Hemorrhagic stroke: symptoms, treatment, first aid
Hemorrhagic stroke - the most severe brain damage. Mortality after stroke is from 50 to 90 % of victims according to the injured area. So, stroke of the brain stem leads to almost instant death, hemorrhage in the periphery provides a better chance of surviving.
The disease develops rapidly and its consequences are unusually severe.
What is stroke
Under this name are United all cases of stroke. The disease is accompanied by the formation of certain neurological signs that persist or develop over 24 hours. The highest mortality is observed in the first days of the disease.
The so-called small stroke is that the neurologic deficit regressed 3 weeks, instead of days. The mortality rate in this period is 35%.
There are three types of stroke, depending on the nature of the violation circulation
- Ischemic - the most common and not so strictly leading to death of 70-80% of cases. Ischemic stroke of the brain is, in fact, a heart attack, tissue death due to blockage or narrowing of a feeding artery and cell death of brain tissue.
- Subarachnoid hemorrhage - rupture of the vessel arising from the cranial trauma, aneurysm rupture, vascular diseases, tumors and so on.
- Hemorrhagic stroke of the brain accompanied by bleeding. The rupture of the vessel occurs via two main mechanisms.
When hypertensive crisis is the failure of self-regulation arteries: they lose the ability to shrink and only passively dilate under pressure. Blood with not only arteries but also veins, and capillaries, as pressure compensation. But if cerebral blood flow continues to increase, blood vascular can't take it.
The second mechanism is associated with the opposite phenomenon - spasm or paralysis of the arterial vascular of the brain. Ischemic lesion is formed, violated the metabolic processes in the landscape and containers.
In the end wall of the arterioles are permeable to plasma and erythrocytes. Blood seeps through the walls and seeps into the surrounding brain tissue.
Depending on the nature and distribution of spasm, the formation of one large or multiple foci of hemorrhagic lesions.
The picture is complicated by the occurrence of intracerebral hematoma: blood from the vessel forms a cavity, fills it. Subsequently, this cavity forms a scar ortransformirovalsya in the cyst. The consequence is severe in both cases. How I live after this disease, much depends on how quickly the patient receives emergency assistance.
Ischemic stroke is usually diagnosed in patients older than 60 years on the background of rheumatic heart defects, heart attack, disturbances of hemodynamics. Hemorrhagic stroke was observed in the age group from 45 to 65 years. The usual "accompaniment" is hypertension and atherosclerosis.
According to the statics of ischemic stroke is the second most common cause of death and the first of disability. Disabled after the disease is 70-80%, of which 20-30% require constant care.
Types of stroke
Like ischemic, hemorrhagic stroke is classified to several signs pointing to the affected area.
- Damage to the periphery or deep in the brain tissue. Refers to the most "safe" damage. Rarely provokes swelling. Consequences is far from easy, but it is peripheral to the hemorrhage often becomes a stroke, moved up, and there are also such cases.
- Venticular - extravasation of blood in the lateral ventricles.
- Subarachnoid - spilled blood between the membranes of the brain. After damage of the trunk of this form has the most serious consequences.
- Combo - occurs with extensive lesion.
There are primary and secondary stroke
- Primary - a consequence of hypertension or damage to the vessel walls caused by constant excessive pressure. It provokes a strong emotional or physical stress at elevated pressure.
- Secondary - here, the true cause is the rupture of the aneurysm, anomaly or acquired deformity of the vessel, leading to its damage or violation of the permeability of the walls.
The severity of the disease from secondary or primary hemorrhage does not. The consequences are equally terrible, but the prognosis is not good.
The hemorrhage occurs suddenly, is characterized by General cerebral and local neurological signs. Often a pre-stroke condition is so unexpressed that the patient does not pay attention to deterioration.
The symptoms of the threat are as follows:
- nausea and vomiting for no apparent reason, vomiting does not bring relief;
- severe dizziness, headache;
- irregular intermittent pulse, weakness;
- the skin loses its sensitivity, there is numbness of hands and feet.
Hemorrhagic stroke usually manifests itself as a sharp headache and transient lossconsciousness. Then you may experience drowsiness or agitation, a state of stupefaction, nausea. Often the patient falls into a coma, which is one of the worst consequences.
The forecast for recovery from the coma is extremely poor. In 16% of cases the symptoms are similar to epileptic seizure, which is one good reason for the early call an ambulance.
If the patient remains conscious and does not feel anything special, except for dizziness, fatigue and some disorientation in space, there is a high probability that the assistance will not be provided on time.
The main risk factors of stroke.
Fortunately, hemorrhagic stroke has several symptoms associated with the lesions.
- A stroke patient is unable to smile. If damaged the right hemisphere, the left side of the face remains stationary. If you suffered a left part, you will barely feel the right side of his face.
- The victim could not stick out his tongue - he is in an unnatural position, sink on one side.
- When you try to repeat even a simple sentence often breaks diction. This is an optional feature as the hemorrhage does not always affect speech centers.
- When you try to raise both arms, as a rule, the patient can not hold them at the same height. Alternatively, you need to ask the patient to put their hands palms down and cover his eyes. If one arm begins to move to the side and down, then was bleeding.
When observing at least one of the following symptoms in conjunction with headache or transient loss of consciousness should immediately call an ambulance. From how quickly the measures will be taken in the literal sense of the word depends for its life and health.
Critical in hemorrhagic stroke are the first 3 hours, at least 6. If during this time the patient will be helped, the threat to life is greatly reduced - up to 20%. Moreover, with timely aid, the threat of disability is also significantly reduced, the consequences mitigated, perhaps even full recovery of brain functions.
Of course, the prognosis of recovery in this case depends on many factors: how much time passed, what area of the brain affected, what other diseases are in the anamnesis, but still, it is the actions in the first 3 hours can save lives.
It is useless to conduct their own victim in the hospital, as not every clinic can provide the help you need. Treatment of hemorrhagic stroke is carried out in specialized institutions. Therefore, the correct action is emergency call descriptionsymptoms and indication of how much time has passed since the loss of consciousness.
- The victim should be laid so that the head and neck were on one line and placed at an angle of 30 degrees. Use pillows, folded clothes, and so on.
- If the victim began vomiting, turn head to one side.
- Need to unbutton the clothes, loosen the tie, not to give the patient to make sudden movements.
- If loss of consciousness is not observed rhythmic breathing, you must begin CPR. The state of the pulse to pay attention not worth it.
- It is impossible to give the patient a drink, since it is possible that as a result of a stroke paralyzed the organs of swallowing.
Even the most urgent assistance is impossible without a diagnosis. In this case, it is important to localize the lesion. The main treatment of hemorrhagic stroke begins with research.
In the first few hours the most informative method is computed tomography. This way you can get a full picture of a blood clot. After the beginning of sucking - for about a day, the precision of the imaging decreases.
At the stage of formation of the cyst, using magnetic--resonance imaging.
After installation, diagnosis, treatment. The goal is to do the following:
- the normalization of the pressure - reducing the load on the blood vascular contributes to more rapid recovery. Used blockers, ACE inhibitors;
- the prevention or reduction of edema - diuretics;
- regulation of blood viscosity. The use of anticoagulants is contraindicated. The coagulopathy corrected by introduction of the platelet concentrate, fresh frozen plasma;
- pain relief - analgesics;
The first task in stroke is the conclusion of blood, getting rid of the hematoma. If it does not exceed 3 cm in diameter is surgery.
Rehabilitation of patients
The effects of a stroke include a severe damages. Timely taken measures exclude some of them, and with a part can be overcome with proper rehabilitation measures. How long they should last depends on the severity of the disease and the nature of the damage.
And even in this case, the prognosis is rarely comforting: hemorrhagic stroke becomes the cause of 70-80 cases of disability of 100.
The most frequently observed such effects:
- mobility impairments - lameness, paralysis of the legs or arms. As frightening as this may sound, but these effectsamong the most acceptable as it does not involve personality changes or disorders of cerebral functions;
- the imbalance of urination and defecation;
- the change of perception, the development of dementia;
- a disturbance in speech, with the score, writing;
- memory impairment, loss of orientation in space and time;
- change behavioral complexes, suspiciousness, aggression, delayed reaction;
- vegetative coma.
This condition is the least treatable. Although medical statistics and recorded cases of sudden release of patients from this kind of coma and the restoration of most functions. However, it's really rare.
Rehabilitation of patients after stroke in any case should not be seen as desirable, but not mandatory. No matter how much time was occupied by the restoration, without the relevant procedures and treatment is impossible, even partial restoration of function.
- Physiotherapy is a complex of various measures aimed at restoring motor skills and sensitivity. Various forms of paralysis - frequent consequences of stroke.
- Correction of swallowing after stroke is often observed this disorder. Patients are fed small portions and control the process of chewing and swallowing.
- The correction of speech - lessons for the restoration of speech, reading skills and numeracy.
- Occupational therapy - a set of measures for the rehabilitation of the hand.
- Psychological help - the specialist not only provides emotional support and helps restore the structure of personality, helps the patient to adapt after the hardest shocks.
Primary or early rehabilitation takes at least 3-4 weeks. And even if the future prognosis is favorable, a repeated course should be carried out within six months.
Hemorrhagic stroke is among the most severe lesions of the brain, the brain is a real disaster, requiring immediate action to save human life. Despite the severe consequences of its practitioners are confident that with timely surgery, the support of family and effort on the part of the patient, possible recovery of all functions within 1-2 years.