Why do seizures occur after a stroke and how to help the patient

• How does a hemorrhagic stroke occur?
• What types of hematomas occur in hemorrhagic stroke?
• Symptoms of hemorrhagic stroke
• Recovery time after hemorrhagic stroke
• Rehabilitation objectives
• Recovery points after hemorrhagic stroke
• Types of rehabilitation after hemorrhagic stroke
• Drug treatment
• Motor recovery
• Movement restoration techniques
• Speech restoration
• Restoring breathing and swallowing
• Psychological recovery

Hemorrhagic stroke is a condition of acute circulatory disturbance in the brain, accompanied by hemorrhage into the cranial cavity and leading to the formation of hematomas.
Today, hemorrhagic stroke is a serious condition leading to disability. The disease mainly affects men, but most often it is women who die. Mortality is very high, with hemorrhage leading to the death of almost 50% of patients. This occurs within 30 days after the attack occurred.

But even after the crisis is over, the struggle must continue, because problems with blood circulation that began in the brain have many consequences. But in this case, rehabilitation after a hemorrhagic stroke, along with the patient’s gradual return to normal life, is possible.

How does a hemorrhagic stroke occur?

Cerebral hemorrhage during a stroke is a spontaneous phenomenon. The functioning of the brain requires large amounts of oxygen from the blood. Nutrition is produced thanks to two carotid and two vertebral arteries, which form a circle between themselves passing through the base of the brain.

When a vessel is damaged, acute blood failure occurs, which is necessarily compensated by healthy vessels. However, over time, the effectiveness of such a mutual assistance system decreases. The appearance of cerebral hemorrhage during a hemorrhagic stroke is caused by sudden ruptures of the vascular walls or their increased permeability due to other chronic diseases.

During a cerebral hemorrhage, the death of brain cells that are damaged by blood contact occurs. In nearby areas of the brain, oxygen deficiency begins, since blood does not reach them and cannot move further through the vascular system.

Possible complications

Older people, who make up the bulk of those affected, are more sensitive to the side effects of anticonvulsant medications. It's connected with:

• simultaneous use of 3 or more medications of different pharmacological groups that can interact with each other;
• unsatisfactory condition of the liver, kidneys;
• the presence of cognitive impairment;
• accumulation of antiepileptic drugs in blood serum.

Most common side effects

What types of hematomas occur in hemorrhagic stroke?

Types of hematomas in cerebral hemorrhage or hemorrhagic stroke:

1. Parenchymatous with the distribution of blood directly inside or under the membrane of the brain, with the formation of hematomas and with saturation of the nerve brain tissue. With such a hemorrhagic stroke, severe neurological deficits can form.
2. Intraventricular with the effusion of blood into the ventricles of the brain, with tissue penetration and the formation of a hematoma. With this type, death especially often occurs within 3-5 days.
3. Subarachnoid hemorrhages in the area between the arachnoid and pia mater of the brain.
4. Mixed types of strokes, in which focal hemorrhages appear in different parts of the brain.

There is also a classification based on the volume of blood that forms hematomas: small - up to 20 ml, medium - in the range of 20-50 ml, large - from 50 and above.

Types of brain strokes

The most common ischemic stroke (infarction) of the brain - 85% of cases, hemorrhagic stroke occurs in 15% of cases. Strokes can be caused by several reasons:

• formation of thromboembolism in heart diseases;
• acute circulatory disorders in the cervical and large cerebral arteries;
• disturbance of blood circulation in the small arteries of the brain during the acute course of the process.

Symptoms of hemorrhagic stroke

With hemorrhoidal stroke, symptoms most often appear suddenly, mainly during the daytime and during very heavy physical activity. The following symptoms are typical:

• convulsions;
• Strong headache;
• sudden loss of consciousness;
• nausea and vomiting;
• serious depression of a person's consciousness, similar to or leading to a coma

In addition, general symptoms of a stroke appear:

• decreased facial expressions and muscle strength affecting any part of the body;
• the occurrence of speech disorders and problems with visual perception;
• loss of coordination of movement with impaired ability to move.

During an attack, the patient's skin becomes cold and sometimes acquires a purplish-bluish tint. Breathing becomes more frequent, noisy, with wheezing. Sometimes, on the affected side, the pupil dilates, diverges, or chaotic movements of the eyeballs occur.

An important indicator of the severity of the patient’s current condition is comatose status with loss of consciousness, which can last several days. This makes the prognosis very unfavorable.

Subarachnoid hemorrhage most often results from rupture of a cerebral aneurysm. As a result, the patient experiences severe headaches localized in the back of the head and forehead. Then it spreads to the rest of the head. Later, other symptoms of hemorrhagic stroke appear.

In case of extensive cerebral hemorrhage, neurosurgical microtechnical operations are performed. In this case, removal of the hematoma leads to a decrease in pressure on the brain tissue and prevents the development of brain edema. But surgery is performed strictly for medical reasons.

In case of an aneurysm, surgery is performed to stop bleeding, and the patient is prescribed hemostatic drugs. Often with subarachnoid lesions, narrowing of the vessel occurs and the development of ischemic stroke. In this case, calcium channel blockers are necessarily prescribed to prevent narrowing and spasm of the vascular walls.

In the first 3 weeks after the attack, the patient’s condition remains the most severe due to progressive cerebral edema, as well as a gradual increase in cerebral symptoms. If there are any chronic pathologies in the body, aggravated by a hemorrhagic stroke, the patient may die. A month later, the patient begins to experience regression of cerebral symptoms and blood pressure stabilizes.

This is interesting! It is recommended to always have glycine in your home medicine cabinet. Many qualified doctors classify this drug as a neuroprotector or a substance that protects brain tissue.

If unpleasant weakness in the limbs or speech disorder occurs, you should immediately put 5 glycine tablets under your tongue. To some extent, such prevention can prevent acute brain damage and the development of hemorrhagic lesions.

Many people are interested in the difference between ischemic and hemorrhagic stroke. Two such lesions have almost identical symptoms, but have different reasons for the development of such a serious pathology. With ischemic stroke, the prognosis is favorable and mainly depends on the degree of brain damage that has occurred.

The following symptoms are characteristic of each type of this disease:

• suppression of speech ability;
• partial or complete paralysis of the body and limbs;
• impairment of visual sensitivity or its complete loss;
• impaired coordination of movements;
• complete loss of hearing in a hemorrhagic condition;
• • serious inhibition of the functions of the cerebral cortex;
• • increased blood pressure.

The consequences of a stroke mainly depend on the location and extent of the existing lesion. A hemorrhagic attack has an acute onset and progresses rapidly. The onset of coma in this case is possible within the first few minutes or hours. With ischemic stroke, the symptoms are less severe.

Damage to the left hemisphere leads to paralysis of the right side of the body. Hemorrhage in the cerebellar area deprives the patient of sensitivity, the ability to swallow, see and speak. Often the consequence of a hemorrhagic stroke is the gradual development of dementia or dementia.

Urgent Care

What to do with cramps after a stroke - if a muscle spasm occurs, you must:

1. Call an ambulance immediately;
2. If convulsions are accompanied by loss of consciousness, you need to put the patient on the sofa;
3. Open the window and remove tight clothing from the patient to ensure oxygen access;
4. Place a pillow or cushion under your head, remove hard or sharp objects that could cause injury;
5. Remove food or vomit from the mouth and remove dentures;
6. If breathing is impaired and wheezing occurs, the patient should be placed on his side;
7. If a seizure continues for a long time, you will have to restrain the patient to prevent accidental injury;
8. If the patient is conscious and suffers from strong muscle contractions, it is recommended to prepare a mustard compress with olive oil or gently rub the legs.

Attention!

Basic treatment of seizures after a stroke can only be prescribed by a neurologist after a comprehensive diagnosis.

First aid rules for seizures after a stroke

Recovery time after hemorrhagic stroke

The rehabilitation performed after such a brain injury consists of several stages:

• early period, lasting about six months after the attack;
• later recovery, lasting from six months to 1 year;
• the stage of final recovery, which in its duration occupies the entire subsequent time.

A year after the attack, residual effects begin. The best results during rehabilitation can be obtained in the first year; for this reason, recovery should not be delayed.

Effective results are obtained by strictly observing the following important principles:

• taking action at an early stage of ongoing treatment in a hospital;
• daily implementation by the patient of appropriate recommendations without any delays;
• prescribing special physical activity with appropriate intensity and gradual complication of exercises.

In addition, it is very important to take comprehensive measures: prescribing physiotherapy, drug treatment and the necessary correction of the patient’s psychological state. During this period, a recovering person must protect himself from unnecessary stressful situations, and also be surrounded by the care and love of family and friends.

Differentiated treatment of ischemic stroke

The specific (differentiated) treatment of ischemic stroke is based on reperfusion therapy aimed at restoring the lumen of the vascular bed. Among the methods of treating ischemic stroke, thrombolytic therapy is a method whose effectiveness has been proven by the results of large multicenter studies. The first study, conducted by the National Institute of Nerve Diseases and Stroke in 1995, showed that intravenous rt-PA administered within 3 hours of the onset of ischemic stroke significantly improved outcome. Also in 1995, the results of the European Study of Acute Ischemic Stroke (ECASS-1) were published, which studied the effectiveness of rt-PA prescribed within 6 hours of the onset of stroke at a dose of 1.1 mg/kg. Along with clinical improvement, some patients had a high risk of intracerebral hemorrhage. Three years later, results emerged from the ECASS-2 study, which was performed with rt-PA at a dose of 0.9 mg/kg within a 6-hour “therapeutic window.” Good recovery was observed in 54.3% treated with rt-PA, compared with 46% treated with placebo. Another large study assessed the effectiveness of rt-PA when administered within 3 to 5 hours of the onset of stroke symptoms. The results of this study, like ECASS-2, showed that the incidence of intracerebral hemorrhage was slightly higher when rt-PA was administered within 6 hours than within 3 hours.

A study of the possibility of thrombolysis within 0 to 6 hours using recombinant prourokinase, which was injected locally into the vessel for angiographically confirmed thrombosis of the middle cerebral artery, showed that thrombolytic therapy can be effective up to 6 hours from the onset of stroke, provided that patients are carefully selected. It was proposed to take measures to expand the “therapeutic window” when conducting thrombolysis in patients with acute ischemic stroke. These and other studies have made it possible to develop recommendations for thrombolytic therapy in patients with acute ischemic stroke.

The indication for its implementation is acute ischemic stroke lasting 3 hours from the onset of the disease in patients under 80 years of age. Before starting this treatment, a CT scan of the brain should be performed to rule out hemorrhagic stroke. Thrombolysis is not recommended for patients with severe stroke, large infarcts, blood pressure > 185/110 mmHg, or if the stroke occurred during sleep. Because thrombolytic agents increase the risk of bleeding, the effectiveness and safety of their use should be discussed with the patient and his family before initiating therapy.

Tissue plasminogen activator is currently recognized as the main cerebral thrombolytic. Intravenous administration of plasminogen activator (rt-PA) at a dose of 0.9 mg/kg (10% of the dose administered as a bolus, then slowly over 60 minutes) is indicated in the first 3 hours from the onset of stroke. In selected patients, rt-PA may be administered between 3 and 6 hours. Intravenous administration of streptokinase is not recommended, as there is a high likelihood of bleeding. In patients with acute basilar occlusion and occlusion of the proximal middle cerebral artery, intra-arterial administration is possible in specialized centers.

Rehabilitation objectives

The main objectives of the ongoing rehabilitation are:

1. Work on restoring lost everyday and physiological functions of a person suffering from a stroke. Restoring full range of motion, the ability to independently care for oneself and perform simple household chores.
2. Restoration of lost professional ability to work with a return to the previous place of activity or assistance in retraining.
3. Maintaining the necessary social activity of a person, first of all, restoring his contact with loved ones and the ability to make new acquaintances;

It is very important to prevent a possible relapse and correct the patient’s current lifestyle.

Recovery points after hemorrhagic stroke

Complications for the patient mainly depend on the location of the hemorrhage that occurs, as well as its volume. Today there are the following groups of possible threatening consequences:

1. Motor disorders. The appearance of severe weakness and paresis in a person, the patient’s inability to accept and maintain a sitting position. This may be paralysis of one side of the body, high muscle tone or spasms that occur, which seriously complicates self-care, requires mandatory assistance and causes a lot of inconvenience to the person.
2. Impaired sensitivity is, for example, numbness of the limbs, a feeling of “insects under the skin” and burning, the inability to control the hands, leading to various everyday problems.
3. The appearance of speech pathologies after a stroke is confusion of speech and the inability to correctly pronounce individual sounds or loss of the ability to maintain a conversation. There may be loss of skills such as recognizing the meaning of words, counting, reading, telling time by a clock, and understanding calendar periodicity.
4. Problems with swallowing when eating food and various liquids, and in some cases, complete loss of the ability to eat independently.
5. Disorders of the excretory system: the appearance of urinary and stool incontinence, problems with the intestines and urinary system that arise on an ongoing basis.

The patient often develops acute and chronic psychological and mental disorders in the form of depression, excessive emotional temper or apathy. Sometimes partial amnesia occurs: the inability to recognize familiar people or objects, the understanding of performing simple everyday actions disappears.

Main signs of seizure syndrome

During cramps, certain muscle groups contract or twitch. The duration of the convulsive syndrome varies from a few seconds to ten minutes. A patient who has suffered a stroke most often suffers from short-term cramps throughout the body. They can occur in the legs, arms, neck or face. After an attack of convulsions, the patient loses consciousness or falls asleep as a result of the brain being in a state of shock. Seizures may manifest differently. Some patients experience mild tremors, while others suffer from severe seizures.

Convulsions during and after a stroke can occur:

• short-term contractions of the facial muscles (in this case, one half of the face may become distorted and a mask-like face may appear);
• numbness of the muscles of the limbs, complete loss of control over them, the appearance of a feeling of a wooden arm or leg;
• contraction of the facial muscles against the background of numbness of the limbs.

Types of rehabilitation after hemorrhagic stroke

The necessary medicinal and motor rehabilitation is carried out for the following purposes:

• significant reduction in the risk of recurrence of hemorrhagic stroke;
• gradual return to normal lifestyle;
• return of lost ability to work;
• the patient performs basic skills and actions;
• preserving the patient’s identity through the provision of social and psychological assistance.

Drug treatment

In the human brain, dead neurons are replaced with elements with high activity. But due to the increasing load, additional energy is necessarily required. Neurons that remain alive after damage restore lost functions over time.

Prescribed medications provide additional nutrition and significantly improve recovery processes in the brain. Additional courses of essential drug therapy are recommended once every three months throughout the year.

Drugs that are administered to the patient by injection during treatment:

• nootropics, which include piracetam, Actovegin and other drugs;
• medications to stimulate the necessary impulses in brain cells, for example, proserin or neuromidin;
• selected B vitamins that improve cell metabolism.

Taking the prescribed medications should continue even after completion of the prescribed treatment in the hospital. At home, tablets are taken with food.

Chronically high blood pressure is corrected with medication. If necessary, the doctor prescribes suitable medications for blood pressure, calcium channel blockers in vascular cells, or drugs to lower blood sugar levels.

Motor recovery

It is necessary to restore lost movement already at the stage of inpatient treatment after primary care has been provided. It is imperative to provide physical activity to the limbs to improve blood circulation, which helps in reducing tone and prevents the appearance of congestion in the blood vessels, and also protects the patient from the occurrence of pneumonia due to a recumbent lifestyle.

The position of the limbs in a supine state, if necessary, is corrected using a splint or special weights. Such patients must turn over every 2 hours to prevent the appearance of bedsores on the skin; in addition, this is recommended to stabilize blood pressure.

A few days after the attack, passive gymnastics begins, during which the person is assisted in smooth movement of various parts of the body. Procedures are carried out only if the person does not experience pain. If the condition improves, you should help the patient learn to take a sitting position, and then help him restore an upright position. Before walking, leg training is performed in order to regain the lost sense of position in space. Then the patient needs to begin to move around using supports, walkers and canes.

Movement restoration techniques

Physical therapy plays a significant role in the rehabilitation of lost motor ability. In this case, suitable exercises are developed for different muscle groups, classes are conducted using special simulators, and a device is used to reduce high muscle tone.

Prescribing a special massage is very useful. First, the limbs are stroked with a sufficiently high muscle tone, and then other muscle groups are rubbed. The use of a warm heating pad before the session significantly improves the effect. The massage procedure can take 20 minutes and mainly depends on the current condition of the patient.

Effective methods of physiotherapy include oxygen baths, electrophoresis of blood vessels in the neck, and electrical stimulation of muscles that have lost their functions as a result of a stroke.

Speech restoration

The return of speech is possible even after an attack that occurred more than a year ago. Conversation after a stroke should be slow and words pronounced clearly. At the same time, there is no need to rush to answer and ask difficult questions.

Working with a speech therapist helps a lot in restoring muscle functionality. Practicing in front of a mirror can also be very useful. In the process of noticeable improvements, it is possible to complicate tasks and stimulate a person to pronounce more complex spoken phrases.

Restoring breathing and swallowing

Nutrition of patients in a hospital is most often performed using a special feeding tube. Then comes the time to independently master the skill of eating food. Proper preparation of foods greatly simplifies the rehabilitation of a patient seriously affected by a stroke. Cooked food should be warm, not hard and have a soft texture. Flavorful foods trigger saliva production.

Patients should absolutely not be rushed during the process of eating; this process can take half an hour or more. You may need help holding a utensil or spoon. Restoration of the functions of the swallowing muscles occurs with regular repetition of the nutritional process.

Who can have a stroke? Predisposing factors

It is generally accepted that stroke occurs only in older people. However, in recent decades the disease has been rapidly becoming younger. An attack can occur as early as 40 years of age or even earlier.

Main risk factors:

• disturbances in sleep and nutrition when entering a “dangerous” age – over 50 years;
• hypertension;
• chronic heart disease;
• high stress loads at work;
• smoking and alcohol abuse;
• temporary, rapidly passing ischemic attacks;
• high blood cholesterol levels;
• obesity;
• diabetes mellitus (it increases the likelihood of not only the first, but also a second stroke);
• hereditary factor;
• lack of timely hospitalization during an attack and lack of qualified medical care in municipal hospitals;
• trauma (the rarest cause of stroke)

However, symptoms and causes differ between women and men.

The main distinguishing features of female attacks:

• the predominance of the disease is of the hemorrhagic type;
• very long and difficult recovery of functions;
• high mortality;
• high loads on blood vessels during pregnancy;
• Among the main causes are migraines, headaches, and great stress;
• it’s easier to see the first symptoms of an approaching “blow”;
• One of the provoking factors is taking oral contraceptives.

The most pronounced symptoms in women include: weakness, slowness of movement, shortness of breath, wheezing, increased heart rate, blurred vision, double vision, fainting, impaired hearing, pain on one side of the face and body, and unbearable headache.

In men

The main risk factors are impaired blood circulation, blockage of blood vessels, rupture of arteries with subsequent hemorrhage, blood thickening due to various diseases, obesity, diabetes mellitus, lack of physical activity, poor diet and eating disorders, bad habits, severe physical activity, vegetative-vascular dystonia, hypertension .

The main signs of a stroke in men may appear periodically, but go away over time. In this situation, the most dangerous thing is to decide that the trouble is over. After all, most likely, these are just transient ischemic attacks, signaling the approach of a stroke.

With the ischemic type, a man may feel dizziness, severe headache (it cannot be relieved by painkillers), weakness, decreased sensitivity in the limbs and numbness, short-term fainting, and vomiting.

A hemorrhagic attack is expressed by loss of consciousness, a sharp increase in pressure, the face becomes very red, noises are heard when breathing, facial asymmetry is noticeable, and vomiting occurs.