Repeated ischemic stroke: prognosis for the patient, survival, treatment features. Care and rehabilitation of patients in Moscow

Repeated ischemic stroke occupies one of the first places among diseases leading to disability and death. If life expectancy after the first stroke averages eight to nine years, then a second acute cerebrovascular accident can reduce it to two to three years. Therefore, in modern neurology clinics, one of which is the Yusupov Hospital, a large role is given to secondary stroke prevention.

It is proper prevention and treatment that can prevent the recurrence of a vascular accident, because, according to statistics, the probability of a second stroke within a year after the first is about 15%, and after a few years - up to 30-40%.

Who's at risk

After a primary stroke, the body retains mechanisms that provoke the following development of events: intravascular thrombus formation, vascular atherosclerosis. The patient, as a rule, also has a number of concomitant diseases, often in advanced forms: hypertension, diabetes mellitus, arrhythmia, heart failure and others. Preventing recurrent ischemic stroke in such cases is a rather difficult task, but thanks to the efforts of qualified specialists at the Yusupov Hospital, it is feasible.

Repeated ischemic stroke sometimes threatens even patients who are unaware that they have already suffered a vascular accident: patients with short-term disturbances of cardiac or cerebral circulation, the so-called transient ischemic attacks, manifested by the sudden onset of headache, dizziness, numbness of the arm or leg - symptoms which are often ignored, despite the fact that they are the first alarm bells preceding a stroke. The threat of vascular attack increases even more with transient loss of vision, speech, weakness in the upper or lower limb, sudden amnesia and other symptoms.

In this case, the patient should not hesitate; it is recommended to seek medical help as soon as possible at the neurology clinic of the Yusupov Hospital to obtain a doctor’s consultation. You will undergo the necessary examinations: ultrasound examination of large vessels (first of all, it is necessary to examine the carotid arteries), an electrocardiogram, ECHO-CG, detailed blood tests for the lipid profile and the tendency to form blood clots, the level of homocysteine - an amino acid that causes early atherosclerosis and thrombus formation, as well as several times increasing the risk of stroke and heart attack.

A similar examination is also recommended for patients who have suffered a hypertensive crisis, attacks of angina pectoris (pain in the heart area), or arrhythmia. These conditions often precede a stroke and are manifestations of transient ischemic attacks.

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How long do they live after a stroke: statistics in detail

The life expectancy of a person after a stroke is highly individual. In 20% of cases, a person’s death occurs instantly.

Studies have shown that in the first 30 days the mortality rate is 30-40%; after the first year after a stroke, approximately 50% of patients die.

The repeated process of cerebral circulatory disturbance increases the possibility of death. Often, if a patient has a first stroke, he can live up to 10 years, but with a second attack on the brain, life expectancy is no more than 3 years.

The reason for such a high mortality rate after a second stroke is that after the first attack, lesions remain in the brain.

Dependence on age and gender

With hemorrhage before 40 years of age, the death rate is 15%, after 50 years of age – 45% of cases.

Women have a higher mortality rate than men – 39% versus 29%.

It is several times more difficult for newborns and people aged 65 years and above to survive a stroke. This is due to age-related factors in blood vessels and their walls, which cannot recover quickly. In newborns, the cells have not yet formed. Such wall problems lead to:

inflammation of the cranial nerves;
damage to the vascular system;
hemorrhage.

Lesion size

This is the main aspect that affects how long a person can live after a stroke. Tissues susceptible to necrosis take a long time to recover.

The larger the affected area, the worse the prognosis.

How consequences affect the outcome

If after a stroke the patient begins to develop concomitant pathologies (paralysis, numbness or impaired psychological functions), then life expectancy decreases several times.

Life expectancy without movement

A person who is immobilized after an attack does not have the necessary desire for long-term recovery. Because of this psychological feature, a person does not strive to adhere to all norms and procedures, which is why muscle endurance decreases, fibers lose tone, and blood flow in the limbs is disrupted.

This ultimately leads to blood clots and tissue necrosis, which poison the blood.

Causes

There are several reasons for the development of a recurrent stroke, including factors beyond a person’s control that provoke the development of a recurrent stroke:

Patient's age
Hypertonic disease,
Alcohol, drug addiction, smoking,
Poor nutrition
Failure to follow doctor's recommendations
Stress,
Obesity,
Sedentary lifestyle,
High cholesterol levels
Increased irritability
Diseases of the cardiovascular system,
Improper work and rest schedule, night shifts, disturbed sleep,
Diabetes.

The most common type of vascular disorder is ischemic stroke, which accounts for up to 85% of cases. This type of stroke is caused by blockage of blood vessels supplying the brain or their critical narrowing.

The development of ischemic stroke is caused, first of all, by a person’s destructive lifestyle, which means: alcohol abuse, heavy smoking, poor diet, physical inactivity (lack of physical activity). Such habits lead to a deficiency of oxygen in the brain, associated with inadequate heart function, the loss of the vessels’ elasticity and ability to expand, due to which the blood flow increases, which is necessary for the normal functioning of the central nervous system.

Repeated ischemic stroke occurs due to a number of main reasons:

psychological and emotional stress;
excessive stress, heavy physical labor (most often, relapses occur during the summer season, if the patient spends a long time in an uncomfortable position, upside down, and also under the scorching sun, as a result of which dehydration occurs, increasing the risk of vascular accident);
deterioration in quality of life;
deterioration of the environmental situation;
indifferent attitude towards one’s own health (neglect of prevention, poor lifestyle).

Probability of relapse

The chances of getting a second stroke depend on the number and type of risk factors - specific indicators associated with morbidity, these include:

age. Beginning at age 55, the chances of surviving a brain stroke double every decade (3);
previous cerebral hemorrhage, significant area of necrosis;
late provision of medical care for the onset of a brain stroke;
atherosclerosis of the great vessels;
smoking;
excess weight;
alcohol abuse;
sedentary lifestyle;
previous myocardial infarction;
atrial fibrillation;
diabetes;
high cholesterol.

Symptoms and consequences

The symptoms of a second stroke are not always the same as those of the first stroke, and they are sometimes quite difficult to determine. Therefore, at the first manifestations of discomfort, it is advisable to turn to professionals - to the neurology center of the Yusupov Hospital, where the patient will quickly undergo a comprehensive examination and be prescribed immediate treatment, thereby minimizing the risk of developing severe complications. Our specialists will organize transportation of the patient to the hospital.

The main symptoms that should cause alarm in a patient who has previously suffered a first stroke:

the muscles of the face, body or limbs become paralyzed or numb;
vision deteriorates sharply, vision decreases, blindness occurs;
speech abilities are impaired;
consciousness is disturbed: slight drowsiness is felt, fainting occurs, coordination of movements is impaired;
Nausea and vomiting occur.

The severity of the attack depends on the volume of the affected part of the brain and the location of the affected area. Among the likely consequences of repeated ischemic stroke in the absence of adequate medical care are the following:

loss of control over the senses;
loss of ability to think;
impairment or loss of motor function;
death (in patients who have suffered a recurrent ischemic stroke, survival is significantly reduced).

Patients suffer a repeated ischemic stroke much more severely than the first, and it is sometimes impossible to predict what consequences it will accompany. In some cases, the nature of the resulting pathologies becomes irreversible. Therefore, the main role belongs primarily to stroke prevention.

Treatment of recurrent stroke and recovery after relapse

If there is a second stroke, the medical tactics are the same as for the first stroke. The patient must be hospitalized and placed in the intensive care unit (or intensive care unit). If it is necessary to lower blood pressure, antihypertensive drugs are administered intramuscularly or intravenously. Magnesium sulfate is used to combat cerebral edema. Recurrence of a hemorrhagic stroke requires measures to stop the bleeding. The patient is administered Aminocaproic acid, Vicasol or Etamsilate.

In case of repeated ischemic stroke, drugs that dilate blood vessels are indicated; they help to use reserves in the form of collateral vessels. The patient is administered vitamin PP, Drotaverine (No-Shpa), Eufillin, Papaverine and Complamin. To normalize blood viscosity, Reopoliglucin solution is used intravenously. Vascular tone is effectively restored by Vinpocetine and Cavinton.

Please note: Cortexin, Aminalon and Cerebrolysin are indicated for the restoration of nerve cells after 2 strokes. These drugs minimize the harmful effects of hypoxia on neurons.

With a second stroke, recovery is slow. After discharge home, the patient should be under the supervision of a neurologist. Rehabilitation requires the participation of an experienced psychotherapist. Patients who realize the severity of their condition tend to become depressed, and this only slows down the healing process. A patient who has suffered a stroke is taught relaxation techniques. Classes with a specialist allow you to stabilize your psycho-emotional state and create a positive attitude, which contributes to the speedy restoration of lost functions.

The text was checked by expert doctors: Head of the socio-psychological service of the Alkoklinik MC, psychologist Yu.P. Baranova, L.A. Serova, a psychiatrist-narcologist.

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First aid

When the first symptoms of a stroke appear:

Place the patient on the bed.
Call an ambulance.
Place the patient on his back or side if vomiting begins or he loses consciousness.
Unfasten clothes and belt.
Open the window to allow fresh air into the room.
Place a cold wet towel or ice in a bag wrapped in cotton cloth on your head.
Measure the patient’s blood pressure, pulse, and monitor blood pressure and breathing until the doctors arrive.
If necessary, give medications that were previously prescribed by the attending physician.
Constantly talk to the patient, try to get answers to questions from him, and do not lose contact.

Forecast

As is already known, the five-year survival prognosis is disappointing. Loss of intellectual and motor abilities after a second stroke can be lifelong. Most patients after a relapse suffer from irreversible changes and pathologies in the cerebral cortex.

After lesions, patients usually experience disability. In more than half of patients, after suffering a recurrent stroke, a coma occurs, which does not allow the doctor to give a positive prognosis about recovery from it.

Rehabilitation of patients after repeated ischemic stroke in the neurology clinic of the Yusupov Hospital is based on traditional, latest and original methods for the recovery of patients who have suffered a stroke.

Thanks to the extensive practice and rich knowledge of the clinic’s specialists in the field of rehabilitation medicine, comprehensive rehabilitation of patients is carried out at the highest level, meeting international standards.

For optimal rehabilitation, patients are provided with comfortable conditions of stay: cozy rooms, good nutrition and attentive attitude of the staff.

Call by phone and the coordinating doctor will answer all your questions.

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Life after ischemic stroke

If the patient experiences an acute period of stroke, then residual disorders are possible in the form of:

complete immobilization;
paralysis on one side of the body;
partial paralysis of a limb;
paresthesia (numbness with loss of skin sensitivity);
speech and swallowing disorders;
vestibular disorders;
hearing loss;
pelvic paralysis with inability to control bowel and bladder movements;
decreased intelligence;
changes in psyche and character;
impossibility of self-service.

Recovery of various impaired functions in patients with ischemic stroke occurs at different rates. Thanks to the use of innovative techniques in the rehabilitation clinic of the Yusupov Hospital, movement disorders go away faster, and it may take longer to restore speech. After discharge from the hospital, patients need support from loved ones and continued rehabilitation under the supervision of specialists from the Yusupov Hospital.

Prognosis in older people

In patients with ischemic stroke, age is one of the most important factors that influence the prognosis and quality of life after the acute period of the disease. In older people, ischemic stroke is much more severe than in younger patients. Doctors at the Yusupov Hospital take an individual approach to the treatment of elderly patients; when prescribing medications, they use doses recommended for a certain age. When using innovative methods of kinesitherapy, the age characteristics of the body are taken into account.

The prognosis after an ischemic stroke suffered by an elderly person is influenced by the following factors:

localization of the ischemic focus;
prevalence of cerebral infarction zone;
a disease that caused a stroke;
severity of neurological symptoms.

Coma caused by cerebral edema is the most severe neurological manifestation of a stroke, sharply worsening the prognosis.

Factors that positively influence the results of rehabilitation of elderly patients and improve the prognosis are:

a small lesion confirmed by computed tomography;
maintaining the patient's full consciousness;
minimal number of neurological damages;
absence of pronounced atherosclerotic changes in blood vessels according to the results of Dopplerography of the arteries of the head and neck;
the patient's profession requiring constant mental stress;
normal blood pressure;
absence of arrhythmias and other heart diseases.

Treatment

A patient with a recurrent stroke most often ends up in the intensive care unit. At the Yusupov Hospital, doctors begin treatment and early rehabilitation immediately after diagnosis. The prognosis is most favorable when patients are admitted to the neurology clinic within the first 4 hours from the appearance of the first signs of acute cerebral circulation. Doctors at the neurology clinic prescribe adequate treatment, thanks to which the nerve cells around the ischemic site completely restore functional activity.

The use of thrombolysis therapy by neurologists at the Yusupov Hospital for elderly patients significantly improves the prognosis. As a thromolytic agent, doctors at the neurology clinic use the most effective drug - tissue plasminogen activator. After the clot dissolves, blood flow through the affected vessels is restored, the supply of oxygen and nutrients to the ischemic area and the area around the cerebral infarction improves. The outcome of ischemic stroke is improved by the use of ancrod (an enzyme from snake venom) in the first 3 hours after the development of acute cerebrovascular accident and for five subsequent days.

To prevent further formation of blood clots and re-embolism, elderly people are given:

direct anticoagulants (sodium heparin or low molecular weight heparin);
antiplatelet agents;
drug from the thienopyridine group Ticlopidine.

If there are contraindications or a high risk of complications from taking these drugs, doctors at the Yusupov Hospital prescribe Clopidogrel to patients. Drugs with neuroprotective and neurometabolic effects improve the plasticity of nerve cells. The tone of cerebral arteries in elderly people increases under the influence of vasoactive drugs.

In elderly people, ischemic stroke often occurs against the background of severe arterial hypertension. During the 7-10 days of the acute period of stroke, cardiologists at the Yusupov Hospital when the patient’s systolic blood pressure is less than 200 mm. rt. Art. do not carry out antihypertensive therapy, since hypotension worsens the oxygen saturation of brain areas susceptible to ischemia. In patients with systolic blood pressure above 200 mm. rt. Art. it is reduced very slowly to numbers of 10 mm. rt. Art. exceeding the pressure to which the patient is adapted. After the acute period, cardiologists select individual antihypertensive therapy.

Characteristic symptoms

Recurrence of a brain stroke in most people affects the same area as the first time. The clinical picture may be supplemented by unfamiliar disorders if the localization of necrosis or its area is very different.

The main signs of pathology include:

unilateral/bilateral numbness, immobilization of the limbs, lower part of the face;
partial blindness;
double vision;
unsteadiness of gait;
lack of coordination;
confusion, incoherence, sluggish speech.

The main symptoms may be supplemented by headache, dizziness, nausea, vomiting, fainting, and convulsions. The development of the disease can be smooth (the number and strength of clinical signs increase gradually) or rapid. The latter is more typical for the hemorrhagic form, extensive cerebral infarction.

Rehabilitation

Early rehabilitation significantly improves the prognosis after a stroke. Doctors at the Yusupov Hospital begin to carry out rehabilitation measures from the first day the patient is admitted to the neurology clinic. The intensity of the rehabilitation program depends on the patient’s condition and the degree of his disability. At the Yusupov Hospital, the department for seriously ill patients is equipped with special multifunctional beds. Using the devices of a multifunctional bed, medical personnel can periodically change the patient’s position, carry out hygiene procedures, and care for the patient. Changing your posture helps avoid the formation of bedsores and congestion. To reduce the risk of developing contractures, joint pain, pneumonia, and deep vein thrombosis at the Yusupov Hospital, specialists carry out passive rehabilitation from the first days of treatment.

To improve the prognosis of older people, rehabilitation specialists at the Yusupov Hospital after a stroke use the following innovative methods for restoring impaired functions:

PNF;
Voita therapy;
minor manual therapy;
Castillo-Morales method;
kinesio taping;
Mulligan concept;
Bobath therapy.

Recommendations after a recurrent stroke

All patients who have suffered a stroke are at risk of relapse of the disease. Doctors at the Yusupov Hospital give recommendations to patients on nutrition and prevention of recurrent stroke:

Dieting. Refusal of spicy, smoked, fatty and sweet foods, alcohol, caviar, eggs, liver. The menu includes more vegetables, fruits, and grains.
Rejection of bad habits.
Refusal of heavy physical labor, night shifts, and work with high psycho-emotional stress.
Sleep at least 8 hours a day.
Avoid stressful situations.
During the rehabilitation period, measure blood pressure every day, after completion of rehabilitation at least 3 times a week.
Take medications prescribed by your doctor in a timely manner and strictly on time.
Regularly undergo preventive examinations.
Do the recommended therapeutic exercises daily.

Rehabilitation after a stroke at home

After overcoming the acute period in the hospital, a rehabilitation period begins for a pensioner with a stroke. Relatives need to decide where it is better for an elderly person to undergo a recovery course: at home or in a rehabilitation center.

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If the family has decided to independently care for the patient after a stroke, they need to follow the recommendations of the attending physician and maintain constant contact with specialized specialists: a psychologist, a neurologist, a speech therapist.

At home, a separate place is assigned to a bedridden patient after a stroke. The bed is equipped with an anti-decubitus mattress. A small table is placed nearby, on which essential items are placed: a bottle of water, care products, a table lamp.

Specialists can come to the home 1-2 times a week, work with the patient and teach home methods of conducting developmental activities. The rest of the time, family members carry out the recommended exercises with the pensioner for 10-20 minutes several times a day. During weekly visits, specialists monitor the dynamics of changes, make additions and adjustments.

Motor abilities are restored using a complex of therapeutic exercises. Before performing the exercises, it is advisable for the patient to take a shower or bath to warm up the body. If there are contraindications to taking a bath or other difficulties, the affected areas are warmed with a heating pad. The muscles will be more flexible and there will be no pain.

Examples of gymnastic exercises:

pulling up while lying on your back, holding the headboard of the bed;
eye movements left and right, up and down with closed and open eyelids;
alternately raising the right and left arms and legs;
bending the knee and grabbing the shin with the hand;
joint movements of healthy and motionless limbs to the right and left with a rubber ring put on them.

When carrying out therapeutic exercises, the pensioner’s condition is closely monitored. He shouldn't get tired. If such signs are observed, it means that the amount of stress does not correspond to the physical strength of the patient. We need to make an adjustment: reduce the pace and number of exercises.

Speech is restored by memorizing poetry and tongue twisters. At the initial stage, simple children's poems are chosen, which are easier for a pensioner to recite after a stroke. Gradually more complex material is selected.

Looking at family photographs can activate the process of remembering, since it is easier for the patient to recall the past in his memory. An elderly person remembers acquaintances and friends in the images, then the events associated with them. He tries to pronounce the names of the places he has visited, the objects he sees in the images.

Scientists believe that singing has a beneficial effect on people who have suffered a stroke. If they hear singing, sing together with loved ones, speech activity will be restored faster.

For rehabilitation to be successful, an elderly person should not be in a social “vacuum”: you constantly need to communicate with him, talk, ask questions, even if at first he cannot answer them. In this way, the patient’s desire to speak is stimulated, he remembers words and their meaning.

Chess, checkers, and dominoes are used to develop thinking abilities. In a family, even a small child can take part in restoring the health of a grandfather or grandmother by putting together puzzles, mosaics, or playing a board game.

A separate issue is the organization of nutrition for an elderly person after a stroke.

Excluded from use:

alcoholic drinks;
fatty and spicy foods;
coffee, strong tea;
sweets.

It is advisable to add to the diet:

drink liquid of at least 1.5 liters. per day;
increase consumption of fruits and vegetables;
eat whole grains;
replace sweets with dried fruits.

Food should consist of useful substances and be easily digestible so that the body is not overloaded.

It is useful to cook boiled vegetables, dishes from lean fish and meat, and porridge with low-fat milk. If there are paresis and problems with swallowing, the patient is fed through a tube with ready-made nutritional mixtures. As soon as the opportunity arises, you need to take the patient for a walk. Staying in the fresh air is good for brain activity, the body receives oxygen and vitamin D, and appetite appears.

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The moral atmosphere in the house is of great importance. Patients who receive family support recover faster. If they experience hostility from others or rudeness, the healing process is slowed down. There is no need to criticize and laugh at clumsiness and awkwardness. Only with encouragement will an elderly person develop a strong desire to overcome the disease.