Sažetak
Uvod: Milioni ljudi godišnje umre od posljedica moždanog udara, pa čak i više ljudi ostaju trajni invalidi kao posljedica infarkta mozga, moždani udar i krvarenje u sluznice mozga.
Cilj rada: Analizirati etiologiju, faktore rizika za moždani udar, dijagnostičke postupake, ishod kod bolesnika sa moždanim udarom, teretman i rehabilitaciju.
Materijali i metode: retrospektivna analiza pacijenata sa moždanim udarom na Odjelu za neurologiju u Opštoj bolnici u Strumici, s naglaskom na vrste moždanog udara, faktore rizika, simptome i komplikacije, učestalost bolesnika sa moždanim udarom u gradu, kao i ishod bolesti. Primjena fizikalne medicine i rehabilitacije, vrsta vježbe koja se provodi kod bolesnika sa moždanim udarom, kada se počinјe i trajanje rehabilitacije za bolje rezultate. Rezultati: Učestalost ishemijskog moždanog udara iznosi oko 87 % od svih slučajeva moždanog udara, a samo 13% je hemoragijski moždani udar. U periodu od 2011. godine 24 bolesnika s hemoragijski moždani udar i 192 s ishemijskim moždanog udara.U 2012 godini bilo je ukupno 13 bolesnika sa hemoragijskim moždanim udarom i 160 bolesnika sa ishemijskim mozdanim udarom, a u 2013 godini 19 bolesnika s hemoragijskim moždanim udarom i 173 sa ishemijskim moždanim udarom ili ukupno 581 pacijent. Diskusija: U našoj državi, iako je 20% pacijenata umre u prvih mjesec dana nakon moždanog udara u prvoj godini oko 30% odnosno ukupno 1.800 ljudi godišnje umre od moždanog udara, a 1 pacient na dan umire u Skoplju. Trenutno, u našoj zemlji ima oko 16.000 pacijenata od moždanog udara.
Oko 20% bolesnika preživjelih od moždanog udara je radno aktivno. Od 30 do 40% pacijenata završava sa prosječnom ocjenom invalidnosti, kada se sami brinu o sebi, ali nisu radnoaktivni. Oko 20% pacijenata preživjelih od moždanog udara je trajno nepokretno.
Zaključak: Faktori rizika za nastanak moždanog udara su: arterijska hipertenzija, ateroskleroza i povišeni kolesterol. Potrebno je poduzimati preventivne mjere za reguliranje faktora rizika kako bi se smanjili morbiditet i mortalitet. Statistika u R. Makedoniji pokazuje da pacijenti sa moždanim udarom učestali kod mlađe populacije. Dok su ranije statistike pokazale da oštećenje mozga utiče na pojedince u šestoj i sedmoj deceniji života. Ranija istraživanja ukazuju na to da se moždani udar danas javlja češće kod osoba treće i četvrte decenije.
Ključne riječi: ishemijski i hemoragijski moždani udar, cerebrovaskularnih.
Summary
Introduction: Millions of people a year die of a stroke, and even more people to remain permanently disabled as a result of cerebral infarction, stroke and bleeding in the lining of brains.
Objective: To analyze the aetiology, risk factors for stroke, diagnostic procedures, the outcome in patients with stroke, treatments offer and rehabilitation. Materials and Methods: A retrospective analysis of patients with stroke, Department of Neurology at the General Hospital Strumica, with emphasis on the type of stroke, risk factors, symptoms and complications, the incidence of patients with stroke in the city, as well as the outcome of the disease, application of physical medicine and rehabilitation, a type of exercise that is performed in patients with stroke, when it starts and duration of rehabilitation for better results.
Results: Ischemic stroke is about 87% of all cases of stroke, and only 13% with hemorrhagic stroke. Between 2011 24 patients with hemorrhagic stroke and 192 with ischemic stroke.In 2012 years 13 patients with hemorrhagic stroke and 160 ischemic stroke udar.2013godina 19 patients with hemorrhagic stroke and 173 with ischemic stroke or vkupno581 patient.
Discussion: in our country, even though 20 percent of patients die within the first month after stroke in the first year, about 30 percent, or a total of 1,800 people a year die from stroke and one patient per day die in Skopje. Currently, in our country there are about 16,000 patients from stroke. In 20 percent of patients with stroke survivors returned to their employability. From 30 to 40 percent of patients end up with an average grade of disability, when you take care of themselves, but not to work. And about 20 percent of patients with severe disabilities from which some remains bedridden.
Conclusion: hypertension, atherosclerosis and high cholesterol are major risk factors in patients with ischemic and hemorrhagic stroke. It is necessary to undertake preventive measures to curb the risk factors in order to reduce morbidity and mortality in these patients.Statistic Republic of Macedonia shows that patients with stroke becomes the younger. While earlier statistics showed that the brain damage affects individuals in the sixth and seventh decade of life, recent indicators suggest that stroke is now occurring more frequently in those third and fourth decade. Download age of stroke, according to neurologists in the country is the reason for stress and unhealthy lifestyles.
Keywords: ischemic and hemorrhagic stroke, cerebrovascular.
Introduction
Millions of people a year die of a stroke, and even more people to remain permanently disabled as a result of cerebral infarction, stroke and bleeding under the lining of the brain. If you know that the world annually to reach 20 million new patients with stroke, and about 6,000 in Macedonia, it is clear why it is necessary to know more facts about this disease and the consequences of stroke. Statistics says the following: deaths worldwide each year five million of stroke. In our country, 20 percent of patients die within the first month after stroke, in the first year of 30 percent, or 1,800 total per year die from stroke, according to one day die in Skopje. Only 20 percent of patients with stroke survivors returned to their employability. From 30 to 40 percent of patients end up with an average grade of disability, when you take care of themselves, but are unable to work. Internationally day stroke is celebrated on 29 October, and the goal is to warn the public about the importance of prevention activities and promote a healthy lifestyle, early treatment and timely rehabilitation of persons who have suffered a stroke, to sensitize the public about the risk factors of stroke, while raising awareness and prevention of stroke. The objective is to analyze the aetiology,Risk factors for stroke, diagnostic procedures, the outcome in patients with stroke and treatment and rehabilitation. The purpose of the Bachelor thesis is to analyze the, aetiology, risk factors for stroke, diagnostic procedures, the outcome in patients with stroke and treatment and, rehabilitation. Stroke,, cerebrovascular stroke or stroke known as a clinical syndrome characterized by an acute loss brain function that takes longer than 24 hours or leading to death. Becomes due to spontaneous bleeding in the brain parenchyma (intercerebral bleeding) or the space around the brain (subarachnoid haemorrhagic) or hemorrhagic stroke, or as a result of inadequate blood supply to the brain (ischemic stroke), due to thrombosis, embolism, or poor blood flow associated with diseases of the blood vessels, heart or blood.Etiologic risk factors for stroke include: risk factors in a way of life, potentially cured risk factors, other risk factors.Ischemic stroke, cerebrovascular -vaskular that can occur in two ways: Cerebral thrombosis and cerebral embolism. -vaskular Hemorrhagic cerebrovascular stroke, which may be bleeding in the brain, subarachnoid hemorrhage, ischemic stroke. With ischemic stroke is considered that about 87% of all cases of stroke, but only 13% with hemorrhagic stroke. Ischemic stroke is usually caused by obstruction of blood vessels or blockage of blood vessels (arteries) that supply blood to the brain. Cerebral thrombosis is actually blockage of blood vessels with atherosclerotic material or blood clot originating from the carotid artery or modified elsewhere. The blood usually comes from the great arteries, and rarely small blood vessels. Thrombosis is usually caused by long-term arteriosclerosis. Cerebral embolism is the obstruction of blood, small pieces of thrombus, tumor, oily droplets or group of bacteria. In cerebral embolism embolus through the circulation leads to cerebral arteries leading to blockage, causing cognitive, motor and sensory impairment. The main cause of embolism is deep vein thrombosis. In a small number of patients may break the vessel wall and spill blood into the brain tissue -hemoragic stroke. Since blood flows under high pressure burst arteries, damage brain tissue and the formation of a hematoma (blood mass) which puts pressure on the surrounding normal tissue, and prevents blood flow and leads to extinction of the same. Intracerebral hemorrhagic occurs in rupture of blood vessels in the brain and causes bleeding spilling into the surrounding brain tissue, damaging brain cells. Reasons hypertension, arteriovenous malformation, degenerative changes in the blood vessels, blood clotting disorder, hemophilia and other blood diseases.Subarachnoidalis haemorrhagic is the flow of blood in the subarachnoid space, caused by any reason, the appearance of images clinically dramatic apoplectic insult.Approximately 77% of all subarachnoid hemorrhagic occur due to rupture of the aneurysm. Other causes include injury, vasculitis, circulation disorder, hypertension, and can not be the cause of the bleeding.This signals a sudden, severe headache, vomiting, and photophobia. If subarachnoid hemorrhagic is combined with bleeding in the brain, there are a variety of neurological deficits such as hemiparesis. If the bleeding is very difficult to appear comatose. Symptoms: Quick Test (FAST) for the detection of stroke:
Symptoms: Quick Test (FAST) for the detection of stroke:
F – Face – Ask the person to smile. If one side of the mouth idle / crooked? A person who is no longer symmetrical?
A – Hands – They’re looking to raise both arms. Does one arm drop?
S – Speak – Can you put together a simple sentence? Speak clearly?
T – Time – If any of these signs, you should immediately call an ambulance.
Complications from stroke: muscle weakness or paralysis (paralysis), loss of sensation, difficulty with speech and swallowing, visual problems, dizziness, headache, vomiting, loss of consciousness, memory loss, emotional problems, sensitivity to external temperature sensitivity to problems, mood, poor care of yourself.Coma in patients with stroke: Coma is the most severe form of human consciousness, including lack of response to sound, touch, light and painful stimuli, but also the loss of normal sleep function. Coma is a state of unconsciousness lasting more than 6 hours and can last for days, months or years. The appearance which has two primary reasons, structural abnormalities and metabolic disorders. Structural abnormalities, tumors, stroke, hematoma, bleeding in the brain, and more. Metabolic causes include toxicity, increased blood flow in the brain, increasing the pressure intracranial, hypo / hyperthermia and others. Patients who are in a comatose state, the head is turned towards the focal point, his face red, swollen and sweating. A paralysis of the facial nerve from the central type occurs chubby cheeks phenomenon smoking his pipe. The pulse of the patient is full, nervous and correct. Breathing is Chein-Shtouks (fast and deep breathing with periods of apnea). The first step in the treatment of patients in a coma patient hemodynamic provides the ability to maintain airway. After that it is necessary to determine the reason that led to coma, and access to further treatment. Medical history and physical examination, diagnostic tests and procedures and blood tests, clinical picture, CT-scan, digital angiography. Painful is located in the department of acute stroke treatment that lasts more than a week, and then in a comprehensive department of stroke where treatment and rehabilitation lasts from several weeks to several months. Treatment of patients with stroke. There are five key points in the treatment of acute stroke: the treatment of the general condition should be stabilized, specific therapy against certain aspects of the pathogenesis of stroke and neuroprotection, prophylaxis and treatment of complications that may be neurological or medical, early secondary prevention, which is aimed at the prevention of stroke, early rehabilitation. The goals of rehabilitation of patients with stroke: Extensive long-term therapy has to correct or mitigate the consequences disease,to support the patient to adapt to the situation, prevention of stroke.
Materials and Methods: This was a retrospective statistical analysis of patients with strokes of the Department of Neurology, General Hospital in Strumica, with emphasis on the type of stroke, risk factors, symptoms and complications, the incidence of patients with stroke in the outcome of the disease. Applying physical medicine and rehabilitation, time and type of exercise that are applied in patients with stroke.
Results: In ischemic stroke, is considered to be about 87% of all cases of stroke, but only 13% with hemorrhagic stroke.
1. Graphic trend in the number of strokes recorded in the General Hospital PHI Strumica
2. Graphic display the number of hemorrhagic and ischemic strokes per month 2011god.
3. Overview number of hemorrhagic and ischemic strokes per month 2012 years.
4. Graphical display of the number of hemorrhagic and ischemic strokes per month 2012 years.
Discussion
Ischemic stroke is about 87% of all cases of stroke, and only 13% with hemorrhagic stroke. Between 2011 24 patients with hemorrhagic stroke and 192 with ischemic stroke.In 2012 years 13 patients with hemorrhagic stroke and 160 ischemic stroke udar.2013godina 19 patients with hemorrhagic stroke and 173 with ischemic stroke or vkupno581 patient in our country, even though 20 percent of patients die within the first month after stroke in the first year, about 30 percent, or a total of 1,800 people a year die from stroke and one patient per day die in Skopje. Currently, in our country there are about 16,000 patients from stroke. In 20 percent of patients with stroke survivors returned to their employability. From 30 to 40 percent of patients end up with an average grade of disability, when you take care of themselves, but not to work. And about 20 percent of patients with severe disabilities from which some remains bedridden.
Conclusion
Hypertension, atherosclerosis and high cholesterol are major risk factors in patients with ischemic and hemorrhagic stroke. It is necessary to undertake preventive measures to curb the risk factors in order to reduce morbidity and mortality in these patients.Statistic Republic of Macedonia shows that patients with stroke becomes the younger. While earlier statistics showed that the brain damage affects individuals in the sixth and seventh decade of life, recent indicators suggest that stroke is now occurring more frequently in those third and fourth decade. Download age of stroke, according to neurologists in the country is the reason for stress and unhealthy lifestyles. A larger influx of patients with stroke is significant in changeable weather accompanied by sudden changes in atmospheric pressure. Specific protection against stroke, but the prevention or timely visits to the doctor, the application of a healthy lifestyle tips to reduce smoking and alcohol use among young people, especially in summer. The moves are not only a health issue, but also because of social treatment and rehabilitation of these people costs are high, especially as their condition requires long-term treatment. Upon completion of the rehabilitation of these people are unable to work, some are off, and the other ends fatally.
References
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