Stroke, causes and symptoms, first emergency medical care for a stroke.

A stroke is a serious neurological disease that develops as a result of an acute violation of blood flow through the cerebral vessels and resulting from oxygen starvation of nerve cells with their subsequent death. Depending on in which part of the brain this disorder occurred, the symptoms of a stroke can manifest themselves in different ways and can be from minor to very severe. 

Stroke, causes and symptoms, first emergency medical care for a stroke.

In most cases, the primary cause of impaired blood supply to the brain is arteriosclerosis of the arteries. In this disease, there is a similarity to myocardial infarction, so in neurology they often use a different definition – cerebral infarction. Due to growing atherosclerotic plaques filled with cholesterol, the lumen of the vessels is gradually narrowing. If, due to some factors, a cerebral artery ruptures or a complete abrupt cessation of blood flow inside it occurs, a stroke develops.

, and the result is the same lack of blood supply to the brain – ischemia, passing into the necrosis of part of the gray matter.

For a stroke, the same risk factors as for coronary heart disease are significant: smoking, a sedentary lifestyle, a diet high in animal fats, an increase in blood cholesterol, etc. If the patient has signs of coronary arteriosclerosis (angina pectoris myocardial infarction, heart failure), he should be attentive to his health, as he is more likely than a person not suffering from these diseases to develop a stroke.

The disease is not always observed exclusively in the elderly; young, even in the absence of atherosclerotic changes in blood vessels, can also become its victims. For example, cerebral hemorrhage is possible with an overdose of certain medications, and in pregnant women it can occur due to pathologies – preeclampsia and eclampsia.

Symptoms of a stroke.

Different parts of the brain perform various functions and are responsible for “their” areas of the body and “responsibilities”. Therefore, the symptoms can be absolutely anything – from hearing impairment to paralysis. All symptoms of a stroke are divided into three groups. Cerebral symptoms are signs of any disorder in the central nervous system, autonomic ones are the reaction of the autonomic nervous system to the cessation of blood flow in a particular area of ​​the brain.

Focal symptoms of a stroke are direct signs of a lack of blood supply in a particular area of ​​gray matter. According to the latter, you can determine exactly where the stroke occurred and which blood vessel is affected. Common cerebral symptoms include spilled or local headache, which can reach great strength, fainting (usually short-lived), nausea and vomiting.

Various disorders of consciousness are possible: lethargy or, conversely, excessive excitement, in which the patient is practically uncontrollable, a sharp decrease in attention and memory, impaired mental processes, disorientation. There are emotional disorders (irritability, anger, laughter, crying, depressive manifestations). A common cerebral symptom is dizziness..

Vegetative symptoms are less diverse. It can be chills or a feeling of heat, sweating, the appearance of “goose” skin, a feeling of interruptions in the work of the heart, trembling, a feeling of lack of air. More often, a stroke occurs in those areas of the brain that are responsible for voluntary, that is, controlled by the person himself, movements. The “loss” of the function of a particular part of the brain in these cases is manifested by focal symptoms such as paresis, a partial loss of ability to move. Or paralysis, complete inability to control muscles.

In the first case, this will be manifested by weakness in one or both limbs on the one hand, difficulties when asking to perform some kind of movement (clench your fist, keep your hands on the weight, bend your leg at the knee, take several steps, etc.). In the second, a person will no longer feel the affected part of the body and move it. If the blood flow has stopped in the area of ​​the brain responsible for the muscles of the face, there are symptoms of a stroke such as drooping of the eyelid or corner of the mouth on one side.

Sometimes patients with a stroke can have a speech disorder. Viscosity, fuzziness in the sound of words appears, speech becomes slow, often resembling the manner of speaking when intoxicated. With paralysis, the patient is able to generally lose the ability to pronounce sounds. Nerves extending from the right and left sides of the brain and spinal cord to the organs intersect along their path. Therefore, if a person has a violation of mobility (hearing, vision) on the one hand, the focus of ischemia is in the opposite part of the brain.

Hemorrhagic stroke is most often affected by people of both sexes up to 60 years. Moreover, the disease usually begins in the afternoon or evening, in the midst of activity. Often, it is preceded by a hypertensive crisis, stress or physical activity. Ischemic disorders usually occur in the elderly, can begin at any time, but mainly at night and in the early morning hours. The development of the disease is relatively slow: dozens of minutes or hours pass from full health to vivid symptoms.

First Aid Stroke Medical Aid.

For proper emergency care for a stroke, it is first necessary to determine whether the patient has a cerebrovascular accident or not. Why you can conduct several tests for mobility in different muscle groups. The simplest of them is to ask the patient to say a few words (to assess the clarity of speech) or stick out his tongue. With a stroke, it may deviate to the side.

Also, a person with a stroke is often not able to frown his forehead or grin: his face becomes asymmetric, since on the one hand the blood supply to part of the brain is impaired, so there will be a unilateral violation of facial expressions. The task of diagnosing the condition is facilitated if the patient has obvious signs of the disease (omission of the angle of the mouth) that has just appeared. Checking the function of the arms and legs is simple. You need to ask a person to perform several movements. Better at the same time symmetrical limbs or alternately.

In case of a recent disease with paresis, for example, of the right upper limb, the patient, upon request, can raise his hands to the same level, but after a few seconds the right one will lower. Sometimes differences between limb functions are more difficult to detect. For example, both hands move the same way, but when asked to squeeze the fingers on the wrist of the doctor or person providing care from the side opposite to the stroke (where the paresis is), the compression is weaker.

In more severe cases for diagnosis, there are no motor disorders among the focal symptoms of a stroke. The disease is manifested, for example, by a sudden visual impairment on the one hand. In such cases, one must be very attentive to cerebral and autonomic symptoms. Stroke is a very dangerous disease. Therefore, when providing emergency care, first of all, care must be taken to transfer the patient to the hands of doctors as soon as possible.

It is laid on a level surface and provides him with access to fresh air. If a person is conscious and scared, you need to try to calm him down, since the increase in blood pressure, accompanying severe stress, can lead to an aggravation of the condition. Throughout the waiting time for doctors or transporting the patient to the hospital (transport only lying!) They control the level of blood pressure, respiratory rate of the pulse.

In patients with facial expressions, the lesion may be located in the medulla oblongata. There are also vasomotor and respiratory centers. If they are in the zone of damage, the patient stops breathing and palpitations. In this case, you need to immediately begin cardiopulmonary resuscitation. When even at first glance the patient’s condition is serious (he is unconscious, a large part of his body is paralyzed), you cannot move a person yourself, you should wait for the arrival of the ambulance team.

As for medicines, with high blood pressure, a patient can be given a drug to reduce it. For example, captopril at a dose of 25 mg under the tongue or nifedipine tablet. However, even in such a simple action, care must be taken. If it is known that the same captopril in this patient sharply reduces blood pressure, its dose should be reduced in order to avoid a deterioration in well-being. When the upper, systolic, blood pressure is less than 180 mm Hg. Art., it is better to refrain from this group of drugs.

A stroke can bring with it a complication such as cerebral edema. In order to prevent it, you should give the patient 40–80 mg of furosemide or administer it intravenously. If one of the assistants has injection skills. To improve metabolic processes, reduce oxygen starvation in the brain, you should give the patient 3-4 tablets of glycine under the tongue. Arriving physicians must definitely say what medicines and in what dose the patient has already been given.

Based on the book “Quick help in emergency situations”.
Kashin S.P..

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