Ischemic stroke in combat conditions. Vasculocerebral injury

During armed conflicts, the incidence of ischemic stroke among military personnel increases substantially compared with peacetime. In addition to the elevated risk of combat-related injuries, military service members are exposed to intense physical and emotional stress and extreme environmental factors, which contribute to the toll of both common (atherosclerotic arterial changes, diabetes mellitus, obesity, cardiovascular diseases) and specific risk factors more typical of young adults (cardiac sources of embolism, non-inflammatory and inflammatory arteriopathies, coagulation disorders), as well as generate additional stroke risk factors unique to combat conditions. Firearm injuries have a special place in the pathogenesis of combat-related ischemic stroke. We have proposed and substantiated the term vasculocerebral injury. It is a distinct type of combat firearm injury, representing a cascade of sequential interrelated pathological changes occurring in the damaged major precerebral arteries (aorta, brachiocephalic trunk, common and internal carotid arteries, vertebral arteries), cerebral arteries, their vascular territories, blood cellular elements, and surrounding tissues as a result of the complex damaging effect of a high-energy projectile (shock wave, lateral impact energy, vortex flow), ultimately leading to pathophysiologically heterogeneous secondary acute cerebrovascular lesions, including ischemic stroke. Clinical cases of vasculocerebral injury are presented. Early identification of cervical and cranial vascular injuries contributes to timely and optimal treatment tactic selection (surgical, conservative, including differentiated antithrombotic therapy) and improves ischemic stroke prevention during combat operations.