What Is a Posterior Stroke?

"Cerebral stroke" is also known as "stroke" and "cerebral vascular accident" (CVA). It is an acute cerebrovascular disease. It is a group of diseases that cause brain tissue damage due to sudden rupture of blood vessels in the brain or the inability of blood to flow into the brain due to vascular occlusion, including ischemic and hemorrhagic stroke. The incidence of ischemic stroke is higher than that of hemorrhagic stroke, accounting for 60% to 70% of the total number of strokes. Occlusion and stenosis of the internal carotid and vertebral arteries can cause ischemic stroke, mostly over 40 years of age, more men than women, and severe cases can cause death. Mortality from hemorrhagic stroke is high. Surveys show that combined stroke in urban and rural areas has become the number one cause of death in China and the leading cause of disability in Chinese adults. Stroke has the characteristics of high morbidity, high mortality, and high disability. Different types of stroke are treated differently. Due to the lack of effective treatments, prevention is currently considered to be the best measure. Hypertension is an important controllable risk factor for stroke. Therefore, antihypertensive treatment is particularly important to prevent the onset and recurrence of stroke. Education on stroke risk factors and aura symptoms should be strengthened in order to prevent and cure stroke.

Basic Information

nickname

Stroke, cerebrovascular accident

English name

stroke

Visiting department

Neurology, Cardiac Surgery

Common causes

Small emboli on the inner wall of the blood supply vessel of the brain, which can cause arterial-arterial embolism after falling off; it can also be caused by cerebrovascular or thrombotic bleeding

Common symptoms

Headache, vomiting, disturbance of consciousness, coma, hemiplegia, choking, etc.

Causes of stroke

Vascular risk factors

The most common cause of stroke is a small emboli on the inner wall of the blood supply to the brain, which leads to arterial-arterial embolism, which is ischemic stroke. It may also be caused by cerebrovascular or thrombotic bleeding, which is a hemorrhagic stroke. Coronary heart disease patients with atrial fibrillation are prone to mural thrombosis in the heart valves. Embolism can clog cerebral blood vessels and cause ischemic stroke. Other factors include hypertension, diabetes, and hyperlipidemia. Among them, hypertension is the most important risk factor for the onset of stroke in the Chinese population, especially the abnormal rise in blood pressure in the morning. The study found that early morning hypertension is the strongest independent predictor of stroke events. The risk of ischemic stroke during the early morning period is 4 times that of other periods. For every 10mmHg increase in early morning blood pressure, the risk of stroke increases by 44%.

The main cause of stenosis and occlusion of the internal carotid or vertebral arteries is atherosclerosis. In addition, arterial intimal hyperplasia and hypertrophy caused by collagenous diseases, hypertension, arterial changes, rheumatic heart disease or arteritis, blood diseases, metabolic diseases, drug reactions, tumors, connective tissue diseases, etc. Carotid artery thrombosis associated with cervical lymphadenitis and tonsillitis in children, as well as congenital carotid artery distortion, can cause internal carotid artery stenosis and occlusion, or stroke caused by rupture of blood vessels. Cervical spondylosis or osteoporosis of the skull base can cause vertebral artery ischemia.

2. Gender, age, race and other factors

Studies have found that the incidence of stroke is higher in our population than in heart disease, as opposed to in Europe and America.

3. Bad lifestyle

There are usually multiple risk factors at the same time, such as smoking, unhealthy diet, obesity, lack of proper exercise, excessive alcohol consumption and high homocysteine; and patients have some basic diseases such as hypertension, diabetes and hyperlipidemia. Will increase the risk of stroke.

Clinical manifestations of stroke

The most common symptoms of stroke are sudden weakness on one side of the face, arms, or legs, sudden fainting, unconsciousness, and other symptoms, including sudden numbness of the face, arms, or legs on one side or sudden mouth and eye distortion, Hemiplegia; confusion, difficulty speaking or understanding; difficulty in seeing with one or both eyes; difficulty in travelling, dizziness, loss of balance or coordination; severe headache without cause; fainting, etc. There are three types of neurological dysfunction and duration of symptoms after cerebral artery stenosis and occlusion.

1. Transient ischemic attack (TIA)

Internal carotid artery ischemia manifests as sudden limb movement and sensory disturbances, aphasia, transient blindness in one eye, etc., with few conscious disturbances. Vertebral artery ischemia manifests as dizziness, tinnitus, hearing impairment, diplopia, gait instability, and difficulty swallowing. Symptoms last less than 2 hours and can recur, even several or dozens of times a day. It can relieve itself without sequelae. There were no obvious infarcts in the brain.

2. Reversible ischemic neurological dysfunction (RIND)

It is basically the same as TIA, but the neurological dysfunction lasts for more than 24 hours, and some patients can reach several days or dozens of days, and finally gradually recover. The brain may have small infarcts, most of which are reversible.

3. Complete Stroke (CS)

Symptoms are more severe than TIA and RIND, worsening, and often with disturbances of consciousness. Obvious infarcts appear in the brain. Neurological dysfunction cannot be recovered for a long time, and complete stroke can be divided into three types: mild, moderate and severe.

4. Stroke Omen

Studies have found that the common signs of stroke are:

(1) Dizziness, especially when you suddenly feel dizzy.

(2) Limb numbness, I suddenly feel numbness on one side of the face or hands and feet, and some are numbness of tongue and numbness of lips.

(3) temporarily illegible or ineffective speech.

(4) Weak limbs or inability to move.

(5) Different headaches than usual.

(6) Sudden fall or fainting for unknown reasons.

(7) Transient loss of consciousness or sudden changes in personality and intelligence.

(8) The whole body is obviously weak, and the limbs are weak.

(9) Nausea and vomiting or blood pressure fluctuations.

(10) Lethargic and drowsy all day.

(11) Involuntary twitching of one or one limb.

(12) There is a sudden feeling in the eyes that can't see what appears in front of you.

Stroke check

General inspection

By measuring the height, weight and blood pressure of the human body, a scientific judgment is made as to whether the weight is normal and whether the blood pressure is normal.

2. Medical examination

The basic conditions of the vital organs such as the heart, lungs, liver, and spleen are checked by sight, touch, palpation, and hearing, and the relevant signs of common diseases are found, or common diseases are initially excluded.

3. Cerebral angiography

It shows the narrowing, occlusion or distortion of cerebral arteries in different parts. When the carotid artery is narrow at the beginning, the neck should be included in the radiograph.

4. Head and Neck Magnetic Resonance Angiography (MRA) or High Resolution Magnetic Resonance Imaging (HRMRI)

(HRMRI) can show the entire course of the carotid artery. HRMRI is more helpful for the analysis of pathological components of atheroma.

5. Carotid B-mode ultrasound and transcranial Doppler ultrasound (TCD) detection

For non-invasive examination, it can be used as a screening method for diagnosing stenosis and occlusion of the initial segment of internal carotid artery and intracranial artery. Carotid color Doppler ultrasound can detect carotid artery structure and atherosclerotic plaque morphology, scope, nature, and degree of arterial stenosis; early detection of arterial vascular disease is effective in preventing and reducing cardiovascular and cerebrovascular diseases such as coronary heart disease and ischemic cerebrovascular disease Onset provides objective hemodynamic basis. Transcranial Doppler understands the blood flow of intracranial and extracranial blood vessels, cerebral arterial ring blood vessels and their branches, and determines whether there are vascular diseases such as sclerosis, stenosis, ischemia, deformity, and spasm. Dynamic monitoring of cerebrovascular diseases.

Stroke diagnosis and differential diagnosis

Diagnostic technology

These include neurological examinations, computed tomography (without contrast enhancement in most cases) or nuclear magnetic resonance, Doppler ultrasound, and angiography, relying primarily on clinical symptoms, supplemented by imaging techniques. Imaging technology can also help identify the subtype and cause of stroke. A blood test can also help with the diagnosis.

2. Symptom identification

The typical symptoms of stroke are headache and vomiting, which can easily be confused with other diseases. You can use the "FAST" judgment method:

F is the face. Ask the patient to smile and see if the patient's mouth is crooked. Asymmetry in the face of the stroke patient will occur, and the patient will not smile normally.

A is arm (arm), asking the patient to raise his hands to see if the patient has limb numbness;

S is speech (speech), ask the patient to repeat a sentence to see if the speech is difficult to express or inarticulate;

T is Time (Time), clearly record the time of onset, and seek medical treatment immediately.

Stroke treatment

Severe stroke can cause permanent nerve damage. If the acute stage is not diagnosed and treated in time, it can cause serious complications and even death. Stroke can be divided into hemorrhagic stroke and ischemic stroke, and there are different treatment methods depending on the site of occurrence. Specific treatments include thrombolysis, antiplatelet therapy, early anticoagulation, and neuroprotection. Nonspecific treatments include antihypertensive therapy, blood glucose management, cerebral edema, and management of intracranial hypertension.

Drug treatment

Thrombolytic therapy is currently recognized as the most effective treatment method for stroke, but there is a strict time window requirement (intravenous thrombolysis is limited to 4.5 hours, and arterial thrombolysis can be extended appropriately).

For patients with existing stroke and hypertension, blood pressure control in the acute phase of stroke should be carried out in accordance with the guidelines for stroke. The target of blood pressure treatment for chronic or old stroke should generally reach <140 / 90mmHg, Patients with diabetes should have a blood pressure goal of <130 / 80mmHg. The principle of antihypertensive treatment for stroke is stable, long-lasting and effective control of 24-hour blood pressure, especially early morning blood pressure. Five commonly used antihypertensive drugs can play a role in preventing stroke or transient ischemia by reducing blood pressure. Among them, calcium antagonist (CCB) has clear clinical evidence in reducing the risk of stroke. Antihypertensive drugs should start with small doses, closely observe blood pressure levels and adverse reactions, and control blood pressure within a safe range (within 160 / 100mmHg) as much as possible. Patients should start with a small dose when antihypertensive treatment, and should not lower blood pressure too quickly to prevent insufficient blood supply to the brain. Patients with elevated blood pressure within 24 hours of the onset of acute ischemic stroke should be treated with caution.

Patients who already have hypertension, diabetes, hyperlipidemia and other diseases need to take the following drugs: aspirin, -blockers, angiotensin converting enzyme inhibitors, statins.

2. Surgery

(1) Carotid endarterectomy is suitable for severe stenosis of the extracranial segment of the internal carotid artery (the stenosis exceeds 70%), and the stenosis is below the angle of the mandible. Surgery can also be considered within 24 hours of complete occlusion of the internal carotid artery. If the occlusion exceeds 24 to 48 hours and the brain has softened, surgery should not be performed.

(2) Extracranial-intracranial arterial anastomosis is effective in preventing TIA. Superficial temporal artery-middle cerebral artery anastomosis, occipital artery-posterior inferior cerebellar artery anastomosis, occipital artery-posterior cerebral artery anastomosis can be selected.

Stroke prevention

For the prevention of stroke, follow the strategy of tertiary prevention: primary prevention is to target people with stroke risk factors, actively treat the risk factors, and regularly monitor the occurrence of other risk factors and take targeted measures to reduce the incidence of the disease; it has been proven , Smoking ban, limiting the salt content in the diet, eating more fresh fruits and vegetables, regular physical exercise, and avoiding excessive drinking can reduce the risk of cardiovascular disease. In addition, medications for diabetes, hypertension and hyperlipidemia are needed to reduce the risk of cardiovascular disease and prevent stroke. Secondary prevention refers to the early diagnosis and early treatment of patients who have suffered one or more strokes, to prevent the occurrence of severe cerebrovascular disease. The commonly used five types of antihypertensive drugs can be used for secondary prevention of stroke. People with other diseases such as diabetes carry out secondary prevention of cardiovascular disease. These interventions combined with smoking cessation can often prevent nearly 75% of recurrent vascular events. Tertiary prevention is to strengthen rehabilitation care for patients who have suffered stroke, to prevent the disease from getting worse.

The prevention of stroke is mainly the prevention and treatment of risk factors.

The effect of blood pressure control on stroke prevention is significant. For stroke patients with stable disease, long-term adherence to antihypertensive drugs is still required.