A popular recommendation is that a person with the first signs of a stroke needs to have their fingertips pierced or cut. This will supposedly reduce the pressure, and the blood clot, along with the flowing blood, will move from its place. We decided to check whether the effectiveness of this practice is supported by scientific evidence.

This non-standard First aid method is suggested to be used if a stroke is suspected bloggers V "Zene"and on YouTube, users social networks And forums. Often the advice is based on personal experience - supposedly this is what saved the author or helped him save another person. The recommendation to cut or pierce the fingertips during a stroke can be found on website Lipetsk Dental Clinic No. 1, on Belarusian health portals and in Ukrainian Media. Real case of using this method described blogger and ambulance paramedic Inessa Kolpakova: “We arrive at the address, and it’s as if all the parts are there "The saws were removed at once. <...> It occurred to someone to cut her (the patient with a suspected stroke - editor's note) fingers and toes, release the blood, reduce the pressure, so that with this pressure the blood clot would come out of her head."

Stroke is an acute violation cerebrovascular accident (CVA), which leads to damage to brain cells. Symptoms of this condition include sudden weakness in the limbs, problems with speech and coordination, and facial asymmetry. The collective term “stroke” refers to several different pathologies: cerebral infarction (ischemic stroke), intracerebral hemorrhage (hemorrhagic stroke) and subarachnoid hemorrhage (bleeding into the cavity between the arachnoid mater and the pia mater).

Ischemic stroke arises due to impaired blood supply to the brain, most often due to blockage of blood vessels by a blood clot or atherosclerotic plaques. Blocking the lumen of the vessel leads to an acute lack of oxygen, as a result of which brain cells begin to die - tissue necrosis occurs. The longer the circulatory disorder persists, the larger the affected area becomes. Because of this, the performance of functions for which the damaged area of the brain was responsible deteriorates.

Hemorrhagic stroke is characterized by rupture of blood vessels and bleeding in the brain. The spilled blood penetrates into neighboring areas of this organ and forms a hematoma, which puts pressure on the brain structures, causing them to shift. This leads to impaired functioning of the affected area of the brain. Hemorrhagic stroke occurs due to high blood pressure, vascular aneurysm, or blood pathologies leading to clotting disorders.

In the case of subarachnoid hemorrhage, blood enters the space between the membranes of the brain and edema develops there, which compresses other vessels and also disrupts the normal functioning of the organ.

More than 80% strokes - ischemic, about 10–15% are hemorrhagic, and subarachnoid hemorrhages have to about 5% of all cases, that is, in 15–20% of strokes, there is simply no blood clot that could be “pushed out” with the help of provoked bleeding.

In turn, ischemic strokes, depending on the pathogenetics share for the following types:

atherothrombotic - the lumen of the vessel is completely or partially blocked by either atherosclerotic plaques consisting of cholesterol and other compounds of fat, calcium and connective tissue fibers, or blood clots developing against the background of atherosclerosis. When the vessel is blocked, the blood flow downstream stops, after which the nerve cells quickly die. The higher upstream the thrombosis has developed, the larger the damaged area of the brain and the more severe the symptoms;
cardioembolic - disruption of blood supply caused by substances wandering through the bloodstream emboli, most often by blood clots formed in the cavity of the heart, but reaching the brain;
other types - for example, those occurring in connection with inflammation of the choroid due to acute or chronic meningitis, vasculitis and syphilis, dissection of the wall of the cerebral arteries or aorta, increased blood viscosity, degeneration of the wall of small arteries and its replacement with lipids and collagen, etc.

Scheme of narrowing of the artery lumen due to atherosclerosis. Atherosclerotic plaques are shown in yellow. Source

However, in most cases of stroke in almost all age groups, doctors don't find no narrowing of the lumen of the vessel, no blood clot, or diseases causing pathology. This type of stroke is called cryptogenic. Among patients over 50 years of age in whom the cause of the disorder has been identified, cardioembolism is the second most common, and atherosclerosis is the fourth.

Distribution of causes of stroke depending on age. Source

It turns out that of ischemic strokes, which account for about 80% of strokes, about half also occur without blockage of blood vessels and, therefore, cuts to the fingertips, even in theory, will not alleviate the patient’s condition in any way. In addition, if by external symptoms we distinguish ischemic stroke from hemorrhagic or hemorrhage into the subarachnoid space as a whole Maybe, then it is impossible to determine by eye whether an ischemic stroke is caused by a blood clot or not.

To figure out whether punctures or cuts to the fingertips will still help with ischemic strokes caused precisely by thromboembolism, you need to understand how the circulatory system works. Blood vessels share into three types: arteries (through which blood moves from the heart to different parts of the body), veins (through which blood returns to the heart) and capillaries (connect arteries and veins).

If you look at the diagram of the arteries of the hand, it becomes clear that there are no arteries in the fingertips themselves; they are penetrated by a network of small capillaries. Diameter the own palmar digital arteries closest to the pads of the fingers in the area of the distal interphalangeal joint closest to the pads are extremely small - only 0.7–0.8 mm.

At the same time, the diameter of the cerebral arteries much more - from 2 mm, that is, a foreign body that has clogged a vessel of this diameter will not be able to leave it through an incision on the fingertip. Even if the clot were to move (and an ischemic stroke occurs due to the fact that it literally gets stuck in the lumen of the vessel), there is no guarantee that it will move towards the finger and will not get stuck somewhere else along the way, for example, in another part of the brain. Moreover, when massive bleeding, that is, loss of about 20% of the total volume of circulating blood (this cannot be achieved by cutting the fingertips, but this can happen if large vessels are damaged), is happening vasoconstriction is a narrowing of the lumen of blood vessels in the body, slowing down or even completely stopping the flow of blood in the vessels. Therefore, no thrombus can “wash” the slowed blood flow out of a collapsed artery. Note that such a volume of blood loss is dangerous in itself, since great the risk of developing hypovolemic shock, a potentially fatal condition fraught with irreversible changes in all organs. Therefore, the idea of cutting not the fingertips of a stroke patient, but larger vessels, should also be abandoned.

If you suspect a stroke, experts recommend first performing a simple test, the sequence of actions in which can be remembered by the abbreviation U.D.A.R.:

U (smile) - ask the person to smile. With a stroke, the smile is often asymmetrical, crooked, one corner of the mouth is drooping;
D (movement) - ask the person to simultaneously raise both arms or legs (if he is lying down). Usually the arm or leg on the side opposite to the source of the stroke does not rise or moves much more slowly and out of sync with the other;
A (articulation) - ask a person to pronounce a phrase. Stroke is often accompanied by speech impairment;
R (decision) - if the victim cannot complete one or more tasks, call an ambulance and report the test results.

While the doctors are on their way, need to help the patient take a horizontal position - best on his side, slightly raising his head. The victim should not eat, drink or take any medications: firstly, during a stroke, the swallowing process may be disrupted and the person may choke, and secondly, ischemic and hemorrhagic strokes require completely different therapy. It is impossible to accurately make a correct diagnosis at home, so any medicine can harm the patient. If the patient has difficulty breathing, you can open the windows in the room and unfasten tight clothes; if, on the contrary, he is cold, it is permissible to cover the victim. In case of loss of consciousness and breathing problems, cardiopulmonary resuscitation can be performed. It is important to remember that nerve cells without sufficient blood supply die within 5 minutes. and no improvised means can save them; this zone will suffer in any case. However, a border area (penumbra) is formed around the dead cells, the nerve cells in which are in danger of death, but they can only be saved by complex therapy in a specialized medical institution. The longer treatment is delayed, the larger the penumbra becomes, which means that the prognosis for life and subsequent recovery of the patient worsens. Therefore, the main task of a person who helps a stroke victim is to ensure that an ambulance is called as quickly as possible and to inform doctors in advance about the observed symptoms.

Useless and even dangerous advice to cut your fingertips if you have a stroke has been circulating on the Internet for many years. Unlike most other sources, on social networks he often diverges in the form of the same text as a recommendation from a certain Chinese doctor. The unnamed doctor, who, by the way, also suggests piercing the earlobes as part of first aid for a stroke, also shares his own experience of saving a victim in 1979. Moreover, in the viral text, the character's gender changes several times: first he is male (“In 1979, I taught at Fung Gaap College in Taichung”), then female (“One day another teacher ran into my class and said excitedly: “Ms. Liu, come quickly, our leader seems to have had a stroke!””), then again male (“I immediately went to the third floor”) and again female (“When I saw our leader Mr. Chen Fu Tian, he was pale"). Moreover, the city of Taichung is not in China, but in Taiwan, and Fung Gaap College is there No. In turn, the grammatical heterogeneity of the narrative may be due to the fact that the text was originally written in a foreign language and distorted when translated into Russian.

Indeed, the groundlessness of the advice about puncturing the fingertips during a stroke back in 2006 sorted it out The New York Times newspaper. There, the source of the recommendation was identified as a viral email campaign. Even earlier, in 2004, the American fact-checking project Snopes also wrote about this advice, indicating that it appeared no later than 2003 and just in the form of a mailing list. Its full text in 2007 posted Dr. Steven Novella on his blog. From the letter, the reason for the author’s “gender change” becomes clear - the text was written on behalf of a certain Irene Liu, whose father allegedly died of a stroke and now she shares useful information with others. It was she, according to the text, who learned about the unusual method from a Chinese doctor. In addition to the useless practice of finger pricking, it contains much more frightening advice: do not take the victim to the hospital, because shaking in the car will supposedly cause all the capillaries in his brain to burst. As mentioned above, a stroke is not a burst capillary, but a disruption of blood supply in an artery (less often in a vein), and 80% of strokes are not a hemorrhage, but a blockage of a vessel.

Thus, the list of actions to help a patient with a stroke is very limited: you just need to immediately call an ambulance and provide the patient with a safe and comfortable position. No medications or manipulations, except perhaps cardiopulmonary resuscitation (if the person helping, of course, knows how to do it), are not required and can only do harm. Cutting the fingertips will definitely not help dislodge the blood clot, and cutting larger vessels can lead to life-threatening blood loss and shock.

Cover image: DALL-E