Hemorrhagic stroke: treatment, consequences and predictions
One of the most dangerous diseases of the brain is hemorrhagic stroke. It happens spontaneously, and in people over 35 years of age and, according to statistics, is in the top five pathologies that result in the fatal outcome of .This is explained by the fact that as a result of such a stroke there is a hemorrhage in the brain with the subsequent formation of edema.Table of contents:
Hemorrhagic stroke is a type of stroke.Unlike ischemic, which happens more often and with timely diagnosis is successfully cured, the hemorrhagic often results in the death of the patient .With such a stroke there is a disturbance of cerebral circulation, rupture of the vessels and, directly, a hemorrhage into the cavity of the skull.In the risk group - people aged 35 - 50 years who suffer from hypertension.
Please note! The severity of the condition is determined by the size of the bursted vessel, depending on which the brain can get up to 100 ml of blood.Subsequently, it damages cells, displaces tissues, provokes the development of hematoma and cerebral edema.
The success of treating hemorrhagic stroke depends on the timeliness of the provision of qualified medical care. In case of its absence, tissue necrosis begins, which ends with a lethal outcome. Severe consequences of the disease occur after 3-6 hours.After that, the chances of survival in humans are minimal .And even if he manages to survive, most likely, the rest of the days he will spend in the vegetative state.
The mechanism of development of hemorrhagic stroke, as well as the reasons for its occurrence, are well studied, however, until now this disease is difficult to diagnose.To facilitate the task of the doctor, as well as to protect yourself from serious consequences, it is worth remembering the factors that can provoke pathology.
Most people suffer from an ailment who have:
- hypertension and hypertension( they account for up to 85% of all diagnoses);
- congenital or acquired vascular aneurysm;
- arterio-venous malformations;
- vasculitis, inflammatory and dystrophic changes in the walls of blood vessels;
- blood diseases, in which the process of its coagulation is violated, for example, hemophilia;
- cirrhosis of the liver, which leads to a decrease in the level of red blood cells;
- birth defects of cerebral vessels or inflammation of their walls;
- vitamin deficiency;
- diabetes mellitus;
- brain tumors;
- cardiovascular diseases and spinal cord diseases;
- amyloid angiopathy, which is manifested by the deposition of protein on the walls of blood vessels;
Important! The risk of hemorrhagic stroke increases with the use of anticoagulants, fibrinotic drugs and other drugs that dilute blood( aspirin, heparin).
In addition, at risk people who:
- abuse alcohol;
- use drugs;
- suffer from obesity or lipid spectrum disorders;
- abuse fatty and meat foods;
- are constantly in a state of nervous overstrain or are prone to frequent stress;
- suffered solar or thermal shock;
- hard work( meaning physical labor);
- have relatives with such a pathology( in this case we are talking about heredity).
Elevated blood pressure causes a thickening of the muscular layer of the arteries and arterioles.Subsequently they are impregnated with blood proteins and become brittle.This leads to the development of microaneurysm - an expansion, which at moments of a sharp increase in blood pressure( hypertensive crisis) can be ruptured.
Another variant of the development of pathology is damage to the walls of blood vessels, which increases their permeability, and blood passes through them.In medical practice, this concept is called the "diapedesis bleeding".
Please note! Hemorrhagic stroke, characterized directly by a hemorrhage, is diagnosed most often in the elderly.Meanwhile, aneurysms( dilatations of the lumen of blood vessels) or malformations of their development, which in the future can cause a hemorrhagic stroke, are found not only in young people, but also in adolescents and children.In this case, they are strongly recommended to follow a healthy lifestyle and closely monitor their health.
Symptoms of hemorrhagic stroke
The biggest danger of the disease lies in the fact that it arises suddenly.In this case, a piercing, sharp pain in the head appears after which the person loses consciousness.
Meanwhile, the appearance of this pain is preceded by certain signs.You can watch them from several hours to several days.These are:
- causeless nausea and vomiting, which does not bring relief;
- numbness of hands and feet;
- inflow of blood to the skin of the face;
- decreased skin sensitivity;
- pulsation in the head;
- impossibility to look at light;
- intermittent pulse;
- sudden loss of control when a person does not understand where he is and can not speak;
- double vision or vision impairment.
If these symptoms occur, seek medical attention immediately or call an ambulance.Before the time of her arrival, it is enough to conduct a small test to make sure that your suspicions are correct.
To do this, ask the patient:
- smile - in the case of a hemorrhagic stroke, his smile will be twisted due to the immobility of one half of the face;
- show the tongue - the latter will also be curved in the mouth;
- raise your hands - with the pre-sultry condition, raise both hands simultaneously and keep them at the same height problematic;
- say your name or repeat any sentence - it will be difficult to do this because of slurred speech.
Along with these signs, the patient may have fever, breathing stops, convulsions may develop.
The progression of the disease and the appearance of cerebral edema are evidenced by the :
- , an apparent strabismus;
- Sluggish response of pupils to light;
- facial asymmetry;
- change in rhythm and depth of breathing;
- cardiac dysrhythmia;
- "floating" movements of eyeballs;
- a strong drop in blood pressure.
Depending on the location of the lesion, the following are identified:
- Subaranchoid hemorrhage is characterized by the accumulation of blood under the meninges.Develops due to an aneurysm or vascular pathology.
- Parenchymal hemorrhage is the most popular type, characterized by the ingress of blood into the brain substance.As a consequence, a person is diagnosed with a hematoma - a cavity with blood, which entails the death of the surrounding cells and, thereby, increases the risk of lethal outcome, or hemorrhagic impregnation.The latter is characterized by the ingress of blood into the nerve tissue and manifests itself with increased vascular permeability or the administration of anticoagulants.Due to less impact on the tissue than in the case of hematoma, the prognosis of its treatment is favorable.
- Intraventricular hemorrhage - is fixed when the vascular plexus ruptures and often ends with hydrocephalus and brain edema.Despite all the efforts of physicians, such patients die already on the 2nd - 3rd day after the development of hemorrhagic stroke.
- Sub- and epidural hemorrhages - they are traumatic.
Please note! There are also mixed hemorrhages in which changes occur that are characteristic of different types of stroke.
Depending on the localization of hematomas, subdural and intracerebral are distinguished.The first are found under the dura mater.
Intracerebral can be in different areas, which is why this type of stroke is divided into:
- lateral - localized in the subcortical nuclei;
- lobar - in the lobes of the brain, capturing white and gray matter;
- medial - in the thalamus zone;
- mixed - hematomas appear immediately in several places.
By the time elapsed since the development of the pathology, the following are distinguished:
- Acute period in which the blood pressure increases in the cranial cavity due to hemorrhage.At this point, the blood continues to accumulate, affecting the nerve tissue and provoking the appearance of cerebral edema.The maximum period that can last an acute period is up to 7 days.
- Restorative stage - characterized by the development of reparative processes, removal of blood and tissue repair.It can last up to several months, starting from 2 - 4 weeks.
- Residual events period.It stretches for life.In the case of timely provision of medical qualified care, patients not only restore speech and body functions, but also remain able to work.
Diagnosis of hemorrhagic stroke
If you have a headache, especially one that is constantly localized in one place, you should immediately go to see a neurologist. Additionally, he can recommend consultations of an endocrinologist, rheumatologist, cardiologist or ophthalmologist.
Diagnosis of hemorrhagic stroke consists in:
- collection of anamnesis;
- for computed tomography, which allows to reveal the size and location of lesion localization;
- in some cases carrying out magnetic resonance imaging;
- carrying out lumbar puncture and examination of cerebrospinal fluid for the detection of the number of red blood cells;
- angiography, including with the introduction of contrast agent;
- electroencephalography and radiography of the skull.
First aid for hemorrhagic stroke and treatment
First aid for hemorrhagic stroke consists in:
- calling the ambulance team;
- placing the patient on the bed so that his head is 30 degrees above the body;
- release it from crushing clothing;
- providing him with fresh air.
Please note! It is forbidden to give food and drink to such patients before the arrival of doctors.In extreme cases, they can moisten the lips with water.Also, it is not allowed to give them pressure-reducing drugs, because as a result of a sharp fall of the latter, the brain risks not receiving the nutrients necessary for normal functioning.With the development of seizures, care should be taken to ensure that the tongue does not sink and does not block the access of oxygen.
Treatment of hemorrhagic stroke depends on its type.As a rule, hematomas are removed surgically by carrying out trepanation of the skull.Parenchymal hemorrhages are treated medically with neuroprotectors, osmodiuretics, antibiotics, electrolyte solutions, calcium channel blockers and drugs that stop blood .Along with this, prophylaxis of pressure sores is carried out.
Subsequently, the patient is prescribed a strict bed rest, which can last up to 3 weeks, and proper nutrition, if the person is conscious.Solid food is allowed except for sour, smoked, salty, fatty, and also tea and coffee.
Important! During this period not only smoking is prohibited, but also the use of fresh vegetables and fruits, chocolate, seafood, as they all contribute to the development of repeated hemorrhages.
Consequences of hemorrhagic stroke, forecast
Up to 80% of people die due to a hemorrhagic stroke.The rest survive and even sometimes get rid of the consequences of .The nature of the latter is determined by the localization, the size of the hemorrhage, and the timeliness of the care.
With a hemorrhagic stroke, one can expect:
- coma, which ends with a vegetative state or death;
- of deep disability;
- impaired motor function;
- full or partial speech loss;
- lack of swallowing movements;
- loss of ability to perform simple actions related to orientation in space;
- disturbing the thought process, loss of memory, logical thinking;
- behavior disorders, when there is an unreasonable aggression, crying, fright;
- psychological abnormalities, problems with sleep;
- loss of ability to control acts of urination and defecation;
- appearance of epilepsy;
- the onset of pain syndrome in different parts of the body.
Do not give accurate predictions.In medical practice, many cases where patients survived after severe hemorrhages or died due to small ones. The lost legal capacity was returned thanks to the hard work and support of relatives.
For this, depending on the damage, the following can be used and carried out:
- physiotherapy and massage;
- color therapy;
- lessons with speech therapist;
- training on simulators.
Hemorrhagic stroke is a dangerous disease that affects people around the world.Due to increased mortality, it is easier to prevent than to treat.To do this, it is enough to lead a healthy lifestyle and regularly undergo examinations with a doctor.
Chumachenko Olga, doctor, medical reviewer