stroke

Introduction
Stroke has cerebral infarction as a disease in which blood vessels are blocked and intracranial hemorrhage as a disease that blood vessels break (Figure 1)
stroke
Here, we will focus on representative diseases that are treated by neurosurgery, among various strokes.

subarachnoid hemorrhage
Subarachnoid hemorrhage is characterized by a sudden headache. It is expressed as strong pain that I have never experienced before, "pain like beat with a bat" or "pain like lightning thunder". Others may cause vomiting and disturbance of consciousness. Very light ones may have mild headache, dizziness, nausea only. It happens for various reasons (Figure 2),
subarachnoid hemorrhage
The most common thing is the rupture of a Cobb (cerebral aneurysm) formed in a blood vessel of the brain. CT diagnosis is useful for diagnosis (Figure 3).
subarachnoid hemorrhage
In light bleeding, diagnosis with CT is sometimes difficult. In that case, MRI examination and cerebrospinal fluid examination are used together. Because the death rate due to reruption of aneurysm is very high, it is necessary to have a quick diagnosis and treatment in a specialized facility. If a cerebral aneurysm that causes bleeding is found, intravascular surgery will be performed such as clipping an aneurysm by surgery or filling aneurysm with a special coil (Fig. 4).
Treatment of cerebral aneurysms
In 2011, Kumamoto Prefecture's subarachnoid hemorrhage survey, 383 people in all prefectures underwent subarachnoid hemorrhage in one year, and 20.9 people occurred per 100 thousand population. From 60s to 80s average age was 67.1 years old. About 50% of those who had good treatment outcome, about 70% among those who could be treated (Kumamoto Prefecture Cerebrovascular Injury Data Bank). It is a very scary disease that requires immediate medical treatment and delays in diagnosis and treatment may cause severe sequelae. In case of sudden severe headache or unusual headache, please get medical examination as soon as possible.

cerebral hemorrhage
Cerebral haemorrhage is often referred to as hypertensive cerebral hemorrhage because it occurs mainly due to high blood pressure after the middle age. Recently, there have been cases of cerebral hemorrhage occurring due to other drugs such as warfarin and aspirin because they take medicine that makes blood hard to clump. Cerebral haemorrhages such as children and young people who do not have a history of hypertension are likely to be frequently bleeding due to blood vessel malformations.
Depending on the site of bleeding, it is divided from putamen bleeding, thalamic bleeding, cerebral hemorrhage, bridge hemorrhage, subcortical bleeding, etc. (Figure 5).
cerebral hemorrhage
Symptoms vary according to the site of bleeding, but hemiplegia, aphasia, disturbance of consciousness, etc. are recognized. It is diagnosed by CT and MRI and angiography are performed as necessary. For treatment, systemic management and blood pressure management are strictly performed first, and operation indication is decided taking into consideration symptoms, life prognosis, function prognosis, age, hematoma volume, etc. Surgery includes removal of craniotomas, stereotactic or endoscopic hematoma aspiration (Figure 7).
cerebral hemorrhage
cerebral infarction
Among cerebral infarctions, lacunar infarction caused by clogging of thin blood vessels in the brain and atherothrombotic cerebral infarction that occurs due to clogging of the thick artery of the brain with thrombus caused by arteriosclerosis, thrombus formed by the heart obstruct the artery of the brain There is a cardiogenic cerebral embolism that occurs to do. In general, medical treatment is the main subject. Among them, "carotid artery stenosis" is said to occur at the origin of the internal carotid artery in the cervix, atherosclerosis occurs, diseases causing cerebral ischemic attacks and infarction due to cerebral blood flow reduction and thrombus formation as an embolus source Yes. As a treatment, a surgical operation (carotid endarterectomy) to remove thickened atherosclerotic intima (FIG. 8)
cerebral infarction
Endovascular surgery, drug treatment and so on. We also know that treatment results of endarterectomy are better than medications when the stenosis is strong. In addition, due to internal carotid artery obstruction and blood flow decrease due to stenosis and occlusion of intracranial vessels, bypass surgery may be performed in cases of cerebral infarction and transient ischemic attacks.

Endovascular operation
Endovascular surgery is a treatment method using a catheter, but it is a field that has developed remarkably due to recent improvements in catheters and embolic materials, advances in imaging equipment, technological improvement of catheter operation by surgeons, and so on. It is useful not only for treatment of aneurysm, but also for treatment of cerebral vascular malformations, dural arteriovenous malformations and so on. It is also becoming possible to inflate thinned blood vessels with a balloon (balloon), or treat a stent by expanding it from the inside to the stenotic lesion of the carotid artery (Fig. 9).
Endovascular operation
It seems that it will develop further in the future, and many patients are expected to benefit from this.

Finally
The above is the explanation focusing on treatment to be performed by neurosurgery in stroke. However, prevention of stroke is more important than anything else. Hypertension, diabetes, hyperlipidemia, atrial fibrillation, smoking etc. are cited as risk factors for stroke, but please consult with your family teacher to receive these appropriate treatments. Also, let's take into consideration diet, exercise, weight control, alcohol intake and so on.
If there is something to worry about, please do not hesitate to consult us.