腦梗塞 stroke

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A stroke, previously known medically as a cerebrovascular accident (CVA), cerebrovascular infarction이라고도 함,  is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain.

This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).^[1]

As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.^[2]

 

A stroke is a medical emergency and can cause permanent neurological damage, complications, and even death.

It is the leading cause of adult disability in the United States and Europe and it is the number two cause of death worldwide.^[3]

Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation.^[4] High blood pressure is the most important modifiable risk factor of stroke.^[2]

A stroke is occasionally treated in a hospital with thrombolysis (also known as a "clot buster"). Post-stroke prevention may involve the administration of antiplatelet drugs such as aspirin and dipyridamole, control and reduction of hypertension, the use of statins, and in selected patients with carotid endarterectomy, the use of anticoagulants.^[2] Treatment to recover any lost function is stroke rehabilitation, involving health professions such as speech and language therapy, physical therapy and occupational therapy.

 

The traditional definition of stroke, devised by the World Health Organization in the 1970s,^[5] is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours.^[2] With the availability of treatments that, when given early, can reduce stroke severity, many now prefer alternative concepts, such as brain attack and acute ischemic cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome respectively), that reflect the urgency of stroke symptoms and the need to act swiftly.^[6]

 

Classification

A slice of brain from the autopsy of a person who suffered an acute middle cerebral artery (MCA) stroke

 

 

Strokes can be classified into two major categories: ischemic and hemorrhagic.^[7] Ischemic strokes are those that are caused by interruption of the blood supply, while hemorrhagic strokes are the ones which result from rupture of a blood vessel or an abnormal vascular structure. About 87% of strokes are caused by ischemia, and the remainder by hemorrhage. Some hemorrhages develop inside areas of ischemia ("hemorrhagic transformation"). It is unknown how many hemorrhages actually start as ischemic stroke.^[2]

[edit] Ischemic

Main articles: Cerebral infarction and Brain ischemia

In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen:

1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
2. Embolism (obstruction due to an embolus from elsewhere in the body, see below),^[2]
3. Systemic hypoperfusion (general decrease in blood supply, e.g. in shock)^[8]
4. Venous thrombosis.^[9]

Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes.^[2][10]

There are various classification systems for acute ischemic stroke. The Oxford Community Stroke Project classification (OCSP, also known as the Bamford or Oxford classification) relies primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain affected, the underlying cause, and the prognosis.^[11][12] The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, a stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of cardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation).^[2][13]

[edit] Hemorrhagic

Main articles: Intracranial hemorrhage and intracerebral hemorrhage

CT scan showing an intracerebral hemorrhage with associated intraventricular hemorrhage.

Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system). The main types of extra-axial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull), subdural hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and pia mater). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g. headache, previous head injury).

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뇌경색이란?   뇌의 동맥 내강이 도중에 막혀 버리어, 그 앞으로 혈액이 흐르지 못하게 되는 병입니다. 그 동맥에서 혈액의 공급을 받고 있던 뇌의 부분이 산소가 부족하여 괴사 되고, 기능이 저하되거나 상실 되기도 합니다. 뇌경색에는 뇌혈전과 뇌전색이 있습니다 뇌경색은 왜 생기나요?   -뇌혈전의 경우는 동맥경화증이 가장 큰 원인입니다. -뇌전색의 경우는 심장판막증, 심방세동을 가진 환자 또는 심내막염, 심근경색증, 인공심장판막대치술을 받은 환자에서 심장 내에서 형성된 혈전으로부터 떨어져 나온 색전조각들이 뇌동맥을 막기 때문입니다. 뇌경색의 증상은?   뇌경색의 종류에 따른 증상입니다. 뇌혈전 : 뇌의 동맥에 동맥경화가 있으며 내강이 좁아지고, 그 부위에 혈액의 체중이 생깁니다. 그 때문에 혈전이 생기어 내강을 폐색해 버리는 것이 뇌혈전입니다. 보통은 안면을 포함한 한쪽 손발의 마비나 감각의 저하가 생깁니다. 혀가 잘 돌지 않는 수가 많고, 실어증을 일으키는 수도 있으며, 때로는 의식장애가 서서히 심하게 되어 혼수상태에 빠지는 수도 있습니다. 뇌색전 : 뇌 이외의 부위에 발생한 혈전, 세균, 종양, 지방 따위의 덩어리가 혈액 속에 흘러 들어서, 뇌의 동맥에 걸려 폐색시키는 것을 말합니다. 뇌혈전과 거의 같은 증세가 나타나지만, 갑자기 일어나서, 증세가 몇 분만에 나타나는 것이 특징으로, 뇌혈전과 같이 시간이 흐름에 따라 서서히 심해지는 경우는 흔치 않습니다. 출혈성 뇌경색 : 뇌경색을 일으켜도 막힌 혈전 따위가 자연히 녹아서, 다시 혈액이 흐르게 되는 수가 있습니다. 그렇게 되면 폐색 되어 있던 부위에서 앞 쪽의 동맥을 혈액이 흘러오지 않았기 때문에 장애 되어 있었으므로, 혈류가 재개되면 약해진 동맥벽에서 혈액이 배어나와 뇌 속으로 출혈 하게 됩니다. 이것을 출혈성 뇌경색이라고 합니다. 자리잡고 있던 뇌경색의 병세가 며칠 있다가 갑자기 악화 되었을 때에는 출혈성 뇌경색의 가능성이 있지만, 증세가 가벼운 경우에는, CT스캔이나 뇌혈관 촬영 따위를 하지않으면 분명하게 알 수 없는 수도 있습니다. 뇌경색은 어떻게 치료하나요?   증상에 따라서 뇌졸중 일반의 치료를 하지만, 혈전을 녹이는 혈전 용해제, 혈액을 굳지 않게 하는 항응혈제나 항혈소판 응집제, 뇌의 부종을 없애고, 혈액의 흐름이나 대사를 개선할 목적으로 뇌압 강하제(만니톨, 스테로이드 제제) 등이 사용됩니다. 생활 가이드   가장 중요한 것은 혈압을 조절하는 것이며 이 밖의 위험 인자 즉, 당뇨병, 비만증, 고지혈증 등을 엄격히 치료해야 하고 금연은 물론이며 짜게 먹지 않는 식생활, 스트레스를 적당히 해소하는 여유 있는 삶과 정신, 과로를 피하는 것 등이 중요합니다. 적당하고 적합한 운동을 꾸준히 하는 것도 고혈압은 물론이고 뇌졸중을 피하는 좋은 방법 중의 하나입니다.   A: 스스로 느끼는 증상으로 술에 취한 사람처럼 발음이 명확하지 못하며, 물체가 겹쳐 보이고, 침을 삼키기 어려우며, 유난히 한 쪽 손, 발이나 팔, 다리가 저리고, 두 눈으로 보고 있는데 마치 한 눈으로 보는 듯한 느낌이 들면 중풍을 의심해 볼 수 있겠습니다.     Hypertension is an important global health issue and is currently increasing at a rapid pace in most industrializing nations. Although a number of risk factors have been linked with the development of hypertension, including obesity, high dietary sodium, and chronic psychosocial stress, these factors cannot fully explain the variation in blood pressure and hypertension rates that occurs within and between populations. The present study uses data collected on adults from three indigenous Siberian populations (Evenki, Buryat, and Yakut [Sakha]) to test the hypothesis of Luke et al. (Hypertension 43 (2004) 555-560) that basal metabolic rate (BMR) and blood pressure are positively associated independent of body size. When adjusted for body size and composition, as well as potentially confounding variables such as age, smoking status, ethnicity, and degree of urbanization, BMR was positively correlated with systolic blood pressure (SBP; P < 0.01) and pulse pressure (PP; P < 0.01); BMR showed a trend with diastolic blood pressure (DBP; P = 0.08). Thus, higher BMR is associated with higher SBP and PP; this is opposite the well-documented inverse relationship between physical activity and blood pressure. If the influence of BMR on blood pressure is confirmed, the systematically elevated BMRs of indigenous Siberians may help explain the relatively high blood pressures and hypertension rates documented among native Siberians in the post-Soviet period. These findings underscore the importance of considering the influence of biological adaptation to regional environmental conditions in structuring health changes associated with economic development and lifestyle