Stroke in the elderly

Stroke in the elderly is an acute cerebrovascular accident with damage to brain tissue and disruption of its functions.

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Causes stroke in the elderly

Depending on the nature of the pathological process, stroke in the elderly is divided into hemorrhagic and ischemic.

Hemorrhagic stroke includes bleeding into the brain tissue (parenchymal) and under the membranes of the brain (subarachnoid, subdural, epidural).

Ischemic stroke in the elderly occurs as a result of difficulty or cessation of blood flow to one or another part of the brain and is accompanied by softening of an area of brain tissue - cerebral infarction.

The most common cause of stroke in the elderly is arterial hypertension, caused by hypertension, kidney disease, pheochromocytoma, some endocrine disorders; with atherosclerosis affecting the main vessels of the brain in the neck. Stroke can also be caused by:

• rheumatism,
• various vasculitis (syphilitic, allergic, obliterating thromboangiitis, Takayasu's disease),
• diabetes mellitus,
• cerebral aneurysms,
• blood diseases (aplastic anemia, erythremia, leukemia, thrombocytopenic purpura),
• acute infections,
• carbon monoxide poisoning, heart defects, myocardial infarction.

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Forms

Hemorrhagic stroke in the elderly

Most often develops at the age of 45-60 years. It occurs suddenly after another excitement or sudden overfatigue. Initial symptoms are headache, vomiting, disturbances of consciousness, rapid breathing, bradycardia or tachycardia, hemiplegia or hemiparesis.

In elderly and senile people, hemorrhages occur less violently than in young people, often not accompanied by pronounced general cerebral symptoms, often without a temperature reaction and changes in blood counts.

In the fundus of a hemorrhagic stroke, hemorrhages in the retina, a picture of hypertensive retinopathy with edema and hemorrhages can be detected. A general blood test reveals leukocytosis with a shift in the leukocyte formula to the left, an increase in ESR, and also an increase in blood viscosity, an increase in fibrinolytic activity, hyperglycemia, azotemia, bilirubinemia, and a decrease in potassium content. When examining the cerebrospinal fluid, an admixture of blood in the cerebrospinal fluid is detected. Electroencephalography reveals gross diffuse changes in the bioelectrical activity of the brain, sometimes with interhemispheric asymmetry. Angiography can reveal a shift in intracerebral vessels or the presence of the so-called avascular zone.

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Ischemic stroke in the elderly

In geriatric practice, ischemic brain lesions predominate.

The development of ischemic stroke is often preceded by transient cerebrovascular accidents, which are the result of a short-term deficiency in blood supply to the brain in the area in which the infarction later develops.

In case of thrombosis of cerebral vessels, patients experience dizziness, short-term disturbances of consciousness (semi-fainting states), and darkening of the eyes. Ischemic stroke in elderly people can develop at any time of the day, but most often it occurs in the morning or at night. In elderly and old people, ischemic stroke often develops following myocardial infarction. A gradual (over several hours, and sometimes days) increase in focal neurological symptoms (deterioration of vision, paresis, paralysis) is typical. In this case, a wave-like severity of symptoms is often noted - sometimes it intensifies, then weakens again. In case of embolic ischemic stroke, neurological symptoms occur simultaneously and are immediately maximally pronounced.

A distinctive feature of ischemic stroke is the prevalence of focal symptoms over general cerebral ones. More reliable information is obtained from angiography, computed tomography and magnetic resonance imaging of the brain.

Treatment stroke in the elderly

Treatment of patients with cerebral stroke should be carried out in a hospital. Hospital conditions significantly expand therapeutic possibilities and ensure constant monitoring of the patient's condition. Patients with a deep comatose state with a gross violation of vital functions are not subject to transportation to a hospital from home; hospitalization is also inappropriate in cases of repeated cerebrovascular accidents with the presence of dementia and other mental disorders, patients with incurable somatic diseases.

The general principles of stroke treatment are:

1. Effects on the cardiovascular system - use of cardiac glycosides in cases of severe myocardial contractility reduction, antihypertensive agents (calcium antagonists (nifedipine), beta-blockers (obzidan and diuretics (lasix), respiratory analeptics (cordiamine, sulfocamphocaine).
2. Correction of homeostasis by introducing electrolyte solutions (5% glucose solution, 0.9% sodium chloride solution, Ringer's solution, 4% sodium bicarbonate solution, polarizing mixture in a total volume of up to 2p), low-molecular dextrans (rheopolyglucin up to 400 ml), correction of hypokalemia, hypochloremia.
3. To combat cerebral edema: 10 ml of 2.4% euphyllin, 1 ml of lasix are administered intravenously, if necessary - mannitol, urea; antihistamines (diphenhydramine, pipolfen), novocaine; hydrocortisone, dexamethasone, prednisolone, glycerin can be used internally.

Elimination of vegetative disorders: in case of hyperthermia, "lytic" mixtures are prescribed, including diphenhydramine, novocaine, analgin; neurovegetative blockade is performed using droperidol, diphenhydramine, aminazine; rubbing the patient's body with alcohol until red-hot is recommended, which increases heat transfer, regional hypothermia of large vessels (cooling the area of the carotid arteries, axillary and groin areas), wrapping with wet sheets.

In hemorrhagic stroke - increase the coagulating properties of the blood and reduce the permeability of the vascular wall using calcium preparations (10 ml of 10% calcium chloride solution intravenously or calcium gluconate intramuscularly), vikasop (2 ml of 1%), 5-10 ml of 3% ascorbic acid solution, 10% gelatin - 20-50 ml intravenously, rutin, rutamin, e-aminocaproic acid (5% - up to 100 ml), dicynone (2 ml - 250 mg) intravenously or intramuscularly; surgical treatment is possible - puncture stereotactic removal of lateral hematoma after CT, various methods of surgical treatment of cerebral aneurysms.

In ischemic stroke: increase blood flow to the brain by dilating regional cerebral vessels and reducing vascular spasm, improving collateral circulation using vasodilators (10 ml of 2.4% euphyllin solution intravenously), nicotinic acid (1% solution 1-2 ml intravenously), stugeron, trental, etc.; improve venous outflow by administering cocarboxylase (50 mg) and diethene (10 mg); normalize coagulation and rheological properties of blood using heparin (5,000-10,000 IU intravenously or intramuscularly for 3 days), phenylin and other indirect anticoagulants (up to 2-3 months), acetylsalicylic acid, complamine, prodectin, trental, etc.

Increasing the resistance of brain tissue to hypoxia and improving brain metabolism - using inhibitors of tissue metabolism (neuroleptics, regional hypothermia) ATP, vitamins and amino acids (cocarboxylase, glutamic acid, glycine, B vitamins, vitamin E), nootropics (aminalon, piracetam), cerebrolysin, actovegin, hyperbaric oxygenation.

When caring for a patient with a stroke, it is necessary to:

• monitor hemodynamic parameters, the nature and frequency of respiratory movements every 1-2 hours;
• monitor the condition of the skin and determine the water balance daily;
• ensure compliance with bed rest with the implementation of all measures to care for the seriously ill;
• to prevent pneumonia, constipation, urosepsis, thromboembolic complications;
• prevent the development of contractures;
• in case of speech impairment, determine the method of communication with the patient and perform speech therapy exercises;
• in case of swallowing disorders, provide parenteral feeding and feeding through a tube;
• if hyperthermia is present, care for the patient as in the second period of fever.