Shock War: Is it possible to defeat a stroke
Every year, more than 450 thousand Russians suffer a stroke. The name of the dangerous disease is translated from Latin as "blow, attack". This is the whole point of it — a sudden and acute violation of cerebral circulation. With a stroke, brain tissue begins to die in order to preserve a person's ability to think and move, every second is precious. About what factors provoke a terrible diagnosis, by what signs to determine a stroke and how to restore health after a stroke — in the material of Izvestia.
Why men are more prone to stress
Experts associate the prospects of earning a dangerous disease with lifestyle and hereditary characteristics. Doctors divide all risk factors into controlled ones (which can be influenced independently or with medical help) and uncontrolled ones — genetic, demographic, and age. Maria Panova, a medical expert at the ORBI Stroke Foundation, a rehabilitologist, neurologist, and epileptologist, listed to Izvestia the causes of stroke that should be considered in order to minimize possible risks.
—Uncontrolled factors are age over 50; hereditary predisposition (many genes associated with increased risks have been found) and gender — men are more likely to suffer from stroke than women," the expert explained.
The list of controlled cases includes hypertension, atrial fibrillation and other heart diseases, smoking, alcohol and illicit substances, overweight, eating disorders, lack of physical activity, and diabetes mellitus.
The main reason why representatives of the stronger sex are more prone to stroke is due to the fact that they usually have more negative factors that lead to circulatory disorders, says Denis Prokofiev, a cardiologist with the status of "Moscow Doctor." Among such risks, he calls uncontrolled blood pressure, abdominal obesity and bad habits.
Women are more protected from stroke due to their hormonal background, says the specialist. Estrogens affect the functioning of the central nervous system, positively affecting the emotional state and stress tolerance. "Female" hormones regulate the level of serotonin— a neurotransmitter that ensures a good mood, and protect against stress hormones. Estrogens improve blood supply to the brain and reduce the risk of thrombosis, which is important for stroke prevention.
— Plus, women are more prone to expressing feelings, they "reset" negative emotions, whereas everyone knows that "men don't cry," says Prokofiev. — As a result, the levels of adrenaline, serotonin, and cortisol (the stress hormone) in the male body are subject to fairly strong fluctuations. All this creates a huge load on the vessels.
Pent-up emotions, chronic stress, and depression often serve as a starting point for a stroke. Acute stress occurs suddenly and does not last long, but it can cause a sharp rise in blood pressure, and this is fraught with a sudden violation of cerebral circulation. Chronic stress lasts for months and years, changing the biochemistry of the brain and the body as a whole. Such tests have a bad effect on blood circulation and at some point a person is overtaken by the very blow that leads to damage and death of brain cells, Panova emphasizes.
The high numbers on the blood pressure monitor are a special marker. Unlike women, men do not attach importance to these indicators.
"In no case should episodes of high blood pressure be ignored," Prokofiev urges. — Sometimes people say, they say, I normally transfer 180 to 100 or 160 to 100 indicators. But blood pressure should not be higher than 120 over 80.
Types of stroke
Modern medicine distinguishes two main types of stroke — ischemic and hemorrhagic.
Ischemic stroke is the result of a violation of the patency of the cerebral arteries, in which blood flow to the brain stops. Without nutrition, cells die, and an organ infarction develops, similar to, for example, a myocardial infarction, explains Maria Panova.
A hemorrhagic stroke is a hemorrhage in the brain that occurs due to rupture of blood vessels, usually against the background of high blood pressure, notes Denis Prokofiev. It is less common than ischemic, but more dangerous to life and health.
— Cerebral hemorrhage is formed most often due to rupture of a pathologically altered vessel, - says Panova. — The vessel wall tears, blood flows freely, and areas of the brain experience nutritional deficiencies due to the hemorrhage itself, reactive vascular spasm and inflammation, as well as swelling and compression of the brain.
An intermediate stage before a stroke is called a transient ischemic attack (TIA), an acute, short—term episode associated with a lack of blood supply to the brain. In this case, vascular spasm does not last long, and full recovery takes 24 hours. Unlike a stroke, brain cells do not die during TIA, and if you consult a doctor in a timely manner, the consequences will be beneficial.
"The symptoms of a transient attack are very similar to a stroke: visual impairment, headache, dizziness, problems with decreased muscle strength, numbness of the arm, impaired facial expressions, speech and memory," Prokofiev lists. — Sometimes a person loses consciousness, but this is just a short-term episode that just needs to be diagnosed and stopped in a timely manner.
TIA is sometimes referred to as a micro-stroke or pre-stroke condition, but these are not scientific terms.
What is the Golden window?
In medicine, there is such a thing as a "golden window" — this is the first 3-4.5 hours after the detection of signs of stroke. The bill literally goes on for minutes. Why is it important to know and be able to identify the signs of a stroke?:
— you need to ask a person to smile — during a stroke, facial asymmetry will be noticeable;
— suggest stretching your arms out in front of you — a person who has suffered a stroke will not be able to do this with both hands in the same way due to muscle weakness;
— if you ask to say a simple phrase, it will be unclear.
If there is at least one sign, then it is necessary to call an ambulance. Rarer and more unusual symptoms include a sudden change in behavior, unsteadiness when walking, a "thunderous" headache, and a convulsive attack for the first time, Maria Panova notes.
— The sooner a person is taken to a specialized vascular center, the more likely it is to restore blood flow in the affected area of the brain, — emphasizes the interlocutor of Izvestia. — There is a concept of "ischemic penumbra" — this is when part of the nerve cells die immediately during a stroke, but there is a zone in which they are in a borderline state — they can still be saved. Efforts during the "golden window" period are aimed at the rapid recovery of these cells.
Before the ambulance arrives, the person must be laid on a horizontal surface, unbutton clothes, take out dentures (if any) and provide fresh air. The rehabilitologist advises to measure the patient's blood pressure and calculate the pulse rate in order to inform the doctors about this information later. Relatives should behave as confidently and calmly as possible in order to reduce the stress level of the victim. A person should not be given any medications, including to reduce blood pressure and "for the heart." According to Panova, artificially rapid pressure reduction can worsen stroke symptoms due to impaired blood circulation in the brain.
Doctors urge not to take up treatment on their own, guided by information from the Internet.
Hemorrhagic and ischemic strokes are treated in completely different ways. If you give a blood—thinning drug to a person with hemorrhagic fever, it will greatly harm him, warns Denis Prokofiev. — And in no case should a person be given water, because his swallowing function may be impaired — he risks choking on liquid.
How to return to work
According to the VTsIOM study "The Socio‑economic burden of stroke in the Russian Federation" (2023), only 34% of people were able to return to work after a stroke, of which only 20% were able to find full—time employment. When brain cells die, a person loses some of their abilities and skills. The list of consequences includes problems such as impaired coordination, constant muscle tension, slurred speech, problems with memory and thinking, malfunctions of vital organs and systems. But this is not a reason for despondency and inaction.
According to Maria Panova, an individual recovery program should be developed for each person, taking into account their neurological deficits and personal needs. The expert recommends asking the neurologist at the polyclinic at your place of residence about the possibilities available in the region, and clarifying the algorithm of actions for obtaining botulinum therapy and other restorative measures. A physical therapist, occupational therapist, speech therapist, neuropsychologist, doctor of physical and rehabilitation medicine, and rehabilitation nurse help patients regain their health after a stroke.
Bobat therapy and PNF techniques are mentioned as effective measures to help overcome some of the consequences of stroke. They help to restore motor functions, give a person the opportunity to perform simple everyday activities. The work goes on with both the nervous system and the muscles, so that the patient begins to move more naturally and consciously, rather than stiffly or chaotically, as it happens after a stroke.
Bobat therapy is named after its founders, neurophysiologist Karl Bobat and his wife, physiotherapist Bertha Bobat. The essence of the therapy they developed is that even a damaged brain can be retrained by harnessing its biological ability to create and rebuild neural connections.
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