Definition of stroke Stroke is a group of disorders characterized by localized neurological deficits caused by disturbances in blood circulation to the brain. It includes diseases of intracranial and extracranial arteries, veins and sinuses, but arterial diseases are more common. Causes and pathogenesis of stroke Hypertension and atherosclerosis are the main causative factors of this disease, so it is mostly seen in middle-aged and old people. According to its pathological changes, it is divided into two categories: hemorrhagic and ischemic cerebrovascular disease. I. Intracranial hemorrhage. Subarachnoid hemorrhage. Aneurysm rupture caused by: congenital aneurysm; arteriosclerotic aneurysm; bacterial aneurysm. Vascular malformation. Arteriosclerosis. Intracranial anomalous vascular reticulosis. Other. Cause unknown. Cerebral hemorrhage. Hypertensive cerebral hemorrhage. Hemorrhage secondary to infarction. Tumoral hemorrhage. Caused by blood disease. Arteritis. Drug induced (anticoagulants, thrombolytic agents such as urokinase). Cerebrovascular malformation or aneurysm. Other. Unspecified cause. Epidural hemorrhage. Subdural hemorrhage. Cerebral infarction (carotid system and vertebrobasilar system). Cerebral thrombosis. Caused by atherosclerosis. Various types of arteritis. Traumatic and other physical factors. Blood diseases such as erythrocytosis. Drugs. Other causes. Cerebral infarction. Cardiac origin. Arterial origin. Other (fat embolism, gas embolism, tumor embolism, parasite embolism, phlebitis embolism, etc.). Cavernous infarction. Vascular dementia. Others. Transient ischemic attack. Carotid artery system. Vertebral a basilar artery system. IV.Cerebral hypoperfusion. V. Hypertensive encephalopathy. VI. Intracranial aneurysm. Congenital aneurysm. Arteriosclerotic aneurysm. Bacterial aneurysm. Traumatic pseudoaneurysm. Others. Intracranial vascular malformation. Cerebral arteriovenous malformation. Cavernous hemangioma. Venous vascular malformations. Galen’s vein tumor. Internal carotid artery cavernous sinus fistula. Capillary hemangiomatosis. Hemangiomatosis of one side of the brain. Intracranial and extracranial vascular transportation arteriovenous malformations. Other. VIII. Cerebral arteritis. Infectious arteritis. Aortitis (aortic arch syndrome). Diffuse lupus erythematosus. Polyarteritis nodosa. Temporal arteritis. Occlusive thrombophlebitis. Leptospirosis arteritis. Other. IX. Cerebral arterial steal syndrome. X. Intracranial anomalous vascular network syndrome. XI.Intracranial venous sinus and cerebral vein thrombosis. Cavernous sinus thrombosis. Upper sagittal sinus thrombosis. Straight sinus thrombosis. Transverse sinus thrombosis. Other. XII. Cerebral arteriosclerosis. Complications of stroke Cerebral hernia Most patients with cerebrovascular disease die in the acute stage, mostly due to massive hemorrhage, displacement or destruction of brain midline structures, whole brain edema, the formation of cerebral hernia, so that the brain stem is extruded and displaced, endangering the center of life. Domestic reports, cerebral hemorrhage combined with cerebral hernia deaths accounted for 44.8% to 50.1%, so timely and effective lowering of intracranial pressure, reducing cerebral edema, preventing the formation of cerebral hernia is the key measure for the success or failure of treatment. When patients have the following conditions: ① severe headache or extreme agitation; ② frequent vomiting or convulsions; ③ slowing down of respiration and heart rate, increase of blood pressure; ④ gradual aggravation of impaired consciousness; ⑤ unequal pupil size bilaterally; then it suggests that the intracranial pressure is obviously increased, and cerebral herniation may be possible, and it should be aggressively dehydrated or surgically treated. Cerebro-cerebral syndrome When cerebral hemorrhage affects the lower thalamus, which is the higher center of vegetative nerves, leading to neurohumoral disorders, it often causes cardio-cerebral functional or organic changes, which is called cerebro-cerebral syndrome. Cerebro-cardiac syndrome often occurs in two forms: one is cerebro-cardiac stroke, i.e., cerebral hemorrhage firstly, and then cardiovascular disease occurs. The second is a simultaneous brain-cardiac stroke, in which a brain hemorrhage and cardiovascular disease occur at or near the same time. However, due to the mutual concealment of symptoms, it is often easy to cause misdiagnosis and affect the treatment. Therefore, high attention should be paid to the rescue process, and the patient should be carefully asked about the medical history and carefully observed whether the patient has the manifestation of cardiac insufficiency. If there is chest tightness, shortness of breath, cyanosis, etc., the bottom of the lungs have wet rhonchi, low heart sound and tachycardia and other abnormal phenomena, should be timely for electrocardiography. Once heart rhythm disorder and ECG changes appear, it should be treated as organic heart disease while treating cerebral hemorrhage. Bladder and rectal dysfunction Mild cerebral hemorrhage patients are often not accustomed to lying down to defecate, and then appear temporary “postural urinary retention” and stool dryness. In severe patients, when the lesion affects the hemispheric motor centers, frequent urination and increased intravesical pressure often occur. If the third ventricle is stimulated, there is often increased rectal mobility, leading to a high degree of bowel hyperactivity, with the patient having frequent bowel movements, but with a low volume of bowel movements at each time. If the gray nodule is damaged, involuntary defecation may occur. If the whole brain is damaged, patients in deep coma often experience diaphoresis or urinary retention. Renal failure and electrolyte disorders Cerebral hemorrhage patients due to coma or aphasia, can not respond to the subjective sensations, coupled with the complexity of the symptoms, the treatment of the more contradictory; also often due to frequent vomiting, fever, sweating, the application of dehydrating agents and rehydration of insufficient fluids, resulting in water loss, electrolyte disorders and renal failure. Sometimes acidosis is caused by hypoxia, starvation, respiratory abnormalities, etc., or alkalosis occurs occasionally. However, the above symptoms are often easily concealed and neglected in the case of coma or co-infection, which makes the condition aggravated day by day, so attention should be paid to observation. When finding the deepening and accelerating of respiration, tachycardia, aggravation of impaired consciousness, decrease of blood pressure, decrease or absence of urine, limb and facial edema or dehydration, etc., it is necessary to search for the cause of the disease carefully, and make the examination of carbon dioxide binding capacity, non-protein nitrogen, blood gas analysis and quantitative measurement of electrolytes in time, and deal with it in time if any abnormality is found. Central thermoregulation disorder When cerebral hemorrhage affects the lower and anterior thalamus, the heat dissipation mechanism is destroyed, which can cause persistent high fever, and the body temperature often reaches more than 40 ℃, accompanied by no sweating, cold limbs, tachycardia, rapid respiration, etc. However, the white blood cells are usually not increased. However, the white blood cells generally do not increase, compound aminopyrine, aspirin can not make it down, sometimes with barbiturates plus ice pillows to lower the temperature effectively, such as untimely treatment, a few hours can die. Decubitus ulcers Cerebrovascular patients often due to hemiplegia, long-term bedridden, coupled with some patients are fat, not easy to turn over and care, sacrococcygeal, internal and external ankles, heels, hips and other bone protruding parts of the body, often due to long-term pressure, impaired blood circulation and lead to localized malnutrition, the occurrence of decubitus ulcers. Diagnosis and differential diagnosis of stroke Diagnosis of stroke Correct diagnosis is the prerequisite for reasonable treatment. In order to make a good cerebrovascular diagnosis, in addition to a detailed medical history and a careful physical examination, necessary auxiliary examinations should be performed and scientifically analyzed. Cerebrovascular disease diagnosis includes the following aspects: localization diagnosis According to the patient’s symptoms and signs, analyze the location of the lesion, is it diffuse or limited? Is the lesion diffuse or limited? Is it central or peripheral? The specific site of the lesion is then indicated. Lesions in the cerebral hemispheres, cerebellum, and brainstem present differently. Cerebral hemispheric lesions show contralateral facial paralysis, tongue paralysis, hemiparesis and hemianopsia; cerebellar lesions mainly show severe vertigo, unsteadiness, nystagmus, etc. Brainstem lesions are more complex, mainly cross paralysis, ipsilateral mouth distortion, tongue slanting, contralateral hemiparesis and hyperalgesia. ct examination can clarify the exact location of the lesion. Qualitative diagnosis According to the onset of the disease, the characteristics of the disease and the location of the lesion, analyze the nature of the disease, whether it is hemorrhagic or ischemic cerebrovascular disease. The two treatments are different and must be clearly identified. Etiological diagnosis From the whole process of the onset of the disease, combined with localization and characterization, to find out the specific causes of the disease. Cerebrovascular disease is mainly caused by hypertension and cerebral atherosclerosis. However, in recent years, it has been found that changes in certain components of the blood and hypercoagulability often lead to cerebral infarction. Cerebral aneurysms, cerebral vascular malformations, and arteritis also lead to many cerebral hemorrhages, and these must be clarified. Treatment of stroke Cerebrovascular disease has a high incidence rate, death rate and disability rate, so prevention and treatment should be strengthened. There are specific treatments for specific diseases. Acute stage: Internal medicine treatment: General treatment: quiet bed; sedative, antispasmodic and analgesic drugs; head cooling. Adjust blood pressure. Reduce intracranial pressure. Attention to caloric supplementation and water, electrolyte and acid-alkaline balance. Prevent complications. Surgical treatment. Recovery period: The main purpose of treatment is to promote functional recovery of paralyzed limbs and speech disorders, improve brain function, reduce sequelae and prevent recurrence. Prevent high blood pressure and emotional excitement, live a regular life, eat moderately and avoid dry stools. Functional exercise. Drug therapy: drugs to promote neurometabolism, such as cerebral fukang, cytidine, cerebral vivo, r-amyl caseinate, coenzyme Q10, vitamin B, vitamin E, and vasodilator drugs, etc. Traditional Chinese medicine prescriptions to activate blood circulation and remove blood stasis, benefit qi, nourish the liver and kidney, and dissolve phlegm to open the orifices, etc., should also be used. Physiotherapy, body therapy and acupuncture can also be used. Stroke prevention Primary prevention: “If an individual has only one or more of the above risk factors without cerebrovascular aura or manifestations, we classify him/her as a target of primary prevention, i.e., actively treating the existing risk factors, while regularly monitoring the occurrence of other risk factors and taking targeted measures. Secondary prevention: Individuals with existing risk factors and aura of stroke, such as transient ischemic attack, are given early diagnosis and early treatment to prevent the occurrence of serious cerebrovascular disease, which is classified as secondary prevention. Tertiary prevention: For patients who have already suffered from stroke, early or ultra-early treatment to reduce the degree of disability, remove or treat the risk factors to prevent its recurrence is the tertiary prevention. The so-called early treatment refers to the treatment of the acute phase of the patient a few hours after the onset of the disease, and the so-called ultra-early treatment refers to the implementation of the treatment within a few hours after the onset of the disease, such as ischemic stroke, the onset of the thrombolytic therapy started within 6 hours, the earlier the targeted therapeutic interventions, the better the therapeutic effect, and the lower the level of disability is likely to be.