One of the most serious vascular pathologies is hemorrhagic stroke of the brain. The prognosis for recovery from this disease is very unfavorable - about 70% of cases are fatal, and more than half of the survivors remain disabled for life. This depends not only on the area of damage, but also on the timeliness of first aid to the patient. The way rehabilitation after a stroke is also very important for recovery.
Hemorrhagic stroke of the brain - what is it?
Diseases associated with impaired cerebral circulation, in recent years are increasingly common. Moreover, not only older people are exposed to them, but also young people and even children. About a fifth of all such cases are hemorrhagic stroke of the brain. The prognosis of recovery with this pathology is unfavorable, since the risk of death and disability is very high.
A stroke is a violation of the blood supply to the brain, leading to serious health consequences. It can be ischemic when it develops gradually due to blockage of a blood vessel. A hemorrhagic stroke of the brain is slightly less common, the prognosis and consequences after which are more unfavorable. This pathology develops rapidly due to cerebral hemorrhage due to rupture of a blood vessel.
Hemorrhagic stroke occurs in about 30 people out of 100 thousand. According to statistics, in Russia every 1.5-2 minutes someone develops a stroke. This severe neurological pathology can overtake anyone, people most susceptible to it are 40-60 years old, but even a young person can have a stroke.
Varieties
There are hemorrhagic strokes at the location of the hemorrhage and the degree of brain damage. When a vessel ruptures, blood from it enters the intracranial space. There is a hematoma, edema develops. As a result, brain cells die. Usually this happens in one place, but the prognosis and consequences after a hemorrhagic stroke are always unfavorable.
Most commonly, subarachnoid hemorrhage occurs. In this case, blood enters between the membranes of the brain. Mostly young people and even children are affected by this form of pathology. When hemorrhage occurs in the brain tissue, they speak of a parenchymal stroke. In this case, hemorrhage can occur in one hemisphere of the brain - on the right or left side. A stroke in this case is characterized by unilateral paralysis or muscle paresis. In addition, hemorrhage in the brain stem or cerebellum may occur. The most serious condition develops with an extensive stroke, when there are multiple ruptures of blood vessels in different parts of the brain.
Any kind of hemorrhagic stroke can have an acute or subacute course. Most common acute stroke. In this case, neurological symptoms develop in a few minutes or even seconds. Brain edema rapidly increases, which in many cases leads to the death of the patient. The subacute course of the stroke is more favorable, as it develops gradually, so the patient can be provided with timely help. After the first hemorrhage, his condition stabilizes a little. Cerebral edema develops after a few days, then repeated hemorrhages are possible if treatment is not started.
Causes of hemorrhagic stroke
What is this, not everyone knows, although hemorrhage can occur in any person. Pathology is especially common in people with diseases of the cardiovascular system. The main cause of hemorrhagic stroke of the brain is considered high blood pressure. This can be hypertension or symptomatic arterial hypertension, developing against the background of pathologies of the kidneys or endocrine system.
High blood pressure is especially harmful to blood vessels in combination with atherosclerosis. After all, the walls of blood vessels, thinned by pathological processes, can rupture with a sudden rise in pressure. In this case, blood is poured into the surrounding brain tissue. Therefore, hypertension is the main cause of hemorrhagic stroke. Almost 80% of hemorrhages appear on the background of this pathology.
In addition, such pathologies can provoke the development of hemorrhagic stroke:
- systemic lupus erythematosus;
- systemic vascular diseases - vasculitis, arteritis;
- congenital malformation of blood vessels;
- amyloid angiopathy;
- aneurysm;
- encephalopathy;
- hemorrhagic diathesis;
- hemophilia;
- sickle cell anemia;
- diabetes;
- obesity;
- cancerous tumors;
- sepsis.
Against the background of these diseases, hemorrhage is formed under the influence of provoking factors. This can be frequent consumption of fatty foods or alcohol, a sedentary lifestyle, severe stress, a sharp physical strain, prolonged exposure to the sun.
But not only in sick people, hemorrhagic stroke can occur. Cerebral hemorrhage sometimes suddenly develops against the background of absolute health in case of traumatic brain injury, after an overdose of anticoagulants or Amphetamine, in case of alcohol abuse or smoking.
The clinical picture of pathology
A favorable prognosis of hemorrhagic stroke of the brain depends on how the patient was provided with help in time. Hemorrhage can occur in everyone, and usually it develops suddenly. Therefore, it is important to know how this dangerous pathology manifests itself. Sometimes so-called precursors appear in some patients. This may be dizziness, headache, decreased vision, numbness of half of the face, reddish fog before the eyes, a rush of blood to the face. But this does not always happen, so a lot depends on how others will respond to the condition of the patient.
First of all, a stroke is characterized by a sharp and severe headache. Patients characterize her as a blow. In this case, loss of consciousness may occur, but not always. In addition, you can notice other symptoms of hemorrhagic cerebral stroke:
- severe nausea, vomiting;
- psychomotor agitation;
- tachycardia;
- increased sweating;
- increase in pressure;
- labored breathing;
- seizures as an epileptic seizure.
These symptoms may not appear all at once, sometimes there is no pronounced symptomatology. But if you suspect a stroke, if the patient is conscious, you can ask him to perform several actions. With hemorrhage, problems arise with the pronunciation of coherent phrases, the patient cannot smile, one does not rise when raising hands, imbalance and distortion of the face are observed. It is very important when such symptoms appear, call an ambulance as soon as possible. After all, the prognosis of recovery greatly depends on whether treatment was started in the first 4 hours after hemorrhage.
In addition, with the defeat of one of the hemispheres of the brain, other so-called focal symptoms appear. Hemorrhagic stroke of the right or left side is manifested by different signs. Hemorrhage in the left hemisphere is more common. In this case, speech problems appear. The patient not only cannot pronounce words distinctly or formulate thoughts, but does not understand what they are told. He does not have a glance. In addition, there is paralysis in the right half of the body. Hemorrhage in the right hemisphere is more difficult to recognize, since it does not manifest itself with such obvious signs. Possible paralysis of the left half of the body, partial memory loss, there is a violation of orientation in space, coordination of movements and apathy.
Features of subarachnoid hemorrhage
Most often, this type of hemorrhagic stroke occurs in young people. The reasons for this are because subarachnoid hemorrhage develops mainly due to vascular aneurysm. The rupture of such an affected vessel can occur suddenly under the influence of a traumatic brain injury, a sharp increase in blood pressure, strong physical or psycho-emotional overstrain.
This type of stroke always develops abruptly and suddenly, usually in completely healthy people. Precursors very rarely appear in front of the hemorrhage itself, usually a sharp sharp headache immediately occurs, like a dagger blow to the back of the head. Severe nausea, vomiting, and cramps may occur. Often there is stiff neck and increased sensitivity of all senses. Psychomotor agitation also develops. In this type of stroke, hemorrhage does not affect brain tissue, so neurological symptoms do not develop. But at the same time, serious consequences often arise in the form of a delay in the outflow of cerebrospinal fluid and its accumulation in the meninges. This threatens with the development of hydrocephalus or leptomeningitis. In addition, vasospasm or repeated hemorrhage often develops.
First aid
The prognosis of recovery from a hemorrhagic stroke is highly dependent on the provision of care in the first hours after hemorrhage. It is very important that people who are near the victim react in time and call an ambulance. But before the doctor arrives, you need to try to alleviate the condition of the patient. It is important to lay it so that the head is above the body, remove or unfasten the tightening clothes. Adequate fresh air must also be provided. If possible, measure the patient’s blood pressure, and if it increases, give him the necessary medicine. You can not give vasodilator drugs, as well as any liquid. If the patient is unconscious, you need to lay him on his side so that vomit does not get into the respiratory tract. Sometimes it is still recommended to apply a cold to the head.
When a patient is admitted with a suspected stroke in the hospital, they immediately have a brain tomography scan. Then it is necessary to carry out all measures to eliminate the factors that threaten the patient's life. It can be a heart massage, mechanical ventilation. It is also necessary to eliminate cerebral edema and stop the blood supply to the affected areas. It is important that all these measures be taken within 4 hours after the stroke, so that the prognosis and consequences of hemorrhagic stroke are favorable. After stopping the bleeding, therapeutic measures are carried out aimed at restoring blood circulation and tissue regeneration.
Treatment features
The features of therapy after a stroke depend on the location of the hemorrhage and the amount of spilled blood. Timeliness of the start of medical care is also very important. Sometimes a patient needs an operation to stop bleeding and restore normal blood supply. But often conservative therapy is enough. The choice of its methods depends on the severity and cause of hemorrhagic stroke. The prognosis of treatment may be favorable if the patient does not have serious pathologies of the circulatory system, severe cerebral edema has not developed, and tissues are not damaged. First of all, it is necessary to stop bleeding from a ruptured vessel. Then the amount of fluid in the body decreases with the help of diuretics. In addition, it is necessary to lower blood pressure and calm the patient.
Treatment of hemorrhagic stroke (the symptoms were presented above) is carried out with the help of medications. They help restore the blood supply to the brain and its functions, and also facilitate the patient's condition. The following tools are used:
- Drugs for lowering blood pressure - "Atenolol", "Bisoprolol", "Timolol" and others.
- Antispasmodics for relieving spasm of blood vessels and pain - "Papaverine", "Halidor", "Gimekromon" or "No-Shpa".
- Calcium antagonists - "Latsipil", "Isoptin", "Nimotop".
- Preparations for the normalization of intracranial pressure - "Lasix", "Reogluman."
- Sedatives - "Elenium", "Diazepam".
Recovery prognosis
Among all neurological and vascular pathologies, the most dangerous is hemorrhagic stroke. The prognosis of recovery is favorable only for 25-30% of people who have had hemorrhage. And among them, more than half remain disabled. In addition, even with adequate treatment, the risk of repeated hemorrhage is high. Patients may lose the ability to think adequately, often mental disorders develop. Many after stroke suffer from paralysis of the limbs, impaired coordination of movements, loss of speech function. It is especially dangerous if the patient falls into a coma after a hemorrhagic stroke. The prognosis in this case is the most unfavorable - in almost 90% of such cases, a fatal outcome is recorded. It is difficult to remove the patient from a coma even in resuscitation conditions; this condition disrupts the functioning of the respiratory, digestive and urinary system.
The prognosis of hemorrhagic cerebral stroke in the elderly is unfavorable. Their vessels are already weak, often there are various circulatory disorders, delayed tissue repair processes. They often develop such severe consequences of a stroke as memory loss, limb paralysis, speech impairment, loss of ability to coordinate movements. In addition, it is in old age that hemorrhage most often ends in death.
Even a prognosis of hemorrhagic cerebral stroke in young people with the presence of serious health conditions may be unfavorable. Only about 10% of patients return to their usual lives. This usually depends on the location of the hemorrhage and the severity. But usually with a rupture of the vessel, a hematoma is quickly formed. It compresses brain tissue, leading to the formation of edema, impaired venous outflow and increased intracranial pressure. All this can lead to compression of the parts of the brain responsible for breathing or cardiac activity. In addition, necrotic processes or inflammation in the brain tissue develops.
Stroke Recovery
If it was possible to stabilize the patient after a stroke and normalize blood circulation, this does not mean that he recovered. Rehabilitation is also needed, often very long and difficult. To restore the patient’s ability to serve himself, he and his relatives may need a long and persistent rehabilitation.
In the most mild cases, it takes several months, but most often stretches over years. Her tasks are to restore the lost functions of speech, writing, walking. It is often also required to educate the patient in self-care skills. Classes should be regular, upon termination at least temporarily, the results of recovery deteriorate. If the patient was not given first aid on time after the hemorrhage, he remains an invalid, bedridden, often unable to dress on his own, there is.
If it was possible to achieve a complete restoration of the patient’s health, this does not mean that he can return to normal life. Such people have a high risk of having a second stroke. Therefore, it is very important to eat right, to avoid stress and hard physical work, to abandon bad habits. You must also constantly monitor your blood pressure.
Rehabilitation technique
The choice of recovery methods depends on the severity of the patient's condition, his age and the location of the hemorrhage. There are several areas of rehabilitation:
- Propulsion. It is aimed at restoring not only walking skills, but also the ability to perform the usual actions of servicing oneself.
- Speech. It is necessary for patients who have speech impairment, classes with a speech therapist are conducted for them.
- Psychotherapeutic rehabilitation is very important, as many patients can hardly tolerate bed rest and isolation from society.
- Cognitive direction involves the restoration of logical thinking, memory, concentration.
In addition to drugs, classes with a speech therapist and psychologist, the patient is prescribed massage, physiotherapy exercises, physiotherapy. Effectively spa treatment, the correct diet is very important. If all the recommendations of the doctor are followed, many patients have a chance to return to normal life.