Emergency care for hemorrhagic stroke should be carried out in a neurological or intensive care unit, according to the principles formulated by B. S. Vilensky (1986):
1. Normalization of vital functions (see the topic GENERAL ISSUES IN RESUSCITATION).
2. The patient should be put to bed with raised head end.
3. For hemorrhagic stroke products with hemostatic and angioprotective properties are indicated. The drug of choice for this purpose is dicinone (synonyms: etamsylate, cyclonamide). The hemostatic effect of dicinone when administered intravenously begins within 5-15 minutes. the maximum effect occurs after 1-2 hours, the effect lasts 4-6 hours or more. 2-4 ml of 12.5% solution is administered intravenously, then 2 ml every 4-6 hours. Can be administered intravenously by drip, adding to conventional solutions for infusion (M. D. Mashkovsky, 1997).
4. For normalization of blood pressure at the emergency stage, you can use intravenous injections of dibazole (2-4 ml of 1% solution), clonidine (1 ml of 0.01% solution), droperidol (2-4 ml of 0.25% solution) . If there is no effect, ganglion blockers are indicated - pentamine (1 ml of 5% solution) or benzohexonium (1 ml of 2.5% solution), but the administration of these drugs must be done with caution and constant monitoring of blood pressure.
5. Due to the sharp increase fibrinolysis cerebrospinal fluid, epsilon-aminocaproic acid is indicated from 20 to 30 g/24 hours during the first 3-6 weeks (F. E. Gorbacheva, A. A. Skoromei, N. N. Yakhno, 1995).
6. Relief of cerebral edema and intracranial hypertension - see the topic CEREBRAL EDEMA.
7. Relief of hyperthermic syndrome(if available); convulsive syndrome (if any).
8. In the absence of consciousness, preventive antibiotics are prescribed to prevent the development of pneumonia.
9. Care aimed at preventing trophic complications (bedsores).
10. Control of intestinal function.
11. Symptomatic therapy.
Note. The listed activities are adapted to the specific situation.
First aid for stroke
First aid for a stroke begins in the first few minutes after the disease. This will help avoid the development of irreversible processes in the brain and prevent death. It is known that the next three hours after a stroke are a crucial period of time and are called the therapeutic window. If first aid for a stroke was provided correctly and within these 3 hours, then there is hope for a favorable outcome of the disease and normal subsequent restoration of body functions.
Types of strokes:
- Ischemic stroke is a cerebral infarction. Accounts for more than 75% of all cases.
- Hemorrhagic stroke is bleeding in the brain.
Stroke - symptoms and first aid
Signs hemorrhagic stroke:
- Sharp severe headache.
- Hearing loss.
- Vomit.
- Paralysis of limbs.
- Distorted facial expressions.
- Increased salivation.
Symptoms of ischemic stroke:
- Gradual numbness of the limbs.
- Weakness in an arm or leg on one side of the body.
- Speech disorders.
- Numbness of the face.
- Headache.
- Dizziness.
- Loss of coordination.
- Deterioration of vision.
- Cramps.
First of all, emergency medical care should be called if a stroke or its obvious symptoms appear. Please note that when calling, it is necessary to describe in detail the signs of the disease and the patient’s condition.
Emergency care for stroke
After calling the neurological team, it is necessary to provide first aid to the stroke victim.
Hemorrhagic stroke - first aid:
- Place the patient on the bed or floor so that the shoulders and head are slightly elevated (about 30% of the surface). It is important not to move the victim too much and not to allow him to go home if the stroke occurred on the street;
- remove or unfasten all constrictive items of clothing (collar, tie, belt);
- if there are dentures in the mouth, they must be removed;
- provide access to fresh air;
- the victim's head should be tilted slightly to one side;
- when vomiting, thoroughly clean the oral cavity using gauze or other natural fabric;
- apply something cold to your head (a bottle of water or frozen food). The compress is applied to the side of the head opposite the numb or paralyzed limbs;
- maintain blood circulation in the arms and legs (cover with a blanket, put on a heating pad or mustard plaster);
- monitor salivation, clean the oral cavity from excess saliva in a timely manner;
- in case of paralysis, rub the limbs with any oil-alcohol mixture (you need to mix 2 parts vegetable oil and 1 part alcohol).
First aid for ischemic stroke:
Emergency care for strokes
Strokes are acute circulatory disorders in the brain (cerebral) and spinal cord (spinal cord). Main clinical forms: I - transient disorders (a - transient ischemic attacks, b - hypertensive cerebral crises); II - hemorrhagic strokes (non-traumatic hemorrhage in the brain or spinal cord); III - ischemic strokes (cerebral infarctions) with thrombosis, embolism, stenosis or compression of blood vessels, as well as with a decrease in general hemodynamics (non-thrombotic softening).
With the embolic nature of a cerebral stroke and with venous thrombosis, hemorrhagic cerebral infarction often develops; IV - combined strokes, when there are simultaneously areas of softening and foci of hemorrhage.
Transient cerebrovascular accidents (TCI) are the most common variant of cerebral stroke or hypertension, atherosclerosis of cerebral vessels and the impact on these vessels of pathologically altered cervical vertebrae (spondylogenic circulatory disorders in the vertebrobasilar region). This option includes only those observations in which general cerebral and focal neurological symptoms disappear after 24 hours.
Symptoms. Characterized by general cerebral and focal disorders. General cerebral symptoms include headache, non-systemic dizziness, nausea, vomiting, noise in the head, possible disturbances of consciousness, psychomotor agitation, and epileptiform seizures. General cerebral symptoms are especially characteristic of hypertensive cerebral crises. Hypotonic crises are characterized by less pronounced cerebral symptoms and are observed against the background of low blood pressure and weakened pulse.
Focal symptoms most often manifest themselves in the form of paresthesia, numbness, tingling in local areas of the skin of the face or limbs. Motor disorders are usually limited to the hand or only to the fingers and paresis of the lower facial muscles, speech disturbances, dysarthria are observed, deep reflexes in the limbs increase, and pathological signs appear. In cases of stenosis or occlusion of the carotid artery, transient crossed oculopyramidal syndrome is pathognomonic: decreased vision or complete blindness in one eye and weakness in the arm and leg opposite the eye. In this case, the pulsation of the carotid arteries may change (weakening or disappearance of pulsation on one side), and a systolic blowing noise is heard during auscultation. If there is a circulatory disorder in the vertebrobasilar region, darkening of the vision, dizziness, coordination disorders, nystagmus, diplopia, and impaired sensitivity in the face and tongue are characteristic. Transient disturbances in the large radiculomedullary arteries are manifested by myelogenous intermittent claudication (when walking or physical activity, weakness of the lower extremities, paresthesia in them, and transient dysfunction of the pelvic organs, which resolve independently after a short rest), appear.
Diagnostics. When examining a patient, it is impossible to immediately determine whether the present cerebrovascular accident will be transient or persistent. This can be concluded only after a day.
Urgent Care. The patient must be provided with complete physical and psycho-emotional rest. The difference in the pathogenetic mechanisms of PNMK also determines different therapeutic measures. For atherosclerotic cerebrovascular insufficiency, cardiotonic drugs are used (1 ml of 0.06% corticone solution or 0.025% strophanthin solution is administered intravenously with glucose, 10% sulfocamphocaine solution 2 ml subcutaneously, intramuscularly or slowly intravenously, 1 ml of cordiamine subcutaneously), vasopressor (in case of a sharp drop in blood pressure, 1 ml of 1% solution of mezaton, 1 ml of 10% solution of sodium caffeine benzonate is administered subcutaneously or intramuscularly) to improve cerebral blood flow (10 ml of 2.4% solution of aminophylline intravenously slowly with 10 ml saline solution, 4 ml of 2% papaverine solution intravenously, 5 ml of 2% trental solution in a dropper with saline solution or 5% glucose) drugs. Sedatives are prescribed (bromocamphor 0.25 g 2 times a day, motherwort tincture 30 drops 2 times a day) and various symptomatic drugs aimed at relieving headaches, dizziness, nausea, vomiting, hiccups, etc.
Hospitalization. to a neurological or specialized neurosurgical hospital (angioneurosurgical department).
Hemorrhagic stroke.
Hemorrhage develops by two mechanisms: by the type of diapedesis and due to rupture of the vessel. Diapedetic hemorrhage occurs with hypertensive crisis, vasculitis, leukemia, hemophilia, acute coagulopathic syndrome, uremia. Hemorrhage due to vessel rupture occurs with arterial hypertension and local defects of the vascular wall (atherosclerotic plaque, aneurysm, etc.). Intracerebral hematoma is most often localized in the area of the subcortical ganglia and internal capsule. Less commonly, a primary hematoma forms in the cerebellum and brain stem.
Symptoms. Hemorrhagic stroke of any location is characterized by general cerebral symptoms: severe headache, nausea and vomiting, bradycardia, rapid depression of consciousness. Focal symptoms depend on the location of the hemorrhage. More often, hemorrhagic stroke develops in middle-aged and elderly people and occurs suddenly, at any time of the day. The patient falls, loses consciousness, and vomits. On examination, the face is purple, the breathing is snoring (stertorous), urinary incontinence. Blood pressure is often elevated. Considering the predominance of the lesion in the internal capsule of the brain, hemiplegia and hemihypesthesia can also be detected when the patient is unconscious. In case of blood breakthrough into the subarachnoseal space, meningeal symptoms are added. When blood breaks into the ventricles of the brain, hormetonic convulsions develop, disturbances of consciousness deepen to the point of atonic coma, pupils dilate, body temperature rises, breathing problems increase, tachycardia increases, and after a few hours death can occur. Subarachnoid hemorrhage usually develops suddenly (rupture of an aneurysm), with physical stress: a severe headache occurs, sometimes radiating along the spine, followed by nausea, vomiting, psychomotor agitation, sweating, ophthalmic symptoms, and depressed consciousness.
Diagnostics. Based on characteristic clinical symptoms and cerebrospinal fluid examination data.
Urgent Care. For hemorrhagic stroke, the following are necessary: strict bed rest, stopping bleeding, reducing blood pressure to normal, reducing intracranial pressure, combating edema and swelling of the brain, eliminating acute respiratory disorders, combating cardiovascular disorders and psychomotor agitation.
Transportation of the patient to a neurological hospital is carried out as soon as possible after the onset of a cerebral stroke, observing all precautions: carefully placing the patient on a stretcher and bed, maintaining a horizontal position when carrying, avoiding shaking, etc. Before transportation, the patient is administered hemostatic agents (vicasol , dicinone, calcium gluconate), apply a venous tourniquet to the thighs to reduce the volume of circulating blood. In case of threatening respiratory failure, transportation with IVP and oxygen inhalation are advisable. In the early stages, administration of epsilon-aminocaproic acid (100 ml of 5% solution intravenously) with 2000 units of heparin is indicated. To reduce intracranial pressure, active dehydration therapy is carried out: Lasix 4-6 ml of 1% solution (40-60 mg) intramuscularly, mannitol or mannitol (200-400 ml of 15% solution intravenous drip). the earliest possible use of means of “metabolic protection” of brain tissue and antioxidants is justified (sodium hydroxybutyrate 10 ml of a 20% solution intravenously slowly - 1-2 ml per minute; piracetam 5 ml of a 20% solution intravenously; tocopherol acetate 1 ml 10-30 % solution intramuscularly; ascorbic acid 2 ml of 5% solution IV or IM. Fibrinolysis inhibitors and proteolytic enzymes are also administered in the early stages: Trasylol (contrical) 10,000-20,000 IU IV drip.
It should be remembered that the development of spontaneous subarachnoid hemorrhage in young people is often caused by rupture of arterial aneurysms.
Hospitalization. urgent to the neurosurgical hospital.
Ischemic strokes.
Three groups of main etiological factors leading to ischemic stroke can be distinguished: changes in the walls of blood vessels (atherosclerosis, vasculitis), embolic lesions and hematological changes (erythrocytosis, thrombotic thrombocytopenia, hypercoagulation, etc.).
Symptoms. Patients gradually develop headaches, dizziness, a feeling of numbness and weakness in the limbs. The disease usually develops against the background of coronary heart disease and other signs of atherosclerosis and diabetes. In young people, ischemic stroke is often the result of vasculitis or a blood disorder. Focal symptoms come to the fore of the clinical picture of the disease; cerebral symptoms develop somewhat later and are less pronounced than with a hemorrhagic stroke. The face of such patients is usually pale, blood pressure is normal or elevated. With embolism of cerebral vessels, the disease resembles a hemorrhagic stroke in its clinical picture; short-term clonic convulsions are characteristic before the development of limb paralysis, and depression of consciousness rapidly increases (apoplectic form).
Urgent Care. Basic principles: inhibition of thrombus formation and lysis of fresh thrombi, limitation of areas of ischemia and perifocal cerebral edema, improvement of function of cardio-vascular system, elimination of acute respiratory disorders In case of thrombosis or thromboembolism of the vessels of the brain or spinal cord, it is necessary to immediately begin treatment with heparin or fibrolysin (iv up to 20,000 units of heparin at normal blood pressure). Along with anticoagulants, antiplatelet agents and vasodilators (5 ml of 2% solution of pentoxifylline, trental IV) should be administered, and hemodilution should be performed with rheopolyglucin (400 ml IV at a rate of 20-40 drops/min). During a crisis rise in blood pressure, it should be reduced to a “working” level due to a violation of the autoregulation of cerebral circulation during this period and the dependence of cerebral blood flow on the level of blood pressure. Improve microcirculation using dipyridamole (chimes, persantine - 2 ml of 05% solution IV or IM), trental (0.1 g - 5 ml of 2% solution IV dropwise in 250 ml of saline or 5% solution glucose), Cavinton (2-4 ml of 05% solution in 300 ml of physiological solution intravenously).
In ischemic stroke with severe cerebral edema, cerebral embolism and hemorrhagic infarction, more active use of osmodiuretics is required. For psychomotor agitation, seduxen (2-4 ml of 05% solution IM), haloperidol (0.1-1.0 ml of 05% solution IM) or sodium hydroxybutyrate (5 ml of 20% solution IM or IV) is administered V).
Disturbances in the rhythm and strength of heart contractions can be both the background against which a stroke develops (often embolic type) and a consequence of impaired central regulation of the heart. In the first case, emergency measures are carried out according to the same principles as for cardiac arrhythmias without cerebral circulation impairment. In this case, it is advisable to avoid large doses of beta blockers, especially anaprilin, and sudden arterial hypotension. For myocardial ischemia, the full scope of appropriate care is provided, which, as a rule, is also useful for cerebral ischemia. If possible, drugs that cause severe dilatation of cerebral vessels, in particular nitroglycerin, should be avoided. Against the background of high blood pressure, this can lead to increased cerebral edema and the emergence of a persistent focus of ischemia.
Hospitalization. For all cerebral strokes, hospitalization of patients in the intensive care unit or neurological department (specialized neurovascular department) is indicated. The exception is cases with severe impairment of vital functions and in an agonizing state, when transportation itself is dangerous. Respiratory resuscitation is quite effective only for small-focal lesions of the brain stem.
Medical care for the development of strokes must be timely and adequate, and carried out in a specialized department (neurological hospital or intensive care unit). Treatment in the first hours after the appearance of the first symptoms of the disease is aimed at eliminating the cause of the pathological process, localization, especially with damage to the brain stem and progression of edema of brain tissue, as well as the nature of changes in nerve cells, associated disorders and the general condition of the patient. First aid for a stroke consists of timeliness, continuity and correct tactics at the prehospital stage (immediately after the development of a stroke).
Etiology and pathogenesis of stroke development
Stroke is a pathological condition that develops due to an acute disruption of the blood supply to the neurons of the brain, as a result of blockage of an arterial vessel (ischemic stroke) or its rupture (hemorrhagic stroke). This disease is accompanied by the development of general cerebral or focal neurological symptoms and causes persistent disorders in the form of paralysis, vestibular disorders or speech disorders, which subsequently cause disability or various limitations in patients after strokes (cognitive disorders, social adaptation disorders and motor disorders).
Main symptoms of strokes
Almost always, the symptoms of stroke development are:
- sudden severe headache and/or facial soreness, weakness of facial muscles, accompanied by visual impairment (up to complete blindness) or hearing (feeling of congestion);
- vomit;
- dizziness, poor coordination of movements, unsteadiness of gait, falls;
- short-term loss of consciousness followed by the development of speech disorders (aphasia);
- paralysis (of limbs, face, tongue), swallowing disorders;
- memory impairment and increased forgetfulness;
- seizures;
- loss of consciousness with severe facial hyperemia on the affected side (with a hemorrhagic stroke) with breathing disorders (noisy, rapid breathing) and the development of a soporous or comatose state.
If these symptoms appear, it is necessary to provide the patient with emergency assistance at home and immediately call an ambulance.
First aid at home at the pre-medical stage
What to do in case of a stroke before the ambulance arrives - the patient must be provided with complete rest, and if necessary, urgent Care in case of stroke - maintaining the patient’s vital functions:
- normalization of breathing - you need to ensure an influx of fresh air (open a window or window), while freeing the airways from mucus, sputum or vomit, turning the patient's head to the side, clean the oral cavity with a clean handkerchief, remove removable dentures. It is also necessary to remove all constricting objects (tie, scarf, unfasten buttons when squeezing the neck with a tight collar);
- to prevent the development and progression of cerebral edema - raise the patient’s head and upper body by 25-30 centimeters;
- in case of convulsive syndrome, it is necessary to: prevent tongue biting by carefully inserting a dense cloth between the teeth and remove objects that can hit your head;
- in case of cardiac arrest, emergency cardiopulmonary resuscitation (indirect cardiac massage and/or artificial respiration) must be performed.
Features of emergency care
It is important to know that at home you should not try to bring the patient to consciousness using ammonia or other medications, especially in the presence of seizures, may worsen the patient’s condition and progression of neurological symptoms.
Mandatory monitoring of blood pressure and pulse (for atrial fibrillation) is also necessary.
It must be remembered that a sharp decrease in blood pressure as a result of taking medications can lead to an increase in the focus of necrosis during cerebral infarction or to an increase in hematoma during a hemorrhagic stroke, therefore taking any antihypertensive drugs is strictly contraindicated. But information about the dynamics of changes in blood pressure will help the attending physician make a diagnosis and prescribe adequate treatment.
Tactics of an ambulance doctor at the prehospital stage
Immediately after the development of cerebral infarction, the formation of stable foci of necrosis occurs, and as a result, pronounced structural and morphological changes in the neurons of the brain within 3-6 hours after the onset of the first symptoms - the “therapeutic window”. If during the first hours the blood supply to the ischemic area is restored, the process of formation of the necrosis focus stops and minimal neurological deficit is observed. Therefore, an important factor in the prehospital stage is emergency medical care and hospitalization of the patient.
Emergency care for a stroke is provided to the patient by an emergency physician. It consists of carrying out symptomatic intensive therapy aimed at eliminating life-threatening disorders. If necessary, tracheal intubation, chest compressions and artificial respiration are performed. With the development of convulsive syndrome, anticonvulsants are administered, and with the progression of cerebral edema, osmodiuretics are administered.
First aid for a stroke, provided in a timely and professional manner, is the best prognosis for life, the formation of consequences, rehabilitation and social adaptation of patients after a brain accident.
Stroke (stroke) is a rapidly developing focal or global disorder of brain function that lasts more than 24 hours or leads to death if another genesis of the disease is excluded. Develops against the background of atherosclerosis of cerebral vessels, hypertension, their combination, or as a result of rupture of cerebral aneurysms.
Diagnostics
The clinical picture depends on the nature of the process (ischemia or hemorrhage), localization (hemispheres, brainstem, cerebellum), rate of development of the process (sudden, gradual). A stroke of any origin is characterized by the presence of focal symptoms of brain damage (hemiparesis or hemiplegia, less often monoparesis and damage to the cranial nerves - facial, hypoglossal, oculomotor) and general cerebral symptoms of varying severity (headache, dizziness, nausea, vomiting, impaired consciousness).
ACVA is clinically manifested by subarachnoid or intracerebral hemorrhage (hemorrhagic stroke), or ischemic stroke.
Transient cerebrovascular accident (TCI) is a
a condition in which focal symptoms undergo complete regression in a period of less than 24 hours. The diagnosis is made retrospectively.
Subarachnoid hemorrhages develop as a result of rupture of aneurysms and, less often, against the background of hypertension. Characterized by the sudden onset of a sharp headache, followed by nausea, vomiting, motor agitation, tachycardia, and sweating. With massive subarachnoid hemorrhage, depression of consciousness is usually observed. Focal symptoms are often absent.
Hemorrhagic stroke - hemorrhage into the brain; characterized by severe headache, vomiting, rapid (or sudden) depression of consciousness, accompanied by the appearance of severe symptoms of impaired limb function or bulbar disorders. It usually develops during the day, while awake.
Ischemic stroke is a disease that leads to a decrease or cessation of blood supply to a certain part of the brain. It is characterized by a gradual (over hours or minutes) increase in focal symptoms corresponding to the affected vascular area. General cerebral symptoms are usually less pronounced. It develops more often with normal or low blood pressure, often during sleep.
At the prehospital stage, differentiation of the nature of the stroke (ischemic, hemorrhagic, subarachnoid hemorrhage) and its localization is not required.
Differential diagnosis should be made from traumatic brain injury (history, presence of traces of trauma on the head) and much less often from meningoencephalitis (history, signs of a general infectious process, rash).
Urgent Care:
— basic (undifferentiated) therapy includes emergency correction of vital functions - restoration of patency of the upper respiratory tract, if necessary - tracheal intubation, artificial ventilation, as well as normalization of hemodynamics and cardiac activity;
— for blood pressure significantly higher than usual values - reducing it to levels slightly higher than the “working” level, usual for a given patient; if there is no information, then to a level of 180/90 mm Hg. Art.; for this use - 0.5-1 ml of 0.01% solution of clonidine (clonidine) in 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly or 1-2 tablets sublingually (if necessary, the administration of the drug can be repeated), or pentamine - no more than 0.5 ml of a 5% solution intravenously at the same dilution or 0.5-1 ml intramuscularly;
— as an additional means you can use dibazol 5-8 ml of 1% solution intravenously or nifedipine (Corinfar, phenigidine) - 1 tablet (10 mg) sublingually;
— for the relief of convulsive seizures, psychomotor agitation - diazepam (Relanium, Seduxen, Sibazon) 2-4 ml intravenously in 10 ml of 0.9% sodium chloride solution slowly or intramuscularly or Rohypnol 1-2 ml intramuscularly;
- if ineffective - sodium hydroxybutyrate 20% solution at the rate of 70 mg/kg body weight in a 5-10% glucose solution intravenously slowly;
— in case of repeated vomiting - Cerucal (Raglan) 2 ml intravenously in 0.9% sodium chloride solution intravenously or intramuscularly;
— vitamin B 6 2 ml of 5% solution intravenously;
— droperidol 1-3 ml of 0.025% solution, taking into account the patient’s body weight;
— for headaches- 2 ml of 50% analgin solution or 5 ml of baralgin intravenously or intramuscularly;
- tramal - 2 ml.
For patients of working age, in the first hours of the disease it is mandatory to call a specialized neurological (neuro-resuscitation) team. Hospitalization on a stretcher to the neurological (neurovascular) department is indicated.
If you refuse hospitalization, call a neurologist at the clinic and, if necessary, actively visit an emergency doctor after 3-4 hours.
Patients in deep atonic coma (5-4 points on the Glasgow scale) with intractable severe breathing disorders are not transportable; unstable hemodynamics, with a rapid, steady deterioration of the condition.
Dangers and complications:
- aspiration of vomit;
- inability to normalize blood pressure;
- cerebral edema;
- breakthrough of blood into the ventricles of the brain.
Note
7. Early use of antihypoxants and activators of cellular metabolism is possible (nootropil 60 ml (12 g) intravenously 2 times a day after 12 hours on the first day; Cerebrolysin 15-50 ml intravenous drip per 100-300 ml isotonic sodium chloride solution in 2 doses ; glycine 1 tablet under the tongue; Riboxin 10 ml intravenously as a bolus; solcoseryl 4 ml as an intravenous bolus. In severe cases, 250 ml of a 10% solution of solcoseryl intravenously as a drip can significantly reduce the number of irreversibly damaged cells in the ischemic zone and reduce the area of perifocal edema.
2. Aminazine and propazine should be excluded from drugs prescribed for any form of stroke. These drugs sharply inhibit the functions of brain stem structures and clearly worsen the condition of patients, especially the elderly and senile.
3. Magnesium sulfate is not used for convulsive syndrome and to lower blood pressure.
4. Eufillin is indicated only in the first hours of a mild stroke.
5. Furosemide (Lasix) and other dehydrating drugs (mannitol, reogluman, glycerol) should not be administered at the prehospital stage. The need to prescribe dehydrating agents can only be determined in a hospital based on the results of determining plasma osmolality and sodium content in blood serum.
6. In the absence of a specialized neurological team, hospitalization in the neurological department is indicated.
7. For patients of any age with a first or repeated stroke with minor defects after previous episodes, a specialized neurological (neuro-resuscitation) team can also be called on the first day of the disease.
CONVIVUS SYNDROME
Diagnostics
A generalized generalized convulsive seizure is characterized by the presence of tonic-clonic convulsions in the extremities, accompanied by loss of consciousness, foam at the mouth, often tongue biting, involuntary urination, and sometimes defecation. At the end of the attack, a pronounced respiratory arrhythmia is observed. Long periods of apnea are possible. At the end of the seizure, the patient is in a deep coma, the pupils are maximally dilated, without reaction to light, the skin is cyanotic, often moist.
Simple partial seizures without loss of consciousness are manifested by clonic or tonic convulsions in certain muscle groups.
Complex partial seizures (temporal lobe epilepsy or psychomotor seizures) are episodic changes in behavior when the patient loses contact with the outside world. The beginning of such attacks can be an aura (olfactory, gustatory, visual, a feeling of “already seen,” micro- or macropsia). During complex attacks, inhibition of motor activity may be observed; or smacking lips, swallowing, walking aimlessly, picking at one’s own clothes (automatisms). At the end of the attack, amnesia is noted for the events that took place during the attack.
The equivalents of convulsive seizures manifest themselves in the form of gross disorientation, somnambulism and a prolonged twilight state, during which unconscious, severe asocial acts can be committed.
Status epilepticus is a fixed epileptic state due to a prolonged epileptic seizure or a series of seizures repeated at short intervals. Status epilepticus and frequent seizures are life-threatening conditions.
A seizure can be a manifestation of genuine ("congenital") and symptomatic epilepsy - a consequence of previous diseases (brain trauma, cerebrovascular accident, neuroinfection, tumor, tuberculosis,
syphilis, toxoplasmosis, cysticercosis, Morgagni-Adams-Stokes syndrome, ventricular fibrillation, eclampsia) and intoxication.
Differential diagnosis
At the prehospital stage, determining the cause of a seizure is often extremely difficult. Anamnesis and clinical data are of great importance. It is necessary to be especially vigilant in relation, first of all, to traumatic brain injury, acute cerebrovascular accidents, heart rhythm disturbances, eclampsia, tetanus and exogenous intoxications.
Urgent Care
1. After a single convulsive seizure - diazepam (Relanium, Seduxen, Sibazon) - 2 ml intramuscularly (as a prevention of repeated seizures).
2. With a series of convulsive seizures:
- relief of convulsive syndrome: diazepam (Relanium, Seduxen, Sibazon) - 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly, Rohypnol 1-2 ml intramuscularly;
- if there is no effect - sodium hydroxybutyrate 20% solution at the rate of 70 mg/kg body weight intravenously in a 5-10% glucose solution;
— headache relief: analgin 2 ml of 50% solution; baralgin 5 ml; Tramal 2 ml intravenously or intramuscularly.
3. Status epilepticus
- prevention of head and torso injuries;
- restoration of airway patency;
- relief of convulsive syndrome: diazepam (Relanium, Seduxen, Sibazon) - 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or vnfecta - sodium hydroxybutyrate 20% solution at the rate of 70 mg/kg body weight intravenously at 5-10 % glucose solution;
- if there is no effect - inhalation anesthesia with nitrous oxide mixed with oxygen (2:1).
- decongestant therapy: furosemide (Lasix) 40 mg per 10-20 ml of 40% glucose solution or 0.9% sodium chloride solution (in patients diabetes mellitus) intravenously;
Headache relief:
— analgin — 2 ml of 50% solution
— baralgin — 5 ml;
- Tramal - 2 ml intravenously or intramuscularly.
According to indications:
- when blood pressure increases significantly above the patient’s usual levels - antihypertensive drugs (clonidine intravenously, intramuscularly or sublingually tablets, dibazol intravenously or intramuscularly);
— with tachycardia over 100 beats/min — see “Tachyarrhythmias”;
- for bradycardia less than 60 beats/min - atropine;
- for hyperthermia above 38°C - analgin.
Patients with their first seizure in their life should be hospitalized to determine its cause. In case of refusal of hospitalization with a rapid recovery of consciousness and the absence of general cerebral and focal neurological symptoms, it is recommended to urgently contact a neurologist at a local clinic. If consciousness is restored slowly, there are general cerebral and (or) focal symptoms, then a call to a specialized neurological (neuro-resuscitation) team is indicated, and in its absence, an active visit after 2-5 hours.
In the case of relief of both a convulsive syndrome of known etiology and post-ictal changes in consciousness, the patient can be left at home with subsequent observation by a neurologist at the clinic.
Patients with terminated status epilepticus or a series of convulsive seizures are hospitalized in a multidisciplinary hospital with a neurological and intensive care unit, and in the case of convulsive syndrome caused presumably by traumatic brain injury, in a neurosurgical department.
Intractable status epilepticus or a series of convulsive seizures is an indication to call a specialized neurological (neuro-resuscitation) team. If this is not the case, hospitalization is required.
If there is a disturbance in the activity of the heart, leading to a convulsive syndrome, appropriate therapy or calling a specialized cardiology team. In case of eclampsia, exogenous intoxication - action according to the appropriate standard.
Asphyxia during a seizure;
- development of acute heart failure.
Note
1. Aminazine is not an anticonvulsant.
2. Magnesium sulfate and chloral hydrate are currently not used for the relief of convulsive syndrome due to their low effectiveness.
3. The use of hexenal or sodium thiopental to relieve status epilepticus is possible only in the conditions of a specialized team if there are conditions and the ability to transfer the patient to mechanical ventilation if necessary (laryngoscope, set of endotracheal tubes, ventilator).
4. For hypocalcemic convulsions, calcium gluconate (10-20 ml of a 10% solution intravenously or intramuscularly), calcium chloride (10-20 ml of a 10% solution strictly intravenously) are administered.
5. For hypokalemic convulsions, administer panangin (10 ml intravenously), potassium chloride (10 ml of 10% solution intravenously).
Diagnostics
Fainting is a short-term (usually within 10-30 s) loss of consciousness, in most cases accompanied by a decrease in postural vascular tone. Fainting is based on transient hypoxia of the brain, which occurs due to various reasons - a decrease in cardiac output, cardiac arrhythmias, a reflex decrease in vascular tone, etc.
Fainting (syncope) conditions can be conditionally divided into two most common forms - vasodepressor (synonyms - vasovagal, neurogenic) fainting, which is based on a reflex decrease in postural vascular tone, and fainting associated with diseases of the heart and great vessels.
Syncope conditions have different prognostic significance depending on their genesis. Fainting associated with pathological conditions of the cardiovascular system can be a harbinger of sudden death and require mandatory identification of their causes and adequate treatment. It must be remembered that fainting can be the onset of a serious illness (myocardial infarction, pulmonary embolism, etc.).
The most common clinical form is vasodepressor syncope, in which there is a reflex decrease in peripheral vascular tone and a response to external or psychogenic factors (fear, anxiety, the sight of blood, medical instruments, vein puncture, heat environment, staying in a stuffy room, etc.). The development of fainting is preceded by a short prodromal period, during which weakness, nausea, ringing in the ears, yawning, darkening of the eyes, pallor, and cold sweat are noted.
If the loss of consciousness is short-term, then convulsions are not observed.
If fainting lasts more than 15-20 seconds, then clonic and tonic convulsions are observed. During syncope, there is a decrease in blood pressure with or without bradycardia. This group also includes fainting,
fainting with increased sensitivity of the carotid sinus, as well as so-called “situational” fainting - with prolonged coughing, defecation, urination.
Fainting associated with diseases of the cardiovascular system usually occurs suddenly, without a prodromal period. They are divided into two main groups - those associated with disturbances of heart rhythm and conduction and those caused by a decrease in cardiac output (aortic stenosis, hypertrophic cardiomyopathy, myxoma and spherical thrombi in the atria, myocardial infarction, pulmonary embolism, dissecting aortic aneurysm).
A differential diagnosis of fainting must be made from epilepsy, hypoglycemia, narcolepsy, coma of various origins, diseases of the vestibular apparatus, organic pathology of the brain, hysteria.
In most cases, diagnosis can be made based on a detailed history, physical examination, and ECG recording. To confirm the vasodepressor nature of fainting, positional tests are performed (from simple orthostatic tests to the use of a special inclined table); to increase sensitivity, tests are carried out against the background of drug therapy. If these actions do not clarify the cause of fainting, then subsequent examinations are carried out depending on the identified pathological condition.
In the presence of heart disease: Holter ECG monitoring, echocardiography, electrophysiological study, position tests; if necessary, cardiac catheterization.
In the absence of heart disease: positional tests, consultation with a neurologist, psychiatrist, Holter ECG monitoring, electroencephalogram, and, if necessary, computed tomography of the brain, angiography.
Urgent Care
In case of fainting it is usually not required.
The patient must be placed in a horizontal position on his back; give the lower limbs an elevated position, free the neck and chest from constricting clothing.
Patients should not be seated immediately, as this may lead to recurrence of fainting.
If the patient does not regain consciousness, then it is necessary to exclude traumatic brain injury (if there was a fall) or other causes of prolonged loss of consciousness mentioned above.
If syncope is caused by a cardiac condition, then emergency care may be necessary to eliminate the immediate cause of syncope - tachyarrhythmia, bradycardia, hypotension, etc. (see relevant standards).
CRANIO BRAIN INJURY
Traumatic brain injury (TBI) is a collective concept that includes damage to the integument of the skull (see standard “Wounds of the Head”) and the contents of the cranium - the substance of the brain, cranial nerves, blood vessels, liquor-containing containers (cerebral ventricles) and liquor pathways. There are 3 types of TBI - concussion, contusion and compression of the brain.
Diagnostics
Concussion is a loss of consciousness lasting from a few seconds to 30 minutes. After restoration of consciousness - weakness, headache, nausea, possible vomiting, violent reaction to stimuli (light, sounds); underestimation of the condition (possible refusal of hospitalization). Retrograde amnesia.
Brain contusion occurs against the background of a concussion and is characterized by the presence of general cerebral (see above) and focal symptoms.
There are three degrees of severity.
Mild degree
Loss of consciousness lasting from several minutes to 1-2 hours. Restoration of consciousness is possible already at the prehospital stage. Reflex asymmetry. Paresis of facial muscles. Possible breathing problems due to retraction of the lower jaw or aspiration of vomit.
Average degree
Loss of consciousness lasting from tens of minutes to several hours. Subsequently - lethargy, drowsiness, stupor. Possible psycho-emotional agitation. Violation of pupillary, corneal reactions, oculomotor disorders. Nystagmus. Severe meningeal symptoms. Arterial hypertension, tachycardia or tendency to bradycardia. Breathing disturbances (see above) or severe shortness of breath are possible.
Severe degree
Loss of consciousness lasting from several hours to several days and even weeks. The victim is not in contact, it is possible to open the eyes to a shout or painful stimuli, there are oculomotor disorders (divergent strabismus, floating movements of the eyeballs, sometimes asymmetrical, absence or asymmetry of the oculocephalic reflex, disturbance of pupillary reactions, size and shape of the pupils). Characteristic changes in muscle tone, position of the limbs (increased tone of the flexors of the arms and extensors of the legs, increased tone of the flexors of one arm and extensors of the other, increased tone of the extensors of both arms and legs, a symmetrical decrease in muscle tone up to atony), asymmetry of deep reflexes, pathological foot signs. The severity of meningeal symptoms in the early stages does not reflect the severity of traumatic brain injury. The development of convulsive syndrome is possible. Breathing disorders are characterized by changes in the rhythm and depth of respiratory movements and are in accordance with the depth of loss of consciousness. It is possible to develop hyper- or hypoventilation, periodization of breathing, or the appearance of periods of apnea. Hemodynamic disorders are usually manifested by arterial hypertension, bradycardia or tachycardia. In case of severe injury with damage to brain stem structures, arterial hypotension may develop, usually in combination with atonic coma and severe respiratory depression.
Compression of the brain - develops against the background of a concussion and bruise. Most often it is caused by the development of an intracranial hematoma, less often by compression of the brain by fragments of the skull bones or developing cerebral edema. Manifests itself as intracranial hypertension syndrome. Characteristic features include contralateral hemiparesis, homolateral mydriasis, combined with asymmetry of ocular reflexes, bradycardia, and focal epileptic seizures. Sometimes a light gap appears.
Differential diagnosis
It is carried out against alcoholic or other exogenous poisoning, acute cerebrovascular accidents.
Urgent Care:
I. For concussion Emergency prehospital care is not required.
When overexcited:
- intravenous administration of 2-4 ml of 0.5% solution of seduxen (Relanium, Sibazon);
- mandatory transportation to the hospital (neurological department).
II. For bruises and compression of the brain:
1. Provide access to the vein.
2. With the development of a terminal condition:
— cardiopulmonary resuscitation (see standard “Sudden death”).
3. In case of circulatory decompensation:
— intravenous drip administration of rheopolyglucin, crystalloid solutions;
- if necessary - dopamine 200 mg in 400 ml of isotonic sodium chloride solution or any other crystalloid solution intravenously at a rate that ensures maintenance of blood pressure at the level of 120. 140 mm Hg. st
- glucocorticoid hormones - prednisolone or solu-medrol 90-150 mg or betamethasone (celeston) 12-16 mg intravenously.
4. In an unconscious state:
- examine and mechanically clean the oral cavity;
- Sellick technique;
- perform direct laryngoscopy - do not straighten your head!;
- stabilization of the cervical spine - slight stretching with hands;
- intubate the trachea (without muscle relaxants!), regardless of whether mechanical ventilation will be performed or not; muscle relaxants (succinylcholine chloride, ditilin, listenone) at a dose of 1-2 mg/kg are administered only by doctors of intensive care surgical teams.
If spontaneous breathing is ineffective:
- artificial ventilation of the lungs in the mode of moderate hyperventilation (12-14 l/min for a patient with a body weight of 75-80 kg).
5. For psychomotor agitation, convulsions and as a premedication:
- inject subcutaneously a 0.1% atropine solution - 0.5-1 ml;
- intravenously propofol 1-2 mg/kg or sodium thiopental 3-5 mg/kg or seduxen 0.5% solution - 2-4 ml or 20% sodium hydroxybutyrate solution 15-20 ml, dormicum 0.1-0.2 mg /kg;
— during transportation, control the respiratory rhythm.
6. For intracranial hypertension syndrome:
- intravenous 1% solution of furosemide (Lasix) 2-4 ml (in case of decompensated blood loss - combined injury - do not administer Lasix!)
— glucocorticoid hormones (see paragraph 3);
- artificial hyperventilation.
7. For pain syndrome:
- intramuscularly (or intravenously slowly) 50% analgin solution 50% 4 ml and 1-2% diphenhydramine solution - 2 ml and (or) 0.5% tramal solution - 2-4 ml (200-400 mg) or other non-narcotic analgesic in appropriate doses.
Do not administer opiates!
8. For head wounds and external bleeding from them, clean the wound and treat the edges with an antiseptic (see standard “Head Wounds”).
9. Transportation to a hospital with a neurosurgical service. In critical condition, go to the intensive care unit.
SPINAL INJURY
Spinal injury most often occurs with excessive flexion and hyperextension of the spine in the most mobile places, which is observed in divers, when falling from a height, on the back,
in case of auto and motorcycle injuries, strong direct impact from behind.
Diagnostics
Anamnestic data; pain at the point of application of traumatic force and upon palpation along the line of the spinous processes, pain with a soft axial load on the spine, impaired movement in the arms and legs or only in the legs, a feeling of numbness, tingling in one of the arms, loss of tactile and pain sensitivity in the hands and feet With concomitant trauma to the organs of the chest cavity (pneumo-, hemothorax), there is increasing respiratory failure, and with trauma to the abdominal organs, there is a clinical picture of acute blood loss and traumatic shock.
Differential diagnosis
Spinal injury should be differentiated from acute thoracic and lumbosacral radiculitis, dislocation of intervertebral discs.
Urgent Care
Basic principles: treatment of concomitant life-threatening injuries, restoration of free airway patency, and in case of acute respiratory failure - artificial ventilation. Anesthesia, transport immobilization, maintenance of reduced peripheral vascular tone, early glucocorticoid therapy with methylprednisolone.
Spinal injury without spinal cord injury
Urgent Care:
— baralgin — 5 ml intravenously or intramuscularly;
— analgin 2 ml intravenously;
— nitrous oxide with oxygen 2:1 through a mask of an anesthesia machine, autoanalgesia with Trilene: 0.4% in a gas-narcotic mixture through the “Trilan” or “Tringal” device, “cervical collar” (regardless of the level of spinal damage), carefully placing the victim on a stretcher with the help of 3-5 people, transportation to a traumatology or neurosurgical department.
Spinal injury with spinal cord injury
Exclude concomitant trauma (tension hemothorax, pneumothorax, trauma to organs, abdominal cavity, internal and external bleeding).
With increasing respiratory failure as a result of tension pneumothorax:
— urgent puncture and catheterization of the pleural cavity in the second intercostal space along the midclavicular line.
With increasing ARF due to hemothorax:
- urgent puncture and catheterization of the pleural cavity in the sixth - seventh intercostal space along the posterior axillary line;
— restore free patency of the upper respiratory tract (if necessary) up to conicotomy and endotracheal intubation.
In case of injury in the cervical spine, endotracheal intubation should be performed extremely carefully, without tilting the head. In this case, conicotomy using a special conicotome is more indicated.
The presence of ARF after restoration of airway patency, the number of respiratory movements more than 40-50 per minute or less than 10 per minute is an indication for artificial ventilation.
Stop external bleeding
With ongoing internal bleeding and blood pressure below 90 mm Hg. Art. - see standard "Blood loss":
- polyionic solutions (disol, trisol, chlosol, acesol, Hartmann's solution, etc.); the rate and volume of infusion should be such as to ensure a blood pressure of 90 mmHg. Art.;
- vasopressors (norepinephrine, mesaton, etc.) - 1 ml in one of the plasma-substituting solutions;
— methylprednisolone intravenously up to 300 mg during the period of assistance;
- baralgin - 5 ml intravenously,
- nitrous oxide with oxygen 2:1 through an anesthesia machine mask;
— autoanalgesia with Trilene 0.4 vol. % in a gas-narcotic mixture through the Trilan or Tringal devices;
- ketalar - 2 mg/kg body weight intravenously or 4 mg/kg - intramuscularly;
— seduxen (Relanium) 0.2 mg/kg body weight in combination with sodium hydroxybutyrate 60-80 mg/kg body weight intravenously (for long-term transportation of more than two hours);
- “cervical collar” (regardless of the level of spinal damage);
— careful placement on a stretcher with the help of 3-5 people;
— transportation to a multidisciplinary hospital (neurosurgery or intensive care unit) when blood pressure is restored to at least 90 mm Hg. Art. and adequate ventilation.
MYASTHENIAS.
MYASTHENIC AND CHOLINERGIC CRISES
Myasthenia gravis is an acquired autoimmune disease. It is characterized by a pronounced phenomenon of pathological muscle fatigue and muscle weakness due to insufficiency of acetylcholine receptors on the motor end plate of the nerve.
Diagnostics
Pathological muscle fatigue is a unique and specific symptom of this disease. The muscle weakness that develops in this case differs from ordinary paresis in that when movements are repeated (especially in a rapid rhythm), it increases sharply and can reach the degree of complete paralysis. When muscles work at a slow pace, especially after sleep and rest, muscle strength is maintained for a relatively long time.
In typical cases, the first to appear are oculomotor disorders - double vision of objects, especially during prolonged reading, drooping eyelids. The lesion is asymmetrical and symptoms are dynamic: in the morning the condition is better, in the evening ptosis and double vision increase significantly. Later, weakness and fatigue of the facial muscles and masticatory muscles appear. When weakness spreads to the muscles of the extremities, the proximal muscles suffer more, first in the arms. In generalized forms, one of the most severe symptoms is weakness of the respiratory muscles.
Modern classification based on clinical features identifies:
- generalized myasthenia gravis without impairment of vital functions and with impairment of vital functions;
— local forms without impairment of vital functions and with impairment of vital functions.
Differential diagnosis
Myasthenia gravis, which begins in old age, requires differentiation from cerebrovascular accidents.
Myasthenic crisis is a sudden deterioration in the condition of a patient with myasthenia, which poses an immediate danger to life, since due to the weakness of the respiratory and bulbar muscles, insufficiency of external respiration or serious bulbar disorders may occur. Provoking factors are violation of the treatment regimen with anticholinesterase drugs, as well as acute respiratory viral infections, various infectious diseases, physical and psycho-emotional stress, 1-2 days of the menstrual period.
Urgent Care:
- when the first signs of respiratory failure or dysphagia appear - tracheal intubation, auxiliary or artificial ventilation;
— prozerin 0.05% solution — 2-3 ml intramuscularly or intravenously, if there is no effect, then after 30-40 minutes the dose is repeated intramuscularly;
- prednisolone 90-120 mg intravenously (1.5-2 mg/kg).
Cholinergic crises: occur with excessive dosages of anticholinesterase drugs as a result of patients independently increasing the doses recommended by the doctor. Myasthenic crisis with excessive therapy can turn into cholinergic. Symptoms of excessive cholinergic action develop. In this case, signs of both nicotine and muscarinic intoxication arise - fibrillary twitching, miosis, salivation, abdominal pain, agitation, often breathing problems, pallor, coldness, marbling of the skin. There is a dissociation in the increased need for anticholinesterase drugs and a decrease in muscle strength after their administration.
Urgent Care
There are no specific means for getting out of a crisis.
- Use atropine 0.1% solution - 1 ml intravenously or subcutaneously, repeat the dose if necessary.
— For breathing disorders and bronchial hypersecretion — mechanical ventilation, toilet of the upper respiratory tract.
— Temporary withdrawal of anticholinesterase drugs.
Patients with myasthenic and cholinergic crises are subject to emergency hospitalization in hospitals with intensive care and neurological departments.
Dangers and complications
- development of acute respiratory failure.
ACUTE HYPERTENSIVE ENCEPHALOPATHY
Acute hypertensive encephalopathy is a syndrome that occurs as a result of a rapid sharp rise in blood pressure in patients with arterial hypertension of various origins. In this case, multiple small foci of hemorrhage and ischemia and cerebral edema may occur.
Diagnostics
The clinical picture is characterized primarily by pronounced general cerebral symptoms - a rapidly growing headache of a pressing or bursting nature, nausea, vomiting, dizziness.
research is predominantly non-systemic in nature; blurred vision, “flickering of spots”, blurred vision. These are accompanied by psychomotor agitation, stupor, drowsiness, and disorientation in place and time. At extremely high blood pressure levels, loss of consciousness, general convulsive seizures, and mild membrane symptoms may occur. Vegetative-vascular disorders are grossly expressed: hyperemia or pallor of the face, hyperhidrosis, pain in the heart, palpitations, dry mouth. Focal microsymptoms are often absent. Blood pressure significantly exceeds the patient’s usual figures and often reaches the level of 260.300/150. 180mmHg
Differential diagnosis
It should be carried out against hemorrhagic stroke (in the presence of focal symptoms) and subarachnoid hemorrhage (especially in the presence of a meningeal symptom complex).
Urgent Care:
1. Reduce blood pressure to 150/100 mmHg. Art. To do this use:
- clonidine (clonidine) 0.01% solution - 1 ml in 10 ml of 0.9% sodium chloride solution intravenously or 1-2 tablets sublingually (if necessary, the drug can be repeated).
2. To reduce the severity of cerebral edema and reduce intracranial pressure:
- dexamethasone 12-16 mg (or 90-120 mg prednisolone) in 10 ml of 0.9% sodium chloride solution intravenously;
- lasix (furosemide) 20-40 mg in 10 ml of 0.9% sodium chloride solution intravenously;
3. To relieve seizures and psychomotor agitation:
- diazepam (Relanium, Seduxen, Sibazon) 2-4 ml + 10 ml of 0.9% sodium chloride solution intravenously slowly or intramuscularly or Rohypnol 1-2 ml intramuscularly;
- if ineffective - sodium hydroxybutyrate 20% at the rate of 50-70 mg/kg body weight on 5-10% glucose intravenously slowly.
4. In case of repeated vomiting - Cerucal (Raglan) 2.0 ml intravenously in 0.9% sodium chloride solution intravenously or intramuscularly; vitamin B 6 5% solution - 2 ml intravenously.
Dangers and complications:
- obstruction of the upper respiratory tract by vomit;
- aspiration of vomit;
- inability to normalize blood pressure.
Migraine is a disease caused by hereditarily determined dysfunction of vasomotor regulation, manifested mainly in the form of periodically recurring attacks of headache, often in one half of the head.
Diagnostics
A migraine attack is manifested by a pulsating headache, usually one-sided, often in the forehead and temple, often accompanied by nausea, vomiting, sensitivity to light and sound, irritability and malaise. In the interictal period, health does not suffer. The disease begins in prepubertal, pubertal or adolescence. There are often indications of the family-hereditary nature of the disease.
At classic migraine 10-15 minutes before the onset of the headache, a visual aura appears in the form of a flickering scotoma, distortion of objects or blurred vision. The prodrome is followed by a unilateral, progressive, throbbing headache.
At simple migraine characteristic throbbing pain occurs without prodromal visual disturbances.
At associated migraine headache is combined with transient neurological disorders (ophthalmoplegia, hemiplegia, aphasia), which usually precede the headache, but can occur after it.
At migraine status Migraine attacks can follow one after another without a break for several days.
Differential diagnosis
It should be carried out against organic brain lesions (tumors, aneurysms of cerebral vessels, cerebrovascular accidents), especially with associated forms of migraine (ophthalmoplegic, hemiplegic) and against subarachnoid hemorrhages with thunderous “splitting” headaches.
Urgent Care:
— ergotamine 1 tablet. (1 mg)
— obzidan (propranolol) 1 tablet. (40 mg)
— Relanium 2 ml intramuscularly
Patients with migraine status are subject to hospitalization in a neurological hospital.
ACUTE INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY GUILLIAIN-BARRE
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is a disease whose pathogenesis is based on immunological disorders, ultimately leading to diffuse primary segmental demyelination primarily in the anterior roots and proximal parts of the spinal nerves, plexuses, limb nerves and autonomic ganglia.
In approximately half of the patients, 1-3 weeks before the onset of the first neurological symptoms, diseases of the upper respiratory tract, sore throat, and transient intestinal disorders are observed. At the onset of the disease, paresthesia in the feet and myalgia in the legs are noted; often bilateral paresis of facial muscles, bulbar and oculomotor disorders. The leading symptom is flaccid paralysis. Muscles are affected diffusely and symmetrically. Muscle weakness spreads in an upward direction, involving the muscles of the legs, pelvic girdle, torso, neck, and respiratory muscles. Muscle weakness progresses over 2-3 weeks, but sometimes tetraplegia can develop within a few hours or days. As the disease progresses, respiratory failure and bulbar disorders develop. All patients develop muscle hypotonia, hypo- or areflexia; Symptoms of tension in the nerve trunks persist for a long time (Lasega, Neri). Orthostatic hypotension, tachycardia, and paroxysmal arrhythmia may occur.
Urgent Care:
If signs of respiratory failure develop, transfer to mechanical ventilation.
Patients are subject to emergency hospitalization in a multidisciplinary hospital with intensive care and neurological departments.
Main dangers and complications:
- development of acute respiratory failure;
- sudden cardiac arrest as a result of involvement of the autonomic apparatus of the heart in the process (rare).
Note
Currently, treatment with corticosteroids for AIDP is not recommended, since their use does not change the course of the disease and may even contribute to relapse of the disease
ACUTE PAIN SYNDROME IN VERTEBROGENIC DISORDERS
Back pain is an extremely common symptom. Among spinal lesions accompanied by neurological disorders, the most common are degenerative-dystrophic processes: osteochondrosis and spondyloarthrosis. Diagnosis of acute and chronic pain in the back and neck should begin with excluding the possible connection of lumbodynia, thoracalgia and cervicalgia with diseases of the thoracic and abdominal organs.
The most common cause of back and neck pain in vertebrogenic disorders are compression syndromes and reflex muscular-tonic disorders.
Lumbar syndromes.
The clinical picture is characterized by back pain, forced body position, and limited mobility of the spine. Pain caused by diseases of the upper lumbar spine usually radiates to the anterior surfaces of the thighs and legs. Pain associated with damage to the lower lumbar and sacral segments of the spine is projected to the gluteal region, the hip joint area, the posterior and posterolateral surfaces of the thighs, from the lateral surface of the calf to the outer part of the ankle, the dorsal surface of the foot and the first or second and third toes, or along the the back of the calf to the heel, on the plantar surface of the foot and in the fourth and fifth toes. It has an aching, dull, long-lasting character of varying intensity. Paresthesia can be observed in all of these areas.
Cervical syndromes.
Pain that occurs in the cervical spine is felt in the neck and occipital part of the head, and can radiate to the shoulder, forearm, and fingers; caused or aggravated by movements or certain positions of the neck, accompanied by pain when pressing and limited mobility of the neck. The pain is aching and constant, sometimes it can take the form of lumbago, and is often accompanied by tension in the paravertebral muscles. Very often, the provoking moment in the occurrence of acute pain syndrome is an injury, even a minor one, to which the patient often does not pay attention.
Chest syndromes.
Due to the fact that the thoracic spine (unlike the lumbar and cervical) is inactive, herniated thoracic discs with compression of the roots and spinal cord are rare.
Differential diagnosis
It should be carried out for diseases of the thoracic and abdominal organs, the clinical picture of which includes reflected pain in the spine; from tumor, infectious and metabolic diseases of the spine.
Urgent Care:
- bed rest until the pain subsides;
- avoid sharp bends, turns and painful poses;
- analgesics: analgin 50% solution 2-4 ml intramuscularly or intravenously, baralgin 5 ml intramuscularly or intravenously, reopirin (nirabutol) 5 ml intramuscularly, tramal 2 ml intramuscularly or intravenously, relanium 2 ml intramuscularly.
Patients whose acute pain syndrome is accompanied by the presence of focal lesions of the spinal cord that have developed as a result of impaired spinal circulation or compression of the spinal cord (paraparesis, tetraparesis) are subject to emergency hospitalization. In other cases, patients are left at home under the supervision of a neurologist.
HEADACHE AND DISLOCATION SYNDROME IN VOLUME LONG INTRACRANIAL PROCESSES
Term "Headache" includes all types of pain and discomfort localized in the head area, but in everyday life it is most often used to refer to unpleasant sensations in the cranial vault. Headache is one of the most common painful conditions in humans. It can be a signal of a serious illness or reflect only a state of tension or fatigue. Due to its dual nature - benign or potentially malignant - headaches require the attention of a doctor.
It is necessary to find out the nature, localization, duration and dynamics of headache over time, the conditions that cause it, intensify or weaken it. In most cases, the headache is aching, localized deep in the skull, long-lasting, dull, but not intense. The patient may talk about compression, pressure or a sensation of “breaking” the head, but this can be judged by muscle tension or a psychological crisis. Determining the degree of pain intensity is not of great importance, since it reflects more the patient’s attitude towards his condition than the true severity of the pain syndrome. The best indicator in this case is the degree of disability. Data regarding the localization of headaches are often informative and allow one to fairly accurately determine the source of pain if it is extracranial structures (inflammation of the temporal arteries). Pathological changes in the paranasal sinuses, teeth, eyes and upper cervical vertebrae also have a fairly defined area of distribution. Headache is the leading symptom in ordinary and classic migraine, cluster headache, tension headache, subarachnoid hemorrhage, meningitis; often for a long time it is the only symptom of a primary or metastatic brain tumor, noted in the structure of premenstrual syndrome, with various infectious diseases, with asthenopia (prolonged visual strain); for arterial hypertension and diseases occurring with symptoms of arterial hypertension; temporal arteritis, skull trauma, glaucoma and some other eye diseases, neuralgia of the trigeminal, glossopharyngeal, nasociliary, Vidian nerves, neuralgia of the pterygopalatine ganglion and a number of other diseases.
Main clinical types of headaches
Migraine - see standard "Migraine"
Cluster headache, also called paroxysmal nocturnal cephalalgia, histamine headache, and Horton's syndrome, occurs 4 times more often in men than in women. It manifests itself as periodic short-term (from 15 minutes to 2 hours) paroxysms of extremely severe unilateral headache, which occurs without prodromal phenomena 2-3 hours after falling asleep and is most often localized in the orbital area. The pain is intense and persistent and is accompanied by lacrimation, nasal congestion, followed by rhinorrhea, sometimes a rush of blood to the face and swelling of the cheek. Tends to recur every night for weeks or months, followed by a light interval for a number of years.
The clinical picture of pain is so characteristic that its description has no diagnostic value, although sometimes there is a need to differentiate from a carotid artery aneurysm, brain tumor, or sinusitis.
Urgent Care
Cluster headaches are very difficult to treat. Sometimes it is possible to interrupt an attack by taking ergotamine 1 mg (1 tablet) or propranolol (40-80 mg) or indomethacin (25-50 mg).
If ineffective:
— prednisolone 30 mg intramuscularly;
— verapamil 80 mg, other calcium antagonists;
- instillation of lidocaine 1 ml of 4% solution into the nose.
Psychogenic headache refers to a group of syndromes, including tension headache, muscle tension headache, and headache associated with anxiety and depression. These are dull, pressing, squeezing the head in the form of a “hoop”
or “helmet” pain that gets worse with emotional stress, anxiety, overwork. Many of these patients have depression, an asthenic or neurotic state.
The following can be used as emergency aid:
— analgin 50% solution 2-4 intramuscularly or intravenously;
- Relanium (seduxen, palium, sibazon) 2 ml intramuscularly or intravenously;
— baralgin 5 ml intramuscularly or intravenously.
Headache due to arterial hypertension - see standard "Hypertensive crisis"; "Acute hypertensive encephalopathy."
Headache due to subarachnoid hemorrhage - see standard "Strokes".
Headache due to traumatic brain injury - see standard "Craniobrain injury".
Headache due to temporal arteritis - the disease occurs mainly in men over 50 years of age and is characterized by a constant dull aching unilateral headache in the temple area, aggravated by coughing, straining, and jaw movement. On examination, expansion and increased pulsation of the temporal artery are noted, which is painful on palpation. Low-grade fever is detected.
Therapy - salicylates, non-steroidal anti-inflammatory drugs, hormonal drugs.
Urgent Care:
— analgin 50% solution 2-4 ml intramuscularly or intravenously;
— prednisolone 30 mg or dexamethasone 4 mg intramuscularly;
- aspirin 0.5 ml orally.
Headache due to intracranial space-occupying formations - brain tumors, intracranial post-traumatic and vascular hematomas, brain abscesses. An increase in brain volume due to the development of a pathological process and edema entails disturbances in the circulation of cerebrospinal fluid and venous outflow from the cranial cavity, gradual depletion of compensatory capabilities, and redistribution of cerebrospinal fluid in reserve spaces. Depending on the location of the pathological process, various parts of the brain’s liquor-conducting system are subject to compression, and the outflow of cerebrospinal fluid from the cranial cavity is disrupted. Due to sharp liquorodynamic disturbances with a continuing increase in intracranial pressure, conditions are created for various forms mixing of individual parts of the brain in relation to the formations of the dura mater delimiting the cranial cavity (cerebellar tentorium and the greater falciform process), as well as into the foramen magnum. The end result of such displacements is herniation (pinching) of the brain stem. There are two main, most frequently occurring levels of herniation - into the notch of the cerebellar tentorium ("superior herniation" - leads to compression, infringement of the anterior part of the brain stem) and into the foramen magnum ("inferior herniation") - leads to compression of the medulla oblongata from the back and sides ). Progressive pathological processes of supratentorial localization are characterized by a fronto-occipital sequence of symptoms and, accordingly, symptoms of “upper” and then “lower” herniation are first identified. Lesions in the region of the posterior cranial fossa manifest themselves directly as symptoms of “lower” herniation.
In the very initial stage of the “upper” herniation, patients with preserved consciousness experience increased headaches, general hyperesthesia, extrasystole, irritability, decreased level of attention, drowsiness, changes in the usual rhythm of sleep and wakefulness, thirst, “smacking” movements of the lips. Depending on the nature of the pathological process and emergency treatment prescribed at this stage, symptoms may be reversible or gradually increase in severity. In the latter case, indications for emergency neurosurgical treatment arise. Extremely important is the large individual variability in the duration of individual stages of the formation of the midbrain lesion syndrome and the timing during which the bulbar syndrome is detected. The nature of the pathological process is of some importance in this regard - herniation syndrome develops most quickly with extensive hemispheric hematomas. From the moment the first symptoms appear until death as a result of herniation of the medulla oblongata into the foramen magnum can take from 30 minutes to several hours. This situation requires repeated inspections every 10-15 minutes to make the right tactical decision.
With further development of the process, depression of consciousness steadily progresses until deep coma. Against this background, the following changes occur sequentially: the anisocoria phase (wide pupil on the side of the pathological process) is replaced by bilateral dilation of the pupils; tonic extension of the lower extremities appears with a flexion posture of the upper extremities; the appearance of hemiparesis on the side opposite the dilated pupil. As the herniation continues, symptoms disappear that make it possible to judge the localization of the process, pyramidal disorders become bilateral; arterial hypertension, tachycardia, arrhythmia, respiratory disorders, and hyperthermia increase.
Herniation into the foramen magnum is characterized by symptoms of damage to the lower parts of the brain stem and a sharp depression of the functions of the medulla oblongata: atonic coma, dilated pupils that do not respond to light, the gaze is motionless, tonic reflexes and foot pathological signs fade away; Breathing disorders progressively increase, blood pressure decreases, tachycardia gradually gives way to bradycardia, the pulse is arrhythmic, body temperature gradually decreases.
Urgent Care
Maintenance of life during the development of “lower” herniation is achieved by mechanical ventilation and constant correction of hemodynamic parameters. Restoration of brain function can be achieved in rare cases and only as a result of emergency surgery.
Emergency hospitalization in a multidisciplinary hospital with neurosurgical and intensive care units.
Treatment algorithms for diseases affecting the nervous system
Hemorrhagic stroke (Emergency care algorithm)
For hemorrhagic stroke:
1. Strict bed rest, stopping bleeding, reducing blood pressure to normal, reducing intracranial pressure, combating edema and swelling of the brain, eliminating acute breathing disorders, combating cardiovascular disorders and psychomotor agitation.
2. Transportation of the patient to a neurological hospital is carried out as early as possible after the onset of a cerebral stroke, observing all precautions: carefully placing the patient on a stretcher and bed, maintaining a horizontal position when carrying, avoiding shaking, etc.
Before transportation, the patient is administered hemostatic agents (vicasol, dicinone, calcium gluconate), and a venous tourniquet is applied to the thighs to reduce the volume of circulating blood.
In case of threatening respiratory failure, transportation with IVP and oxygen inhalation are advisable. In the early stages, the administration of epsilon-aminocaproic acid (100 ml of a 5% solution intravenously) with 5000 units of heparin is indicated. To reduce intracranial pressure, active dehydration therapy is carried out: Lasix 4-6 ml of a 1% solution (40-60 mg) intramuscularly, mannitol or mannitol (200-400 ml of a 15% solution intravenously). The earliest possible use of means of “metabolic protection” of brain tissue and antioxidants is justified (sodium hydroxybutyrate - 10 ml of a 20% solution intravenously slowly - 1-2 ml per minute; piracetam - 5 ml of a 20% solution intravenously; tocopherol acetate 1 ml of 10-30% solution intramuscularly; ascorbic acid 2 ml of 5% solution intravenously or intramuscularly).
Fibrinolysis inhibitors and proteolytic enzymes are also administered in the early stages: trasylol (contrical) 10,000-20,000 units intravenously. It should be remembered that the development of spontaneous subarachnoid hemorrhage in young people is often caused by rupture of arterial aneurysms.
3. Hospitalization. urgent to the neurosurgical hospital.
Ischemic stroke (cerebral infarction)
Ischemic stroke develops as a result of partial or complete blockage of a blood vessel supplying one or another part of the brain, as a result of which normal blood flow through the affected bed is disrupted.
Main causes of ischemic stroke.
- Changes in the walls of extracranial and intracranial vessels that occur with persistent arterial hypertension, atherosclerosis, arteritis of various etiologies.
Ischemic stroke, as a rule, develops in old age, and there is some relationship with mental and physical activity. An ischemic stroke can develop gradually over several hours or even days.
Typical precursors of ischemic stroke are dizziness, short-term loss of consciousness, darkening of the eyes, general weakness, and transient paresthesia of the extremities.
Ischemic stroke is characterized by a predominance of focal symptoms over cerebral symptoms. In this case, focal symptoms depend on the location of the affected vessel: anterior, middle or posterior cerebral artery, vertebral arteries.
The consciousness of the victim during the development of an ischemic stroke is usually not impaired, the headache is mild or absent, there are no symptoms of irritation of the meninges, the skin is pale, the body temperature is normal, and the cerebrospinal fluid is not changed.
At the initial stage of the disease, it is not always possible to differentiate individual types of ischemia of local areas from each other. In such cases, the diagnosis is made retrospectively.
Diagnosis of a typical ischemic stroke is not difficult. Reliable diagnostic methods include MRI, CT, cerebral angiography, and lumbar puncture.
Patients with ischemic stroke are hospitalized in the neurological or intensive care unit of the hospital, where they receive emergency care.
- Patients are prescribed strict bed rest.
Contrary to popular belief, stroke is not a disease. Yes, such a diagnosis exists and it is given, but more and more specialists cease to consider stroke an independent disease, calling it a complication of a number of vascular diseases. In terms of frequency, this pathology ranks second among all causes of death. That is why knowledge of its symptoms and diagnostic methods (including the pre-hospital stage) can seriously affect the health of both the entire society and the individual.
We recommend reading:Types of stroke
Experts distinguish two main types of stroke based on their main cause:
- Ischemic stroke, arising as a consequence of various disorders leading to a sharp deterioration in blood supply to areas of the brain;
- Hemorrhagic stroke, which refers to the outpouring of blood from vessels of various sizes; in this case, pathological changes in the brain are caused by a developing and increasing hematoma, compressing the brain structures.
There is a separate classification of ischemic stroke, taking into account most diseases leading to its development. It is of interest only to specialists, but it is important for us to understand in what cases this severe pathology can develop.
Causes of stroke
Because stroke is considered a complication, a single cause cannot be clearly identified. Here we are talking rather about risk factors that increase the likelihood of this pathology and are divided into two groups:
- modifiable and
- unmodifiable.
The former include a number of diseases that lead to damage to the vascular wall or poor circulation in other ways:
- arterial;
- heart disease;
- ciliated;
- carried over in the past;
- disorders of fat metabolism (dyslipoproteinemia);
- diseases that damage the carotid arteries that supply the brain.
Modifiable risk factors also include lifestyle features:
- smoking;
- excess body weight;
- unhealthy diet with a predominance of saturated fats, lack of plant fibers;
- alcohol abuse;
- absence or severe lack of physical activity;
- consumption;
- decreased blood testosterone levels;
- acute and chronic.
Non-modifiable factors– this is something that cannot be changed by any methods: gender, age, genetic predisposition.
TO conditionally unmodifiable factors This includes chronic heart failure, which, although it can be compensated to a certain extent, cannot be completely cured.
The factors described above relate primarily to ischemic stroke, which is much more common than hemorrhagic stroke. The development of the latter is led by:
- arterial hypertension;
- any pathology of the blood vessels supplying the brain;
- disorders of blood coagulation function under the influence of taking anticoagulants, disaggregants, thrombolytics or due to pathology of the thrombus formation system;
- taking various types of psychostimulants - amphetamines, cocaine, etc.;
- alcohol abuse.
Situations that can trigger a stroke
The development of complications is possible even against the background of general well-being, but often a breakdown of compensation mechanisms occurs in cases where the load on the vessels exceeds a certain critical level. Such situations may be associated with everyday life, with the presence of various diseases, with external circumstances:
- a sharp transition from a lying position to a standing position (sometimes it is enough to switch to a sitting position);
- dense food;
- hot bath;
- hot season;
- increased physical and mental stress;
- cardiac arrhythmias;
- a sharp decrease in blood pressure (most often under the influence of medications).
Symptoms of a stroke
In terms of diagnosis, stroke is a rather difficult task even for doctors. Normal inflammation of the trigeminal nerve, which innervates the facial muscles, leads to the appearance of some symptoms characteristic of a stroke. If at this moment a person’s level is also increased, the likelihood of an error increases significantly. 
However, a stroke is a disease in which it is better for the doctor to assume the worst rather than miss its occurrence. Therefore, it should be suspected in all cases when:
- sudden weakness, numbness, “goosebumps” in the arm or leg occur, especially if symptoms appear in only one half of the body;
- facial asymmetry appears;
- vision decreases or disappears, visual artifacts appear that were not there before (loss of part of the visual field, “spots”);
- speech deteriorates, becoming incoherent and meaningless;
- a severe headache appears for no apparent reason, especially if its onset is of the nature of a “blow”;
- consciousness is impaired from mild stupor when the patient reacts to external stimuli with a slight delay, until consciousness is completely turned off - coma.
To simplify the prehospital diagnosis of stroke, a group of British doctors developed the FAST complex in 1998. This is a series simple manipulations, with help in most cases one can at least suspect this pathology.
The essence of this complex is as follows:
- F –face or person. This element consists of determining the symmetry of the face and identifying paresis of facial muscles. To identify problems, the patient is offered:
- Show teeth. During a stroke, the shape of the mouth resembles a tennis racket - one half of the lips moves apart, while the other remains closed.
- Smile. With a stroke, there is a lack of work of the facial muscles on one side of the face.
- Puff out your cheeks. During a stroke, one cheek retains tone, while the other does not inflate (doctors say “parusitis”, from the word “sail”).
- A –arm or hand. This element is necessary to identify motor and sensory disorders. To detect pathology, the patient undergoes several tests:
- A lying patient raises both arms to an angle of 45° (a sitting patient raises both arms to an angle of 90°). During a stroke, one of the arms lags behind or does not rise at all.
- The doctor raises both the patient’s hands above his head, joining them with his palms, holds them in this position for 5 seconds, and then releases them. One of the arms gradually lowers.
- For a lying patient, both legs are bent at the hip and knee joints at an angle of 90°. During a stroke, a person cannot hold one of his legs in this position.
- The patient forms from the index and thumb hand ring (like the OK sign). The doctor inserts his index finger into the ring and tries to break it without applying much force. If successful, a stroke is suspected.
- The patient should squeeze the doctor's hands with both hands. In this case, a difference in compression force is revealed, which is inevitable during a stroke.
- S –speech or speech. Allows you to identify violations of speech functions, as well as a person’s ability to navigate in space, time and in his personality. The beginning of identifying this element is to interview loved ones who could note the moment when the violations occurred. Then the doctor moves on to questions:
- What is your name? How old are you? – the patient may not answer these questions if he is not self-oriented.
- Where are you at? What date, day, month, year is it today? – a patient with a stroke may be disoriented in place, time, space and will not be able to answer correctly.
- When receiving answers, the doctor pays attention to the delay in response and the intelligibility of speech.
- T -time or time. This is not a diagnostic element, but an important stage of medical care. There is a so-called “therapeutic window” - 6 hours from the moment the first symptoms of a stroke appear. This period should be taken into account, since it is at this time that it is possible to carry out such therapeutic measures that can completely eliminate the disease.
Diagnostics
Although the FAST complex makes it possible to establish a diagnosis of stroke with a fairly high degree of confidence (80-90%), to definitively confirm this fact, a full range of measures is required. Conducting laboratory and instrumental studies also allows us to determine the tactics of further treatment and make a prognosis regarding the outcome of the disease.
The examination begins with a survey of the patient or his relatives. The doctor pays attention to the moment of the onset of the stroke and identifies the dynamics of the development of symptoms. It is very important to find out everything about concomitant diseases that could lead to a stroke, as well as learn about your predisposition to it.
At the second stage, routine tests and studies are carried out:
At the third stage, instrumental diagnostics are carried out. Computed tomography and magnetic resonance imaging are used to identify the fact of a stroke, clarify its nature (ischemic or hemorrhagic), the affected area, and also to exclude other diseases with similar symptoms. Sometimes these methods are supplemented with angiography, which allows one to visualize the state of blood vessels in the necrosis zone and adjacent tissues.
Doppler ultrasound also allows you to find out what condition the brain vessels are in, assess the degree of their narrowing and deterioration of blood supply to intracranial structures.
Other diagnostic methods provide little information to help doctors, so they are not usually used.
This is the most insidious form of cerebral ischemia (malnutrition). Its danger is that the symptoms characteristic of a stroke appear quite quickly and disappear just as quickly (within an hour). Being not too pronounced, they often pass by the patient’s attention and do not alarm him. But Hippocrates also wrote: “Unusual attacks of stupor and anesthesia are signs of impending apoplexy.”(apoplexy used to be called all forms of stroke).
A transient ischemic attack is not nearly as harmless as it seems. According to researchers, in the presence of ischemia within half an hour, a third of patients already experience organic changes in the brain tissue. That is why, if the slightest signs of a stroke appear (even if they disappear after a few minutes), you should immediately consult a doctor to diagnose and prevent disorders of the blood supply to the brain.
Stroke treatment
Stroke is an extremely serious complication, so its treatment should begin as early as possible. However, drug therapy should not always be used in the first minutes, since often the rush to prescribe drugs worsens the prognosis of the disease.
The main rule is to call an ambulance, provide first aid if necessary and send the patient to the hospital, where he will be given a full range of treatment measures:
- adequate oxygen supply;
- control of respiratory functions;
- reducing the severity of cerebral edema;
- elimination of possible fever;
- correction of impaired metabolic parameters;
- symptomatic treatment.
In addition, specialists may prescribe specific treatment:
- thrombolysis (administration of special drugs that dissolve blood clots in the blood vessels of the brain);
- anticoagulant and antiplatelet therapy for the same purpose;
- surgery to remove a blood clot, angioplasty.
Timely treatment of stroke can significantly limit the focus of brain tissue necrosis. As a result, a person can avoid death, and in some cases, disability. However, stroke still remains an extremely serious pathology, which should be treated only under the supervision of a doctor.
Bozbey Gennady Andreevich, emergency physician
Stroke is an acute cerebrovascular accident (ACVA). The causes may be hemorrhage, embolism, thrombosis, vasospasm. Currently, this insidious disease affects not only older people, but also young people. If a person has a stroke, then it is very important not to waste time and begin to provide him with first aid even before the medical team arrives.
Let's take a closer look at the causes of stroke and its diagnosis.
Etiological factors of stroke
- Atherosclerosis of cerebral vessels.
- Vascular abnormalities (aneurysms, narrowings).
- Blood diseases.
An unhealthy lifestyle is also of great importance: inactivity, stress, drinking alcohol and smoking, poor nutrition.
Diagnosis of stroke
There are several types of stroke: hemorrhagic, ischemic and mixed. The first type usually begins acutely, with the development of coma. The other two types may develop gradually, with precursors.
Here are some signs that will help suspect the development of stroke:
- headache, loss of consciousness, coma;
- paresthesia (numbness) of the limbs on one side;
- rotation (outward deviation) of the foot on the paralyzed side;
- smoothness of the nasolabial triangle and drooping corner of the mouth;
- affected limbs fall “like whips”;
- slurred, slurred speech.
Thus, if a person is conscious, then to determine the presence of a stroke, three simple things must be done:
- Ask to smile(the patient's mouth will be unnaturally distorted).
- Ask any question(the person may either not understand you at all, or will not be able to answer or will answer inarticulately).
- Ask for a show of hands(in one direction this will be impossible to do).
If you find any of the above symptoms in a person, you must immediately call ambulance and begin emergency first aid measures. It is very important to transport the victim to the hospital within the first 3-5 hours. Since it is at this time that effective medical care can be provided and thereby possibly save lives and prevent the development of further ischemia and complications.
First aid for stroke
- Lay with the head end raised.
- Remove the dentures and carefully turn your head to the side.
- Provide air access (unbutton your tie, shirt collar, open the windows).
- If you have a device at hand, measure the pressure.
- In case of high blood pressure, give capoten under the tongue or any other medicine familiar to a person. It must be remembered that the pressure should drop gradually.
- If you have glycine in your medicine cabinet, you can take about ten tablets, crush them and give them under the patient’s tongue for resorption.
It is strictly forbidden to:
- Reduce blood pressure sharply.
- Give drugs like no-shpa and papaverine, as they cause steal syndrome, which consists in the fact that unaffected vessels dilate, and the blood supply to the ischemic area worsens.
Summarizing all of the above, we can conclude that the life and performance of a person who has suffered a stroke will depend on quick and coordinated actions. Don’t be afraid to seem funny; in case of doubt, it’s better to play it safe once again and call an ambulance.
