DISEASES OF THE NERVOUS SYSTEM : CEREBRAL INFARCTION (APOPLEXIA CEREBRI) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
When bleeding, less the embolism, the patient suddenly loses consciousness; brain disease that mostly develops slowly, loss of consciousness is not required, but sometimes can also be observed. If there has been a massive hemorrhage, especially if the blood into the ventricles of the brain, there comatose state, from which, depending on the severity, the patient, or soon the leaves, or in this state dies. Some patients have vomiting, fever. At the time of stroke all patients pale - a consequence of the shock; in case of massive bleeding on the ground hypertension face soon is red. In the early days may be absent reflexes, which are then restored and rise: sometimes they rise at the beginning of the stroke. Pathological reflexes (Babinski, Rossolimo) are almost always. Sometimes there are tonic spasms of the hands and feet, which indicates a breakthrough in the ventricles of the brain. The main clinical syndrome in cerebral stroke depends on the location of the lesion. With the defeat of the anterior cerebral artery is observed pyramid monoplegia (crotalinae), with right-sided localization of left - sided apraxia; with the defeat of the middle cerebral artery in the initial part of its trunk - full hemiplegia with hemianesthesia, with the localization of the left - aphasia. On the opposite from the fire side is marked paralysis of the facial nerve of the Central type, the same language deviates in the direction of the palsy (damage to m. genioglossus). In the localization process in the cortex - spastic monoplegia or monopoles; other symptoms depending on the parties and the length of the hearth. When the lesion in the left parietal lobe - apraxia, agraphia, Alexis, amnestic aphasia. With the defeat of the posterior cerebral artery is marked on the opposite side of the hearth side thalamic syndrome: hemiparesis, hemianesthesia, hamatake and hyperpathia. When lesions of the cerebral vessels of the leg - alternating paralysis Weber: on the side of the lesion a lesion of the oculomotor nerve on the opposite - side hemiparesis or hemiplegia. With the defeat of the vessel bridge - syndrome Miller-Gubler: on the side of the hearth - paralysis VII couples, opposite - paralysis of the limbs; the syndrome Favilla: on the side of the hearth - paresis of lateral eye muscles on the opposite hemiplegia. With the defeat of the rear lower cerebellar artery, which supplies the medulla is the syndrome of Wallenberg: on the opposite side of the hearth-side - dissociated anesthesia, on the side of the hearth - paralysis of the soft palate and vocal cords, the cerebellar gamecentral and syndrome Claude Bernard-Horner. When bilateral lesions of the pyramidal system - phenomenon pseudobulbar palsy: aphonia, impaired swallowing, dysarthria, reflexes of oral automatism, but no degenerative atrophy of the muscles of the tongue, as in true bulbar palsy.
Course and outcome. After the acute period, if the patient does not die, a disease regresses. The degree of regression depends on the localization and extent of the lesion, age of the patient, his General condition. Some patients may have contractures type Wernicke-Mann: the hand in a state of flexion, leg - extensii. In paralyzed extremities often have a friendly movement (since-nesii). Full recovery of lost functions is rarely observed.
In atypical cases, it is necessary to exclude hemorrhage in the brain tumor or acute advanced tumor (acute brain tumor), in which there is stagnant nipples optic nerve, more pronounced cerebral phenomena; encephalitis, which are common phenomena characteristic of infection, there is mnogochasovoj, increase in symptoms, no high blood pressure; uremia and diabetes, for which it is necessary always to make a careful examination of urine and blood. Embolism and hemorrhage develop suddenly; thrombosis has almost always prodromal period with the forerunners. When the hemorrhage is high blood pressure in the brain is normal, sometimes lower. Thrombosis is usually observed in older age embolism in young hemorrhage - people of different ages. From diseases of the meninges to exclude meningitis and subarachnoid hemorrhage. Subarachnoid hemorrhage may join the stroke as a complication; often occurs with hypertension. When the puncture in the cerebrospinal fluid is found the blood. Subarachnoid hemorrhage can occur due to some infections (syphilis, endocarditis, flu). Sometimes the nature of the infection cannot be established.
In addition to the above, we must bear in mind the gaps a.meningea media and hemorrhagic internal pachymeninges.
In order to prevent the development of vascular hypertension and arteriosclerosis patients are recommended to regulate work and rest. Avoid mental injuries that worsen over and can result in cerebral stroke. The great value has a therapeutic effect on the patient and sedatives. Resolutely prohibit all substances which excite vessels: alcohol, Smoking. Food should be varied, with a predominance of vegetarian dishes. If necessary, designate a special diet. The restrict fluid intake to 4 - 6 glasses per day. Eggs give in limited quantities. Fat entities are encouraged to limit food, especially carbohydrates and fats. Good salt-free mode. Treatment of hypertension (see).
When the hemorrhage is cold to the head, warm feet, in the brain - heat on the head. You need to clean the intestines. In the fall of cardiac activity - injection of camphor. Absolute rest for 5 to 7 days. When residual paralysis from the 3rd - 4th week of illness apply physiotherapy, massage. Treatment of aphasia is the systematic practice with patients who are taught to speak. In many cases, hemorrhages in the brain has been successfully applied autohemotherapy: 5 - 6th day after the development of cerebral stroke start infusion with 3 ml of 2 times within 6 days, add each time 1 ml, bringing the dose to 10 ml Total 12 - 15 injection. General or local darsonval, bath Hauffe. In the acute period when the strokes to apply physiotherapy cannot.