The classification of strokes is based on many factors. First of all, they are based on whether there is a blockage of blood vessels or their rupture. In this regard, ischemic and hemorrhagic strokes are distinguished, respectively . Many people suffer from such a brain pathology. The article will consider the stroke: classification, etiology and clinic.
The concept of ischemic pathology
The classification of strokes should begin to be studied with the form that is caused by blockage of the vessels of the brain. It is most often diagnosed in elderly patients who have the following concomitant pathologies:
- diabetes;
- violation of conduction and heart rate;
- rheumatic heart diseases;
- myocardial infarction;
- diseases of the main arteries ;
- hormonal contraception;
- Ischemic heart disease;
- unilateral migraine;
- violations of the rheological properties of blood.
A stroke develops when the arteries that feed brain tissue become clogged or narrowed. Its cells begin to die if they do not get the necessary nutrients and oxygen.
Another name for ischemic stroke is cerebral infarction. Tissues with this pathology are destroyed gradually, the process does not stop even after the restoration of the normal blood flow. Therefore, urgent medical care for the patient is needed.
Classification of ischemic stroke by pathogenesis
This pathology can be a consequence of the development of a particular ailment of the cardiovascular system. Classification of ischemic stroke is carried out according to a number of signs, among which pathogenesis occupies one of the leading positions.
According to this factor, the following types of it are distinguished:
- lacunar, which occurs due to occlusion of small-caliber arteries;
- atherothrombotic - the cause of which is atherosclerosis of large arteries, as a result of which arterio-arterial embolism appears;
- cardioembolic, due to myocardial infarction, valvular heart disease or arrhythmia;
- ischemic disorders associated with more rare causes: atherosclerotic vasculopathies, stratification of arterial walls, hypercoagulation of blood;
- pathology of unknown etiology, in which the cause is not established, or there may be several.
This TOAST classification of strokes is the most common.
Symptoms of Ischemic Stroke
Relatives and relatives notice them in response to irritations and the appearance of the patient:
- vomiting and headache;
- pain sensitivity, voice and motor functions are lost or reduced;
- consciousness is disturbed.
Depending on the severity of the condition and the affected area, the following signs of this pathology are distinguished:
- disorientation in space and stunning;
- eye pain, especially when moving eyeballs;
- loss of consciousness with short-term convulsions;
- headache.
For right-sided ischemic stroke, the following picture is characteristic:
- depression and lethargy;
- paralysis and deprivation of sensitivity of the facial muscles on the left side of the face;
- numbness and paralysis of the body on the left;
- impaired memory.
In this case, the left hemisphere of the brain is responsible for speech, so it can remain normal.
Left-sided stroke is characterized by the following symptoms:
- speech disorder;
- impaired coordination of movements and a sense of balance;
- violation of smell, hearing, vision, in severe cases, the disorder extends to both sides;
- sensitivity of the right side of the body with its paralysis of varying degrees suffers.
Thus, there is a classification of strokes by neurology.
This pathology can be characterized by:
- acute onset, in which there is a rapid increase in neurological symptoms, is characteristic of patients with atrial fibrillation;
- undulating when the symptoms gradually increase;
- tumor-like, in which the increase in ischemia occurs over a long period, which leads to significant damage to brain tissue.
A characteristic sign of the disease is the inability to smile and that the tongue, when protruding from the mouth, deviates from the center to the side.
Types of defeat
Classification of ischemic stroke by neurology distinguishes the following types of this pathology:
- transient ischemic attacks, in which neurological disorders are focal in nature, regressing within a day after their occurrence;
- minor stroke - restoration of neurological functions is carried out within 2-21 days;
- progressive - focal and cerebral symptoms develop over several hours or days with incomplete restoration of subsequently functions;
- completed stroke - regression may not occur completely or may not occur at all.
Recognized Species in the World
Classification of strokes is not only in our country. When recording diagnoses, there is a single system (ICD-10) in which each disease has its own unique code. The WHO classification of strokes is based on the latter. In accordance with it, the following types of diseases are distinguished:
- cerebral infarction;
- subarachnoid hemorrhage;
- cerebral hemorrhage;
- not defined.
The second and third types belong to hemorrhagic stroke.
Types of ischemic pathology by periods
Depending on the course of the pathology and the period after its passage, the following classification is used for periods of stroke:
- The sharpest - the first three days. At the same time, three hours after the onset of progression, the ailment is called a “therapeutic window”, in which thrombolytic drugs can be systematically administered. Regression may occur during the first day.
- An acute period of up to 4 weeks.
- The early recovery period is up to 6 months.
- A similar late - up to 2 years.
- The residual period is after this period.
Thus, the classification of ischemic strokes is carried out on a fairly wide range of factors.
Causes of Brain Hemorrhage
As indicated earlier, the pathology in question can occur not only due to blockage, but also because of vascular ruptures. Thus, in accordance with the classification of cerebral strokes, not only its ischemic variety, but also hemorrhagic, is distinguished.
The causes of this form of the disease are as follows:
- brain hemorrhage;
- cirrhosis of the liver, leading to a violation of blood coagulation and a decrease in platelets that trigger hemorrhages;
- the appointment of fibrinolytic drugs, antiplatelet agents, anticoagulants;
- pathologies with bleeding disorders: hemophilia, thrombocytopenia;
- dystrophic and inflammatory dynamics of the walls of blood vessels: amyloid angiopathy, vasculitis;
- arteriovenous malformations;
- vascular aneurysms;
- arterial hypertension.
Moreover, the last three reasons are the most common.
According to the classification of strokes, which provides for their division into hemorrhagic and ischemic, only 15% of the total number of pathologies are referred to the former.
Clinical Hemorrhage Clinic
It is determined by the size and location of the lesion. Signs of impaired brain function depend on what kind of structure is damaged. Most often, speech, sensory and motor areas are affected. If hemorrhage is localized in the brain stem, then the vasomotor and respiratory centers can be damaged, which can lead to a quick fatal outcome.
Signs of a brain hemorrhage
For hemorrhagic stroke, the same symptoms are characteristic as for ischemic stroke, in particular, a person cannot raise two hands at the same time, smile, stick his tongue out in a straight position, disorders in the opposite part of the body affected by the hemisphere. In addition, with this type of pathology, the eyeballs turn towards hemorrhage.
If the cerebellum is affected, then speech dynamics appear, inability to be in a standing position, impaired walking, dizziness, vomiting, occipital headache. If hemorrhages in this part of the brain are large, then swelling quickly occurs, which wedges into the occipital foramen, which leads to death.
With hemorrhage in the hemisphere, blood enters the ventricles of the brain. In this case, a person either falls into a coma, or his consciousness is violated, which is a threat to life.
Subarachnoid hemorrhage can be accompanied by severe headache and other symptoms characteristic of a stroke with the development of coma.
With hemorrhage, bilateral paralysis develops in the brain stem, the cardiovascular and respiratory systems are disrupted, there is a sharp loss of consciousness, rapid development of coma, and swallowing and sensitivity are disturbed. The probability of death reaches 90%.
Types of hemorrhagic strokes
They are distinguished depending on the structural dynamics and localization in the brain. In accordance with this, in the classification of hemorrhagic stroke, the following types of hemorrhages are distinguished:
- sub- and epidural;
- intraventricular;
- parenchymal;
- subarachnoid.
The first of them are mostly traumatic in nature and are treated by neurosurgeons.
Intraventricular hemorrhages can occur due to rupture of the vascular plexus, but more often blood enters there as a result of the presence of large hemispherical hematomas. At the same time, the cerebrospinal fluid paths are closed with blood, the outflow of cerebrospinal fluid from the skull is disrupted, due to which hydrocephalus develops, and cerebral edema increases. Survival in this case is very low. As a rule, patients die in the first two days after blood enters the ventricles.
Parenchymal hemorrhage is the most common type of hemorrhagic stroke. In this case, the blood enters the substance of the brain itself. Parenchymal hemorrhages, in turn, are divided into two varieties:
- hematoma;
- hemorrhagic impregnation.
The first is a cavity filled with blood. In this case, the cells in the affected area die, which causes a neurological deficit and poses a threat to the lives of patients. The chances of a favorable outcome are negligible.
In the second case, blood penetrates between the elements of the nervous tissue, while large-scale death of neurons, as in the first case, does not occur, therefore, the prognosis is more favorable. This type of stroke can be caused by treatment with anticoagulants, thrombocytopenia, arterial hypertension.
With subarachnoid hemorrhage, blood accumulates under the pia mater, which consists of blood vessels and covers the brain from the outside. This type is caused by vascular malformations and aneurysms. When a vessel ruptures, blood spreads over the surface of the brain. Sometimes involvement of the brain tissue in the pathological process is noted, in this case they speak of subarachnoid-parenchymal hemorrhage.
Complications
With ischemic stroke, the following consequences are possible:
- epilepsy (it develops in every fifth case);
- depression, irritability, changeable moods;
- the appearance of various pain syndromes;
- paralysis, weakness;
- motor impairment;
- urination disorders and bowel movements;
- cerebral edema;
- cognitive impairment;
- pulmonary thromboembolism;
- deep vein thrombosis of the leg;
- urinary tract infections, bedsores, pneumonia and other pathologies.
With left-sided ischemia, a person ceases to orient in time and space, positions himself as a healthy individual, does not recognize relatives and friends.
In the first week, death can occur due to secondary ischemia of the brain stem, in which foci of heart attack form. In addition, an ischemic ailment can turn into hemorrhagic with the formation of secondary hemorrhage. Cerebral edema may also occur.
With the hemorrhagic variety, myocardial infarction, arrhythmia, decompensation of cardiac activity, the development of blood clots with the possibility of developing pulmonary thromboembolism, the appearance of pressure sores, sepsis, congestive pneumonia, and urinary tract infections can occur.
The most dangerous complications in this case are:
- violation of the function of external respiration and systemic hemodynamics;
- the development of hydrocephalus;
- cerebral edema;
- blood entering the ventricles.
Moreover, these complications can appear both in the acute period of the development of the disease and later.
Finally
There is a multiple classification of strokes for various reasons. By type, it is divided into ischemic and hemorrhagic. In relation to the first, the classification is more extensive. Varieties are distinguished by pathogenesis, by ICD-10, which is supported by WHO, by neurology, by period. Different types are characterized by similar symptoms, especially in terms of paralysis of the opposite side of the body that is affected by the hemisphere, impossibility of protruding the tongue, raising the arms. The fatal outcome in ischemic stroke is 15-20%, while in hemorrhagic stroke it reaches 80-90%.