Stroke hemorrhagic is a clinical form of acute cerebrovascular accident( ONMC).In 85% of cases, this form develops in violation of the integrity( rupture) of intracranial vessels. And 15% of hemorrhagic strokes are associated with increased vascular wall permeability.
According to the statements of practicing physicians, hemorrhagic stroke is the most dangerous, severe type of stroke, because it is characterized by a direct rupture of cerebral vessels and subsequent hemorrhage into the brain tissue. Naturally, the consequences of this condition are also most dangerous, and the prognosis of recovery may be disappointing.
This forecast is due to the fact that after a hemorrhagic stroke edema, compression and death of brain tissues is incredibly fast, which means that for emergency care physicians have a minimum amount of time, and the chance of a life can easily be lost.
Classification of
The classification of hemorrhagic strokes in ICD 10 is based on the localization of hemorrhage. Depending on this, four types of disease are distinguished:
- intracerebral , when the hematoma is located in the parenchyma of the nervous tissue;
- subarachnoid , resulting from damage to the vessels of the arachnoid membrane;
- ventricular , in which blood is detected in one of the four ventricles of the brain or its aqueduct;
- about mixed type is said with the combination of the first three.
In different areas of the lesion, specific symptoms may develop, allowing even after examining the patient to assume the location of the hematoma.
Hemorrhagic stroke - what is it?
This is a brain damage that develops as a result of damage to the vascular wall and, as a result, a hemorrhage into the tissue or into the space between the membranes of the brain. In the latter case, hemorrhagic stroke takes treatment exceptionally prompt. Especially if there is an outflow of a large amount of blood.
The disease occurs more often suddenly, during the day, at the time of high blood pressure( hypertensive crisis), with severe physical exertion or emotional overstrain.
Stroke of the brain stem is a very dangerous condition, as in this department are located vital nerve centers, as well as the nucleus of the cranial nerves. With hemorrhage to the trunk, in addition to the development of bilateral paralysis, impaired sensitivity and swallowing, a sharp loss of consciousness with rapid development of coma, a violation of respiratory and cardiovascular systems in connection with the defeat of the respiratory and vasomotor centers. In such severe cases, the likelihood of a lethal outcome is 80-90%.
Pathogenesis of
A trigger mechanism for parenchymal hemorrhage is a violation of the permeability and / or integrity of the vessels of the internal structures of the brain. As a result, the blood flows or penetrates through the vascular wall. There is a disorganization( disruption) of the work of neurons with their quick death. Moreover, the brain tissue suffers both from impregnation with blood and from its exit through the "ravaging" vessel is much larger than with hemorrhagic stroke in the brain envelopes. Therefore, even a small amount of blood can cause great damage.
With subarachnoid hemorrhage, on the other hand, in the case of rupture of the blood vessel, the blood to a lesser degree exerts pressure on the brain cells. But it spreads very quickly, which increases the zone of "defeat".For all types of hemorrhagic strokes, the rapid development of cerebral edema is characteristic.
Causes of
Why does hemorrhagic stroke occur, and what is it? A stroke of the brain can arise due to congenital and acquired pathologies leading to the processes:
- of anatomical changes, destruction of arteries in arterial hypertension;
- formation and rupture of intracranial aneurysms, arteriovenous malformations, dural fistulas and carotid-cavernous anastomoses;
- to the exit of blood from microangiomas, amyloid plaques( with amyloid angiopathy);
- intracranial vein thrombosis;
- is a septic artery inflammation.
The most common cause of hemorrhagic stroke is persistent increase in blood pressure. Hypertensive crisis leads to spasm and paralysis of the cerebral arteries and arterioles. As a result, there is insufficient supply of blood to the brain tissue. In other words, ischemia develops, as a result of which metabolic processes are violated, which contribute to an increase in the permeability of blood vessels for plasma and shaped elements.
Symptoms of
In the case of hemorrhagic stroke, the symptoms develop rapidly, they are as follows:
- Rapidly growing headaches - especially very severe, accompanied by nausea with vomiting, tidal flashes and ripples in the head, pain in the eyes when looking at bright light or when the pupils rotatesides, the appearance of red circles before the eyes,
- Disorders of the respiratory process, palpitations.
- Disturbances of consciousness of varying severity - sopor, stunning or coma.
Perhaps a sudden onset of the disease with the development of an epileptic seizure. On the background of full health on the beach, during intense emotions at work, during a trauma, a person with a cry crashes, throws back his head, struggles in convulsions, breathes hoarsely, foam comes from his mouth( possibly with blood due to the bite of the tongue).
As a rule, hemorrhagic stroke has a one-sided character, that is, it affects the right or left side. The further complications will depend on the affected side of the brain.
To diagnose an attack in other people:
- Ask to smile if the smile is asymmetric, then the likelihood of a stroke is high.
- Raise your hands and ask them to hold them in front of you, if one hand is lowered, then there is also the risk of an attack.
- Ask the simplest question - if speech is changed, this is also a sign of a stroke.
At the first manifestations of a stroke, immediate medical attention is required - an ambulance should be called in and sent to the hospital.
Diagnosis
The diagnosis of "hemorrhagic stroke" in a medical institution is performed on the basis of the following research methods:
- computed tomography( CT) of the brain;
- magnetic resonance imaging( MRI) of the brain;
- electrocardiography;
- cerebral angiography;
- lumbar puncture.
Based on data from all studies, the patient is assigned treatment - a set of emergency measures that stabilize the patient's condition, and then - eliminating the consequences of a stroke.
Treatment of hemorrhagic stroke
With diagnosed hemorrhagic stroke, the treatment consists of a complex of measures for emergency care and a subsequent long recovery period( rehabilitation), carried out in stages. The patient's therapy should be started in the first 2-4 hours after the onset of symptoms in the neurological or neurosurgical department of the hospital. In case the stroke is extensive, the patient may fall into a coma, which requires hospitalization in the intensive care unit.
The main task of doctors is to maintain the normal operation of organs and systems, especially vital ones. For this purpose, drugs that support the work of the heart are being introduced. If breathing is disturbed, intubation of the trachea is performed and the patient is connected to the ventilator. With hemorrhagic stroke, it is necessary to lower arterial blood pressure as soon as possible in order to eliminate further bleeding. It is recommended to maintain systolic blood pressure at 130 mm Hg. It is necessary to fight with brain edema, administer diuretics.
Surgical methods of treatment are also often used. It is addressed in those cases when there is a large hemorrhage( 40 or more ml of blood) in the cerebellum caused by an aneurysm and leading to deformation of the brainstem, obstructive hydrocephalus and extensive subcortical hematoma( from 3 cm in diameter).
During the operation, the surgeon must completely remove clots of blood from the surface of the brain, minimally damaging his tissues, thereby reducing the amount of neurotoxic substances from the hemorrhage formation and reducing intracranial pressure.
Consequences of
Complications of hemorrhagic stroke can occur both in an acute period and for a long time from the time of hemorrhage.
Among the most common can be identified:
- Violation of motor functions, paresis and paralysis.
- Violation of speech, difficulty in writing, reading and counting.
- Changes in perception.
- Violations in the sphere of thinking, memory impairment, loss of learning ability.
- Behavior change, manifested in the form of aggression, slow reaction, fearfulness, etc.
- Changes in the emotional and sensory spheres( depression, sudden change of mood, anxiety, low self-esteem).
- Infringement of processes of an emiction and a defecation.
- Pain sensations that are not stopped by analgesics.
- Epileptic disorders.
The consequences of hemorrhagic stroke, as a rule, remain for the rest of your life. Violations of motor and sensory function, speech, swallowing require constant attention from relatives caring for the patient. In case of inability to move and walk, it is necessary to ensure the prevention of pressure sores.
Rehabilitation
Recovery is a lengthy process and it requires both the patient and his close relatives, patience, endurance, perseverance and faith. To restore the motor functions, a set of activities is used, including:
- physiotherapy
- massage
- classes on special simulators.
To restore speech, you need to have a speech therapist and psychologist. The rehabilitation period depends on the degree of severity of brain damage. As a rule, with extensive stroke, rehabilitation takes several years. Often, patients retain motor impairments for the rest of their lives. According to statistics, only 15-20% of patients return to full-fledged life.
Recovery prognosis
The prognosis for hemorrhagic stroke is generally unfavorable. The overall lethality reaches 60-70%, after removal of intracerebral hematomas - about 50%.Approximately 90% of patients, in a state of sopor or coma, die in the first five days, despite intensive therapy.
- The main causes of death of both operated and unoperated patients are an increasing edema and dislocation of the brain( 30-40%).
- The second most frequent cause is a recurrence of hemorrhage( 10-20%).
Approximately 2/3 of the patients who suffered a stroke remain disabled. The main factors determining the outcome of the disease, consider the volume of hematoma, the concomitant breakthrough of blood in the ventricles, the localization of the hematoma in the brainstem, the previous reception of anticoagulants, the previous heart disease, the elderly.