Consequences of cerebral edema after a stroke, recommendations from specialists

One of the dangerous conditions is cerebral edema during a stroke, which inevitably occurs. This process is the accumulation of fluid in the brain tissue and nerve cells, which leads to high pressure inside the skull and, as a result, severe headaches and other serious consequences. How to diagnose, treat correctly, and what is the prognosis after cerebral edema during a stroke?

Cerebral edema during stroke, types of this condition

Cerebral edema and stroke are two “inseparable” conditions. A stroke is a hemorrhage in the brain tissue, after which it swells and swells.

There are two types of this phenomenon:

1. Ischemic, caused by thrombosis of arteries and nerve endings of brain cells.
2. Hemorrhagic, occurring as a result of increased intracranial pressure, in which the vessels cannot withstand and rupture.

If, due to damage to brain tissue, cerebral edema during a stroke spreads to the cerebellum oblongata, in most cases death occurs. This is due to the fact that the process occurs with the death of cells of the respiratory system and blood vessels of the musculoskeletal center.

Common Causes

The pathological condition occurs only due to the growth of intercellular substance and cerebrospinal fluid in the skull. Factors directly leading to the development of the disease are most often the following:

1. increase in blood plasma pressure;
2. transformation of the blood balance towards an alkaline composition reduces its fluidity;
3. deficiency of nutrients and oxygen deficiency causes a decrease in the intensity of transport of substances;
4. disorder in the main arteries and veins of normal circulation;
5. Failure of energy metabolism in brain cells causes local inflammation and congestion in the affected areas, which forms an increase in cells due to a large volume of excess fluid.

Classification of cerebral edema

Based on the nature of its course, cerebral edema during stroke is classified into two main types:

1. Cytotoxic, in which there is significant swelling of brain cells.
2. Vasogenic, characterized by the leakage of brain fluid into the intercellular space.

Based on volume and location, cerebral edema during stroke is divided into the following types:

• Local, developing clearly in the area of ​​damage,
• Diffuse, in which the lesion affected one hemisphere,
• Generalized, covering two hemispheres of the brain.

Based on the form of formation and the degree of damage, swelling can be expressed differently.

Consequences and prognosis

Cerebral edema during a stroke is dangerous because the person who suffered it may face various negative consequences in the future. Partial death of nerve tissue can lead to remission of some body functions, which often cannot be restored because they are irreversible.

The most common of them are: distortion of the facial muscles, chronic migraines, difficulties in performing certain movements, dulling of sensory perception, mental pathologies of varying severity.

Another common consequence is the possibility of relapse . At the same time, its nature and severity of consequences are aggravated.

Rehabilitation

The consequences and final condition after cerebral edema due to a stroke are a prerequisite for the implementation of rehabilitation measures that allow the human body to partially recover. They pursue the goal of the most complete social adaptation of a person and the possibility of restoring lost motor functioning.

Recovery is carried out in two directions: physiological and psychological. Psychological recovery often requires help and advice from a psychologist or psychiatrist, as well as specific exercises. Positive conditions created within the family circle are of high importance.

It is very important for a person undergoing rehabilitation not to feel like a heavy burden for family and friends. It is important that he has a favorite pastime or an interesting hobby, a sufficient social circle and the opportunity to share his thoughts with someone.

Physiological recovery contributes to the acquisition of physical capacity and the return of basic life skills. It occurs with the help of therapeutic exercises, physical exercises and therapeutic massage, which a person can do independently or with outside help.

Symptoms of cerebral edema after a stroke

Due to the increase in tissue inside the skull, significant pressure occurs on it, so the first obvious manifestation is a severe headache. In addition, cerebral edema after a stroke is accompanied by the following symptoms:

• Increasing headache
• Partial loss of vision or focus,
• Disorientation in space,
• Swelling of the face, general puffiness, or unilateral swelling of the face during a stroke,
• Sudden onset of nausea and vomiting (not associated with other causes),
• Speech impairment, swelling of the tongue after a stroke,
• Partial or complete anemia of the limbs,
• Slight memory loss
• The appearance of seizures
• Shortness of breath, irregular breathing rhythm.

The essence of pathology

A stroke is a process of disruption of cerebral circulation. It occurs for two reasons:

• vascular spasm and ischemia of the medulla area,
• rupture of a vessel and bleeding into the brain.

In connection with these mechanisms, ischemic and hemorrhagic stroke are distinguished. Numerous factors contribute to the occurrence of these conditions.

Table. Provoking factors for cerebrovascular accidents.

The peak formation of ischemic lesions occurs in old age. Hemorrhagic strokes occur at any age.

Symptoms

Any type of cerebrovascular accident has a characteristic clinical picture. More severe symptoms are observed with hemorrhagic stroke. Ischemia develops gradually, so symptoms develop over several hours.

With ischemic damage, moderate headache, dizziness, nausea and vomiting are noted. Against this background, focal symptoms appear. They depend on which part of the brain is affected by ischemia and the extent of the lesion. The main manifestations are:

• visual and hearing impairment, hallucinations are possible,
• speech impairment of varying severity,
• paresis and paralysis of the limbs - left or right, bottom or top,
• impaired sensitivity in different parts of the body,
• paresis or paralysis of facial muscles.

With the development of intracerebral hemorrhage, a sudden headache occurs, accompanied by nausea and vomiting. There is blurred vision and tinnitus. Within an hour, focal signs develop. They depend on the area in which the hemorrhage occurred. Their severity increases as the intracerebral hematoma increases. Hemorrhagic stroke is characterized by more severe symptoms. Often, an extensive hematoma leads to the development of a coma.

Attention! A stroke patient acquires a characteristic appearance. Due to paresis of the facial muscles, the corner of the mouth and eye droop, the cheek hangs on one side and swells. If a person is conscious, he cannot completely close his eyes or bare his teeth. There is a speech disorder - the person pronounces only individual sounds.

More information about diagnosing a stroke is described in the video:

Cerebral edema during stroke, prognosis for life

In difficult situations, stupor and even a coma develop; in this case, cerebral edema during a stroke, the prognosis for life is no more than 40%.

With small lesions of brain tissue, the prognosis for normalization of the condition is much better. With proper treatment, although some brain cells die, there is a lack of dopamine in the blood. As a result, the patient may develop consequences such as irritability, depression, etc.

The prognosis for life after rehabilitation directly depends on timely assistance provided and the degree of localization of the volume. Possible consequences:

• Decreased physical activity
• Loss of muscle tone
• Insomnia,
• Absent-mindedness,
• Migraine,
• Fast fatiguability.

Rehabilitation

Recovery of the consequences of a stroke after swelling is determined by the promptness of therapy. If the affected area is too small, the patient recovers completely . Often patients suffer from unilateral paralysis. For rehabilitation purposes, psychological and physiological effects are carried out. For the purpose of psychological rehabilitation, you need to get help from specialists, consult a psychotherapist, and take regular classes.

A positive atmosphere in the family is of great importance. The patient should not feel like a burden to loved ones. It is advisable to find a job he likes, in company with other patients after serious illnesses.

Physiological procedures allow you to restore the ability to self-care and perform everyday skills. This procedure is carried out using physiotherapy and gymnastics. Initially, the specialist teaches the patient the first exercises, then he can perform them independently at home.

It will be possible to restore the functionality of the body only partially by performing procedures determined individually for each person. Let us list the general characteristics of such rehabilitation methods. After some time after the condition has stabilized, the patient needs to increase physical activity. Massage on damaged areas. Active motivational support. Increased physical activity.

Patients need to follow dietary recommendations to restore the functioning of the cellular structure and saturate the body with useful microelements.

Diagnostics

To identify this condition, it is important to conduct a qualified examination and comprehensive tests:

1. Examination by an experienced neurologist, collecting anamnesis, determining reflexes, the presence of seizures and disturbances in movement and speech.
2. Spinal puncture, characterizing the level of pressure inside the skull.
3. Examination by an ophthalmologist, examination of the fundus to determine swelling of the intraocular nerve.
4. MRI and CT scan of the skull.

In addition, the following laboratory tests are prescribed:

• Blood analysis,
• Biochemistry,
• Coagulogram.

Emergency help

Brain swelling after a stroke can develop very quickly; on average, during a stroke, brain swelling reaches its peak after 30-40 minutes. At the first symptoms (swelling of the tongue, loss of coordination, speech), timely medical attention is necessary; this will help prevent serious complications.

Before the peak of the condition occurs, it is necessary to put the person in a horizontal position and measure the pressure. If the level is elevated, antihypertensive drugs are immediately prescribed:

• Beta blockers (Acebutalol, Atenolol, Bisoprolol),
• Calcium channel inhibitors (Acridipine, Breinal, Plendil).

It is imperative to take medications to eliminate the consequences of this condition and lower blood pressure. For this it is recommended to use sedatives.

To normalize body temperature and stimulate the outflow of fluid, apply ice compresses until an ambulance arrives.

You should not self-medicate if you experience cerebral edema during a stroke; urgent hospitalization is necessary.

Preventive and therapeutic measures

It often happens that to avoid cerebral edema during a stroke, it is enough to regularly carry out preventive measures aimed at adjusting diet and rest, especially for people who are overweight or prone to hypertension.

It is necessary to periodically monitor blood pressure, avoid drinking alcohol, nicotine and other bad habits, as well as emotional stress. Lead an active lifestyle and spend more time in the fresh air, exercise and follow a proper, balanced diet.

There are a number of medications, as well as vitamins and microelements aimed at preventing strokes, as well as traditional methods. In short, the choice is quite wide.

Treatment of cerebral edema

As for treatment, in accordance with the medical opinion and diagnosis, a course of therapy is prescribed, the purpose of which is to slow down and eliminate edema, as well as ensure the drainage of excess fluid. These goals are achieved through medication and surgery.

Treatment includes several points and is carried out in the intensive care unit or intensive care unit:

1. Maintaining adequate respiratory function. For this purpose, medications are prescribed to stabilize breathing. Regular monitoring is carried out, the purpose of which is to regulate normal breathing, periodic sanitation of the respiratory tract is carried out, as well as oxygen therapy. In some cases, the patient is transferred to a ventilator.
2. Restoration of microcirculation and blood circulation, to stabilize which special medications are prescribed that relieve vasospasm. The parameters of the cardiovascular system are monitored, and intravenous infusion is administered to maintain the required level of pressure in the circulatory system. Polyglucin or macrodex are used to thin the blood.
3. Ensuring fluid drainage to reduce intracranial pressure. For this, mannitol is used, a drug that pumps out excess fluid from the brain. It is subsequently excreted from the body in urine. In some cases, a drainage procedure is performed through a catheter or forced decompression using craniotomy.
4. Methods for eliminating hypoxia include the use of antihypoxic medications (Citicoline), which reduce hypoxia and prevent further development of swelling.

Treatment of cerebral edema after stroke

Based on the results of examinations and tests, an experienced doctor prescribes an individual treatment regimen for each specific case in order to minimize the risk of complications.

The patient needs round-the-clock care and observation. First of all, it is necessary to provide the patient with oxygen access to the brain and eliminate the source of edema.

Therapy

Treatment and elimination of edema consists of complex therapy. Qualified treatment in a hospital will speed up recovery and prevent serious consequences:

Restoration of blood circulation

• In case of edema after an ischemic stroke, to eliminate thrombosis, blood circulation is normalized through fibrinolytic therapy using the enzymes Urokinase and Alteplase.
• In case of edema after a hemorrhagic stroke, blood flow is restored using an antihypertensive technique.
• If a patient has increased blood clotting, antiplatelet agents such as Aspirin and Clopidogrel help normalize blood flow. To prevent aspiration of vomit, a nasogastric tube must be installed.

Elimination of fluid Taking diuretics restores normal levels of fluid circulation and helps eliminate cerebral edema after a stroke. To get rid of excess fluid in the area of ​​edema, osmodiuretics are prescribed, for example, Mannitol solution (depending on contraindications 10, 15, 20% concentration), Sorbitol 40%, Glycerol. To enhance the effect of the drug Mannitol, a course of saluretics is required, for example, the drug Furosemide.

Relieving seizures Stroke and its consequences do not go away without seizures; they must be eliminated. To achieve the desired effect, muscle relaxants and barbiturates will be indispensable; for this, effective drugs such as Relanium and Thiopental are prescribed.

Normalization of breathing If the partial pressure of oxygen drops and there is dysfunction of the respiratory system, a course of artificial ventilation is prescribed. If necessary, an oxygen therapy procedure is performed, oxygen is introduced into the body to saturate the blood and brain cells, which will speed up recovery.

A comprehensive course of medications is also prescribed:

1. Angioprotectors normalize the state of cell membranes in the brain space - “Troxevasin”, “Ascorutin”, “Ditsinon”.
2. To increase vascular tone, take Trental and Cavinton.
3. Corticosteroids can quickly slow down the spread of edema.

Important! In case of cerebral edema as a result of a stroke, intravenous administration of the necessary drugs is preferable to normalize blood flow and pressure levels, as well as to prevent the development of infection.

How is the treatment carried out?

Initially, it is advisable to use medicinal and conservative treatment. The following groups of drugs are used for treatment:

1. Diuretics - serve for emergency evacuation of excess fluid from the brain. Drainage of the peri-cerebral region and craniotomy are resorted to in exceptional cases;
2. Antihypertensives - used in cases of other genesis with secondary hypertension to reduce blood pressure and cure hypertension if the tonometer readings exceed 180 to 100;
3. Nootropics - serves for the rapid restoration of brain tissue cells;
4. Anticoagulants - normalize blood composition and fluidity;
5. Antiplatelet agents - taken to prevent and prevent thrombosis in the vessels of the brain, improve blood circulation;
6. Painkillers - relieve the main symptom - headache;
7. Anticonvulsants - help prevent muscle spasms. Normalize the patient's condition.

To identify the stage of progression of the pathology in a hospital setting, the nature of the course of the disease is diagnosed. When detecting cerebral edema in the initial stages, the doctor relies on the effectiveness of medications of different groups.

In case of late detection of stroke, radical methods are used - surgery:

• Craniotomy is the most effective way to immediately relieve pressure in the skull. If possible, surgery allows you to eliminate the cause of edema in the future;
• Installation of a catheter - after opening the skull, this device is used to remove excess fluid, a necessary measure for hemorrhagic stroke.

Useful video on the topic: