Complete characterization of hemorrhagic stroke: symptoms and treatment

From this article you will learn: what is hemorrhagic stroke, seven types of illness. Symptoms and treatment.

Article content:

What is this disease?
Types of hemorrhagic strokes
Causes of development and risk factors
Symptoms and manifestations
Diagnosis
Stages of treatment, modern methods and drugs
The newest directions in the treatment of hemorrhagic stroke
Prevention, prognosis, outcomes

Hemorrhagic stroke is an acute cerebral hemorrhage due to ruptureor increase vascular permeability. This disorder of cerebral circulation differs from the classical( ischemic) stroke, which occurs more often( 70% of patients).

The nature of vessel changes in ischemic stroke is a clogging of their lumen with thrombi, resulting in the gradual necrosis of brain cells, and with hemorrhagic - a violation of the integrity of the vascular wall, resulting in the brain tissue soaked and squashed with blood.

A stroke of the brain of the hemorrhagic type is a dangerous and insidious disease. It is characterized by:

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Suddenness( 60-65% of patients have hemorrhage without any previous symptoms).
High mortality( 60-70% of patients die within the first week after the onset of the disease).
Deep disability of surviving patients - 70-80% of people are bedridden and can not serve themselves, the remaining 20-30% have a less pronounced neurological deficit( disabilities of limbs, walking, speech, vision, intellect, etc.)

More than 80%hemorrhages in the brain are associated with increased blood pressure( hypertension).Taking antihypertensive drugs( normalizing blood pressure) can reduce the risk of stroke, the amount of hemorrhage and the severity of brain damage. If patients are hospitalized in a hospital in the first 3 hours, this increases the chances of survival. Specialized rehabilitation centers help to restore as much as possible the lost functions of the brain after a stroke. Complete recovery rarely occurs, but it is possible.

Treatment of strokes is performed by a neurologist( neuropathologist), and if necessary, surgical treatment - a neurosurgeon.

This article describes in detail how hemorrhagic strokes occur, and how dangerous they are, what are the causes of development and manifestations, how to treat this disease, what the outcomes and forecasts depend on.

The essence and stages of hemorrhagic stroke

Stroke - necrosis of the brain region due to circulatory disorders. Hemorrhagic type of stroke is one of the varieties of the disease, which is based on hemorrhage in the tissue, membranes or ventricles of the brain.

Stages of development of pathological changes are as follows:

A rupture or weakening with an increase in the permeability of the wall of an arterial or venous vessel that is responsible for the blood supply of the brain( inflow or outflow of blood).
Blood flow outside the vessel into the cranial cavity.
Formation of a hematoma( blood clot) or impregnation of brain tissue with blood.
Direct destruction, irritation of brain cells with blood and products of its decay.
Compression, displacement of nerve centers located near the hemorrhage.
The appearance of the edema of the entire brain, which is compressed in a cavity, limited by the bones of the skull.

The result of all these changes is a violation of the function of not only the destroyed nerve cells, but the entire brain. The more such hemorrhage in volume, the more pronounced neurological disorders, and the heavier the patient's condition. There is a risk of sudden stopping of breathing and heart.

Types of hemorrhagic strokes

Depending on the area of the brain in which hemorrhage is located, 7 types of hemorrhagic strokes can be identified. They are listed in the table:

stroke type	hemorrhage Localization
hemispheric	Surface sections of the right or left hemisphere
subcortical	deep sections of one of the hemispheres
Stem	deepest central office( bore) in which are located the center of breathing and heartbeat
Cerebellar	rear part of the brain - cerebellum
Stroke-hematoma	Blood clot in the space between the surface of the brain and its membranes
Ventricular hemorrhage	Blood in the cavity,circulates the cerebrospinal fluid
Subarachnoid hemorrhage	Blood clot between the cerebral membranes - the space through which the liquor circulates

Causes of development and risk factors

The main reason for hemorrhagic stroke is a decrease in the strength and elasticity of the intracerebral vessels. This can be caused by such factors:

Arterial hypertension is a rise in pressure both in the form of sudden changes( hypertensive crises with a pressure of up to 190-220 / 100-120 mmHg), and at a constant slight increase( 150-160 /90-100 mm Hg).
Congenital and acquired vascular anomalies - malformations( pathological plexuses of defective arteries, veins and lymphatic ducts in the form of glomeruli), and aneurysms( lamination, thinning and baggy protrusion of the vessel wall).

Atherosclerosis is the deposition of cholesterol plaques in the lumen of the cerebral arteries, which makes them weak and brittle, especially in places where they branch at right angles.
Inflammatory and dystrophic changes in blood vessels( replacement of the normal wall with a scar or incomplete tissue) against encephalitis, lupus erythematosus, vasculitis, chronic intoxications of the body.
Reduction of blood clotting, which may be due to diseases( hemophilia, leukemia, thrombocytopenia), hypovitaminosis, overdose of blood-thinning drugs( aspirin, heparin, warfarin, etc.).

People at risk for

People with increased susceptibility to hemorrhagic stroke are at risk for developing this disease:

Risk factors	Increased likelihood of stroke
Increased blood pressure	20-25%
Overweight	15-20%
Elevated cholesterol inblood	13-16%
Low blood neutrophil count( blood leukocytes)	12-13%
Insufficient nutrition and diets	10-11%
Alcohol abuse and smoking	3-5%
Stresses, physical and mental	3-5%
Diabetes mellitus, chronic heart disease	3-4%
Hemorrhages in the brain of close relatives	2-3%

Symptoms and manifestations of hemorrhagic stroke

In 65-75% of cases, hemorrhagic stroke occurs during the day, when the person is maximally active. He manifests a sharp loss of consciousness in a few seconds. During this time, patients only manage to issue a sudden loud cry, which is due to a severe headache, drawing the attention of others. After that, the person loses consciousness and falls.

1. Symptoms of stroke precursors

Some patients( 20-30%) may note for several minutes, hours or even days of the stroke preceding symptoms:

severe headache in the form of attacks or persistent;Dizziness
and general weakness;
nausea and vomiting, not bringing relief;
increase or decrease of sensitivity, numbness of the skin of the limbs and face;
hot flush and red face;
irritability in relation to bright light and loud sounds;
muscle weakness of the limbs on one half of the body, skewness of the face;
visual disturbances in the form of falling out of the fields in the field of view.

2. Manifestations at the height of the disease

A detailed clinical picture of hemorrhagic stroke is represented by such manifestations and symptoms:

Absence of consciousness( coma) or sopor( lethargy, drowsiness).
Frequent noisy, or weakened breathing.
Seizures( whole body tension, head tilt and twitching of limb muscles).
Skewed face due to muscle tension on the side of the affected hemisphere or relaxation( lowering the corner of the mouth, upper eyelid, paroxysmal movements of the cheek during breathing) on the opposite side of the stroke).

Rotation of the eyes towards the affected hemisphere of the brain, or their chaotic movements( "floating" eyeballs).
Pupil dilated on the side of the affected hemisphere.
Decreased or increased muscle tone and reflexes on the limbs opposite to the affected half of the brain.
Meningeal symptoms - tension of the occipital muscles, inability to bend the head, lead the chin to the chest.

The general condition of patients with hemorrhagic stroke is severe, critical. At any time death may occur as a result of stopping breathing and heartbeat. Therefore, patients in the shortest time should be delivered to a medical institution. Hemorrhages in the hemisphere are less dangerous to life, in contrast to strokes of trunk localization or bursting into the ventricles of the brain, which in 98% of cases terminate lethal.

3. Manifestations in the recovery period

If patients with hemorrhagic stroke can be saved, they face a neurological deficit - symptoms caused by damage to the area of the brain into which the hemorrhage occurred. These can be:

permanent headaches;
movement coordination disorder;
paresis and paralysis - violation of limb movements on one half of the body, as they are constantly in a semi-bent position and they can not be unbent;
speech impairment and its complete absence;
mental disorders and irritability;
visual impairment up to complete blindness;
skewed faces;
the inability to walk independently and even sit;
vegetative state - absence of any signs of cerebral activity( consciousness, memory, speech, movements) with saved breathing and palpitations.

Symptoms of the disease and their duration depend on the location of the hemorrhage and its volume. The first 3 days are the most dangerous, because at this time in the brain there are serious violations. Most deaths( 80-90%) occur precisely during this period. The remaining 10-20% of patients die within one to two weeks. Surviving patients are gradually recovering from a few weeks to 9-10 months.

Diagnosis

Based on the symptoms and data of the examination, the diagnosis of hemorrhagic stroke can only be suspected. Such a disease requires accurate verification( confirmation), as this affects the therapeutic tactics. Reliable diagnostic methods:

Lumbar puncture - a puncture by a thin needle of the spinal canal, through which the cerebral fluid( cerebrospinal fluid) circulates in order to take it for analysis. The diagnosis of hemorrhagic stroke becomes obvious if a large number of erythrocytes is found in the cerebrospinal fluid, or it has a pink color.

Lumbar puncture is a relatively simple and harmless procedure, so patients and their relatives should not refuse to hold it, especially if there is no possibility of another diagnosis.

Computer and magnetic resonance imaging - modern methods of rapid and reliable diagnosis of hemorrhagic strokes. They allow not only to determine the very fact of the disease, but also to estimate the size, volume, location of the hemorrhage, its relation to the ventricular system. Based on these data, you can determine the choice of treatment method, the forecast and the most likely outcome.
Angiography of cerebral vessels - the introduction of contrast material into the cerebral arteries with further registration of the cerebral vascular pattern on the X-ray film and electronic carrier. In this way, the exact location of the ruptured vessel can be determined. But the most important advantage of the method is its preventive value: angiography can detect vascular anomalies( malformations and aneurysms) in the brain and carry out their elimination before the rupture.

Stages of treatment, modern methods and preparations

The main rule of medical care for hemorrhagic stroke is to start treatment as early as possible( within the first 3 hours after the onset of the disease). The general algorithm of medical measures consists of three stages.

Stage one - emergency care

Its goal is to maintain life, immediately transport the patient to the nearest hospital, where there is a resuscitation department. At this time:

Assessment of the level of consciousness.
Evaluation of the pulse on the arteries of the neck and palpitation - in their absence, begin cardiac massage( about 100 pressure per minute on the lower part of the sternum).
Evaluation of breathing - if it is not available, start artificial respiration by mouth-to-mouth method( put the patient on his back, stretch his neck as far as possible, head back, perform two inhalations for 30 strokes with cardiac massage).
If breathing and palpitation are maintained, and also with convulsions, create conditions for airway patency: lay the patient to one side, ensuring free outflow of saliva and foam from the mouth.
Measurement and correction of blood pressure( more often it needs to be reduced: injections of Magnesium sulfate, Enalapril, drops Pharmadipine, diuretics).
Slightly raise the head end, or make sure that the head is in a horizontal position, but in no case was lower than the body position.
Apply an ice pack to your head.

Stage two - specialized care and medical treatment

Most patients with hemorrhagic stroke are in serious or extremely serious condition. Therefore, they are hospitalized either in the intensive care unit or in the intensive care unit, where there are conditions for performing resuscitation if necessary( hardware breathing, droppers, defibrillator).Treatment at this stage:

Measurement and correction of blood pressure: when increasing intravenously or intramuscularly enter Enap, Benzohexonium, Dibasol. If the patient can swallow - drops of Pharmadipin, tablets Metoprolol, Clopheline. Low pressure is corrected by the introduction of Mesaton, Dopamine, Prednisolone.
Breathing assurance: if it is absent or inadequate, artificial ventilation is necessary on the apparatus, if it is stored, the oxygen mixture is brought through the mask.

Reducing brain edema - drug administration: L-lysine escinate, Dexamethasone, Furosemide, Manitol.
Maintenance of brain cells supply - intravenous injections: Ceraxon, Actovegin, Cavinton, Thiocetam, Pyracetam, Cortexin.
Hemostatic drugs: Dicycin, Etamsylate, Vikasol, Aminocaproic acid;
Maintenance of blood microcirculation at the optimal level: intravenous infusion Reosorbilact, Cytoflavin, Glucose with vitamins.

Is operation necessary?

Not all cerebral hemorrhages can be surgically eradicated. Three types of operations are used:

Trepanation - removal of a fragment of the skull bone above the hemorrhage area. Through the formed channel, the accumulated blood is removed. The advantage of the technique is that it allows not only to remove the hematoma, but also reduces the pressure in the cranial cavity and cerebral edema. The operation is most suitable for superficial hemorrhages in the hemisphere, stroke-hematomas.
Puncture - skull puncture under the control of special equipment. The needle is brought to the hemorrhage zone with further suction of blood. The method is indicated for hemorrhagic stroke in the deep parts of the brain.

Drainage operations are the installation of tubular drainages in the ventricles of the brain in order to ensure the outflow of liquor with blood, reducing intracranial pressure.

Stage three - restoration of damaged nerve cells and rehabilitation

How hemorrhagic stroke is treated in the final stage:

Medications. It is necessary to continue taking medications restoring brain cells: Cortexin, Thiocetam, Fezam, Sermion, Actovegin, Cerebrolysin, Cinnarizine, etc.
Providing the body with nutrients: with preserved swallowing - enriched with vitamins and protein, in case of swallowing - mixtures and crushed productsnutrition, which are introduced into the stomach through the probe, in the absence of consciousness - intravenous administration of amino acids( Infezol, Aminosol).
Prophylaxis of decubitus: change the patient's body position every 2 hours, use an anti-decubitus mattress, wipe the skin with camphor alcohol.
Prevention of infectious complications from the respiratory tract( pneumonia): administer antibiotics( Ceftriaxone, Levofloxacin, Amikacin).
Special therapeutic exercise, gymnastics, massage, physiotherapy. To begin such a recovery treatment should be immediately after the stabilization of the patient's condition. But a full-scale complex rehabilitation can be carried out only in the conditions of specialized rehabilitation centers.

The newest directions in the treatment of hemorrhagic stroke

The most discussed modern method of treatment of cerebral circulation disorders is the introduction of stem cells( human cells, from which all cells of the body occur).The procedure is indeed very effective, but involves a number of difficulties:

does not have a sufficient number of clinics that are engaged in growing stem cells;
the process of cultivation is long, therefore it must be carried out in advance, before any diseases come;
extremely high cost of the procedure;
even stem cells can not affect the prognosis for massive hemorrhages or strokes in the brain stem.

Prevention, prognosis, outcomes

To prevent hemorrhagic stroke is also difficult, as well as to treat it, but it is possible. For this you need:

Eliminate all possible causes and risk factors( they are described in the section "Persons at risk"), especially in individuals after 45-50 years of age.
To deal with the treatment of hypertension.
Severe recurring headaches, which were not previously there, an uncontrolled rise in blood pressure - an occasion for angiography of cerebral vessels. It will eliminate weak vessels, which will prevent the disease.

Unfortunately, about 70% of patients with hemorrhagic stroke die. Basically this happens for the following reasons:

elderly age( over 70 years);
severe concomitant diseases( heart, lungs, internal organs);
large hemorrhage;
breakthrough of blood in the ventricles of the brain;
localization of stroke in the brain stem.

If these factors are not noted, life forecasts are favorable. Early treatment( within the first 3 hours after the onset of the stroke), persistent and prolonged rehabilitation( about a year) increase the chances of maximizing the full recovery of a person. At the age of 45-56 years with small hemorrhages in the cerebral cortex it is possible.