Early warning and risk factor management of stroke: Practical training in prevention and first aid for individuals with hypertension, diabetes, and obesity.

6. How to detect cerebral thrombosis early? Patients with cerebral thrombosis often experience symptoms several days before the onset of the disease. Elderly individuals experiencing dizziness, headache, blurred vision, fatigue, significant memory loss, numbness or weakness on one side of the body, unsteady pen grip, crooked handwriting, difficulty performing tasks, or slurred speech often indicate the possibility of an attack. Particular attention should be paid to recurrent, transient numbness or weakness in the limbs, headache, dizziness, and speech difficulties-symptoms of insufficient blood supply to the brain. These are all warning signs of cerebral thrombosis and require immediate medical attention.

7. What are the uncontrollable and controllable risk factors for stroke? Uncontrollable risk factors include the following: (1) Age: The incidence and mortality rates of cerebrovascular diseases increase logarithmically with age. As people age, the likelihood of developing hypertension, diabetes, hyperlipidemia, etc., increases, and arteries become stiff and less elastic, making them more prone to infarction and rupture. (2) Gender: Men are at higher risk of stroke than women, especially before the age of 75. However, after the age of 75, the gender factor reverses, with women being significantly more at risk than men. (3) Family or genetic factors: People with a family history of stroke are more prone to stroke, and genetic factors are often closely related to hypertension, diabetes, obesity, and other related diseases. Therefore, people with a family history of stroke should pay special attention to the prevention and treatment of related diseases. Risk factors for stroke include both uncontrollable and modifiable factors, such as hypertension, coronary heart disease, diabetes, dyslipidemia, asymptomatic carotid artery disease, smoking, excessive alcohol consumption, and cerebral arteriosclerosis. Stroke patients often have multiple stroke risk factors, such as hypertension, heart disease, diabetes, hyperlipidemia, hyperfibrinogenemia, and smoking. Carefully identifying these controllable risk factors and focusing on individualized comprehensive prevention and treatment of the main risk factors is key to successful stroke prevention.

8. What are the triggering factors for stroke? Approximately 60% of stroke patients have identifiable triggers, such as anger, overexertion, overeating, excessive exertion, alcohol consumption, emotional excitement, straining during bowel movements, discontinuation of antihypertensive medication, and sexual activity. These can be summarized as: climate change, emotional excitement, excessive exertion, and irregular diet. Stroke is related to climate change, with a higher incidence in winter and autumn than in summer. This is because in winter, the cold weather causes blood vessels to constrict, leading to increased blood pressure; while in summer, the hot weather causes blood vessels to dilate, blood pressure to drop, and excessive sweating leads to relatively concentrated blood and increased blood viscosity, which can also cause stroke. Emotional excitement can also raise blood pressure and cause stroke. Therefore, anger, excitement, and resentment should be avoided as much as possible. Excessive fatigue refers to overly busy or strenuous work, life, or study; excessive exertion includes lifting heavy objects, straining during bowel movements, and excessive physical exercise. Both can cause high blood pressure, becoming triggers for stroke. Overeating and consuming excessively oily foods can significantly increase blood lipid levels, slow blood circulation, raise blood pressure, and promote stroke formation.

9. Hypertension is the leading risk factor for stroke. Hypertension is the leading risk factor for stroke, and more than 80% of cerebral hemorrhage patients are caused by ruptured blood vessels due to hypertension or arteriosclerosis. The ratio of stroke in hypertensive individuals to those with normal blood pressure is approximately 7:1. Whether it is a hemorrhagic stroke or an ischemic stroke, blood pressure and stroke incidence are directly proportional. The higher the blood pressure, the more strokes occur, and the higher the mortality rate. Hypertension leads to cerebrovascular disease mainly for two reasons: First, when blood pressure rises sharply to a certain level, cerebral arteries undergo paralytic dilation, resulting in cerebral edema, i.e., hypertensive crisis or hypertensive encephalopathy; second, long-term chronic hypertension causes atherosclerosis of cerebral arteries and hyalinization of cerebral arterioles, eventually leading to ischemia or infarction of the brain tissue innervated by the artery due to narrowing or occlusion; third, long-term hypertension causes hyalinization (fibrinoid necrosis) of the walls of small cerebral arteries, which can reduce the elasticity of the arterial intima, forming miliary aneurysms. When arterial blood pressure rises, the intima ruptures, causing cerebral hemorrhage. Furthermore, a sudden drop in blood pressure can also lead to cerebral infarction on the basis of extensive cerebral arteriosclerosis caused by hypertension. Therefore, understanding the role of hypertension in the pathogenesis of cerebrovascular diseases and rationally controlling hypertension are key to preventing cerebrovascular diseases.

10. Arteriosclerosis is the most common cause of cerebral thrombosis. Arteriosclerosis is the most common cause of insufficient blood supply to the brain or cerebral thrombosis. Its pathological basis is the deep fatty degeneration and cholesterol deposition in the arterial intima, forming atherosclerotic plaques. Depending on the location of the affected cerebral arteries, clinical manifestations may include cerebral dysfunction syndrome, transient ischemic attack, and cerebral thrombosis. Among these, atherosclerotic vascular stenosis, occlusion, or thrombotic cerebral infarction is the most common. Due to the long-term effects of hypertension and arteriosclerosis, atherosclerotic stenosis or occlusion occurs in the extracranial segment of the internal carotid artery, and stenosis or occlusion occurs in the intracranial segments of the internal carotid artery, basilar artery, circle of blood at the base of the brain, or the origin of the middle cerebral artery and posterior cerebral artery. Endothelial damage leads to local platelet aggregation and fibrin deposition, causing extensive ischemia and necrosis in the blood supply areas of the aforementioned vessels, resulting in various types of motor and sensory disturbances. Therefore, preventing the occurrence and development of arteriosclerosis plays a significant role in reducing the incidence of stroke.

11. Diabetes and obesity increase the risk of stroke. Diabetes can cause vascular damage such as atherosclerosis, which is the basis for stroke. Diabetic patients are 2 to 6 times more likely to develop cerebrovascular disease than non-diabetic controls of the same age. Among patients experiencing their first ischemic stroke, some deny a history of diabetes, but their fasting blood glucose levels meet or exceed the diagnostic criteria for diabetes. Others have impaired glucose tolerance, indicating that elevated blood glucose and abnormal glucose metabolism are involved in the pathophysiological process of cerebrovascular disease. Obese individuals have a 40% higher chance of stroke compared to the general population. People with abdominal obesity are more prone to stroke than those with hip obesity, which is related to endocrine and metabolic disorders in obese individuals. Obese individuals have elevated cholesterol and triglycerides and decreased high-density lipoprotein in their blood. These three factors are closely related to atherosclerosis. Furthermore, obese individuals often have co-existing conditions such as hypertension, diabetes, and coronary heart disease, all of which are risk factors for stroke.

12. What to do when a stroke patient is found? When an elderly person suddenly experiences symptoms such as headache, vomiting, blank expression, drooping eyes, rapid breathing, frothing at the mouth, constricted or unequal pupils, altered consciousness, slurred speech, limited movement on one side or in all four limbs, incontinence, and drooling, the first thing to consider is cerebrovascular disease. (1) After the patient is found to have the stroke, they should generally be placed in a supine position with their head turned to the side to facilitate the drainage of vomit and sputum. If necessary, use your fingers to suction them out in time to keep the airway open and prevent suffocation. (2) You should immediately call the emergency center to contact the hospital for admission. Before the doctor arrives, the patient should be kept absolutely quiet and should not be moved at will. (3) After the stroke, treatment should be carried out as close to home as possible. Long-distance transport of the patient should be avoided. If it is necessary to move the patient, it should be kept as stable as possible to reduce the jolting of the patient and avoid aggravating the condition. (4) The patient should be kept absolutely in bed and kept quiet. If possible, assist the doctor to perform a head CT scan as soon as possible. The appropriateness of the emergency treatment methods for cerebrovascular diseases directly affects the patient's treatment outcome and prognosis. If a family member or someone nearby suffers a stroke, they should be taken to the hospital immediately for emergency treatment to avoid delaying treatment.