Hemorrhagic stroke - Causes, symptoms and treatment. MF.
Hemorrhagic stroke - acute disturbance of cerebral circulation with a breakthrough of blood vessels and cerebral hemorrhage. This is the most serious brain accident.
Causes of hemorrhagic stroke:
- The most common cause is hypertension and arterial hypertension( in 85% of cases)
- congenital and acquired cerebral aneurysms;
- atherosclerosis;
- blood diseases;
- inflammatory changes of cerebral vessels;collagenoses;amyloid angiopathy;
- intoxication;
- beriberi.
As a result of these diseases, the functioning of the walls of the cerebral vessels( endothelium) is violated, their permeability is enhanced. And with high arterial pressure, the load on the endothelium increases, which leads to the development of microaneurysms and aneurysms( saccular vasodilation).For their formation, the role of the stroke of the brain vessels, their branching at an angle of 90 degrees, still plays a role.
Localization distinguishes parenchymal( hemispheric, subcortical, in the cerebellum, stem, in the bridge of the brain), subarachnoid( basal and convective).Perhaps the development of intracerebral hematomas, subdural hematomas.
The trigger mechanism of hemorrhage is the hypertensive crisis, inadequate physical activity, stress, insolation( overheating in the sun), trauma.
Symptoms of hemorrhagic stroke
Hemorrhage is very bleeding. In 50 - 90% of cases, a lethal outcome is observed.
Severity of symptoms is caused by the formation of secondary stem symptoms - brainstem edema, displacement of it, wedging.
Outpoured blood triggers a cascade of biochemical reactions, leading, in the first 2 days, to the development of vasogenic brain edema( acute period).On the third day, delayed angiospasm develops, which leads to the development of necrotic angiopathy and calcium cell death.
It is possible to develop a hemorrhage by diapedesis bleeding - due to a prolonged spasm of the vessel, a slowing of the blood flow in it, and its subsequent persistent expansion. In this case, there is a disruption in the functioning of the endothelium, the permeability of the vessel wall increases, the plasma and blood elements sweat out from it into the surrounding tissues. Small hemorrhages, merging, form various hemorrhagic foci in size.
You should take special care of the headache. It can be a harbinger of a brain disaster.
The development of stroke is acute( apoplexy), sudden with a rapid increase in neurologic symptoms.
Rapidly growing headache - especially severe, with nausea and vomiting, "hot flashes and ripples" in the head, pain in the eyes when looking at bright light and when rotating with eyes to the sides, red circles before the eyes, respiratory disorders, palpitations, hemiplegia or hemiparesis(paralysis of the same limbs - right-sided or left-sided), a violation of consciousness of varying severity - stunning, sopor or coma. Here is the scenario of hemorrhagic stroke.
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).
The view is directed towards the hemorrhage, the patient looks at the affected side of the brain, on the side of the hemorrhage the wide pupil( mydriasis), possibly the divergent strabismus, eyeballs make "floating" movements, the sight is not fixed;on the opposite side of the hemorrhage, the atony( lowering) of the upper eyelid develops, the corner of the mouth hangs, the cheek does not retain air( the "sail" symptom) when breathing.
There are meningeal symptoms - it is impossible to tilt the head forward and get the chin to the chest, it is impossible in the supine position on the back and bending the leg in the hip joint to unbend it in the knee.
The course of extensive hemorrhages in the cerebral hemisphere can be complicated by a secondary stem syndrome. Disturbances of breathing, cardiac activity, consciousness increase, muscle tone changes as a type of periodic tonic spasms with a sharp increase in the tone in the extremities( grometonia) and increased muscle tone of extensors( extensors) and the relative relaxation of flexor muscles( decerebrate rigidity), development of alternating syndromessyndromes that combine the defeat of the cranial nerves on the side of the focus of hemorrhage with movement disorders and sensitivity on the opposite side).
43-73% of hemorrhages result in a breakthrough in the ventricles of the brain. With the breakthrough of blood into the ventricles, the patient's condition sharply becomes heavier-a coma develops, bilateral pathological signs appear, protective reflexes, hemiplegia is combined with motor anxiety of non-paralyzed limbs( violent movements seem conscious at the same time( the patients pull on the blanket as if they want to cover themselves with a blanket)the symptoms of the defeat of the autonomic nervous system deepen( there is a chill, a cold sweat, a significant increase in temperature). The appearance of these symptoms is prognostic
The first symptoms of a stroke require immediate help - it is necessary to call an ambulance and to hospitalize the patient
examination Headache, especially repeated with the same type of localization, should always lead to a consultation and examination to the neurologist. The aneurysm or other vascular pathology detected in time, timely operativetreatment can save from a brain catastrophe and even death. Therefore, it is necessary to do magnetic resonance imaging, possibly with the introduction of contrastof substance and angiography mode. The scope of the examinations is assigned individually.
Consultations of the oculist, cardiologist, rheumatologist, endocrinologist, blood tests - coagulogram, lipidogram are also possible.
The diagnosis of a hemorrhagic stroke is made by a neurologist clinically. For neuroimaging the computer tomography of the brain is performed, which immediately "sees" the primary hemorrhage.
Treatment of hemorrhagic stroke
The patient should immediately be hospitalized in a specialized department with the presence of resuscitation and a neurosurgeon. The main method of treatment - neurosurgical - remove bleeding blood. The question of surgical treatment according to computed tomography and estimation of the quantity of blood and the affected area is being solved. The severity of the general condition of the patient is also taken into account. A number of tests are being done, the patient is examined by an ophthalmologist, a therapist, an anesthesiologist.
Undifferentiated stroke treatment includes:
- normalization of the function of external respiration, respiratory resuscitation;
- regulation of the functions of the cardiovascular system;
- correction of blood pressure;
- Neuroprotection - Semax 1.5% - drops in the nose;ceraxone or somazine, cerebrolysin intravenously, cytochrome, cytomac.
- antioxidants - mildronate, actovegin or solcoseryl, mexidol intravenously;vitamin E.
- vasoactive drugs for improving microcirculation - trental, sermion.
Differential treatment of hemorrhages:
- neurosurgical treatment;
- strict bed rest, raised head end of the bed;
- if necessary - glucocorticoids, mannitol, lasix, calcium antagonists, antiserotonergic drugs, protease inhibitors, aminocaproic acid, hemofobin. ..
- with craniocerebral trauma - antibiotics.
The severity of these drugs excludes any initiative in appointments.
In the subacute period and the period of consequences of hemorrhagic stroke patients should be on dispensary registration, treat the main somatic disease, undergo neurorehabilitation courses.
Subarachnoid hemorrhage
Subarachnoid hemorrhage develops when an aneurysm of the vessel or other vascular malformation breaks with a hemorrhage into the subarachnoid space( a cavity between the soft and arachnoid medulla of the brain and spinal cord, filled with cerebrospinal fluid( CSF).)
Three stages are distinguished in development:
1 the outflow of blood into the subarachnoid space, the spread along the liquor ways and the development of the cerebro-hypertensive syndrome;
2 coagulation of blood in the cerebrospinal fluid with the formation of clots, a violation of liquorodynamics and the development of vasospasm;
3 the dissolution of clots and the release of fibrinolysis products into the cerebrospinal fluid, which intensifies vasospasm.
With a favorable course, microcirculation is restored and the structure of the brain is not affected.
Symptoms of the disease: sudden headache, photophobia, dizziness, vomiting, possibly the development of an epileptic attack.
Immediate hospitalization in a specialized department is necessary.
Diagnosis: examination of the oculist - on the fundus there is edema of the optic nerve discs, small-point hemorrhages, hypertensive angiopathy;CT scan;lumbar puncture;magnetic resonance tomography in angiography, computed tomography.
Intracerebral hematomas are accumulations of liquid blood or clots in the brain tissues. Most often occur with craniocerebral trauma and can develop within 12 - 36 hours.
The clinical picture is caused by the primary damage to the brain tissue in the hemorrhage zone and the symptoms of the hematoma effect on the surrounding brain structures - headache, loss of consciousness up to coma and focal neurological signs( hemiparesis, aphasia, convulsive seizures).
The urgent hospitalization in the neurosurgical department is shown.
All head injuries require an examination of a neurologist and a neurosurgeon, who, if necessary, will prescribe additional examinations.
Computer tomography, magnetic resonance tomography, angiography is used to solve the problem of surgical treatment.
Subdural hematoma
Subdural hematoma is a hemorrhage into the space between the solid and arachnoid medulla. Dangerous such a hematoma is the compression of the brain. The insidious subdural hematoma is the time of its development. Perhaps acute development: trauma - hematoma - clinical manifestations. And maybe the presence of a "light gap": trauma, loss of consciousness - a light period with almost no complaints from several hours to several days - a sharp deterioration, loss of consciousness, an increase in neurological symptoms.
Therefore it is important to always consult a doctor - a neurosurgeon if you have a head injury. Treatment - surgical - removal of the hematoma.
In all cases of hemorrhages, drug therapy is used to normalize the vital functions of the patient and to preserve uninjured brain neurons. Treatment is prescribed only by doctors, in specialized departments.
Pregnosis after hemorrhagic stroke
Maximum mortality( mortality) from hemorrhagic stroke in the first-second day of the disease due to destruction, cerebral edema or compression of vital centers located with the brain stem.
In case of a favorable course of the stroke, as the consciousness clears up, focal symptoms clearly appear - neurological defects that depend on the localization of the hemorrhagic focus - hemiplegia, hemianopsia( loss of half of the field of vision), hemianesis( loss of half-body sensitivity and the same limbs), speech disordersleft hemisphere), apraktoagnostichesky syndrome( unrecognition and inability)( with defeat of the right hemisphere), mental disorder( with damage to the frontal lobes of the brain).Hemiplegia is expressed by paralysis of the limbs and paralysis of the muscles of the face and tongue. At the same time, the tone of flexor muscles increases in the arm, and the extensor muscles in the leg, which leads to the appearance of the characteristic Wernicke-Mann posture, to the formation of flexural contractures in the joints of the hand and extensor contractions in the joints of the foot.
The recovery period is long. The maximum possible reduction in neurological deficit occurs in the first year from the moment of a brain accident. Gradually, the intensity of recovery decreases and after three years there is a residual period, that is, a period of residual phenomena.
Pose Wernike - Mana in a patient who had a hemorrhagic stroke.
Consultation of a doctor on the topic of hemorrhagic stroke
Question: Is there a prevention of hemorrhagic diseases?
Answer: Prevention of hemorrhagic stroke is, first of all, control of blood pressure and body weight, quitting smoking, alcohol abuse, excessive salt intake, and keeping a quiet lifestyle.
Question: 3 months after hemorrhagic stroke neurologist appointed a control MRT - why?
Answer: To exclude fresh foci of hemorrhage, to detect outcomes of hemorrhagic stroke, either a cyst develops( size, location. ..) or cystic and gliotic changes( "scar" changes), to exclude vascular malformation, to correct treatment.
Question: Is full recovery possible after a hemorrhagic stroke?
Answer: no, there will always be a neurological defect. Complete recovery of functions is possible with subarachnoid hemorrhage.
Question: Do sanatoriums exist to treat patients after strokes?
Answer: yes, but patients who are able to self-serve and who do not have general contraindications are admitted there.
Doctor neurologist Kobzeva S.V.