Stroke, an attack of acute cerebrovascular disease, mainly includes cerebral hemorrhage and cerebral infarction. Many families of stroke patients do not quite understand how to better help patients, here to introduce some stroke tips to you.
1. Can brain hemorrhage be treated surgically?
Brain hemorrhage surgery is commonly known as “eye surgery”, in which a special medical drill is used to punch a hole into the hematoma from outside the skull and place a drainage tube to release the hemorrhage, thus reducing the pressure of the hematoma on the brain tissue to reduce brain edema and intracranial pressure.
Whether a brain hemorrhage can be treated surgically is related to the site and amount of bleeding. The indications for surgery (bleeding volume) are different for different sites of hemorrhage: lobule: 40 ml; nucleus accumbens: 30 ml; thalamus: 10 ml; cerebellum: 10 ml or hematoma diameter of 3 cm; brainstem hemorrhage with a diameter of less than 1.8 cm generally has a good prognosis, and those with a prognosis of more than 1.8 cm have a poor prognosis and can be operated on as appropriate; intraventricular hemorrhage can cause obstructive hydrocephalus, and ventricular drainage can be used as appropriate. This for, also depends on whether there are contraindications: such as coagulation disorders, etc.
2.Is thrombolysis possible in cerebral infarction?
Regardless of cerebral infarction or myocardial infarction, thrombolysis is an important means to allow blood vessels to reopen and brain tissues to regain blood and oxygen supply and reduce neural cell necrosis. However, there are strict time requirements and indications for this treatment. For acute cerebral infarction, if the onset is within 3 hours, thrombolysis can be considered in combination with head CT, blood pressure and the degree of limb strength reduction; 3-6 hours should be more cautious; more than 6 hours is not for thrombolytic treatment. However, cerebral infarction is an infarction of the arterial system, and the conventional thrombolytic therapy is to input thrombolytic drugs from peripheral veins, which will not only act on the cerebral arteries but also reach all parts of the body with blood, so there is a certain risk of bleeding in other parts of the body with intravenous thrombolysis. Arterial thrombolysis, on the other hand, is more technically demanding and less easy to master.
Younger patients benefit more from thrombolysis because the sequelae can be reduced and the quality of life is not affected too badly in the future. In contrast, the incidence of complications such as bleeding is relatively high in elderly patients, and the need for quality of life is lower, so thrombolysis is generally not recommended unless the physical condition is very good.
3. Why do some patients become comatose?
Coma is a sign of severe impairment of consciousness. In the early stage, it can be a mild impairment of consciousness, manifesting as drowsiness and lethargy, and further development of the disease will enter a coma state. Coma caused by acute cerebrovascular disease is usually mostly infarction or hemorrhage in the brainstem. If the infarction foci in the cerebral hemispheres are large or the hemorrhage is large, it will cause more serious cerebral edema and impaired consciousness.
4.What treatment can be taken for cerebral hemorrhage?
Western medical treatment is to surgically drain the hemorrhage if it can be done in the early stage, and to absorb the rest by oneself, and to prevent and control the cerebral edema (such as mannitol sedation) and blood pressure, and to use some drugs to nourish the nerves and improve the brain metabolism, and to maintain the balance of water, electrolytes, nutrition and heat. After the acute phase (usually 2 weeks), the patient basically relies on self-absorption of the hematoma and rehabilitation exercises, in addition, there is nothing more that can be done by Western medicine, and the focus of treatment turns to prevention of rebleeding or infarction.
Some patients with cerebral hemorrhage combined with cerebral infarction cannot use anticoagulant and platelet aggregation inhibiting drugs and blood activating herbal injections like simple cerebral infarction, but only neutral treatment to control blood pressure and cranial pressure, maintain water-electrolyte balance, prevent pulmonary infection, decubitus ulcer, venous thrombosis of lower limbs and other complications, and pay attention to timely passage of lower stool. However, we can consider taking tonics to help hematoma absorption and limb recovery, and to help sedation, wake-up call and infection prevention, and the specific prescription needs to be more suitable for each patient’s condition after examination and diagnosis.
5.Why is there an increase in limb movement disorder or consciousness disorder?
The reason why limb dyskinesia or impaired consciousness occurs is because the nerve cells are ischemic or compressed by a hematoma, resulting in hypoxic necrosis. In this case, edema occurs in brain tissue, and it gradually worsens as time progresses, which is a necessary stage of acute cerebrovascular disease. Because of the limited volume of the cranial cavity, cerebral edema can lead to increased intracranial pressure, resulting in headache, vomiting, and even coma, and severe cerebral edema can induce brain herniation, resulting in death. In the elderly, intracranial hypertension is usually less severe than in younger people because of shrinking brain tissue. As nerve cell necrosis and cerebral edema progress, various symptoms can worsen or increase, such as progression from limb weakness to complete hemiparesis and from clarity to coma. Only the degree of neuronal necrosis and cerebral edema will vary depending on the area and location of hemorrhage/ischemia in the patient, and therefore the symptoms appear less equally, with mild or severe degrees. Brain edema usually develops to its peak after 36-72 hours, then gradually subsides and usually recovers within 1-2 weeks, so 1-2 weeks after the onset of the disease is generally referred to as the acute phase, but neuronal necrosis is a long-term problem and therefore leaves sequelae.
6.When can I start rehabilitation training?
If blood pressure and heartbeat and respiration are stable, you can consider starting rehabilitation (acupuncture, limb exercise, bladder function exercise, speech and swallowing function exercise), and the first six months are the best time for rehabilitation. What the family can do is mainly to place the limbs in functional positions (many books in the bookstore will talk about this, and attention should be paid to it early on to prevent joint deformation), help the patient to perform passive exercises (especially for patients with impaired consciousness), flex and extend the limbs, massage and stimulate to restore their sensation, prevent stiffness and deformation of the joints, and prevent muscle atrophy. Poorly moving lower limbs should wear special elastic stockings to prevent venous thrombosis of the lower limbs.
7.What should I do if I have difficulty swallowing or do not eat?
Many patients with acute cerebrovascular disease have difficulty swallowing, and it is easy to choke and cough on a liquid diet, while thick food is good to swallow. If the swallowing difficulty seriously affects the daily feeding, or does not eat because of the consciousness disorder, you should put down a gastric tube (foreign countries prefer to create a fistula between the stomach and abdominal wall, but we Chinese people generally cannot accept psychologically), so that both nasal feeding of drugs and nutrition can be ensured, too poor nutrition muscle atrophy is easy, but also easy to secondary infection. But pay attention to each nasal feeding before the gastric tube should be unobstructed, nasal feeding can not be too fast, the upper body should be elevated at least 30 degrees, nasal feeding 2 hours before lying down. Be alert to whether the patient has vomiting or regurgitation of accidental aspiration.
8. About skin care.
Bedridden patients who are completely unable to take care of themselves should be assisted by family members to turn over once every 2-4 hours and pat the parts under pressure, especially the back and buttocks, which can prevent bed sores and pneumonia. Make several bagel-like cotton pads for the feet. The heels, sacrococcygeal area, and the two g’s are the parts most prone to bed sores breaking out, especially in patients who are wasted.
9.About Chinese medicine treatment
In addition to timely Western medical treatment for acute cerebrovascular disease, early intervention in Chinese medicine can help alleviate the disease and reduce complications and sequelae. The treatment of stroke in TCM mostly starts from wind, fire, phlegm, stasis, deficiency and internal reality, and the focus varies from patient to patient. The use of blood-boosting herbal injections or oral medications (including western drugs that inhibit platelet aggregation or anticoagulation and fibrin-lowering) alone cannot solve the problem comprehensively, so many patients do not have good results.
As for the commonly used An Gong Niu Huang Wan, its power of clearing heat and expelling phlegm to open the orifice is stronger and is more suitable for patients in the acute stage of stroke with impaired consciousness and more obvious heat signs (e.g. fever, red face, red tongue, yellow coating), but less suitable for patients with less obvious heat signs.
Remember that recovery from a stroke and prevention of another stroke are both very important and a lasting matter. Many patients will have depression and anxiety, and family support is important for the patient, financially, temporally and psychologically included. I wish your family a speedy recovery!