Pathogenesis of stroke ©
STROKE (late lat. Insultus attack) - an acute violation of cerebral circulation. Blood circulation disturbance can be in a brain - cerebral I. or in a spinal cord - spinal I. (see. Spinal cord, pathology).
According to the WHO materials, the frequency of new cases of I. during the year ranges from 1.27 to 7.4 per 1000 population, which to a certain extent depends on the age of the patients. In the US, per 1000 people. population I. revealed in 2.6 cases. In Japan, in persons older than 40 years of age, hemiplegia or other symptoms of transferred I. were found in 15.7 cases per 1000 population. The structure of the vascular lesions of the brain changes mainly due to an increase in the number of ischemic forms. According to data from a number of clinics analyzed in the Institute of Neurology of the Academy of Medical Sciences of the USSR, in 1963 the number of softenings exceeded the number of hemorrhages by 23%, and in 1969 by 32%. In the 30s. in England, the mortality from cerebral hemorrhage exceeded the mortality from softening more than 2 times, and in the 70s. mortality from softening exceeds the mortality from hemorrhages. Mortality from cerebrovascular diseases in most economically developed countries is in third place after heart disease and tumors, accounting for 12–15% of total mortality. The risk factors for developing I. are: 1) a genetic predisposition to vascular diseases and impaired cerebral and coronary circulation; 2) hyperlipidemia associated with impaired lipid metabolism; 3) arterial hypertension; 4) hyperglycemia; 5) obesity; 6) insufficient physical. activity; 7) smoking; 8) the age of patients (the number of patients with I. in older age groups increases); 9) the history of repeated regional cerebral vascular crises; 10) individual features of the constitution (pyknic), mode of life and nutrition (a positive correlation was established between the consumption of cereals, sugar and the mortality rate from vascular lesions of the brain); 11) repeated stresses and prolonged neuro-psychological overstrain. With the combination of three and more unfavorable factors, the predisposition to I. increases.
By the nature of patol, the process I. is divided into two groups: hemorrhagic and ischemic (cerebral infarction).
To hemorrhagic I. include hemorrhages in the substance of the brain (parenchymal) and under the lining of the brain (subarachnoidal, subdural, epidural), as well as combined forms - subarachnoid-parenchymal or parenchymal-subarachnoid, parenchymal-ventricular.
Ischemic I. subdivided into thrombotic (including embolic) and nonthrombotic. Thrombotic is related to cerebral infarction, which develops as a result of complete occlusion of extra- or intracranial vessels caused by thrombosis, embolism, obliteration of the vessel with atherosclerotic plaque, etc. cerebrovascular disease. In some cases, mixed forms of I. are found: a combination of hemorrhagic and ischemic foci, for example, subarachnoid hemorrhage and cerebral infarction.
1999
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