Migrenozny stroke — the sharp violation of brain blood circulation caused by the vascular frustration accompanying a migraine paroxysm. In typical cases more than 1 hour are characterized by preservation of symptoms of migrenozny aura. Neurologic deficiency is presented by violations of sight, the speech, sensitivity, the motive sphere. Diagnostics is directed to establishment of communication of a stroke with migraine, an exception of other etiology, includes assessment of the neurologic status, cerebral neurovisualization, UZDG, laboratory researches. Treatment consists in the combined use of vazodilatiruyushchy, neurotyre-tread, antiagregantny, antimigrenozny pharmaceuticals.
The Migrenozny stroke is a complication of migraine and one of ONMK reasons at persons of young age. The assumption of communication of a stroke and migraine was stated at the end of the 19th century. Confirmation of interrelation became possible with the advent of tomographic methods of neurovisualization. The research is long the patients having migraine revealed existence in cerebral substance of zones of the postponed lacunary heart attacks, the ischemic centers of different prescription. Earlier experts in the field of neurology associated a migrenozny stroke only with ischemic type of the sharp violation of brain blood circulation (SVBBC). Certain modern clinical physicians claim that at migraine also the hemorrhagic stroke can develop. The most often migrenozny stroke is observed at women up to 45 years. Pathology occurs at men less often because of lower prevalence of migraine.
Reasons of a migrenozny stroke
Data of a number of the European researches of women aged from 20 up to 45 years showed that the risk of development of ONMK among having migraine increases by 3,5 times. The main reason — the vascular changes accompanying a migrenozny paroxysm. The probability of transition of the migrenozny attack to a stroke increases with additional risk factors:
- Reception of oral contraceptives. Pharmaceuticals of this group aggravate the course of a disease at 70-80% of patients, increase tendency to aggregation of platelets. The risk of a stroke increases in the presence of the accompanying obesity.
- Nicotine addiction. Smoking negatively is reflected in a condition of a vascular wall, functioning of mechanisms of regulation of a vascular tone. Data of researches confirm increase in risk of ONMK by 3 times at the smoking patients in comparison with non-smoking.
- Existence of migrenozny aura. At simple migrenozny paroxysms the probability of a stroke is increased by 2,2 times in comparison with an average in population. Existence of the aura preceding an attack increases risk degree by 2-3 times.
- High frequency of the attacks. Researches show prevalence among the patients who had a migrenozny stroke with existence more than one paroxysm a month.
- Family anamnesis of migraine. Presence of a hereditary factor (presence of patients with migraine among relatives) increases probability of ONMK even with a low frequency of the attacks.
The etiofaktor provoking a migrenozny stroke are similar to the reasons starting the migrenozny attack. Stressful situations, excessive emotional reactions, physical and mental overfatigue, the use of separate products (wine, chocolate), visual loading (blinking, excessively bright light), hormonal shifts are capable to provoke a paroxysm.
Pathogenetic the migrenozny paroxysm includes a vascular component — alternation / dilatation of a certain vascular site. Bazilyarny migraine is connected with a pathological tone of vessels of the vertebro-bazilyarny pool, oftalmoplegichesky migraine — with changes of a lobby brain, internal sleepy arteries, eye — with violations in a back brain artery. The paroxysm is followed by the same aura — the tranzitorny neurologic deficiency caused by a local vazokonstriktorny component with short-term ischemia of the respective site of cerebral fabrics. The tendency, characteristic of migraine, to the raised tromboobrazovaniye aggravated with the operating factors of additional risk promotes accession of a trombotichesky component. Passing ischemia is transformed to permanent violation of cerebral blood supply — there is a stroke.
As opposed to the existing representation that during the migrenozny attack exclusively ischemic stroke develops, a number of authors specifies probability of hemorrhagic character of ONMK. Intracerebral bleeding is possible owing to a rupture of the aneurism of an intrakranialny vessel formed as a result of attendants paroxysms of migraine of numerous cycles a spasm dilatation.
Symptoms of a migrenozny stroke
The typical paroxysm of a hemicrany — the pain extending to the half-heads is noted. Repeated vomiting, a giperesteziya is characteristic. The symptomatology depends on localization of vascular problems, repeats manifestations of the aura preceding a tsefalgiya. Focal neurologic deficiency arises against the background of a hemicrany, without treatment more than 7 days remain. In a classical case the migrenozny stroke proceeds to similarly usual attack, feature is preservation of symptoms of aura more than 60 minutes. Clinical manifestations can have persistiruyushchy character: to appear and disappear, weaken and accrue again.
In 80% of cases visual frustration are observed: diplopiya, sight zatumanivaniye, loss of the site of the visual field (formation of scotoma, emergence of a gemianopsiya), squint. Weakness in extremities, a sleep, a dizartriya, agnosia elements (violation of recognition of objects, persons, places) is possible. Disorder of coordination proceeds as a vestibular ataxy more often: dizziness, instability, unsteadiness of walking. The cerebellar syndrome is in certain cases noted: too wide movements, gait violation, handwriting change, the chanted speech.
As the migrenozny stroke proceeds against the background of the standard migrenozny attack, patients do not see a doctor before development of the expressed neurologic deficiency. In the absence of adequate therapy the extensive ischemic center is formed, there is a death of neurons causing formation of permanent neurologic frustration. After the postponed ONMK various neurologic symptoms, visual violations, speech disturbance remain. Repeated migraine - the associated strokes lead to emergence of multiple focal changes, development of atrophic processes in cerebral structures.
Emergence of ONMK at the patient with migraine is possible out of communication with a paroxysm. The diagnosis migraine - the induced stroke is exposed by the following criteria: emergence of focal symptomatology happened during the typical migrenozny attack, neurologic deficiency corresponds to symptoms of aura, characteristic of the patient, there are no other reasons of development of brain ischemia. Diagnostic search includes:
- Collecting anamnesis. It is directed to identification of cases and frequency of similar paroxysms in the past, the established diagnosis "migraine", to hereditary predisposition.
- Neurologic survey. Allows the neurologist to confirm existence, to estimate degree of expressiveness of neurologic deficiency.
- Brain MRT. Visualizes a zone of sharp ischemic changes. At patients with a long standing of migraine diagnostics of the "old" centers of ischemia, lacunary heart attacks, atrophic processes is possible. According to indications of MRT replace brain KT, MCKT.
- Koagulogramma. Informs on a condition of a hemostasis. It is necessary for an exception of the diseases of blood leading to thrombosis of cerebral vessels.
- UZDG of vessels of the head and neck. Allows to exclude other causes of a stroke: carotid occlusion, thrombembolia of an intrakranialny vessel.
Treatment of a migrenozny stroke
Emergency aid in the conditions of a neurologic hospital, intensive care unit is necessary for the patient. Treatment is directed to knocking over of pathogenetic mechanisms of a disease: elimination of a spasm, improvement of rheological properties of blood, protection of nervous cages against ischemia. It is carried out in a complex, includes the following components:
- Vazoaktivny pharmaceuticals. Reduce the vascular spasm acting as a basic link in development of ischemia. The medicines selectively influencing cerebral arteries are applied: , , .
- The means improving a blood rheology. Interfere with a tromboobrazovaniye, reduce viscosity of blood, restore its fluidity. Help to improve microcirculation of an affected area.
- Neuroprotectors. Increase resistance of neurons to a hypoxia by reduction of the biochemical shifts caused by ischemia. Apply , glutamic acid.
- Antimigrenozny medicines. Medicines of the choice are triptana () — agonists of serotoninergichesky receptors of TsNS, blockers of calcic channels (). Purpose of antikonvulsant is possible (a topiramata, medicines valproyevy to - you).
Therapy is most effective if medical actions are begun during the first hours diseases. After end of the sharp period rehabilitation is necessary for patients. Restoration of volume of movements is carried out by means of LFK, massage, reflexotherapy. Violations of the speech demand occupations with the logopedist.
Forecast and prevention
The Migrenozny stroke seldom is followed by deep neurologic deficiency. In due time begun therapy promotes full regress of focal symptomatology. Complications develop at a long absence of antiischemic treatment. The basis of prevention is made by the effective mezhpristupny treatment directed to urezheny frequencies of the attacks. The patient should reconsider the way of life, to normalize a day regimen, to learn to perceive quietly and kindly the taking place events, to exclude the factors provoking migraine. Selection of the pharmaceutical capable to stop a migrenozny paroxysm in the most initial stage is necessary. It is always recommended to patient to carry with itself the appointed medicine, to accept it at the first signs of the beginning attack.