Hemorrhagic stroke: implications as live after hemorrhagic stroke

Hemorrhagic stroke, cerebrovascular accident (CVA) on hemorrhagic type - acute clinical syndrome, which is a consequence of cerebral vascular damage and hemorrhage brain. The primary cause of the damage can be both arteries and veins. The larger the damaged vessel, the more abundant bleeding, in severe cases, tissue poured to 100 ml of blood. The resulting hematoma mechanically compresses and displaces the nerve tissue in the affected area is rapidly developing edema.

If, within three hours of the victim has not medical assistance will be provided, the chances of survival decrease rapidly and tend to zero. According to statistics, the share of hemorrhagic strokes account for just over 20% of strokes.

What it is?

Hemorrhagic stroke - is acute hemorrhage arising in the brain due to rupture or increased vascular permeability. Such ischemic attack differs from the classical (ischemic) stroke, which occurs more frequently (70% of patients).

Character vascular changes in ischemic stroke - thrombus occlusion of the lumen, whereby necrosis occurs gradual cells brain and in hemorrhagic - violation of the integrity of the vascular wall, resulting brain tissue is impregnated and compressed streamed blood.

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cerebral hemorrhagic stroke type - a dangerous and insidious disease. It is characterized by:

1. High mortality (60-70% of patients die within the first week after the onset of illness).
2. The suddenness (in 60-65% of patients with hemorrhage occurs without previous symptoms).
3. Profound disability surviving patients - 70-80% of people chained to the bed and can not care for themselves, others 20-30% are less pronounced neurologic deficit (disrupted extremities, walking, speech, vision, intellect and so forth.)

Over 80% of brain hemorrhage associated with increased blood pressure (hypertension). Taking antihypertensive drugs (normalizes blood pressure) can reduce the risk of stroke, the amount of bleeding and severity of brain damage. If patients are hospitalized in the hospital in the first 3 hours, this increases the chances of survival. Specialized rehabilitation centers help as much as possible to restore the lost brain function after a stroke. Full recovery occurs rarely, but possible.

Classification

It should be noted that the stroke of the brain stem leads to almost instant death. Only in rare cases it is possible to save the life of a patient with the diagnosis. In this case, the probability of returning to normal life is absent.

The brain stem is the center of all body systems, and is directly connected to the spinal cord. He serves as a link between the teams think tanks and nerves of the body: it is thanks to him we are able to move, to breathe, to swallow, to see, hear, and so on. The brain stem regulates the blood circulation, thermoregulation, heart rate. That's why its damage in stroke often leads to death.

By origin distinguish between primary and secondary hemorrhagic stroke:

Primary	It provoked a crisis of hypertensive or thinning the walls of arteries and veins caused by prolonged loads on them (e.g., due to the increased pressure, physical and nervous overloads and etc)
Secondary	It triggered by rupture of the aneurysm, hemangiomas and other vascular deformities and abnormalities (malformations), congenital or formed during life.

Depending on the location of the zone are the following types of hemorrhagic stroke:

1. Subarachnoid - bleeding into the space between the hard, soft and arachnoid brain;
2. Cerebral hemorrhage at the periphery or in its thicker tissue;
3. Ventikulyarnoe hemorrhage - localizes to the lateral ventricles;
4. Combined Type: Dating with extensive hemorrhage, affecting multiple areas of the brain.

Peripheral hemorrhage is much less dangerous than intracerebral which necessarily provoke bruising, edema and subsequent death of brain tissue. Hematoma also distinguished by the localization:

1. Lobar - hematoma is localized within the same lobe of the brain, without departing from the cerebral cortex.
2. Medial - bleeding affects the thalamus.
3. Lateral - defeat subcortical nuclei localized in the white matter of the cerebral hemispheres (fence, amygdala, caudate, lenticular nucleus).
4. Mixed - hematoma, affecting multiple areas of the brain, are the most common.

Clinical manifestations

The symptoms of hemorrhagic stroke are varied and are divided into two major groups: cerebral and focal. Also, symptoms greatly depends on the location of hemorrhage focus, its size, physical condition of the patient, and many other factors.

By the cerebral symptoms of hemorrhagic stroke include the following features:

1. Impairment of consciousness (stunning, stupor, coma). The more focus - the lower the level of consciousness. However, with the defeat of even a small brainstem hemorrhage focus leads to a marked suppression of consciousness.
2. Dizziness.
3. Nausea, vomiting.
4. Headache.
5. General weakness.
6. Respiratory disorders.
7. Hemodynamic disturbances.

By predominantly focal symptoms are signs:

1. Paresis or plegia in the limbs, more often hemiparesis.
2. Paresis of mimic muscles.
3. speech disorders, develop mainly in the defeat of the left temporal lobe.
4. Visual disturbances (including development anisocoria).
5. Hearing impairment.

Suspected stroke should be in all types of speech disorders in a patient, weakness in the arm and leg on one side, the development of seizures without precipitating factors (for example, such factors include alcohol), impairment of consciousness until Tuesday. In any suspicious cases it is better to play it safe and call an ambulance. Conduct and evaluation of the situation with suspected stroke should be considered in a separate article.

Coma in hemorrhagic stroke

Approximately 90% of patients with GI in the state of sopor or coma die in the first five days, despite intensive therapy. Disorders of consciousness characteristic of many pathologies, manifested suppression functions of the brain reticular formation.

Violations of brain functions develop under the influence:

1. Endo- and exotoxins - derivatives of end products of metabolism;
2. Oxygen and energy starvation of the brain;
3. Metabolic disorders in the brain structures;
4. Expanding the volume of brain substance.

The highest value in the development of coma have acidosis, cerebral edema, raised intracranial pressure, cerebral microcirculatory disorder fluids and blood.

Coma affects the functioning of the respiratory system, allocation of (kidney) digestion (liver, intestine). Withdrawal from a coma at home is impossible and very difficult even in the intensive care unit.

The clinical definition of coma carried GCS (Glasgow coma scale), using some other techniques of relevance to clinicians. Allocate Preko and four stages of coma. The easiest first and hopeless condition of the patient corresponds to the fourth stage of coma.

Treatment

stroke therapy in the acute phase may comprise:

• Management of pain, body temperature correction (paracetamol efferalgan, naproxen, diclofenac, often - Opiates, propafol). Intravenous give aspizol, dantrolene, drip - magnesium sulfate.
• lowering blood pressure, which contributes to stop bleeding in the brain. For this purpose, intravenously administered drugs: labetalol, nicardipine, esmolol, hydralazine. However, the sharp decrease in pressure in the first days do not allow. Further appointed tableted drugs - captopril, enalapril, Capoten (as basic therapy or orally by gavage).
• Diuretics with persistent increase pressure (chlorothiazide, andapamid, Lasix), calcium antagonists (Nimotop, nifedipine).
• In the event of a sudden hypotension appointed drip vasopressors (noradrenaline, phenylephrine, dopamine).
• Often used for continuous intravenous infusion administration of these agents to control the pressure level every 15 minutes.
• It recommended dexamethasone for 3 days to reduce the cerebral edema (i.v.). If the swelling progresses, drip administered glycerol, mannitol, albumin, Refortan.
• Often used for continuous intravenous infusion administration of these agents to control the pressure level every 15 minutes.
• Preparations for the correction of neurological symptoms (sedative - diazepam, muscle relaxants - vecuronium).
• Local therapy aimed at eliminating bedsores and skin treatment includes camphor alcohol, seeding the talc.
• Symptomatic therapy - anticonvulsants (lorazepam or thiopental anesthesia for 1-2 hours), drugs for nausea and vomiting (metoclopramide, torekan) against agitation (Haloperidol). When pneumonia and urinary tract infection is carried out antibiotic treatment.

In the presence of large hematomas (50 ml.) Is performed surgery. Excision of bleeding site can be carried out if it is localized in the accessible parts of the brain, and if the patient is not in a coma. Most often applied clipping the neck of the aneurysm, puncture-elimination hematoma aspiration, direct its removal and drainage of the ventricles.

Effects

If patients manage to save, they are faced with neurological deficits - symptoms due to damage of the areas of the brain, which was bleeding.

It can be the same posledviya hemorrhagic stroke:

• paresis and paralysis - a violation of limb movement on one side of the body, since they are constantly in the half-bent position and straighten them is impossible;
• the speech and its absence;
• mental disorder and irritability;
• persistent headache;
• ataxia;
• inability to walk or even sit;
• visual disturbances up to blindness;
• wry face;
• vegetative state - the absence of any signs of brain activity (consciousness, memory, speech, movements), while maintaining breathing and heartbeat.

Symptoms and their duration depend on the localization of the hemorrhage and its volume. The first 3 days are the most dangerous, because at this time of serious violations occur in the brain. The majority of deaths (80-90%) occur during this period. The remaining 10-20% of patients die within one to two weeks. Surviving patients are gradually recovering from a few weeks up to 9-10 months.

Left-hand side

If the left side is struck, the effects are characterized by the violation of the right side of the body. The patient, a complete or partial paralysis, and is suffering not only the leg and arm, but also half of the tongue, the larynx. These patients appear abnormal gait characteristic posture of the right hand (composed of a boat).

The victim has deteriorated memory and speech, impaired the opportunity to clearly express thoughts. For lesions of the left hemisphere of the brain characterized by problems with the recognition of the time sequence, it can not decompose complex elements into components. There are violations of the written and spoken word.

Right side

If struck right side, amym dangerous consequence of damage is the brain stem, wherein the person's chances of survival are close to zero. This department is responsible for the functioning of the heart and respiratory system.

Diagnose a hemorrhagic stroke on the right is difficult, because in this part of the orientation of the centers are in the area and sensitivity. This defeat is determined by speech disruption of right-handed (left-handed speech center in the left hemisphere). In addition, there is a clear relationship: so in violation of the right half of the brain functionality suffers the left side and vice versa.

How many live after a hemorrhagic stroke?

Prediction of hemorrhagic stroke is unfavorable. It depends on the location and extent of damage. Dangerous bleeding in the brain stem, which is accompanied by respiratory failure and abrupt, poorly correctable drugs, reduction of blood pressure to the critical numbers. Heavy flows and often ends in lethal hemorrhage into the ventricles with their breakthrough.

How many live in hemorrhagic stroke? This pathology ends lethally in 50-90% of cases. Possible death in the very first day - on a background of generalized seizures, when there is a breathing disorder. Often death comes later, to the 2nd week. This is due to a cascade of biochemical reactions that run the outpouring of blood in the skull cavity and leading to brain cell death. If there was not a brain bias, nor his herniation (falling into the bone hole) or breakthrough blood into the ventricles, and compensatory abilities of the brain large enough (this is more common in children and young adults), then the person has great a chance to survive.

For 1-2 weeks, in addition to neurological disorders, join complications associated with immobility of the patient, exacerbation of chronic him disease or its connection to a respirator (pneumonia, bedsores, hepatic, renal, cardiovascular failure). And if they do not lead to death, by the end of 2-3 weeks of cerebral edema docked. By week 3, it is clear what the consequences of hemorrhagic stroke in this case.

Recovery from stroke

The rehabilitation period after hemorrhagic stroke long, especially in the elderly. It depends on the lost functions and does not guarantee their complete rehabilitation. The fastest way to lose the ability to recover in the first year after the stroke, then the process is slower. The neurological deficit, which remained after three years, is likely to remain for a lifetime.

Neurologist and rehabilitation specialists are ready to maximally help restore lost functions. For this:

• held sessions with a psychologist or a psychotherapist;
• with the loss of reading / writing skills classes for renewal;
• held hydrotherapy (massage in the pool, light exercises in the water);
• classes on special simulators;
• for violations of human speech reproduction would have to deal with a speech therapist; with paresis or paralysis fizioprotsedury held (e.g., using the "Miauton"), massage and exercise therapy are performed with the instructor;
• prescribers, which will help to renew the neural connections lost ( "Tserakson", "Somazina") lowering elevated blood pressure ( "Enalapril" "Nifedipine"), antidepressants, sedatives and facilities;
• Color therapy - treatment with visual images.

The forecast recovery depends on how big the scope hemorrhage, as well as how qualified were the actions of doctors and rehabilitation specialists. Hemorrhagic stroke - this is a very complex pathology, the consequences of which is completely unlikely to get rid of. Supportive treatment and rehabilitation continues for a long time.