Everyone knows that stroke is considered one of the most complex and severe diseases of the heart and blood vessels. This is due to the fact that this pathology very often entails a person's disability or even a fatal outcome. Stroke is nothing more than a violation of blood circulation in the brain, which causes damage to its tissues.
What is a hemorrhagic stroke
This pathology is the result of a rupture of a blood vessel, which leads to an outflow of blood to the brain. This organ is highly susceptible to various types of bleeding, and therefore damage can occur quite quickly.
As a result, there is irritation of the brain tissue, which leads to the formation of edema. The accumulation of blood can lead to the fact that the cells of this site will weaken and die. In addition, bleeding can cause increased pressure, because it presses the brain to the skull.
Unlike ischemic hemorrhagic stroke of the brain is a sharp stoppage of the blood supply of a part of the brain. This may be due to clotting with a blood clot or a spasm of the vessel.
. Case history
The first mention of this disease was made by Hippocrates in 460 AD.BC.In his notes you can find information about cases of loss of consciousness, which occurred as a result of brain pathologies.
Subsequently, Galen led signs of a disease that is accompanied by a sharp loss of consciousness. In 1628, William Harvey studied the features of the movement of blood in the body. Thanks to the acquired knowledge, it was possible to determine the causes of stroke.
In addition, the pathogenesis of the disease was also helped by Rudolf Virchow, who first began using terms such as embolism and thrombosis. Also, this scientist managed to establish that thrombosis is not associated with inflammatory processes, but is caused by the fatty degeneration of the vessel wall.
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Classification and types of pathology
Depending on the location of the hemorrhage, the following types are distinguished:
- Parenchymal. This term is called intracerebral hemorrhage.
- Ventricular. In this case, the lateral ventricles are affected.
- Subarachnoid. Hemorrhage occurs in the area located between the arachnoid and the soft shell of the brain.
- Mixed.
Depending on the location of the blood tumor, the following types are distinguished:
- Lobar. In this case, the blood lies within the hemisphere of the brain.
- Lateral. In this situation, the tumor affects the subcortical nuclei.
- Medial. In this case, the thalamus is affected.
Depending on the cause of the development, the stroke can be:
- Primary. Due to the prolonged elevated blood pressure, the walls of the vessels are thinned. If there is a sharp pressure surge, the wall of the vein or artery may explode.
- Secondary. In this case, the stroke occurs due to vascular malformation, which can be congenital or acquired.
Also, a stroke can affect the right or left side of the brain. If the work of the right hemisphere is disrupted, paralysis of the left side of the trunk occurs. If left side is injured, the right side can be paralyzed.
In addition, specialists identify such conditions:
- Hemorrhagic transformation of cerebral infarction. Usually, with a cerebral infarction, there are small petechial hemorrhages. Usually they do not affect the clinical picture of the disease. However, they sometimes merge, forming more bulky centers.
- Ischemic stroke with hemorrhagic impregnation. Enough dangerous state, which is difficult to identify and choose the right treatment. The determining factor that affects the course of the disease is a second stroke. This condition usually develops after two or four days.
Clinic and pathogenesis of hemorrhagic stroke
Pathology is characterized by an acute onset of development and is often accompanied by an increase in blood pressure. This condition is characterized by acute headache, vomiting, nausea, dizziness.
Quite rapidly develop focal features, and then the level of wakefulness decreases. A person can experience mild stun or fall into a coma.
Neurological signs directly depend on the location of the hematoma. The most commonly observed disorders of speech, memory disorders, loss of sensitivity, hemiparesis.
The most difficult period is considered to be three weeks after a stroke. At this stage, progressive cerebral edema is formed, which often leads to the death of the patient. At the beginning of the fourth week, cerebral symptoms begin to regress and the effects of focal lesions appear.
To make a prognosis of the development of the disease, it is often performed an analysis of the content of IL-10 in serum. This substance is an anti-inflammatory cytokine. The high content of this component is characteristic for the mild course of the disease, which often has a positive outcome.
In people with moderate disease, IL-10 is absent from the blood test on the first day, but increases on the tenth day. In patients with severe course of the disease, the participation of IL-10 is not detected in the pathogenesis of stroke on either the first or the tenth day. Its content does not significantly increase at the end of the acute period.
The main reason for this stroke is the rupture of the intracranial artery. This may be due to a violation of the vascular wall nutrition or vessel changes that occur under the influence of various factors.
To a hemorrhage may result:
- Aneurysm rupture. This formation is an expansion of the container of the saccular form, which is accompanied by the thinning of its wall. Often takes place after infectious diseases of the brain or traumatic injuries.
- The rupture of malformation. It is a tangle of arteries and veins that intertwine with each other.
There are certain factors that increase the threat of this pathology development:
- Elevated blood pressure.
- Diabetes mellitus. This pathology produces a toxic effect on the walls of the arteries.
- Drinking lots of alcoholic beverages.
- Smoking.
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Symptoms and signs
Usually, hemorrhagic stroke develops suddenly. Most often this happens in the daytime.
The first signs of this status are:
- Redness of the face.
- Arrhythmia.
- Intensive headache.
- Decreased or slowed heart rate.
- The appearance of red flies in front of the eyes.
- Violation of breathing, the appearance of wheezing.
- Dysfunction of swallowing.
- Enlarged pupils.
- Nausea and vomiting.
- Violation or loss of consciousness.
- Intensive neck vessel pulsation.
- Increase in blood pressure.
- Paralysis of the hands or face area.
- Coldness of the skin.
- Urination disorder.
Signs of a pathology grow within a few minutes or hours. The development of symptoms is largely influenced by the location of the localization of hemorrhage. There may be speech disorders, blindness or strabismus, loss of hearing, smell, memory, behavior change, neurological disorders, loss of sensitivity.
If extensive hemorrhage occurs, secondary symptoms associated with brain dislocation may join. These can be convulsive conditions, fainting, coma.
Diagnosis of hemorrhagic stroke
The main diagnostic procedures include:
- MRI( magnetic resonance imaging);
- spiral computed tomography;
- conventional computerized tomography of the brain.
With the help of these studies it is possible to estimate the size and location of the hematoma, the level of the dislocation of the brain, the presence of edema, the area of prevalence of hemorrhage. To monitor the development of the hematoma and to assess the state of brain tissue, it is recommended to perform repeated studies.
It is very important to conduct differential diagnosis to understand what distinguishes hemorrhagic stroke from ischemic, and to establish the correct diagnosis. According to clinical data, this is impossible. Ischemic stroke is characterized by the absence of meningeal symptoms. Also for this pathology is characterized by a gradual development of cerebral symptomatology.
In the case of ischemic stroke, the cerebrospinal fluid, which is examined by performing a lumbar puncture, has a normal composition, while in hemorrhagic stroke there may be blood impurities in it. Because of this, doctors consider it more dangerous than ischemic.
On the photo - MRI of the brain for hemorrhagic stroke:
Emergency care for
In case of hemorrhagic stroke, the algorithm for emergency care is as follows:
- The patient needs to ensure strict bed rest and stop bleeding. Bring blood pressure back to normal, reduce intracranial pressure, cope with brain edema, eliminate acute breathing disorders. It is also necessary to eliminate psychomotor agitation and cardiovascular disorders.
- After this, the patient should be immediately transported to the neurological hospital. It is very important to observe the precautionary measures: carefully put the person on a stretcher, ensure his horizontal position, avoid shaking.
- Before transporting a patient, he should enter hemostatic means and apply a venous tourniquet to his hips - this will help reduce the amount of circulating blood.
- If breathing is impaired, the patient should be transported with inhalation of oxygen.
- After this person, you urgently need to be hospitalized in a neurosurgical stationary department.
Hemorrhagic stroke is a very serious pathology that can have very deplorable health consequences or even result in death. Therefore, it is so important when the first signs of pathology appear, to send a person to a hospital - timely assistance can save his life.
We offer you to watch a video in which you can find detailed and accessible information about the first aid for stroke patients: