Hemorrhagic stroke – an acute violation of cerebral circulation with a breakthrough of blood vessels and hemorrhage in the brain. This is the worst brain disaster.
Causes of hemorrhagic stroke:
– The most common cause is hypertension and arterial hypertension (in 85% of cases) – congenital and acquired aneurysms of the brain vessels; – atherosclerosis; – blood diseases; – inflammatory changes in the cerebral vessels; collagenosis; amyloid angiopathy; – intoxication; – avitaminosis.
As a result of these diseases, the functioning of the walls of the cerebral vessels (endothelium) is impaired, and their permeability is enhanced. And with high blood pressure, the load on the endothelium increases, which leads to the development of microaneurysms and aneurysms (saccular distension of the vessels). For their formation, the peculiarity of the course of the cerebral vessels still plays a role, their branching at an angle of 90 degrees.
According to localization, parenchymal (hemispheric, subcortical, cerebellum, stem, brain bridge), subarachnoid (basal and convexital) are distinguished. Perhaps the development of intracerebral hematomas, subdural hematomas.
The triggering mechanism of hemorrhage is hypertensive crisis, inadequate physical exertion, stress, insolation (overheating in the sun), injury.
Symptoms of hemorrhagic stroke
Hemorrhage is extremely difficult. Fatal outcome is observed in 50–90% of cases.
The severity of symptoms is due to the formation of secondary stem symptoms – swelling of the brain stem, its displacement, insertion.
The erupted blood triggers a cascade of biochemical reactions, leading, in the first 2 days, to the development of vasogenic cerebral edema (acute period). On the third day, delayed angiospasm develops, which leads to the development of necrotic angiopathy and calcium cell death.
Possible development of hemorrhage by diapedemic bleeding – due to prolonged spasm of the vessel, slowing blood flow in it, and its subsequent persistent expansion. At the same time, there is a violation of the functioning of the endothelium, increases the permeability of the vessel wall, the exudation of plasma and blood elements into the surrounding tissues. Small hemorrhages, merging, form hemorrhagic foci of various sizes.
It should be especially attentive to headaches. She may be a precursor to a brain catastrophe.
The development of acute stroke (apoplexy), sudden with a rapid increase in neurological symptoms.
Rapidly growing headache – especially severe, with nausea and vomiting, "hot flashes and throbbing" in the head, pain in the eyes when looking at the bright light and when the eyes rotate on the sides, red circles before the eyes, respiratory disorders, palpitations, hemiplegia or hemiparesis ( paralysis of like limbs – right or left), impaired consciousness of varying severity – stunning, stupor or coma. Here is the scenario of hemorrhagic stroke.
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 with a cry falls, throws back his head, beats in convulsions, breathes hoarsely, foam comes out of his mouth (possibly with blood due to tongue bite).
The gaze is turned to the side of hemorrhage, the patient looks at the injured side of the brain, the wide pupil (mydriasis) is on the side of the hemorrhage, perhaps the diverging squint, eyeballs make “floating” movements, the look is not fixed; Atony (omission) of the upper eyelid develops on the side opposite to hemorrhage, the corner of the mouth hangs down, the cheek does not hold air when breathing (the “sail” symptom).
Meningeal symptoms appear – it is impossible to tilt the head forward and reach with a chin to the chest, it is impossible to bend it at the knee while lying on its back and bending the leg at the hip joint.
The course of extensive hemorrhages in the cerebral hemisphere may be complicated by secondary stem syndrome. Respiratory disorders, cardiac activity, consciousness increase, muscle tone changes according to the type of periodic tonic spasms with a sharp increase in the tone of the extremities (hormonetium) and increased muscle tone of the extensors (extensors) and relative relaxation of the flexor muscles (decerebral rigidity), alternating syndromes may develop ( syndromes that combine damage to the cranial nerves on the side of the hemorrhage focus with movement and sensitivity disorders on the opposite side).
43-73% of hemorrhages end with a breakthrough of blood into the ventricles of the brain. When the patient breaks through the blood into the ventricles, the condition of the patient becomes dramatically heavier – coma develops, bilateral pathological signs appear, protective reflexes, hemiplegia is combined with anxiety of the non-paralyzed limbs (violent movements appear conscious (patients pull a blanket over themselves, as if they want to hide themselves with a blanket), hormetonium, symptoms of a vegetative nervous system are deepened (chills appear, cold sweat, a significant increase in temperature.) The appearance of these symptoms is prognostic favorably.
At the first symptoms of a stroke, immediate help is required – it is necessary to call an ambulance and hospitalize the patient.
Headache, especially recurring with the same type of localization should always lead to a consultation and examination by a neurologist. Identified in time aneurysm or other vascular pathology, timely surgical treatment can save from brain catastrophe and even death. Therefore, magnetic resonance imaging will have to be done, possibly with the introduction of a contrast agent and in angiography mode. The volume of examinations is assigned individually.
Consultations of an ophthalmologist, cardiologist, rheumatologist, endocrinologist, blood tests are also possible – coagulogram, lipidogram.
The diagnosis of hemorrhagic stroke is made by a neurologist clinically. For neuroimaging, computed tomography of the brain is performed, which immediately "sees" the primary hemorrhage.
Hemorrhagic stroke treatment
The patient should immediately be hospitalized in a specialized department with the presence of resuscitation and a neurosurgeon. The main method of treatment – neurosurgical – to remove the outflowing blood. The issue of operative treatment according to computed tomography and the assessment of the amount of blood and the affected area is being resolved. The severity of the patient’s general condition is also taken into account. A number of tests are being done, the patient is examined by an oculist, therapist, and an anesthesiologist.
Undifferentiated treatment of stroke includes:
– normalization of respiratory function, respiratory resuscitation; – regulation of the functions of the cardiovascular system; – blood pressure correction; – neuroprotection – semax