Right-sided ischemic stroke: features and effects
- 20 Sep 19:15
- Causes and risk factors of ischemic stroke
- Classification of ischemic stroke
- function of the right hemisphere of the brain
- clinical picture of right-brain infarction
- diagnosis of ischemic stroke
- treatment of cerebral infarction
Ischemicstroke is one of the most frequent causes of death and disability among the population of developed countries. A few decades ago, the number of cases of hemorrhagic and ischemic stroke was equal, but today, the brain stroke is diagnosed in 85% of patients with apoplexy. Such sad statistics is associated with an increase in the prevalence of major risk factors for ischemic stroke - atherosclerosis, hypertension, diabetes mellitus, heart disease, ill-health, and bad habits.
The human brain consists of 2 hemispheres, the left and right. Infarction of the brain affects them with practically the same frequency. But, as practice shows, the right hemisphere stroke is easier, and recovery after it is more complete than after the left-hand stroke. Although rapid diagnosis of the right heart attack of the cerebral tissue is somewhat difficult due to the features of the first signs of pathology.
When lesions of the right hemiferous have almost no problems with the language, since the lingual center is in the left hemisphere( except for people with dominant right hemisphere of the brain).And violations of the language, as you know, is the landmark that the patients and others themselves pay attention to. Thus, the stroke of the right cerebral hemisphere may remain unrecognized for some time, which leads to late diagnosis and deterioration of the prognosis.
Causes and risk factors for ischemic stroke
Causes and risk factors for the development of acute right ischemia of the right brain of the brain are no different from those with left-handed impact.
The direct cause of the development of a heart attack of the right brain is a blockage of arterial vessels that feed it. At the same time block the flow of blood can an atherosclerotic plaque, embolus, thrombotic mass, the vessel can squeeze outwards or spasm for a long time. Also, until the development of an ischemic stroke can lead to hemodynamic disorders that are accompanied by a decrease in systemic blood pressure with the development of hypoxia in the brain.
The main risk factors for ischemic stroke:
- arterial hypertension( primary and symptomatic);
- is a violation of lipid metabolism with hypercholesterolemia, which leads to the development of cerebral atherosclerosis;
- smoking and alcohol abuse;
- migraine with aura;
- receiving hormonal oral contraceptives;
- diabetes mellitus;
- embolic diseases of the heart( congenital and acquired defects, flashing arrhythmias and other cardiac arrhythmias, artificial valves, rhythm driver);
- is a disease of the blood system with its increased susceptibility to coagulation;
- cervical osteochondrosis;
- systemic vasculitis( Takayasu's disease, Kawasaki's syndrome, etc.);
- infectious endocarditis;
- deep thrombosis of the shin and thighs.
The basis of the development of pathological changes in ischemic stroke is the discontinuation of blood access to the part of the brain that is powered by the blocked artery. The larger the diameter of the affected vessel, the worse the prognosis and the more coarse neurological defect will be observed in humans. If the neurons are oxygen free for 3-7 minutes, they have irreversible changes and cells die, in the brain tissue a necrosis( heart attack) is formed, which is subsequently replaced by scar tissue. As a result, the function of this area of the brain tissue, which will manifest itself by different focal neurological symptoms, is lost.
If within these few minutes blood flow spontaneously recovers( this is often the case), then the neurons do not die, and all the symptoms go unnoticed. Such a condition is called transient ischemic attack or microinsulte.
Video Transmission of Stroke Causes:
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Classification of ischemic stroke
There are several classifications of ischemic stroke, but the distribution of ischemia is of practical importance in terms of rates of development, since it defines therapeutic tactics and the direction of prevention.
The rates of development of acute cerebral ischemia are:
Functions of the right hemisphere of the brain
In order to understand why the ischemic stroke of the right hemisphere affects those and not other functions of the body, it is necessary to understand what corresponds to the right brain hemifield.
The main functions of the right hemisphere :
- control of the active movements of the left half of the body;
- providing facial expressions facial expressions;
- sensitivity to the left side of the body;
- vision, hearing, smell;
- feelings of intuition;
- orientation in space and location of a person;
- perception of non-verbal information( signs, symbols, images);
- recognition of emotions of other people by intonation and facial expressions, movements;
- is responsible for understanding metaphor and figurative meaning of words;
- is responsible for perceptions of music, a tendency to it;
- defines the tendency to draw;
- provides the functions of the brain, which is multitasking, that is, the simultaneous processing of several streams of information;
- provides an opportunity to fantasize, dream;
- allows you to perceive an item as a whole, rather than a set of individual details;
- is responsible for recognizing individuals;The
- is responsible for the perception of different colors;
- allows you to find differences between something;
- provides a person with the ability to think concretely.
. Accordingly, if this hemisphere is damaged, all of the described functions may be lost and eventually lost. The first effects of right-sided stroke that may be seen are left-handed paralysis of the arms and legs( hemiparesis) or one of the extremities, central paralysis of the mimic muscles on the left, visual impairment( obscurity, duality, loss of field of vision), hearing impairment, and odor. There are no language problems. Such a symptom( aphasia) can be observed only in people with dominant right hemisphere.
Much later, there are other symptoms of lesions of the right cerebral hemisphere that are associated with loss of one or more of the functions described above. A person may lose the ability to recognize the faces of people familiar with his subjects, can not understand the humor and metaphors( everything perceives literally).Loses tilt to music, to drawing. Ability to navigate in familiar terrain, the ability to find differences, learn colors, understand the emotions of other people.
Features of the clinical picture of right cerebral infarction
As already mentioned, often rapid diagnosis of the disease is difficult, since there is no problem with the language. The following symptoms are indicated for the development of right-sided stroke:
- headache, head swirling, nausea, vomiting;
- may be a disturbance of consciousness or loss of consciousness;
- is a reduction in muscle strength and complete inability to move in the left limbs;
- paralysis of the left side of the face( lower left corner of the mouth, sagging of the left lower stomach and cheeks);
- visual symptoms;
- sudden loss of orientation in the surrounding;
- sensory impairment on the left( tingling, numbness);
- sudden violation of coordination and equilibrium;
- rapid heartbeat, shortness of breath;
- excessive thawing;
- dry mouth;
- change in the normal color of the skin;
- Blood Pressure Increases.
If these signs are detected, seek medical advice immediately or call an ambulance. After all, every lost minute can stand for the patient's health or even life.
Diagnosis of ischemic stroke
For rapid diagnosis of a stroke, you can use the following test, which consists of 4 points:
In a hospital, a person with a stroke necessarily prescribes consultation of a neurologist, neurosurgeon, cardiologist. Conduct a complete laboratory examination of blood and urine, computer or magnetic resonance imaging of the brain, ECG, radiography of the chest, ultrasound of the heart, blood pressure monitoring. All these examinations allow to determine the type of stroke, its localization and magnitude, to form a competent medical program, to diagnose the concomitant pathology
Treatment of cerebral infarction
Treatment of right ischemic stroke is no different from the lesions of the left hemisphere of the brain. Conduct basic and specific therapy.
Basic treatment includes the following activities:
- support for basic functions of human life( respiration, cardiovascular system, homeostasis support);
- pressure normalization( in case of its increase, pressure is reduced gradually, since a sharp drop only increases the damage to the brain);
- normalizes temperature, since hyperthermia during a stroke negatively affects the prognosis;
- prevention and treatment of complications( pneumonia, pulmonary embolism, deep vein thrombosis of the limbs, bedsores);
- symptomatic therapy( elimination of tachycardia, arrhythmia, seizure, vomiting and other pathological symptoms);
- prevention and treatment of brain edema.
Specific treatment includes :
- for thrombolysis( if no more than 6 hours has passed since the stroke), intravenous administration of special medications, thrombolytics that can dissolve the blood clot in the brain, thereby reducing the area of brain damage and significantlythe forecast improves( high chances of recovery);
- prescribes anticoagulants and antiaggregants, drugs that dilute blood and prevent the re-formation of blood clots;
- neuroprotection - the introduction of drugs that protect even more viable neurons from damage.
First-aid stroke video:
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Thus, we can conclude that the right-side ischemic stroke is not different from the left-hand side for reasons, mechanism of development, principles of diagnosis and treatment. But it has the features of the clinical course and the corresponding consequences that need to be taken into account during the rehabilitation phase.