The most common cause of cerebrovascular blockage (cerebral thrombosis) is atherosclerosis, and its development can be accelerated by diabetes, hyperlipidemia and hypertension. The disease is mostly seen in elderly people with atherosclerosis over 50-60 years old. Special attention should be paid to a light diet with less salt, more green vegetables, less animal meat and more fish. If it is not too serious and handled properly, it can be treated. Cerebral thrombosis refers to the formation of thrombus based on pathological changes in the walls of the arteries supplying the brain inside and outside the skull, resulting in occlusion of blood vessels due to slow blood flow, changes in blood composition or increased blood viscosity. The most common cause is atherosclerosis. Diabetes mellitus, hyperlipidemia and hypertension, etc.
Blockage of cerebral blood vessels
Accelerates the development of cerebral atherosclerosis. The most common sites of cerebral thrombosis are the common carotid artery, the internal carotid artery, the lower basilar artery, the upper vertebral artery, the junction of the vertebral and basilar arteries, the middle cerebral artery trunk, the posterior cerebral artery and the anterior cerebral artery. Other causes include nonspecific arteritis, leptospirosis, aneurysm, collagenosis, true erythrocytosis, and head and neck trauma.
Normal blood flows smoothly through the blood vessels, the river of our body, transporting oxygen and metabolites needed by tissues to maintain the normal function of the heart, brain, kidneys and other organs. As we age, our standard of living continues to improve and our unhealthy lifestyle leads to high blood pressure and high blood cholesterol, when there is too much cholesterol, triglycerides, LDL and other “blood waste” in the blood, it will accumulate on the walls of the blood vessels and “block” them. When there is too much “blood waste” such as cholesterol, triglycerides and LDL in the blood, it will “block” the blood vessels (i.e., form what is medically called atherosclerosis), just like a stagnant river, the downstream will be cut off. This prevents blood from being supplied in a timely manner and causes ischemia and hypoxia in the tissues, resulting in related diseases and symptoms.
When the blood vessel is partially “blocked”, it will cause insufficient blood supply to the heart muscle, coronary heart disease, myocardial infarction, clinical manifestations are: panic, shortness of breath, chest tightness, difficulty in breathing, chest pain; recurrent irregular pulse, too slow or too fast; feeling breath-holding during sleep, needing a high pillow to feel comfortable; pain in the left shoulder behind the sternum, accompanied by false sweat Long-term episodes of left shoulder pain (with radiation). “Blockage” in the brain can cause cerebral blood supply deficiency, cerebral thrombosis, cerebral embolism, cerebral hemorrhage sequelae, etc. Clinical manifestations include dizziness, dizziness, tinnitus, blurred vision, blackness in front of the eyes; intermittent or persistent headache; neurological weakness, inattention, memory loss; general weakness, accompanied by sweating, low fever; stroke hemiplegia, numbness of limbs, face, mouth and tongue (especially fingers), slurred spitting, drooling, nose bleeding; nausea, vomiting, insomnia, drowsiness, impatience, suspicion; mood perversion, childishness, sluggishness, strong crying and laughing; poor mental health in the morning, inability to sleep at night, insomnia, dreaminess, emotional instability, periodic mental abnormalities, feeling tired and weak all day long; poor mental health, unsteady gait; numbness of limbs Weakness, chills, etc. When the blood vessel is completely blocked, it will cause acute myocardial infarction and acute cerebral infarction, which are lethal and asymptomatic, or with the above symptoms, it is too late to rescue. Therefore, the key to solve the cardiovascular disease is to solve the “blood vessel blockage”, as long as the “blood vessel blockage” is cleared, we can fundamentally solve the cardiovascular disease and its symptoms. This is also the reason why many patients receive infusion twice a year to “flush the blood vessels and expand the blood vessels” to prevent their recurrence.
Abnormal gait
Stumbling gait and weakness of the walking leg is one of the precursors of hemiplegia. A sudden change in gait with numbness and weakness of the limbs is a precursor to cerebrovascular blockage.
Constant yawning
80% of people who suffer from ischemic cerebral thrombosis will experience yawning continuously 5 to 10 days before the onset of the disease.
Abnormal blood pressure
A sudden and sustained increase in blood pressure above 200/120mmHg is a precursor to cerebrovascular blockage; a sudden drop in blood pressure below 80/50mmHg is a precursor to the formation of cerebral thrombosis.
Sudden and severe headache
Any sudden onset of severe headache; accompanied by convulsive seizures; with a history of head trauma; accompanied by coma and drowsiness; sudden changes in the nature, location and distribution of headache; headache aggravated by coughing and exertion; severe pain, which can wake up at night in pain. If you have one of the above precursors of cerebrovascular blockage, you should go to the hospital for examination and treatment as early as possible.
Nose bleeding
This is a red flag worth noting. Several times of heavy nosebleeds, together with bleeding from the fundus of the eyes and hematuria, such a person may have cerebrovascular blockage within six months.
Sudden vertigo
Vertigo is an extremely common symptom among the precursors of cerebrovascular blockage, and can occur at any time before cerebrovascular disease, especially most often when waking up in the early morning. In addition, it also occurs easily after fatigue or bathing. Especially in hypertensive patients, if vertigo occurs repeatedly more than 5 times in 1 to 2 days, the risk of cerebral hemorrhage or cerebral infarction increases.
Other symptoms
In addition to the above precursor symptoms of cerebrovascular blockage, choking and coughing, difficulty in swallowing, sudden onset of hemianesthesia, fatigue, drowsiness, tinnitus, etc. are also precursor manifestations of cerebrovascular blockage.
(A) General symptoms: The disease is mostly seen in elderly people aged 50 to 60 years or older with arteriosclerosis, and some have a history of diabetes mellitus. The onset of the disease often occurs in quiet time or during sleep, and the symptoms gradually reach their peak within 1 to 3 days. Some patients have one or more episodes of transient ischemia before the disease. Except in severe cases, the symptoms gradually reach their peak within 1 to 3 days, and the consciousness is mostly clear, and the increase of intracranial pressure is not obvious.
(B) Confined neurological symptoms of the brain: the variability is large and related to the degree of vascular occlusion, size and location of occluded vessels and good or bad collateral circulation.
1. Internal carotid artery system.
(1)Internal carotid artery system: hemiparesis, hemianesthesia, hemianopsia, triple hemianopsia and psychiatric symptoms are common. The primary hemianopathy also has varying degrees of aphasia, dysfunctions and dyscognition, and also primary optic nerve atrophy on the side of the lesion, with characteristic blindness of the diseased eye with contralateral hemiparesis called black mask crossed palsy, Horner’s sign, actinic nerve palsy, and decreased retinal artery pressure.
(2) Middle cerebral artery: the most common. There is a triple hemianopia sign in main trunk occlusion and aphasia in the fashion of main hemisphere lesions.
(3) Anterior cerebral artery: because the anterior communicating artery provides collateral circulation, proximal obstruction may be asymptomatic; when the peripheral branch is involved, it often invades the medial frontal lobe, and paralysis is more severe in the lower extremities, which may be accompanied by cortical sensory impairment and urinary disturbance in the lower extremities; deep penetrating branch obstruction, affecting the anterior branch of the internal capsule, often presents with mediated central facial and tongue paresis and light paralysis of the upper extremities. Bilateral occlusion of the anterior cerebral artery may present with psychiatric symptoms accompanied by bilateral paralysis.
2. Vertebral a basilar artery system.
(1) Posterior inferior cerebellar artery syndrome: It causes infarction of the dorsolateral part of the medulla oblongata, vertigo, nystagmus, linguopharyngeal and vagal nerve palsy on the side of the lesion, cerebellar ataxia and Hroner’s sign, and hyperalgesia or loss of sensation in the trunk and limbs contralateral to the side of the lesion.
(2) Paramedian central artery: very rare.
(3) Anterior inferior cerebellar artery: vertigo, nystagmus, gaze of both eyes to the contralateral side of the lesion, tinnitus and deafness on the side of the lesion, Horner’s sign and cerebellar ataxia, hypesthesia or loss of sensation in the lateral part of the lesion and the contralateral limb.
(4) Basilar artery: hyperthermia, coma, pinpoint pupils, limb flaccidity and medullary paralysis. In acute complete occlusion, the patient’s life can be rapidly endangered, and individual patients present with atresia syndrome.
(5) Posterior cerebral artery: manifests as occipital parietal syndrome, with hemianopia and transient visual impairment such as black haze, etc. In addition, there may be body image disturbance, loss of recognition, loss of use, etc.
Multi-static onset
The symptoms appear during sleep or after waking up, and often worsen gradually. There is no severe headache or disturbance of consciousness, but hemiparesis and aphasia are obvious. The age of onset is high, and there are risk factors for stroke such as atherosclerosis and hypertension or transient cerebral ischemic attack.
Cerebrospinal fluid is mostly normal
CT scan shows hypointense areas of cerebral ischemic lesions (mostly normal within 6 hours of onset). Cerebral angiography can show the site and extent of thrombosis and collateral circulation. Doppler can detect cerebral blood flow and help in diagnosis. Routine blood and urine tests, blood glucose, blood lipids, blood flow, and electrocardiogram can be performed to differentiate from cerebral hemorrhage and cerebral embolism.
Cerebral hemogram
Cerebral hemogram is one of the most valuable tests for diagnosing cerebrovascular blockage, and is known as the “gold standard” for dizziness and headache diagnosis.
Acute phase.
The principle is to improve the blood circulation in the cerebral ischemic area and promote the recovery of neurological function as soon as possible.
1. Relieve cerebral edema: for patients with large and severe infarct areas, dehydrating agents or diuretics can be used.
2.Improve microcirculation: use low-molecular dextrose, which can reduce blood viscosity and improve microcirculation.
3.Dilution of blood: ① equal-volume hemodilution therapy: blood is released through a vein, while an equal amount of fluid is replaced; ② high-volume hemodilution therapy: intravenous injection of fluid without blood to achieve the purpose of volume expansion.
4. Thrombolysis: ①Streptokinase. ②Urokinase.
5.Anticoagulation: to prevent the extension of thrombus and the occurrence of new thrombus. ①Heparin. ②Dicoumarin.
6.Vasodilator: It is generally believed that the effect of vasodilator is not certain, and it can sometimes aggravate the disease in severe patients with increased intracranial pressure, so it is not recommended to use it in the early stage.
7.Other: Hyperbaric oxygen therapy, extracorporeal counterpulsation therapy and photometric blood therapy can also be used for this disease.
Recovery period.
Continue to strengthen the functional exercise of paralyzed limbs and speech function training, in addition to drugs, can be used with physical therapy, body therapy and acupuncture, etc.. In addition, anti-platelet aggregation agents, such as pansentine or aspirin, can be taken for a long time to help prevent relapse.
Pay special attention to less salt in general, light, eat more green vegetables and less animal meat. Eat more fish. Take medicines to lower blood lipids
Chinese medicine works well. 12 grams of angelica, 15 grams of raw earth, 10 grams of peach kernel, 10 grams of safflower, 12 grams of red peony, 20 grams of cow’s knee, 20 grams of kudzu, 20 grams of oyster, 15 grams of hooked vine, 10 grams of dulcimer, 15 grams of cloud ling, 15 grams of cinnamon stick, 10 grams of licorice, 10 grams of Chuanxiong, decoction in water, three times a day.
Recovery medication: The best treatment medicine for cerebrovascular blockage in the acute stage should be mainly western medicine, because western medicine has the advantages of fast onset of action and strong treatment target, which can quickly inhibit the development of the disease, but most western medicine has large side effects, causing damage to patients’ liver and kidneys and resistance to medicine (47% of patients will have resistance to aspirin), so it is not suitable for patients with cerebral thrombosis to take for a long time. The most effective means to effectively improve the symptoms and reduce the high recurrence rate of cerebral thrombosis is to adhere to reliable long-acting drug therapy. Only with scientific medication can we effectively treat the underlying lesions such as atherosclerotic plaque formation and high blood viscosity that cause cerebral thrombosis, thus preventing the continued formation of atherosclerosis and preventing the formation of thrombus again. It also creates a good internal environment for brain tissue, restores the brain nervous system, and improves the signs of motor and speech nervous system under its control.
Treatment during the rehabilitation period
Experimental and clinical studies have shown that due to the plasticity of the central nervous system, it has the possibility of functional reconstruction in the recovery process after brain injury. Currently, it is believed that patients with cerebral thrombotic infarction-induced limb movement disorders can significantly reduce or mitigate the sequelae of paralysis through regular rehabilitation training. The “misuse syndrome” is the result of increased spasticity, abnormal spasticity patterns and abnormal gait, as well as foot drop and pronation.
Improper plyometric training can exacerbate spasticity, and proper rehabilitation can alleviate this spasticity and lead to coordination of limb movements. Once the wrong training method is used, such as repeatedly practicing forceful grasping with the affected hand, it will strengthen the flexor muscle synergy of the affected upper limb, which will aggravate the spasm of the muscles responsible for joint flexion and cause deformity in elbow flexion, wrist flexion and finger flexion, making it more difficult to restore hand function. In fact, limb movement disorders are not only a matter of muscle weakness, but the uncoordinated muscle contraction is also an important cause of motor dysfunction. Therefore, it should not be mistaken that rehabilitation is strength training. The purpose of recovery treatment is to improve symptoms such as dizziness and headache, limb numbness disorder and unfavorable language to the best condition; and to reduce the high recurrence rate of cerebral thrombosis infarction.
At present, in the daily home care rehabilitation treatment, domestic home type limb movement rehabilitation device is often used to restore the movement of damaged limbs. In addition to the direct exercise of muscle strength, the passive antagonistic effect of the simulated movement coordinates and governs the functional state of the limb and restores its dynamic balance; at the same time, the repeated movement can provide feedback to the brain to promote the information, so that it can achieve the maximum functional reconstruction as soon as possible and break the spasticity pattern It is easy to operate, especially for home use, and restores voluntary motor control. This therapy can make the paralyzed limb simulate normal movement, enhance the patient’s self-confidence in recovery, and maximize the recovery of the patient’s muscle tone and limb movement.
1.Scientific and accurate use of drugs to prevent recurrence of cerebral infarction
Cerebral infarction is a chronic cerebrovascular accident with high recurrence and irreversibility, and patients still need to take medication regularly according to doctors’ orders after discharge, control the underlying lesions of arteriosclerosis such as hypertension, hyperlipidemia and diabetes, and review them regularly at hospitals. The effective drugs commonly used to treat cerebral infarction include anti-platelet aggregation drugs.
2.Start rehabilitation treatment as early and actively as possible
As mentioned before, cerebral infarction leaves many sequelae after formation, 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 of life, 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 6-12 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.
3.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 who have right-sided hemiplegia and are used to using their right hand (right-handedness) should train their left hand to do things. The clothes should be loose and soft, and special styles can be sewn according to special needs, such as putting a latch on the sleeve of the affected limb to measure blood pressure when going to the doctor. When dressing, wear the paralyzed side first, and then wear the healthy side; when undressing, take off the healthy side first, and then take off the affected side.
4, face reality, adjust emotions as the saying goes: “sickness comes like a mountain, sickness goes like a silk”. This saying is more apt for cerebrovascular patients. Facing 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 have good effects on depression and anxiety after cerebrovascular disease.
5.Functional recovery care of sequelae
(1) Patients with language disorders are more agitated and distressed. Health care personnel should contact patients more often, understand patients’ pain, keep patients in a relaxed mood and eliminate tension. Patients must be induced and encouraged to speak as early as possible, patiently correcting pronunciation from simple to complex, such as “e”, “ah”, “song”, etc., and repeatedly practicing persistently. This is helpful to promote the improvement and recovery of language function.
(2) In the acute stage of care, attention should be paid to the placement of the paralyzed limb in a functional position to prevent contracture deformity of the limb, mostly in supine and lateral positions. When the patient’s condition is stable, the patient should be guided and assisted to perform functional exercises with the help of a home-based limb exercise rehabilitation device, starting with simple flexion and extension, requiring adequate and reasonable activities to avoid damaging muscles and joints, 2 to 4 times a day for 5 to 30 minutes each time. It is also combined with medication, massage of the affected limb, acupuncture of Quchi, Hegu, and Foot Sanli. The patient is instructed to soak the affected limb with hot water frequently to promote its blood circulation.
(3) Skewed corners of the mouth. Clinically, it is common to see incomplete eyelid closure on the diseased side, drooping corners of the mouth, inability to wrinkle the forehead, close the eyes, puff out the cheeks, and whistle. Patients often develop negative emotions and lose confidence in treatment. The nurse should be sympathetic to the patient and give mental encouragement in order to gain trust and relieve their emotions. Diet should be easily digestible and nutritious liquid or semi-liquid diet. Combine with acupuncture of the cheek carriage, the ground compartment, Yingxiang and Sibai. Encourage the patient to do more eye, mouth and face exercises and massage the area frequently.
Hirudin has high affinity for thrombin and can form an extremely stable complex with thrombin, which has the effect of inhibiting the activity of thrombin at low concentration, and is a natural special inhibitor of thrombin.
Pharmacological effects.
①Anti-coagulation and anti-thrombotic: Hirudin can prolong or inhibit the coagulation process. Since hirudin directly targets thrombin, it can effectively prevent fibrin and blood cells from binding to form blood clots, so it can prevent the formation and extension of all kinds of blood clots.
②Hirudin can reduce platelet surface activity, inhibit platelet aggregation and reduce platelet adhesion.
③Effect on blood variation flow: leech decoction can reduce blood viscosity and decrease the content of fibrinogen in plasma.
④Lowering blood lipids: leech decoction given by gavage to experimental animals can lower the content of triglycerides and lipoproteins in the blood of rats, and can also lower the content of cholesterol and triglycerides in the blood of rabbits with hyperlipidemia on food bait, so that atherosclerotic plaques in the aorta and coronary arteries of experimental animals disappear and cholesterol crystals are reduced.
⑤ Hirudin can increase cerebral blood flow, promote the absorption of experimental cerebral hematoma in rats, reduce inflammatory reactive edema around hematoma, relieve intracranial hypertension, improve local blood circulation and protect brain tissue.