Causes of cerebral thrombosis
I. Atherosclerosis
Atherosclerosis is the most common cause of cerebral thrombosis, so much so that the latest classification of cerebrovascular diseases renames cerebral thrombosis as “atherosclerotic thrombotic cerebral infarction”.
The development of atherosclerosis is associated with endothelial cell damage, high blood lipids, hypertension, and abnormal hemodynamics. The cause of atherosclerosis is thought to be related to high levels of blood lipids, particularly a substance called low-density lipoprotein-cholesterol (LDL-C). It is also associated with lifestyle, nutritional and genetic factors. For example, eating foods that contain too much fat (fatty meats, fats) and carbohydrates (sugar, starch, etc.); too little physical activity; obesity, having hypertension, diabetes and their family history (parents or/and siblings with the same disease), etc. Recent studies have found that atherosclerosis is associated with mutations in genes such as apolipoprotein, a protein associated with fat metabolism.
Atherosclerosis is a systemic vascular disease that occurs in different organs to produce the corresponding disease. For example, atherosclerosis in the coronary arteries supplying the heart leads to coronary arteriosclerotic heart disease (coronary heart disease). Atherosclerosis of the cerebral arteries mainly occurs in the large and middle arteries supplying the brain, and the most likely sites of stenosis are at the bifurcation of the common carotid artery in the neck, the entry of the vertebral artery into the cranial cavity, and the beginning and bifurcation of the basilar artery. Due to the breakdown of the intima, lipid deposits form plaques, platelets and fibrin in the blood are deposited on top of the plaques and become mechanized, resulting in thickening of the vessel wall and narrowing of the vessel lumen, leading to insufficient blood supply to the brain. If the lesion develops further, the lumen of the blood vessel is severely narrowed or even completely occluded, or the blood is thickened due to the high viscosity of the blood (commonly known as blood thickening), thrombus is formed on the plaque to block the blood vessel, then ischemic necrosis of brain cells in the blood supply area of this blood vessel can occur.
Second, the less common causes of cerebral thrombosis
Various arterial inflammation, such as infectious arteritis (tuberculosis, parasitic, septicemia, etc.), collagenous arteritis (such as a disease called systemic lupus erythematosus), vaso-occlusive vasculitis, etc. Hypercoagulable states caused by various diseases, such as abnormally elevated red blood cells in patients with chronic lung disease due to chronic hypoxia, and women in early pregnancy due to vomiting and dehydration combined with elevated estrogen and progesterone, may induce cerebral thrombosis. In addition, there is a rare disease characterized by increased red blood cells called “true erythrocytosis”, and patients with this disease are also prone to cerebral thrombosis.
How to deal with the patient after discovering cerebral thrombosis
I. Keep sedation
For light patients, the patient can be made to lie down with the head about 30 degrees high. Regardless of the means of transportation, the patient should be sent to a nearby municipal hospital within 1 to 2 hours as far as possible to avoid delaying the transfer to a small hospital without the corresponding examination equipment. It is best to call 120 emergency vehicles for seriously ill patients. When waiting for a car, if the patient has become unconscious, vomiting and other symptoms, he can turn his head to the side to avoid accidental inhalation of vomit into the lungs.
Second, try to prepare sufficient cash or checks
To avoid delaying treatment due to unavailability of funds when arriving at the hospital.
Family members in the hospital and the doctor’s cooperation in treatment
(1) Assist in nursing care
Most of the patients with cerebral thrombosis are obese, some of them have diabetes, and now they have hemiplegia, local neurotrophic disorders, and prolonged compression may cause skin breakdown and “bedsores”. Once it happens, it may aggravate the cerebrovascular disease due to infection and fever, and in serious cases, it may lead to sepsis and death of the patient. Therefore, family members should pay attention to regular turning and back patting, scrubbing the skin with warm water, and gently massaging the pressed parts, especially the more prominent parts of the skeleton, such as the spine and sacrococcygeal area, when accompanying the patient. The frequency of turning is usually about 2 hours. If skin breakdown is found, report to the health care provider for early treatment. Patients with urinary and fecal incontinence should have their diapers changed regularly and should be washed with warm water, dried and powdered after each bowel movement.
(2) Dietary problems
Some patients have difficulty swallowing after the disease, which is caused by paralysis of the muscles in charge of swallowing.
Patients choke and cough when eating, especially when drinking water, and even spurt food out of the mouth and nose. At this time, care should be taken not to force the patient to take water or medication. For lighter patients, they can be allowed to eat sticky food, such as thick porridge and soft rice. Boil vegetables, minced meat and other side dishes and mix them into the rice, avoiding too thin and dry food, which can be easily swallowed. Oral medications, if not contraindicated, can be crushed and mixed in food. In severe cases, a nasal feeding diet is required, i.e., a rubber tube is inserted into the stomach through the nostril and food such as rice soup, milk and vegetable juice is injected into the stomach with a syringe to ensure adequate nutrition. Similarly, oral medications can be injected through the stomach tube. Note that the injected food and medication must not have large particles to avoid blocking the gastric tube. Nasal feeding is a necessary means to ensure treatment at a certain stage and is directly related to the success or failure of patient resuscitation. Some patients and family members are reluctant to accept the gastric tube, so that the patient can barely swallow, which is very dangerous, if the food is inhaled into the respiratory tract by mistake, the lighter the lung infection, resulting in aspiration pneumonia; the heavier the death may be due to asphyxia.
(3) Observe the change of condition and report the abnormal condition to the medical personnel in time.
Patients with cerebral thrombosis have a relatively slow onset, with mild symptoms at the onset, and most of them will not have impaired consciousness. However, the condition may worsen progressively within a few hours or days. Despite the aggressive measures taken by the health care provider to treat the condition, sometimes the progression cannot be stopped. If the blocked blood vessel is large, the area of brain tissue necrosis is large, and cerebral edema is obvious, the patient may gradually develop drowsiness, i.e., he can wake up when called, and fall asleep again immediately without calling. Severe cases may enter coma. Family members should observe whether the strength of the paralyzed limbs gradually becomes smaller or even completely immobile. What is the mental state? If the patient is found to be drowsy and depressed, notify the medical staff immediately. At the same time, for critically ill patients, record the amount of food and water consumed and the amount of urine consumed every day for the doctor’s reference.
(4) Help the patient to move the paralyzed limbs and promote rehabilitation at an early stage.
On the second day of illness, if the condition is stable, you can start to do passive movement of the limbs, that is, help the patient to stretch and flex the paralyzed limbs. This will help to promote blood circulation of the paralyzed limb, prevent deep vein thrombosis, promote muscle strength and joint mobility, and prevent contracture and deformation of the limb. The patient’s paralyzed limb should be placed in an antispastic position when inactive, i.e., lying supine with the affected upper limb on a pillow so that it is slightly abducted and externally rotated, the elbow joint slightly flexed, the wrist joint slightly dorsally extended, and the hand holding a cylindrical object of appropriate size, such as a roll of hand paper. The back is padded so that it is forward and upward; the outer hip of the lower limb is padded so that the hip joint is inward and the pelvis is forward, and a soft pillow is placed under the knee joint so that the knee joint is flexed and the ankle joint should be kept at 90° to prevent the foot from sagging, and the patient’s foot can be placed on the bed or wall or in a homemade splint. A head height of 30° is appropriate when lying supine, not too high. In lateral position, a pillow should be placed in front of the chest and lower limbs, with the upper limbs extended and the lower limbs flexed on the pillow.
(5) Pay attention to the emotional changes of the patient.
Patients suddenly lose the ability to move and speak, and even lose the ability to take care of themselves and work, so it is emotionally difficult to bear. Family members should actively cooperate with the medical staff, comfort and encourage the patient to cooperate with treatment and rehabilitation exercises. Try to avoid making the patient emotionally agitated.
Home care and treatment during the recovery period of cerebral thrombosis
Brain cells die due to ischemia and hypoxia when the blood vessel is occluded. The later the treatment starts, the larger the blocked blood vessel is, the more brain cells die, and the brain cells cannot be regenerated after death. Therefore, despite the active measures taken by doctors, patients are inevitably left with different degrees of disabilities, also called “sequelae”. These sequelae cannot be solved in the hospital, especially in the general hospital where the main purpose is to save lives, and they need to be solved in the rehabilitation hospital.
First, regular medication on time to prevent the re-occurrence of cerebral thrombosis people still need to be discharged from the hospital according to the doctor.
After discharge, people still need to take medication regularly according to the doctor’s order, control the underlying pathologies of arteriosclerosis such as diabetes and hypertension, and regularly go to the hospital for review. Commonly used drugs include anti-platelet aggregation drugs, such as small doses of aspirin and resorcinol; brain protection drugs, such as nimodipine; oxygen free radical scavengers, such as vitamin E and vitamin C, etc. Some patients hate to take drugs, all the advertised drugs want to try, or think that the more drugs eat the better. In fact, this is not good for the body. Not to mention that the efficacy of drugs may not be as magical as advertised, any drug has to be metabolized by the liver and kidneys, so taking too many drugs will increase the burden on the liver and kidneys of the elderly, who are already not very healthy. What drugs to take and how to take them? It is best to follow the advice of doctors and not blindly follow advertisements.
Second, start rehabilitation treatment as early and actively as possible.
As mentioned before, cerebral thrombosis leaves many sequelae, such as monoplegia, hemiplegia, aphasia, etc. The effect of drugs on these sequelae is very limited, while through active and regular rehabilitation treatment, most patients can achieve self-care, and some can even return to work. Those who are able to do so should go to a regular rehabilitation hospital for systematic rehabilitation. If you cannot go to a rehabilitation hospital for various reasons, you can buy some books and videos on the subject and do it yourself at home. Early rehabilitation is advisable. The best time for rehabilitation is within 3-6 months after the disease. After half a year, as muscle atrophy and joint contracture have occurred, rehabilitation is more difficult, but it will also be helpful.
Third, daily life training.
In addition to training the affected limb as early as possible, attention should be paid to developing the potential of the healthy limb. Patients with right-sided hemiplegia who are accustomed to using their right hand (right-handedness) should train their left hand to do things at this time. Clothes should be made loose and soft, and special styles can be sewn according to special needs, for example, a latch can be installed on the sleeve of the affected limb to measure blood pressure when going to the doctor. When dressing, put on the paralyzed side first, then the healthy side; when undressing, take off the healthy side first, then the affected side.
Fourth, face reality and adjust your emotions.
As the saying goes: “Sickness comes like a mountain, sickness goes like a silk”. This saying is more apt for cerebrovascular patients. Faced with the fait accompli, you should adjust your emotions and actively rehabilitate to return to society as soon as possible. Patients with severe mood disorders can ask their doctors for help and use antidepressants, such as Prozac, which are good for depression and anxiety after cerebrovascular disease.
Does a patient with cerebral thrombosis have to receive infusion once every six months?
I often encounter patients with post-thrombotic cerebral disease in outpatient clinics who ask for infusion. The reason is that I heard that infusion must be given once every six months after cerebral thrombosis to prevent the recurrence of thrombosis. This is actually unfounded. Cerebral thrombosis is a disease prone to recurrence, but its onset is mainly related to arteriosclerosis and blood viscosity. Prevention and control of arteriosclerosis is a long-term problem, not just a few days of drip can solve, need to pay attention to various aspects from life and living to drug treatment, long-term regular oral anti-atherosclerotic drugs can also achieve the purpose of preventing thrombosis. On the other hand, infusion is not harmless. In actual x, because the drug is injected directly into the blood vessel, there are many potential dangers, such as infusion reaction, phlebitis, and heart failure caused by too fast infusion. Therefore, intravenous drips are only necessary when the condition is urgent and the drug needs to be delivered into the body as soon as possible, or when the patient is in a coma and other conditions make it impossible to take the drug orally. As a general medical principle: do not inject intramuscularly drugs that can be taken orally; do not IV drip drugs that can be injected intramuscularly in order to reduce the chance of adverse reactions.
Diet for patients with cerebral thrombosis
Most patients with cerebral thrombosis are obese, have high blood lipids, high blood sugar and high blood pressure, all of which are risk factors for atherosclerosis. In addition to taking the corresponding medication, dietary adjustment has an important role.
1, first of all, obese patients should limit the intake of staple foods and reduce the weight to normal or close to the standard weight. Generally control the amount of staple food at about 300 grams per day. If the patient can not eat enough vegetables, soy products to supplement, try to develop the habit of eating eighty percent full.
2, eat less or do not eat animal fat and animal offal, such as fatty meat, fatty intestines, belly, because these foods contain very high cholesterol and saturated fatty acids, easy to aggravate atherosclerosis.
3, eat more high-quality protein, such as milk, chicken and duck (preferably wild woodchuck), fish, eggs (egg yolk should be eaten less), soy products, less pork, beef, mutton, and lean meat is better.
4, eat more vitamin-rich food, such as vitamin C-rich fresh fruit, tomatoes, hawthorn, etc.; vitamin B6-rich soy products, dairy, eggs; vitamin E-rich green leafy vegetables, beans, etc.
5, diet should be based on light, avoid too salty, it is best not to eat salty dishes. Because eating too salty, easy to cause hypertension.
6, eat more fibrous food, such as celery, coarse grains, etc., to increase gastrointestinal motility, to avoid dry stools. Patients with constipation should drink more water, which can promote defecation, but also due to the increase in urine, to prevent urinary tract infections beneficial. Some patients, due to mobility, fear of urination and do not drink water, is very unfavorable
Measures
1, control risk factors: such as hypertension, atherosclerosis, diabetes, smoking, alcoholism, obesity, hyperlipidemia, increased blood viscosity and other factors, should be actively intervened. Measures are: reduce blood pressure, control diet, quit smoking, avoid alcohol, lose weight and prevent fat, reduce blood lipids and blood viscosity, and treat diabetes.
2, anti-platelet agents: such as aspirin has a good preventive effect on the recurrence of cerebral thrombosis, suitable for long-term use. Ceclopidine also has good effect.
3.Carotid endarterectomy: When the carotid stenosis exceeds 70%, it should be removed in time.