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HOSPITAL REGISTER OF STROKE IN ANDIJAN CITY
Kodirov Javokhirbek Shukhratjon ugli
Andijan State Medical Institute
Abstract.
Stroke is a clinical syndrome represented by focal and/or general cerebral disorders,
developing suddenly as a result of stroke. Transient ischemic attack - transient episodes of
neurological dysfunction caused by regional ischemia of the tissues of the brain, spinal cord or
retina, but not leading to the development of infarction of the ischemic area [according to X-ray
computed tomography (CT) or magnetic resonance imaging (MRI)]
Kеywоrds:
Stroke, diagnosis, method, treatment.
INTRОDUСTIОN
Thus, regardless of the short duration (less than 24 hours) of clinically manifest symptoms, the
presence of an infarction according to neuroimaging data allows us to make a diagnosis of cerebral
infarction. At the same time, due to insufficient sensitivity of routine CT for early detection of an
ischemic focus, especially in the posterior circulation system, a compromise diagnostic algorithm is
used: if the neurological deficit lasts more than 24 hours, it is possible to make a diagnosis of
ischemic stroke even in the absence of radiological confirmation (based on clinical criteria).
"Minor stroke" (reversible neurological deficit) is a clinical neurological syndrome that develops as
a result of an acute disorder of cerebral circulation, in which the dysfunction is restored within the
first 3 weeks of the disease.
The first 5 days of stroke are defined as the most acute period. The acute period of stroke is
considered for 28 days. Up to 6 months – early recovery period, up to 2 years – late recovery period.
MАTЕRIАLS АND MЕTHОDS
Ischemic stroke is caused by a decrease in blood flow (usually due to occlusion of large or small
arteries) in a certain area of impaired cerebral vascularization with the formation of a limited
infarction.
The following is included in the ICD-10 section "Cerebrovascular diseases": I63. Cerebral infarction.
The localization of cerebral infarctions is based on the vasotopic principle: dependence on the blood
supply zone.
Pathogenetic subtypes of ischemic stroke are distinguished [based on the TOAST criteria (Trial of
Org 10172 in Acute Stroke Treatment)]:
I. Atherothrombotic stroke.
II. Cardioembolic stroke.
III. Lacunar stroke.
IV. Stroke of other established etiology.
V. Stroke of unknown etiology (cryptogenic).
I. Atherothrombotic stroke (including arterio-arterial embolism)
• Onset is usually intermittent, stepwise, with a gradual increase in symptoms over hours or days.
Often debuts during sleep. The presence of atherosclerotic lesions of extra- and/or intracranial
arteries (pronounced stenotic, occlusive process, atherosclerotic plaque with an uneven surface, with
an adjacent thrombus) on the side corresponding to the focal lesion of the brain.
• Often preceded by TIA.
• The size of the lesion can vary from small to extensive.
Features of clinical manifestations with occlusion at different levels of the carotid basin (anterior
circulation system):
• external carotid artery (ECA) - pain and numbness of half of the face;
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• common carotid artery (CCA) — optic-pyramidal syndrome, oculopyramidal syndrome, decreased
pulsation of the internal carotid artery (ICA) and temporal artery;
• siphon of the ICA — hemisyndromes, blepharospasm, aphasia, other higher cortical functions;
• bilateral lesion of the carotid artery (CA) — tetraplegia, there may be alternation of symptoms of
different hemispheres.
RЕSULTS АND DISСUSSIОN
Features of clinical manifestations in case of occlusion at different levels of the vertebrobasilar basin
(VBB) (posterior circulation system):
• stenosis of the subclavian artery proximal to the beginning of the vertebral artery (VA) —
numbness, pain in the arm. Physical activity
on the left arm can lead to redistribution of blood flow from the VBB to the arteries of the upper
limb, which is accompanied by subclavian steal syndrome;
• occlusion of the precranial part of the VA — clinical manifestation of severe alternating syndrome
with bulbar disorders, cruciate hemiplegia. Forced position of the head — the head is tilted towards
the thrombosis and turned to the side opposite to the thrombus;
• occlusion of the intracranial part of the VA is characterized by severe clinical symptoms: sudden
onset, rapid increase in syndromes, pronounced vegetative manifestations, often a disturbance in the
rhythm of breathing;
• occlusion of the basilar artery (BA) is characterized by impaired consciousness, development of
the "locked-in" syndrome, vegetative disorders, hyperthermia, headache, systemic dizziness, mono-
and tetraparesis, changes in muscle tone, hormetonia, pseudobulbar syndrome, alternating
syndromes of the cerebral peduncle and pons.
Hemodynamic variant of an acute vascular event
• Onset is sudden or stepwise, both in an active patient and in one at rest.
• Localization of the lesion is the zone of adjacent blood supply.
• Presence of extra- and/or intracranial artery pathology:
— atherosclerotic lesions (multiple, combined, echeloned stenosis);
— arterial deformations with septal stenosis;
— abnormalities of the cerebral vascular system (dissociation of the circle of Willis, arterial
hypoplasia).
• Hemodynamic factor:
— decreased blood pressure (BP) (physiological — during sleep, after eating, hot baths and other
events, as well as orthostatic, iatrogenic arterial hypotension, hypovolemia); decreased cardiac
output [decreased stroke volume due to myocardial ischemia, significant decrease in heart rate
(HR)].
СОNСLUSIОN
Characterized by rapid onset of systemic inflammatory reaction, purulent-septic complications,
severe trophic disorders, respiratory distress syndrome with impaired alveolar ventilation, disorders
of motor function of the stomach and intestines with stagnation, microthrombosis and
thromboembolism, stress ulcers, hemorrhagic syndrome, enteric and hepatorenal failure, laboratory-
confirmed progressive hemostasis disorders. In 45% of severe strokes, similar syndromes of vital
function impairment develop.
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