Hemorrhagic stroke (hemorrhage in the brain)
Hemorrhagic stroke (apoplexic stroke) develops as a result of a violation of the integrity (rupture) of the arterial vessels of the brain against the background of a hypertensive crisis (a sharp increase in blood pressure). Blood penetrates the brain tissue, forming a hematoma (blood clot). Compression and death of brain tissue causes a characteristic clinical picture and symptoms characteristic of this disease. Hemorrhage in the brain more often affects the elderly. Full information about hemorrhagic stroke treatment and possible complications can be obtained on our website: https://dobrobut.com/.
Most often the disease is caused by:
- severe forms of hypertension and other pathologies that lead to a sudden increase in pressure;
- congenital vascular diseases (anomalies) - aneurysms;
- long-term use of high doses of thrombolytic drugs (blood thinners);
- hereditary blood coagulation disorder - hemophilia;
- blows and other injuries to the head.
Hemorrhage in the brain in newborns can be a consequence of traumatic injuries during childbirth.
Mechanism of hemorrhagic stroke development
The chain of changes in blood vessels that leads to hemorrhage looks like this:
- The pathological process (formation of cholesterol plaques and blood clots in the vessel lumen) leads to thinning of the muscular wall of the artery.
- Formation or progression of existing aneurysms (sac-like protrusions of a vessel).
- Destruction of the wall and its delamination up to complete rupture.
These three main mechanical factors lead to hemorrhage, which forms the basis of a hemorrhagic stroke. Bleeding can be diapedesis (with an effusion of blood, plasma, and formed elements through a whole but thinned vessel wall). The second option is a complete rupture of an artery with abundant arterial blood loss. As a result, hematomas and necrotic changes in brain tissue are formed.
How a hemorrhagic stroke manifests itself
Any person who knows the features of its manifestation can suspect a brain hemorrhage.
Symptoms requiring immediate help and treatment of a hemorrhagic stroke:
- preliminary signs – a sharp headache, reddening of the face, vision in "red color";
- loss of consciousness with characteristic wheezing, accelerated and intermittent breathing;
- manifestations of arrhythmia;
- immediately developed paralysis or paresis (partial loss of mobility) of various parts of the body;
- high blood pressure;
- disruption of eye movements, facial expressions;
- specific meningeal symptoms (which are determined by medical diagnosis).
Diagnostic examination
Diagnostics required for the treatment of hemorrhagic stroke consist of:
- neurological examination (detection of specific stroke manifestations);
- taking for analysis of cerebrospinal fluid (to determine the presence of blood elements);
- examination of the eyes by the method of ophthalmoscopy;
- computed tomography of the brain with angiography (to clarify the localization of the vessel rupture, blood volume);
- MRI of the head;
- laboratory blood tests (clinical and biochemical).
Treatment of hemorrhagic stroke
The prognosis of the disease depends on when the treatment measures began. The earlier the treatment of a stroke (hemorrhage in the brain) is started, the more optimistic the outcome. If help is provided in the first minutes and hours, the survival of people with cerebral apoplexy and the restoration of lost functions have much higher chances.
Treatment of extensive cerebral hemorrhage is carried out only in hospitals. The patient is immediately taken to the intensive care unit or intensive care unit.
Emergency therapeutic complex includes:
- medical normalization of pressure with hypotensive drugs administered intravenously, drip on saline solutions;
- use of means that normalize the work of the heart muscle - cardiotonics;
- ensuring respiratory tract hygiene, cleaning the oral and nasal cavity from mucus, vomitus, blood);
- in severe cases – artificial lung ventilation;
- prevention and treatment of cerebral edema with diuretic and corticosteroid drugs;
- in some cases – antibiotic therapy to prevent the development of infections;
- to exclude the development of blood clots - the introduction of heparin and other thrombolytics, to consolidate their effect, patients are given antiplatelet agents and vasoprotective drugs (which protect vessels from further rupture);
- introduction of drugs that contribute to the restoration and protection of nerve cells - nootropics.
The treatment complex is supplemented with vitamin therapy to increase the viability of brain cells. In order to reduce energy needs and eliminate stressors, patients are prescribed sleeping pills and tranquilizers.
Surgical treatment of hemorrhagic stroke
Unsuccessful conservative measures require the use of more radical methods of treatment. Surgery for brain hemorrhage is indicated if the heart is in good condition and if the hematoma is superficial. Thrombotic formations of deep structures of the brain undergo surgical treatment much less often, the effect of surgical intervention in these cases is lower.
The operation is carried out by the method of craniotomy (dissection of the scalp and trepanation of the skull). Blood clots and necrotic masses are removed.
The method of stereotaxic aspiration is sometimes used. It is more expensive and less traumatic. It is carried out through a small hole with the help of a special cannula and a screw that destroys thrombotic masses.
Rehabilitation, prognosis, prevention
A stroke with brain hemorrhage is one of the most serious pathologies. About 30% of patients die. The danger of repeated apoplexies is high. The process of rehabilitation, restoration of lost functions requires special perseverance and a long time. Prevention consists in regular examination, adherence to dietary recommendations, maintenance of normal pressure indicators. Patients are advised to take walks and moderate physical activity.
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