Neurologist about the pre-stroke state, manifestations of the disease and the "therapeutic window"

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

In Belarus, 25-30 thousand people fall ill with stroke every year. Moreover, every fourth patient is at risk of dying from acute cerebrovascular accident during the first episode. In addition, a fatal outcome can develop within a year after the disease as a result of complications or repeated circulatory disorders. The sad statistics is complemented by the fact that only 20% of patients return to work after a stroke. Understanding the seriousness of the situation, we believe, should encourage a more attentive attitude to the health of one's own and those close to them. 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 symptoms of a pre-stroke state, manifestations of the disease and the "therapeutic window" in the project "In the subject" on the YouTube channel of BelTA.

A stroke does not occur in a completely healthy person.

According to Vyacheslav Vashchilin, a stroke is a disease that 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.

The DOCTOR emphasizes 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, this is always a secondary condition. To prevent it from developing, certain prevention is required," he said.

How to recognize a pre-stroke condition

According to the chief freelance neurologist, a pre-stroke state is a fairly common term. It is understood 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 a stroke. With a very high probability, this can be called a pre-stroke state," Vyacheslav Vashchilin noted.

So that the battle for the harvest does not end in a stroke

The chief freelance neurologist explained why summer residents are at particular risk. After winter physical inactivity, a person begins to work hard on the plot and provokes risk factors that can lead to the development of a stroke. This refers to an increase in blood pressure during physical activity in an untrained person, an excessive load on the cardiovascular system, which can cause heart rhythm disturbance and coronary heart disease, a load on peripheral vessels, the venous system, Vyacheslav Vashchilin explained.

Another problem is dehydration. In people who drink insufficient amounts of fluid, the development of blood clots, a violation of coagulation, is not excluded. This is a serious problem, especially for older people, Vyacheslav Vashchilin noted. 

“If a person drinks little liquid, in conditions of high temperature this can lead to increased blood clotting and the risk of thrombosis. Therefore, you do not need to work under the scorching sun, and you should approach the increase in physical activity quite gradually,” he added.

The chief freelance neurologist also answered whether it is possible to stay with your HEAD down for a long time while working in the garden. According to him, prolonged exposure to an inclined position can be more likely to provoke problems associated with the spine. “Yes, there are reasons for the development of a stroke that arise due to the influence of the pathology of the spine on the vessels that feed the brain. But this is a rarer situation than the one caused by the main risk factors - dehydration, increased and jumps in blood pressure,” said Vyacheslav Vashchilin.

"A person, having worked hard in the country, comes home, measures his blood pressure and, finding high blood pressure figures, uncontrollably takes antihypertensive drugs in large quantities, greatly reducing pressure. These jumps are more likely to lead to disruption of the blood supply to the brain," added the chief freelancer neurologist.

Contraceptives and cerebral infarction

By the way, taking contraceptives increases the risk of developing a cerebral infarction by 1.5 times. In this regard, many studies have been conducted and there is even a Cochrane review (an international organization conducts a meta-analysis of all studies and provides a general view of the situation). "According to the available data, women who take contraceptives are approximately 1.5 times more likely to develop a cerebral infarction than those who do not take them," Vyacheslav Vashchilin said.

At the same time, he noted, modern drugs contain low doses of estrogen, so the risks are significantly reduced. However, along with taking contraceptives, other factors also matter. There is information in a number of publications that the risks of developing a stroke in women who take contraceptives, but monitor their blood pressure, do not drink ALCOHOL and do not smoke, are approximately comparable to those of women who do not take them.

"The topic is relevant, but the view on it is ambiguous. There is a risk, but it is not so high. In each case, when taking contraceptives, one must proceed from medical indications," Vyacheslav Vashchilin noted.

Answering the question of how long contraceptives should be taken for the risks to seriously increase, the chief freelance neurologist said that in this case there is no time-dependent effect. "Contraceptives can affect the blood coagulation system, so the disease can develop both after using the first package, and after a few years, when several risk factors come together," he said.

The most common symptoms of a stroke

In the primary diagnosis of stroke throughout the world, a standard technique is used - the FAST test (Face Arm Speech Test). This English abbreviation stands for "face - hand - speech - test". This is due to the fact that most often with the disease, speech is disturbed, weakness in the arm or leg and asymmetry of the face occur. "These are the most noticeable and most frequent symptoms in the development of acute cerebrovascular accident," Vyacheslav Vashchilin noted.

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

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. That is, this is an acute situation,” the chief freelance neurologist emphasized.

Microstroke is hard to miss

In some cases, if the volume of the lesion is small (the so-called lacunar, or transient violation of cerebral blood supply), a person may not feel any neurological deficit some time after this episode. But with neuroimaging - computed or magnetic resonance imaging - the focus of brain damage is detected.

At the same time, a violation of movement, awkwardness in the hand, weakness, a person will feel first of all himself. The asymmetry of the face (the eye blinks badly, saliva flows from one corner of the mouth) he also cannot miss. "It's almost impossible not to notice it yourself," the doctor said.

Therefore, as practice shows, young patients with a stroke most often go to the ambulance themselves, but grandparents often endure: maybe it will pass.

Is there pain in a stroke?

Vyacheslav Vashchilin explained: an acute violation of cerebral blood supply occurs due to subarachnoid, or intracerebral, hemorrhage, and due to a lesion like a brain infarction.

He noted that pain syndrome is not typical for cerebral infarction. “It can develop when the stroke is already regressing, and for various reasons, pain may appear in the post-stroke period, but in the acute period, pain in cerebral infarction is not typical,” said the chief freelance neurologist. “And quite the opposite with subarachnoid hemorrhage, when the pain is severe . Patients, as a rule, talk about a pronounced and acute headache (as if hit with a dagger), which occurs due to irritation of the meninges.

Strokes can also cause other symptoms, such as hearing and vision problems. "Some experts single out impaired blood supply to the organ of vision or the auditory analyzer as a separate problem, while others consider acute cerebrovascular accident as a general problem. In any case, we are talking about peripheral analyzers that are located in the cranium and are supplied with blood by the same vessels as the brain" - said Vyacheslav Vashchilin.

He noted that with a sharp impairment of vision and hearing, 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," he stressed.

What if there is numbness in the limbs?

Numbness in a limb can occur if you sit your leg or lie down your arm in a dream. However, this feeling is rather a subjective interpretation. “This is how a person can describe both weakness in the arm and the appearance of some unpleasant painful paresthesias. Most often this is a symptom of a peripheral problem, and not a brain lesion. Numbness and “goosebumps” in the fingertips, palm, leg are not characteristic of a stroke, " - said Vyacheslav Vashchilin.

"We can sit or lay down our arm, but in this case, the restoration of peripheral blood supply will lead to the restoration of limb function within a few minutes. For this, you do not need to wait half an hour - an hour. That is, the restoration of blood supply in peripheral tissues occurs quite quickly. But if the process lasts several longer, this is a reason to call an ambulance," he said.

At the same time, the chief freelance neurologist noted that the appearance of any incomprehensible symptomatology that does not go away within a few minutes is already a reason to seek medical help.

There are only 4.5 hours 

There are only 4.5 hours to radically influence the development of acute cerebrovascular accident and save at least some of the dying brain cells. This is the so-called therapeutic window. 

“We talk about the concept of a “therapeutic window” when we are trying to restore the blood supply to the brain,” said Vyacheslav Vashchilin. “The lesion goes through several stages. First, a small nuclear part is damaged. There is a so-called penumbra zone around it. In this part of the brain, nerve cells work bad due to insufficient blood flow, but still viable.Having restored the blood supply in this area, we return them to life, to work.If you do not take active steps within 3.5-4.5 hours, poorly functioning nerve cells will go into discharge dead."

According to studies, the greatest effect of thrombolytic therapy and the lowest risk of side effects are achieved within 4.5 hours. “Intravenous administration of alteplase, which, in simple terms, dissolves blood clots, is most effective during this particular period. Therefore, all medical documents that regulate our work are aimed at conducting thrombolytic therapy precisely at this time interval. 4.5 hours," Vyacheslav Vashchilin noted.

At the same time, he noted, science does not stand still: thanks to new opportunities and programs, it is possible to more correctly single out the “penumbra window” and talk about its size and relationship with the lesion core. Due to this, in some cases, the "therapeutic window" can expand.

The chief external neurologist emphasized that the "therapeutic window" of 4.5 hours is not the time from the onset of symptoms to the call to the doctor, but the time from the onset of symptoms to the moment when the patient is given a drug. It is important to understand that after the patient is taken to the hospital, X-ray computed tomography is performed to exclude other pathologies, for example, a brain tumor, intracerebral hemorrhage, and an inflammatory process. "Having diagnosed and confirmed a cerebral infarction, we can carry out thrombolytic therapy," he said.

Only 20-30% of stroke patients fall into the "therapeutic window"

“The statistics that we have show that 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,” Vyacheslav Vashchilin said.

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

How to reduce the risk of recurrent cerebral infarction

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.

"According to statistics, the probability of getting a second cerebral infarction within a year is quite high - 5-10%. Influencing these risk factors allows us to carry out secondary prevention, which reduces the risk of a second stroke," Vyacheslav Vashchilin said.

According to the chief freelance neurologist, the system of rehabilitation of patients after a stroke is well established in Belarus. "This is a long process. Rehabilitation begins literally from the first day after the initial stage of treatment and continues both in the medical institution where the patient is (each stroke department has a rehabilitation doctor, a speech therapist), and at the next stage," he said. he.

Is it necessary to examine the vessels after covid-19

Patients who have had a COVID-19 infection, in some cases, 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,” Vyacheslav Vashchilin noted.

As for preventive examinations of blood vessels, the age of a person is an indication, he noted. “We know that from the age of 55, the risk of a stroke increases by 2 times every 10 years. The fact of undergoing COVID-19 in itself, in the absence of other risk factors, is not, in my opinion, fundamental. Unfortunately, almost everyone had covid during the pandemic. -infection, some several times. Therefore, you need to focus directly on clinical indications, "the chief freelance neurologist believes.

Heart rhythm disturbances detected by ECG, some discomfort in the heart area, high cholesterol or other symptoms - this is a reason to undergo an additional study of the cardiovascular system, Vyacheslav Vashchilin noted.

At what age to undergo duplex scanning of blood vessels

"Investigation of the vascular system (and in routine practice this is duplex scanning of the brachiocephalic arteries) is a very informative method. It is desirable to undergo it as part of preventive dispensary observation for people over 55 years of age. If there are changes, it is desirable not only to perceive this as a statement of fact, but also to take therapy, allowing to maintain the blood coagulation system at the required level and to prevent the further growth of atherosclerotic plaques,” said Vyacheslav Vashchilin.

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 in 3-6 months. If the plaque is 20-30%, then the study can be completed in a year," the physician said.

In the future, the frequency of control of the condition of atherosclerotic plaques decreases, since they are usually stable. "If we see that within the first year or several months the plaques change in size, this is an indication to either conduct more careful and more frequent monitoring, or prescribe treatment," said the chief external neurologist.

Young people without clinical indications do not need to undergo duplex scanning of blood vessels, Vyacheslav Vashchilin noted. “A doctor is always happy when a patient has a lot of examinations, when there is something to evaluate and analyze. But protocols, routine practice do not involve a general duplex scanning of cerebral vessels,” he said. “However, hereditary predisposition, the appearance of incomprehensible symptoms, complaints, or the presence of factors risk (cardiac arrhythmia or high cholesterol) is a reason to conduct a vascular study at a younger age," he said.

Whether to reduce blood pressure in a patient with a stroke

And finally, first aid. It is desirable to lay the patient with signs of a stroke in a horizontal position. “Unless a person has had vomiting, seizures, another potentially dangerous cause of sudden death that requires intervention, it is better not to do anything until the ambulance arrives,” said the chief freelance neurologist.

According to him, a patient with a stroke before the arrival of doctors can measure blood pressure, but it is not recommended to take measures to reduce it sharply on your own.

“A person has autoregulation of cerebral blood supply. Up to 200-220 mm Hg is the pressure at which the brain can provide adequate blood supply,” said the chief freelance neurologist. “In some cases, the pressure increases automatically by the body to maintain adequate blood supply, so a sharp decrease can, on the contrary, cause side effects - hypoperfusion, brain stealing. Therefore, even medical teams that come to the patient lower blood pressure slowly. "

If the pressure is above 200, after consulting with the emergency doctor, you can give a drug to reduce it. The most common is captopril. “In any case, before giving a person any medication, it is better to consult a doctor who is going to help, and not do it on your own,” Vyacheslav Vashchilin emphasized.

As for drinking, you can give it, he added. "If there is no vomiting, swallowing disorders, because of which a person can simply choke, then, of course, you can give a drink," he said.

BELTA.

plus.yandex.byAdvertising