How to remove heaviness in the body after a stroke. Consequences of a stroke

Many people are concerned about the causes of stroke, the symptoms and treatment, and what exactly the condition is. The disease is very dangerous in its course and the existing complications that affect a person after the acute phase of the disease has been eliminated. The only way to save the patient is urgent hospitalization and emergency measures to normalize well-being.

It is very important to know what the causes of a stroke can be so that you can take timely preventive measures and prevent the occurrence of this disease.

Feature of the disease

Regardless of the causes of a stroke, it is a pathological change in blood circulation in the brain, manifested in neurological lesions.

As a result of these processes, some parts of the brain lose their functional abilities, which adversely affects the functioning of the organs and systems controlled by these areas.

Classification

Quite wide and includes the provoking causes, the mechanism of development, the peculiarity and magnitude of the lesion. It is customary to distinguish such types as:

ischemic;
hemorrhagic;
lacunar;
extensive;
spinal;
spicy;
microstroke;
repeated.

Ischemic stroke is one of the most common brain damage among all other types. Its cause may be a violation of the delivery of nutrients and oxygen to brain cells, which can occur due to vasoconstriction. Hemorrhagic stroke is a consequence of rupture of cerebral vessels, as a result of which blood fills the cavities. This leads to hematoma formation and edema.

A massive stroke is any massive lesion. It has more pronounced symptoms and often leads to the death of the patient or disability for a long time. In addition, they are classified according to severity.

Ischemic stroke

The most common is ischemic brain injury. It is diagnosed mainly in older people over the age of 60. Among the main causes of ischemic stroke are:

changes in the properties of blood;
heart disease;
pathology of the arteries;
diabetes;
bad habits.

Often such an attack occurs quite unexpectedly, at night. The mechanism of this process is based on a violation of the patency of blood vessels. This is mainly due to blockage and narrowing of the arteries. In this case, the supply of nutrients and oxygen to the brain cells is disrupted, which provokes their necrosis.

As a rule, the causes of ischemic stroke are closely related to various diseases that occur in the body. When a certain part of the brain is cut off from blood circulation, the symptoms of the disease appear within the first hours and can persist for more than a day. Independently, the disease can occur with the formation of thrombosis as a result of smoking, stress, malnutrition, hypothermia.

It is important not only to know the causes of a stroke, but also what are its main types according to the degree of damage. In particular, there are such varieties as:

transistor;
small;
progressive;
extensive.

The easiest is a micro-stroke or a transistor one, since a small area is affected and the tissues are restored literally within a day. According to the pathogenesis, the ischemic form of stroke is divided into such types as:

thromboembolic;
hemodynamic;
lacunar.

The thromboembolic type of the disease is characterized by the formation of a blood clot, and is also associated with arterial embolism, as well as atherosclerosis. A pathological process proceeds with an increase in symptoms throughout the day and may have a focal lesion of various sizes. The hemodynamic type provokes vasospasm and prolonged nutritional deficiency. Often it is due to low blood pressure, myocardial ischemia and bradycardia. It can manifest itself in the form of a sharp attack or in steps.

The lacunar type affects small arteries. It is formed mainly in the subcortical areas and has a small lesion. Among the main provoking factor, hypertension should be distinguished.

Hemorrhagic stroke

Intracerebral hemorrhage may be due to exposure to trauma. In addition, among the main causes of hemorrhagic stroke, it is necessary to highlight the abnormal permeability of the walls of blood vessels. As a result of this, they break and release blood, which leads to blocking of the function of the brain areas. Basically, vascular permeability changes due to frequent arterial hypertension.

When this type of disease occurs, brain cells are damaged. The causes of hemorrhagic stroke are caused by blood clots and vasospasms occurring against the background of:

beriberi;
intoxication;
atherosclerosis.

In addition, the violation can occur under the influence of high pressure, provoked by hypertension. Intracerebral hemorrhage occurs quite unexpectedly when blood vessels rupture. Often, this condition occurs during the day under the influence of significant psychological and physical stress and stress.

subarachnoid stroke

The causes of a subarachnoid type stroke are associated with a head injury or aneurysm rupture. Damage to a blood vessel located on the surface of the brain provokes the release of blood into the space located between the meninges.

Among the irritating factors, drug use, anemia, and poor blood clotting should be highlighted. Often this type of hemorrhage is localized in the lower part of the brain, as well as on the surface.

Causes

Despite the fact that age is the main provoking factor, however, among the main causes of stroke, one should also highlight such as:

hereditary factor;
smoking;
malnutrition;
insufficient physical activity;
the presence of comorbidities.

In people who have had a stroke, in general, there are several provoking factors. Older people are at the greatest risk, especially if they often have high blood pressure, they lead a sedentary lifestyle and are overweight. However, young people are also not immune from the occurrence of this disease.

Often a stroke occurs in men, but kills more women. This has a lot to do with average life expectancy. Causes of stroke in women may be associated with contraceptive use and pregnancy.

Race is important. Most often, the disease affects representatives of ethnic minorities. The greatest difference is observed in young people. According to studies, socio-economic factors have a great influence.

Cigarette smoking is one of the main causes of stroke in men and women. If a person smokes a pack of cigarettes a day, then he has a much greater risk of developing the disease than non-smokers. It can remain very high for 14 years after quitting smoking.

Among the main causes of stroke in young people are alcohol abuse and drug use, especially methamphetamine and cocaine. In addition, anabolic steroids attached to sports accessories and athletes' clothing significantly increase the risk.

Taking anti-inflammatory drugs and frequent stress can lead to the onset of the disease.

The onset of the disease in childhood

The causes of stroke in children are mainly associated with factors such as:

congenital anomalies of cerebral vessels;
hemolytic anemia;
dangerous infectious diseases;
DIC syndrome.

Since the child's nervous system is able to recover, with competent timely treatment, it is possible to achieve normalization of well-being and brain functions.

Main symptoms

The first signs of a stroke are very dependent on the location and size of the lesion. It is worth noting that the symptoms of hemorrhage can be more pronounced, and with an extensive lesion, the death of the patient usually occurs. In a person who feels unwell, vascular disorders can be assumed by signs such as:

numbness of some parts of the body;
loss of control;
headache;
double vision and blurred vision;
sensory and motor disorders;
vomiting, dizziness, nausea.

All these symptoms can only be recognized by the patient himself, provided that he is conscious. However, often an acute cerebrovascular accident causes from which the patient cannot get out.

It is imperative to know what the causes and symptoms of a stroke are, so that you can provide medical assistance to the victim in a timely manner. It is worth remembering that a person in this state should not be shaken, trying to seat, since such actions will only aggravate well-being.

In the acute period of any type of stroke, neurologists distinguish cerebral and neurological disorders. The development is based on hypoxia caused by ischemia or increased pressure and hemorrhage. Among the main symptoms are:

severe headaches;
disturbance of consciousness;
nausea and vomiting;
convulsions.

Neurological manifestations indicate damage to a specific area of the brain. The main symptoms include:

violation or complete loss of motor functions;
violation of sensitivity on the opposite side of the lesion;
change in the position of the eyes;
drooping corners of the mouth;
speech disorder;
occurrence of pathological reflexes.

All these signs are very important in terms of prognosis, as well as determining which part of the brain has been affected.

If the lesion has affected the subarachnoid space, then this is accompanied by:

severe headache;
severe cerebral symptoms;
the onset of a coma.

Neurologists consider damage to the brain stem to be a dangerous condition, since the most important nerve centers that ensure the vital activity of the body are concentrated in this area. In this case, a stroke becomes the cause of death of the patient, since a very strong hemorrhage occurs. Among the main symptoms it is necessary to highlight:

loss of consciousness and coma;
bilateral paralysis;
violation of sensitivity;
violation of swallowing function;
worsening of breathing and cardiac activity.

Extensive hemorrhage in the ventricles of the brain poses a very serious threat to the patient's life. Among the main signs, it is necessary to single out a sharp impairment of consciousness and a coma.

Hemorrhage in the region of the cerebellum threatens with a very rapid development of edema, which leads to the death of the patient. Among the main signs of such a condition, it is necessary to highlight:

severe headache in the back of the head;
vomiting;
dizziness;
lack of coordination;
speech disorder.

Since the frontal lobes are responsible for many functions that determine the personality, their defeat leads to mental disorders, as well as convulsive seizures. Human behavior changes very dramatically almost beyond recognition, however, paralysis, motor and speech disorders are also observed.

When the temporal region is affected, symptoms such as:

hearing impairment;
loss of the ability to perceive sounds;
the formation of temporal lobe epilepsy;
hallucinations.

It is imperative to know what the main causes of a stroke and the symptoms of a violation can be, as this will allow timely assistance to the patient, which increases his chances of recovery.

Carrying out diagnostics

The causes of a brain stroke can be very different, as well as its symptoms. However, it is very important to conduct a timely comprehensive diagnosis in order to detect the disease. The sooner it can be diagnosed, the better the prognosis for the patient and the greater the chance of recovery. Diagnostics includes:

physical and neurological examination;
studying the patient's medical history;
carrying out laboratory tests;
display tests.

Many of these procedures are done to assess the risk of major strokes in the future. For patients whose lesions are very severe, first of all, it is necessary to determine the type of course of the disease, since drug therapy is prescribed based on the data obtained and some drugs are most effective only in the first 3-4 hours after the lesion. However, if the disease was provoked by bleeding, then these drugs will only increase it, which will lead to the death of the patient.

For diagnostics, methods such as:

dopplerography;
tomography;
angiography;
electrocardiogram;
echocardiography.

Dopplerography allows you to study the blood circulation in the veins and arteries through the use of ultrasound. This study allows you to determine the presence of blood clots, impaired blood flow, as well as many other problems. High frequency sound waves are directed to the desired area of the brain.

Tomography allows you to distinguish between ischemic and hemorrhagic stroke. Angiography is an invasive procedure, with deep penetration into the patient's body. It can be used in case of need for surgery, and also allows you to detect an aneurysm.

An electrocardiogram evaluates the activity of the heart muscle and its features, which is important for examining a patient. Echocardiography is used to look at the valves and chambers of the heart. This will determine the presence of blood clots or risk factors for blood clots.

First aid

Regardless of the cause of the stroke, first aid must be provided in a timely and correct manner. The most important thing is to immediately call an ambulance, and before the doctor arrives, you need to remove all excess clothing, unfasten your belt. Then lay the victim on a pillow so that his head is above the level of the bed.

Ensure the flow of fresh air into the room, as well as periodically measure the pressure so that the doctor understands the peculiarity of the condition. If the pressure is elevated, then it is worth giving the patient the drug that he usually took to lower it. If there are no required medicines in the house, then you just need to lower the patient's legs into hot water.

With nausea, all measures must be taken so that the vomit does not enter the respiratory tract. A patient with a stroke is transported strictly in the supine position.

Carrying out treatment

The causes and treatment of stroke can be very different, it all depends on the individual characteristics of the patient, as well as the type of disease. The most important thing is to take action in the first 6 hours after an attack. Treatment begins with correcting the problem with the heart and respiratory system. Important is the normalization of cerebral circulation, as well as the stabilization of blood composition.

With cerebral ischemia, a drug such as Actilyse is used. In addition, anticoagulants are required, for example, Fragmin, Heparin, neurophrotics - Glycine, Piracetam. Since the patient may have blood clots, then its thinners are required, for example, Cardiomagnyl, antiplatelet agents - Ticlid, vasoactive agents - Sermion, Trental.

Since the causes of cerebral stroke of the hemorrhagic type are associated with rupture of blood vessels, it proceeds more severely than ischemic. In the presence of a hemorrhage, a consultation with a neurosurgeon is required, as well as an operation to remove a blood clot or clamp a vessel.

It is worth remembering that there are no effective drugs for the treatment of this disease. Drug therapy is prescribed only for the prevention of complications and the prevention of recurrent stroke.

Regardless of the causes of stroke in men and women, as well as their age, after treatment, comprehensive rehabilitation is required. Violation of cerebral circulation leads to the formation of a pathological focus in the brain, and the cells around it are in a state of reduced activity or complete inhibition. Timely therapeutic measures will help restore their activity.

It is necessary to start carrying out rehabilitation measures even during the period of the patient's stay in the hospital. Much depends on the psychological state of the patient. All ongoing recovery activities are monitored by a neurologist or a rehabilitation specialist. Rehabilitation includes:

medicinal preparations;
physiotherapy;
massage;
psychotherapy;
physiotherapy exercises.

It is also important to teach the patient lost or impaired skills. In patients who have had a microstroke, they are restored literally within a month.

It is very important to clearly and systematically perform all the exercises recommended by the doctor, without missing a single day. The peculiarity of physiotherapy exercises should be agreed with the attending doctor.

With a long recovery period and a tendency to spasms, massage has a good effect. Its correct implementation significantly improves blood circulation in the tissues and helps to reduce congestion. In addition, massage helps to regulate muscle tone.

For the treatment of speech disorders, the help of a speech therapist-aphasiologist is required. By performing training exercises according to special techniques, the patient can begin to pronounce words much faster, and then whole sentences. Memory recovery is also required. It is very important to provide psychological comfort for the patient, as this will contribute to a faster recovery.

Consequences of a stroke

The causes and consequences of a stroke should be taken into account first of all in order to prevent a deterioration in well-being and quickly recover. The consequences depend on a variety of factors, in particular such as:

degree of damage;
localization;
help speed.

Some effects may be temporary, and the patient quickly returns to normal. More severe brain damage provokes various complications. As a result, the patient's movements become difficult or impossible to perform. Changes in gait may require additional support. In addition, the disease manifests itself in the asymmetry of the face. This affects the cheeks, mouth and lips. This causes very severe discomfort when eating or drinking, and also leads to a visible cosmetic defect.

Very often in a person, after a stroke, there is a violation of sensitivity, which is characterized by a lack of ability to feel heat, cold, pain, or even the very part of the body. In addition, the consequences can manifest themselves in the development of pain syndrome, which can be different in intensity and localization.

How long do people live after a stroke

Regardless of the cause of stroke in women and men, no one can say for sure how long they live after the disease. Each case is individual, as is the person affected by this violation. According to statistics, 35% of deaths occur in the first month after treatment, 50% occur in the first year. Sometimes death occurs almost immediately, and in some cases a person can live for a very long time and recover almost completely.

The most common causes that lead to the death of a patient are:

smoking;
diabetes;
hypertension;
atherosclerosis;
heart diseases.

When two or more factors are combined, the risk of death is significantly increased. To increase life expectancy, it is necessary to carry out preventive measures and lead a healthy lifestyle. All these recommendations should be followed especially carefully in the first months after brain damage, since during this period there is a high probability of relapse.

Possible Complications

There are a variety of causes of stroke in men and women, which lead to very dangerous complications, which is why in order to normalize well-being, you must strictly follow all the recommendations of the attending doctor. Complications after a previous stroke are mainly associated not with the violation itself, but with the patient's prolonged stay in the supine position.

As a result, bed sores often occur. Their development begins with the formation of blue-red areas and gradually tissue necrosis occurs. This is a very painful process, and it is difficult to treat.

In addition, another dangerous complication is pneumonia. Its development is due to the fact that the process of expectoration of sputum is disturbed. Due to stagnation, its accumulation and subsequent infection occurs.

Thrombosis in bedridden patients is often hidden under edema of paralyzed limbs, which greatly exacerbates the situation. When a blood clot breaks off, the consequences can be very dangerous. The lack of movement often leads to a deterioration in intestinal motility, which can lead to the development of an inflammatory process, as well as intestinal obstruction.

Coma is a common complication of stroke. The prognosis for this condition can be different and strictly individual, however, it is worth preparing for a long rehabilitation period and making every effort to restore.

Prevention

Since the causes in the elderly can be very different, it is important to carry out comprehensive prevention in order to prevent the development of such a condition. This disease is much easier to prevent than to treat later for a long time. Preventive measures include:

proper organization of work and rest;
sleep regulation;
complete nutrition;
stress prevention;
restriction of salt in the diet;
timely treatment of cardiovascular diseases.

The best way to avoid a stroke is to prevent the occurrence of atherosclerosis and other heart diseases. Controlling blood pressure and testing for diabetes is very important. If necessary, the doctor will prescribe drugs that normalize the microcirculation of cerebral vessels, and it is also possible to take medications that prevent the development of hypoxia.

After a stroke, it is important to prevent its recurrence. The risk is significantly increased with hypertension, valvular disease, arrhythmias, diabetes, and heart failure. Prevention should last at least 4 years and a healthy lifestyle should be maintained.

A stroke is a disease of the brain that occurs due to a violation of blood circulation in it. As a result, neurons no longer receive enough nutrients and oxygen, which leads to their death.

The consequences of the disease can be different - from minor violations to death. The article will look at how long people usually live after a stroke, are there any chances for a full recovery, and how to achieve a speedy recovery.

To do this, it is important to take into account several factors at the same time.

There are two main types of stroke - ischemic and hemorrhagic. Each of them has its own causes, symptoms, consequences and predictions. Consider both diseases and compare them in terms of consequences for the patient and the degree of danger.

Hemorrhagic stroke occurs due to intoxication, lack of vitamins, inflammation in the vessels of the brain. In this situation, the integrity of the walls of blood vessels is violated, blood penetrates under the membrane of the brain and into its ventricles. Violation of the blood supply leads to dangerous consequences. Often this pathology is referred to as intracerebral hemorrhage. The disease is very difficult to treat, but if the patient learns to observe a certain discipline in terms of nutrition and treatment, he can recover.
Ischemic stroke occurs due to a violation of the patency of the cerebral vessels and the subsequent death of neurons due to the lack of oxygen. In the people, this disease was called "brain infarction." It can be triggered by a number of other pathologies - heart rhythm failure, atherosclerosis, diabetes mellitus. The greatest risk of such brain damage in people who suffer from high or low pressure, obesity.

How long you live after suffering a brain disease depends on several factors. Both hemorrhagic and ischemic strokes are a real blow not only to the brain, but also to the body as a whole, therefore, even with adequate treatment, the patient will not succeed in becoming completely healthy: recovery will be only partial.

How long do people live after a stroke

What is the life expectancy of the average person after a stroke? This question worries most people with this diagnosis. The further life of the patient, its quality and rhythm depends on the answer to this question.

After all, you will definitely have to change a number of habits and follow certain rules in order to recover as quickly as possible. Traditionally, life expectancy is not significantly reduced, although, as medical statistics show, stroke survivors generally live 3-6 years less. The average duration is about 65-70 years, provided that the doctor's recommendations are followed unconditionally.

Statistics say that life after a stroke becomes different, and for a full recovery, you have to make efforts. As for mortality, there are the following statistics:

before the age of 45, no more than a quarter of all patients who are diagnosed with this disease die;
after 50 years, the figure rises to 40%;
after 70 years, only 20% of patients can survive a stroke (without the possibility of a full recovery).

Aggravating factors

Most often, representatives of the weaker sex suffer from this disease, but it also happens in men. 40% of patients need rehabilitation measures, and 50% of this number remain disabled for life. It is especially difficult for people who are at risk. The following factors increase the risk of stroke:

hypertension;
previous microstroke (more about it)
obesity;
diabetes;
vascular diseases;
abuse of alcohol, coffee, tobacco;
increased physical activity;
emotional overstrain;
uncontrolled intake of certain groups of drugs;
pregnancy;
traumatic brain injury;
mental disorders;
old age.

To prevent ischemic and hemorrhagic stroke, if at least one of the above risk factors is present, it is necessary to undergo regular preventive examinations and, if necessary, go to the hospital for treatment. In the first months after a stroke, recovery is faster than later.

Factors affecting life expectancy after a stroke

The subsequent life after a stroke will depend on the type of disease, the degree of damage and the presence of additional background diseases. There are a number of circumstances that can both facilitate and complicate the course of the underlying disease and the process of restoring brain cells. So, here are the key factors that have a direct impact on the recovery process:

Damage area. It affects the future life of the patient. In the case of extensive damage, the cells are damaged so badly that they can no longer be restored. Because of this, the functioning of the brain is disrupted, which leads to malfunctions in other systems and organs, and even to the death of the patient.
Consequences of a stroke. Patients suffering from paralysis, impaired speech function, sensitivity, mental disorders are unlikely to be able to lead a normal and fulfilling life. If they manage to recover, then only partially. Forecasts are unfavorable because these conditions lead to bedsores, intoxication, and other complications. All these phenomena significantly reduce life expectancy.
Age features. In the process of recovery after a stroke, the elderly have the least chance. The fact is that their cells do not have the ability to quickly renew themselves, they often develop inflammatory processes, vascular pathologies, repeated hemorrhages, heart attacks occur. Even if patients manage to survive the attack itself, in case of nervous overstrain, an attack of hypertension, there is a risk of a second stroke. In addition, women have much more chances to recover than men, which is associated with their physiological characteristics. Therefore, the general condition of the patient also depends on age and sex.
Prolonged immobility. When a patient recovers from a stroke, he is often unable to move due to paralysis, paresis. If you neglect the implementation of the rehabilitation program, the muscles gradually lose their tone, the blood supply to the internal organs worsens. This leads to thrombosis, tissue necrosis, intoxication. Therefore, the condition worsens even more, inflammation, infectious processes, and cardiovascular diseases develop. Such a patient has much less time to live than a person who regularly moves, does exercises and has a positive attitude.
Localization of the disease. Of course, the prognosis directly depends on the localization of the affected areas. Ischemia can affect the tissues that supply blood to the carotid artery, basilar and vertebral, as well as their branches. In addition, ischemic cerebral stroke is the most dangerous condition that reduces the chances of survival. Hemorrhagic stroke most often affects the shell (in 55% of cases), thalamus, cerebellum, brain stem.

No one can give an unequivocal answer to the question related to life expectancy after a stroke. This is due to the individual characteristics of each organism. However, according to statistics, about 35% of deaths occur in the first month after the disease, and 50% of patients die during the first year. In any case, one recommendation should be followed: lead a healthy lifestyle. It is he who will avoid complications, prolong life and make it more complete.

Lifestyle after a stroke

In order for life after a stroke to be not only long, but also happy, it is necessary to contact a specialist in a timely manner. This step is relevant for those who are only at risk, and for those who have already suffered a brain disease. The doctor will conduct a comprehensive examination and offer an individual course of therapy and prevention. It may include:

taking medication,
cure of chronic pathologies that aggravate the general condition;
diet food,
massage,
physiotherapy,
surgical intervention.

After taking adequate and timely measures, we should talk about full recovery and preventing the appearance of foci of inflammation. After all, the disease often ends in disability or death for the reason that in 70% of cases, patients postpone a visit to the doctor indefinitely.

Recovery period

Recovery after a pathology involves the use of certain medications. These are tablets, drops, injections, solutions. Most often, doctors prescribe neurostimulants, coagulants, nootropics, etc. Traditionally, the duration of the course is at least 5 months, and it is important that the use continues even when the disease subsides and the symptoms subside. Drug therapy, carried out under the supervision of a physician, provides:

restoration of damaged cells;
regulation of metabolic processes;
improving the supply of brain cells with oxygen;
activation of blood circulation in the damaged area.

If a person after a stroke stops taking these drugs, the damaged areas of the brain will not fully recover, and the body will not be able to fully function. If you refuse to take drugs that stop seizures, this will lead to a relapse of the disease and, most likely, to death or coma.

In the first month, the rehabilitation of patients involves the following activities:

stay in a specialized department of the hospital for 2-4 weeks, depending on the degree of damage;
restoration of brain cells located near the lesion with the help of special medical measures;
muscle recovery. This requires therapeutic exercises, moderate physical activity;
massage.

If the above measures have given the desired effect, doctors proceed to the stage of discharge and subsequent rehabilitation, which includes:

restoration of speech function through special exercises;
adherence to the principles of proper nutrition;
regular walks in the fresh air.

Compliance with a therapeutic diet is the basis for rehabilitation after a stroke. This is especially true in situations where the patient is overweight or has high blood sugar levels. The menu should include foods with a lot of fiber, as well as follow the principle of fractional nutrition (eating food in small portions, but often). The following products are prohibited:

pork and other fatty meats;
high-fat fish;
smoked products;
sausages;
dairy products with a high percentage of fat content;
pastries, pastries;
grape;
legumes (lentils, peas, beans, chickpeas, beans);
soda;
tea and coffee.

It is best to give preference to a vegetarian diet (soups, stewed vegetables, cereals). You can include dried fruits, herbal decoctions in the diet.

Such a diet will allow not only to get rid of excess weight, but also to normalize blood circulation, and prevent a recurrent stroke.

Prevention of recurrent stroke

The likelihood of a second attack increases if the simplest rules of recovery are not followed. During the first few days after the illness, special attention must be paid to preventing a relapse. Each subsequent defeat is fraught with even more serious deviations in the work of the body, the psyche. The most serious threat at this stage is death.

In order to avoid such consequences, it is necessary to find out the causes of the disease, carry out a number of preventive procedures, and coordinate restorative measures with the doctor. Next, you should take the medicines prescribed by your doctor and have regular check-ups.

An important role is played by the rejection of bad habits (drinking alcohol, smoking), prohibited foods (sweets, smoked meats, fast food) and dieting, since not only the likelihood of a relapse depends on nutrition, but also the general state of health. In addition, there are a number of rules, following which will reduce the risk of relapse:

changing eating habits;
getting rid of extra pounds;
regular walking;
physical education;
treatment of chronic diseases;
constant medical supervision.

The doctor will individually advise each patient on what to do in order to prolong life and improve its quality. It will also set the maximum allowable blood pressure that will need to be maintained.

In addition, the doctor will make a list of medications that you need to take for a speedy recovery. In order to reduce the likelihood of relapse, you should take a blood test and determine the content of glucose in it. This will reduce the chance of another stroke.

Thus, each patient lives after a stroke for a different number of years. It mainly depends on his gender, age, degree of damage as a result of the disease, localization of the lesion and other factors.

A competent approach to rehabilitation and prevention of recurrent stroke guarantees not only an increase in life expectancy, but also an improvement in general condition. The patient will be able to return to his usual rhythm and feel great.

There are two ways to describe them:

Single time line.
A "unique" timeline that reflects the recovery of individual stroke survivors.

Both approaches are useful.

Single timeline

A single time line is an average recovery process after a stroke. It gives a general idea of what stage of recovery the stroke survivor is in. If a person says, “I had a stroke seven months ago,” then doctors and therapists can make certain assumptions about what stage of recovery they are in. The unified timeline is also useful in research, in particular for determining the group of stroke survivors who are being treated. For example, a study might include “people 3-5 months after their stroke.”

The four stages of a stroke on a single timeline look like this:

Hyperacute: 6 hours from the first symptoms.
Acute: first 7 days.
Subacute: after the first 7 days to 3 months.
Chronic: after 3 months until the end of life.

"Unique" timeline

The "unique" timeline is based on studies using brain scans of people who have had a stroke. These scientific studies show that each stroke proceeds in its own way. Stroke survivors enter and exit phases of recovery at different times.

The choice of the best strategy depends in part on what stage of recovery the stroke survivor is in. Each strategy works at a certain stage.

Figuring out what phase a stroke survivor is in is often a matter of simple observation. The way the body moves makes it possible to understand what is going on in the brain. The survivor of a stroke and those around him can help determine the stage of recovery after an illness.

Hyperacute phase

In both forms of the timeline, the hyperacute stage is the same: from the first symptoms to 6 hours after the stroke.

As soon as the first symptom is discovered, the time has come! Some stroke survivors do not receive emergency care during the hyperacute period. This is unfortunate because this is the only period in which an aggressive clot-busting drug can be used. This drug, called TPA (tissue plasminogen activator), is a thrombolytic (“thrombo” - a blood clot, “litik” - destructive). (Caution: tPA is contraindicated in hemorrhagic strokes.) Stroke survivors who receive tPA generally recover better and faster. That is why it is vital to recognize a stroke and get emergency care. The sooner a stroke survivor can get to the hospital, the more likely they are to receive a tPA. Literally: time is the brain. Other medical interventions that can save the brain are also done during this phase. Providing emergency medical care is essential not only to save as much of the brain as possible, it is often of great importance to save the life of a stroke survivor.

What is the best recovery strategy during the hyperacute phase?

The most important thing a stroke survivor and their caregivers can do to help their recovery is seek emergency medical care as soon as possible. Call 911. Wasted time is wasted brain. During this period, no recovery occurs. If the patient is awake, health care providers may perform motion tests that will provide information about the extent of the damage caused by the stroke. However, at this stage, you should focus primarily on two tasks:

Saving a patient's life.
Saving as much of the brain as possible.

Acute phase

During the acute phase, two regions appear in the brain.

killed by a stroke;
all his neurons (nerve cells) are dead;
has no chance of brain restructuring (neuroplasticity);
forms a cavity in the brain that is filled with fluid.

Penumbra:

much larger than the core;
represents billions and billions of neurons;
alive, but barely;
eventually become a useful or useless region of the brain depending on what is done during rehabilitation.

A stroke causes the blood supply to the nucleus and penumbra to be cut off because the blood vessels are either clogged (in stroke with vascular blockage) or ruptured (in stroke with hemorrhage).

The interruption of the blood supply leads to the death of the nucleus. Penumbra remains alive, but barely. Because the main blood vessel is (at least temporarily) down, the penumbra uses the smaller blood vessels to continue life. The neurons in the penumbra receive enough blood to survive the acute phase, but not enough. Due to the reduced blood supply, the neurons in the penumbra are unable to do their job.

But for the billions of neurons in the penumbra, there is another problem.

Damage to any part of the body causes many body systems to come to the aid of the affected area. Think of the swelling caused by a twisted ankle or a bruised arm. The same thing happens with penumbra after a stroke. It receives calcium, catabolic enzymes, free radicals, nitric oxide and other chemicals. And this area is flooded with "metabolic soup" designed to promote recovery, which causes swelling. While this mixture of chemicals aids in recovery, it provides a meager environment for neurons to function.

Thus, the penumbra experiences two problems caused by a stroke:

Insufficient blood supply.
A mixture of chemicals that interfere with the functioning of neurons.

These two factors put a large area of the brain (the penumbra) inactive. The neurons in it are alive, but "stunned". The special term "cortical shock" is used to refer to this phenomenon. For many stroke survivors, this leads to paralysis. But paralysis during the acute phase will not necessarily be permanent. In some stroke survivors, penumbra neurons start working again. The restoration of the penumbra occurs at the next stage - in the subacute phase.

What is the recovery strategy during the acute phase?

Intensive care during the acute phase is a bad idea.

During the acute phase, the brain remains in a very painful state. Penumbra neurons are especially vulnerable. Let's look at animal studies that have been induced to have a stroke. For those who were forced to do too many tasks in a short period of time after a stroke, brain damage increased. In human studies, the results of intensive rehabilitation (heavy exercise soon after a stroke) have been mixed at best. Scientists continue to look for an answer to the question: “What loads will be excessive during the acute phase?” And until it is found, the rules are simple:

follow the recommendations of doctors;
listen to the advice of therapists and nurses;
don't stress.

Intense effort during the acute phase will impair recovery. But this does not mean that there should be no therapy. For many patients, doctors prescribe bed rest for the first 2-3 days after a stroke. However, even at this time, treatment begins. Doctors often make passive (without any patient effort) movements to the stroke survivor, that is, move his limbs along their range of motion. These actions will help maintain muscle length and joint health.

Once bed rest has been lifted by the doctor, therapists will use their own clinical judgment to carefully and safely restore the stroke survivor's movement. During the acute phase, most of the therapy is done "at the patient's bed" (in the patient's room). Therapists begin a gentle restoration of movement. Physicians who work with patients in the acute phase often describe their approach to treatment in a simple phrase: "We do what the patient can do safely."

Before conducting therapy in the acute phase, doctors will check:

the ability to reason and understand safety rules;
ability to follow commands;
orientation in time and space (eg, "Where are you? Who am I? What time of day, season," etc.?) (Many patients may feel offended by such simple questions; however, they are important in determining the degree safety of therapy.);
memory;
ability to solve problems;
vision;
the ability to actively move the limbs (active range of motion, or AMA);
strength;
fine motor coordination;
Feel.

After the evaluation, the treatment starts with very simple movements and actions. For example, if it is safe, then doctors will help stroke survivors:

reach for objects, touch or take them with your hand / brush from the affected side;
sit on the edge of the bed;
change position from sitting to standing;
walk.

During the acute phase, listen carefully to the recommendations of therapists. Therapists, as well as doctors and nurses, will advise you on which recovery strategies to use. Caregivers can also be helpful, acting on the advice of a therapist when the stroke survivor is most active. The caregiver's job can include anything from talking to the stroke survivor to encouraging them to perform basic movements (such as unclenching and clenching their hand).

In addition, caregivers are important for recovery during the acute phase, as they often spend many hours a day with the stroke survivor and can inform doctors of changes in their ability to move. For example, a person after a stroke is not able to bend his elbow at all on Monday. Then - without any exercise - on Wednesday he can flex his elbow a few degrees. This phenomenon is known as spontaneous recovery and is extremely important to recognize for two reasons:

This is a sign of the subacute phase (which is discussed next).
This indicates when you can start really difficult and effective work.

If you are caring for a stroke survivor and you see spontaneous recovery, let your doctor know! The most V8.ZHN8.I phase of recovery (subacute) has begun!

Subacute phase

Begins	Ends
The first penumbra neurons begin to function again	All neurons in the penumbra function

For many stroke survivors, the subacute phase is a time of great hope. At this stage, there is a huge influx of neurons, which allows the stroke survivor to recover at a rapid pace. A significant portion of recovery is considered spontaneous recovery (significant recovery with little effort). The reason for this rapid spontaneous recovery is that neurons that have been "turned off" are "turned on" again. Some stroke survivors experience an almost complete recovery during the subacute phase. Other stroke survivors are not so fortunate. They take longer to “turn on” the neurons again, as they have one problem with the penumbra.

Problem with penumbra

The brain obeys the rule "what you do not use, you lose." If the penumbra neurons are not made to work again, they stop doing so. This process (the loss of function by unused neurons) is known as the "forgot how to use" phenomenon.

But why not use penumbra neurons? Of course, the stroke survivor will be encouraged to move. And the movements that a stroke survivor performs will set the neurons in motion and will not allow the “forgotten to use” phenomenon to develop, right? For a minority of people after a stroke, this is exactly the case. These “lucky stroke survivors” quickly recover functional (applicable, practical) movements and never develop the “forgot how to use” phenomenon.

But many stroke survivors "learn" not to use neurons. Much of the reason for the phenomenon is that the managed care system imposes a "meet it, greet it, treat it and put it on the street" approach on therapists. Doctors are guided by "rule number 1": ensure their safety, functionality and send them out the door. Functionality is indeed the end goal. But for stroke survivors who have not yet regained function, there is only one way to “get out the door”: compensation (using only the healthy side of the limb). Involving the healthy side in all movements means that the neurons in the penumbra will not have the load necessary to put them to work. When penumbra neurons become usable, no one asks for anything from them - this is how the “forgot how to use” phenomenon develops.

What is the best recovery strategy during the subacute phase?

The subacute phase is the most important stage in the recovery process. Its degree is determined by the intensity and quality of efforts at this particular time. Successful completion of the subacute phase provides the highest level of recovery.

During the subacute phase, billions of stroke-surviving neurons gain the ability to return to work. The point at which each neuron becomes ready for action is the beginning of the chronic period (which we will discuss next).

Much of the recovery during the subacute phase is due to the “turning on” of neurons that have been “turned off”. This is the essence of spontaneous recovery: neurons that are not available for work at the subacute stage become capable of it. During this phase, many stroke survivors have the opportunity to "ride the wave of spontaneous recovery." Everyone wants to take credit for healing. The stroke survivor might say something like, "I'm recovering well because I'm really working hard at it," and the therapist will assume that the stroke survivor is recovering because of intensive care. But much of the recovery during the subacute phase is due to the fact that billions and billions of neurons become usable again. As the swelling subsides after a muscle injury, so does the swelling after a stroke, as a result of which the neurons are able to return to work.

chronic phase

At some point, all the neurons in the penumbra regain functionality, so the "wave" to ride disappears. This is a sign of the onset of the chronic phase.

When the subacute phase ends and the chronic phase begins, the stroke survivor has two types of neurons. Let's call them "working neurons" and "lazy neurons".

Working neurons

Some neurons feel quite normal and immediately return (during the subacute phase) to what they were doing before the stroke.

For example, neurons can return to...

...elbow flexion, then to...
...raising the leg while walking, then to...
... control over the movements of the mouth during speech, then to ...
...opening the hand...
etc.

Working neurons take over their duties again. It is these neurons that, when activated during the subacute phase, provide spontaneous recovery.

"Lazy" neurons

These neurons are never asked to do anything after a stroke. As a result of a process known as the "forgot how to use" phenomenon, they are temporarily out of service. As is true for the rest of the brain, every neuron obeys the “what you don’t use, you lose” rule. "Lazy" neurons lose connections between themselves and other neurons, which are called "synaptic connections".

Usually, neurons use connections to communicate with other neurons. When this interaction occurs, they remain operational. If a neuron is not in contact with other neurons, connections are lost. This is the essence of the principle of the brain "what you do not use, you lose." Each of these non-working neurons loses dendrites - branches that provide connections between neurons. The word "branch" is aptly chosen here. In fact, there is a special term for shortening these branches - pruning (or pruning) - similar to pruning the branches of bushes or trees. Scientists use the expressions "dendritic pruning" or "dendritic pruning". This is exactly what happens to “lazy” neurons under the influence of the “forgot how to use” phenomenon. They lose touch.

The chronic period begins when all the neurons of the penumbra have become either working or “lazy”. At this point, the stroke survivor no longer spontaneously recovers. Doctors can recognize this stage of recovery - it's relatively easy to see. Stroke survivors never recover. Clinicians call this plateau. Due to the requirements of the managed care system (insurance companies), physicians are required to discharge (finish treatment) stroke survivors whose condition has reached a plateau. The idea is: “This patient is no longer getting better. Why should we pay for further treatment?”

For many stroke survivors, the plateau may not be permanent. Researchers have discovered two specific methods for coping with plateaus during the chronic phase.

Inclusion in the work of "lazy" neurons.
Connecting other brain neurons to perform functions lost during a stroke.

Inclusion in the work of "lazy" neurons

The reactivation of "lazy" neurons is known as "the elimination of the phenomenon of "forgot how to use"". The idea is to load "lazy" neurons so that they are forced to establish new connections with neighboring neurons (here the key word is "forced"). In fact, one way to force neurons to use unactivated connections is called "forced use". Forced use is a part of forced movement therapy in which the healthy limb is not allowed to perform any action. This encourages the diseased limb to perform difficult and uncomfortable work. But it is precisely this kind of work that forces the brain to rebuild itself. Changing the brain (also known as learning) is a difficult task, whether it's learning a foreign language or learning to play the violin. The key to learning, including transformation after a stroke, is task complexity. When we force "lazy" neurons to reach out to other neurons, this leads to the formation of new connections between them. Forcing "lazy" neurons to establish connections is one way to recover from a stroke during the chronic phase.

Connecting Other Brain Neurons to Perform Functions Lost During a Stroke

The brain is "plastic" and, like the plastic found in everything from auto parts to plastic bottles, it can physically change. In order for a plastic bottle to change shape, it must be heated. To change the brain, he needs an intense load. Here is an example of the manifestation of plasticity after a stroke.

Neurons from different parts of the brain are ready to perform tasks that they have never been asked to perform before. This is the capacity for plasticity, and stroke survivors may well use it in the chronic phase. Difficult tasks force other neurons in the brain to perform functions lost during a stroke.

What is the best recovery strategy during the chronic phase?

Below are the general rules for recovery during the chronic phase. Note that various strategies are described to help stroke survivors succeed during the chronic phase.

Recovery requires independent efforts. Sooner or later there comes a moment after which there is no longer a therapist next to the person who has had a stroke. Therapists can help you periodically during the chronic phase (i.e. every 6 months, year, etc.). They look at what the stroke survivor is doing and give advice on how to rehabilitate. But in the chronic stage, there is no need for therapists. Once treatment is over, stroke survivors must take control of their own recovery. This stage of recovery is based on hard independent work. Patients who are willing to take charge of this process need the tools to start and follow the “upward spiral of recovery.” This is facilitated by the presence of a practical need for everything - from coordination of movements to endurance of the cardiovascular system. There are many recovery options during the chronic phase, from working on muscle strength to using mental training.
Forget the plateau: it doesn't exist. The word "plateau" literally means "leveling off" and is used to describe the period when a stroke survivor stops recovering. Traditionally, the recovery curve was thought to have one plateau at the end of the subacute phase. Research in recent decades has shown that some stroke survivors can overcome plateaus. During the chronic phase, recovery consists of many plateaus that occur over a number of years.
Stay fit. Everyone is getting old. As we age, staying fit is vital to everything from overall health to being able to continue doing what we love. But stroke survivors expend too much energy. After a stroke, basic activities of daily living (i.e. walking, dressing, etc.) require twice as much energy, and stroke survivors need even more as recovery takes effort.
Do not allow soft tissues to contract. When tissue shortening occurs (i.e., muscle tension is noted), recovery of movement may be compromised and/or completely stopped. Even if you do a lot of hard work, but at the same time you do not have enough muscle length, you will not move further - it's simple. This is especially true of the tendency for soft tissue shortening in the elbow, wrist, and flexors of the fingers in the arm and hand. The main problem in the leg is the calf muscle. Muscle spasticity in the calf muscle keeps the foot tilted down. If she stays in that position long enough, the calf muscle will contract. But many other muscles are also at risk.

Recovery focused on phases

There are three ways in which recovery can take place.

Strength increases: You develop muscle strength and cardiovascular (heart and lung) endurance.

Strength development should be encouraged during the subacute and chronic phases of a stroke.
Strength development during the hyperacute and acute phases will impair recovery.

The penumbra is restored: during the subacute phase, the neurons of the penumbra restore their functions.

The brain is being rebuilt: during the chronic phase, brain plasticity allows another area of the brain to take over the lost function.

Faced with the consequences of a stroke in loved ones, we are often unable to immediately appreciate how important it is not to give up, to fight for the approach of the moment when a loved one will return to normal life again. But in order for the rehabilitation to be successful, it is necessary to understand what needs to be done and, most importantly, when. We will try to delve into the problems associated with recovery after a stroke in this article.

Consequences of a stroke

There are two main types of stroke - ischemic and hemorrhagic, each of which is caused by special causes and has specific consequences.

Man after hemorrhagic stroke

This type of stroke is considered to be the most dangerous, because it is associated with cerebral hemorrhage, which means that the affected area can have a significant area. Patients who have had a hemorrhagic stroke experience serious problems with movement, speech, memory, and clarity of consciousness. Partial paralysis is one of the most common consequences; it affects the right or left side of the body (facial, arm, leg), depending on the location of the brain lesion. There comes a complete or partial loss of motor activity, a change in muscle tone and sensitivity. In addition, behavior and psychological state change: speech after a stroke becomes slurred, incoherent, with obvious violations of the sequence of words or sounds. There are problems with memory, character recognition, as well as depression and apathy.

Man after ischemic stroke

The consequences of this type of stroke may be less severe, in the mildest cases, after a short period of time, full restoration of body functions occurs. Nevertheless, doctors do not give positive forecasts very often - circulatory problems in the brain rarely go unnoticed. After an ischemic stroke, swallowing, speech, motor function, information processing and behavioral disorders occur. Often a stroke of this type is accompanied by subsequent pain syndromes that do not have a physiological basis, but are caused by neurological problems.

Throughout the recovery period after a stroke, you need to carefully monitor the upper limit of the patient's blood pressure in order to take timely action in case of a dangerous increase. The normal indicator is 120-160 mm Hg. Art.

If the result of a stroke is paralysis, then the patient needs bed rest. At the same time, every 2–3 hours, the position of the patient's body should be changed to avoid the formation of bedsores. It is necessary to monitor the regularity and quality of secretions, change linen in a timely manner, observe any changes in the skin and mucous membranes. At later stages, passive and then active gymnastics, massage should be practiced first, it is necessary to restore the patient's motor functions, if possible. During this period, the psychological and emotional support of relatives and friends is very important.

Methods of rehabilitation therapy and evaluation of their effectiveness

Ways to accelerate rehabilitation after a stroke are regularly improved, which helps patients partially or completely restore lost functions and return to their previous standard of living.

Medical treatment

The main task of medications during this period is to restore normal blood flow in the brain and prevent the re-formation of a blood clot. Therefore, doctors prescribe drugs to patients that reduce the level of blood clotting, improve cerebral circulation, lower blood pressure, as well as neuroprotectors to protect cells. Only a professional doctor can prescribe specific medications and follow the course of treatment.

Botox therapy

Spasticity is a medical term meaning a condition when individual muscles or groups of them are in constant tone. This phenomenon is typical for patients who have recently had a stroke. To combat spasms, Botox injections are used in the problem area, muscle relaxants reduce muscle tension or even completely nullify it.

exercise therapy

This is one of the simplest yet most effective ways to regain mobility in your arms and legs after a stroke. The main task of physical therapy is to “wake up” the nerve fibers that have fallen into biochemical stress, create new chains of connections between them so that the patient can return to normal life or get by with minimal outside help.

Massage

After a stroke, the muscles need to be restored, and for this, doctors recommend using a special therapeutic massage. This procedure improves blood circulation, reduces spastic conditions, removes fluids from tissues and has a positive effect on the functioning of the central nervous system.

Physiotherapy

Methods based on various physical influences. They can be very effective for restoring blood circulation, reducing pain syndromes, and improving the functioning of various organs. The abundance of methods allows you to choose the appropriate option for each specific case or develop a whole range of measures aimed at the rehabilitation of body systems. Physiotherapeutic procedures include electrical muscle stimulation, laser therapy, electrophoresis, vibration massage and others.

Reflexology

Impact on acupuncture or biologically active points of the body helps to activate its vitality, in fact, being an effective additional method of treatment. Acupuncture and injections reduce muscle tone in spastic conditions, regulate the functioning of the nervous system and improve the condition of the musculoskeletal system.

kinesthetics

One of the most modern ways to restore the independence of the patient after a stroke. It consists in gradual learning to perform movements that do not cause pain. For example, for bedridden patients, one of the main tasks of kinesthetics is the ability to independently regularly change the position of the body in order to prevent the formation of bedsores.

Bobath therapy

This is a whole complex of measures based on the ability of healthy areas of the brain to take on responsibilities that were previously the prerogative of the damaged ones. Day after day, the patient learns again to accept and adequately perceive the correct body positions in space. Throughout the entire process of therapy, a doctor is next to the patient, who prevents the occurrence of pathological motor reactions of the body and helps to carry out useful movements.

Diet and phytotherapy

In the post-stroke state, the patient needs proper nutrition with a minimum content of fatty foods - the main source of bad cholesterol. The basis of the menu most often become fresh vegetables and fruits, lean meat, whole grains. It is best if the diet is prescribed by a doctor, based on the characteristics of a particular case. As phytotherapeutic methods, treatment with essential oils (rosemary, tea tree, sage), as well as the use of decoctions and tinctures (rose hips, St. John's wort, oregano) are used.

Psychotherapy

After a stroke, any patient needs psychological help, preferably provided by a professional. In addition to the fact that depressive states can be caused by brain disorders, the patient experiences constant stress due to his helplessness. A sharp change in social status can adversely affect the psychological state of the patient and even slow down the course of recovery as a whole.

Ergotherapy

Behavioral reactions during the recovery period also change most often, so the patient needs to re-learn the simplest things - handling household appliances, using transport, reading, writing, building social bonds. The main goal of occupational therapy is to return the patient to normal life and restore working capacity.

Some time after the first stroke, the likelihood of a second one increases by 4–14%. The most dangerous period is the first 2 years after the attack.

Length of rehabilitation after a stroke

It is necessary to take measures to restore each lost function of the body after a stroke as soon as the patient's condition stabilizes. With an integrated approach to this task, motor activity returns to the patient after 6 months, and speech skill - within 2-3 years. Of course, the term depends on the degree of brain damage, the quality of the procedures performed, and even on the desire of the patient himself, but if you approach the solution of the problem with all responsibility, then the first results will not be long in coming.

The more sudden a stroke occurs, the more shocking the consequences become. Just yesterday, your close relative was healthy and cheerful, but today he cannot do without outside help. It must be understood that in this situation a lot depends on the people who are next to him. And the matter is not only in the degree of professionalism (although this is an important factor), but also in simple human care and understanding.

So, the stroke still happened. Behind the agonizing days of worries for the life of a loved one. You weren't allowed into the intensive care unit. They refused to name the medicines that you could and would like to buy. Doctors argued this by the fact that everything necessary for the patient is, but he needs not so much. Neurologists were in no hurry to report information about the prognosis, limiting themselves to the vague "stable, severe condition."

But now you or your loved one is feeling better. We were allowed to get up and walk. And, finally, she was discharged under the supervision of a neurologist and an internist at a polyclinic.

It seems that everything should be simple and clear. A lot of useful information is given by the attending physician at discharge. This is also written in the abstract in the discharge summary, which the patient receives in his hands.

But, apparently, the stress from all the negative events is so strong that few people listen to people in white coats. Therefore, a typical situation is when a person with a recent stroke comes to an appointment with a polyclinic neurologist, who is sure that a drop every six months with a magic "vascular" drug is a guarantee of the absence of a repeated stroke, and nothing else needs to be done.

Therefore, I decided to write this post, in which I want to talk about life after a stroke, about what to do and what not to do in order to avoid a second vascular catastrophe.

Myths about life after a stroke

Let's immediately deal with common folk speculations that have nothing to do with reality.

Droppers. There is not a single dropper that would help significantly reduce the neurological deficit in a patient who has had a stroke. There will be no magical improvement when a person could not speak and suddenly speech was restored at once, the hand did not work - and suddenly the strength of the muscles became the same. There is not a single dropper that would even slightly reduce the risk of a second stroke.

Vascular and nootropic drugs. For some reason, the attention of stroke patients and their relatives is riveted to this group of drugs. I will name a few of them: vinpocetine, trental, piracetam, mexidol, actovegin, cerebrolysin, cortexin. They are considered a panacea for stroke. That is, it is widely believed that you can score on everything, but go to the neurologist for the appointment of drugs from these groups, and then drink / drip all this stuff for a month or two - it is necessary. Otherwise - a repeated stroke.

In fact, these drugs do nothing to help prevent recurrent CVA at all. Chosen wisely, they help reduce cognitive impairment (improve memory, attention), remove dizziness and do something else. This helps to somewhat improve the patient's quality of life, but that's all - not the main thing.

Bed rest. A surprising number of people believe that a stroke is an excuse to move as little as possible. Ideally, lock yourself in your apartment and move from bed to TV to refrigerator and back. Depression, which is a frequent companion of stroke patients, also has a negative effect on the desire to move.

In Russia, post-stroke depression is usually given little attention, which is understandable: prescribing antidepressants to a mountain of drugs (without exaggeration, this is 10-15 drugs daily) is a problem that a doctor does not want to think about. Because for this you will need to convince the patient to give up 4-5 positions on the list, which are not very necessary, but go and prove to the patient that drinking trental with phezam all year round is not at all necessary.

course medication treatment. Another mistake is to tune in to the fact that after a stroke it is enough to limit yourself to a course of taking drugs. This is not true. It is hard to accept the fact that now you will have to drink a handful of pills for life. Daily. Don't miss an appointment. But this is just one of a series of changes that will take some getting used to.

How life changes after a stroke

Tablets. Here is a list of medications that a stroke patient usually takes:

Hypotensive. Ideally, pressure pills are selected by a cardiologist. In parallel, the specialist corrects rhythm disturbances, if any. It is important to remember that, for example, atrial fibrillation is a serious risk factor for stroke, and therefore it must be dealt with.

Statins. Drugs "from cholesterol" - another important component of treatment. That is why doctors shake the patient, ask him to donate his blood for the lipid spectrum at least once every six months. Statins help to normalize this very lipid spectrum and stop the formation of new atherosclerotic plaques, and therefore reduce the risk of recurrent stroke.

Antiaggregants. Blood thinners, aspirin and company.

This also includes drugs to normalize blood glucose levels in diabetics. If a stroke occurs, the selection and administration of these medications should be taken with redoubled enthusiasm, because the absence of high blood sugar is a significant plus that reduces the risk of a recurrent stroke in a diabetic.

Visiting doctors. For some reason, it is generally accepted that patients after a stroke are the "property" of neurologists. It's not like that at all. Going to a neurologist, if the condition does not worsen and new neurological symptoms do not appear, is enough once every six months. It is much more useful to turn your eyes towards a cardiologist and an endocrinologist (because there is nothing more important than normal pressure and a normal blood glucose level). It makes sense sometimes to visit an ophthalmologist to see how things are in the fundus.

Surveys. Here are the tests you need to look at every six months:

General analysis of blood and urine,
- blood glucose,
- blood lipid spectrum.

Of the examinations, an ECG (and other examination methods, if prescribed by a cardiologist - ultrasound of the heart, holter, and others) should be passed once every six months and a duplex examination of the brachiocephalic vessels (ultrasound of the cervical vessels is "in a common way") once a year or two years.

After a stroke, you do not need to do an MRI of the head every year, in the hope that post-stroke changes will resolve. They're not going anywhere. But the good news is that the brain has the property of neuroplasticity.

The surviving neurons will partially take over the duties of the dead. New neural connections are formed. All this requires effort, patience and consistency from the patient. And they will most likely be rewarded: speech will improve, muscle strength will increase in a weakened limb, etc. We will not see this on an MRI - all improvements will occur clinically.

Rehabilitation. In addition to what I have already listed, this is a massage of the limbs, as well as classes with a specialist in physical therapy and a speech therapist. Still - the help of the psychologist or the psychotherapist. This is what they know so well in Germany and Israel, and they don't know how well here. The problem is that the rehabilitation departments of our public hospitals take only "pretty", that is, more or less healthy patients. Those who have a high rehabilitation potential. Those who do not have serious comorbidities. Everyone needs rehab...

Rehabilitation after a stroke is still a problem for Russia. Patients and their relatives focus their attention on knocking out droppers from the local therapist and buying expensive drugs. And the importance of real work with the patient fades into the background. It is not right. If funds are limited, it is important to understand that, for example, it is better to opt for a visit to a speech therapist instead of "dripping" Actovegin.

Physical activity. Moving is necessary. But it's important to discuss with your neurologist the type of physical activity you plan to do. Many patients with a joyful cry: "Dacha - this is fitness!" they rush to the beds and, under the scorching sun, begin to pull out weeds for hours. There they often get a second stroke, in this position - booty up. Because the pressure rises, and in general, spending time in the middle of the beds is a serious burden on the circulatory system.

But swimming, walking, running (provided that not very large weight and joints allow) and even dancing - why not. The main thing is regularity and moderation. In other words, lying gloomily on the couch with the certainty that life is over is just as harmful as pulling weights in the hall every day. A stroke is an occasion to make friends with your body, listen to it and look for the best type of physical activity (after discussing it with your doctor, of course).

Bad habits. I hope it is clear to everyone that smoking and drinking a liter of beer every night will have to be abandoned. In fact, a very small percentage of my patients listen to this recommendation.

Of my practice, 10 percent of patients seriously change their lives. Usually these are women. It seems to me that their motivation to follow the doctor's recommendations is connected with the fact that there is something to live for: interesting work, hobbies, children and grandchildren, husband. The rest smoke and drink as before the disease. And often a repeated stroke becomes fatal for them.

disability and work. Previously, almost every person who had a stroke could count on disability. Now the requirements for referring a patient to determine the disability group have become tougher. Not so long ago, I had a patient with the consequences of an ischemic stroke in the stem structures: fuzzy speech, awkwardness in the right hand (there was no noticeable muscle weakness, but it became difficult to hold a pen and write) and terrible weakness. He was not given a disability - it was assumed that he could work as a turner. I have had many similar cases this year.

Therefore, good rehabilitation after a stroke is not empty words. Our state, alas, needs sick people less and less. They need only themselves and relatives.

And that is why it is so important to prioritize the treatment of a person who has had a stroke, and also to understand that not everything depends on the Lord God and the attending physician, and much can be changed by the patient himself.