What Is the Connection Between Aphasia and Strokes?

Acute cerebrovascular disease is commonly known as stroke and stroke. The clinical manifestations are characterized by sudden fainting (or not fainting), skewed mouth and eyes, hemiplegia, and speech difficulties.

Stroke (acute cerebrovascular disease)

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Stroke, cardiovascular disease, and malignant tumors constitute the top three diseases with the highest mortality rates today. In particular, the diagnosis of cerebrovascular diseases is more difficult, but there are fewer treatment drugs and methods, which seriously affects health and longevity.

Chinese name: Stroke (acute cerebrovascular disease)
Commonly known: Stroke

Clinical manifestation: Suddenly passed out
Types of: Cerebral hemorrhage

Stroke and cardiovascular disease,

Common types of acute cerebrovascular disease:

(1) Cerebral hemorrhage;

(2) Subarachnoid hemorrhage;

(3) Cerebral infarction (including cerebral thrombosis);

(4) Transient ischemic attack (called minor stroke).

Cerebrovascular disease ischemic, including cerebral thrombosis and cerebral embolism; hemorrhagic, including

Stroke patients often have a history of hypertension and cerebral arteriosclerosis. Once a stroke occurs, it is more troublesome to treat. Even if rescue is out of danger, there are still many sequelae such as hemiplegia, which will not heal for a long time. Early detection and early action can often prevent serious consequences. So, what are the signs of a stroke?

Stroke patients often first experience the sudden numbness or weakness on one side of their face or hands and feet, the corners of their mouths being crooked, and drooling; the sudden appearance of temporary difficulty in speech or inability to understand what others are saying; temporary blurred vision or invisible things; Dizziness or shaking, or even fainting; lethargy without obvious causes; sudden changes in personality or intelligence; unexplained headaches, etc. Any one or more of the above symptoms should allow the patient to immediately rest in bed and keep quiet, not to be nervous, excited, fearful, or irritable. It is better to call an ambulance or ask a doctor to check. If there is no condition, when you need to go to a nearby hospital for treatment, you should use a stretcher to carry it on the car. Prevent bumps on the road. The patient cannot lay down forcefully, lying flat with his head tilted to one side to prevent the vomit from getting into the trachea.

Stroke is a pathological manifestation of cerebral blood circulation disorders caused by cerebrovascular disease. Can be divided into two categories of hemorrhagic stroke and ischemic stroke. Cerebral hemorrhage and subarachnoid hemorrhage are hemorrhagic strokes; cerebral embolism and cerebral thrombosis are ischemic strokes. The clinical manifestations of hemorrhagic stroke are severe headache, vomiting, manic, lethargy,

I. Prevention and treatment of primary diseases: The longer the hypertension, the more obvious the vascular sclerosis, and the stroke is more likely to occur. Usually, blood pressure should be checked frequently, medication should be adhered to, and blood pressure should be controlled within normal range as much as possible. Coronary heart disease often results in a decrease in the pumping capacity of the heart due to arrhythmia, slowing cerebral blood flow and prone to ischemic stroke. Hyperlipidemia can lead to atherosclerosis and increased blood viscosity. Diabetes can harden arterial walls and increase blood viscosity. Both can induce a stroke. Therefore, effective control of primary diseases is the key to preventing stroke.

2. Emotional smoothness: Relaxed and happy mood can effectively prevent the aggravation of primary diseases such as hypertension.

Distract yourself by listening to light music and talking to young people. Don't watch nervous, scary movies. When in trouble, don't get angry, pay attention to work and rest. In the morning when you go shopping on the empty stomach and exercise, you should eat some snacks to prevent hypoglycemia and cerebral thrombosis. Significant changes in the weather, especially the sudden cold, can cause blood vessels to contract and increase blood pressure, leading to worsening of the condition. Add extra clothes to keep warm.

3. Quit smoking and drinking: Smoking and drinking will further damage the heart function, increase blood viscosity, increase blood lipids, and easily induce stroke.

4. Keep the stool unobstructed: The stool should be kept unobstructed at all times, and it should not be irritated during the bowel movement, so as to avoid the increase of abdominal pressure, the sudden increase of cerebral blood flow and cerebral hemorrhage.

V. Diet adjustment: diet should be light. Eat more fresh vegetables and aquatic products, such as greens, radishes, kelp, and laver.

Eat less and eat more. To eat enough dietary fiber and moisturizing food, fasting fatty meat and animal viscera, do not eat irritating onions, peppers, coffee and so on. Eat less refined sugar, honey, fruit candy, and pastries. Limiting the amount of salt to less than 4 grams per day can prevent water retention and reduce the burden on the heart.

6. Physical exercise: choose to exercise in Tai Chi, walking, qigong and other items. You cannot stay in bed all day long, and staying in bed for a long time will slow down blood flow and produce ischemic stroke, which is also not conducive to the gradual recovery of body function after stroke.

7. Seek medical treatment in time: If you find that you have unstable walking, weakness on one side of your limbs, crooked mouth, numbness of the lips, or a grip on the floor, you may have cerebral vasospasm or a small stroke.

More than half of the stroke patients do not speak or speak unclearly or although they can speak spontaneously, they can't answer the question and can't understand the meaning of others. These are all language barriers caused by stroke. Medically, the speech disorders of stroke patients are divided into two categories: aphasia and dysarthria. The former is divided into motor aphasia, sensory aphasia, mixed aphasia, and named aphasia.

Motor aphasia is also called expressive aphasia. Although the patient can understand other people's language (verbal, written), he cannot use spoken or written words to express his meaning. If the patient cannot speak at all, it is called complete motor aphasia; if the patient can only speak simple sentences but not complex sentences, it is called incomplete motor aphasia.

Sensory aphasia is also known as receptive aphasia. Although the patient has the ability to speak, he does not understand the meaning of others and his own. The content of the speech is chaotic or intermittent. He often answers questions and uses wrong words, which prevents normal conversation.

Mixed aphasia has both motor and sensory aphasia. The patient neither understood nor understood what the other person said.

Patients with named aphasia can tell the purpose of the object, but they cannot tell the name of the object. Sometimes the name of the item is occasionally spoken, but it is forgotten instantly, so it is also called amnesia.

Aphasia lesions are all in the language center of the cerebral cortex. There are currently no specific drugs that specifically target the language center. Active treatment of the primary disease, the aphasia of most patients can gradually recover as the primary disease improves. Special functional training is very important for the smooth recovery of aphasia patients. It is now believed that the earlier the rehabilitation of speech disorders, the better, and the recovery will be faster within 3 months after the illness, and it will be difficult to recover after one year. Functional rehabilitation training includes pronunciation training, phrase training, conversation training, reading aloud training, reciting sentence training, text recognition, pointing out item names, executing commands, pictures, and physical matching exercises.

Rehabilitation training for patients with complete aphasia should begin with learning pronunciation like teaching children how to speak, such as letting patients make "ah" sounds or whistling with their mouths to induce pronunciation. Then talk about the common words, such as eating, drinking, okay, OK, etc., or show a card and ask the patient to read the above words. Teach disyllabic words, phrases, short sentences, long sentences, etc. in turn. Combining speaking with visual stimuli during training, such as combining with meals when saying "eat", or combining literacy with pictures and reading with pictures. Patients with incomplete motor aphasia can speak words, phrases, sentences, or speak fluently. Patients often have poor vocabulary, slow speech, and repeated language. Patients of this type should be patiently taught, repeated reading stories, practice flexibility, and practice language skills.

Patients with sensory aphasia are more difficult to train than motor aphasia. Can use visual logic method, gesture method for training. If you put a face plate on the patient, put a towel on, and say "wash your face" to the patient, although the patient does not understand the meaning of "wash your face", logically he will understand that you want him to wash his face. Repeated for so many days, language and vision will be combined over time, and language functions will be restored. Gesture method means that the family member or the accompany person uses gesture and language to train the patient. If the patient is allowed to "eat", the trainer will use chopsticks to demonstrate the action of eating many times, and the patient will soon understand, and take the initiative to take chopsticks to eat.

Functional training of patients with mixed aphasia is more difficult, and a combination of speaking, sight, and hearing must be adopted repeatedly. If the patient is allowed to wear a sweater, he must both say "wear a sweater" for the patient to listen to, and point to the prepared sweater, and make a gesture to show the patient.

Another type of language disorder caused by stroke is dysphonia, which is mainly manifested by inaccurate pronunciation, unclear speech, abnormal tone, speed and rhythm, and excessive nasal sounds. Rehabilitation methods must include pronunciation training as early as possible, including starting pronunciation, continuous pronunciation, volume control, tone control, etc .; movement training of vocal organs, such as lip and tongue movements, and soft jaw elevation; etc. pronunciation rhythm training, including stress training and intonation training And pause exercises. This type of patients often have excessive muscle tension in the whole body, including excessive tension in the throat language muscles. Respiratory training, breathing control, and other relaxation therapies can reduce the tension in the throat language muscles, which can lay the foundation for breathing and pronunciation. Relaxation therapy through psychological behavior or drugs to reduce the tension of speech muscles is also one of the important rehabilitation methods for such patients.

Cerebrovascular accident is stroke, which is a disorder of blood circulation in the brain caused by cerebrovascular disease. He is paralyzed on the ipsilateral hand and foot, that is, hemiplegia. Serious coma, convulsions, and even death.

Stroke can be divided into two categories: ischemic stroke and hemorrhagic stroke.

Ischemic stroke includes both arteriosclerotic cerebral thrombosis and cerebral embolism. Arteriosclerotic cerebral thrombosis accounts for 60% of stroke patients. After arteriosclerosis, the blood vessels become narrow, the walls of the blood vessels are not smooth, the blood flow is slow and coagulates, and some brain tissue ischemic and necrotic. This kind of stroke is common in the elderly, and often occurs during sleep. When you wake up, you find that your hands and feet are not listening, and the condition often develops gradually after the onset of illness. Cerebral embolism is caused by "emboli" formed in other parts, which occludes the cerebral blood vessels with the blood flowing into the cerebral blood vessels, causing ischemia and necrosis of some brain tissues. Common "emboli", such as thrombus shed from the atrium in patients with atrial fibrillation; bacterial emboli detached from heart valves in patients with subacute bacterial endocarditis; fat plugs that enter blood vessels when long bone fractures occur Child; air emboli in the case of diving. Patients with cerebral embolism have the basis of other diseases, and the attack is sudden.

Hemorrhagic strokes include hypertensive cerebral hemorrhage and subarachnoid hemorrhage. Hypertensive cerebral hemorrhage is seen in patients with long-term hypertension. When the blood pressure fluctuates greatly, the middle cerebral artery is ruptured and cerebral hemorrhage occurs, which causes some brain tissue to be necrotic. This kind of stroke is more common in people with long-term hypertension without proper treatment, and often occurs under drinking, agitation, anger or exertion. Cerebral hemorrhage patients often can quickly enter a coma, such as bleeding in the pontine, and often accompanied by high fever. Subarachnoid hemorrhage, mostly rupture of congenital aneurysm at the bottom of the brain. This type of bleeding is common in young people and even children. There may be some headaches before the attack, severe headaches, coma, and convulsions during the attack.

The diagnosis of cerebrovascular accidents is not difficult. A lumbar puncture test to check whether there is blood in the cerebrospinal fluid is very helpful for identifying which type of stroke.

Cerebrovascular accidents should be treated locally. The main treatment for ischemic stroke is to improve blood circulation in the brain. Low-molecular dextran, salvia, aspirin and other drugs are commonly used. For hemorrhagic stroke, the main treatment measures are to reduce intracranial pressure and eliminate cerebral edema. Drugs such as mannitol and dexamethasone are commonly used. If the cerebral aneurysm is suspected to be ruptured, cerebral angiography can be performed when the patient's condition allows, sometimes surgical treatment.

Hemiplegia of the hands and feet is the main sequelae of stroke, and timely treatment with acupuncture, massage, leveling therapy, etc., combined with proper exercise, can improve the condition.

The prevention of stroke is mainly to treat hypertension and control blood pressure within the basic normal range. Patients should be optimistic and maintain emotional stability. Appropriate activities should be carried out for the elderly and do not stay in bed for long. People with transient ischemic symptoms should take some persantin or aspirin to prevent cerebral thrombosis.

What is Stroke Medicine Popular Science magazine "chemists - Good Books" Author: NEUROLOGY

Stroke usually refers to acute cerebrovascular disease, also known as cerebrovascular accident, stroke. Stroke is often divided into ischemic stroke, hemorrhagic stroke, and mixed stroke.

Ischemic stroke includes: 1. Transient ischemic attack, clinical symptoms usually completely disappear within 24 hours; 2. Cerebral thrombosis, the onset is relatively slow, and the condition is mostly progressive; 3. Cerebral embolism, sudden onset, multiple It is the sudden detachment of the heart or the embolus from the blood stream into the brain tissue, which blocks the blood vessels; 4. Lacunar infarction, which is the blockage of small intracranial blood vessels, the patient's symptoms are not serious, or there are no clinical symptoms, often Frequent, good prognosis.

Hemorrhagic strokes include: 1. Cerebral hemorrhage, mostly caused by hypertensive cerebral arteriosclerosis, and progresses rapidly, often accompanied by consciousness disorders, and more limited signs such as hemiplegia, hemiplegia, hemianopia, and aphasia; 2. subarachnoid Cavity hemorrhage is mainly caused by congenital cerebral aneurysm rupture, vascular malformation and hemorrhage of cerebral arteriosclerosis. The bleeding is all in the subarachnoid space on the brain surface. The onset is usually severe headache or accompanied by vomiting or conscious disturbance. Transient neck stiffness without local signs such as paralysis may not be obvious.

Mixed stroke refers to a fresh cerebrovascular lesion with bleeding and infarction during a CT scan of the skull. Such patients are rare.

Stroke can be treated, it is also possible to recover Medicine Popular Science "chemists - Good Books" Author: NEUROLOGY

Stroke ranks first or second among the causes of death from various diseases. Survivors often leave different degrees of disability, and the disease is prone to recurrence. Therefore, people often have a fear of stroke.

Studies have shown that after ischemic stroke, the blood flow in the central necrotic area of the diseased brain tissue is basically interrupted. At present, there is no cure, but the ischemic area (penumbra) around the necrotic area can be treated. Therefore, the goal of treating stroke is to minimize the necrotic area and rescue the penumbra. Therefore, the treatment must promote an "early" word. Patients with transient cerebral ischemia and lacunar infarction can be cured with appropriate treatment and neuroprotective agents. Some patients with cerebral infarction undergo interventional therapy in the acute phase (within 24 hours) and very early (3-6 hours), and the condition may recover quickly. For targeted factors such as high blood pressure, heart disease, and diabetes, adopting targeted and standardized treatment can achieve twice the result with less effort and prevent recurrence.

For patients with cerebral hemorrhage, the timely treatment of cerebral edema and other basic treatments may be used to pass the dangerous period to achieve the purpose of rehabilitation. Patients with a large amount of bleeding or vascular malformations or aneurysms should promptly ask the surgeon to perform the corresponding surgical treatment, which can also achieve the purpose of turning the crisis into safety, and it may be cured.

Contemporary popular science magazine profiles medicine rescue stroke "chemists - Good Books" Author: Yang Louchun

The previous understanding of the prognosis of stroke was very pessimistic. Most doctors and patients defaulted to having a stroke, which was either death or severe disability, and lost their ability to work. For nearly half a century, due to continuous research on the pathology, pathophysiology, and biochemistry of the disease, and the invention of advanced stroke diagnostic methods, such as brain CT, magnetic resonance imaging, digital subtraction cerebral angiography, etc. Advent, enabling fast and safe diagnosis. At the same time, the prognosis of stroke has been greatly improved due to the continuous progress and improvement of neurology, surgery and rehabilitation. Some patients can return to health after timely and proper treatment, and they can continue to work, and the disability rate is also lower than before.

The establishment of fast and safe diagnosis methods has greatly shortened the process of waiting for diagnosis in the past. Therefore, the current rescue of stroke should be as fast and timely as possible, and the principle of never wasting time as in the case of cardiovascular disease can be realized. Therefore, some experts abroad have advocated that the rescue of stroke should involve the participation of all sectors of society. This may not be possible in most parts of developing countries, but this is the direction and should be sought. In China, most regions with conditions already have rescue centers for cerebrovascular disease (the so-called Intensive Care Unite, ICU). Their members include neurosurgeons, general physicians and nursing staff, and they need to undergo specialized training, such as In the process of receiving patients, pre-hospital ambulance should be given, and emergency ABC should be performed, that is, on the way to the hospital, the patient's airway should be kept clear and normal breathing should be maintained; normal blood circulation should be maintained. Although this is not required by everyone, it is a prerequisite for further rescues. After the patient enters the ICU ward, the neurologist should immediately use his skilled professional knowledge to understand the comprehensive medical history and conduct a comprehensive clinical examination. When necessary, he or she should decide with the neurosurgeon or radiologist whether to perform CT or other special examinations. And read the film together to determine what type of stroke and what treatment is needed. At the same time, a monitoring device is given.

During this period, according to the medical history and physical examination results, the problems of comorbidities should be considered, such as chest radiographs, electrocardiograms, urine routine, liver function, and hemorheology.

If it is determined that ischemic stroke is needed for thrombolytic therapy, the time window of treatment should be taken into consideration immediately, because after cerebral infarction, if the blood in the infarct area reopens, the risk of cerebral hemorrhage will increase. Moreover, once the brain tissue has been infarcted, it is difficult to restore its function even if its blood flow is restored. Therefore, it is necessary to strive for thrombolysis when the local cerebral blood flow has been reduced, but the thrombolysis may not be effective until it is completely infarcted. Therefore, contemporary experts at home and abroad have advocated that in the absence of contraindications, it is most appropriate to give thrombolytic therapy within 3 to 6 hours after the onset of disease, especially arterial thrombolysis. Of course, the time window is not absolutely set, and a comprehensive decision should be made based on the overall situation of the patient.

Now it is advocated that when the condition is not very serious and there are no important comorbidities, it is not necessary to stay in bed for a long time, and it is advisable to carry out rehabilitation treatment in an early and orderly manner, such as training language, massaging of paralyzed limbs, passive exercise physiotherapy, etc.

After cerebral infarction should be treated Journal of Medicine Popular Science "chemists - Good Books" Author: Zhang Tianlin Yang Luchun

Cerebral infarction, commonly known as stroke, is a common disease in the elderly. The main hazard is its high mortality and disability. In recent years, with the advancement of medical science and technology, the treatment of cerebral infarction has made great progress, and the prognosis of patients has been greatly improved. But it all depends on timely treatment in the early stages of the disease.

The adult brain only accounts for 2% to 3% of body weight, but blood demand accounts for 15% to 20% of the whole body blood supply, and oxygen consumption and sugar consumption account for 20% and 25% of the whole body supply, respectively. It can be seen that the brain's demand for oxygen is quite large. Scientific research proves that at normal temperature, brain activity stops after 2 minutes of hypoxia, and brain cells begin to die after 5 minutes of hypoxia, resulting in permanent damage. However, at the current scientific level, dead brain cells cannot be regenerated. Therefore, whether the cerebral infarction can be treated in time and restore the cerebral blood flow supply has become one of the key factors determining the prognosis of patients.

At present, the best treatment time for cerebral infarction at home and abroad is generally less than 3 hours after onset. In order to achieve early treatment, we must first correctly understand the early manifestations of cerebral infarction and attract sufficient attention. Cerebral infarction usually starts suddenly. Frequent symptoms include half-numbness, weakness or paralysis, crooked mouth, unclear speech or inability to speak, and inability to understand others. Some patients may have headaches, dizziness, and vomiting. In severe cases, unconsciousness or coma can occur. When the patient has the above symptoms or one of the above symptoms, he should be immediately sent to the hospital for a systematic examination by a specialist and the necessary equipment examinations, such as head CT, MRI (magnetic resonance) and so on. After diagnosis, according to the condition, the corresponding treatment is given to achieve the best therapeutic effect. In daily work, we have also encountered some patients who did not understand the early manifestations of the disease or did not pay much attention to less serious conditions, and thought they could recover on their own, but delayed treatment and missed the best treatment time, which led to their condition. Aggravated. Therefore, when patients or their family members suspect the possibility of cerebral infarction, they should seek medical treatment immediately without delay.

Risk factors for stroke and magazines aura symptoms pharmaceutical science "chemists - Good Books" Author: Li Xiao

Stroke, also known as cerebrovascular disease, is one of the most common diseases that endanger human health. It is a so-called "three high" disease with high morbidity, high mortality and disability. Therefore, it is of great significance to understand and understand the risk factors, induced causes and aura symptoms of stroke, in order to prevent the occurrence of stroke and reduce the disability rate.

The blood supply to the brain mainly comes from the carotid system and the vertebrobasilar system. When the blood vessels of these two systems are damaged, it can cause rupture or blockage of the blood vessels, causing cerebral hemorrhage or cerebral ischemia.

I. Stroke risk factors: The main risk factors for cerebrovascular damage are hypertension, arteriosclerosis, diabetes, heart disease (such as rheumatic heart disease, coronary heart disease, especially when arrhythmia occurs), high blood lipids, high blood viscosity The age of onset of stroke is mainly middle-aged and older who are over 40, and obese people are more likely to have a stroke.

2. Aura symptoms of stroke: Middle-aged and elderly people with a history of the above should pay attention to the following aura symptoms. The aura symptoms of stroke include: 1. Sudden headaches, dizziness, vomiting, and dark eyes before a person with a history of hypertension and arteriosclerosis, such as numbness and weakness in one limb, often predicting the occurrence of bloody cerebrovascular disease; 2 Repeated speech insufficiency, blurred vision, numbness on one side of the face or limbs, heaviness, weakness, inability to move or paresis are typical manifestations of transient ischemic attacks of the internal carotid artery system. Precursors of cerebral infarction; 3. Sudden vision rotation, tinnitus, vomiting, unclear speech, inaccurate material extraction, unstable walking, numbness of the limbs, or even a sudden fall, is a manifestation of insufficient blood supply to the vertebrobasilar artery, indicating the system Severe ischemic stroke is about to occur.

3. Stroke-inducing factors: There are many causes of stroke, for example, emotional excitement, excessive excitement, inadequate eating (eating, overeating, etc.), strenuous exercise, excessive stool strain, and climate change (such as a sudden drop in temperature or temperature) Too high), improper medication (such as improper use of antihypertensive drugs, resulting in blood pressure does not drop or drop too low, too fast, etc.).

These causes are related to fluctuations in blood pressure and arteriosclerosis. Therefore, effective measures should be taken to avoid or eliminate these causes as far as possible, which is conducive to the prevention of stroke.

4. Is stroke hereditary? The answer is yes. Studies have shown that parents generally have a history of stroke, and their children are four times more likely to have a stroke. Therefore, those with a history of this disease should strengthen prevention.

5. Will the stroke recur? The answer is also yes. Therefore, stroke patients should regularly go to the clinic for re-examination, monitor blood pressure and check blood viscosity parameters, and adjust the corresponding drugs if necessary.

Thrombolytic therapy of acute cerebral infarction Medicine Popular Science "chemists - Good Books" Author: Yang Li

In the past ten years, with the improvement of people's living standards, changes in diet structure and development of neuroimaging technology, the incidence and diagnosis of acute cerebral infarction in China have increased significantly. People have experienced the illness through themselves or their relatives and friends. , Have recognized the dangers of the disease and its sequelae, the physical, mental and financial burden on patients and their families and society. Many people have begun to pay attention to prevent the disease, or adjust the diet structure, or quit smoking and drinking habits, and some have sought help from doctors. s help. From the perspective of the occurrence and development of the disease, prevention is necessary, but we should also understand some of the treatment measures after the occurrence of acute cerebral infarction, which is very important to save patients' lives and reduce the degree of disability.

When it comes to the treatment of cerebral infarction, we should first understand the pathogenesis and pathogenesis of some acute cerebral infarctions. About 80% of patients with acute cerebral infarction have blood clots in the skull or in the cervical arteries that supply brain blood. Blood clots block blood flow, causing sudden ischemia of brain tissue in the corresponding area. Nerve cells have irreversible necrosis within a few minutes, and although the nerve cells surrounding the central necrosis zone have terminated their biological electrical activity, they still maintain ionic balance and structural integrity for a certain period of time, meaning that the cells themselves are still There is no death. This area is called the penumbra. If the blood supply is increased in time, these nerve cell functions may recover. The purpose of treatment of acute phase of cerebral infarction is to dissolve the emboli as soon as possible, improve blood circulation in the ischemic area, and rescue the penumbra, thereby reducing the sequelae. Thrombolytic therapy is to dissolve the thrombus with thrombolytic drugs, so as to restore blood circulation in the infarcted area as soon as possible. There was a 63-year-old elderly patient who suddenly had weakness in his right limb during dinner. He dropped the chopsticks and was taken to our hospital by his son. The patient used to be healthy. At that time, he had a clean body and a blood pressure of 170/100 mm Hg. The speech is vague, the corners of the mouth are left, and the upper and lower limbs can only move on the bed surface. The head CT scan does not show high and low density shadows. The head MRI scan shows a low T2 signal in the left basal ganglia. Cerebral infarction of lateral basal ganglia. The patient's arterial thrombolysis was treated immediately after asking the family's consent. The next morning, the patient was able to speak and his limbs could be lifted off the bed. Patients can be discharged on foot after two weeks. From this point of view, the ultra-early thrombolytic treatment of cerebral infarction has indeed brought great benefits to patients. But isn't it applicable to all patients with cerebral infarction? No. Sometimes family members cannot understand why doctors refuse to treat patients with thrombolysis. In fact, there are strict indications and contraindications for thrombolytic therapy, which is related to the pathological process of cerebral infarction and the pharmacological mechanism of thrombolytic drugs. With the prolongation of ischemic time, necrotic brain cells increase, brain tissue edema, vascular wall is compressed, and necrosis. At this time, if blood vessels reopen, cerebral hemorrhage is prone to occur, which is a serious complication of thrombolytic therapy. In addition, the mechanism of thrombolytic drugs is by activating plasminogen to plasmin, which degrades fibrin and fibrinogen in the thrombus, but the thrombolytic drug will also destroy the blood coagulation while dissolving the thrombus. Function, there is danger of bleeding from other organs.

Of course, the thrombolytic treatment of cerebral infarction also has a development process. When this method was initially applied, the incidence of cerebral hemorrhage or other organ bleeding was still high. In response to this phenomenon, scientists found through animal experiments and clinical observations Thrombolytic therapy within 6 hours of onset can significantly reduce the occurrence of bleeding, so the acute cerebral infarction was set as the time window for thrombolytic therapy within 6 hours of onset. There is also a development process for the study of thrombolytic drugs. At present, there are two types of thrombolytic drugs that can be used, of which urokinase and defibrase are non-thrombotic, that is, this kind of drugs will reduce fibrinogen in plasma and destroy some coagulation while dissolving thrombus. Factors that prolong the body's clotting time and easily cause bleeding. Tissue-type plasminogen activator is thrombus-selective. It can degrade fibrin in thrombus far more than free fibrinogen or fibrin in plasma, so it has good thrombolytic effect and fewer complications. But it's expensive.

The doctor is very cautious when formulating a treatment plan for each patient. He must consider the patient's past physical condition comprehensively. The medical history of the disease and the current physical condition or even the family financial situation can be determined. Therefore, for acute cerebral infarction, Patients with acute cerebral infarction who have an onset of disease for more than 6 hours, an onset of blood pressure exceeding 200/120 mm Hg, prolonged clotting time, or a blood system disease or recent history of cerebral hemorrhage or surgery are generally not suitable for thrombolytic therapy. .

Most patients receiving thrombolytic therapy can obtain obvious treatment effects. So, is it all done so far? Of course not. Patients and their families should be alert to the danger of recurrent cerebral infarction. Anticoagulants can be used on the premise of clinical coagulation test, and brain protective agents and brain metabolizing agents can be used to promote the recovery of nerve cell function. At the same time, rehabilitation treatment should be started as soon as possible. Allow the patient to return to the appropriate level of health as soon as possible.

Is acute stroke often associated with constipation, and how is the clinical study?

Patients with acute stroke often have constipation, so clinicians have paid great attention to constipation of acute stroke. Many scholars have applied the rule of law to treat stroke and achieved good results.

Shao Nianfang observed 100 cases of stroke patients, and found that 36% had dysentery. Among them, 11% were middle dysentery, and Tongtong decoction was used for the treatment. Tongfang decoction: 9 ~ 12 grams of rhubarb and Shichangpu. , 9 grams of Magnolia, 15 to 18 grams of gardenia, 30 grams of whole melon, 15 to 30 grams of raw hawthorn, and achieved satisfactory results. Deng Zhenming believes that the method of diarrhea and diarrhea is one of the important treatments for the acute stage of stroke. 250 cases of stroke were treated, including 150 cases of phlegm and heat, which accounted for 55.7%. Qi decoction, melon, gallbladder, raw rhubarb, mirabilite, and think that the stool should be laxative, purify phlegm, remove heat and remove product as the degree, should not be excessive. Tang Zongming believes that the Tongzhi method can only be used for the heat syndrome and closed card of stroke; Xu Jingfan believes that the bottom of the kettle is to be paid, and Tongxie fever is the main method for the treatment of cerebral hemorrhage. Antelope hook rattan soup or use vermiculite rolling sputum pills to remove incense. Wang Ziyao used the Dachengqi Decoction to treat cerebral hemorrhage, and achieved good curative effects. Medicinal rhubarb, Glauber's salt (Chong), Scutellaria baicalensis, Plaster, Zhishi, Chuanpu, Forsythia Suspensa, Salvia miltiorrhiza, Shichangpu and so on. Si Wenzhong believes that the Tongluo method is mainly suitable for patients with insufficiency of TCM due to intracerebral hemorrhage. This method has the function of dilating blood vessels, reducing capillary permeability, resisting infection, improving microcirculation, reducing wound surface exudation, improving capillary fragility, and reducing intracranial Pressure to absorb the bleeding and increase cerebral blood oxygen supply.

How is constipation treated in patients with acute stroke?

There are two main types of stroke in acute onset: one is hyperactivity of liver and yin and the disturbance of internal wind; the other is phlegm and heat, and the obstruction is blocked. The internal wind twitches convulsively? Concealed and clear consciousness means fainting the servant without knowing the personnel, crossing the meridians is oblique, the limb is paralyzed; phlegm heat inside Sheng is irritable face, phlegm in the throat, difficulty in stool. As for the treatment, the author has clinical experience. Whenever I see constipation, my head is swollen and painful, my face is red and irritated, my mouth is dry, my mouth is spitting, my tongue is red and yellow, and my skin is greasy. The symptoms of smoky stomach and disturbing heart, emergency response to diarrhea and phlegm, and phlegm and collaterals, often have better results.

Some people have found through clinical observation that there are a considerable number of cases, and within 3 to 5 days of the acute stage, evidence of phlegm fever is present. The short person is within 6 hours and the elderly is 2 to 3 days. The tongue coating changes from thin white and greasy to yellow or yellow greasy moss, and then the abdomen swells and there is dry feces in the abdomen. It is expected that a good effect can be obtained by removing phlegm.

What is the mechanism of increased intracranial pressure in acute cerebrovascular disease?

Occupation of hematoma during cerebral hemorrhage and edema and swelling of the tissue surrounding the secondary hematoma are the main factors for the increase of intracranial pressure. When the pressure of hematoma or edema causes a certain degree of brain tissue displacement, it can affect the smooth circulation of cerebrospinal fluid in the interventricular foramen or aqueduct, and increase the pressure in the lateral ventricle, thereby further increasing the intracranial pressure significantly. When intracranial hematomas break into the ventricle directly or indirectly (the brain tissue between the hematoma and the ventricle is softened and punctured after a certain period of time due to hypoxia and edema), this intracranial pressure increases. Cerebellar hematomas or infarctions are more likely to prevent cerebrospinal fluid from flowing out of the fourth ventricle and cause intracranial elevation to occur earlier and more severely.

The rapid development of cerebral infarction, because there is a piece of brain tissue hypoxia, edema or even liquefaction, there is always a certain degree of intracranial pressure. If the infarct size is large, the increase in intracranial pressure is also significant, and similar effects to intracranial hematomas can occur. Cerebral infarction is different from intracranial hematoma in that the swelling and liquefaction of cerebral edema caused by the infarction develop after the infarction, so the increase in intracranial pressure is later than the appearance of intracranial hematoma. In both cases, there is a high-pressure area in the cranial cavity, which forms a pressure difference between different parts, which is easy to cause the displacement of brain tissue and cerebral hernia.

When subarachnoid hemorrhage occurs, blood entering the subarachnoid space and secondary cerebral edema can increase intracranial pressure. Especially a few days after the onset of a large number of red blood cells blocking the arachnoid granules, the cerebrospinal fluid can be made to return to the blood slowly, and the intracranial cerebrospinal fluid can accumulate, which increases the intracranial pressure. This is an increase in intracranial pressure in the late stage of the disease without exacerbation of focal symptoms.

Intracranial venous sinus obstruction, due to venous return and yang, the brain tissue swells and swells. At the same time, if the venous sinus of the yang is the transverse sinus or superior sagittal sinus, there are also factors that cerebrospinal fluid obstruction can cause increased intracranial pressure .

How to estimate the condition of acute stage of cerebrovascular disease?

Acute cerebrovascular disease is fierce. Patients will be unconscious in a short period of time, have high fever, convulsions, and incontinence. Some people die unfortunately within a few days or even hours. In the past, cerebrovascular disease was regarded as "incurable disease" ". In modern times, although the treatment and rescue of cerebrovascular diseases have improved significantly, in addition to medical treatment, surgical treatment can also be performed. In China, the mortality of ischemic cerebrovascular disease is about 14% to 30%, while that of hemorrhagic cerebrovascular disease is 24% to 60%. The reason is related to the nature and degree of the disease. The estimation of cerebrovascular disease in the acute stage can be made from the following aspects:

(1) If it is diagnosed with ischemic cerebrovascular disease, it is more likely to survive, and if it is hemorrhagic cerebrovascular disease, it is more likely to die.

(2) The degree of coma may be deepened from shallow to deep coma, or awake and comatose once, which indicates that the condition is serious, suggesting an increase in cerebral pressure (cerebral edema), the possibility of heavy bleeding, or damage to the brain. Dry life center.

(3) The pupils on both sides are obviously asymmetric. If one side of the pupil suddenly disappears and changes first, the breathing becomes slower and pauses, the breathing rhythm becomes like a sigh-like breath, the blood pressure and body temperature start to rise and then suddenly drop, showing a state of shock, indicating the occurrence of cerebral hernia Some brain tissues are prominent, displaced, and squeeze the center of life of the brainstem), and must be rescued urgently. Patients with cerebral hernia may die of sudden respiratory arrest, shock, and failure.

(4) Gastrointestinal bleeding often occurs in patients with severe cerebral hemorrhage. It indicates bad signs, with a mortality rate of nearly 90%, which usually occurs within one week of the acute phase, with vomiting mostly, and a small amount of blood in the stool. Gastrointestinal bleeding may be caused by damage to the hypothalamus and brainstem. As a result, the esophagus, stomach, duodenum and small intestinal mucosa undergo vascular permeability changes and acute nutritional disorders, causing extensive mucosal erosions, ulcers and bleeding.

(5) High or low blood pressure, such as a blood pressure higher than 26.7 / 16.0kPa or lower than 12.0 / 8.0kPa, indicates a poor condition. Elevated blood pressure is caused by increased intracranial pressure, cerebral edema, and neurological reflexes.

(6) Total hemiplegia and limbs are paralyzed in the limbs, which often indicates that the brainstem, ventricle is involved, and the condition is extremely serious.

(7) Excessive body temperature such as above 39 ° C or below 35 ° C indicates poor prognosis. High fever is caused by a central temperature regulation disorder or a bacterial infection, which can aggravate brain tissue damage.

(8) Due to increased intracranial pressure, frequent vomiting and repeated convulsions can occur. It indicates that the lesion is serious.

In summary, the estimation of the condition and prognosis depends not only on the size of the lesion, the location and the degree of damage to the surrounding brain tissue, but also to the disturbance of cerebral blood circulation and brain stem involvement.

What is the significance of eyeball abnormalities in the acute phase of cerebrovascular disease?

The eyes of a normal person are always synchronized, and this synergy is achieved through the cooperation of the oculomotor nerve and the abduction nerve. When these nerves are damaged, eyeball abnormalities occur.

The spontaneous floating of the eyes at rest indicates that the brainstem function still exists. In a deep coma, the eyes are fixed at the center, suggesting midbrain involvement. Separation strabismus in both eyes, if exotropia disappears after stimulation, indicates that the brainstem is not damaged. If it does not disappear and the strabismus is obvious, it indicates that the midbrain has been damaged. The patient's eyes leaned towards the paralyzed side, as if looking at his paralyzed limb, suggesting a brain stem hemorrhage. Patients with thalamic hemorrhage can't turn their eyes upward, but turn them down, as if staring at the tip of their nose. Eyes move back and forth faster, common in recurrent bilateral cerebral hemorrhage. In a deep coma, the revolving head test showed that the reflective eye movement disappeared, and when the head was tilted upward, if the symmetrical vertical movement of the eyes disappeared, it suggested that the upper end of the brain stem was affected by thalamic hemorrhage.

Cerebrovascular patients' abnormal eye position is related to the size of cerebral hemorrhage. That is, patients with moderate and heavy bleeding have abnormal eyeballs, while small and excessive bleeding do not show abnormal eyeball positions. In addition, those with short disease course or secondary brain stem damage did not show abnormal eye position.

Therefore, the abnormal position of the eyeball is of great significance for judging the bleeding site and the severity of the disease.

What is the significance of pupil changes in the acute phase of cerebrovascular patients?

Normal adult pupils are 3 to 4 millimeters in size, are equally contoured on both sides, and are sensitive to light. In patients with cerebrovascular disease, pupil changes often occur in the acute phase. It is manifested as bilateral asymmetric pupils, or bilateral pupils diminished, and bilateral pupils dilated. These changes are the reflection of lesions in different parts on the pupil. Therefore, when pupil asymmetry occurs, the side with the smaller pupil is the lesion side, or the side with the larger pupil is the lesion side.

When a cerebellar notch hernia occurs in a supra-occipital lesion, the oculomotor nerve on the side of the lesion is completely paralyzed, and the pupil on this side shrinks first, and then gradually dilates. One-sided pupil dilation is common in internal carotid artery thrombosis, posterior cerebellar arterial thrombosis, or Horner's sign due to damage to the lower thalamus. At this time, the side where the pupil is reduced is the lesion side. The extreme narrowing of the pupils on both sides shows a needle-like size, which is a manifestation of pontine damage and ventricular hemorrhage. For the occipital foramen hernia, the pupils on both sides are dilated and the light reflection disappears. This is the state of the pupil before the critical condition or death.

What is the significance of pulse body temperature changes in cerebrovascular patients?

Acute cerebral circulation disorders are mainly caused by severe cerebral edema and intracranial hypertension.26.7kPa(200mmHg)40/

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The treatment of acute phase of transient ischemic attack is very important. You should go to the hospital for emergency treatment immediately after the onset of the disease. The measures should be rapid, correct, and effective. In addition to bed rest, you can use low-molecular dextran or traditional Chinese medicine to activate blood circulation to remove blood stasis. Use Danshen in the glucose solution for intravenous drip; Patients with headache and cerebral edema can use the dehydrating agent mannitol intravenously. Vasodilators and antispasmodics may be effective. Cerebrolysin can also be taken orally, 25 to 50 mg each time, 3 times a day for 3 months. Anti-platelet aggregation and blood viscosity reducing drugs can be applied during the intermittent period, such as aspirin 0.3 g, taken twice a day after or during meals. To prevent aspirin from irritating the gastric mucosa, take enteric Spirin tablets can reduce side effects, such as taking Pansentin tablets 3 times a day, 50mg each time, the effect is better. Studies on aspirin suggest that aspirin can reduce platelet aggregation, which is because prostaglandin, an inhibitor of platelet aggregation, can be released in the vascular endothelium, which maintains an active balance with thromboxane produced in platelets. To ensure that blood does not coagulate. When arterial endothelium is damaged, prostacyclin, which produces antiplatelet aggregation and vasodilation, reduces platelet aggregation at the site of the diseased blood vessel, and releases thromboxane, which can cause cerebral arterial spasm and ischemic attack. Aspirin blocks the conversion of arachidonic acid to thromboxane, so it may prevent ischemic attacks and cerebral thrombosis. In recent years, when a clear diagnosis of transient ischemic attack is caused by extracranial arterial disease, surgical treatment such as arterial intimal stripping, vascular reconstruction, artificial bypass can be considered. For the attack of transient ischemic attack, the cause must be treated. If there is high blood pressure, blood pressure reduction is necessary. In some patients, the transient ischemic attack will be relieved quickly after the blood pressure drops. It is not easy for the elderly to lower blood pressure too quickly and violently, and the rapid drop in blood pressure sometimes causes cerebral ischemic attacks. Generally, the blood pressure is controlled at 17.3 21.3 / 12.0 12.5kPa. If the attack is caused by cervical spondylopathy, the cervical spine should be treated disease. In short, for the treatment of transient ischemic attacks, the first is to control and the second is to prevent recurrence. Therefore, patients should be followed up and observed for a long time, and careful and systematic observation and treatment should be performed from the first attack. .

Cerebral hemorrhage is a disease with a very high lethal and disability rate. When high blood pressure or aneurysm rupture induces cerebral hemorrhage, a large amount of bleeding is instantaneous, squeezing the brain tissue, and gradually developing brain edema and necrosis, and even cerebral hernia is life-threatening. The time to treat this type of acute illness is life. At this time, the "robot brain stereotactic technology" is used to quickly perform drainage of the fixed-position tube on the bleeding site, which can effectively reduce the blood pressure on the brain tissue, prevent the occurrence of brain tissue necrosis and cerebral hernia, and actively save the patient's life and reduce cerebral hemorrhage. Disability rate. The time required for traditional surgery to find a patient's cerebral hemorrhage to the patient's operation is about 3 hours, while robot-assisted brain stereotactic technology only takes 1 hour. This technique is suitable for patients with bleeding volume as small as 1 milliliter to tens of milliliters. For patients with excessive bleeding and causing hernia tendencies, we still recommend craniotomy. One day after robotic stereotactic intracranial hematoma drainage, Craniotomy is recommended for patients with ongoing bleeding. In clinical practice, 95% of patients with cerebral hemorrhage use this method with the least damage, the effect is very obvious, and the disease is most effectively controlled. ^[1]

Professor Tian Zengmin, the chief expert of neurosurgery of the July 31st Hospital of China Aerospace Science and Industry Corporation ^[2], uses robotic stereotactic surgery with minimally invasive, safe, and reliable features, which can quickly and accurately locate the location, size, volume, and volume of intracranial lesions. Shape and relationship with surrounding brain tissue; can quickly and accurately find the best surgical path; can quickly damage, control and repair intracranial lesions accurately. Especially for small deep brain lesions, multiple lesions and lesions located in important functional areas that are not suitable for craniotomy, and for elderly patients and patients who are too weak to tolerate craniotomy, stereotactic surgery has other irreplaceable features. ^[3] .

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