In Russia, as well as in many other things the world countries, the stroke takes the third place among the reasons of death rate after cardiovascular and oncological diseases. Even at a favorable outcome far not always the person manages to return to work, to a former way of life. And as a result the family, a society, the state suffer. For example, Natalia Gundareva and Jean Pol Belmondo - idols of many both many admirers of theatre and cinema - have forced all to worry enough. These outstanding actors almost simultaneously had a stroke - the heaviest vascular disease of a brain. Fortunately, in both cases treatment was successful. But so happens far not always. the Stroke (an armour. insultus - blow), or sharp infringement of brain blood circulation, meets often enough. In Russia it arises annually more than at 400 thousand persons. The risk of development of a stroke progressively accrues with age increase. At young men (till 45 years) the stroke annually arises only at one person from 30 thousand, and by 80 years the probability of its development becomes very high (at one of four men and at one of five women). A stroke - one of the most frequent causes of death. In a sharp stage (first three weeks) 30-35 % of patients perish, and by the end of the first year after a stroke the number of failures exceeds 50 %. About 10 % gone through a stroke become dependent on assistance. Only 20 % of patients come back to the former job. Economic consequences of disease are very great. So, for example, in the USA expenses only on medical aid and rehabilitation reach 15-20 billion dollars a year, and two thirds of this enormous sum is spent for hospitalisation. Whether But so struggle against this terrible disease is unpromising?

last 30 years in economically developed countries decrease in death rate from a stroke is observed. So, in Australia with 1967 for 1992 it has decreased more than on 70 % both at men, and at women. Preventive programs on struggle against the arterial hypertension, spent and in our country, and abroad, give good effect, reducing disease of a stroke on 45-50 %. Hence, successful struggle against this terrible disease is quite real. But, unfortunately, Russia while is included into number of the countries with the highest death rate from a stroke. The main originators of occurrence of a stroke - cardiovascular diseases, first of all an arterial hypertension and an atherosclerosis. a brain - unique vital body, therefore the nature has taken care of its protection. Brain blood supply in norm is independent, in many respects not dependent on level of the general blood circulation as has own system of regulation. However this independence is saved only until sistolicheskoe (top) arterial pressure does not exceed 180 mm of a mercury column. If it passes this side the brain blood-groove starts to follow increase in the general arterial pressure passively. Functioning in normal conditions, the brain redistributes blood streams between separate zones according to their power expenses. Substantial increase of arterial pressure can call failure of self-control of brain blood circulation and infringement of functions of a brain. Direct rupture or blood vessel corking becomes the stroke reason . At vessel rupture there is a hemorrhage in a brain (gemorragichesky a stroke) or under brain covers (subarahnoidalnoe a hemorrhage). But the most widespread kind of a stroke - ischemic, connected with corking of brain vessels. Ischemic strokes meet approximately four times more often, than gemorragicheskie. Rupture or vessel corking break normal blood supply of a brain, and the brain fabric is very sensitive to a lack arriving with oxygen and glucose blood. If blood inflow to this or that site of a brain sharply worsens and in due time the vessels providing kollateralnoe its (roundabout) blood supply various symptoms can be shown do not join: a sharp headache and dizziness, infringement of consciousness and epilepticheskie attacks, frustration of movements, sensitivity loss in finitenesses, infringements of speech, sight, coordination. In due time rendered medical aid gives up much bigger hope of a favorable outcome of disease. But in practice often it occurs just what isn`t needed, and patients get to specialised establishment late. Let`s recollect at least such fact. In March, 1953 at And. V.Stalin there was the hardest hemorrhage in a brain, but within many hours it remained without medical aid: were afraid to disturb, thought, that sleeps, if, of course, did not think the worst. Alas, similar incidents meet both now, and, unfortunately, quite often. To treat a stroke it is necessary depending on the reason which have called it, to establish which modern medical diagnostic technologies allow. Their arsenal is great enough and represents such possibilities, about which else half a century ago doctors could not and dream. Thanks to new methods it is possible to establish character, size and an arrangement of the centre of defeat in a brain, and also the concrete mechanism of infringements of blood circulation. This necessary condition for the proved choice of ways and treatment means. Modern methods of research by physical principles are subdivided on x-ray, radiological, magnitno-resonant, ultrasonic, electrophysiological, reologicheskie. With their help it is possible to receive the various information as about changes in walls of vessels and substance of a brain (image reception), and about functional characteristics of brain blood circulation (speed of a blood-groove on vessels and other indicators). For improvement of quality of the image, an estimation of a status of a brain use various ways kontrastirovanija, functional tests and mathematical processing of results of research. Approximately in 30 % of cases gemorragicheskogo a stroke surgical intervention is required. Treatment term in neurologic or angionevrologicheskom a hospital averages three-four weeks, and at heavy forms of disease and it is more. The stroke frequently divides human life on two parts: before and after. The the status of the patient is easier, the begin active regenerative treatment (rehabilitation) earlier. At impellent infringements it, first of all, medical gymnastics, training to walking and skills samoobslu zhivanija, and as additional methods - massage, electrostimulation of muscles, balneoterapija. At speech infringements employment with the logopedist-afaziologom and reception of the preparations improving exchange processes in a brain are necessary: nootropil, entsefabol, aminalon, tserebrolizin, etc. the Important principle of rehabilitation - active participation of the patient and members of his family in training to movements, speech, reading and the letter. Unfortunately, quite often patients underestimate or ignore the arisen defects and consequently sceptically concern spent employment or even refuse them. As a result there is a sharp decrease in impellent and mental activity. It is very important to create a benevolent climate in family relations. In postinsultnyj the period, especially during first time, patients happen irritable, depressive, and is frequent also the aggressive. Therefore it is necessary for associates to do the utmost, that in new conditions of the patient has taken a worthy place in a family, felt the necessary person with which opinion are considered which judgement value. To restoration of the broken functions are dangerous both excessive guardianship, and indifference, indifference from relatives. Unfortunately, terms of the most intensive restoration of functions are limited: 3-6 months - for volume of movements and walking; 12 months - for difficult household and labour skills; 2-3 years - for speech. But also further, in spite of the fact that restoration process is considerably slowed down, it is necessary to be engaged in medical gymnastics, and also to accept the means warning development of repeated strokes. It, first of all, the preparations reducing arterial pressure and expanding vessels of a brain (kavinto n, stugeron, sermion, tanakan), antiagreganty, reducing ability trombotsitov to slipaniju (aspirin, trombo-ass, tiklid, kurantil), and anticoagulants - the means interfering fast curling of blood (fenilin, neodikuma rin, sinkumar). The preparations improving a metabolism in a brain and reducing level lipidov in blood (gemfibrozil, probukol, lipostabil, nicotinic acid) are Besides, useful. As the arterial hypertension is a major factor of risk for strokes including repeated, gipotenzivnaja therapy has special value. The choice of means with which help it is possible to lower arterial pressure, is great enough. For this purpose use preparations of different classes. Diuretiki (gidrohlortiazid, arifon, brinaldiks) strengthen secretory function of kidneys and help an organism to get rid of surplus of a liquid. Alpha-adrenoblokatory (prazozin, doksazozin) and beta-adrenoblokatory (atenolol, propranolol, nadolol) reduce sensitivity of nervous receptors to action of holes-adrenaline of the-transmitter of nervous signals. Such preparations as prestarium, captopril, enalapril, lozartan and valsartan, brake action angiotenzinprevrashchajushchego enzyme which calls pressure increase. Help at a hypertension and antagonists of calcium (nifedipine, nimodipin, verapamil), and also the preparations of the central action representing different chemical compounds (clonidine, dopegit, tsint). Treatment any one of the listed means effectively only at a soft and moderate hypertension. To avoid the big doses and the by-effects connected with them, apply the combined therapy. It is very important to reduce arterial pressure gradually, especially to older persons with the changed vessels. It is necessary to have patience - the desirable result can achieve only in two-three weeks of regular treatment. Even if arterial pressure became stably low, all the same it is not necessary to refuse a drug intake. Otherwise again there can be symptoms of illness which, apparently, have already receded: head and warm pains, dizziness. As a result because of own carelessness it is possible to lose that is reached by long course of treatment. Cautiously to reduce doses or to cancel one of combined preparations it is possible only in the event that arterial pressure long time is kept on an optimum level at good state of health. it is necessary to reduce arterial pressure to what level?

Optimum it is considered pressure at which not only the risk of complications decreases, but also blood supply of a brain, heart and kidneys does not worsen. Decrease both sistolicheskogo (top), and diastolicheskogo (bottom) pressure is important. The patient of young age (till 45 years) with a soft arterial hypertension it reduce to 120-130/80 mm hg, and on the average and advanced age (45 years and are more senior) - to 140/90 mm hg At patients with heavy and malignant forms of an arterial hypertension, with the expressed insufficiency of blood supply of a brain in order to avoid complications recommend to reduce arterial pressure not only gradually, but also it is no more, than on 10-15 % from initial level. It is necessary to supervise not only arterial pressure, but also a status of warm activity (periodically to remove the electrocardiogram) to check level of sugar, cholesterol and protrombina in blood. Regular treatment allows to improve the general status of the person who has had a stroke, and to restore the broken functions. It is important not to lose courage, not to regret work and patience, persistently and accurately to follow recommendations of the doctor. After all, as is known, nothing ventured, nothing gained. And certainly struggle against this illness, first of all, should provide effective preventive maintenance, both individual, and carried out among the population. the stroke can be prevented, as the reasons of its occurrence, preventive maintenance and treatment methods are well enough studied. Experience both domestic, and foreign researchers shows, that in population groups where there is an early revealing, treatment and dispansernoe supervision of patients with the raised arterial pressure, it is possible to lower disease of a stroke twice. An arterial hypertension - one of the major, but not the unique reason of occurrence of a stroke. Not smaller value has an atherosclerosis. With it to struggle more difficultly, but also here there are big reserves. First of all - refusal of smoking. Poisons which contain in a tobacco smoke, amaze an internal cover of vessels that promotes development of atherosclerotic plaques. As a result there is a stenosis (gleam narrowing) or corking of vessels, blood supply worsens, that is all conditions for development of sharp infringements of brain blood circulation are created. The healthy way of life provides a balanced diet with restriction of animal fats and high-calorific carbohydrates (sugar, confectionery products, a white loaf). It is especially necessary the sick diabetes, which in itself represents serious threat of defeat of heart and vessels. Fresh vegetables, fruit, fish products are obligatory. Physical activity, regular employment by physical culture are necessary. It is necessary as it is possible to happen is more often on fresh air, and holiday to spend out of a city. Sports, swimming, ski, bicycle and pedestrian walks - how much fascinating sports exercises for all tastes and accessible to each of us allow to save long years good health and high working capacity! Treatment of an atherosclerosis by the preparations reducing level lipidov, appoint when the strict diet observed not less of 6 months, does not reduce the cholesterol maintenance in blood to optimum indicators. The special attention to the health should be turned, if there were the first zvonochki trouble in cardiovascular system: frequent headaches, dizziness, noise in a head, memory and working capacity decrease. Terrible alarm signals - short-term weakness or onemenie in finitenesses, zatumanivanie sight, blindness on one eye, loss of fields of vision, memory blackouts, difficulties of speech, sharp attacks of dizziness and poshatyvanija at walking. In possible adverse changes in other vascular systems specify such symptoms, as a pain and other unpleasant sensations in the field of heart or behind a breast, sensation onemenija in the feet, an alternating lameness - pains in calves of the feet, arising at walking and stopping if the person stops. At an atherosclerosis changes only in one vascular system are seldom observed. The combined defeat of vessels of heart, a brain and feet is much more often marked. This extremely dangerous combination is especially characteristic for malicious smokers. If there is a suspicion on vascular disease of the brain, sick direct to neurologic clinic for out-patient or stationary inspection. Application of modern methods of diagnostics allows to establish precisely the reason of malfunctions in system of blood circulation and to accept effective measures, not to admit development of brain accident. Now the doctor any more so is powerless, as still 20-30 years ago. It is possible to ascertain, that in struggle against a stroke - one of the major and medicine challenges - we at last, as they say, were issued in the end of a tunnel. Improvement of social conditions, the ecology, a healthy way of life, timely revealing and adequate treatment suffering the basic cardiovascular diseases and having factors of their risk - here main principles of decrease in disease of sharp infringements of brain blood circulation. It should promote preservation of gold fund of the nation - people of able-bodied age, to their active creative longevity.

DIAGNOSTICS of DISEASES of VESSELS of the BRAIN

X-ray methods. The computer tomography of a brain combines last achievements x-ray and computer facilities. The bunch of X-rays consistently under the set program "appears through" brain fabrics, and degree of easing of a bunch is fixed by a considerable quantity of gauges. The computer processes the signals which have arrived fro m gauges, and gives out result in the form of pictures - brain "cuts". Thanks to computer volume ografii for the first time the real became exact to define an arrangement and the size of the centre of defeat of a brain, its character, to reveal the general changes of a brain. Using rentgenokontrastnoe substance, it is possible to observe of blood moving on brain vessels - this method is called cerebral angiografiej. Magnitno-resonant methods. The Magnitno-resonant tomography is based on the phenomenon of a nuclear magnetic resonance. Under the influence of a magnetic field protons which are a part of biomolecules, get ability to absorb radio-frequency impulses. This absorption is registered and by means of the computer will be transformed to the image of "cuts" of a brain in three planes. To track a blood-groove, into blood enter a preparation containing gadoliny. This chemical element possesses paramagnetic properties, and it is easy for registering by means of a magnetic resonance. Ultrasonic methods. Ultrasonic methods of research on informativnosti concede x-ray and magnitno-resonant a little, however they are irreplaceable at mass inspections. There are some versions of researches by means of the reflected ultrasonic waves. Doplerografija it is based on the analysis of shift of frequency of the ultrasonic waves reflected from moving blood cells (eritrotsitov). Especially effectively duplex scanning which unites possibilities doplerografii and ehotomografii and allows to estimate simultaneously a status of walls of vessels and a blood-groove. By means of duplex scanning it is possible to establish, the atherosclerotic plaque as a source coming off from it embolov, corking smaller brain vessels is how much dangerous. Colour coding of streams allows to differentiate more accurately moving objects (blood) from motionless (walls of vessels) to see small vessels. elektroentsefalografija (EEG) - a method of research of the brain, based on registration of its electric potentials. If defeats of vessels of a brain do not lead to the expressed damages of its fabric changes EEG, as a rule, are insignificant. Revealing of the latent pathological processes is helped by carrying out of functional tests: sound and light irritations, hyperventilation. Initial EEG it is transformed by the computer to a digital form. Then the obtained data are represented in the form of a map of distribution of capacity of various kinds of electric activity of a brain. This research allows to estimate objectively presence and an arrangement of the centres of pathological activity and other changes EEG. Research reologicheskih properties of blood characterises its fluidity which changes depending on the sizes of a vessel and speed of a blood-groove. This method define bent eritrotsitov and trombotsitov to slipaniju and to education of the units promoting corking of vessels.

BRAIN BLOOD SUPPLY

Brain blood circulation makes approximately 20 % of the general blood-groove. Blood arrives in a brain mainly through two carotids - the main vessels originating directly from an aorta, and also through two pozvonochnye arteries. The left and right carotids it is possible to grope easily on each side necks. In the top part of a neck each of them shares on external and internal carotids. Further the internal carotid branches, forming some large vessels. Major of them - forward and back brain arteries. The nature has providently taken care of system of indemnification of blood supply of a brain. Thanks to connecting arteries it is formed so-called villiziev a circle providing redistribution of blood in case of corking by one of arteries.

FIRST AID AT the STROKE

the First, that it is necessary to make, if the patient had the symptoms, allowing to suspect sharp infringement of brain blood circulation, - to call a brigade of the first help. The patient cannot be disturbed. Therefore ask to leave those relatives and close people who cannot really help. Lay the patient so that the head and the top part of a trunk have been raised, unbutton a collar for simplification of breath. It is necessary to provide access of fresh air, to open a window leaf. If the patient had a vomiting, turn his head on one side and clear an oral cavity a scarf or a gauze. One of displays of a sharp stroke can be epileptichesky an attack. The person loses consciousness, and in some seconds at it spasms which some minutes proceed begin. Sometimes convulsive attacks repeat, following one behind another. What to do in this case? Turn the patient sideways, enclose it under a head a pillow (if it happens the at home), the clothes curtailed into the platen or a bag (if it has occurred out of the house). Holding a head hands, constantly wipe a scarf foam allocated from a mouth that it has not got to respiratory ways. That the patient has not bitted tongue, between a teeth insert a comb or the stick which has been wrapped up by a scarf. In no event it is impossible to keep with force hands and feet, to try to unclench the fingers shown by a spasm, and furthermore to lean on sick of all body. It can lead to attack strengthening, casual dislocations and crises. And feet of the patient it is necessary to hold hands slightly only that it did not injure itself(himself) and associates. Categorically it is forbidden to use liquid ammonia! It can call respiratory standstill, and spilt in haste, on imprudence - heavy burns. It is impossible to transfer the patient during an attack. If at it pulse is not probed, heart has stopped and breath has stopped, immediately begin indirect massage of heart and artificial breath "a mouth in a mouth" or "a mouth in a nose". All the rest - a problem of the first help. If the patient for any reasons remained at home, the main thing - to provide correct leaving. The bed should be equal, without folds. For education preventive maintenance kontraktur (tugopodvizhnosti) the paralysed finitenesses stack definitely. A hand put on a pillow, straighten and take aside so that it and a humeral joint were at one level in a horizontal plane. A brush turn a palm upwards, fingers straighten and plant. To keep a hand in such position, apply sacks with sand and longetki. Under a knee joint of the paralysed foot enclose the platen from cotton wool. Foot keep under a corner of 90 degrees by means of rubber draught or an emphasis in a wooden box. If the patient lays on healthy to a side a hand have along a trunk or bend under a corner of 90 degrees on a pillow. A foot bend in tazobedrennom and knee joints, under it enclose a pillow. Position of the patient on one side and on a back is changed by each 2 hours.

MAJOR FACTORS of RISK of OCCURRENCE of the STROKE: the raised arterial pressure of disease of heart an infringement diabetes reologicheskih properties of blood smoking abusing alcohol an inactive way of life, excess weight stresses the burdened heredity (a stroke, a myocardium heart attack, an arterial hypertension at close relatives)