Stroke prevention and treatment

Cerebrovascular diseases are one of the leading causes of death in the Russian Federation, and disability after a stroke ranks first among all causes of primary disability.

An important step in the selection of people who need preventive measures is the recognition of risk factors for stroke. Risk factors for the development of cerebrovascular disease can be divided into unmodified (age, gender, hereditary predisposition) and modifiable, which include arterial hypertension, atrial fibrillation, diabetes mellitus, asymptomatic carotid artery disease, as well as lifestyle risk factors (tobacco smoking, alcohol abuse, overweight, poor nutrition, insufficient physical activity, stress).

Thus, stroke prevention consists of the following provisions.

1. Know your blood pressure. Check it at least once a year. If it is elevated, work with your doctor to keep it under control.

• High blood pressure (hypertension) is the leading cause of stroke;
• If the upper number (your systolic blood pressure) is consistently above 140 or if the lower number (your diastolic blood pressure) is consistently above 90, consult your doctor;
• If your doctor confirms that you have high blood pressure, he may recommend some changes in your diet, regular exercise, or medication;
• Drug therapy for hypertension is constantly improving. With the right choice of drugs, you will not experience side effects, and your quality of life will not suffer.

2. Find out if you have a heart rhythm disorder. Cardiac arrhythmia is an irregular heartbeat that disrupts cardiac function and allows blood to stagnate in some parts of the heart. Blood that does not move through the body can clot. Contractions of the heart can separate part of the blood clot into the general blood flow, which can lead to impaired cerebral circulation.

• The doctor can make a diagnosis with a thorough examination of your pulse;
• Cardiac arrhythmia can be confirmed by electrocardiography;
• If you have a heart rhythm disorder, your doctor may suggest that you take medications that reduce blood clotting.

3.If you smoke, stop.

• The risk of stroke in smokers is 6 times higher than in non-smokers;
• As soon as you stop smoking, your risk of stroke will begin to decrease immediately;
• In five years, your risk of stroke will be the same as that of non-smokers.

4. Do not abuse alcohol.

• Excessive alcohol intake increases the risk of stroke;
• Remember that alcohol can interact with the medications you are taking, and it is dangerous in large doses.

5. Find out if you have high cholesterol.

• Increased cholesterol increases the risk of stroke;
• Lowering the level of cholesterol (if it was elevated) reduces the risk of stroke;
• Reducing cholesterol in most people can be achieved by diet, exercise, and some require medication therapy.
• Taking medications and selecting their dose should be carried out under the control of the blood lipid profile and must be combined with a special diet. It is worth noting that the use of these drugs should be lifelong.

6. If you have diabetes, strictly follow your doctor's recommendations to control your diabetes.

• Often, diabetes can be controlled by careful attention to your diet;
• Work with your doctor and dietitian to create a nutrition program that meets your needs and your lifestyle;
• Your doctor may suggest lifestyle changes and medications that will allow you to control your blood glucose levels;
• Having diabetes increases your risk of stroke, but by controlling your blood glucose levels, you can reduce your risk of stroke.

7. Use physical exercise to increase your activity in your normal life.

• Engage in daily physical dynamic exercises;
• Walking for 30 minutes daily can improve your health and reduce your risk of stroke;
• Outdoor walks,
• If you don't like walking, choose other types of physical activity that suit your lifestyle: cycling, swimming, dancing, tennis, and so on.

8. A diet with a low salt content, the use of fruits and fish is recommended.

• Reducing salt intake per 100 mmol / day (5.8 g of table salt-no more than 1 teaspoon, including salt contained in bread and other food products) - reduces mortality from CHD by 16%, from strokes by 23% and overall mortality by 13%;
• Eating vegetables and fruits prevents stroke due to the activation of antioxidant mechanisms and less polyunsaturated fatty acids, increased potassium content;
• Eating oily sea fish and salmon 2 to 4 times a week reduces the risk of stroke by 48% compared to those who included fish in their diet only once a week and less often.

9. Consult your doctor if you have circulatory problems.

• Strokes can be associated with problems related to the heart, arteries, and veins, or the blood flowing through them. Your doctor may examine you for these problems;
• Fat depots caused by atherosclerosis or other diseases can disrupt blood flow through the arteries that carry blood from the heart to the brain. These arteries, located on each side of the neck, are called the carotid and vertebral arteries;
• In the case of severe narrowing or blockage of blood vessels, a stroke may occur;
• For severe anemia and other diseases, interact with your doctor to solve your problems. Improper management of these diseases can lead to stroke;
• Circulatory problems are usually treated with medication. If your doctor recommends aspirin, warfarin, dipyridamole, or others, take them as prescribed;
• Sometimes surgery is required to correct circulatory problems , such as severe arterial stenosis.

10. If you notice the following signs of impaired cerebral circulation, seek immediate medical attention.

• Sudden weakness or loss of sensation on the face, arm, or leg, especially if it is on one side of the body;
• Difficulty speaking or understanding simple statements;
• Dizziness, loss of balance or coordination, especially when combined with other symptoms such as impaired speech, double vision, numbness, or weakness;
• Sudden, unexplained, intense headache.

Every year, more than 20% of the total number of strokes are repeated. Prevention of recurrent strokes should be carried out taking into account the causes and mechanisms of their development: correction of cardiac pathology, taking indirect anticoagulants or antiplatelet agents, adequate antihypertensive therapy, angiosurgical operations.

First aid in case of suspected stroke.

So, how can you help if there is a suspicion of a stroke in a native person (or a stranger, a passerby, etc.).

• Don't panic!

Without giving any sign that something serious has happened, we will try to calm the person and encourage them with the words: "Everything will be fine now, lie down, and we will call an ambulance and wait for the doctors." We put the person in an elevated position: the head and shoulders lie comfortably on the pillow, so that there is no bending of the neck and deterioration of blood flow through the vertebral arteries. Feet down.

If the tongue sinks, turn the head to the side so that the person does not choke on saliva or vomit if vomiting begins.

• We call an ambulance.

To do this, dial the single emergency phone number "112", then "03". We describe the observed symptoms to the operator in as much detail as possible and report the time of their occurrence.

• Open a window or window pane.

We will try to ensure maximum oxygen access to the room. We unbutton the collar and the clothing that makes it difficult to breathe on the victim, we release the belt. We remove removable dentures and vomit from the mouth.

• With the help of a tonometer, we measure blood pressure.

Remember: high blood pressure can not be sharply reduced! With a sharp decrease, the suffering area of the brain increases, which does not receive nutrients.

A patient with hypertension should have "emergency" medications, such as captopril.

If it is not possible to measure blood pressure, you can not give pressure-reducing drugs! It can be low enough, and the situation will only get worse.

And one more important point: if a person has a broken swallowing, you can not give him pills – he can choke.

• We give 10 tablets of glycine.

If swallowing is not disturbed and there is such a drug as glycine at home, you should not be afraid to give the patient up to 10 tablets of this drug under the tongue for 15-20 minutes (the most convenient scheme of taking three tablets at a time: 3+3+4). Glycine can be given to all patients, regardless of the type of stroke (only if the swallowing function is not impaired!).

These are the five main actions for suspected stroke. We emphasize: for relatives, the most important thing is to quickly suspect a stroke and call an ambulance team so that the doctor assesses the situation. Other actions are also not useless: performing them while waiting for the arrival of doctors, you prevent the situation from getting worse. Thanks to your efforts, an ischemic stroke will not turn into a hemorrhagic one, a small area of brain cells will die, or everything will recover quickly.

Neurologist GUZ " LOKB»

Rybina Elena Valeryevna