(I) Atherosclerosis?
Atherosclerosis is the most common cause of cerebral thrombosis, so much so that the latest classification of cerebrovascular disease renamed cerebral thrombosis as "atherosclerotic thrombotic cerebral infarction".
The development of atherosclerosis is associated with vascular endothelial cell damage, hyperlipidemia, hypertension, and hemodynamic abnormalities. The etiology of the development of atherosclerosis is thought to be related to high levels of blood lipids, particularly a substance called low-density lipoprotein-cholesterol (LDL-C). It is also related to lifestyle, nutrition and genetic factors. For example, eating foods that contain too much fat (fatty meats, grease) and carbohydrates (sugar, starch, etc.); too little physical activity; obesity, high blood pressure, diabetes mellitus and their family history (parents or/and siblings with the same disease). Recent studies have found that atherosclerosis is associated with mutations in genes such as apolipoprotein, a protein involved in fat metabolism.?
Atherosclerosis is a systemic disease of the blood vessels that occurs in different organs. If atherosclerosis occurs in the coronary arteries that supply the heart, you can get coronary atherosclerotic heart disease (coronary heart disease). Atherosclerosis of the cerebral arteries occurs mainly in the large and medium arteries supplying the brain, and the most vulnerable sites for stenosis are the bifurcation of the common carotid artery in the neck, the vertebral artery entering the cranial cavity, and the beginning and bifurcation of the basilar artery. As the endothelium breaks down, lipid deposits form plaques, and platelets and fibrin in the blood are deposited on top of the plaques and become mechanized, resulting in thickening of the vessel wall and narrowing of the vessel lumen, leading to insufficient blood supply to the brain. If the lesion develops further, the lumen of the blood vessel is severely narrowed or even completely occluded, or on the basis of narrowing due to high blood viscosity (commonly known as thickening of the blood), a thrombus is formed on the plaque to block the blood vessel, and ischemic necrosis of the brain cells in the area of the blood supply of this blood vessel can occur.
(ii) Less common causes of cerebral thrombosis?
A variety of arterial inflammatory diseases, such as infectious arteritis (tuberculous, parasitic, septic, etc.), collagenopathic arteritis (e.g., a disease called systemic lupus erythematosus), and vaso-occlusive vasculitis. Hypercoagulability caused by various diseases, such as the abnormal elevation of red blood cells in patients with chronic lung disease due to prolonged hypoxia, and hypercoagulability in women in early pregnancy due to vomiting and dehydration combined with elevated estrogen and progesterone, may induce cerebral thrombosis. In addition, there is a rare disease characterized by an increase in red blood cells called "true erythrocytosis", patients with this disease are also prone to cerebral thrombosis.
How do I know if I have a cerebral thrombosis?
To confirm whether a person has a cerebral thrombosis, it is not enough to rely on the above clinical manifestations and the doctor's examination, but also requires the following necessary instruments and laboratory tests.
(A) CT scan of the head?
CT scan is a more convenient and cheaper test to diagnose cerebral thrombosis. It can clarify the location of brain tissue necrosis (i.e., cerebral infarction), the size, the degree of cerebral edema and other guiding information for treatment. However, the lesion can not be detected within 24 hours of the onset of the disease, and the significance of CT scanning at this time is to exclude cerebral hemorrhage, in order to buy time for the early start of treatment. In addition, the shortcoming of CT is that it does not show the lesions in the brainstem and cerebellum well.
(2) Cranial magnetic **** vibration scan (MRI)?
This test can make up for the shortcomings of head CT in 24 hours can not find lesions, and some parts of the lesions of the poor display, especially magnetic *** vibration angiography (MRA) can still show the larger occluded blood vessels. Its shortcomings are that it is more expensive, and the ownership rate of hospitals is not high. And some patients can't have this test because they have metal objects in their bodies that can't be removed, such as cardiac pacemakers, metal teeth, and fracture nails, limiting its use.?
(C) Cerebral angiography?
The test can find the site of stenosis and occlusion of blood vessels, and in the early stage (within 6 hours of the onset of the disease) can still be injected directly into the stenosis or occlusion of thrombolytic drugs for thrombolysis, but the disadvantage is that there is a certain amount of damage and complications.
The treatment of patients found to have cerebral thrombosis?
(I) Maintain sedation?
The light patients can be allowed to lie down, head high 30 degrees ° or so, regardless of the means of transportation, the patient should be sent to the nearby municipal hospitals as far as possible within 1 to 2 hours, to avoid the first small hospitals due to the lack of appropriate examination equipment transfer and delay. The best dialing 120 emergency vehicles, waiting for the car, such as the patient has a consciousness disorder, vomiting and other symptoms, can be the head side to one side, so as to avoid vomit accidentally inhaled into the lungs.
(2) Try to have enough cash or checks ready?
To avoid delays in treatment due to unavailability of funds when you arrive at the hospital.?
Family members work with doctors at the hospital for treatment?
(a) Assist in care?
Cerebral thrombosis patients are mostly obese, some also combined with diabetes mellitus, now hemiplegia, local neurotrophic disorders, the pressure for too long will cause skin ulceration, the formation of "bedsores". Once occurred may be due to infection and fever and aggravate cerebrovascular disease, severe cases can also cause sepsis and cause the patient's death. Therefore, family members should pay attention to turn over, patting the back, scrubbing the skin with warm water, and gently massaging the parts that have been pressed, especially the more prominent parts of the skeleton, such as the spine, sacrum and tail. The frequency of turning is usually about 2 hours. If you find a skin ulcer, report it to the health care provider for early treatment. Patients with urinary and fecal incontinence should change their diapers, wash with warm water after each visit, dry and put on talcum powder.
(ii) Dietary problems?
Some patients have difficulty swallowing after the disease, which is caused by paralysis of the muscles in charge of swallowing.
The patient chokes and coughs when eating, especially when drinking water, and even food is sprayed out from the mouth and nose. At this time, we should be careful not to force the patient to eat water or medicine. For light patients can be allowed to eat sticky food, such as thick porridge, soft rice and so on. Boiled and chopped vegetables, minced meat and other side dishes are mixed into the rice, avoiding too thin and too dry food, which can be easily swallowed. Oral medications can be crushed and mixed into food if not contraindicated. Serious patients require a nasal diet, in which a rubber tube is inserted into the stomach through the nostrils, and food such as rice soup, milk, vegetable juice, etc., is injected into the stomach with a syringe to ensure adequate nutrition. Oral medications can also be injected through the gastric tube. Care must be taken that the injected food and medicines do not have large particles to avoid blocking the gastric tube. Nasogastric feeding diet at a certain stage is to ensure that the treatment must be means, directly related to the success or failure of the patient's rescue. Some patients and their families are reluctant to accept the gastric tube, so that the patient reluctantly swallowed, this is very dangerous, if the food is mistakenly inhaled into the respiratory tract, the lesser caused by lung infection, resulting in aspiration pneumonia; the heavier may be due to asphyxiation and death.
(3) Pay attention to the observation of changes in the condition and report any abnormalities to the medical staff in time?
Patients with cerebral thrombosis have a relatively slow onset of symptoms, and most of them do not have consciousness disorders. However, the condition may progressively worsen within a few hours or days. Despite aggressive treatment, healthcare professionals sometimes cannot stop the progression of the disease. If the blocked blood vessels are large, the area of necrosis of brain tissue is large, and cerebral edema is obvious, the patient may gradually develop drowsiness, i.e., he can wake up when called, and fall asleep again immediately when not called. Severe cases may enter coma. Family members should pay attention to observe whether the strength of the paralyzed limbs of the patient gradually becomes smaller or even completely inactive. What is the mental state? If the patient is found to be drowsy and depressed, notify the medical staff immediately. At the same time, the critically ill patient should record the daily amount of food and water, urine volume, etc., so that the doctor reference.
(4) Early to help patients move paralyzed limbs, promote rehabilitation?
The day after the onset of the disease, if the condition is stable, you can start to do passive movement of the limbs, that is, to help the patient paralyzed limb extension and flexion activities. This is conducive to promoting blood circulation in the paralyzed limbs, preventing deep vein thrombosis, promoting muscle strength and joint mobility, and preventing limb contracture and deformation. Inactivity should make the patient's paralyzed limbs in the anti-spasmodic position, i.e., lying on the back with the affected upper limb on a pillow so that it is slightly abducted, externally rotated, elbow joints slightly flexed, wrist joints slightly dorsally extended, holding a cylindrical object of the appropriate size, such as a roll of handkerchiefs. Cushion the back so that it is forward and upward; the lower limbs outside the hip pad so that the hip joint is inward, the pelvis is forward, a soft pillow under the knee joint so that the knee joint is flexed, the ankle joint should be kept at 90 ° to prevent foot prolapse, the patient can be allowed to put the top of the foot on the bed or the wall or the homemade splints. Head height of 30° is appropriate when lying on the back, not too high. Lateral position should be taken as far as possible paralyzed limb on the upper position, in front of the chest and lower limbs in front of each placed a pillow, upper limb extension, lower limb flexion on the pillow.
(E) pay attention to the patient's emotional changes?
Patients from normal people suddenly lose the ability to move and language, to the loss of self-care and work ability, emotionally difficult to bear, so there are often depression, anxiety and other emotional changes, temperamental, and even personality changes. Family members should actively cooperate with medical personnel, comfort and encourage the patient to cooperate with treatment and rehabilitation exercises. Try to avoid letting the patient emotional excitement.
Family care and treatment during the recovery period of cerebral thrombosis?
Brain cells die due to ischemia and hypoxia when the blood vessels are occluded. The later the treatment starts, the bigger the blocked blood vessels are, the more brain cells die, and the brain cells cannot be regenerated after death. Therefore, despite the many positive measures taken by doctors, patients will inevitably be left with different degrees of disability, also known as "sequelae". These sequelae are not possible in the hospital, especially to save lives as the main purpose of the general hospital to be resolved, need to be in the rehabilitation hospital, in our country is still mainly home for further convalescence and rehabilitation.
(I) regular medication on time to prevent the recurrence of cerebral thrombosis? After the patient is discharged from the hospital still need to take medication regularly according to the doctor
Student instructions, control diabetes, hypertension and other atherosclerosis of the underlying lesions, and regularly to the hospital for review. Commonly used drugs are anti-platelet aggregation of drugs, such as small-dose aspirin, against the Keloid; cerebral protection drugs, such as nimodipine; oxygen free radical scavengers, such as vitamin E, vitamin C and so on. Some patients hate to take medicine, all the advertised drugs want to try, or think that the more drugs the better. In fact, this is not good for the body. Not to mention that the efficacy of drugs may not be as magical as the ads say, alone any drug has to be metabolized by the liver and kidneys, too much medication will aggravate the burden of the liver and kidneys of the elderly has not been too healthy; pharmacologically, too many drugs into the body, each other will play a role in reducing the efficacy of their own, or even aggravate the side-effects, to the body causing harm. What drugs to take and how to take them? It is best to listen to your doctor's advice and not blindly follow advertisements.?
(ii) Start rehabilitation treatment as early as possible and actively?
As mentioned before, cerebral thrombosis will leave many sequelae, such as monoparesis, hemiparesis, aphasia, etc. The effect of drugs on these sequelae is very limited, while through active and formal rehabilitation, most patients can achieve self-care, and some can return to work. It is better for those who have the condition to go to regular rehabilitation hospitals for systematic rehabilitation. Those who cannot go to rehabilitation hospitals for various reasons can buy some books and videotapes on the subject and do it at home. Rehabilitation should be carried out as early as possible. Three to six months after the disease is the best time for rehabilitation, half a year later due to muscle atrophy and joint contracture has occurred, rehabilitation is more difficult, but also will have a certain degree of help.
(3) Daily life training?
After the disease, many of the previous living habits are broken. In addition to training the affected limb as early as possible, attention should also be paid to developing the potential of the healthy limb. Patients with right hemiplegia who are accustomed to using their right hand (right limb) should train their left hand to do things. Clothes should be made loose and soft, and special styles can be sewn according to special needs, e.g. a zipper can be installed 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 the healthy side; when undressing, take off the healthy side first and then the affected side.
(4) Facing reality and adjusting emotions?
As the saying goes: "Sickness comes like a mountain, sickness goes like a silk". This saying is more aptly used in cerebrovascular patients. In the face of a 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 to help them use antidepressants, such as Prozac, which can have a good effect on depression and anxiety after cerebrovascular disease.
Does a patient with cerebral thrombosis have to be given fluids once every six months?
Frequently encountered in the outpatient clinic cerebral thrombosis sequelae of patients requesting infusion. The reason is that I have heard that after a cerebral thrombosis must be transfused once every six months to prevent the recurrence of thrombosis. In fact, this is unfounded. Cerebral thrombosis is a disease that is easy to recur, but its onset is mainly related to atherosclerosis and blood viscosity, the prevention and treatment of atherosclerosis is a long-term problem, not just a few days of drip can be solved, need to pay attention to various aspects of daily life to drug therapy, long-term regular oral anti-atherosclerosis drugs can also achieve the purpose of preventing blood clots. On the other hand, infusion is not harmless. In fact, because the drip is directly injected into the blood vessels, there are many potential dangers, such as infusion reaction, phlebitis; infusion too quickly lead to heart failure. Therefore, IV drips are only necessary in cases of emergency where the medication needs to be delivered into the body as quickly as possible, or when the patient is comatose and other conditions make it impossible to take the medication orally. As a general medical principle: do not give intramuscular injections of drugs that can be taken orally; do not administer intravenous drips of drugs that can be given intramuscularly to minimize the chance of adverse reactions.?
Dietary regimen for patients with cerebral thrombosis?
Most patients with cerebral thrombosis are obese, have high blood fat, high blood sugar, high blood pressure, etc. These abnormalities are risk factors for atherosclerosis. In addition to taking the appropriate medication, dietary modification has an important role to play.
1. First of all, obese patients should limit the intake of staple foods and reduce their body weight to normal or close to standard weight. Generally control the amount of staple food at about 300 grams per day. If the patient is not full can be supplemented with vegetables and soy products, try to develop the habit of eating 80% full.
2. Eat less or not eat animal fat and animal offal, such as fat meat, fat intestines, belly, because these foods contain high cholesterol and saturated fatty acids, easy to aggravate atherosclerosis.
3. Eat more high-quality protein, such as milk, chicken and duck (preferably wild woodchucks), fish, eggs (egg yolks should be eaten sparingly), soybean products, and less pork, beef, mutton, and to lean meat is good.?
4. Eat more vitamin-rich foods, such as vitamin C-rich fresh fruits, tomatoes, hawthorn, etc.; vitamin B6-rich soy products, dairy, eggs; vitamin E-rich green leafy vegetables, beans, etc.?
5. Diet should be light, avoid over-salting, and it is best not to eat salty food. Because eating too salty, easy to cause high blood pressure.?
6. Eat more fiber foods, such as celery, coarse grains, etc., to increase gastrointestinal peristalsis and avoid dry stools. Patients with constipation should drink more water, which can promote defecation, but also due to the increase in urine, to prevent urinary tract infections is beneficial. Some patients, due to mobility, fear of urination and do not drink water, is very unfavorable