Hemorrhagic stroke includes: cerebral hemorrhage and subarachnoid hemorrhage.
Ischemic stroke includes: cerebral infarction (cerebral thrombosis, cerebral embolism, lacunar infarction, multiple cerebral infarction) and transient ischemic attack. The usual symptoms are mouth-eye deviation, language impairment, hemiplegia, disturbance of consciousness, dysphagia and so on. Stroke-prone people are mostly middle-aged and elderly people.
1, cerebral thrombosis (thrombotic cerebral infarction)
Also known as cerebral thrombosis, it belongs to a kind of cerebral infarction. It is a disease that cerebral atherosclerosis leads to the gradual narrowing or even complete occlusion of blood vessels. Due to the formation of cerebral vascular thrombosis, the blood supply of local brain tissue is insufficient, further softening and necrosis. Symptoms vary according to the location of cerebral thrombosis. Cerebral thrombosis is the disease with the highest incidence of stroke, accounting for more than half of all stroke cases, mostly occurring in middle-aged and elderly people aged 55-65, with more males than females. It often happens in a quiet state. At the beginning, there may be numbness, weakness, dizziness, headache, etc. , and in 2-3 days may appear half limb failure, aphasia, disturbance of consciousness, coma, etc. In severe cases, it may lead to death. The clinical symptoms of cerebral thrombosis and cerebral hemorrhage have many similarities and are easily confused, but the treatment scheme is completely opposite. The former needs hemolysis and the latter needs coagulation. The prognosis of cerebral thrombosis is better than that of cerebral hemorrhage, but some patients will also have sequelae such as hemiplegia.
2. Cerebral embolism (embolic cerebral infarction)
There is a great difference between cerebral embolism and cerebral thrombosis. Its primary disease is not in the brain, but the "embolus" formed by other parts of the body (mostly the blood vessels of the heart and limbs) enters the blood vessels, flows into the cerebral arteries, and blocks the lumen, thus causing cerebral embolism, causing ischemia and softening of brain tissue, resulting in the same consequences as cerebral thrombosis. What is an embolus? There are blood clots, fat, air and vegetation on the heart valve. The incidence of cerebral embolism is also very high, and the onset age is mostly young adults aged 20-40. It has an acute onset without warning, and its symptoms are similar to cerebral thrombosis, such as headache, vomiting, unconsciousness and hemiplegia. Patients with rheumatic heart disease, atrial fibrillation and subacute bacterial endocarditis are more likely to suffer from cerebral embolism than others.
3. Cerebral infarction (lacunar infarction)
Lacunar cerebral infarction is a special type of cerebral infarction. On the basis of hypertension and arterialization, deep cerebral arterioles are occluded, resulting in ischemic softening of brain tissue. The range of lesions is generally 2-20 mm, of which 2-4 mm is the most common. Clinically, most patients have no obvious symptoms, and about 3/4 patients have no symptoms of focal nerve damage, or only mild symptoms such as inattention, memory loss, mild headache, dizziness, dizziness and unresponsiveness. The diagnosis of this disease is mainly CT or MRI. However, multiple lacunar cerebral infarction can affect brain function, lead to progressive decline of intelligence, and eventually lead to cerebrovascular dementia.
The following measures should be taken to prevent lacunar cerebral infarction: 1. Patients with hypertension should be treated with drugs for a long time, and their blood pressure should be measured regularly to keep it within the normal range. 2. Diabetic patients should strictly control their diet, adhere to hypoglycemic treatment, and control their blood sugar within the normal range. The blood pressure of diabetic patients should be controlled at ≤130/85 mmhg; 3. Patients with hyperlipidemia should be treated with lipid-lowering therapy; 4. Check the hemorheology regularly. If the blood viscosity is too high, low-dose aspirin should be taken orally. 5, regular heart examination, pay special attention to the changes of heart function and arrhythmia, improve blood supply to the heart, prevention and treatment of coronary heart disease; 6. For sudden symptoms such as headache, dizziness, dizziness, memory loss, slow response, forgetfulness, blurred vision, facial numbness, etc., we should be vigilant and go to the hospital as soon as possible to have a head CT for early detection and early treatment;
Multiple cerebral infarction refers to multiple ischemic softening infarction in the brain, also known as multiple encephalomalacia. In addition to common paralysis, sensory and language disorders, dementia may also occur. Doctors call this dementia multi-infarct dementia (that is, atherosclerotic dementia). Multiple cerebral infarction is common in men aged 50-60, and hypertension and arteriosclerosis are the main reasons. The more pathological changes in this disease, the higher the incidence of dementia. Bilateral infarction is more prone to dementia than unilateral infarction. Therefore, we should actively prevent the recurrence of cerebral infarction.
5. Transient ischemic attack (TIA), commonly known as small stroke.
Many patients with cerebral infarction have a symptom of limb weakness or numbness in a short time before onset, accompanied by sudden unfavorable speech or unclear pronunciation. However, because the above symptoms often disappear within a few minutes, the head CT examination is normal and it is not easy to attract attention. In fact, this is a transient ischemic attack caused by tiny cerebral thrombosis, which is medically called a small stroke. About half of patients with minor stroke will have hemiplegia within 5 years, so we must attach great importance to minor stroke, see a doctor as soon as possible, and carry out prevention and treatment. The pathological basis of transient ischemic attack also occurs on the basis of cerebral arteriosclerosis, but the degree of lesion is light and the ischemic time of brain tissue is short. Most of them occur in the elderly with a history of arteriosclerosis or hypertension. Symptoms of mild stroke are the same as those of premonitory symptoms of stroke, mainly including sudden landing with objects in hand, hemiplegia, hemiparesis, unilateral sensory disturbance, monocular visual impairment, headache and dizziness, tinnitus, dysphagia, language disorder, etc. The difference between mild stroke and stroke aura is that the symptoms disappear quickly, lasting for several minutes to 1 hour, and the longest is no more than 24 hours. Minor stroke usually returns to normal within 24 hours. If you examine the brain tissue of patients with minor stroke, you will find that no brain cells die. After a minor stroke, the patient's brain cells should be completely normal. If it exceeds 24 hours, the patient will have brain cell death, which is cerebral infarction.