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Prevención y tratamiento del ictus

Autor: Dra. Mercè Piera - Revisado: 8 de Marzo 2012

La prevención y tratamiento con prontitud del ictus es fundamental para disminuir las posibilidades de secuelas del mismo.

El ictus o accidente cerebrovascular es una emergencia médica. Cuanto antes se diagnostique y trate el ictus, menos posibilidades habrá de secuelas del mismo. Así, el objetivo del tratamiento es prevenir la extensión del tejido lesionado y potenciar la capacidad del paciente para funcionar por sí mismo.

El tratamiento del ictus no es curativo y se basa en la rehabilitación y prevención de futuros ictus. La recuperación puede producirse a partir de que otras áreas del cerebro van relevando, en cuanto a funcionamiento, a las zonas dañadas.

Tratamiento inmediato Ante la instauración de un ictus se actúa de urgencia pudiendo aplicar varios medicamentos:

- Fármacos trombolíticos: tienen como finalidad deshacer el coágulo y restablecer el flujo sanguíneo hacia el área afectada con el fin de prevenir la muerte del tejido y la lesión permanente. No obstante, este tipo de tratamiento tienen como inconvenientes que para ser eficaz debe administrarse en las primeras tres horas desde el inicio de los síntomas (criterio que cumplen pocos pacientes) y que como efecto indeseable puede crear hemorragia.

- Fármacos anticoagulantes: En ciertas circunstancias se utilizan otros anticoagulantes como heparina, aspirina y otros para prevenir ictus recurrentes.

- Analgésicos: pueden ser útiles en el control de cefaleas intensas.

- Fármacos antihipertensivos: La hipertensión arterial mal controlada o maligna es causa de accidente cerebrovascular hemorrágico. En este tipo de ictus puede ser necesario el tratamiento con fármacos antihipertensivos.

- Nutrientes y líquidos: La persona que sufre un ictus puede tener dificultades para tragar la comida y bebida, requiriendo la colocación de un catéter intravenoso o un tubo en el estómago a través de los cuales pasen los nutrientes y líquidos.

En la fase aguda, tras un ictus, es necesario el reposo en cama con los siguientes cuidados:

- Cambiar al enfermo de posición cada 3 horas para evitar la formación de úlceras de decúbito. La presión continua sobre una parte concreta de piel provoca una reducción del riego sanguíneo de la zona y la ulceración de la misma.

- El cuerpo debe apoyarse los menos posible sobre la mitad paralizada del mismo con el fin de evitar la aparición de úlceras, edema y malas posturas.

- Para evitar la formación de contracturas musculares: el miembro superior debe descansar con el hombro separado del cuerpo y hacia delante, codo en semiflexión y dedos abiertos y elevados. El miembro inferior debe descansar con los muslos algo abiertos, la rodilla en semiflexión y evitando que las plantas de los pies tiendan a mirarse.

- Se recomienda evitar estiramientos tempranos del brazo paralizado por la posibilidad de lesionar el hombro.

- Si hay que colocar catéteres hay que hacerlo en el brazo no afectado.

Tratamiento a largo plazo

* Tratamiento quirúrgico: La endarterectomía carotídea es una técnica quirúrgica que consiste en extraer las placas ateroscleróticas de las arterias carotidas para prevenir nuevos ictus.

* Rehabilitación: La rehabilitación funcional tras un ictus debe iniciarse lo más rápidamente posible: a los 3 meses, la situación neurológica se estabiliza y hasta los 6 meses se considera que hay posibilidad de mejoría funcional. Una vez se estabiliza el paciente, al cabo de 2 a 3 días puede empezarse el tratamiento rehabilitador que consiste en recuperar la estabilidad del tronco y fuerza en extremidades para poder mantenerse en pie y andar. Una vez se consigue esto, la rehabilitación va dirigida a mejorar la calidad de vida del paciente mediante la recuperación de funciones de la vida cotidiana como el aseo, la alimentación y el vestirse.

- Extremidad inferior: Suele recuperarse y muchas personas consiguen volver a andar aunque sea con ayuda de bastón o férulas.

- Extremidad superior: Es más difícil de recuperar, especialmente, la función de pinza del pulgar, escribir o manejar los cubiertos. La terapia ocupacional tiene como objetivo enseñar a utilizar la mano sana para las actividades de la vida diaria.

- Comunicación: Los problemas de comunicación pueden requerir dibujos, señas verbales u otras estrategias en función del tipo y extensión del déficit de lenguaje.

- Incontinencia: Puede ser necesario sondar al paciente o realizar ejercicios de control tanto de la vejiga como intestinales.

- Orientación: Ante la desorientación del enfermo, la familia y amigos juegan un importante papel. Deben reforzar repetidamente importantes señas de identidad como el nombre, la edad, la fecha, el lugar en que viven para reducir esta desorientación.

Prevención del ictus

La prevención del ictus implica el control de sus factores de riesgo:

- Hipertensión

- Diabetes

- Enfermedades cardiacas

- Tabaco

- Colesterol

- Inactividad física

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