According to the World Health Organization, cardiovascular diseases “are the leading cause of death worldwide – every year more people die from them than from any other disease. It is estimated that 17.3 million people died in 2008, or 30% of all global deaths, of these deaths, an estimated 6.2 million are from the stroke. A large proportion of diseases are recorded in low- and middle-income countries: they account for more than 80% of deaths distributed almost evenly between men E and women. By 2030, Probable, mainly from heart disease and stroke, die about 23.6 million people. According to forecasts, these diseases remain the main causes of death of the individual. “(World Organization of healthcare)
Types of stroke
Stroke is an acute disorder of the cerebral circulation, the symptoms of which persist for more than one day.
There are three types of stroke: ischemic stroke, haemorrhagic stroke, and subarachnoid haemorrhage.
Aschemic stroke most often develops with constriction or blockage of arteries – blood vessels, through which blood enters the brain. The cells of the brain die without getting the necessary oxygen and nutrients. This type of stroke is also called a cerebral infarction by analogy with myocardial infarction.
The reasons for the clogging of the vessel may be different. The vessel can be closed with an embolus – a piece of intracardiac thrombus that occurs with certain diseases of the heart, or a piece of an atherosclerotic plaque located on the wall of a large vessel. The cause of blockage of the vessel may be a thrombosis – the formation of a blood clot (similar to the one that is formed in cuts of the skin with the wound of the surface vessels). A thrombus is usually formed on the surface of an atherosclerotic plaque. Thrombosis is promoted by increased blood coagulability and increased ability to adhere (aggregate) blood platelets (platelets). Spasm of the cerebral vessel leading to a cerebral infarction is a rare phenomenon. Spasm of cerebral vessels usually occurs a few days after subarachnoid haemorrhage.
Sometimes the infarction develops and in the absence of complete blockage of the vessel, when there is only a pronounced stenosis – a narrowing of the lumen of the vessel with an atherosclerotic plaque by 70-90%. With a sudden drop in blood pressure, blood entering the brain through a narrowed vessel, may not be enough for normal brain nutrition, resulting in a heart attack.
With frequent increases in blood pressure, changes in the walls of small vessels that feed deep structures of the brain can develop. These changes lead to narrowing, and often to the closure of these vessels. Sometimes, after another sharp rise in blood pressure (hypertensive crisis), a small heart attack develops in the bloodstream of this vessel (called a “lacunar” infarction in the scientific literature).
Ischemic stroke occurs 4 times more often than another type of stroke – haemorrhagic.
Haemorrhagic stroke often develops when the arteries break. Spilled blood permeates part of the brain, so this type of stroke is also called a haemorrhage to the brain. The most common haemorrhagic stroke occurs in people with arterial hypertension and develops against a background of increased blood pressure. At some point, the vascular wall does not stand up to a sharp rise in blood and breaks. The rarer cause of haemorrhagic stroke is an aneurysm rupture. The rupture of the vessel on the surface of the brain leads to the ingress of blood into the space surrounding the brain (subarachnoid space). This type of stroke is called subarachnoid haemorrhage.
Recognising the signs of a stroke
NHS presents the symptoms of a stroke that must be known to everyone, especially those who care for the elderly and people predisposed to a stroke. «The signs and symptoms of a stroke vary from person to person but usually begin suddenly.
As different parts of your brain control different parts of your body, your symptoms will depend on the part of your brain affected and the extent of the damage.
The main stroke symptoms can be remembered with the word F.A.S.T.:
Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have drooped.
Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm.
Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
Time – it’s time to dial 999 immediately if you notice any of these signs or symptoms.” (NHS)
Operative treatment of stroke can prevent long-term disability and save lives.
The specific treatments suggested depending on whether a stroke is caused by. Treatment usually includes taking one or more different medications, even though some people may moreover need surgery.
Treating ischaemic strokes
A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy (this removes blood clots and helps restore blood flow to the brain).
Most people will be offered a regular dose of aspirin (aspirin is an antiplatelet, which reduces the chances of another clot forming).
Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the future. Also could be recommended Thrombolysis (using injections of a medication called alteplase, which dissolves blood clots and restores blood flow to the brain). This use of “clot-busting” medication is known as thrombolysis.
Treating haemorrhagic strokes
Some people who have had a haemorrhagic stroke will be offered medication to lower their blood pressure and prevent further strokes.
Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy. (NHS)
A 10-year study conducted by Framingham Study cohort identified the following risk factors for stroke: age, systolic pressure, the use of antihypertensive therapy, diabetes mellitus, and cigarette smoking, prior, cardiovascular disease (coronary heart disease, cardiac failure, or intermittent claudication).
Similar data were obtained from the study from the American Heart Association
«No modifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include, hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidaemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache and infection”.
Talor,J.,B.,(2009),My Stroke of Insight: A Brain Scientist’s Personal Journey , Pengrin Group, New York ,NY 10014.
Torbley, M.T.,Selim,M.H.,(2013),The Stroke Book ,2st Edition, Cambrige Univercity press Cambrige, CB28BS
Morrison, K.,(2014) ,Fast Facts for Stroke Care Nursing: An Expert Guide in a Nutshell ,Springer Publishing Company, New York,NY10036.
Wolf, P.A., Belanger, A.J.,(1991),Probability of Stroke: A Risk Profile From the Framingham Study ,The American Heart Association, Dallas, TX 75231 doi: 10.1161/01.STR.22.3.312 Stroke. 199
Primary Prevention of Ischemic Stroke Stroke. (2006); The American Heart Association, Dallas, Inc. All rights res1;22:312-318 https://www.nhs.uk/conditions/stroke/treatment/ (30.11.20017) http://www.doctorfm.ru/lechenie/pervaya-pomoshch-cheloveku-pri-insulte-podrobnoe-rukovodstvo (30.11.2017) http://www.who.int/cardiovascular_diseases/about_cvd/en/( 2.12.1017) https://media4.picsearch.com/is?Ar45WUjTVUrMTzEZ73VOc37egn4s9636x1B0OxgyODA HYPERLINK “https://media4.picsearch.com/is?Ar45WUjTVUrMTzEZ73VOc37egn4s9636x1B0OxgyODA&height=227″& HYPERLINK “https://media4.picsearch.com/is?Ar45WUjTVUrMTzEZ73VOc37egn4s9636x1B0OxgyODA&height=227″height=227 (2.12.2017)