Stroke: knowledge of stroke, risk factor, treatment

knowledge of stroke

The knowledge of Stroke for medical students, doctors, and people (Expert Homeopathy: Dr. Anutosh Chakraborty)

The first part of the basic knowledge and concepts of  stroke 

1) Stroke, when the blood flow to the human brain is obstructed, including vascular obstruction (ischemic stroke) and blood vessel rupture and bleeding (hemorrhagic stroke), resulting in Brain cells cannot obtain oxygen and nutrients to maintain normal activities, and some brain cells are damaged or die. Each patient with a stroke has a different severity, depending on the area of ​​the brain affected by the stroke and the severity of the damage.

2. Stroke is divided into two categories: Ischemic stroke and Hemorrhagic stroke

3. The risk factors for stroke include high blood pressure, diabetes, dyslipidemia, atrial fibrillation, asymptomatic carotid artery stenosis, smoking, excessive drinking, unreasonable diet, lack of exercise, overweight or obesity, high homocysteine Hyperemia, excessive fatigue, and emotional stress, family history of stroke, etc.

4. Atherosclerosis is one of the main risk factors for stroke.

5. Dyslipidemia can lead to atherosclerosis, which is one of the risk factors for stroke. We must attach great importance to the hazards of hyperlipidemia, detect it as soon as possible, and treat it actively.

6. "H" type hypertension refers to essential hypertension accompanied by elevated plasma homocysteine. The risk of stroke is about 5 times higher than that of patients with simple hypertension and 25 times higher than that of normal people. -30 times. Patients with hypertension need to check the plasma homocysteine ​​concentration.

7. Diabetes patients have a 2-3 times higher risk of stroke than the average person. In clinically repeated ischemic stroke patients, 10%-30% are accompanied by diabetes. Among the deaths of ischemic stroke, the number of diabetic patients is more than twice that of non-diabetic patients.

8. Stroke has obvious familial clustering, except that genetic factors are irresistible factors, and an unhealthy lifestyle is the main reason.

9. Primary prevention of stroke refers to the prevention before the onset of stroke, mainly for people who have not suffered from a stroke, through early changes in unhealthy lifestyles, and proactively controlling related risk factors, so as to achieve the purpose of preventing or delaying the onset of stroke. The method is regular health checkups, early detection of stroke risk factors, and early intervention, and at the same time adhere to a reasonable diet, control weight, quit smoking and limit alcohol, and maintain psychological balance.

10. Stroke has serious hazards such as high morbidity, high disability, high recurrence, and high mortality, which brings heavy economic burdens to society and families.

11. "Mild stroke" is medically called "transient ischemic attack". A small stroke can produce stroke-like symptoms, but it does not last. The time is usually from a few minutes to a few hours, and it can be completely relieved within 24 hours at most. About one-third of stroke patients have had a small stroke several days, weeks, or even months before the onset of illness. Patients with minor strokes need to go to the hospital for examination and evaluation in time.

12. The incidence of stroke is related to the season. Generally, it is easy to occur in the spring, summer, autumn, and winter seasons.

13. Carotid endarterectomy (CEA) is to remove severely narrowed carotid end arterial atherosclerotic plaque (stenosis more than 70%), and it is an effective method to prevent and treat ischemic cerebrovascular disease.

14. The experience of developed countries in Europe and the United States shows that doing a good job of screening and prevention stroke can effectively reduce the incidence of stroke.

15. The common sequelae of stroke mainly include slurred speech or speech, hemiplegia, dysphoria, incontinence, dementia, etc.

16. Once the following early symptoms of stroke appear, you need to see a doctor immediately, or call 120!
(a) Sudden numbness or weakness of the face and limbs, especially on one side of the body.
(b) Sudden inability to say the name of the object, difficulty in speaking or understanding.
(c) Sudden unclear vision in one or both eyes.
(d) Sudden difficulty in walking, dizziness, accompanied by nausea, vomiting, loss of balance, or
uncoordinated limbs.
(e) Sudden unexplained severe headache, which may be accompanied by nausea and vomiting;

17. The golden rescue time for acute ischemic stroke is 4.5 hours.

The second part is to establish a healthy lifestyle and behavior, prevent stroke 

1. Control weight. Overweight and obese people reduce their weight by adopting a healthy lifestyle and increasing physical activity to reduce the risk of stroke. The target body mass index (BMI) is 18.5-24.0kg/m2, and the waist circumference is less than 90cm for men and 80cm for women.

2. Exercise moderately. Use a physical activity that suits you to reduce the risk of stroke. Adults take moderate physical exercise at least 3 times a week, and the average daily activity time is not less than 30 minutes (such as brisk walking, jogging, or other aerobic metabolic exercises, etc.).

3. Quit smoking and limit alcohol. Smokers should quit smoking, and non-smokers should also avoid passive smoking. Non-drinkers do not advocate the use of small amounts of alcohol to prevent cardiovascular and cerebrovascular diseases; drinkers should be moderate, not excessive alcohol. Limit daily liquor <50ml or wine <100ml or beer <300ml.

4. Reasonable diet. Eat more vegetables and fruits, eat grains, milk, beans, and meat in moderation, and take care of the first level of stroke prevention. Low-sugar, low-salt, low-fat diet, and smoking cessation are beneficial to the prevention of stroke.

5. People with a history of stroke, transient ischemic attack, and people over 40 should have regular physical examinations to understand whether their heart function is abnormal, especially whether there is atrial fibrillation or ischemic changes. At the same time, blood pressure, blood sugar, and blood lipid levels should be monitored, and if abnormalities are found, they should be actively treated to reduce the risk of stroke.

6. Men over the age of 40 and postmenopausal women should undergo blood lipid examinations every year, and people at high risk of stroke should undergo blood lipid examinations every six months. Patients with dyslipidemia should first change their lifestyles, and those who are ineffective should be treated with drugs.

7. The elderly should slow down their movement speed to prevent rapid changes in posture.

8. Peace of mind, stable mood, and keeping blood pressure stable is very important to prevent stroke.

9. Attention should be paid to adjustments during climate change and seasonal exchanges, and take measures to keep warm and properly cool down.

10. For patients with a history of stroke, active treatment of the primary disease can effectively prevent the recurrence of stroke.

11. Deficiency of folic acid, vitamin B6, vitamin B12, and other nutrients in the body is the cause of "H" type hypertension, which can be controlled by adjusting lifestyle, regulating diet, and taking folic acid and other drugs.

12. The diet of "H" type hypertension recommends the "One, Two, Three, Four, Five" diet recommended by the Chinese Nutrition Society. Namely:

  • One refers to 1 bag of milk per day.
  • The second refers to about 250 grams of carbohydrates per day.
  • The third refers to 3 servings of high-protein foods a day.
  • Fourth refers to the combination of thickness and fineness, moderately sweet and salty, small and frequent meals, and avoid over satisfaction.
  • Five refers to 500 grams of vegetables and fruits per day.

13. Prevent hyperlipidemia:

(a) Adjust a reasonable diet and reduce the intake of saturated fatty acids and cholesterol.
(b) Adjust the way of life and work. Actively participate in sports activities, avoid sedentary movement, and control weight.
(c) Stop smoking and limit alcohol.
(d) Those with a family history of coronary heart disease, diabetes, and primary hyperlipidemia should have a comprehensive examination of blood lipids, blood sugar, and liver function on a regular basis every year.
(e) Men over 40 years old and women after menopause should have a comprehensive blood lipid check every year.
(f) Adults over the age of 20 should check their plasma total cholesterol level regularly.
(g) All patients with pancreatitis should measure plasma triglyceride levels.

14. Community health service centers and hospitals should be responsible for screening and intervention work for people at high risk of stroke.

15. Stroke screening can screen out people at high risk of stroke early, and provide health education and reasonable intervention for intervenable risk factors to prevent the occurrence or recurrence of stroke.

The third part is the basic skills of prevention and treatment of stroke (Expert Homeopathy: Dr. Anutosh Chakraborty)

1. Stroke risk assessment, the following more than 3 items are high-risk groups.
(a) A history of hypertension (≥140/90 mmHg), or taking antihypertensive drugs.
(b) Atrial fibrillation and valvular disease.
(c) Smoking.
(d) Dyslipidemia or unknown.
(e) Diabetes.
(f) Rarely do physical activities (the standard of physical exercise is to exercise ≥3 times a week, ≥30 minutes each time, and last for more than 1 year. Engaging in agricultural manual labor can be regarded as physical activity).
(g) Obviously overweight or Obesity (BMI≥26 kg/m2).
(h) A family history of stroke.

2. Stroke screening methods and steps:

(a) Physician's consultation, medical history collection. Focus on inquiries about previous hypertension, hyperlipidemia, diabetes and history of cardiovascular and cerebrovascular diseases, history of smoking and drinking, eating habits, family history of cardiovascular and cerebrovascular diseases, etc., measuring height, weight, abdominal circumference, blood pressure of both upper limbs, auditory vascular murmurs, and Nervous system physical examination, etc.

(b) Laboratory inspection. Those who need further examination based on medical history and signs of abnormal indicators in the past. Including blood routine, urine routine, blood biochemistry, blood coagulation function, blood immune examination, etc.

(c) Cerebral and neck vascular ultrasound. Cerebral and neck vascular ultrasound is the most basic and convenient non-invasive examination for stroke screening, intraoperative monitoring, and postoperative follow-up, including carotid ultrasound and transcranial Doppler ultrasound.

(d) Other equipment inspection: ECG, echocardiogram, etc.

(e) CT cerebrovascular imaging (CTA) or MR cerebrovascular imaging (MRA) can be performed when there is a high degree of suspicion of cerebrovascular disease or vascular ultrasound examinations suggest brain and neck vascular disease.

(f) DSA whole cerebral angiography is the current gold standard for the diagnosis of cerebrovascular diseases. This examination is suitable for the definitive diagnosis of cerebrovascular diseases, such as arterial stenosis, aneurysm, vascular malformation, etc., to clarify the cause of cerebral hemorrhage and subarachnoid hemorrhage.

3. "H" type hypertension is screened by checking the plasma homocysteine ​​concentration of hypertensive patients. If the patient's homocysteine ​​exceeds 10μmol/L, it is "H" type hypertension.

4. Carotid artery stenosis screening methods include vascular ultrasound, CT or MRI vascular assessment, and angiography.

5. In addition to controlling high blood pressure, hyperlipidemia and obesity, and developing good living habits, people at high risk of stroke should also take appropriate health interventions. Regular physical examination to determine the body's blood pressure, blood lipids and platelet status, early intervention, and early treatment. Take drugs to prevent the occurrence of cerebrovascular diseases, such as anti-platelet coagulation drugs, drugs that dilate cerebral blood vessels, etc.

6. Pre-hospital first aid for stroke should be controlled within 60 minutes, early recognition of stroke signs, and 60 minutes of pre-hospital first aid is more critical than in-hospital rescue. According to the internationally accepted "FAST" formula, once the symptoms of a stroke are found, one should call 120 immediately, write down the time of the onset, and seek immediate medical attention.

7. The rapid detection method of stroke-the "FAST" judgment method:
F: face (face), ask the patient to smile to see if the patient's mouth is crooked, the face of the stroke patient will appear asymmetry, and the patient will also be unable to smile normally.
A: arm (arm), ask the patient to raise his hands to see if the patient has numbness and weakness;
S: speech (speech), ask the patient to repeat one sentence to see if it is difficult to express or speak Unclearly.
T: Namely Time (time). If anyone or more of the above 3 items appear, call the 120 emergency center immediately, clearly note the time of onset, and send it to the doctor immediately.

8. Family treatment of stroke:
(a) After the initial judgment is a cerebrovascular accident, the patient should be placed on his back, with the head and shoulders slightly elevated, and the head tilted to one side to prevent sputum or vomit from being sucked back into the trachea and causing suffocation. If the patient has vomiting obstruction in the nose, try to pull it out to keep the airway unobstructed.

(b) Untie the patient's collar buttons, tie, trousers, bra, and take out dentures if they have them.

(c) If the patient is awake, care should be taken to comfort the patient and relieve his tension. It is advisable to keep calm, do not panic, do not cry, or call the patient, to avoid causing psychological pressure on the patient.

(d) Call the emergency center or the neurology department of the hospital for help, do not put down the phone when necessary, ask and follow the doctor's guidance for treatment.

(e) Some simple inspections can be done: such as observing whether the patient’s pupils on both sides of the patient are equal to each other with a flashlight; blood pressure should be measured if possible.

(f) Those who have the conditions call an ambulance to transport the patient. If you transport the patient by yourself, the correct method is to use 2-3 people at the same time, one supporting the patient’s head and shoulders, so that the head is not subject to vibration or excessive distortion, and the other supporting the sick back and buttocks. If there is one person, hold up the patient’s waist and legs. The three of them work hard together to lift the patient to a hardwood bed or stretcher. Do not lift the patient upright when carrying, do not hold, drag, back, or carry. patient.

(g) Do not take any hemostatic, blood-activating drugs, Angong Niuhuang Pills, or other drugs on the patient without a doctor's clear diagnosis. "

9. Precautions for family first aid in the event of a sudden stroke:

  • Observe the patient's vital signs, seek help from the hospital, and be taken to the hospital by an ambulance equipped with certain first-aid equipment. 
  • Rescue the place where the patient has fallen. Be careful if you must move.
  • Do not shake, raise the pillow, bend back and forth or twist the head of a stroke patient.
  • The patient has a clear consciousness. The patient can be placed on his back with his head slightly back to open the airway. Pillows are not required, and cotton blankets should be covered to keep warm.
  • Patients who are unconscious should maintain a supine position to keep the airway unobstructed and do not use pillows.
  • Cold can cause vasoconstriction, so keep the room warm and pay attention to indoor air circulation. People with incontinence should take off the patient’s pants and put toilet paper on them.
  • When a stroke patient vomits, turn his face to one side and let him spit out to prevent blockage of the airway.
  • When a stroke patient has convulsions, quickly remove dangerous things around the patient. Wrap chopsticks with a handkerchief and put them in the patient's body to prevent the tongue from biting the tongue during a seizure.

10. Open up a green channel and control the rescue in the hospital within 60 minutes. The hospital should optimize the process as much as possible, strengthen the collaboration of various departments, and allow patients to make a clear diagnosis and receive treatment within 60 minutes.

11. Thrombolytic treatment of acute stroke:
After a stroke, if the blood supply to the brain tissue can be quickly restored, the damage to the brain tissue can be minimized. Early use of thrombus-dissolving drugs can dissolve blood clots that block arteries.

12. Antiplatelet therapy: It is recommended that individuals with a sufficiently high risk of stroke should use aspirin to prevent stroke. Patients with ischemic stroke who are not suitable for thrombolysis in the acute phase should be given oral aspirin as soon as possible after the onset. Antiplatelet drugs such as aspirin can be started 24 hours after thrombolytic therapy. Those who cannot tolerate aspirin may consider clopidogrel.

13. Precautions for carotid endarterectomy:
(a) It is recommended to use aspirin before surgery, and continue to use aspirin and clopidogrel after surgery.
(b) It is recommended to control blood pressure before and after surgery.
(c) It is recommended to use statins after surgery.
(d) It is recommended that noninvasive imaging follow-ups are required for 1 month, 6 months, and every year after carotid endarterectomy.

14. ​​Precautions for the care of patients with stroke sequelae
Hemorrhagic cerebrovascular disease:

Absolutely stay in bed, avoid unnecessary movement, the patient can put a light pillow on the head, raise 15-30 degrees.
in the absence of vomiting, stomach bleeding, and choking Give high-protein, high-vitamin, low-salt, low-fat and easy-to-digest.
liquid food when coughing; keep the bed flat, soft, dry, clean and dry perineum, smooth stool, prevent constipation.
give physical cooling when high fever.
turn over regularly, Cut the back to prevent bedsores.  
Ischemic cerebrovascular disease.
patients should lie supine as much as possible, patients in the acute phase should stay in bed to avoid excessive activity.
the diet should be high in protein and high in vitamins.
take care of urine and urine.
prevent bedsores and respiratory infections, pay attention to observation Time combined with physical signs and the degree of progress of limb paralysis.

15. After the doctor comprehensively evaluates the risk, stroke rehabilitation should be carried out as soon as possible after 48 hours, and the amount of rehabilitation should be carried out gradually from small to large.
16. Family members of stroke patients should pay attention to the occurrence of complications of fever, coma, dysphagia, multiple organ failure, digestive system, circulatory system, respiratory system, and urinary system.

17. Daily life training for stroke rehabilitation includes:
mat exercises: let the patient learn how to move around on the mat, lying on the side and sitting up, gradually getting up, getting out of bed, and so on.
Crutches balance exercises: learn and apply crutches skills, get on and off the wheelchair.
Self-care training: personal hygiene, brushing teeth, washing your face, bathing, etc.; personal body surface modification, combing hair, shaving; going to the toilet or toilet, self-treatment of urine and feces; eating, putting on and taking off clothes; bringing a watch, turning on a light, making a phone call, Wear glasses, etc.

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