inside the blood vessel. If this happens in one of the vessels that carry blood and oxygen to your brain, parts or portions of your brain may be damaged. That's what a stroke is! Thus, get rid of this bad habit right now, not later, and then the risk of getting a stroke will decrease significantly, as well as other chronic health problems, will gradually decrease.

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Control your blood pressure

High blood pressure is one of the leading risk factors for stroke.

High blood pressure, like smoking, also damages the inner wall of the artery. When blood pressure is too high, it pushes against the walls of arteries, including those that carry blood to your brain, and this can damage it through shear stress. Over a long period of time, this shear stress can damage an artery to the point where a clot forms and your brain's oxygen supply is cut off and part of it dies. How to reduce the risk of stroke? Check your blood pressure regularly and take steps to bring it down if it's too high.

Reduce Stroke Risk: Exercise

I bet you are not surprised! Aerobic exercise reduces the risk of stroke in several ways. First, it lowers blood pressure, and hypertension is a strong risk factor for stroke. Physical exercise also helps to reduce the stiffness of blood vessels, which in turn is accompanied by aging. According to the Stroke Association in the UK, regular moderate-intensity exercise can reduce the risk of stroke by 27%.

Physical activity is a healthy habit that reduces the risk of other health problems.

In addition, it helps lower blood pressure, a leading risk factor for stroke.

Watch your weight

Being overweight or obese is another risk factor for ischemic stroke.

The good news is that losing as little as 10% of your total weight (assuming you're overweight) can help reduce your risk of stroke significantly. Weight loss can reduce the risk of stroke in several ways. Accumulated fat causes can damage the inner wall of blood vessels. In addition, being overweight increases the risk of hypertension and insulin resistance, both of which are associated with higher chances of getting a stroke.

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Eat a Mediterranean Diet

Get off all that processed junk and try the Mediterranean diet. Research has linked this eating style to a reduced risk of stroke and heart attack, as well as reduced mortality from many causes. The Mediterranean diet includes fruits, vegetables, olive oil, fish, legumes and whole grains and no processed foods or sugars. Who can argue with that? One study found that switching to this eating style was associated with a 37% reduction in stroke risk. So, choose more whole, plant-based foods for your diet, and you will only benefit your heart and blood vessels!

Treat Diabetes

Diabetes increases the chances of developing cardiovascular disease and increases the risk of stroke.

Unfortunately, we often diagnose type 2 diabetes when it's already established, when it would be better to make lifestyle changes that keep blood sugar at healthy levels before blood vessel damage can cause a stroke. Prevention is the best medicine! Studies show that the Mediterranean diet may be helpful in reducing the risk of type 2 diabetes. Other studies point to the benefits of adding more non-starchy, plant-based foods to your diet to prevent diabetes and lower blood sugar if you have it. Of course, exercise is also part of the equation! Exercise improves insulin sensitivity and helps cells take up glucose more efficiently.

Alcohol only in moderation.

If you must drink alcohol, various holidays and corporate events, stick to only one drink, preferably red wine. Some studies show that light alcohol has cardioprotective effects, but at least one study shows that drinking hard alcohol increases the risk of another type of stroke called a hemorrhagic stroke.

01.06.2016

Statistical medical data show a significant increase in deaths and disorders from stroke.

The most common ischemic variant pathology - more than 80% of cases, while the hemorrhagic type of circulatory disorders - no more than 15%, but according to the severity of the course and the formation of complications, it is more dangerous.

That is why the prevention and identification of the risks of intracranial cerebral accidents is an urgent problem for neurological specialists in all countries. It is given considerable attention by physicians of all directions - from general practitioners to neuropathologists.

Negative Options

Specialists call the causes of stroke a variety of clinical, biochemical, as well as behavioral and other characteristics that indicate an increased likelihood of pathology.

The most important factors of a stroke catastrophe are usually divided into: controlled - amenable to influence by a medical specialist, as well as by the person himself. And uncontrollable - to influence which is not possible.

Controlled:

Factors that cannot be corrected include:

Diagnosis and treatment

To date, the priority national project in the field of preventing the development of strokes is the prophylactic medical examination of the population. The main goal of such examinations is early detection, as well as timely treatment of the above negative factors.

Angiography is one of the diagnostic procedures that are performed for the early detection of a stroke.

For this purpose, diagnostic procedures are carried out:

• ECG and ECHO KG;
• radiography of the spine and lungs;
• blood tests: general and biochemical;
• keeping a diary of blood pressure parameters;
• duplex scanning of blood vessels;
• CT or MRI of the brain;
• angiography.

Depending on the results, more in-depth and expensive diagnostic procedures are prescribed by a specialist.

Individuals taken under control from subgroups according to the risk factors identified in them should undergo control examinations after they have taken appropriate corrective measures, for example, after taking antihypertensive or anticholesterolemic drugs.

Attending a variety of schools - on diabetes, hypertension - will also contribute to the prevention of stroke. A person's awareness of the risk of its occurrence, as well as the severity of the consequences, is the main task of primary care specialists.

During the consultation, in practically healthy individuals, bad habits are identified and fixed, for example, smoking, which can also affect the state of intracranial vessels in the most unfavorable way. Interviews conducted by medical personnel should have an effect on the desire of a person to refuse them.

Timely correction somatic pathologies, adequate impact on them with modern drugs, for example, antidiabetic or antihypertensive drugs, is another of the most important links in the prevention of brain accidents.

Only a comprehensive accounting of all the above risk factors for stroke, as well as their timely correction, can significantly reduce the likelihood of developing acute cerebrovascular accident.

Risk Factors for a Brain Stroke updated: May 30, 2017 by: vitenega

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Stroke is a rather dangerous disease, which affects people far from only old age, but also middle and even very young people.

A stroke is an emergency situation that requires immediate help. It often ends in disability, in many cases even death. In addition to blockage of a blood vessel in the ischemic type, a hemorrhage in the brain against the background of high blood pressure, in other words, a hemorrhagic stroke, can also cause an attack.

Risk factors

A number of factors increase the chance of having a stroke. For example, genes or age are not always to blame, although after 60 years the threat increases significantly. However, everyone can do something to prevent it.

1. Avoid hypertension

High blood pressure is a major risk factor for stroke. Insidious hypertension does not show symptoms at the initial stage. Therefore, patients notice it late. It is important to have your blood pressure checked regularly and take medications for elevated levels.

2. Quit smoking

Nicotine constricts blood vessels and raises blood pressure. A smoker is twice as likely to have a stroke than a non-smoker. However, there is good news: those who quit smoking significantly reduce this risk.

3. With excess body weight: lose weight

Obesity is an important factor in the development of cerebral infarction. Obese people should think about a weight loss program: eat less and better, add physical activity. Older people should talk to their doctor about the extent to which they benefit from weight loss.

4. Keep cholesterol levels normal

Elevated levels of "bad" LDL cholesterol lead to deposits in the vessels of plaques and embolism. What should be the values? Everyone should find out individually with a doctor. Since the limits depend, for example, on the presence of concomitant diseases. In addition, high values ​​of "good" HDL cholesterol are considered positive. A healthy lifestyle, especially a balanced diet and plenty of exercise, can positively affect cholesterol levels.

5. Eat healthy food

Useful for blood vessels is a diet that is commonly known as "Mediterranean". That is: lots of fruits and vegetables, nuts, olive oil instead of cooking oil, less sausage and meat, and lots of fish. Good news for foodies: you can afford to deviate from the rules for one day. It is important to eat right in general.

6. Moderate alcohol consumption

Excessive alcohol consumption increases the death of stroke-affected brain cells, which is unacceptable. Complete abstinence is not required. A glass of red wine a day is even helpful.

7. Move actively

Movement is sometimes the best thing you can do for your health in order to lose weight, normalize blood pressure and maintain the elasticity of blood vessels. Ideal for this endurance exercise, such as swimming or brisk walking. Duration and intensity depend on personal physical fitness. Important Note: Untrained people over 35 years of age should be initially examined by a doctor before starting to exercise.

8. Listen to the rhythm of the heart

A number of heart conditions contribute to the likelihood of a stroke. These include atrial fibrillation, birth defects, and other rhythm disturbances. Possible early signs of heart problems should not be ignored under any circumstances.

9. Control your blood sugar

People with diabetes are twice as likely to have a cerebral infarction than the rest of the population. The reason is that elevated glucose levels can damage blood vessels and promote plaque buildup. In addition, diabetic patients often have other risk factors for stroke, such as hypertension or too high blood lipids. Therefore, diabetic patients should take care of the regulation of sugar levels.

10. Avoid stress

Sometimes stress has nothing wrong, it can even motivate. However, prolonged stress can increase blood pressure and susceptibility to disease. It can indirectly cause a stroke. There is no panacea for chronic stress. Think about what is best for your psyche: sports, an interesting hobby, or perhaps relaxation exercises.

A stroke is an acute violation of the blood supply to the brain, which ceases to receive oxygen and nutrients, which entails irreversible consequences.

A stroke is a serious and dangerous disease that requires urgent treatment. The sooner the patient receives medical attention, the less damage the brain will receive.

There are two main types of stroke:

• Hemorrhagic: occurs as a result of rupture of the vessel, followed by hemorrhage in the brain. The accumulated blood in large quantities begins to create pressure on the brain tissue, which disrupts their activity.
• Ischemic: occurs as a result of compression or blockage by a thrombus or atherosclerotic plaque of a cerebral vessel. According to statistics, this type of stroke occurs most often, namely in 75% of cases.

A stroke almost always entails serious consequences for the health and vital functions of the human body. Most common consequences of a stroke:

• Violation of coordination, the inability to determine the position of the body in space, to maintain balance when moving.
• Violation of sensitivity - the patient loses the ability to feel pain, temperature changes in different parts of the body.
• Visual impairment: double vision, or loss of part of the visual field
• Speech disorder: the patient speaks incoherently, indistinctly, sometimes he cannot understand the speech of another person, it becomes difficult for him to read and write.

About half a million people suffer from a stroke every year. Only 13-15% of them fully restore their health, the rest either die or become disabled. Unfortunately, even after successful rehabilitation and restoration of health, a person who has had a stroke in 50% of cases again encounters this disease within the next five years.

Unfortunately, stroke is rapidly getting younger. Today, young people and girls at the age of 20 face acute circulatory disorders. That is why everyone should know about stroke, risk factors for its development and prevention measures.

There are certain risk factors occurrence of a stroke. Check if they are present in your life:

• Smoking, excessive alcohol consumption, narcotic substances have a detrimental effect on the state of blood vessels, destroying their integrity, and also increases blood pressure.
• High blood pressure(arterial hypertension) increases the risk of stroke by 48%. The vessels of the brain are able to withstand high pressure, but with its spasmodic changes, as well as with constant increased pressure, the walls of the vessels begin to lose their elasticity, which can lead to their ruptures.
• Diabetes considered a serious illness in itself. Most of all, with this disease, the walls of blood vessels suffer, which become more fragile and brittle over time. This state of the vessels is dangerous not only by ruptures, but also by the formation of a large number of blood clots in the places of damage.
• Overweight, obesity, overeating, unhealthy diet. Excess body weight, eating a large amount of food increases the risk of increasing the level of cholesterol in the blood, which is fraught with the development of fatty plaques on the walls of blood vessels, which can clog them.
• Low physical activity. In a person leading a sedentary lifestyle, the risk of stroke increases by 35.8%. The risk group usually includes office workers who spend most of the day sitting, and in the evening they opt not for the gym, but for the home sofa in front of the TV.
• Long-term use of hormonal contraceptives. High doses of estrogens increase the risk of high blood pressure and vascular thrombosis.
• Heredity.

How to reduce the chance of developing a stroke:

• Control your blood pressure. This item is one of the most important. It is necessary to strictly and responsibly treat the doctor's instructions, the drug treatment of hypertension, and regularly take the prescribed drugs. Remember that hypertension is considered the "invisible killer" as high blood pressure is often asymptomatic.
• Watch your nutrition. Avoid baking with white wheat flour, a lot of sweets, sugar. Try to eat more plant-based foods: fruits, greens, vegetables, beans, whole grains, nuts.
• Reduce weight if necessary. Control your calorie intake, make time for physical activity. Reducing weight even by 5 kg helps to lower blood pressure, improve the functioning of the cardiovascular system.
• Give up bad habits. Remember that passive smoking is also detrimental to health.
• Diabetes treatment, blood sugar control. Diet, medication, weight loss will help you lower your blood sugar, which will help reduce your risk of stroke.
• Make it a good habit to exercise regularly which improve the condition of blood vessels, the heart, help to reduce weight, help lower blood pressure. It is not necessary to overload yourself with exercises in the gym. Exercise such as walking (for example, walking from work), running, swimming, cycling for at least 30 minutes a day can significantly reduce the risk of stroke.
• See your doctor regularly especially in the presence of negative heredity. It is easier to prevent a disease than to treat it. Get regular preventive check-ups.

If you make choices every day in favor of a healthy lifestyle, an attentive attitude towards yourself and your loved ones, you can reduce the likelihood of a stroke!

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is a stroke?

Stroke- This is a disease of the central nervous system, characterized by an acute violation of the blood supply to any parts of the brain or spinal cord. The reason for this is always damage to the blood vessels that deliver blood to the brain. Due to impaired blood delivery, brain tissue quickly dies, causing the affected areas of the brain to stop functioning. The death of part of the brain tissue leads to a violation of certain functions of the body ( depends on which part of the brain is affected). In mild cases, the violations that appear may be minor and even completely disappear after a while, while in severe cases, a stroke can cause death or disability of a person.

To understand how and why a stroke develops, as well as how and when it can be cured, certain knowledge about the structure, functioning and blood supply of the brain is needed.

Blood is delivered to the brain through many arteries. Under normal conditions, brain tissue neurons, cells of the nervous system) receives oxygen directly from the blood. At the same time, the main source of energy for nerve cells is glucose ( sugar), which they also get from their blood. It is important to note that the brain tissue has practically no reserves of oxygen and energy that cells could use in critical conditions. This means that if blood circulation is disturbed ( and hence the delivery of oxygen and energy) in a certain part of the brain, the nerve cells located there will immediately begin to experience a lack of oxygen ( hypoxia) and nutritional deficiencies ( that is, in glucose). If the pathological process that caused the violation of microcirculation is not eliminated in a timely manner, after a few minutes the nerve cells will begin to die, which will lead to the appearance of clinical signs of a stroke.

Epidemiology ( stroke statistics)

According to statistics, more than 11 million strokes are recorded on the planet every year. Only a quarter of them are associated with cerebral hemorrhage, while most ( about 75%) occurs due to blockage of the cerebral arteries by blood clots ( blood clots). Among the urban population, strokes are somewhat more common than in rural areas, which is associated with a busy rhythm of life, unhealthy diet, sedentary lifestyle and other factors.

Within the first month from the onset of the disease, more than 35% of people who have had a stroke die, while more than half of the victims die within a year ( causes of death are complications that develop after a stroke). Of the survivors, about 70% of patients become disabled for life, and half of them lose the ability to self-care, and therefore they need constant care.

The disease develops mainly in older and older people ( more than 70% of all strokes are registered in people over 60 years old). Men get sick and die from a stroke 4 times more often than women.

How is a stroke different from a heart attack?

Stroke and heart attack are two different concepts, which, however, are closely intertwined with each other. The definition of stroke has been provided above ( This is an acute violation of cerebral circulation, accompanied by the death of nerve cells in the brain.). At the same time, it is customary to call a heart attack the death of a part of a tissue or an entire organ ( any), which developed due to an acute violation of its blood supply. The cause of a heart attack may be a blockage of a blood vessel by a thrombus ( blood clot), air bubbles or other particles, as well as prolonged spasm ( constriction) blood vessels. According to the terminology, a heart attack can develop in almost any organ - in the heart ( myocardial infarction), in the liver, in the kidneys, and so on. cerebral infarction ( that is, a violation of the blood supply to the brain tissue due to blockage of the cerebral vessel by a thrombus) is called a stroke.

Causes and risk factors in the development of stroke at a young age and in the elderly

Various diseases of internal organs and systems, in particular, the cardiovascular system, central nervous system, blood system, endocrine system, pancreas, and so on, can contribute to the development of a stroke. Often, patients have a combination of several predisposing factors, which greatly complicates the diagnosis and prevention of this disease.

• genetic predisposition;
• elderly age;
• hypertonic disease ( high blood pressure);
• atrial fibrillation;
• atrial fibrillation;
• chronic heart failure;
• other heart conditions;
• aneurysm of the arteries of the brain;
• a brain tumor;
• other malignant tumors;
• malnutrition;
• violation of the metabolism of fats in the body;
• alcohol abuse;
• taking drugs;
• taking certain medications medical stroke);
• acute or chronic stress;
• sedentary lifestyle;
• low testosterone levels in the body;
• anomalies in the development of cerebral vessels;
• sleep apnea syndrome;
• disorders of the blood coagulation system;
• complications of pregnancy eclampsia).

genetic predisposition

It has been scientifically proven that the predisposition to stroke is inherited. As a result of large-scale studies, it was found that the risk of developing a stroke increases by 2 times if at least one of the person's parents had this disease. If both parents have had a stroke, the risk of developing this pathology in their child increases by 3-4 times. This may be due to an inherited predisposition to other diseases that increase the risk of stroke ( arterial hypertension, diabetes mellitus, metabolic disorders).

Age

According to statistics, the vast majority of strokes ( over 95%) develops in people older than 35 years. After the age of 55, the risk of developing a stroke increases by 2 times, after 65 years - by 4 times, and after 75 years - by 8 times. This is due to the fact that in the process of aging there is a thinning and a decrease in the elasticity of the walls of blood vessels, and therefore they can burst when blood pressure increases in them and when exposed to other risk factors. What's more, older people are at increased risk of developing heart disease, cancer, and other conditions that also contribute to stroke.

Diabetes

The presence of diabetes increases the risk of stroke by more than 3 times. The fact is that in diabetes, the process of glucose entering the cells of various tissues, including the walls of blood vessels, is disrupted. This is accompanied by the so-called angiopathy - damage to the blood vessels, narrowing of their lumen and impaired blood flow through them. As a result, blood supply to the brain is disrupted over time, the likelihood of blood clots in the affected vessels of the brain increases, and there is also a risk of rupture of the damaged vessel when exposed to other adverse factors ( stress, high blood pressure, etc.).

Hypertonic disease ( high blood pressure)

According to statistics, arterial hypertension ( that is, a persistent increase in blood pressure greater than 140/90 millimeters of mercury) is accompanied by an increased risk of stroke ( both hemorrhagic, associated with rupture of cerebral vessels, and ischemic, due to impaired blood flow through the vessels of the brain without their rupture).

Under normal conditions, blood flow through the vessels of the brain is regulated by nervous mechanisms and directly depends on blood pressure. If the blood pressure in the vessels is too high, under its influence, the walls of the blood vessels are overstretched and deformed, which at a certain moment ( for example, with another sharp increase in pressure, with physical exertion or stress) can lead to rupture of the vessel. In this case, hemorrhage will be observed, as a result of which blood will enter the medulla.

At the same time, it should be noted that with a long-term progressive ( for decades) arterial hypertension, the walls of blood vessels are deformed and lose their elasticity, that is, they cannot expand and contract normally. This can contribute to the narrowing of the lumen of the vessel up to its blockage. At the same time, through the affected vessel, blood will stop flowing to the medulla, which will cause the death of nerve cells.

Coronary artery disease

Patients with coronary heart disease have a higher risk of stroke than healthy people. This is due to the similarity of the causes and mechanisms of development of these pathologies.

Ischemic heart disease is characterized by impaired oxygen delivery to the heart muscle, which is associated with damage to the blood vessels of the heart. Atherosclerosis may be the cause of vascular damage ( the appearance of fatty deposits in the vascular wall, leading to a narrowing of the lumen of the vessel). Also, the risk of developing coronary heart disease is affected by genetic predisposition, patient age, gender, sedentary lifestyle, bad habits, and so on. All of these risk factors can also lead to damage to cerebral vessels, contributing to the narrowing of their lumen and increasing the risk of stroke.

Atrial fibrillation and atrial fibrillation

These diseases are characterized by a violation of the process of contraction of the heart muscle. At the same time, muscle fibers begin to contract out of sync, chaotically, as a result of which the pumping function of the heart decreases. Blood flow through the chambers of the heart is disrupted, blood can stagnate in them, resulting in an increased risk of blood clots ( blood clots). These blood clots can stay in the chambers of the heart for a long time. If part of the thrombus breaks off, it can enter the systemic circulation with the blood flow and then to various organs and tissues of the body. If such a blood clot enters the blood vessel of the brain and clogs it, this can lead to impaired cerebral circulation and the development of a stroke.

Chronic heart failure

With this pathology, the pumping function of the heart is disrupted, as a result of which it cannot normally pump blood in the body. At the same time, blood microcirculation in various organs is disturbed, which increases the risk of blood clots. If one of these blood clots forms in the vessels of the brain or gets into them from the chambers of the heart, it can lead to a stroke.

Other heart diseases ( cardioembolic stroke)

They talk about cardioembolic stroke in cases where a blood clot became the cause of blockage of a brain vessel ( or embolus) formed in the heart. The reason for this may be a number of diseases of the cardiovascular system, including the arrhythmias described above ( atrial fibrillation, atrial fibrillation), as well as heart surgery, heart trauma, heart tumors, and so on.

The development of a stroke can contribute to:

• Bacterial endocarditis. This pathology is characterized by damage to the valves of the heart muscle by a bacterial infection. The surface shell of the valves ( endocardium), which is normally perfectly smooth, deforms and becomes "rough" in bacterial endocarditis. As a result, platelets and other blood cells can “stick” to it, which over time will lead to the formation of a blood clot. If such a blood clot breaks off and enters the vessels of the brain, the patient develops a stroke.
• Valvular heart disease. With congenital valvular heart disease, the anatomical structure of one or several heart valves is disturbed. At the same time, blood flow through them is disturbed, which contributes to thrombosis, separation of blood clots and their entry into various organs, including the vessels of the brain.
• Valve prostheses. When prosthetic heart valves, instead of a damaged valve, an artificial prosthesis can be installed, which is a “foreign body” for the body. The risk of blood clots on such valves increases, which increases the likelihood of a patient developing a stroke.
• Myocarditis. This is an inflammatory disease that directly affects the heart muscle. With the development of myocarditis in the heart, pathological inflammatory reactions develop, which disrupts blood flow through the heart vessels, and also disrupts the process of muscle contraction. All this contributes to the formation of a blood clot, which can come off and enter the vessels of the brain.

Aneurysm of the arteries of the brain

An aneurysm is a pathological protrusion in the wall of a blood vessel, which is formed as a result of congenital malformations, injuries, infections, and for other reasons. In the presence of an aneurysm, blood flow through the vessel is disturbed, and in the aneurysm itself ( that is, in a sac-like protrusion of the vascular wall) is slowing down. This increases the risk of thrombus formation, which over time can clog the lumen of the vessel and lead to disruption of the blood supply to a certain area of ​​the brain. In addition, it is worth noting that in some cases an aneurysm can be complicated by dissection of the wall of the affected vessel. In this case, blood will begin to enter the newly formed cavity ( between the inner and outer layers of the affected vessel). In this case, the lumen of the affected vessel will quickly close, as a result of which the patient will develop a stroke.

A brain tumor

The risk of stroke is increased in both benign and malignant brain tumors. In the first case, a benign tumor can significantly increase in size, while squeezing neighboring blood vessels and disrupting blood flow through them. At some point, this can lead to complete blockage of the lumen of the vessel and the development of a stroke.

In a malignant tumor, it is also possible that the blood vessels are squeezed by the rapidly growing tumor tissue. At the same time, malignant tumors are characterized by metastasis, that is, the separation of malignant tumor cells and their penetration into blood vessels and nearby tissues. These cells can also clog blood vessels, disrupting blood flow through them and leading to disruption of the blood supply to the brain.

Other malignant tumors

Malignant tumors located in various organs and tissues can also lead to the development of a stroke. First, metastases of these tumors can develop in the brain, disrupting blood flow through the cerebral vessels. Secondly, the development of a malignant process in the body disrupts the blood coagulation system, increasing the risk of blood clots and blockage of blood vessels in the brain, which will lead to a stroke.

Improper nutrition and violation of the metabolism of fats in the body

When eating a large amount of fatty foods, the risk of developing atherosclerosis increases - a disease in which fatty plaques appear in the vascular wall. These plaques can narrow the lumen of the vessel, disrupting the flow of blood through it. Moreover, at some point, such a plaque can rupture, as a result of which the substance contained in it enters the blood vessel and clogs it, provoking a stroke.

Obesity

Obesity increases the risk of stroke, which is associated with various complications inherent in this pathology. First, obesity increases the likelihood of developing atherosclerosis, which, according to the previously described mechanisms, can lead to impaired cerebral circulation. Secondly, obese patients almost always suffer from arterial hypertension ( high blood pressure). If other risk factors are present, this can lead to injury and rupture of a blood vessel in the brain and bleeding into the medulla ( i.e. stroke).

Smoking

Smokers are several times more likely to develop a stroke than non-smokers. This is due to the fact that nicotine and other harmful substances that make up tobacco smoke significantly accelerate the formation of atherosclerotic plaques in blood vessels, including those in the brain. As a result, the risk of plaque rupture and blockage of the vessel by a thrombus increases.

It is worth noting that the risk of rupture of blood vessels in the brain and hemorrhage in the brain tissue in smokers is also increased, but the exact mechanism for the development of this phenomenon remains unexplored.

Alcohol abuse

alcohol abuse ( more than 70 grams per day in terms of pure alcohol) more than doubles the risk of stroke. This is due to the toxic effects of ethanol ( alcohol in alcoholic beverages) on the blood vessels of the brain, on the blood coagulation system, as well as on the functions of the liver and kidneys involved in the removal of toxins from the body. It is also worth noting that chronic alcohol abuse disrupts the functions of the brain nerve cells themselves, as a result of which, if cerebral circulation is disturbed, they will die much faster than in a non-drinking person.

drug use ( amphetamine, cocaine)

Taking certain narcotic and psychotropic substances ( e.g. amphetamines and cocaine) can impair cerebral circulation. The fact is that these substances have a stimulating effect on the cardiovascular system. This leads to an increase in heart rate and a pronounced increase in blood pressure, which, in the presence of additional risk factors, can provoke rupture of cerebral vessels and the development of a stroke. Moreover, with an overdose of these substances, a spasm may be observed ( pronounced and prolonged contraction) cerebral vessels, which will also lead to a stroke.

Medical stroke

This term is used to denote a stroke that has developed due to the intake of certain medications.

The development of medical stroke can contribute to:

• Drugs that disrupt the blood coagulation system ( clotting blood).
• Drugs that increase the risk of blood clots.
• Drugs that increase blood pressure and thereby contribute to the rupture of blood vessels in the brain ( in the presence of other risk factors).
• Drugs that cause constriction ( spasm) brain blood vessels.
• Birth control pills ( oral contraceptives).

Acute or chronic stress

Stress is characterized by a pronounced increase in blood pressure, increased blood flow to the brain, increased blood pressure in the cerebral vessels, and so on. In the presence of additional risk factors, frequent stressful situations and emotional experiences can lead to spasm or rupture of a blood vessel in the brain, that is, to a stroke.

Sedentary lifestyle

With a sedentary lifestyle, the heartbeat and the rate of blood flow through the blood vessels of a person slow down, as a result of which the risk of blood clots and their entry into the vessels of the brain increases. On the other hand, during exercise running, swimming, cycling and so on) the blood flow rate can increase several times, which will significantly reduce the risk of blood clots in the vessels.

It is also worth noting that a sedentary lifestyle contributes to the development of obesity, atherosclerosis and other risk factors listed above. So, for example, when taking a large amount of fatty foods, the so-called "bad" cholesterol enters the bloodstream. It can enter the walls of blood vessels and be deposited there, leading to the formation of atherosclerotic plaques. At the same time, during exercise, cholesterol is “washed out” from the walls of blood vessels, which reduces the risk of developing atherosclerosis and, consequently, stroke.

Low testosterone levels in the body

As a result of scientific research, it was found that the risk of developing a stroke against the background of blockage of cerebral vessels by a blood clot is increased in those men who suffer from a lack of testosterone ( male sex hormone) in organism. The reason for this may be associated with a lack of testosterone obesity, as well as atherosclerosis, but the exact mechanism of the effect of this hormone on the risk of stroke has not been identified.

Anomalies in the development of cerebral vessels

Congenital anomalies in the structure of intracerebral vessels can increase the risk of stroke. So, for example, pathological narrowing or too pronounced tortuosity of a blood vessel can lead to disruption of blood flow through it, which increases the risk of thrombus formation and blockage of the affected vessel. On the other hand, pathological thinning or protrusion of the wall of a blood vessel may be accompanied by its rupture ( for example, with a sharp increase in blood pressure), leading to cerebral hemorrhage.

sleep apnea syndrome

The essence of this pathology is that during sleep the patient stops breathing for a while ( from 10 seconds to 2 - 3 minutes). This disrupts the delivery of oxygen to the body, which is accompanied by a change in the state of the circulatory system, cardiovascular system, metabolism, and so on. It is important to note that during an apnea attack ( respiratory arrest) blood pressure rises sharply, and there is an expansion of the blood vessels of the brain, which significantly increases the risk of developing a stroke right in your sleep.

The cause of sleep apnea can be anomalies in the structure of the upper respiratory tract, night snoring, obesity ( in which there is a narrowing of the lumen of the airways), as well as damage to the central nervous system.

Violation of the blood coagulation system

Blood is maintained in a "fluid" state due to the balance between coagulation ( contributing to the formation of blood clots) and anticoagulant ( promotes blood thinning) systems. If blood clotting is significantly increased ( for example, with malignant tumors, with massive injuries, operations, when taking certain medications, and so on), which can lead to the formation of blood clots in the bloodstream. Blood clots can get into the blood vessels of the brain and cause a stroke.

On the contrary, excessive activation of the anticoagulant system ( with congenital disorders of blood clotting, when taking blood-thinning medications) may increase the risk of bleeding, including hemorrhage into the substance of the brain.

erythremia

This pathology is characterized by an increase in the number of red blood cells ( erythrocytes) in the bloodstream. The blood at the same time becomes too thick, as a result of which the speed of its flow through the blood vessels slows down. Against this background, the risk of blood clots increases, which can lead to blockage of cerebral blood vessels and the development of a stroke.

Complications of pregnancy ( eclampsia)

Some women in the 2nd - 3rd trimesters of pregnancy have such a pathological condition as preeclampsia and ( in severe cases) eclampsia. Preeclampsia is characterized by a pronounced increase in blood pressure, swelling and other symptoms. If this condition is left untreated, it can progress to eclampsia, characterized by even greater pressure increase, cerebral edema, and the development of seizures. Against the background of too high pressure, the risk of rupture of a blood vessel in the brain increases, which can cause hemorrhage into the medulla.

Causes of stroke in children

Not all of the risk factors mentioned above affect the development of stroke in children. The fact is that many of the listed diseases ( e.g. atherosclerosis) develop over decades and only affect adults or the elderly. At the same time, a number of pathologies can also occur in childhood, thereby increasing the likelihood of cerebrovascular accident in a child.

The causes of a stroke in a child can be:

• congenital anomalies in the development of the blood vessels of the brain;
• birth trauma to the head;
• obesity;
• erythremia;
• malnutrition;
• benign or malignant tumors;
• taking medications that affect blood clotting;
• brain surgery;
• massive injuries;
• congenital heart defects;
• severe diabetes mellitus;
• hemophilia ( congenital bleeding disorder characterized by a tendency to bleed).

Kinds ( classification) and pathogenesis ( mechanism) strokes

Brain tissue is extremely sensitive to hypoxia ( lack of oxygen) and energy starvation. If the delivery of oxygen and glucose ( main source of energy for nerve cells) to the brain stops completely, the person loses consciousness within 5-10 seconds, and after 3-7 minutes the nerve cells begin to die. If the blood supply to any particular part of the brain is disturbed ( what happens with a stroke), only those neurons die, to which blood stops flowing, while other nerve cells continue to function normally.

There are several classifications of stroke, but the main one is based on the cause of impaired blood circulation in the medulla. Another classification divides strokes depending on which artery of the brain was affected and which part of the brain was damaged as a result.

Depending on the cause of the violation of cerebral blood flow, a stroke can be:

• Ischemic ( cerebral infarction) - characterized by a narrowing of the lumen of the vessels of the brain as a result of their spasm or blockage by blood clots or other particles.
• Hemorrhagic ( hemorrhage in the brain) - characterized by a rupture of the wall of the blood vessel of the brain and hemorrhage into the brain tissue.

Depending on the affected area of ​​the brain, there are:

• stroke of the right hemisphere of the brain;
• stroke of the left hemisphere of the brain;
• brain stem stroke stem stroke);
• cerebellar stroke;
• spinal cord stroke spinal stroke).

Ischemic stroke

Ischemic stroke is characterized by acute impairment of blood flow through the cerebral vessels ( arteries) as a result of their blockage by a thrombus ( blood clot), atherosclerotic plaque, tumor cells, and so on. As soon as a clot "gets stuck" in a blood vessel, blood flow through the vessel slows down ( if its lumen is partially blocked) or stops altogether ( if its lumen is completely blocked). In the very first seconds after this, a reflex spasm of blood vessels develops in the affected area, as a result of which they narrow even more. However, after a while, spasm ( constriction) vessels is replaced by pathological paralysis ( relaxation) muscles of the vascular wall, as a result of which the vessels in the affected area expand. At the same time, the permeability of the vascular wall increases, as a result of which the liquid part of the blood leaves the vascular bed and passes into the medulla, leading to the development of cerebral edema. Violation of blood and oxygen delivery leads to rapid death of nerve cells in the lesion, which is manifested by characteristic symptoms ( depending on the location of the stroke).

It is important to note that the severity and volume of brain damage in ischemic stroke are closely related to the presence of the so-called collateral ( additional, bypass) circulation. The fact is that blood enters the medulla through several arteries at once ( vertebral arteries, carotid arteries). If a small branch of one of these arteries is affected, branches of other arteries can partially compensate for blood flow in the affected area, thereby prolonging the life of the nerve cells in the affected area.

From a clinical point of view, this can be explained as follows - when a vessel is blocked, part of the nerve cells ( receiving blood only from this vessel) dies immediately ( within 5 - 7 minutes from the onset of a stroke). At the same time, another part receiving small amounts of blood from other vessels) remains viable for a longer time ( tens of minutes or even several hours). If during this time the patient is provided with the necessary medical care ( that is, to remove or "dissolve" the clot that clogged the vessel), this can save a large part of the medulla, thereby reducing the number of complications in the future.

hemorrhagic stroke ( with hemorrhage)

The essence of hemorrhagic stroke is that when the wall of any vessel of the brain ruptures, blood enters the medulla, that is, directly into the nervous tissue. Nerve cells located in the area of ​​hemorrhage immediately die. Those neurons that received blood from the affected also die ( burst) vessel.

Immediately after the rupture of the blood vessel, a reflex spasm of the muscles of the vascular wall occurs, as a result of which this vessel ( as well as other vessels of the brain) are significantly reduced. This may contribute to a more pronounced violation of cerebral circulation and the appearance of additional symptoms of the disease.

It is worth noting that the cause of a hemorrhagic stroke can be not only a rupture of a blood vessel. The fact is that in a number of pathologies ( for example, with prolonged spasm of cerebral vessels, with cerebral edema, with trauma, and so on) there may be a violation of the nervous regulation of the tone of the vascular wall. In this case, the affected vessels may lose their tone and expand. In this case, the permeability of the vascular wall will increase significantly, which in some cases can lead to the release of blood from the vessels into the medulla. The resulting small hemorrhages can merge with each other, forming an extensive area of ​​hemorrhagic stroke.

Transient ( passing) stroke ( transient ischemic attack)

This term is used in cases where the patient has signs of ischemic stroke, but they persist for a short time ( from a few minutes to 24 hours) and completely disappear after 24 hours from the moment of occurrence. The mechanism of development of transient ischemic attack is associated with temporary cerebral ischemia ( that is, a violation of the delivery of blood and oxygen to a certain area of ​​\u200b\u200bthe brain). The reason for this may be small blood clots that temporarily clog the blood vessel, however, against the background of activation of the anticoagulant blood system or drug exposure, they “dissolve”, after which the blood flow through the vessel is restored. Since the formation of a thrombus and impaired cerebral circulation, the functions of nerve cells in the affected area are violated, which is the cause of the symptoms of a stroke. At the same time, the affected cells do not have time to die, as a result of which, after the removal of the thrombus, their function is fully restored.

Another reason for a transient ischemic attack may be the narrowing of the lumen of a vessel affected by atherosclerotic plaque, which blocked it only partially. Against the background of narrowing ( spasm) the plaque temporarily covers the entire lumen of the vessel, which leads to the appearance of signs of a stroke. However, after the spasm is eliminated, the blood flow through the vessel is partially restored, and the symptoms of the disease disappear.

Microstroke ( mini stroke, small stroke)

With this pathology, ischemic stroke develops in small ( thin) cerebral arteries that supply blood to relatively small areas of the brain. At the time of damage to such a vessel, the patient develops characteristic signs of a stroke, which persist for more than 24 hours, but not more than 3 weeks ( the nature of the symptoms depends on the localization of the pathological process). Within a maximum of 3 weeks from the moment of development, all signs of the disease disappear without a trace, and impaired functions are fully restored.

The mechanism of development of a microstroke and recovery of the patient after it is explained as follows. At the time of blockage of any small blood vessel in the brain, the nerve cells supplying it with blood lose their function, as a result of which the patient has signs of a stroke. Some of the cells may die, but most of them survive, since blood begins to flow to them through the collateral ( "bypass") arteries. Over time, the bypass arteries develop quite strongly ( that is, new small branches of blood vessels are formed that provide blood delivery to the affected area of ​​​​the brain), as a result of which the functions of damaged nerve cells are completely restored.

If three weeks after the onset of the disease there are any signs of damage to the central nervous system, this is not a microstroke, but a full-fledged ischemic stroke.

Repeated stroke

A recurrent stroke is said to occur when signs of the disease develop in a patient who has already had one or more strokes in the past. A prerequisite for this is the occurrence of signs of acute cerebrovascular accident, as well as the appearance of new symptoms of damage to the central nervous system ( against the background of already existing complications remaining after a previous stroke).

The development of a recurrent stroke indicates severe disorders of the blood supply to the brain, as well as the presence of a large number of uncontrolled risk factors in the patient, and therefore the likelihood of a favorable outcome is significantly reduced.

Stroke severity

The severity of a stroke is determined by the presence and severity of symptoms of the disease.

Depending on the patient's condition, there are:

• Light severity. It is characteristic of a micro-stroke or transient stroke, when the patient's disorders do not pose a threat to his life. All symptoms of the disease completely disappear within a few weeks from the moment of its onset.
• Medium severity. It is characteristic of a full-fledged stroke, in which there are signs of damage to certain areas of the brain. In this case, the patient has certain neurological disorders ( sensory disturbances, movement disorders, etc.), however, the patient's consciousness is preserved, and the functions of the respiratory, cardiovascular and other vital systems of the body are not disturbed.
• Severe severity. It is characterized by the above symptoms of impaired brain function, as well as