Hemorrhagic stroke - a clinical form of acute cerebrovascular accident (ONMK). 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 permeability of the vascular wall.
According to medical practitioners, hemorrhagic stroke is the most dangerous, severe type of stroke, as it is characterized by a direct rupture of the cerebral vessels and subsequent hemorrhage in the brain tissue. Naturally, the consequences of such a condition are also the most dangerous, and the prognosis for recovery may be disappointing.
This prognosis is associated with the fact that after a hemorrhagic stroke, swelling, compression and death of brain tissue occurs incredibly quickly, which means that doctors have a minimum amount of time to provide emergency care, and the chance of life can easily be lost.
The classification of hemorrhagic strokes by ICD 10 is based on the localization of hemorrhage. Depending on this, there are four types of diseases:
- intracerebral, when the hematoma is located in the parenchyma of the nervous tissue;
- subarachnoid occurring when damage to the vessels of the arachnoid;
- ventricular, in which blood is found in one of the four ventricles of the brain or its aqueduct;
- mixed type is spoken with the combination of the first three.
In various areas of the lesion, specific symptoms may develop, allowing even after examining the patient to suggest the location of the hematoma.
Hemorrhagic stroke - what is it?
This is a brain damage that develops as a result of the damage to the vascular wall and, as a result, hemorrhage occurs in the tissue or in the space between the membranes of the brain. In the latter case, hemorrhagic stroke takes the treatment is extremely operational. In particular, if there was an outpouring of large amounts of blood.
The disease often occurs suddenly, during the day, at the time of high blood pressure (hypertensive crisis), with a strong physical exertion or emotional overstrain.
Stroke of the brain stem is a very dangerous condition, as in this section are located vital nerve centers, as well as the nucleus of cranial nerves. When hemorrhaging into the trunk in addition to the development of bilateral paralysis, impaired sensitivity and swallowing, a sharp loss of consciousness with the rapid development of coma, dysfunction of the respiratory and cardiovascular systems due to damage to the respiratory and vasomotor centers is possible. In such severe cases, the probability of death reaches 80-90%.
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 comes a disorganization (disruption) of the work of neurons with their rapid death. Moreover, the brain tissue suffers both from blood impregnation and from its release through the “wrecked” vessel much more than with hemorrhagic stroke in the membranes of the brain. Therefore, even a small amount of blood can cause great damage.
In subarachnoid hemorrhage, on the other hand, in the event of a rupture of the vessel, the blood exerts less pressure on the brain cells. But it spreads very quickly, which increases the “defeat” zone. For all types of hemorrhagic stroke characterized by rapid development of cerebral edema.
Why does hemorrhagic stroke occur, and what is it? Brain stroke can occur due to congenital and acquired pathologies leading to the following processes:
- anatomical changes, destruction of arteries in arterial hypertension;
- the formation and rupture of intracranial aneurysms, arteriovenous malformations, dural fistulas and carotid-cavernous fistulas;
- the release of blood from microangiomas, amyloid plaques (with amyloid angiopathy);
- thrombosis of intracranial veins;
- septic inflammation of the arteries.
The most common cause of hemorrhagic stroke is a persistent increase in blood pressure. Hypertensive crisis leads to spasm and paralysis of the cerebral arteries and arterioles. As a result, there is an insufficient supply of blood to the brain tissue. In other words, ischemia develops, as a result of which metabolic processes are disturbed, contributing to an increase in vascular permeability for plasma and formed elements.
In the case of a hemorrhagic stroke, symptoms develop acutely, they are as follows:
- Rapidly growing headaches - especially very strong, accompanied by nausea with vomiting, flushing and throbbing in the head, pain in the eyes when looking at bright lighting or when pupils rotate around, the appearance of red circles before the eyes,
- Violations of the respiratory process, palpitations.
- Consciousness of varying degrees of severity - stupor, stunning or coma.
Perhaps a sudden onset of the disease with the development of an epileptic seizure. Against the background of full health on the beach, during strong emotions at work, during an injury, a person cries out, throws his head back, beats in convulsions, breathes hoarsely, foam comes out of his mouth (possibly with blood due to tongue bite).
As a rule, hemorrhagic stroke is one-sided, that is, it affects the right or left side. 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 asymmetrical, then the probability of a stroke is great.
- Raise the hands of a person and ask them to hold in front of you, if one hand goes down, then there is also a risk of a seizure that has happened.
- Ask the simplest question - if speech is changed, then this is also a sign of a stroke.
At the first manifestations of a stroke, immediate medical assistance will be required - you should call an ambulance and send the patient to the hospital.
The diagnosis of "hemorrhagic stroke" in a medical institution is made on the basis of the following research methods:
- computed tomography (CT) scan of the brain;
- magnetic resonance imaging (MRI) of the brain;
- cerebral angiography;
- lumbar (lumbar) puncture.
Based on the data of all studies, the patient is prescribed treatment - a complex of emergency measures that stabilize the patient’s condition and then eliminate the effects of a stroke.
Hemorrhagic stroke treatment
With a diagnosed hemorrhagic stroke, treatment consists of a set of emergency measures and a subsequent long recovery period (rehabilitation), carried out in stages. Patient therapy should be started in the first 2-4 hours after the onset of symptoms in the neurological or neurosurgical department of the hospital. If 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 normal functioning of organs and systems, especially vital ones. To this end, drugs are introduced that support the work of the heart. In case of respiratory failure, tracheal intubation is performed and the patient is connected to a ventilator. In hemorrhagic stroke, it is necessary to reduce 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 combat cerebral edema, enter diuretic drugs.
Surgical treatment is also often used. It is addressed in cases where there is extensive hemorrhage (40 ml or more of blood) in the cerebellum, caused by an aneurysm and resulting in a deformed brainstem, obstructive hydrocephalus and extensive subcortical hematoma (3 cm in diameter).
During the operation, the surgeon must completely remove blood clots from the surface of the brain, minimally damaging its tissue, thereby reducing the amount of neurotoxic substances from the resulting hemorrhage and reducing intracranial pressure.
Complications of hemorrhagic stroke may occur both in the acute period and for a long time after the onset of hemorrhage.
Among the most common are:
- Impaired motor functions, paresis and paralysis.
- Disturbance of speech, difficulty in writing, reading and counting.
- Changes in perception.
- Violations in the field of thinking, memory impairment, loss of ability to learn.
- Behavior change, manifested in the form of aggression, delayed reaction, fearfulness, etc.
- Changes in emotional and sensual spheres (depression, mood swings, anxiety, low self-esteem).
- Violation of urination and defecation.
- Pain that does not stop with analgesics.
- Epileptic disorders.
The consequences of hemorrhagic stroke usually remain for the rest of your life. Disorders of motor and sensory function, speech, swallowing require constant attention from relatives caring for the sick. In case of impossibility of movement and walking, it is necessary to ensure the prevention of pressure sores.
Recovery is a long process and requires both the patient and his close relatives, patience, endurance, perseverance and faith. To restore motor function, a set of measures is used, including:
- physical therapy
- classes on special simulators.
To restore speech, you need classes with a speech therapist and a psychologist. The rehabilitation period depends on the severity of the brain damage. As a rule, with extensive stroke, rehabilitation takes several years. Often, patients maintain motor impairment until the end of life. According to statistics, only 15-20% of patients return to normal life.
The prognosis for hemorrhagic stroke is generally unfavorable. Total mortality reaches 60-70%, after removal of intracerebral hematomas - about 50%. Approximately 90% of patients, in a state of stupor or coma, die in the first five days, despite intensive therapy.
- The main causes of death in both operated and non-operated patients are increasing swelling and dislocation of the brain (30-40%).
- The second most common cause is recurrence of hemorrhage (10-20%).
Approximately 2/3 of stroke patients remain disabled. The main factors determining the outcome of the disease, consider the volume of hematoma, concomitant breakthrough of blood into the ventricles, localization of hematoma in the brain stem, prior to taking anticoagulants, preceding heart disease, old age.