【脳梗塞の後遺症】体の麻痺について
脳梗塞の後遺症として最も多いのが麻痺です。
麻痺の部分や程度は脳梗塞の部位やその後の処置によって異なりますが、麻痺にも種類があるのをご存じですか？麻痺だけでなく、脳梗塞には様々な後遺症があります。
今回は脳梗塞の後遺症や、麻痺について説明したいと思います。
目次
脳梗塞とは？
脳梗塞とは、脳卒中の一つです。
脳梗塞は脳内の血管が狭くなって塞がってしまい、血液が脳の組織に行きわたらなる事をいいます。
また、血液が固まってできた血栓が脳の血管に詰まってしまうと、血液の流れが止まってしまいます。
その結果、脳にとって最も大切な酸素や栄養が運ばれずに、脳の組織が壊死してしまう状態をいいます。
血管が破れて出血してしまうと、脳出血やくも膜下出血になります。これらをまとめて脳卒中と言い、最悪、死に至るとても危険な病気です。
脳梗塞の種類
脳梗塞は主に３つに分類されます。
・ラクナ梗塞
高齢者や高血圧の人に起こりやすいと言われています。脳の深い部分で発生する15ｍｍ以下の小さな脳梗塞です。ダメージを受ける部分が小さいため、症状が現れないことが多く、ラクナ梗塞が起こっていても気づかない事がよくあります。しかし放っておくと太い血管で起こる脳梗塞や脳出血を発症する恐れがあり、認知症になるリスクが高くなります。
・アテローム脳梗塞
高血圧や高脂血症、糖尿病などを患っている中高年に起こりやすいと言われています。
コレステロールが血管の壁に溜まり、分厚く硬くなってしまった状態をアテローム硬化といいます。
頸動脈（首から脳に通る血管）や比較的太く大きな血管で起こる事が多いため、脳梗塞を引き起こします。血液がドロドロの粥状態である事が多く、水分の摂れない睡眠中や起床時に発症しやすい特徴があります。
大きな血管で起こるため、ダメージも大きく、ラクナ梗塞よりも重い症状が出やすいと考えられます。
・心原性脳塞栓症
心房細動や不整脈など、心疾患がある人に起こりやすいと言われています。心臓の中にできた血栓が、脳に向かう頸動脈を通って脳の血管まで到達し、脳梗塞を引き起こしてしまいます。
脳内の太い血管に詰まり、日中の活動時に発症する事が多くあります。突然発症するため、意識障害などの重篤な神経症状があり、死の危険性が高い脳梗塞です。
脳梗塞の症状や障害
①運動障害
・急に片方の手足が動かない
・体の片側に力がはいらない
・食事中に橋や茶わんを落としてしまう
・歩いていても傾いてしまい、まっすぐ歩けない
・つまづきやすい
・片足を引きずる
②言語障害
・言葉が出てこない
・言葉の意味が分からない
・話し方がぎこちない
・是津が回らない
③感覚障害
・片側の手足が突然しびれる
・片側の手などの感覚が鈍くなる
④視覚障害
・物が見えたり見えなくなくなったりする
・物が2重に見える
・視野が狭くなる
・視野が半分欠けて見える
麻痺の種類
麻痺には程度によって呼び名が変わります。
・不全麻痺（ふぜんまひ）
手足に思ったような力が入らない状態。触覚なども衰えてしまう症状。
支障はあるが、まったく動かないわけではない。
・完全麻痺（かんぜんまひ）
不随の意味でも使われ、手足を完全に動かせなくなる症状。痛みや熱さ、冷たさも感じなくなってしまう。
・片麻痺（かたまひ・へんまひ）
一般的には半身不随と呼ばれることがあります。
右、または左の上肢（じょうし：腕の事）と下肢（かし：足の事）の筋力が低下して動かせない状態。
・対麻痺（ついまひ）
左右の上肢、または下肢の対称性に麻痺している状態。
多くは脊髄の損傷によって起こる事が多いです。
・単麻痺（たんまひ）
上下肢のうち、片手、もしくは片足だけ麻痺している状態です。手は握れるが腕が動かなかったり、足首の動きだけが悪いといったり、麻痺の程度は様々です。
・四肢麻痺（ししまひ）
両側上肢、両側下肢の四肢におこる運動麻痺の状態。脳性まひや頚髄損傷などによって生じます。麻痺の程度にもよりますが、ほとんどの動作に介助が必要となります。
脳梗塞に多い麻痺とは？
脳梗塞の後遺症として最も多く発症するのが、先ほど紹介した片麻痺です。
脳が右脳と左脳にわかれ、役割が違うように、片麻痺にも左片麻痺と右片麻痺があり、症状にも違いがあります。
左右の脳は、それぞれの脳と反対側の身体の動きをコントロールしているため、左脳に損傷がある場合は右片麻痺を発症し、右脳に損傷がある場合は左麻痺を発症する場合が多くあります。
【左片麻痺に多い症状】
・失認（しつにん）
感覚を介して対象物を認知する事ができなくなる障害をいいます。左半分の空間を無視してしまう「半側空間無視」という症状は、左側にあるものを見落としたり、障害物に気づかずぶつかったりしてしまいます。
・性格の変容
突然、性格が変わってしまう症状です。温厚だった人が、急に怒りっぽくなったり、いつも素直だった人が急にわがままになったりする症状があります。
【右片麻痺に多い症状】
・失行（しっこう）
意識をしなければ自然に動けますが、指示をされたり意図的に何かをしようとすると、うまく動けなくなる症状です。歩くときの最初の1歩がうまく出せなかったり、足がすくんでしまいます。
・失語症（しつごしょう）
話す、聞く、書く、読むといった能力が低下し、言葉をうまく使えなくなる症状です。聞いた言葉を理解する事はできますが、言葉や名前が出てこなかったり、思ってみない言葉を発してしまうなど、症状には個人差があります。
まとめ
脳梗塞の原因は様々あります。
さらに症状も突然現れます。
何よりもしっかりと予防する事が大切になります。
血圧が高くてお医者さんに行っても、まずは生活習慣を整える事から治療が始まります。
適度な運動、血圧管理、食生活の改善をすることで、脳梗塞の発症リスクは大幅に下げる事ができます。
そして「脳梗塞かも？ 何か変だな？」と思った時は、自己判断をせず、すぐにお医者さんに相談しましょう。
脳梗塞は早期治療、早期リハビリがその後の後遺症に大きく関わってくるため、早期発見が何よりも重要になります。
寝ている間に脳梗塞になってしまう事が一番最悪です。
そうならないためにも、就寝前と起床時にはコップ1杯の水を飲む習慣をつけて、しっかりと予防していきましょう。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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