1 Etiology and pathogenesis of the disease
Hemorrhagic stroke refers to a pathological condition in which there is a nontraumatic hemorrhage directly into the brain tissue or cavity of the cranium, resulting in the death of a portion of the brain tissue. According to the international classification of diseases, there are 3 main types of cerebral hemorrhage, including subarachnoid, intracerebral and other non-traumatic intracranial hemorrhages. Thus, this classification is more based on the parameters of localization of hemorrhage, which led to a stroke.
Currently, many causes and predisposing factors for the development of hemorrhagic stroke are well known. One of the most common causes of stroke of hemorrhagic type is hypertensive disease. As a rule, the development of stroke is observed in the 2-3 stages of hypertension. It should be noted that the most predisposed to stroke patients with hypertension, who also have endocrine diseases, for example, adenoma of the pituitary gland, pheochromocytoma or thyroid pathology, significantly aggravating the patient's condition and predisposing to the current blood flow of hypertension. Other related factors include:
- systemic connective tissue diseases;
- aplasia of hematopoiesis;
- amyloid angiopathy.
In rare cases, the development of hemorrhagic stroke may be caused by congenital malformations of cerebral vessels, various aneurysms, avitaminosis, uremia, primary or secondary brain tissue tumors, abnormal fistulas between the cavernous sinus and carotid artery and hemorrhagic diathesis. Among other things, lead to hemorrhage in the brain can use drugs that have anticoagulant effects. In addition, in extremely rare cases, the development of hemorrhagic stroke may be associated with physical overstrain, as well as with encephalitis.
2 Clinical picture of the disease
Symptomatic manifestations of hemorrhagic stroke are extremely diverse and depend in many respects on the localization of the affected area. In addition, the larger the lesion area, the more distinctly the symptomatology appears. All manifestations can be conditionally subdivided into focal and general cerebral. Symptomatic symptoms include:
- breathing disorder;
- general weakness;
- hemodynamic disorders;
Other cerebral manifestations of stroke may also occur depending on the degree of brain damage. To focal symptoms, indicating the localization of the affected area, include the following manifestations:
- paresis of the limbs;
- speech disorders;
- paresis of facial muscles;
- vision and hearing impairment.
During the development of hemorrhagic stroke, the patient may experience seizures and seizures resembling elliptical ones. Given that the manifestations of developing stroke, as a rule, can be seen clearly enough, it is very important for others to deliver the patient to the hospital as soon as possible.
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3 Diagnosis and treatment of pathology
When a patient signs of hemorrhagic stroke, the patient should be hospitalized as soon as possible. A medical or magnetic resonance imaging is performed in a medical institution to confirm the diagnosis and identify hemorrhages. In addition, blood tests for clotting factors can be immediately assigned. In the presence of normal blood pressure, angiography can be prescribed. If it is not possible to use a computer tomography for diagnostic purposes, puncture of cerebrospinal fluid may be prescribed.
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Hemorrhagic stroke( ICD code 10 I60-I62) is treated in a comprehensive manner. During the treatment, both medication and surgical therapy can be performed. Urgent surgical intervention was provided with increasing subarachnoid hemorrhage, ruptures of aneurysm walls, large accumulation of blood, progressive hydrocephalus, brain wedging syndrome, etc. If there are no indications for an operative intervention, the patient is placed in the intensive care unit or intensive care unit, where vital vital signs are supported. As medicamentous support may be prescribed:
- non-narcotic analgesics;
- ACE inhibitors;
- remedy for relieving vomiting and nausea;
- means for correction of coagulopathy;
- means for antioxidant and neuroprotective therapy.
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Treatment of hemorrhagic stroke is primarily aimed at normalizing the blood circulation of brain tissue, and in the future, to eliminate those disorders that have appeared due to impaired circulation of brain tissue.