I. Definition of cerebrovascular disease
Cerebrovascular disease refers to the brain dysfunction caused by cerebrovascular lesions. Stroke is a neurological deficit syndrome with an acute onset due to local cerebral blood circulation disorder, and the duration of symptoms is at least 24 hours.
II. Classification of cerebrovascular diseases
Cerebrovascular diseases can be divided into ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease according to the pathological changes of the brain, the former including transient ischemic attack, cerebral thrombosis and cerebral embolism; the latter including cerebral hemorrhage and subdural hemorrhage.
Third, the harm of cerebrovascular disease
Cerebrovascular diseases are characterized by high morbidity, high mortality and high disability rate. According to artifact statistics, there are about 2 million new stroke patients in China every year, about 1.5 million people die of cerebrovascular disease every year, and 6-7 million patients survive, of which about three-quarters lose their working ability to varying degrees, and about 40% of them are severely disabled. At present, cerebrovascular disease has become a major disease that endangers the health and life of middle-aged and elderly people in China, and causes a heavy economic burden to the country and many families.
Therefore, how to prevent cerebrovascular disease, reduce its incidence and recurrence rate, and improve the quality of life has become an urgent task, which needs to attract sufficient attention and take active preventive measures.
Fourth, the basic etiology of cerebrovascular disease, risk factors
Many systemic vascular lesions, local cerebrovascular lesions and hematologic lesions are related to the occurrence of cerebrovascular disease, and their causes can be single, or can be caused by a combination of etiologies. The common etiologies are.
1, among vascular wall lesions, vascular damage due to hypertensive atherosclerosis and atherosclerosis is the most common, followed by arteritis due to multiple causes, vascular injury, and congenital vascular disease (such as aneurysm, vascular malformation and congenital stenosis).
2, heart disease and hemodynamic changes such as hypertension, hypotension or sharp fluctuations in blood pressure, as well as cardiac dysfunction, conduction block, rheumatic or non-rheumatic valve disease, cardiomyopathy and arrhythmia, especially atrial fibrillation.
3, blood composition and blood rheology changes, including hyperviscosity due to various causes, such as hyperlipidemia, dehydration, and hyperfibrinemia, as well as abnormal coagulation mechanisms.
4, Other etiologies include emboli such as air, fat, cancer cells and parasites, cerebrovascular compression, trauma, spasm, etc. The etiology of some patients with cerebrovascular disease is unknown.
Epidemiological investigations have found that many factors are closely related to the development of stroke, and these risk factors are mainly.
1. Hypertension is the most important and independent risk factor for stroke. Increased systolic or diastolic blood pressure increases the incidence of stroke; moreover, blood pressure is positively correlated with the risk of cerebral hemorrhage or cerebral infarction, and controlling hypertension can significantly reduce the incidence of stroke.
Heart disease such as heart valve disease, non-rheumatic atrial fibrillation, coronary artery disease, myocardial infarction and heart failure increase the incidence of stroke and are definite risk factors for stroke.
Diabetes is an important risk factor for stroke, and the likelihood of stroke in diabetic patients increases exponentially compared to the general population. Diabetes is associated with vascular disease, hyperlipidemia and ischemic stroke. Hyperglycemia may further aggravate the brain damage after stroke.
4, transient ischemic attack (TIA) and a history of stroke are also risk factors for stroke, about 20% of patients with cerebral infarction have a history of TIA, and the annual incidence of stroke in patients with TIA is 1%-15%; the more frequent the TIA episodes, the higher the risk of stroke.
5, hyperlipidemia can increase blood viscosity and accelerate the occurrence of cerebral atherosclerosis. Hypercholesterolemia, especially increased levels of LDL, is associated with the occurrence of ischemic stroke.
6. Smoking and alcohol abuse are both important risk factors for stroke. Smoking increases plasma fibrinogen levels, increases blood viscosity and vascular wall damage, and causes vasoconstriction and increased blood pressure. The incidence of stroke in alcoholics is four to five times higher than that in the general population, and can especially increase the risk of hemorrhagic stroke.
7, other risk factors for stroke, including reduced physical activity, obesity, excessive intake of salt, meat, animal oil in the diet, and carotid plaque, stenosis, etc.
All of these risk factors can be intervened, and if some of them are identified as modifiable, the morbidity and mortality of stroke can be reduced. Some risk factors, such as advanced age, gender, race, climate, and family history of stroke, cannot be intervened.
V. Common symptoms of cerebrovascular disease
1.Sudden onset of numbness or weakness of the face, upper extremities, or lower extremities, especially on one side of the limb, or a single upper or lower extremity.
2.Sudden onset of difficulty in speaking or understanding, slurred speech, difficulty in swallowing, choking and coughing when drinking or eating.
3.Sudden onset of visual impairment in one or both eyes, loss of visual acuity or narrowing of visual field.
4, Vertigo , i.e., a spinning sensation that persists at rest, but there should be at least one other symptom of cerebrovascular disease present.
5.Sudden difficulty in walking, clumsy gait or difficulty in limb balance and coordination. Limb tremor, swaying, and unstable holding of objects.
The above symptoms may occur mildly, moderately, or severely, or any combination of symptoms.
6. Other symptoms include sudden, severe, unexplained headache, fainting, coma, sudden and significant memory loss, convulsions, etc.
VI. Timing of consultation
Cerebrovascular disease is a medical emergency and serious illness. If the above common symptoms of cerebrovascular disease occur and last for more than 10 minutes, the patient or family members should immediately call the emergency number or go to the emergency room or encephalopathy department of the nearest hospital with cranial CT equipment. Rapid thrombolytic therapy within 6 hours of onset of stroke can improve the prognosis of ischemic stroke and reduce the disability rate. Delayed treatment is likely to aggravate the disease and affect the treatment effect and prognosis. Therefore, it is recommended that patients should seek medical consultation as early as possible.
VII. Treatment principles of cerebrovascular disease
The treatment of ischemic stroke mainly includes: thrombolysis, anti-platelet aggregation, dehydration and cranial pressure reduction, blood pressure regulation, cerebral protection, maintenance of water-electrolyte balance, nutritional support, prevention of complications, traditional Chinese medicine, acupuncture, rehabilitation training, etc.
Treatment for hemorrhagic stroke mainly includes: dehydration to lower cranial pressure, blood pressure regulation, cerebral protection, maintenance of water-electrolyte balance, nutritional support, prevention of complications, traditional Chinese medicine, acupuncture, and rehabilitation training. If the bleeding volume is large and surgery is indicated, surgical treatment should be performed.
VIII. Early rehabilitation of stroke and its importance
The essence of rehabilitation is the process of “learning, exercising, exercising again, learning again”, which is to mobilize the remaining brain tissue to reorganize and re-function. Rehabilitation training can help patients maintain and regain some of the lost functions, correct incorrect posture and movement, and reduce the disability rate so that they can live more independently and even go back to work. Therefore, rehabilitation training is crucial. Soon after a stroke, some of the lost functions will start to be regained. Recovery is fastest in the first few weeks but sometimes lasts for a long time.
Therefore, rehabilitation should be done as early as possible. In ischemic stroke, it can be done after 48 hours as long as the patient is clear, vital signs are stable, and the disease is no longer progressing. Cerebral hemorrhage is generally appropriate after 10 to 14 days. Rehabilitation is a continuous process. Patients and their families should actively cooperate with the rehabilitation physician in rehabilitation training. Only if stroke patients and their families work together and persist for a long time can they achieve the best rehabilitation results.
Nine, how to prevent the occurrence and recurrence of cerebrovascular disease
Cerebrovascular disease has a high incidence, of which about 40% of patients can have recurrence. In view of the serious hazards of cerebrovascular disease, you are advised to
1. Know whether you suffer from hypertension or diabetes or hyperlipidemia. If you suffer from the above diseases, please change your bad dietary habits, exercise appropriately, adhere to long-term medication to control blood pressure and blood sugar, and control blood lipids. And regularly recheck blood pressure, blood sugar and blood lipids.
2. Know whether you are suffering from atrial fibrillation. Atrial fibrillation is an irregular heartbeat, easy to form a heart attached to the wall thrombus. Once the thrombus is dislodged, it is easy to block the cerebral vessels with blood flow and cause stroke. If you suffer from atrial fibrillation, please follow the doctor’s instructions to take long-term anti-platelet aggregation drugs aspirin or anticoagulants to prevent the formation of blood clots.
3.Change the bad lifestyle. If you drink alcohol, please keep it in moderation and do not drink heavily. If you smoke, please quit smoking. In addition, it is recommended that you eat a low-salt and low-fat diet, maintain a balanced diet with adequate intake of fruits, vegetables, cereals, and moderate amount of protein every day. Regular participation in the physical activities you enjoy in your daily life can improve your health and reduce the occurrence of stroke.
4. Cerebrovascular diseases are prone to recurrence, and the more the number of attacks, the more serious the disease and the more severe the sequelae. Therefore, it is extremely important to prevent recurrence of cerebrovascular disease, so you are advised to actively treat to control the risk factors. Patients with ischemic stroke should take long-term anti-platelet aggregation drugs such as aspirin to prevent recurrence of stroke.