What kind of type does stroke have?
There is hemorrhagic stroke (cerebral hemorrhage, subarachnoid hemorrhage) that ischemia-related stroke (cerebral infarction) to greatly divide into stroke, and to be clogged up with blood vessel of brain and blood vessel of brain are torn.
As for the cerebral infarction, cerebral blood vessel is clogged up for some kind of causes, and bloodstream gets worse and develops as cell of brain necrotizes without enough oxygen and nutrition. By the cause, there are atherothrombotic cerebral infarction, cardioembolic, three types of rakuna infarction.
Atherothrombotic cerebral infarction
Atheroma (state that cholesterol collected into rice porridge form) is formed on relatively big arterial inside walls such as the carotid artery (artery sending blood to the head in right and left of neck) and we narrow blood vessel and worsen bloodstream and atheroma is torn, and platelets gather and make clot (lump of blood which coagulated in blood vessel) and that drifts and blocks up bloodstream of brain and develops.
There is clot in heart after arrhythmia and myocardial infarction such as atrial fibrillation and that flows and blocks up blood vessel of brain and has. Generally, extensive cerebral infarction is often caused, and it features in cerebral infarction that symptom is the heaviest.
It develops as thin blood vessel (branch to penetrate) in brain is clogged up. Serious case example that is life-threatening even if aftereffects such as the paralysis may remain is rare cerebral infarction.
Most of cerebral hemorrhage are hypertensive cerebral hemorrhage.
Small lump (aneurysms) generates hypertensive cerebral hemorrhage to small blood vessel (200 - 300㎛) in brain which became fragile for high blood pressure and that is torn and is bleeding in brain and develops.
However, there is cerebral hemorrhage by side effect (antiplatelet agents such as anticoagulant, aspirin such as thrombolytic drug, heparin, warfarin such as t-PA) of medicine, "amyloid blood vessel symptom" (abnormal protein called amyloid depositing in the vascular wall of brain with aging, and becoming fragile, and bleeding) "brain arterio-venous malformation" as well as high blood pressure.
As for subarachnoid hemorrhage, about 50% die before arrival at hospital 35% 10% within one month for onset less than eight hours; is scared; is sick.
By cerebrovascular explosion, blood flows through subarachnoid cavity (in buffy coat in the surface of brain and space between arachnoid, subarachnoid hemorrhage is usually met with cerebrospinal fluid), and it develops.
Cause of cerebrovascular explosion includes "brain arterio-venous malformation" that is "cerebral aneurysm" (lump which part of the root where cerebral artery diverged swelled out, and there was) and natural vascular malformation, but most of subarachnoid hemorrhage 40 years or older are things by cerebral aneurysm explosion.
Cause of cerebral aneurysm does not yet become clear, but it is thought that native factor, rise, arteriosclerosis of blood pressure by aging participate.
What is symptom of stroke?
When even one develops among the next symptoms suddenly, let's doubt stroke.
The paralysis, loss of strength, numbness
We feel numbness that "the exercise paralysis" that power does not enter in particularly physical one side including face and hands and feet did, and there is "sensory disturbance" to feel that sense is dull.
We cannot talk about having thought well (motor aphasia), and there is "articulation disorder" to slur its words by "aphasia" such as (sensory aphasia) that it cannot understand to say of another person and the paralysis of mouth and muscle.
There is "suspensibility dizziness" to feel that "rotatory vertigo" to feel that people turn for dizziness round and round and oneself shake shakily. This both are possible for stroke, but rotatory vertigo produces even inner ear (organ in the depths of ear) disorder.
It seems that half of the fields of vision are missing and is symptom that thing is seen double.
We have characteristic that stroke particularly subarachnoid hemorrhage, headache due to cerebral hemorrhage develop suddenly.
Because cell of brain necrotizes, cerebral infarction is not generally accompanied by headache.
Headache due to cerebral hemorrhage is caused suddenly, too, but degree of headache is milder than subarachnoid hemorrhage and may hardly feel headache.
For subarachnoid hemorrhage, "we have not experienced so far" developing suddenly, please be careful about headaches "hit with hammer". This headache develops suddenly so as to be able to remember, "we came to rapidly have a headache in ○ time ○ minute." later. In addition, it is accompanied by vomiting for headache in most cases. However, unlike cerebral infarction and cerebral hemorrhage, the feature is that it is not often accompanied by symptoms such as the exercise paralysis, sensory disturbance, speech impediment (stroke that later "FAST" does not fulfill). Furthermore, let's warn as bleeding of degree that some blood leaks takes place from cerebral aneurysm as sign of subarachnoid hemorrhage, and it is seen in patient of approximately 50% to be accompanied by transient headache not to overlook "warning attack" that is petit mal of this sign.
Treatment of stroke includes t-PA IV therapy for cerebral infarction and treatment in blood vessel, various cures including craniotomy operation for brain bleeding.
Treatment center in treatment department in cranial nerve Internal medicine, neurosurgery, cranial nerve blood vessel, blood vessel cooperates and treats while utilizing high medical equipment such as 3.0 teslas MRI at our hospital.
Treatment of cerebral infarction
Cerebral infarction provides medical treatment for the immediate nature period (medical therapy), and treatment (clot apheresis) in blood vessel is provided in the center. In addition, treating surgically is performed as the onset prevention.
For medical therapy to give as medical treatment,
- Treatment (thromboclasis therapy, t-PA) to dissolve clot
- Treatment to prevent from having clots
- Treatment to suppress swelling of brain
- Treatment to prevent necrosis of brain
Thromboclasis therapy (t-PA)
We inject medicine called t-PA and dissolve clot which was jam-packed to blood vessel of brain and are cure to revive bloodstream.
It is necessary to give this treatment within 4 hours 30 minutes after the onset.
When symptom that stroke is doubted is seen because it arrives at hospital after developing and gives various tests and must perform medicine for injection surumadeo less than 4 hours 30 minutes, it is important to call ambulance as soon as possible.
In addition, cerebral hemorrhage may be caused when use is late (when we provide this treatment after brain and blood vessel have gone bad).
Difference such as lower figure appears whether you can provide appropriate treatment.
Treatment (clot apheresis) in blood vessel
We can enter and guide thin pipe called catheter from blood vessel of the root of foot to part clogged up with cerebral blood vessel mainly, and treatment in blood vessel is treatment to perform through appliance in that. Treatment in blood vessel has fewer burdens for body than treating surgically (craniotomy operation), and which is hoped for because curative effect breaks out increases. However, we are at risk of blood vessel of brain being clogged up with lumps of blood, and having bleeding.
By the immediate nature period treatment of cerebral infarction
・Penumbra (penumbra) system
We remove clot which was jam-packed to blood vessel of brain which said this through catheter, and treatment to revive bloodstream is performed.
We remove clot and are cure to revive bloodstream by snatching clot with wire which the tip becomes into mesh form.
Penumbra (penumbra) system
We remove by aspirating clot through catheter and are cure to revive bloodstream.
Purpose of treating surgically of cerebral infarction prevents future cerebral infarction in revascularizing to revive bloodstream. It is caused by the fact that atheroma is formed to the carotid artery as for most of atherothrombotic cerebral infarction, and bloodstream gets worse.
・Skill in carotid artery lining membrane detachment
But, there is.
Skill in carotid lining membrane detachment
We cut the cervical carotid artery open and remove atheroma that blood vessel becomes cause becoming small and are operation that aimed at curing from the origin.
Using technique of treatment in blood vessel, blood vessel sends to part becoming small in state that lengthened cylindrical mesh alloy (stent) thin and we blow there up balloon from the inside of stent and expand blood vessel and are operation to detain only stent.
It is operation to seam a certain superficial temporal artery and middle cerebral artery in the inside together outside of the skull, and to make bypass (bypath of bloodstream).
Treatment of cerebral hemorrhage
We use styptic to minimize the damage of brain of the cerebral hemorrhage immediate nature period and use antihypertensive agent. We may be operated on to prevent inside pressure of the skull from breaking out.
We give medical treatment (medical therapy to turn off blood, and to suppress swelling of brain, and to lower blood pressure), but treating surgically (operation) may be usually necessary when bleeding is big.
For the operation method,
But, there is.
In addition, we may perform cerebral ventricle drainage (we let you insert catheter in cerebral ventricle and exhaust blood and cerebrospinal fluid) when hematoma involves intracerebroventricularly and causes hydrocephalus (state that cerebrospinal fluids collect in brain, and cerebral ventricle comes to have a big).
We pierce the skull and are eliminated while seeing hematoma in brain with microscope, and, in the case of putamen bleeding, cerebellum bleeding, cortex bottom bleeding, craniotomy operates.
Intracranially approximately 2cm make a small hole (ugachitojutsu), and insert thin pipe in hematoma, and treatment to aspirate "skill to suck and remove hematoma while photographing in CT in CT instruction hematoma suction" and nerve endoscope while being able to enter, and seeing state of hematoma is performed.
Treatment of subarachnoid hemorrhage
Subarachnoid hemorrhage develops by explosion of cerebral aneurysm mainly.
When cerebral aneurysm explodes and suffers from subarachnoid hemorrhage, surgical management is necessary to prevent the second bleeding (recurrence).
For the operation method of cerebral aneurysm,
・Craniotomy operation (skill in clipping)
・Operation (coil embolization) in blood vessel
But, there is.
As these cures have good point, bad point each, it is necessary to choose appropriate cure after having talked with the medical attendant.
Craniotomy operation (skill in clipping)
We make craniotomy under the general anesthesia and are method to use clip at the root of cerebral aneurysm under the microscope, and to prevent bleeding.
Operation (coil embolization) in blood vessel
Password "FAST" to notice stroke
Let's learn phrase called FAST!
It is motto that FAST refers to symptom at the time of the stroke onset and appropriate correspondence of the case.
Face face is warped
Power does not enter Arm (and legs) arm (foot),
Speech words become complicated.
When, among the symptoms mentioned above, even one one develops suddenly,
You confirm Time onset time, and please consult specialist promptly.
- Let's get over from high blood pressure in the beginning
- We repent if we leave diabetes and stay
- We have a medical examination immediately as soon as arrhythmia is found
- Have will to quit smoking toward the prevention
- If it is alcohol reserve emeha medicine too much, it is bad
- Do not miss too high cholesterol either
- Salt, fat of meal modestly
- Let's continue exercise that physical strength included
- Overweight to trigger all sorts of disease
- As soon as stroke occurred; to hospital
Association of stroke in Japan