DEFINITION

The Accident Vascular Brain (ACV) or Ictus is an illness vascular that it affects to the arteries of the brain or that they come to the brain. For diverse causes the cells of the brain stay without oxygen and lose his function, appearing pictures of palsy of half a body, speech disorders, etc...

CAUSES

The ACV split into two big groups: isquémicos (for lack of blood) or hemorrhagic.
In the first case an obstruction of the blood step takes place to the brain. In most of the cases the obstruction is produced by the presence of badges of ateroma, what we call arterioesclerosis. In other cases it owes at the arrival of a thrombus from other areas of the organism, generally from the heart (embolism).

• The arterioesclerosis is like an aging of the arteries that become rigid, in a progressive process that consists of the accumulation of cholesterol, calcium and other fats in the wall of the arteries. In certain areas of the arteries the punctual tightening is more intense, going so far as to cover almost completely the blood step to the brain.
• If in the area obstructed by badges of ateroma thrombocytes accumulations stick, they go so far as to form clots (thrombi), what we call a cerebral thrombosis.
• These thrombi they can release (embolism), and for his size they come to smaller arteries for which they cannot happen, stop up them completely and produce what is called the sharp isquemia (brain embolism). These embolisms also can have migrated from the heart in different situations (the most frequent for an arrhythmia; the ear fibrillation).
• This situation is very serious since it can evolve to the death of the cerebral cells involved in the isquemia and the irreversible loss of the same ones.

• In other occasions, what takes place is the break of a cerebral artery (for aneurismas or for arterial hypertension). The hemorrhage intracerebral that takes place cannot be liberated on the outside since the brain is shut up in the bone of the skull. For it the blood presses the softest thing, the brain, producing the absence of oxygenation of the area and the subsequent injuries of the textiles (isquemia cerebral).
• The most frequent cause of break of a cerebral artery is the presence of an aneurisma. An aneurisma is a permanent dilation of an artery caused by the weakness of his wall.

TREATMENT

• Initial or sharp phase:
• One must come as soon as possible to a Hospital, since the time saving in beginning the treatment improves the prognosis. Contact quickly with his emergency phone (112, 911, 061) so that they send to him the suitable welfare resource.
• Control of the airline, oxygenation and arterial tension, to assure an ideal oxygenation and perfusión of the cerebral cells.
• Medicines that prevent the aggregation plaquetaria (acid acetilsalicílico, ticlopidina, clopidogrel, dipiridamol, triflusal). In some countries the obstruction is used trombolíticos by intravenous route for revertir quickly.
• If the problem is a muddle over a distance (from the heart), it is possible to be necessary a permanent anticoagulation.
• Control of the arterial hypertension.
• Control of the complications: convulsions, cerebral edema, etc...
• If the picture is hemorrhagic he can be necessary his surgical evacuation (not in all the cases).

• Pursuit phase:
  • In the pictures of cerebral isquemia for arterioesclerosis of the artery carotídea there is realized the endarterectomía of the affected artery. This intervention is realized across an incision in the neck, to gain access up to the artery carotid, is opened and there is realized a cleanliness of the badges of ateroma that exists in his interior. To see Image -
    
    
  
  
  • In the last years skills have developed endovasculares to correct the estenosis carotídea without need for open surgery. It is the angioplastia transluminal percutánea and the stents laying. The angioplastia is the dilation of an artery inflating a ball, across a special catheter inserted by puncture percutánea, across the artery femoral. The patient is awake and can return to his domicile in a few days. The stents is a prosthesis metallurgy, in the shape of wharf that is placed in the taken in area and on having exercised pressure on the vascular wall it supports the opening of the light.
  • The aneurismas, malformations arteriovenosas, etc... that provoke a hemorrhage intracerebral, can need a later surgical intervention or a skill envovascular for his definitive treatment and avoid the relapses.
  • Medicines antiagregantes or anticoagulant like the mentioned ones in the sharp phase. There are investigated new antitrombóticos whose action mechanism adds to his action antiagregante anticoagulant effects and fibrinolíticos.
  • Rehabilitation of the affected functions, so much motorboats as of another order.
  • Control of arterial hypertension, hipercolesterolemia, nicotinism, diabetes, obesity, etc...

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