What Happens After a Stroke?

Stroke sequela refers to a condition that is mainly manifested by hemiplegia, numbness, skewed eyes and eyes, and adverse speech after the onset of acute cerebrovascular disease. Stroke, commonly known as stroke, is the name of a disease in Chinese medicine. The early mortality rate of hemorrhagic stroke is very high. About half of the patients die within a few days of onset. Most of the survivors have different degrees of dyskinesia, cognitive impairment, and speech swallowing Obstacles and other sequelae. Hemiplegia is the main sequelae in patients with ischemic stroke.

Basic Information

English name

sequela of apoplexy

Visiting department

Neurology

Disease site

brain

Disease characteristics

Physical, cognitive, speech and other dysfunctions

Multiple people

Men after age 50

Causes of stroke sequelae

Hemorrhagic stroke

(1) Seasons are more likely to occur in winter and autumn than in summer. This is due to cold weather in winter, vasoconstriction, and increased blood pressure. In summer, the weather turns hot, blood vessels dilate, and blood pressure drops. However, heat stroke in summer and increased sweating can also trigger cerebral hemorrhage.

(2) Emotional emotions can suddenly increase blood pressure and cause cerebral hemorrhage.

(3) Excessive fatigue and excessive force can cause blood pressure to rise and become the cause of sequelae of cerebral hemorrhage.

(4) Eating a full meal and eating too greasy food can increase the lipids in the blood, accelerate blood circulation, and suddenly increase blood pressure, which can cause cerebral hemorrhage.

Cerebral hemorrhage causes different degrees of brain tissue destruction, and there are still different degrees of sequelae after treatment. This is related to the following factors: bleeding volume: the amount of bleeding directly affects the severity of clinical symptoms. bleeding site: bleeding in different parts, the degree of impaired brain function varies. Treatment and nursing during rehabilitation: timely and standardized rehabilitation can greatly reduce the incidence of sequelae.

2. Ischemic stroke

(1) Cardiogenic cerebral embolism.

(2) Hyperlipidemia, hypertension, and diabetes.

(3) Other causes such as arterial inflammation.

Clinical manifestations of stroke sequelae

Hemorrhagic stroke

(1) Limb dysfunction mainly manifests as hemiplegia and sensory and motor dysfunction

(2) Cerebral hemorrhage with large-scale or repeated recurrence may be left with mental and cognitive disorders: such as personality changes, negative pessimism, depression and depression, mental depression, and excitement.

(3) Speech dysfunction.

(4) Dysphagia.

(5) Other symptoms headache, dizziness, nausea, insomnia, dreaming, inattention, tinnitus, dazzling, sweating, palpitations, unstable pace, neck fatigue, weakness, loss of appetite, memory loss, dementia, depression, etc. .

2. Ischemic stroke

(1) Hemiplegia is the most common sequelae of cerebral thrombosis. Muscle weakness, poor mobility, or total inability to move on one side of the limb. Often accompanied by sensory disorders of the ipsilateral limbs such as cold and heat ignorance, pain and so on. Sometimes accompanied by a visual field defect on the ipsilateral side.

(2) Aphasia Motor aphasia occurs when the patient understands the words of others, but cannot express his meaning. Sensory aphasia has no language barriers. It does not understand what others are saying or what it is saying. Naming aphasia manifests itself when you see an object and can tell its purpose, but you cannot name it.

(3) Large-scale or repeated recurrence is also a symptom of cerebral thrombosis sequelae. Mental and intellectual disorders may remain: personality changes, negative pessimism, depression and depression, mental depression, and excitement.

(4) Other symptoms headache, dizziness, nausea, insomnia, dreaming, inattention, tinnitus, dazzling, sweating, palpitations, unstable pace, neck fatigue, fatigue, loss of appetite, memory loss, intolerable noise Wait.

Stroke sequelae examination

Hemorrhagic stroke

The examination mainly includes imaging examination and rehabilitation assessment:

(1) Imaging examination

1) Cerebral angiography has been an important diagnostic method for cerebral hemorrhage. Cerebral angiography is mainly manifested as mass mass.

2) The development of cerebral hemorrhage on CT examination depends on hemoglobin in the blood, and its absorption coefficient of X-ray is significantly larger than that of brain tissue, so it shows a high density shadow.

3) Skull magnetic resonance scan (MRI) of cerebral hemorrhage on MIR can be divided into four layers: the central core layer, which is the most hypoxic; the outer nuclear layer, which is lighter, and the outer marginal layer, phagocytic cells There is hemosiderin in it, the outermost zone is the reaction zone, glial cell proliferation and cerebral edema of varying degrees.

(2) Rehabilitation assessment

Muscle strength, muscle tone, balance function, daily living ability assessment, Brinell staging, speech function assessment, psychological function assessment, etc.

2. Ischemic stroke

The examination mainly includes imaging examination and rehabilitation assessment:

(1) Imaging examination

1) Skull CT scan is a convenient and cheap test for the diagnosis of cerebral thrombosis. It can clarify the location, size, and degree of cerebral edema of brain tissue necrosis (ie, cerebral infarction), which is of guiding significance for treatment, but the lesions are often not found within 24 hours of onset. In addition, the disadvantage of CT lies in the poor display of brainstem and cerebellar lesions.

2) Magnetic resonance scan of the head This examination can make up for the defects that the skull CT can not find the lesion within 24 hours and shows poor lesions in some parts, especially the magnetic resonance angiography can still show large occluded blood vessels. The disadvantage is that it is more expensive, and some patients cannot perform this test because of metal objects that cannot be removed from the body, such as cardiac pacemakers, metal teeth, fracture nails, etc., which limits its use.

3) Cerebral angiography This examination can find the vascular stenosis and occlusion. In the early stage (within 6 hours of onset), thrombolytic drugs can be injected directly into the stenosis or occlusion for thrombolysis. The disadvantage is that there are certain injuries and complications.

(2) Rehabilitation assessment

Muscle strength, muscle tone, balance function, daily living ability assessment, Brinell staging, speech function assessment, psychological function assessment, etc.

Stroke sequelae treatment

Rehabilitation rehabilitation is very important for patients with sequelae of stroke.

Rehabilitation exercise

(1) Functional exercise for facial paralysis.

(2) Language swallowing function training.

(3) Cognitive function training.

(4) Physical function training: transfer training; passive joint activities; inducing active movement of patients; hand function training; training of balance and coordination ability; walking function training.

2.Physiotherapy

It mainly includes functional electrical stimulation, biofeedback, transcranial magnetic stimulation, sequential circulation therapy instrument, acupuncture, hyperbaric oxygen and so on.

Stroke sequelae prognosis

Hemorrhagic stroke

(1) The older the age, the worse the prognosis. The mortality rate below 60 years is lower, accounting for about 30%, and the mortality rate above 70 years can be as high as 70%.

(2) The longer the history of hypertension , the higher the blood pressure, and the worse the prognosis. For those with blood pressure above 200/120 mm Hg, the mortality rate was 30.07%.

(3) The deeper the coma, the longer the coma, and the worse the prognosis. 94% of deep coma died. After the illness, unconsciousness, or the consciousness gradually improves, the prognosis is better. The longer the drowsiness, the worse the prognosis.

(4) The faster the disease progresses, the sooner the symptoms of high intracranial pressure appear, the more severe the performance, and the worse the prognosis.

(5) Hemorrhage The prognosis is worse for those with larger hemorrhage . Hematoma formation and significant shift in midline structure have a poor prognosis. Lumbar penetrating cerebrospinal fluid is colorless and transparent, and the prognosis is good.

(6) The prognosis of the author with epilepsy is poor. Because it can increase cerebral edema or cerebral hemorrhage.

(7) Patients with visceral dysfunction have a poor prognosis. Gastrointestinal bleeding is common, with a mortality rate of 80%.

(8) The prognosis is worse for those with metabolic disorders such as acidosis and electrolyte disturbance.

(9) Repeated authors have poor prognosis.

(10) The worse the therapeutic effect of dehydration and antihypertensive, the worse the prognosis.

2. Ischemic stroke

(1) It is related to the size of the blocked blood vessels. For example, small blood vessels are blocked, the cerebral ischemia is small, the collateral circulation is easy to form, the recovery is faster, and the prognosis is better. Such as blocked blood vessels, large cerebral ischemia, severe damage to brain tissue, slow recovery of clinical symptoms, and poor prognosis.

(2) Those who are slowly and gradually related to the incidence of disease, are more likely to form collateral circulation, cerebral ischemia can be gradually compensated, and the prognosis is better. Acute onset patients fail to establish collateral circulation and have a poor prognosis.

(3) The first attack is related to the number and number of infarcts, and the prognosis is good.

(4) It is related to the nature of the emboli, such as emboli loosening. During the process of running with the blood, it breaks itself, flows to the far end of the blood stream, and blocks small blood vessels. The prognosis is good. Fatty emboli, air emboli, and bacterial emboli have a worse prognosis than cardiogenic emboli. However, the prognosis of patients with brain abscess caused by cardiogenic emboli is poor.

(5) The localization symptoms such as hemiplegia and aphasia after the onset are related to the severity of localized symptoms, and the prognosis is better. Conversely, those with hemiplegia and aphasia have a worse prognosis.

(6) The degree of coma is serious related to the degree of coma. The longer the duration, the worse the prognosis. There was no coma at the onset of the disease, and those who entered the coma later, and the coma gradually worsened, the prognosis was poor. The patient is always awake and has a good prognosis.

(7) It is related to the presence or absence of comorbidities such as combined pressure ulcers, lung infections, urinary tract infections, diabetes, coronary heart disease, arrhythmia, and heart failure. The prognosis is poor. Those without comorbidities have a better prognosis.

(8) Age-related , age-related , poor constitution, and poor prognosis. Young, good constitution, good prognosis.