What kind of disease is a stroke?

Strokes can be broadly divided into ischemic stroke (cerebral infarction), which blocks blood vessels in the brain, and hemorrhagic stroke (cerebral hemorrhage, subarachnoid hemorrhage) in which blood vessels in the brain are broken.

Cerebral infarction is caused by cerebrovascular clogged for some reason, poor blood flow, and necrosis of brain cells due to lack of oxygen and nutrition. There are three types of causes: athermal thrombotic cerebral infarction, myogenic cerebral embolism, and lacna infarction.

On the inner wall of relatively thick arteries such as carotid artery (artery that sends blood to the head on the left and right of the neck), an athermal with cholesterol hardened on the porridge is formed, narrowing blood vessels and damaging blood flow. It breaks and causes platelets to collect and form a blood clot, which flows to block the blood flow of the brain.

Blood clots form in the heart after arrhythmia such as atrial fibrillation or myocardial infarction, which flows to block blood vessels in the brain. In general, it often causes a wide range of cerebral infarction, and is characterized by the most severe symptoms of cerebral infarction.

It is caused by clogging of thin blood vessels (perforated branches) inside the brain. Although sequelae such as paralysis may remain, severe cases that can be life-threatening are rare.

Most cerebral hemorrhage is hypertensive cerebral hemorrhage.
Hypertensive cerebral hemorrhage is caused by high blood pressure, causing aneurysm (crust) in the fragile brain (200 to 300 μm), which is torn and bleeding in the brain.
In addition, "cerebral arteriovenous malformation", thrombolytic solvents such as t-PA, anticoagulants such as heparin and walfarin, "side effects from drugs" such as anti-blood plate agents such as aspirin, and abnormal protein called amyloids deposited on the blood vessel wall of the brain with aging and become fragile and bleeding.

It is said that 10% of subarachnoid hemorrhage will die within 8 hours of onset, and about 50% die within 1 month before arrival at the hospital.
Subarachnoid hemorrhage develops when blood flows out of the cerebrovascular rupture in the subarachnoid space between the soft film and the spider membrane on the surface of the brain, which is usually filled with cerebrospinal fluid.
Causes of cerebrovascular rupture include "cerebral aneurysm" (a bump formed by the bulging base of the cerebral artery branching) and "cerebral arteriovenous malformation", which is a natural vascular malformation. Most subarachnoid hemorrhage is due to cerebral aneurysm r burst.
Although the cause of cerebral aneurysm has not yet been clarified, it is thought that congenital predisposition, increased blood pressure due to aging, and arteriosclerosis are involved.

If at least one of the following symptoms suddenly develops, suspect a stroke:

There are "exercise paralysis" in which force is not applied to one side of the body, such as the face and limbs, and "sensory disorder" in which the feeling of numbness or the feeling of dullness is felt.

There are "aphasia" such as not being able to speak well (motor schizophia) or not being able to understand what others say (sensory aphasia), and "dyssyntax disorder" which is not distorted due to the paralysis of the mouth and muscles.

There are two types of dizziness: "rotating dizziness," which makes you feel like you are spinning around, and "floating dizziness," which makes you feel like you are shaking. Both of these can occur in strokes, but rotary dizziness can also occur in disorders of the inner ear (the organ in the back of the ear).

It is a symptom in which the field of view is half missing or the object looks double.

Strokes, especially subarachnoid hemorrhage, and headaches caused by cerebral hemorrhage, are characterized by sudden onset.

Cerebral infarction is generally not accompanied by headaches because brain cells are necrotic.

Headaches due to cerebral hemorrhage also occur suddenly, but the degree of headache is lighter than subarachnoid hemorrhage, and you may hardly feel a headache.

Beware of sudden symptoms of subarachnoid hemorrhage, "I've never experienced it" or "I've been hit with a hammer." This headache develops later so suddenly that you can remember, "My head hurts suddenly at ○ hours and ○ minutes." Also, in most cases, it involves vomiting in headaches. However, unlike cerebral infarction and cerebral hemorrhage, it is also characteristic that it often does not involve symptoms such as motor paralysis, sensory impairment, and language impairment (stroke that does not apply to "FAST" described below). Furthermore, as a precursor to subarachnoid hemorrhage, approximately 50% of patients have bleeding enough to leak blood from a cerebral aneurysm, and a transient headache, so be careful not to overlook the "warning seizure" which is the pre-harmony.

There are a variety of treatments for stroke, including t-PA intravenous therapy for cerebral infarction, intravascular treatment, and opening surgery for intracerebral hemorrhage.
In our hospital, Internal medicine Brain Neurosurgery and Neurosurgery work together to treat advanced medical equipment such as 3 Tesla MRI.

Cerebral infarction is mainly performed in the acute phase, mainly in medical treatment (drug therapy) and intravascular treatment (thrombotic removal therapy). Surgical treatment is also performed to prevent the onset of disease.

Pharmacotherapy provided as a medical treatment.

• Treatment to dissolve blood clots (thrombolysis therapy, t-PA)
• Treatment to prevent the formation of blood clots
• Treatment to reduce the swelling of the brain
• Treatment to prevent necrosis of the brain

There is something like that.

This is a treatment that restores blood flow by injecting a t-PA drug into a blood clot in the blood vessels of the brain and dissolving it.
This treatment must be performed within 4 hours and 30 minutes after onset.
After the onset, you must arrive at the hospital, perform various tests, and inject the medicine within 4 hours and 30 minutes, so if you have any symptoms of suspected stroke, call an ambulance as soon as possible. Is important.
In addition, after time has passed since the onset and the brain and blood vessels have been damaged, this treatment may cause cerebral hemorrhage.

Intravascular treatment is a treatment in which a thin tube called a catheter is inserted and guided mainly from the blood vessels at the base of the foot to the part where the cerebrovascular is clogged, and through the equipment. Intravascular treatment has less burden on the body than surgical treatment (open surgery), and the therapeutic effect has increased, so the number of people who want it is increasing. However, there is a risk that lumps of blood may clogged blood vessels in the brain or cause bleeding.
In the acute treatment of cerebral infarction
・Stent retriever
・Penumbra (penumbra) system
This is a treatment that removes blood clots in the blood vessels of the brain through a catheter and restores blood flow.

This is a treatment that removes blood clots by removing blood clots with a mesh-shaped wire to restore blood flow.

It is a treatment that restores blood flow by removing blood clots through a catheter.

The purpose of surgical treatment of cerebral infarction is to rebuild blood circulation to prevent future cerebral infarction. Many athermal thrombotic cerebral infarctions are caused by the formation of atherome in the carotid artery and poor blood flow.
As a treatment

• Carotid artery endomal exfoliation
• Stent placement
• Bypass surgery

Yes, there is.

This is an operation aimed at incising the cervical carotid artery to remove atherome, which causes narrowing blood vessels, and cure it from the root.

Using the technique of intravascular treatment, the cylindrical mesh alloy (stent) is sent to the narrow part where the blood vessel is narrowed in a thinly stretched state, where the balloon is inflated from the inside of the stent to expand the blood vessel, and only the stent is placed. It is surgery to place.

This is an operation to create a bypass (blood flow escape) by sewing the shallow occipal artery outside the skull and the middle cerebellar artery inside.

Use hemostasis or antihypertensive agents to minimize brain damage during the acute stage of cerebral hemorrhage. Surgery may be performed to prevent the inside pressure of the skull from increasing.
Usually, medical treatment (such as pharmacotherapy to stop blood, reduce brain swelling, and lower blood pressure) is performed, but surgical treatment (surgery) may be required if bleeding is large.
For surgery

• Opening surgery
• Stereotactic surgery

Yes, there is.
Also, if hematoma extends into the ventricular and causes hydrocephaly (a condition in which the cerebrospinal fluid accumulates in the brain and the ventricular room becomes larger), the ventricular drain (injecting a catheter into the ventricle to discharge blood and cerebrospinal fluid). May be done.

A hole is made in the skull and the hemoma in the brain is removed under a microscope. In the case of shell bleeding, cerebellum bleeding, or subcortical bleeding, cerebellum bleeding, opening surgery is performed.

Drill a small hole of about 2 cm in the skull (perforation) and insert a thin tube into the hematoma and suction and removal of the hematoma while photographing it with CT. Treatment is also being performed to suction while checking the condition of the hematoma.

Subarachnoid hemorrhage is mainly caused by the rupture of cerebral aneurysm.
If a cerebral aneurysm ruptures and causes subarachnoid hemorrhage, surgical treatment is required to prevent the second bleeding (recurrence).
Surgery methods for cerebral aneurysm are used.

• Opening surgery (clipping)
• Invascular surgery (coil embolization)

Yes, there is.
Each of these treatments has its own advantages and disadvantages, so it is necessary to consult with your doctor to select an appropriate treatment.

It is a method of opening up under general anesthesia and clipping at the base of a cerebral aneurysm under a microscope to prevent bleeding.

Under general anesthesia or local anesthesia, a catheter (fine tube) is induced from the blood vessels at the base of the foot to the cerebral aneurysm, and a soft platinum coil is packed into the aneurysm to prevent bleeding.

※Information on each Medical consultation fee for treatment of stroke
Department of Neurology
Department of Neurosurgery
Stroke and Neurological Diseases Division

FAST is a slogan that describes symptoms at the time of the onset of stroke and appropriate responses at that time.

Face face is distorted
Arm (and legs) Arm (and legs) The arm (and feet) is not forceful.
The Speech language is entangled.

If any of the above symptoms suddenly develops, it is necessary to prevent the disease.

Check the time onset of time and see a specialist immediately.

1. Let's get rid of high blood pressure.
2. If you leave diabetes alone, you will regret it
3. As soon as the arrhythmia is found
4. Be willing to stop smoking for prevention
5. Reservation of alcohol is too much poisonous
6. Don't miss too expensive cholesterol
7. Low salt and fat in your diet
8. Let's continue exercising according to physical strength
9. Too much fat that triggers all illnesses
10. As soon as you have a stroke, go to the hospital

Japan Stroke Association