Hemorrhagic stroke of the brain

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 characterized by a direct rupture of cerebral vessels and subsequent hemorrhage in 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 tissue occurs incredibly quickly, and therefore, for emergency care physicians have a minimum amount of time, and the chance of a life can easily be lost.

Classification

The classification of hemorrhagic strokes in ICD 10 is based on the localization of hemorrhage. Depending on this, four types of disease are distinguished:

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intracerebralwhen the hematoma is located in the parenchyma of the nervous tissue;
subarachnoidal, occurring when the vessels of the arachnoid shell are damaged;
ventricular, in which the blood is found in one of the four ventricles of the brain or its aqueduct;
aboutmixed typespeak with a combination of the first three.

In various 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, there is 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, in the daytime, at the time of increased blood pressure (hypertensive crisis), with severe physical exertion or emotional overstrain.

Stroke of the brain stem is a very dangerous condition, since 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 sensation and swallowing, a sharp loss of consciousness with a rapid development of coma, impaired function of the 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

The 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

Why does hemorrhagic stroke occur, and what is it? A stroke of the brain can arise due to congenital and acquired pathologies leading to processes:

anatomical changes, destruction of arteries in arterial hypertension;
formation and rupture of intracranial aneurysms, arteriovenous malformations, dural fistulas and carotid-cavernous anastomoses;
the exit of blood from the microangiomas, amyloid plaques (with amyloid angiopathy);
thrombosis of intracranial veins;
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

In the case of hemorrhagic stroke symptoms develop acute, they consist in the following:

Rapidly growing headaches - especially very severe, accompanied by nausea with vomiting, tidal flashes and rashes in the head, pain in the eyes when looking at bright light or when rotating pupils on the sides, the appearance of red circles in front of the eyes,
Disturbances of the respiratory process, palpitation.
Violations 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 shrinks, throws back head, beats in cramps, breathes hoarsely, foam comes from the 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 probability of a stroke is high.
Raise the hands of the person and ask them to hold 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 stroke, immediate medical attention is required - an ambulance should be called in and sent to the hospital.

Diagnostics

The diagnosis of "hemorrhagic stroke" in a medical institution is carried out on the basis of the following research methods:

computed tomography (CT) scan of the brain;
magnetic resonance imaging (MRI) of the brain;
electrocardiography;
cerebral angiography;
lumbar puncture.

Based on the data of all studies, the patient is assigned treatment - a complex 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, treatment consists of a complex of measures for urgent care and the 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 proper functioning 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. To it address in those cases when there is an extensive hemorrhage (40 and more ml of blood) in the field of a cerebellum caused by an aneurysm and led 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 number of neurotoxic substances from the formed area of hemorrhage and reducing intracranial pressure.

Effects

Complications of hemorrhagic stroke can occur both in the acute period and for a long time from the time of hemorrhage.

Among the most common are:

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 ability to learn.
Change in behavior, 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).
Violation of the processes of urination and 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 requires both the patient and his close relatives, patience, endurance, perseverance and faith. To restore the motor functions, a set of measures is used, including:

exercise therapy
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.

Prognosis of recovery

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, localization hematoma in the brainstem, previous reception of anticoagulants, previous heart disease, elderly age.