Cerebrovascular disease is a common and frequent disease that seriously endangers human health, and is one of the three major diseases that cause human death. With the development of China’s economy, coupled with the obvious acceleration of population aging, the cerebrovascular diseases mainly targeting the elderly have increased significantly.
According to our research results, there are about 6 million cerebrovascular patients in China, 1.3 million new cerebrovascular diseases occur every year, and nearly 1 million people die of cerebrovascular diseases every year. About 3/4 of the lucky ones have hemiplegia and other sequelae, and some patients lose their ability to work and live, which brings great economic and mental burden to the society and families. Therefore, in recent years, cerebrovascular diseases have been included in key scientific research projects at home and abroad, and in-depth research has been conducted.
Since the 70s, the clinical applications of CT, MRI, SPECT, TCBF, electronic computer, blood rheology and microcirculation have not only led to a new understanding of cerebrovascular pathophysiology, pathogenesis and treatment principles. However, the incidence rate, disability rate, recurrence rate and mortality rate of cerebrovascular disease are still high. Further research on cerebrovascular and active prevention and rehabilitation work is still a meaningful work.
1.What is cerebrovascular disease?
Cerebrovascular disease is a group of diseases in which lesions occur in the arteries of the brain or the carotid arteries that innervate the brain, thus causing impaired intracranial blood circulation and damage to brain tissue. The main clinical manifestation is sudden fainting, unconsciousness, or accompanied by distorted mouth and eyes, unfavorable speech and hemiparesis.
2.What are the names of cerebrovascular diseases?
Cerebrovascular disease has many names. For example, a patient was diagnosed with cerebrovascular disease in a local hospital, but when he went to a provincial hospital for examination, the doctor said it was a stroke, and then he went to Beijing for consultation, but he was diagnosed with stroke. In fact, they all diagnosed the same disease. So, why are there so many names for cerebrovascular diseases? This is a result of the development of traditional medicine and modern medicine. Because this disease is fast, vicious, and multifaceted, just like the natural wind, “good and changeable”, so the ancient medical practitioners called this disease “stroke”.
Some doctors now call this disease “stroke”. It also means that the disease occurs suddenly. The word “stroke” means sudden, and the word “stroke” means to get a stroke, so some doctors call this kind of disease “stroke”. In addition, this disease is also called cerebrovascular accident because it occurs when the cerebral blood vessels are accidentally out of order. All of these terms mean the same thing.
It should be noted that some of the above terms, although still commonly used in clinical practice, are transitional terms that do not reflect the nature of the disease. With the wide application of imaging technology such as CT and magnetic resonance, the nature, location, and size of cerebral vessels can be reflected more accurately in a short time through imaging technology, and it is believed that the names of cerebrovascular diseases will tend to be reasonable and accurate in the future.
3.What kinds of cerebrovascular diseases are there?
Cerebrovascular disease is usually divided into two categories: ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease.
Ischemic cerebrovascular disease includes.
① Transient ischemic attack. (TIA, also known as mini-stroke or transient ischemic attack), the cause of which is related to cerebral atherosclerosis and is a functional disorder caused by transient, ischemic, focal damage to brain tissue.
② Cerebral thrombosis, mostly caused by atherosclerotic cherry, various arteritis, trauma and other physical factors, blood disorders caused by local lesions of cerebral vessels formed by the clot blockage and the onset.
③ Cerebral embolism, which can be induced by emboli generated by various diseases entering the bloodstream and blocking the blood vessels in the brain. Clinically, heart disease is the most common cause; followed by fracture, or fat into the blood after trauma; worm eggs or bacterial infection; air into the blood such as pneumothorax, emboli formed by phlebitis, and other factors, embolism caused by cerebral vessels.
Hemorrhagic cerebrovascular disease includes.
① Cerebral hemorrhage, which refers to the rupture and bleeding of blood vessels in the brain parenchyma, excluding traumatic cerebral hemorrhage. Mostly caused by hypertension, cerebral arteriosclerosis, tumors, etc.
② Subarachnoid hemorrhage is caused by the rupture and bleeding of blood vessels at the base of the brain surface and the direct flow of blood into the subarachnoid space. Common causes include ruptured aneurysm, vascular malformation, hypertension, arteriosclerosis, blood disorders, etc.
4.What does medicine know about cerebrovascular disease?
Cerebrovascular disease is an acute disease with variable symptoms, high death rate and heavy sequelae. It has been valued by medical doctors for many generations and has been discussed in many ways. As early as more than 2,000 years ago, during the Spring and Autumn Period and the Warring States Period, the first medical book in China, Nei Jing, contained the name of stroke, and the record of “servant hitting bi-cu”, which means the sudden occurrence of one limb cannot move at will. Also.” It is like “wind is good at moving and changing several times”, so it is called stroke, which is a metaphor for its rapid onset and change. In addition, the Nei Jing also recognized that the occurrence of this disease is closely related to physical constitution and diet. Later, many famous medical scholars conducted in-depth discussions on the causes of the disease.
However, before the Tang and Song dynasties, most medical practitioners believed that the cause of stroke was due to “external wind”. For example, the “Inner Classic”: “wind is the longest of all diseases, good at moving and several changes, because it can unify all the winds; all the dizziness belong to the wind, that is, no wind does not make glare” also. 〈「金匮要略・中风風節病〉〉也述：”Evil in the complex, the skin is not benevolent; evil in the meridian, that is, heavy does not win; evil into the bowels, that is, do not know people; evil into the organs, the tongue that is difficult to speak, mouth saliva.
In the Jin and Yuan dynasties, Chinese medicine has been greatly developed, and the cause of stroke is considered to be due to the imbalance of Yin and Yang, Yin deficiency resulting in hyperactivity of Liver and Yang, fire and wind, Qi and blood reversal, and phlegm and dampness blocking the orifice. Therefore, after the Tang and Song dynasties, the theory of “internal wind” was developed, and there are more discussions, such as Liu Heshan’s opinion that “the heart fire is overwhelming”; Li Dongyuan’s opinion that “the right qi is deficient”; and Zhu Danxi’s opinion that “The dampness and phlegm generate heat.
5.What is the difference between cerebral thrombosis and cerebral embolism?
Cerebral thrombosis and cerebral embolism are both ischemic cerebrovascular diseases. The symptoms of cerebral thrombosis and cerebral embolism are similar and often confused, but the causes are different and should not be confused.
① Cerebral thrombosis mostly occurs after middle age, and the onset is slow, often peaking within a few hours or days. There are usually aura symptoms before the early onset. In contrast, cerebral embolism is mostly seen in young adults under 40 years of age, with a rapid onset, and all symptoms appear in a few seconds to 2-3 minutes, and most of them have no anterior body symptoms.
Cerebral thrombosis is caused by narrowing or occlusion of cerebral blood vessels, resulting in ischemia, softening, necrosis of brain tissue and a series of central nervous symptoms such as hemiplegia, aphasia, and sensory impairment. Cerebral embolism, on the other hand, is caused by the blockage of cerebral blood vessels by solid, gas, liquid and other emboli brought in the blood flow, and the onset is inside the brain, but the root of the disease is outside the brain.
③ Cerebral thrombosis often develops in a quiet and sleepy state, and upon awakening, one finds oneself unable to move freely or aphasic. Cerebral thrombosis often has a history of strenuous exercise and emotional excitement before the onset of cerebral thrombosis, and suddenly develops.
④ Cerebral thrombosis mostly has a history of hypertension, atherosclerosis, transient ischemic attack, diabetes mellitus and other medical conditions. Past medical history of cerebral embolism is diverse, but it is mainly seen in heart disease, postoperative period, trauma, etc.
⑤ Cerebral thrombosis is characterized by hemiplegia and unfavorable speech as the main symptoms, mostly without impairment of consciousness or headache and vomiting. After the onset of cerebral embolism, there are often clinical manifestations such as headache, vomiting, impaired consciousness, aphasia and hemiparesis.
A reliable diagnostic method for ischemic cerebrovascular disease is cerebral angiography, which can show the narrowing of blood vessels, or the site of occlusion. However, cerebral angiography has the risk of aggravating the disease, so it must be done with caution and not blindly.
6.How to distinguish cerebral hemorrhage and cerebral infarction?
Cerebral hemorrhage and cerebral infarction are different in nature and treatment methods, therefore, early and clear diagnosis is needed. In the absence of conditions for CT or MRI examination, they can be differentiated according to the following items:
①Patients with cerebral hemorrhage mostly have a history of hypertension and cerebral atherosclerosis, while patients with cerebral infarction mostly have a history of transient ischemic attack or heart disease.
②Brain hemorrhage mostly develops under emotional excitement or exertion, while cerebral infarction mostly develops at quiet rest.
③Brain hemorrhage has rapid onset and progresses rapidly, often peaking within a few hours, with no aura before onset. In contrast, cerebral infarction progresses slowly, often gradually worsening after 1 – 2 days, and there is often a history of transient ischemic attack before the onset.
④Patients with cerebral hemorrhage often have symptoms of increased intracranial pressure such as headache, vomiting, and neck tonicity after the onset of cerebral hemorrhage, and their blood pressure is also high and they have heavy impairment of consciousness. When cerebral infarction develops, blood pressure is more normal, and there is no headache, vomiting and other symptoms, and the consciousness is clear.
⑤ Patients with cerebral hemorrhage have high pressure of cerebrospinal fluid by lumbar puncture, which is mostly bloody, while patients with cerebral infarction do not have high pressure of cerebrospinal fluid and are clear and bloodless.
⑥Patients with cerebral hemorrhage have more central respiratory disturbances, and their pupils are often asymmetrical, or both pupils are narrowed, and their eyes are deviated and floating. In patients with cerebral infarction, central respiratory disturbance is rare, the pupils are symmetrical on both sides, and the eyes are rarely deviated and floating.
7.What is lacunar cerebral infarction?
Lacunar cerebral infarction is named after the pathological diagnosis. It refers to the general term of fresh or old deep cerebral small infarcts with a diameter of 15-20 mm or less. The occlusion of these small arteries can cause multiple foci of cerebral softening of different sizes, eventually forming large and small lacunae. Depending on the infarcted blood vessels, different neurological symptoms are often manifested. The most common clinical symptoms are headache, dizziness, insomnia, amnesia, limb numbness, movement disorders, dysphonia – dumb hand syndrome, and in severe cases, dementia, hemiparesis, aphasia, etc.
This disease is a serious health hazard for middle-aged and elderly people. In the past, the diagnosis could not be confirmed clinically by relying solely on neurological examination as well as EEG, cerebral angiography and cerebrospinal fluid examination. In recent years, with the wide application of CT and MRI, the diagnosis rate of lacunar cerebral infarction has been greatly improved.
How does lacunar cerebral infarction occur? At present, it is mostly thought to be due to hypertension and cerebral artery cherry. Long-term hypertension can cause small artery cherry and hyaline degeneration, thus producing vascular occlusion; coupled with changes in the body in middle and old age, such as increased blood viscosity, enhanced platelet aggregation, reduced red blood cell deformability, increased lipids, so that the blood is in a hypercoagulable state, slow snow flow, reduced cerebral blood flow, more likely to lead to small artery occlusion, and lacunar cerebral infarction occurs.
8.What are the common causes of cerebrovascular disease?
(1) Hypertensive disease and atherosclerosis.
(2) Heart disease.
(3) Aneurysm and arteriovenous malformation due to abnormal development of intracranial blood vessels.
(4) Certain inflammatory diseases may invade the meninges, cerebral vessels, or cerebrovascular arteritis alone.
(5) Blood disorders.
(6) Metabolic diseases.
(7) Various kinds of trauma, poisoning, brain tumor, brain tumor after radiation therapy, etc. can cause ischemic or hemorrhagic cerebrovascular disease.
9.What drugs are likely to cause cerebrovascular disease?
Cerebrovascular disease can be caused by many factors, the most common ones are hypertension, heart disease, arteriosclerosis and its abnormalities, and some drugs, such as antihypertensive drugs, sedatives, diuretics, etc., are also found to be important factors that induce ischemic cerebrovascular disease.
(1) Antihypertensive drugs.
(2) Sedative drugs.
(3) Hemostatic drugs.
(4) Diuretics.
(5) Contraceptives.
(6) Anti-arrhythmic drugs
10.Which herbal medicines can reduce blood lipids?
Recent clinical studies have shown that many herbal medicines have the effect of lowering blood lipids, such as Cao Zhi Ming, Ze Di, He Shou Wu, Pu Huang, Hawthorn, Rhubarb, Safflower, Ginkgo biloba, Tiger Balm, Evening Primrose, Yin Chen, Wheat Bud, etc.
11.Can tea drinking diet prevent cerebrovascular disease?
Tea drinking has a long history in China. With the improvement of people’s living standards, there will be more and more tea drinkers.
Chinese medicine believes that tea has the effect of clearing the heart and eyes, clearing heat and fire, eliminating food and refreshing. In recent years, scientists at home and abroad have found that tea is rich in nutrients, including tea polyphenols, caffeine, theophylline, vitamin C, vitamin P, vitamin B, niacin and other high content. Tea polyphenols not only can astringent, coagulate bacterial protein, play the role of sterilization and anti-inflammatory, and can promote the absorption of vitamin C and improve its utilization, reduce the concentration of cholesterol and triglyceride in the blood, enhance the capriciousness of microvascular walls, thus reducing the occurrence of atherosclerosis and hypertension. Tea caused by the excitement of the central nervous system, enhance the cerebral cortex, the excitement process, so as to achieve the purpose of invigorating the spirit, eliminate fatigue and improve labor efficiency.
Theophylline contained in tea, can help dissolve fat, have the effect of fat loss, and can expand blood vessels, promote blood circulation and the role of diuretic potassium discharge, so it can prevent hypertension and coronary heart disease, in other words, is to prevent the susceptibility to cerebrovascular disease factors.
It is worth noting that, although drinking tea has certain benefits to health, but generally should not drink too much tea, especially people suffering from hypertension and coronary heart disease, more should not drink strong tea, otherwise, it may induce a faster heartbeat, blood pressure, aggravating the condition.
12.How to prevent the recurrence of cerebrovascular disease?
The following points should be noted to prevent recurrence of cerebrovascular disease.
(1) Be alert to the early symptoms of recurrence. After the symptoms of cerebrovascular disease are relieved, if symptoms such as headache, dizziness, slurred speech, finger inactivity and numbness of half of the limbs appear again, they are mostly recurrence and should be examined and treated in hospital in time.
(2) Eliminate the intrinsic pathological factors of relapse.
(3) Avoid the triggering factors of relapse.
(4) Establish reasonable dietary habits
(5) Adhere to drug treatment
13.Those common foods have lipid-lowering effect?
High lipid level is very dangerous and can easily cause atherosclerosis, hypertension and cardiovascular diseases, etc. Therefore, in addition to lipid-lowering medication, family dietary treatment should not be neglected. Here are a few foods that can lower lipids.
(1) Soy products.
(2) Garlic.
(3) Onion.
(4) Black fungus.
(5) Kelp.
(6) Hawthorn.
14.Why should we pay more attention to the prevention of cerebrovascular disease in autumn and winter?
Cerebrovascular disease is mostly seen in people with hypertension and cerebral arteriosclerosis, and it is especially common when overworked and with violent mood swings. Therefore, effective treatment and control of hypertension and avoiding excessive mental tension and fatigue are the main links to prevent cerebrovascular disease. However, climate change is also a factor that cannot be ignored in inducing cerebrovascular disease. This is because.
① low temperature can make the elasticity of body surface blood vessels decrease, peripheral resistance increases, blood pressure rises, which in turn leads to cerebrovascular rupture and bleeding.
②Cold stimulation can also cause sympathetic excitation and increased secretion of adrenocorticotropic hormone, which causes small arteries to contract spasmodically, increasing peripheral resistance and raising blood pressure.
③Cold can also increase the fibrinogen content in the blood, increase the blood concentration, and promote the formation of emboli in the blood and the onset of disease.
15.How does TCM treat post-stroke sequelae?
(1) Qi deficiency and blood stasis type (2) Liver and Yang hyperactivity type (3) Heart and kidney Yang deficiency type
16.Why should rehabilitation training be carried out for cerebrovascular disease?
After the onset of acute cerebrovascular disease, it can cause a series of symptoms such as hemiplegia, aphasia, and even coma due to the damage to the relevant central nerves. After treatment, some patients’ symptoms can gradually improve, but about 2/3 of them have symptoms such as joint contracture and deformity, muscle atrophy and reduced intelligence, etc. One of the main reasons is the lack of effective rehabilitation treatment.
Rehabilitation training helps to establish the lateral branch circulation of the brain and improve the blood circulation and oxygen supply of the brain. It promotes the normal recovery of self-regulatory functions. It has been proved that those who can adhere to rehabilitation training can not only prevent muscle and joint atrophy, but also enhance the patient’s responsiveness to the outside world, which is important to improve the patient’s quality of life.
So, when to do rehabilitation training? Generally speaking, early training is preferred. Early training can not only promote the recovery of motor function and shorten the recovery period, but also avoid the occurrence of various complications. However, early training for bleeding must be carried out after the condition is stabilized. One week after the onset of ischemic cerebrovascular, and 2-3 weeks after the onset of hemorrhagic cerebrovascular disease, the condition tends to be more stable, and rehabilitation training can be actively started. Some people have followed up 26 patients who had been ill for more than two months and lacked early functional rehabilitation training, and it was found that 19 people held a cane or lost the ability to walk, and only one of them returned to a normal gait. It can be seen that it is not easy to fully restore limb function without early training.
It is worth noting that the more serious the condition, the greater the psychological burden and the greater the difficulty in recovery. Patients and their families should be more confident and active in early rehabilitation training.
Preventive treatment refers to those who already have more obvious cerebrovascular risk factors, or those who have obvious abnormalities in one of the aura indicators, to take treatment in advance. The implementation of preventive treatment is in line with the idea of “treating the disease before it occurs” in Chinese medicine, which means that we should not wait until cerebrovascular disease occurs and then carry out rescue treatment, but rather carry out corrective treatment before the occurrence of factors and signals that may lead to cerebrovascular disease, and the effect of such preventive treatment has been recognized. For example, after Japan and the United States carried out prevention and treatment of hypertension, the immediate effect was that the incidence of cerebrovascular disease tended to decrease, and cerebral hemorrhage in particular was significantly reduced. What are the risk factors and precursor indicators of annoying vascular disease that need to be treated and corrected? The first is hypertension, which is the most dangerous factor, and anyone with blood pressure higher than 140/90 mmHg should be treated for a long time.
After a transient cerebral ischemic attack, recurrence should be prevented, and some cerebral vasodilators should be applied, especially for coronary artery disease, cardiac green disorder, heart enlargement (including left ventricular hypertrophy), atrial fibrillation, and heart failure, etc. Through treatment, better cardiac function can be maintained, and the blood supply to the brain can be kept in a better state. Of course, various treatments that can reduce atherosclerosis are also included. The control of diabetes helps slow down the progression of atherosclerosis. Treatment of cervical spondylosis can reduce the occurrence of inadequate blood supply to the vertebrobasilar artery.
Patients with multiple abnormalities in blood rheology or a hypercoagulable state of the blood, and those with increased platelet aggregation capacity should be treated with medications to keep these indicators within normal or safe limits. Other conditions such as vascular murmurs in the neck, electrocardiograms indicating myocardial ischemia, retinal hemorrhages in the fundus of the eye, and significant abnormalities in cerebral hemograms should be treated to keep them from developing or mutating. Long-term preventive treatment is actually an effective prevention of encephalopathy, and the pre-treatment of various factors and diseases with greater cerebrovascular tendency is one of the active measures to control the further development of the disease and prevent cerebrovascular disease.
17.How to carry out psychological rehabilitation treatment for cerebrovascular patients?
Some cerebrovascular patients have been treated and their lives are out of danger, but they are left with sequelae such as hemiplegia and aphasia, and psychological changes may occur. Some are afraid that the disease will not be cured and death will come at any time; some are pessimistic and disappointed, thinking that they have become cripples and the meaning of life is over, losing confidence in life and even the idea of living lightly; others think that they cannot take care of their own clothes, food, housing and transportation and have become redundant people and burdens in society and family. All these psychological barriers will not only affect the effect of drug treatment, but also not conducive to the implementation of health training, therefore, mental health treatment should be actively carried out.
First of all, the mood of the patient’s mind should be stabilized and a good environment for recovery should be established. The family should show great enthusiasm for the patient’s pessimism and despair and other psychological disorders, often talk with them, take the initiative to help them wash their faces, feed them, bathe them, and handle their urine and stool. They should care for them in everything and should not show any impatience, and should not say anything to hurt their feelings, so that they feel comfortable, not lonely and have the courage to continue living. At the same time, the home should be kept quiet, clean, with adequate lighting and reasonable decoration, to create a clean and comfortable environment, which can help stabilize emotions and promote psychological recovery.
Second, we should actively carry out psychological guidance and pay attention to the effect of drugs. Doctors and families should actively carry out psychological counselling according to the different stages of the disease. For example, when a patient with cerebral hemorrhage is conscious, you can tell the patient that you have some blood in your brain, and after treatment, you are now much better, and when the bleeding is absorbed, the disease will be completely healed. This disease is mostly caused by hypertension and arteriosclerosis, so do not be impatient, do not sit up, to rest at ease, support the medication on time, do not hold your breath and force, to cooperate with the doctor’s treatment, the disease will slowly get better. Through psychological guidance, most patients will face reality, see hope and strive for a good ending, greatly accelerating the recovery. In addition, at different stages of the disease process, patients will also experience pain and other discomforts. Giving medication at the right time to bring into play the biological effects of drugs to relieve the patient’s pain will also increase the patient’s confidence in overcoming the disease.
Third, encourage patients to strengthen functional exercise and actively participate in social activities. Cerebrovascular patients have a certain degree of impairment in their social adaptability due to their physical and mental dysfunction. Therefore, when carrying out psychological rehabilitation treatment for cerebrovascular patients, patients should also be helped to restore their social adaptability, encouraged to get out of bed for exercise, and try to take care of their own lives. The patient should be encouraged to make every bit of progress in the rehabilitation process. At the same time, they should also be encouraged to participate in learning activities, household chores, recreational activities and social activities that they can do to increase their enjoyment of life and disperse their bad emotions, so as to prepare for their return to work and society.