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Accidente Cerebro Vascular
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Accidente Cerebro Vascular

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OTROS NOMBRES 
Ictus.
Embolia cerebral.
Trombosis cerebral.
Apoplejía.
Hemorragia cerebral.

DEFINICIÓN

El Accidente Cerebro Vascular (ACV) o Ictus es una enfermedad vascular que afecta a las arterias del cerebro o que llegan al cerebro. Por diversas causas las células del cerebro quedan sin oxígeno y pierden su función, apareciendo cuadros de parálisis de medio cuerpo, trastornos del habla, etc ...

 CAUSAS

Los ACV se dividen en dos grandes grupos: isquémicos (por falta de sangre) o hemorrágicos.
En el primer caso se produce una obstrucción del paso de sangre al cerebro. En la mayor parte de los casos la obstrucción está producida por la presencia de placas de ateroma, lo que llamamos arterioesclerosis. En otros casos se debe a la llegada de un trombo desde otras zonas del organismo, generalmente desde el corazón (embolia).

La arterioesclerosis es como un envejecimiento de las arterias que se vuelven rígidas, en un proceso progresivo que consiste en la acumulación de colesterol, calcio y otras grasas en la pared de las arterias. En ciertas zonas de las arterias el estrechamiento puntual es más intenso, llegando a tapar casi por completo el paso de sangre al cerebro.
Si en la zona obstruida por placas de ateroma se pegan acúmulos de plaquetas, se llegan a formar coágulos (trombos), lo que llamamos trombosis cerebral.
Estos trombos se pueden soltar (embolia), y por su tamaño llegan a arterias más pequeñas por las que no pueden pasar, las taponan totalmente y producen lo que se llama la isquemia aguda (embolia cerebral). Estas embolias también pueden haber migrado desde el corazón en diferentes situaciones (la más frecuente por una arritmia; la fibrilación auricular).
Esta situación es muy grave ya que puede evolucionar a la muerte de las células cerebrales implicadas en la isquemia y la pérdida irreversible de las mismas.
 
 
 

En otras ocasiones, lo que se produce es la rotura de una arteria cerebral (por aneurismas o por hipertensión arterial). La hemorragia intracerebral que se produce no puede liberarse al exterior ya que el cerebro está encerrado en el hueso del cráneo. Por ello la sangre presiona lo más blando, el cerebro, produciendo la falta de oxigenación de la zona y las lesiones subsecuentes de los tejidos (isquemia cerebral).
La causa más frecuente de rotura de una arteria cerebral es la presencia de un aneurisma. Un aneurisma es una dilatación permanente de una arteria causada por la debilidad de su pared.
 
 TRATAMIENTO

Fase inicial o aguda:
Debe acudirse lo antes posible a un Hospital, ya que el ahorro de tiempo en comenzar el tratamiento mejora el pronóstico. Contacte rápidamente con su teléfono de Emergencias (112, 911, 061) para que le envíen el recurso asistencial adecuado.
Control de la vía aérea, oxigenación y tensión arterial, para asegurar una óptima oxigenación y perfusión de las células cerebrales.
Medicamentos que impidan la agregación plaquetaria (ácido acetilsalicílico, ticlopidina, clopidogrel, dipiridamol, triflusal). En algunos paises se usan trombolíticos por vía intravenosa para revertir rápidamente la obstrucción.
Si el problema es un embolismo a distancia (desde el corazón), se puede precisar de una anticoagulación permanente.
Control de la hipertensión arterial.
Control de las complicaciones: convulsiones, edema cerebral, etc ...
Si el cuadro es hemorrágico puede precisar de su evacuación quirúrgica (no en todos los casos).
Fase de seguimiento:
En los cuadros de isquemia cerebral por arterioesclerosis de la arteria carotídea se realiza la endarterectomía de la arteria afectada. Esta intervención se realiza a través de una incisión en el cuello, para acceder hasta la arteria carótida, se abre y se realiza una limpieza de las placas de ateroma que hay en su interior. 

En los últimos años se han desarrollado técnicas endovasculares para corregir la estenosis carotídea sin necesidad de cirugía abierta. Son la angioplastia transluminal percutánea y la colocación de stents. La angioplastia es la dilatación de una arteria inflando un balón, a través de un catéter especial insertado por punción percutánea, a través de la arteria femoral. El paciente está despierto y puede regresar a su domicilio en pocos días. El stents es una prótesis metálica, en forma de muelle que se coloca en la zona estrechada y al ejercer presión sobre la pared vascular mantiene la apertura de la luz.
Los aneurismas, malformaciones arteriovenosas, etc ... que provocan una hemorragia intracerebral, pueden precisar una intervención quirúrgica posterior o una técnica envovascular para su tratamiento definitivo y evitar las recidivas.
Medicamentos antiagregantes o anticoagulantes como los mencionados en la fase aguda. Se están investigando nuevos antitrombóticos cuyo mecanismo de acción suma a su acción antiagregante efectos anticoagulantes y fibrinolíticos.
Rehabilitación de las funciones afectadas, tanto motoras como de otro orden.
Control de hipertensión arterial, hipercolesterolemia, tabaquismo, diabetes, obesidad, etc ...
 
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