Winter is a time when brain and heart diseases are more likely to occur, as typified by heat shock caused by the temperature difference between a warm room and a cold bathroom or changing room.
These serious cardiovascular diseases require professional treatment as soon as possible, and it is said that treating cerebral infarction more than 4.5 hours after the onset of the disease increases the risk that the subsequent condition will deteriorate significantly. Masu.
Dr. Junko Yamaguchi, Director of the Critical Care Center at Nihon University Itabashi Hospital, gave us an explanation of precautions and prevention methods for cerebral infarction in winter.
One type of stroke is cerebral infarction
As brain diseases, we often hear the term cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, and stroke. What kind of disease is each?
“Cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage are all symptoms of stroke.
Cerebral infarction is a condition in which blood vessels in the brain become blocked or narrowed by a blood clot (blood clot), resulting in poor blood flow.
Cerebral hemorrhage and subarachnoid hemorrhage both occur when a blood vessel ruptures. Cerebral hemorrhage occurs within the brain, and subarachnoid hemorrhage occurs in the subarachnoid space, which covers the brain.” (Dr. Yamaguchi)
There are several types of cerebral infarction, which is one type of stroke.
“Cerebral infarctions are mainly caused by lacunar infarctions, which are blood vessels with a diameter of less than 1 mm deep in the brain that become clogged, or by blood clots that occur when platelets collect in the atheroma, which is a lump of cholesterol, that forms in a large blood vessel and ruptures. There are three types of cerebral infarction: “atherothrombotic cerebral infarction,” and “cardiogenic cerebral infarction,” which is caused by a blood clot formed in the heart that travels to the blood vessels of the brain.
High blood pressure is one of the major causes of cerebral infarction. In addition, diabetes and obesity (metabolic syndrome) are considered risk factors for arteriosclerosis, which can lead to cerebral infarction.” (Dr. Yamaguchi)
The key is early detection and treatment within 4.5 hours of onset.
What kind of treatment is used when a cerebral infarction occurs?
“Currently, the use of a drug called t-PA (tissue plasminogen activator), which was approved for use in 2005, has become established as standard treatment.t-PA is a drug that has a very strong ability to dissolve blood clots, If administered via intravenous injection or infusion within 4.5 hours after the onset of infarction, the occurrence of aftereffects can be greatly reduced.Treatment with t-PA has increased the number of cases in which patients are saved. Ta.
However, if t-PA is administered more than 4.5 hours after the onset of symptoms, blood flow will be resumed in blood vessels that have become fragile due to being blocked by blood clots caused by cerebral infarction, so there is a risk that blood vessels may rupture and cause cerebral hemorrhage. will increase. This is why 4.5 hours from the onset of symptoms is called the “watershed”.
In addition, if there is a history of cerebral hemorrhage, the area of cerebral infarction is wide, or the blood pressure is abnormally high, there is a high possibility of causing cerebral hemorrhage, and t-PA may not be administered even within 4.5 hours of the onset of symptoms. . The same applies if blood tests reveal coagulation abnormalities, hyperglycemia, or platelet count abnormalities.” (Dr. Yamaguchi)
In the case of cerebral infarction, the symptoms often occur when the patient wakes up, or the patient is already found collapsed, and it is thought that in many cases it may not be possible to identify the patient until 4.5 hours after the onset of the disease.
“The Japan Stroke Society’s guidelines state that if the time of onset is unknown, the time of onset should be the time of the last health check. In other words, as soon as it is recognized that the patient is not showing symptoms of cerebral infarction, For example, if you have an abnormality when you wake up, the time you go to bed will be considered the onset time, increasing the possibility that you will not be able to receive t-PA treatment.
However, starting in March 2019, t-PA therapy can be considered if a head MRI shows that it is likely that not much time has passed since the onset of symptoms.
There is nothing better than receiving t-PA, but it is important to start initial treatment as soon as possible, even after 4.5 hours from the onset of symptoms.” (Dr. Yamaguchi)
Checkpoints for early detection
Stroke, including cerebral infarction, is a life-threatening disease with a high possibility of severe sequelae, so early detection and treatment are important. In order to do so, it is a good idea to know the checkpoints that can be called “warnings”.
“There is a tool called CPSS (Cincinnati Prehospital Stroke Scale) that was developed for emergency personnel to judge and evaluate the situation of patients suspected of having a stroke. There are three items to check:
First, check for facial distortion. Have the subject smile to show their teeth or inflate their mouth. Normally, both sides of the face move in the same way, but after a stroke, one side of the face may not move.
Next, check the arm movement. Ask them to raise their arms, close their eyes, and hold for 10 seconds. Normally, both arms can be held up, but after a stroke, one arm either cannot move or cannot be held even if it is raised, and it comes down.
Lastly, get them to have a conversation. If the subject’s speech is unclear, uses inappropriate language, or is unable to speak, it is considered abnormal.
If you see any of these, a stroke is suspected. Please go to a specialized hospital as soon as possible.” (Dr. Yamaguchi)
The American Stroke Association uses the slogan “FAST” to raise awareness about stroke prevention. “F” stands for facial paralysis. “A” is Arm paralysis. “S” stands for Speech and is a language disorder. “T” indicates the time of onset. If even one of the F・A・S signs is present, there is a 70% or higher chance of a stroke.
How to make blood “smooth”?
What precautions should I take on a daily basis to prevent cerebral infarction?
“It is important to keep the blood thin and resistant to clots so that blood clots are less likely to form. Hydration is important for this purpose, and elderly people in particular are less likely to feel thirsty even when they have less water in their bodies. It’s a good idea to drink about one-third to half a glass of water before going to bed or when you wake up to go to the bathroom.
There are many causes of stroke, including diabetes and atrial fibrillation, but the biggest cause is high blood pressure. In order to prevent high blood pressure, please be careful not only of excessive salt intake but also of daily lifestyle habits such as obesity, stress, lack of sleep, drinking alcohol, and smoking.” (Dr. Yamaguchi)
With the winter season in full swing, it is the time of year when the risk of cerebral infarction increases. Take precautions to avoid disrupting your lifestyle by overeating or drinking too much towards the end of the year, and be careful not to overlook early symptoms so that if you do develop the disease, you can treat it as soon as possible.
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