Nickname: stroke, cerebrovascular accident; English name stroke Clinic: neurology, cardiac surgery; Common causes: arterial-arterial embolism caused by small embolus falling off the inner wall of blood supply vessels in the brain; It can also be caused by cerebrovascular or thrombotic bleeding; Common symptoms: headache, vomiting, disturbance of consciousness, coma, hemiplegia, choking cough, etc.
Symptom discrimination
The typical symptoms of stroke are only headache and vomiting, which are easily confused with other diseases. We can use "fast" to judge:
F is the face, ask the patient to smile to see if the patient's mouth is crooked, the face of the stroke patient will be asymmetrical, and the patient can't smile normally;
A is the arm, asking the patient to raise his hands to see if the patient has numbness and weakness;
S is speech, please ask the patient to repeat a sentence to see if it is difficult to express or slurred speech;
T is the time, clearly write down the onset time and send it to the doctor immediately.
treat cordially
Severe stroke will cause permanent nerve damage, and if it is not diagnosed and treated in time in the acute stage, it will cause serious complications and even death. Stroke can be divided into hemorrhagic stroke and ischemic stroke, and there are different treatment methods according to different parts. Specific therapy includes thrombolysis, antiplatelet therapy, early anticoagulation and neuroprotection, while non-specific therapy includes antihypertensive therapy, blood sugar therapy, management of brain edema and intracranial hypertension.
1. drug therapy
Thrombolytic therapy is recognized as the most effective treatment for stroke at present, but it has strict time window requirements (intravenous thrombolysis is limited to 4.5 hours, and arterial thrombolysis can be extended appropriately).
For patients with existing stroke complicated with hypertension, blood pressure control in acute stroke should be carried out according to stroke guidelines, and the goal of blood pressure treatment for chronic or old stroke should generally be achieved.
It is necessary for patients with hypertension, diabetes, hyperlipidemia and other diseases to take the following drugs: aspirin, beta-blockers, angiotensin converting enzyme inhibitors, statins.
2. Surgery
(1) Carotid endarterectomy is suitable for severe stenosis of extracranial internal carotid artery (the stenosis degree is above 70%), and the stenosis degree is below the mandibular angle, which can be achieved by surgery. Surgery can also be considered within 24 hours of complete occlusion of internal carotid artery. If the occlusion lasts for more than 24 ~ 48 hours, if encephalomalacia has occurred, it is not suitable for surgery.
(2) Extracranial-intracranial artery anastomosis is an effective method to prevent TIA. Superficial temporal artery-middle cerebral artery anastomosis, occipital artery-posterior inferior cerebellar artery anastomosis and occipital artery-posterior cerebral artery anastomosis can be selected.
prevent
The prevention of stroke follows the strategy of three-level prevention: the first-level prevention is to actively treat the risk factors for people with stroke risk factors, and at the same time regularly monitor the occurrence of other risk factors and take targeted measures to reduce the occurrence of diseases; Facts have proved that banning smoking, limiting the salt content in diet, eating more fresh fruits and vegetables, exercising regularly and avoiding excessive drinking can reduce the risk of cardiovascular diseases. In addition, drugs for diabetes, hypertension and hyperlipidemia are needed to reduce the risk of cardiovascular diseases and prevent stroke. Secondary prevention is to give early diagnosis and early treatment to patients who have had one or more strokes to prevent the occurrence of serious cerebrovascular diseases. Five commonly used antihypertensive drugs can be used for secondary prevention of stroke; For people who already have diseases such as diabetes, secondary prevention of cardiovascular diseases should be carried out. These interventions combined with smoking cessation can usually prevent nearly 75% vascular recurrence. Three-level prevention is to strengthen rehabilitation care for patients who have already had a stroke to prevent the disease from getting worse.
The prevention of stroke is mainly the prevention and treatment of risk factors.
Controlling blood pressure has a significant effect on preventing stroke. For stroke patients with stable condition, antihypertensive drugs still need to be taken for a long time.