Surely you have heard about Ictus or Stroke, but few know what it is and its repercussions at the brain level. In fact, a stroke is one of the most complex problems for rehabilitation for both those who have had bleeding, and those who have had ischemia.
The word derives from Latin and means beat, same translation for English and Greek. It is a heart attack and just as it happens with the heart, when the nutrition of the blood fails, the brain organ is damaged, Example: when a clot obstructs the cerebral circulation or when there is a hemorrhage. Very prone to be suffered in high blood pressure and can cause brain necrosis even death.
The stroke is therefore an insult of vascular type that alters the blood supply to a region of the brain. The stroke, the “blow”, can be of a different nature: it can be hemorrhagic, as for example it happens as a result of the rupture of a cerebral aneurysm or it can happen of ischemic type.
The definition that the world health organization, the O.M.S. Offers of the brain event is the unexpected appearance of signs and / or signs that refer to focal and / or global deficit (coma) of brain functions, lasting more than 24 hours or has been unfavorable, which cannot be attributed to another cause apparent but to cerebral vasculopathy.
Anyone is not exempt from suffering a cerebral infarction, many famous people have suffered stroke, an example of this has been the famous presenter María Teresa Campos, cerebral ischemia affected her vision in one eye, although two years later she is fully recovered And it has no sequels. Another famous TV presenter Jorge Javier Vázquez, suffered a stroke due to a subarachnoid hemorrhage, after having presented a severe headache and being admitted to emergencies, the presence of a hemorrhage within the subarachnoid space was determined, through that space they run the large arteries that carry blood to the brain. A rupture of one of those arteries fills the entire blood space. causing a stroke and its consequences.
Ictus Cerebral Consequences
A brain attack damages the brain, it is the organ of mental and cognitive functions, therefore an ischemic or hemorrhagic stroke alters those cognitive processes that allow building the movement of the body causing all kinds of consequences in everyday life. Indeed, often the most obvious event after an ischemic stroke that affects brain function is the motor paresis of one half of the body: Hemiparesis and Spasticity.
The consequences of brain disease represent the most delicate aspects of rehabilitation and physiotherapy, because for the recovery of movement it is necessary to recover the cognitive processes that determine it.-
The panorama of rehabilitation in relation to the treatment of cerebral pathology is very wide and often confusing, it is often thought that recovery depends on the types of accidents, it is indifferent if it was a cerebral hemorrhage or a lack of oxygen supply, the treatment doctor is not enough for rehabilitation, when deciding the type of treatment you must be well aware that:
Neurocognitive Rehabilitation, also called the Perfetti Method, is the treatment response that best suits the recovery of stroke and hemiparesis results. The only method that considers the recovery of cognitive processes as the basis of functional movement fundamental.
It is one of the major causes of a stroke, its consequences are determined by the lack of blood supply to the brain which differs from hemorrhage. Blood circulation is interrupted due to an obstruction of an artery that has the task of feeding the brain area. This has always been a complex challenge for rehabilitation. Ischemic stroke is caused by emboli and thrombi:
The Plunger is a blood clot that circulates in the bloodstream and according to its dimensions, will determine the obstruction of the vessel in which it travels and therefore, the stroke.
Indeed, the arteries, as they approach the brain, always become thinner. Thrombi are formed mostly in vessels weakened by arteriosclerosis, through the accumulation of fat in the inner walls that decrease the volume of circulatory flow, determining the ischemic event.
Most of the cerebral infarctions must be attributed to the brain injury, approximately in 80 – 85% of the cases, the rest must be attributed to intracerebral hemorrhage. However, also as a result of a stroke, due to the secondary lesion of some vessels, a cerebral hemorrhage can be verified that received be the name of red heart attack forming a bruise.
Warning signs and their risk factors
Recognizing the signs of an ischemic acv and its risk factors (high blood pressure, sedentary lifestyle, type I diabetes or type II diabetes, poor diet, etc.) are essential to save a life, and reduce the consequences of brain damage, indeed, in the presence of signs of stroke, such as motor and language difficulties, it is essential to call immediately or go to a hospital with stroke unit equipment.
Another way in which a stroke can occur is due to hemorrhages associated with vascular malformations, and rupture of an aneurysm or arteriovenous malformations, they are often congenital, which are not diagnosed early, these malformations cause blood vessels to rupture causing a massive hemorrhage at any time of life.
Among the most common subsequent consequences is hemiparesis, that is, the paresis of one half of the body. This happens because along with brain damage, mental functions (cognitive processes) that allow movement are also damaged, the consequences of stroke include the lack of mobility of the affected side that is not due to a paralysis of the muscles.
This is the image of an iceberg tip. The movement as observed is only the tip of the iceberg, that is, only the visible part of a complex organization offered by cognitive processes.
As noted below, there is much more than can be seen! At the base of the movement are cognitive processes. The alteration of these determines the alteration of the movement.
“LCA damages the brain and Cognitive Processes, not the muscles”. –
Cure of a stroke
Our Central Nervous System enjoys plasticity, it means that it can be modeled on the basis of the experiences we live. Recovering from a stroke means learning again to feel, try, live and move the body, a bit as we have done as children.
How much can you recover?
The quality of the recovery of those who have suffered a stroke is obviously linked to the factors to which they are subjected.
Rehabilitation assumes a central role in the process of recovering from a stroke. The quality of recovery after a brain event will also be determined by the way in which cognitive processes will be recovered based on movement.
Which Rehabilitation is indicated for stroke?
The overview of the applications of methods for the rehabilitation of cerebral ischemia is very broad and often confusing.
To date, Neurocognitive Rehabilitation, generally known as the Perfetti Method or Cognitive Therapeutic Exercise, is the best rehabilitative response in relation to stroke: Why?
- It recovers movement and language, and also considers cognitive processes (the iceberg)
- Exploits the Plasticity of the Brain.
- It is founded on scientific bases.
- It has been used for decades because it is recognized as the most appropriate response for the rehabilitation of brain injury and a hemorrhagic stroke in general.
SIGNS AND SYMPTOMS OF A LCA
What are those of a stroke?
The following examples that follow, only represent some of the disorders through which it is possible to raise the hypothesis of the presence of an injury as established by the World Health Organization
Difficulty in speech, which can be of two types:
- Difficulty articulating sounds and words, this is the result of paralysis of the middle part (hemiparesis) of the body.
- Often, a decrease in the edge of the mouth (crooked mouth) is seen, which causes difficulties.
- The difficulty of language can also manifest itself in understanding and in the difficulty in finding the right words or replace them with others that are often not relevant to the context. This is classified as aphasia and is usually found when the lesion affects the right half of the body (right hemiparesis), that is, the left hemisphere of the brain.
- Sudden headache, often, if it is very intense it can be one of the signs of an ongoing acv. A headache like never before, as if they had stabbed their heads. It is of special care in subjects with arterial hypertension because they are prone to intracerebral hemorrhage.
- Disturbance of sight: referring to half of the field of vision. Disturbances other than those we will address in the left hemiparesis section that are identified in the neglect or lateral spatial hemi negligence.
- Hemiparesis and sensitivity deficit: They manifest as a loss of strength in the middle of the body: leg, arm, back and face. The ability to move the parts themselves. This is perhaps one of the most obvious signs of stroke. “… he moved gracefully and lost his balance like an alcoholic …” Tingling or even the feeling that half of the body does not belong to us, more information about these signs will be treated in the section on left hemiparesis under the name hemi asomatognosia: ” … When I fell on the floor, I felt something under my back, it took me a little while to understand that it was my arm…” LI
- Sudden loss of consciousness.
These are just examples of signs that can appear individually or combined with each other, but not enough for diagnosis. However, intracerebral hemorrhage is a medical emergency that needs to be promptly diagnosed and treated in the hospital, due to the high risk of disability and death.
On the other hand, arterial hypertension is important, which if not checked time can cause the rupture of one of the arteries of the brain causing hemorrhage in one of the hemispheres, the revision of adequate arterial hypertension helps prevent future intracranial hemorrhage.
Importance of recognizing them
Quickly recognize a stroke, can save a life and can significantly reduce the effects of ischemic stroke.
In our experience as rehabilitators, we have collected dozens of patient stories telling that they have manifested certain characteristic signs of LCA a few days before the final attack occurred, which forced them to face the multiple difficulties of the consequences after an event cerebral.
These symptoms of stroke were perceived as minor, so even though they were unusual, they were overlooked waiting for them to resolve spontaneously.
When the symptoms of a stroke, which we will analyze next, appear and disappear throughout a day, we can talk about Transient Ischemic Attack (T.I.A).
It is a mild and momentary ischemic event that, however, in most cases is a true prelude to the problem
If you find yourself in the presence of the characteristics of a stroke, which you will read below, individual or associated, do not waste time and immediately ask for help.
Mobility problems as a symptom of stroke
Who has an ongoing stroke, can probably manifest characteristics related to the mobility of a limb or some half of the body (for the cross control of the two cerebral hemispheres).
Difficulty in holding a cup, a glass, or to articulate the leg for walking. This symptom of stroke is referred to as “weakness.”
Many patients with stroke or cerebral hemorrhage have told me that when they get out of bed, they have fallen immediately.
The first signs of hemiparesis could also involve half of the face, so there could be difficulties in swallowing and modulating the words, many say that their relatives “babbled words as if they were drunk.”
- Sensitivity disorders among the symptoms of ischemia.
- A symptom of stroke is also due to the sensations we perceive from our body, we could feel tingling or have the sensation of not perceiving well, for example, as happens when the dentist anesthetizes our mouth and when trying to drink water, we spill it by the corner of the mouth, the same could happen with an ongoing cerebral ischemia.
- Sounds or lights can also be perceived distorted.
- Speech disorders are some signs of a brain disease.
- When the event affects the left hemisphere of the brain and unless they are left-handed, it is likely to cause language disorders.
- Different from the problems of modulating the words, of which we speak in the problems of the movement, here we speak of the cognitive disorders of the language, where one of the symptoms of an ischemic attack could be precisely the difficulty to speak or the emission of words without sense or disjointed.
In fact, aphasia is a characteristic aspect of right hemiparesis, while lack of awareness of such problems is usually linked to left hemiparesis.
Among the symptoms and signs of the ischemic accident we also find the possibility of perceiving a severe headache, the presence of vomiting and loss of consciousness. In addition, you will have seen the doctors multiple times observing the patient’s pupils with the flashlight, this serves to see the reflection of the pupils, usually a symptom of cerebral hemorrhage can be the loss of the reflex of one of the two pupils when they are subjected to the light.
Golden Hour is defined, at the time between the start of the event and the first events more, and the moment of being admitted to a hospital with a stroke unit, where surgical treatment often plays a crucial role in stopping the spread of intracranial hemorrhage.
INTERESTING FACT: Beware of hypothermia, patients often say that cold brings them complications to move.
Cerebral Infarction Causes
The fundamental premise to address the issue of the causes of cerebral ischemia is that the ischemic event is a cardiovascular consequence.
What I mean is that the causes of cerebral ischemia are related to circulatory problems. In fact, it is the lack of blood supply to the tissue, which determines the injury and all the consequences of the ischemic, motor, cognitive and language accident.
After this premise on cerebral ischemia and its causes, we can define what the risk factors are.
Age clearly affects the possibility of suffering cerebral ischemia, after 65 years the risk increases significantly, however no age is safe from the risk of suffering cerebral ischemia.
Whereas, all other causes of cerebral ischemia that we will treat immediately, can be modified through a correct lifestyle, in fact, a correct diet and constant exercise, can determine an effective prevention of cerebral ischemia.
Proper nutrition is essential to reduce the risks and causes of cerebral ischemia, a high percentage of blood sugars is harmful to blood vessels. Diabetes is a clinical cause of cerebral ischemia; therefore, prevention of this disease is reflected in the prevention of ischemic accident.
Another element to have under control is cholesterol, we have learned during these years to distinguish the “good” and “bad” cholesterol, the second if deposited in the walls of the arteries, creates plaques that reduce blood flow of the vessels, creating “plugs.” This process is the basis of arteriosclerosis. The key word to reduce the risk of increased blood pressure is “feeding.”
Smoking cigarettes is a true killer for our cardiovascular system and deserves one of the first positions as causes of cerebral ischemia, in fact, smoke impoverishes the arteries of their elastic capacity to modify based on blood flow, making the arterial network subject to interruptions and obstructions and then predisposes our body to suffer this inconvenience.
Avoid sedentary lifestyle and do whatever is possible physical exercise, this can avoid the risk of any disease whether cancer of any kind, dementia in old age, and in this case allows us to take care of heart attacks, in addition to protecting us from obesity , which is a trigger, keeping our vascular system trained and reducing the causes.
ISCHEMIA AND CONSEQUENCES
The consequences of a stroke are attributable to brain damage caused by the absence of nutrition from neurons after an artery blockage.
- Ischemic stroke is a serious event for our body, so the risk of mortality is relatively high in the first 30 days and in the first year.
- The most obvious consequences are represented by the hemiparesis of one half of the body (hemiplegia), since ischemia often directly involves one of the two hemispheres.
- Depending on the side where ischemia occurs, the consequence will be left or right hemiparesis, both with their own specific characteristics.
Another secondary and obvious consequence of ischemia is spasticity, it means the tendency of the muscles to harden and stay contracted as a result of excessive efforts.
In fact, immediately after the ischemic event, the picture presented by the patient is flaccid, that is, the total or partial impossibility of movement of one half of the body.
Only then will the organism allow the awakening of nerve circuits, from the simplest as reflexes, to the most complex and elaborate.
Therefore, we can say that spasticity is one of the consequences and inadequate rehabilitation options, aimed at strengthening the first reflex circuits that the body makes available after the ischemic event, without allowing the recovery of the most elaborate and refined ones. A characteristic example is the gait of the hemiplegic patient reaper.
We have talked about the most obvious consequences, such as hemiparesis and muscular hypertonia, which are the aspects in which all therapeutic attention is usually concentrated, because they are tangible and measurable aspects, while attention disorders (neglect), and awareness (anosognosia) if the side of the affected body is the left.
Now, to fully understand the perspective of the consequence and complication, we must address those effects that are often overlooked by post-brain injury rehabilitation: the alteration of cognitive processes.
By cognitive processes we refer to those fundamental elements for our organism that are, among other things, essential for the movement such as perception, attention, memory, learning and movement projection
After this a characteristic complication is the partial loss of perception and sensitivity of one half of the body
The ability to perceive our body is a skill that guarantees us the possibility of moving in the environment where we are, in fact, it is difficult to think that we can walk correctly without perceiving the position of the leg in space and the ground pressure under our feet, the same reasoning applies to the movement of the hand and arm.
Even the other aspects that are often hidden, but altered, such as attention and the ability to project the movement, participate to make our motor behavior possible properly.
In conclusion, this pathology affects the brain functions that allow movement, muscle effects and reflexes are a consequence, so the rehabilitation of the consequences of ischemia, should be directed to the recovery of cognitive processes.
When the characteristic signs and / or symptoms cease within a 24-hour period, we talk about T.I.A. This can last a few minutes or hours and disappear completely without consequences.
It is transitory since it is a risk condition, an alarm signal that can precede a true stroke.
In fact, 20% of cases of Transient Ischemic Attacks (TIA) develop in stroke within a period of one year. The decision to go to the doctor after a transient attack usually prevents fatal or severely disabling strokes.
A study published in the Spanish scientific journal states that; “It is a prevalent pathology that should be considered a medical emergency and not as a benign process, although when examining the subject, it is usually asymptomatic. In its initial evaluation, a basic study must be carried out that includes analytical, chest radiography, electrocardiogram, neuroimaging and ultrasonography of cervical and intracranial arteries. The treatment is based on controlling vascular risk factors and antithrombotic therapy” all the effects that may compromise the brain such as head trauma, hydrocephalus and stroke should be taken into account.
The window of time that should not be exceeded, between stroke and medical intervention, either for thrombolytic therapy, which involves the “disintegration” of the thrombus that prevents blood flow, as for the hematoma reduction operation, is approximately three hours The fact remains that it is essential to arrive at the hospital as soon as possible, so much so that there is talk of “golden hour” or sixty minutes of gold, within which adequate care can not only guarantee survival, but also limit the consequences post-cerebrovascular inconvenience.
Do LCAs warn you with alerts or do they only give you suddenly?
As we have read, cerebrovascular disease can occur in both ways, being a major cause of death and bringing some complications, but in this list we will find several pathologies and signs to which we must treat with care.
HEART DISEASE: Atrial or ventricular fibrillation is the most frequent arrhythmia in clinical practice. Fibrillation is a disease characterized by uncoordinated and disorganized beats, producing an irregular heart rhythm (it can affect the myocardium). But we know that it is not the only heart problem, this complication can also lead to a heart attack. Another complication is cerebrovascular disease. Vascular malformation is also a cause of increased blood pressure. Also, atherosclerosis, atherosclerosis or atherosclerosis. Echocardiography is used to detect fibrillation.
Increase in blood pressure or blood pressure. What could cause a stroke by the cerebrovascular part or infarction, blood pressure control is vital to reduce the risk of stroke.
Thrombosis (venous thrombosis) or embolisms, which affect blood flow of an arterial or venous type, such as the carotid or vertebrobasilar artery (cerebral artery) causing a bleeding problem or a heart attack that affects any part of the brain
Cancer, a tumor can raise intracranial pressure.
Mel, diabetes, Litus, Leukemia, Pneumonia, Hypoglycemia, pulmonary insufficiency, migraine, cardiorespiratory disease. Any condition of these should be treated carefully and in time to reduce the risk of stroke in the affected person.
ICTUS CODE: In neurological dysfunction, we also have Parkinson’s, Alzheimer’s, stroke, hydrocephalus etc. The neurological deficit has been studied by the National Institute of Neurological Disorders and Stroke and has determined through a meta-analysis that neurological impairment In the long term these people can be avoided by physical rehabilitation.
What can cause a brain hemorrhage?
As part ACV, we find intracerebral hemorrhage:
A cerebral hemorrhage occurs when there is a rupture of a blood vessel in the brain, the blood spreads over the brain tissue directly damaging the cells, while indirectly the other areas that no longer receive the blood supply, suffer, as in the case of Ischemic brain disease This bleeding problem can be a consequence of patients with heart disease, poor eating habits, sedentary lifestyle, vices such as alcohol or tobacco.
You should consult your doctor in the treatment with anticoagulants of intracranial hemorrhage, the main thing is surgical treatment, but to avoid reproducing the problem you have to be attentive to the symptoms of an ongoing stroke and follow the doctor’s recommendation. Computed tomography is the study by which they observe the extent of bleeding as it is an intracranial problem. It also serves to diagnose the type of situation.
- Intracerebral hemorrhage
Intracerebral hemorrhage consists of bleeding from the veins or arteries inside the brain. As a general rule, bleeding originates suddenly and evolves very quickly; being so serious that it can cause a coma or even death. Like when a glass is broken by an aneurysm.
The most common cause of this type of intracerebral hemorrhage is hypertension, that is, high blood pressure.
- Subarachnoid hemorrhage
In the hemorrhagic problem of this class, the effusion or bleeding is located in the subarachnoid space. This is between the brain and the membranes that cover them, called meninges. The main causes are two:
- Existence or appearance of an aneurysm.
- Arteriovenous malformations (AVM).
These malformations are part of a congenital alteration (different from the aneurysm) which causes the appearance of traumas and tangled networks of veins and arteries. Even in the case of hemorrhage, the results (hemiplegia) can often lead to the need for rehabilitation intervention to recover cognitive, motor and sensory deficits.
Hemiplegia can be divided into two main groups:
The world of rehabilitation has seen in the last decades many discoveries that have revolutionized the future.
In fact, many researchers realized that in order to obtain a qualitative recovery after a spill, it was necessary to intervene at the base of the problem; that is, the functions of that brain that has suffered damage after bleeding.
Brain functions are defined as cognitive.
Unfortunately, it is not always possible to obtain this type of rehabilitation in all facilities and clinics after cerebral hemorrhage, in fact, a brief recovery is often sought, where the goal is simply muscle strengthening, without taking into account the basis of problem, superficially interpreting the problem of spasticity. These inconveniences of hemorrhagic type when working this type of therapy can directly influence the area of the affected brain and its communicants.
Cerebral hemorrhage and Hematoma, Differences
The patient with bleeding commonly comes from an arterial problem. It can be caused by everything mentioned above or be caused by some malformation, unlike this a bruise is bleeding under the skin. Other bleeding such as gastrointestinal bleeding, coughing up blood or vaginal bleeding may be signs of a disease.
When there is bleeding somewhere in the body, the production of the blood clot increases, which helps to stop the bleeding, although there are exceptions, some people often have clotting problems, it means that the blood does not form clots normally to stop the extent of bleeding. Cerebrovascular disease can be a complication of clotting problems.
All people with hemorrhages, whether in a brain event or of any kind need medical treatment, if it is of the people who have a hemorrhage, consult their doctor for the treatment to follow.
When there is a bruise caused by internal bleeding (blood vessel rupture, without bleeding Re reach the body surface) that usually appears as a body response resulting from trauma can have complications such as those of a stroke, which is why it is especially careful injuries to the skull.
According to its location in the human body, bruises are called:
- Subdural hematoma
- Perichondral hematoma
- Epidural hematoma
- Subarachnoid hematoma
- Subcorionic Hematoma
- Renal hematoma
Epidural hematoma, subarachnoid hematoma and subdural hematoma are what we see through magnetic resonance in a cranial hemorrhage. In fact, there is a recognized story about an American worker, Phineas P. Gage, who due to a stroke suffered severe damage to the brain, specifically in the frontal lobe. Gage underwent noticeable changes in his personality and conduct, which evidenced that the frontal lobes were responsible for processes related to behavior and personality, among many other executive functions.
Effect of fish in prevention of stroke?
Fish is a rich source of Omega 3 that helps lower cholesterol and triglyceride levels at the arterial level, thus avoiding any complications, in fact, nutritionists recommend it to children with hydrocephalus, just as a precaution, good nutrition prevents extra complication