What causes cerebral thrombosis?
(1) Atherosclerosis?
Atherosclerosis is the most common cause of cerebral thrombosis. As for the latest classification of cerebrovascular diseases, cerebral thrombosis has been renamed "atherosclerotic thrombotic cerebral infarction". ?
The occurrence of arteriosclerosis is related to vascular endothelial cell damage, hyperlipidemia, hypertension and hemodynamic abnormalities. The cause of atherosclerosis is believed to be related to high blood lipids, especially high levels of a substance called low-density lipoprotein cholesterol (LDL-C). It is also related to lifestyle, nutritional and genetic factors. For example, the food you eat contains too much fat (fat, oil), carbohydrates (sugar, starch, etc.); too little physical activity; obesity, high blood pressure, diabetes and family history (parents or/and siblings have same disease) etc. The latest research has found that atherosclerosis is associated with mutations in genes such as apolipoprotein, a protein involved in fat metabolism. ?
Atherosclerosis is a systemic vascular disease that causes corresponding diseases when it occurs in different organs. Coronary heart disease (coronary heart disease) occurs when atherosclerosis occurs in the coronary arteries that supply the heart. Atherosclerosis of the cerebral arteries mainly occurs in the large and medium-sized arteries that supply the brain. The most susceptible areas for stenosis are at the bifurcation of the common carotid artery in the neck, where the vertebral artery enters the cranial cavity, and where the basilar artery begins and bifurcates. Due to the rupture of the blood vessel intima and the deposition of lipids to form plaques, platelets and fibrin in the blood are deposited on the plaques and become organized, resulting in thickening of the blood vessel walls and narrowing of the blood vessel lumen, resulting in insufficient blood supply to the brain. If the disease develops further and the blood vessel cavity is severely narrowed or even completely occluded, or on the basis of the stenosis, due to high blood viscosity (commonly known as blood thickening), thrombus is formed on the plaque and blocks the blood vessel, brain damage to the blood supply area of ??this blood vessel can occur. Ischemic necrosis of cells. ?
(2) Less common causes of cerebral thrombosis?
Various arterial inflammations, such as infectious arteritis (tuberculous, parasitic, septic, etc.) ), collagenopathic arteritis (such as a disease called systemic lupus erythematosus), vasculitis obliterans, etc. Hypercoagulable states caused by various diseases, such as chronic lung disease patients with abnormally elevated red blood cells due to long-term hypoxia, and early pregnant women with hypercoagulable states due to vomiting and dehydration combined with elevated estrogen and progesterone, may induce cerebral thrombosis. form. In addition, there is a rare disease characterized by an increase in red blood cells called "polycythemia vera", and patients with this disease are also prone to cerebral thrombosis. ?
How to confirm whether you have cerebral thrombosis?
To confirm whether you have cerebral thrombosis, the above-mentioned clinical manifestations and doctor’s examination alone are not enough. You also need the following necessary instruments and laboratory examination assistance. ?
(1) Head CT?
CT scan is a more convenient and cheaper examination for diagnosing cerebral thrombosis. It can clarify the location and size of brain tissue necrosis (i.e. cerebral infarction), the degree of cerebral edema, and other information that can guide treatment. However, lesions often cannot be found within 24 hours of onset. The significance of CT scan at this time is to rule out cerebral hemorrhage and gain time for early start of treatment. In addition, the disadvantage of CT is that it poorly displays lesions in the brainstem and cerebellum. ?
(2) Head magnetic resonance scan (MRI)?
This examination can make up for the inability of head CT to detect lesions within 24 hours and the display of lesions in certain parts. Unfavorable drawbacks, especially magnetic resonance angiography (MRA), can still reveal larger occluded vessels. Its shortcomings are that it is more expensive and the hospital ownership rate is not high. Moreover, some patients cannot undergo this examination because they have metal objects that cannot be removed from their bodies, such as pacemakers, metal teeth, fracture nails, etc., which limits its use. ?
(3) Cerebral angiography?
This examination can detect vascular stenosis and occlusion. In the early stage (within 6 hours of onset), thrombolytic drugs can be directly injected into the stenosis. Or thrombolysis is performed on the occlusion, but the disadvantage is that there will be certain damage and complications.
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What to do when a patient with cerebral thrombosis is discovered?
(1) Keep calm?
For mild patients, they can be asked to lie down with their head 30 cm high. Degree, no matter what kind of transportation is used, the patient should be sent to a nearby municipal hospital within 1 to 2 hours as much as possible to avoid time delays caused by transfer to a small hospital without corresponding examination equipment. It is best for critically ill patients to call 120 for an emergency ambulance. If the patient has symptoms such as disturbance of consciousness and vomiting while waiting for the ambulance, he or she can turn his or her head to one side to prevent vomitus from being accidentally inhaled into the lungs. ?
(2) Try to prepare enough cash or checks?
So as not to delay treatment due to lack of funds after arriving at the hospital. ?
Family members cooperate with doctors in the hospital?
(1) Assist in nursing care?
Most patients with cerebral thrombosis are obese, and some also have diabetes. , now hemiplegia and local neurotrophic disorder have occurred. Excessive pressure will cause skin ulcers and form "bedsores". Once it occurs, cerebrovascular disease may be aggravated by infection and fever, and in severe cases, it may cause sepsis and cause death of the patient. Therefore, when accompanying the patient, family members should pay attention to turning him over regularly, patting the back, scrubbing the skin with warm water, and gently massaging the pressed parts, especially the parts with prominent bones, such as the spine, sacrococcyx, etc. The frequency of turning over is generally about 2 hours. If skin ulcers are found, report them to medical staff for early treatment. Patients with incontinence should change their diapers frequently, wash them with warm water, dry them and apply talcum powder after each defecation. ?
(2) Eating problems?
Some patients have difficulty swallowing after illness, which is caused by paralysis of the muscles responsible for swallowing.
The patient chokes and coughs when eating, especially when drinking water, and even food squirts out of the mouth and nose. At this time, care should be taken not to force the patient to drink water or medicine. For mild patients, they can be allowed to eat sticky foods, such as thick porridge, soft rice, etc. Chop vegetables, minced meat and other non-staple foods and mix them with rice. Avoid foods that are too thin or dry, which can be easily swallowed. If there are no contraindications for oral medications, they can be crushed and mixed with food. Severely ill patients need nasogastric feeding, that is, a rubber tube is inserted into the stomach through the nostrils, and food such as rice soup, milk, vegetable juice, etc. are injected into the stomach with a syringe to ensure adequate nutrition. Oral medications can also be injected through a stomach tube. Note that the food and medicine injected must not have large particles to avoid blocking the gastric tube. Nasogastric feeding is a necessary means to ensure treatment at a certain stage, and is directly related to the success or failure of patient rescue. Some patients and their families are unwilling to accept gastric tubes and force the patients to swallow. This is very dangerous. If food is accidentally inhaled into the respiratory tract, it may cause lung infection and aspiration pneumonia in mild cases; in severe cases, death may occur due to suffocation. ?
(3) Pay attention to the changes in the condition, and promptly report any abnormalities to medical staff?
Patients with cerebral thrombosis have a relatively slow onset and mild symptoms at the onset. There will be no impairment of consciousness. But the condition may worsen over hours or days. Despite aggressive treatment measures taken by medical staff, sometimes progression of the disease cannot be stopped. If the blocked blood vessels are large, the area of ??brain tissue necrosis is large, and cerebral edema is obvious, the patient may gradually become drowsy, even if he wakes up, he will fall asleep immediately. Severe cases may enter coma. Family members should pay attention to observe whether the patient's paralyzed limbs gradually become less powerful or even completely unable to move. How is your mental state? If a patient is found to be drowsy or listless, notify medical staff immediately. At the same time, critically ill patients should record their daily food intake, urine output, etc. for doctors’ reference. ?
(4) Help the patient to move the paralyzed limbs early and promote recovery?
If the condition is stable on the second day of the onset, you can start to do passive movements of the limbs, that is, help the patient to move the paralyzed limbs Stretching and flexing activities. This will help promote blood circulation in paralyzed limbs, prevent the formation of deep vein thrombosis, promote muscle strength and joint mobility, and prevent limb contracture and deformation. When inactive, the patient's paralyzed limb should be in an anti-spasmodic position, that is, when lying on his back, place the affected upper limb on a pillow so that it is slightly abducted and externally rotated, the elbow joint is slightly flexed, the wrist joint is slightly dorsiflexed, and the hand is held in an appropriate position. sized cylindrical objects, such as toilet paper rolls.
Pad the back so that it moves forward and upward; pad the outer buttocks of the lower limbs to make the hip joints adduct and push the pelvis forward. Place a soft pillow under the knee joints to flex the knee joints. The ankle joints should be kept at 90° to prevent foot drop. The patient's feet can be placed on the bed or wall or a homemade splint can be used. When lying on your back, the head height is 30°, but not too high. When in the lateral position, the paralyzed limb should be placed on top as much as possible. A pillow should be placed in front of the chest and in front of the lower limb. The upper limb should be extended and the lower limb should be flexed and placed on the pillow. ?
(5) Pay attention to the patient's emotional changes?
The patient suddenly loses his ability to move and speak, and even loses his ability to take care of himself and work, which is emotionally unbearable. Therefore, mood changes such as depression and anxiety, moodiness, and even personality changes often occur. Family members should actively cooperate with medical staff, comfort and encourage patients to cooperate with treatment and rehabilitation exercises. Try to avoid making the patient emotional. ?
Home care and treatment during the recovery period of cerebral thrombosis?
Brain cells die due to ischemia and hypoxia when blood vessels are occluded. The later treatment is started, the larger the blocked blood vessels will be. , the more brain cells die, and brain cells cannot regenerate after death. Therefore, despite many proactive measures taken by doctors, patients will inevitably be left with varying degrees of disability, also known as "sequelae". These sequelae cannot be solved in hospitals, especially general hospitals whose main purpose is to save lives. They need to be treated in rehabilitation hospitals. In our country, the main purpose is to go home for further recuperation and recovery. ?
(1) Take medicine on time and regularly to prevent the recurrence of cerebral thrombosis? After discharge, patients still need to take medicine regularly according to the doctor's instructions to control arteriosclerosis such as diabetes and hypertension. For basic lesions, go to the hospital for regular review. Commonly used drugs include anti-platelet aggregation drugs, such as low-dose aspirin and Diclolide; brain protective drugs, such as nimodipine; oxygen free radical scavengers, such as vitamin E, vitamin C, etc. Some patients hate taking medicine and want to try any advertised medicine, or they think that the more medicine they take, the better. In fact, doing so is bad for your body. Not to mention that the efficacy of drugs may not be as miraculous as advertised, but any drug must be metabolized by the liver and kidneys. Taking too many drugs will increase the burden on the already unhealthy liver and kidneys of the elderly; from a pharmacological point of view, , too many drugs entering the body will interact with each other, reduce their respective efficacy, and even aggravate side effects, causing harm to the body. What medicine to take and how to take it? It's best to follow your doctor's advice and not blindly follow advertisements. ?
(2) Start rehabilitation treatment as early as possible and actively?
As mentioned before, cerebral thrombosis will leave many sequelae, such as monoplegia, hemiplegia, aphasia, etc. The effect of drugs on these sequelae is very limited. However, through active and formal rehabilitation treatment, most patients can take care of themselves, and some can return to work. Those who have the conditions are best to go to a regular rehabilitation hospital for systematic rehabilitation. If you are unable to go to a rehabilitation hospital for treatment due to various reasons, you can purchase some relevant books and videos and perform the treatment at home. Rehabilitation should begin as early as possible. The best time for recovery is within 3 to 6 months after the illness. After half a year, due to muscle atrophy and joint contracture, recovery will be more difficult, but it will also be helpful. ?
(3) Daily life training?
After getting sick, many previous living habits have been broken. In addition to training the affected limb as early as possible and formally, attention should also be paid to developing the strength of the healthy limb. potential. Patients with right-sided hemiplegia who are usually right-handed (right-handed) need to train their left hand to do things. The clothes should be loose and soft, and can be sewn into special styles according to special needs. For example, zippers can be installed on the sleeves of the affected limb to measure blood pressure when going to the doctor. When dressing, put on the paralyzed side first, then the healthy side; when taking off clothes, take off the healthy side first, then the affected side. ?
(4) Face the reality and adjust your emotions?
As the saying goes: "Sickness comes like a mountain falling, and sickness goes like a thread." This statement is more appropriate for cerebrovascular patients. Facing the fait accompli, we should adjust our emotions and actively carry out rehabilitation in order to return to society as soon as possible. Patients with severe mood disorders can seek help from a doctor and use antidepressants, such as Prozac, which have a good effect on depression and anxiety after cerebrovascular disease.
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Do patients with cerebral thrombosis have to be infused once every six months?
Patients with sequelae of cerebral thrombosis who are often encountered in outpatient clinics require infusion. The reason is that I heard that cerebral thrombosis must be infused once every six months to prevent recurrence of the thrombosis. In fact, this is unfounded. Cerebral thrombosis is a disease that is easy to relapse, but its onset is mainly related to arteriosclerosis and blood viscosity. Prevention and treatment of arteriosclerosis is a long-term problem, which cannot be solved by simply injecting intravenous drip in a few days. It requires daily life and drug treatment. Pay attention to many aspects, and long-term and regular oral administration of anti-arteriosclerosis drugs can also achieve the purpose of preventing thrombosis. On the other hand, infusion is not harmless. In fact, since intravenous drip injects drugs directly into blood vessels, there are many potential dangers, such as infusion reactions and phlebitis; too fast infusion can lead to heart failure. Therefore, intravenous drip is only necessary when the condition is urgent and the drug needs to be delivered into the body as soon as possible, or when the patient is comatose or otherwise unable to take the drug orally. As a general medical principle: drugs that can be taken orally should not be injected intramuscularly; drugs that can be injected intramuscularly should not be intravenously dripped to reduce the chance of adverse reactions. ?
Dietary care for patients with cerebral thrombosis?
Patients with cerebral thrombosis are mostly obese, have high blood lipids, high blood sugar, and high blood pressure. These abnormalities are risk factors for arteriosclerosis. . In addition to taking corresponding drug treatment, dietary maintenance plays an important role. ?
1. First of all, obese patients should limit their intake of staple foods and reduce their weight to normal or close to the standard weight. Generally, the amount of staple food is controlled at about 300 grams per day. If the patient is not full, he can supplement with vegetables and soy products, and try to develop the habit of eating 80% full. ?
2. Eat less or no animal fat and animal offal, such as fatty meat, fatty intestines, and tripe, because these foods contain high cholesterol and saturated fatty acids, which can easily aggravate arteriosclerosis. ?
3. Eat more high-quality protein, such as milk, chickens and ducks (preferably wild chickens), fish, eggs (egg yolks should be eaten less), soy products, and eat less pigs, cows, Mutton, preferably lean meat. ?
4. Eat more foods rich in vitamins, such as fresh fruits, tomatoes, hawthorns rich in vitamin C; soy products, dairy, and eggs rich in vitamin B6; rich in vitamin E Green leafy vegetables, beans, etc. ?
5. The diet should be mainly light and avoid being too salty. It is best not to eat pickles. Because eating too much salt can easily cause high blood pressure. ?
6. Eat more fiber-rich foods, such as celery, whole grains, etc., to increase gastrointestinal motility and avoid dry stools. Patients with constipation should drink more water, which can promote defecation and prevent urinary system infections due to increased urination. Some patients are afraid of urinating and do not drink water due to limited mobility, which is very disadvantageous
How to prevent cerebral infarction
Recognize the warning symptoms
Once cerebral infarction occurs Infarction, the treatment effect is often unsatisfactory. Therefore, it is extremely important to control risk factors and identify early symptoms (premonitory symptoms). About 25% of patients have a transient ischemic attack before cerebral infarction, which is called a "mini-stroke" in traditional Chinese medicine. The patient mentioned above, Mr. Kang, had a temporary speech disorder the day before the attack.
Common aura symptoms are: temporary ① amaurosis, blindness in one eye or hemianopia; ② memory loss; ③ unclear speech and inability to read words; ④ numbness or weakness of one limb; ⑤ dizziness, Vomiting; ⑥ seeing double vision; ⑦ hoarse voice; ⑧ choking or difficulty swallowing; ⑨ uncoordinated body movements; ⑩ unilateral or bilateral numbness around the mouth and tongue, etc.
Once the above symptoms appear, do not be careless. Although these symptoms will recover quickly, you should go to the hospital as soon as possible to find out the cause, such as CT, carotid artery ultrasound, blood viscosity, immune system and other tests. , and treat the cause.
Avoid risk factors
There are many risk factors for cerebral infarction, some of which cannot be intervened. Such as age, the risk of cerebral infarction will increase year by year after middle age. There is also gender, men are more susceptible to the disease than women. The occurrence of cerebral infarction may also be related to genetics, but family members of cerebral infarction patients can still achieve prevention purposes through appropriate measures.
In addition to uninterventionable risk factors, many diseases and unhealthy lifestyles have been found to be related to cerebral infarction, which can be intervened by adjusting lifestyles or drug treatment. Such as hypertension, diabetes, dyslipidemia, carotid artery stenosis, smoking, long-term heavy drinking, coronary heart disease, atrial fibrillation, obesity and other diseases, as well as bad habits such as lack of exercise.
Hypertension is the most common important risk factor closely related to cerebral infarction. 60% of those with cerebral infarction have a clear history of hypertension. Poorly controlled diabetes can aggravate atherosclerosis, and patients with diabetes are 2 to 3 times more likely to have cerebral infarction than ordinary people. Carotid artery stenosis is a potential risk factor that can easily cause cerebral infarction when hypotension occurs. The greater the amount of smoking, the greater the chance of cerebral infarction. Smokers are 6 times more likely to have cerebral infarction than non-smokers. Dyslipidemia and long-term heavy drinking can also cause atherosclerosis.
In addition, patients with transient ischemic attack and cerebral infarction have a very high risk of recurrence of cerebral infarction and are also regarded as risk factors for cerebral infarction.
1. Food selection for cerebral thrombosis
1. Increase dietary fiber and vitamin C foods, including whole grains, vegetables and fruits. Some foods such as onions, garlic, mushrooms, fungus, kelp, hawthorn, seaweed, light tea, konjac and other foods have lipid-lowering effects.
2. It is advisable to eat light, soft foods that are rich in dietary fiber. It is advisable to use cooking methods such as steaming, boiling, stewing, boiling, stir-frying, boiling, stir-frying, and warm mixing. It is not suitable to fry, boil, or stir-fry. Methods such as deep-frying, stir-frying, drenching in oil, and roasting.
2. Pay attention to the diet of patients with cerebral thrombosis. Patients with cerebral thrombosis must first receive timely treatment. On this basis, combined with dietary therapy, there will be great results. Their diet should be easy to digest and high in vitamins. diet. You can give some fresh vegetables chopped into fine pieces and juiced from fruits and taken frequently. If the patient cannot eat for more than 24 hours, nasal feeding can be given to maintain nutrition. Pay attention to the following in your daily diet:
1. Limit fat intake. The total amount of fat in the daily diet should be reduced, polyunsaturated fatty acids should be increased, and animal fat should be reduced to achieve a p/s ratio of more than 1.8 to reduce the liver's synthesis of endogenous cholesterol. When cooking, do not use animal oil, but use vegetable oil, such as soybean oil, peanut oil, corn oil, etc. The dosage is 25 grams per person per day and within 750 grams per month. To limit food cholesterol, it should be within 300 mg per person per day, that is, you can eat 3 egg yolks per week.
2. Control the total heat. If total fat intake is controlled in the diet, blood lipids will decrease, and the weight of obese or overweight patients will also decrease. It is best to achieve or maintain an ideal weight, which is beneficial to the physiological functions of various internal organs throughout the body.
3. Increase protein appropriately. As the amount of fat in the diet decreases, it is necessary to increase protein appropriately. It can be provided by lean meat and skinless poultry. You can eat more fish, especially sea fish. You should eat a certain amount of soy products every day, such as tofu and dried beans, which are beneficial to lowering blood cholesterol and blood viscosity.
4. Limit the intake of refined sugar and sugary sweets, including snacks, candies and drinks. With the development of the beverage industry, various sugary drinks continue to increase. After local people drink more sugary drinks, the sugar in the body will be converted into fat and accumulated in the body, which will still increase weight, blood sugar, blood lipids and blood viscosity. It is extremely detrimental to the recovery of cerebral thrombosis, so the use of drinks must also be controlled. For example, if a patient with cerebral thrombosis also suffers from diabetes and takes hypoglycemic drugs and develops hypoglycemia, he or she can drink appropriate drinks to prevent the blood sugar from continuing to drop. When the transient hypoglycemia is relieved, stop drinking sweet drinks.
Many manufacturers now produce health-care beverages, mainly low-sugar beverages. Using some sweeteners to replace sucrose has been welcomed by people and meets the requirements and taste of sweet eaters. Common sweeteners include aspartame, stevioside, etc. Its sweetness is dozens of times that of sucrose, its dosage is small, it does not produce heat, is non-toxic, is not absorbed in the body, and can be excreted from the body through the kidneys and urine. Many animal experiments have proven that aspartame is not carcinogenic. Can be used in solution and pastry making.
5. Patients with cerebral thrombosis should consume less salt and adopt a low-salt diet, with 3 grams of salt per day. You can add salt and mix well after cooking.
6. Pay attention to cooking ingredients. In order to increase appetite, you can add some vinegar, tomato sauce, and sesame sauce when cooking. In addition to being a seasoning, vinegar can also accelerate the dissolution of fat and promote digestion and absorption. Tahini has high calcium content. Regular consumption can supplement calcium and has certain benefits in preventing cerebral hemorrhage.
7. Patients with cerebral thrombosis should drink water frequently, especially in the early morning and evening. This thins the blood and prevents blood clots from forming.