CC BY
2UDC 616.8-005
STROKE IS A DISEASE OF THE XXI CENTURY
SHAMSUTDINOVA OKSANA VLADIMIROVNA
Neuropathologist, MSI «Rehabilitation Center for Disabled People in the village of Grekhovo, Altai District, East Kazakhstan Region» of the Department for Coordination of Employment and
Social Programs of the East Kazakhstan Region Altai, Kazakhstan
Annotation. This article discusses the risk factor for acute cerebrovascular accident (ACVA), which is characterized by a sudden onset from several minutes to several hours, manifested by focal neurological symptoms (sensory, coordination, motor, speech, visual and other disorders), as well as general cerebral disorders (depression of consciousness, vomiting, headache, etc.), which may persist for less than or more than 24 hours or may lead to the death of the patient in a fairly short period of time, the cause of which may be cerebrovascular disorders.
Key words: Acute cerebrovascular accident, stroke, risk factor, diagnosis.
Introduction. The study is retrospective, the aetiology, diagnosis of the disease of acute cerebral circulatory disturbance was analysed. The available materials risk factors, clinic and diagnostics of the pathology of the brain disease were studied.
The main part.
According to the latest WHO data, stroke is a rapidly developing global disorder of brain function that lasts more than 24 hours or can lead to the death of the patient, if another cause of the disease is excluded, and is the second leading cause of death worldwide [1,3]. According to international epidemiological studies, in many countries stroke ranks 2-3 in the total mortality of the population. Disability from stroke takes the 1st place among the causes of primary disability, according to the data of various authors up to 40 % [1]. A few surviving patients 8% are able to return to their previous work after suffering an ACVA, 20% of patients cannot walk independently, 31% of patients need assistance and care. Acute disorders of cerebral circulation is one of the significant problems for people of working age, which indicates the special importance of preventive work with the population and, above all, on the control of risk factors, correction both in specific groups of people and in the population as a whole [1,5].
Medical and socio-economic consequences of stroke are very high, lethal outcome in the acute period occurred in 34.6 %, and within the first year after the end of the acute period of the disease in 13.4 %, deep disability with the need for constant care in 20.0 % of stroke patients, 56.0 % are completely unable to work, and only from them 8.0 % of patients return to their previous work activity.
The risk factors.
One of the most important factors that increase the risk of developing ACVA are: arterial hypertension, cardiovascular diseases, atrial fibrillation, diabetes mellitus, pathology of the main arteries of the brain, lipid metabolism disorders, haemostatic disorders. Unadjustable risk factors include: gender, age, heredity, ethnicity. There are also risk factors associated with violation of a healthy lifestyle: smoking, overweight, reduced physical activity, poor diet or insufficient consumption of fruit and vegetables, alcohol abuse, prolonged psycho-emotional tension, constant stress. The main risk factors are smoking 59.8% of adult men and 9.1% of women, hypertension 39.9 and 41.1%; high cholesterol 56.9 and 55.0%; obesity 11.8 and 26.5%; heavy alcohol consumption 12.0% of men and 3.0% of women [7].
Increased systolic and diastolic blood pressure figures in arterial hypertension increase the risk of ischaemic, as well as haemorrhagic stroke. Patients with high arterial hypertension develop stroke 7-10 times more often than patients with normal blood pressure. Stroke mortality doubles for every 10 millimetre of mercury column increase in systolic arterial pressure; reducing high diastolic arterial
pressure by 5 millimetres of mercury column increase and systolic arterial pressure by 12 millimetres of mercury column reduces the risk of developing an ACVA by 34% to 36%. One of the significant risk factors for ischaemic stroke is atrial fibrillation (or atrial fibrillation), in which the risk of stroke increases 3-fold. If the patient has ischaemic heart disease, the risk of stroke increases 2-fold, in case of left ventricular hypertrophy determined on electrocardiogram 3-fold, and in case of heart failure 3-fold. Smoking increases the risk of ischaemic stroke up to 4 times, subarachnoid haemorrhage 3 times, coronary heart disease up to 6 times. The degree of risk depends on the number of cigarettes smoked per day, as well as the duration of smoking, the number of years. Heavy alcohol consumption increases the risk of stroke, especially haemorrhagic stroke, almost twice [8].
Clinic. Stroke must be suspected in cases of acute development of focal neurological symptoms, as well as a sudden change in the level of consciousness. In brain dysfunctions that develop with stroke, focal symptoms are defined, these are neurological manifestations that are associated with the lesion of certain structures of the brain, meningeal syndrome with lesions of the cerebral membranes, brain disorders: headache, vomiting, change of consciousness in the patient. Signs and focal symptoms of ACVA depend on the lesion of a particular cerebral vascular basin.
1. Motor disorders: hemiparesis, hemiplegia on the side opposite to the brain lesion. There is weakness, awkwardness and stiffness in the arm, leg. There may be a combination of arm and lower facial musculature lesions.
2. Sensory disturbances: sensory disturbances in the form of reduced or absent pain, numbness, hypoesthesia, anaesthesia, paresthesias. Hemithymia is most often noted: half of the face, trunk, arm and leg on the side opposite to the lesion.
3. Speech disorders: speech difficulties, slurred and unclear speech, difficulties in understanding the speech of others, sensory and motor aphasia. It is possible to combine speech impairment with writing and reading impairment.
4. Visual disturbances: blurred vision, hemianopsia occurs with lesions in the parietal lobe, hemianopsia occurs with lesions in the temporal lobe.
5. Gaze paresis: restriction of eyeball movement to the side opposite to the stroke centre.
6. Tongue deviation: occurs in the side opposite to the focus of the stroke, the tongue deviates towards the paralysed part of the body.
7. Smoothing of the nasolabial fold: the corner of the mouth is lowered decreased tension of facial muscles on the opposite side of the face from the centre of the stroke [4].
Diagnosis at the prehospital stage.
The main task of primary care physicians and emergency medical services at the pre-hospital stage is to quickly diagnose an ACVA, based on complaints from relatives, history taking, physical and clinical neurological examination. It is not necessary to determine the nature of stroke hemorrhagic or ischemic at the prehospital stage, as it can be determined in hospital after a computer or magnetic resonance imaging of the head. For correct and accurate diagnosis of stroke, it is necessary to know and be able to identify the main clinical and neurological syndromes during neurological examination, which may be focal, general cerebral or meningeal, characteristic of stroke. When collecting anamnesis of a patient with suspected stroke, it is necessary to specify the time of appearance of neurological symptoms and the presence of a risk factor, such as arterial hypertension, diabetes mellitus, atrial fibrillation, ischaemic heart disease, already suffered in the past ACVA, etc. At the pre-hospital stage, it is necessary to make an initial differential diagnosis of stroke with other diseases that have clinical similarity to stroke. Such diseases as hypoglycaemia, seizures, epilepsy, epileptic syndromes, craniocerebral trauma, encephalitis, brain abscess, migraine with aura, brain tumours, psychiatric disorders, coma, metabolic or toxic encephalopathy, multiple sclerosis, acute hypertensive encephalopathy, etc. [2].
At the pre-hospital stage, the first signs of stroke should be diagnosed using the Face Arm Speech Test, and patients with suspected stroke should be urgently transported to the nearest stroke centre. In the acute period, arterial pressure reduction is not recommended unless the level is higher than 220/110 millimetre of mercury collum. Patients suffering from persistent arterial hypertension
should not allow arterial pressure to fall, in persons without a long history of hypertension not lower than 160/90 millimetre of mercury column and in patients with persistent hypertension 180/100 millimetre of mercury column. It is necessary to monitor the patient's blood glucose level in the first 72 hours in the stroke centre [9].
Non-medicamentous treatment.
It is necessary to talk to the patient about lifestyle changes, the harm of smoking and preferably with an official smoking cessation programme, physical exercise on a regular basis, adherence to an optimal diet with a reduction in saturated fats and salt, avoidance of excessive consumption of alcoholic beverages, regular screening of BP and the necessary therapy for arterial hypertension with monitoring of blood coagulation indices [9].
Therapy in the recovery period.
One of the pillars of rehabilitation therapy in stroke patients is multidisciplinary rehabilitation, prevention and control of complications, medication prevention of recurrent stroke, necessary care and restoration of self-care skills. In addition, various groups of medications are used to improve cerebral blood circulation and neurotrophic functions of the brain, to provide symptomatic therapy, and to treat post-stroke conditions in patients. It should be noted, from the point of view of evidence-based medicine at this time there is no complete convincing confirmation of the high efficacy of cerebroprotective, vasoactive, and nootropic agents in the treatment of patients who have suffered a stroke [6].
Conclusions:
1. Some risk factors for stroke, the population is able to change on its own, and this is the need to introduce a healthy lifestyle, nutrition, sports, exclude the use of alcoholic beverages, as well as smoking.
2. Patients at risk, in order to reduce disability among the working population, should be examined, registered, if necessary, outpatient or inpatient treatment.
3. Prevention among patients at risk at the outpatient level.
1. Stroke: A Guide for Physicians / Edited by L.V. Stakhovskaya — M.: OOO "Medical Information Agency", 2013. — p.400
2. Levshakova A. V., Domashchenko M. A. Acute cerebrovascular accident: diagnostic and organizational aspects (lecture). // Scientific and practical journal "Radiology practice" - 2014. -49 p.
3. Handbook of Neurology: / Edited by Lawrence R., Moscow: Medicine, 2000, pp. 290-301.
4. Skvortsova V.I., Krylov V.V. Hemorrhagic stroke: Practical guide- //M. GEOTAR-Media. -2005- P.8-13.
5. Trofimova T.N. Neuroradiology // Publishing house of St. Petersburg Medical Academy of Postgraduate Education - 2005. - 172 p.
6. Kandyba DV. Mistakes in outpatient neurological practice. Part II // Russian family doctor. -2015. - Vol. 19. - No. 1. - P. 13-20. [Kandyba DV. Mistakes in outpatient neurological practice. Part II. Russian family doctor. 2015; 19(1):13-20. (In Russ).] doi: 10.17816/RFD2015113-20.
7. Skoromets A.A., Shcherbuk Yu.A., Aliev K.T., et al. Prehospital care for patients with cerebral strokes in St. Petersburg. Proceedings of the All-Russian scientific-practical. Conference "Vascular diseases of the nervous system" - St. Petersburg, 2011 - P. 5-18.
8. Kandyba D.V. Stroke prevention: a tutorial. — St. Petersburg: Publishing house of the NorthWestern State Medical University named after I.I. Mechnikov, 2013. — 84 p.
9. Acute ischemic stroke. Clinical protocol of the Ministry of Health of the Republic of Kazakhstan dated December 15, 2023. Protocol N199.
LIST OF REFERENCES
