Hemorrhagic stroke (hemorrhoidal) is an acute disorder.
cerebral circulation with a breakthrough of blood vessels and hemorrhage in
brain. This is the worst brain disaster. It happens
spontaneously, and in people over 35 and, according to statistics, enters into
the top five pathologies that are fatal.
This is explained by the fact that as a result of such a stroke occurs
cerebral hemorrhage followed by the formation of edema.
Further in the article, we will answer the question: what is it for
disease, why it is deadly, what are possible
последствия и прогноз для human.
What is hemorrhagic stroke?
Hemorrhagic stroke is an acute hemorrhage in the
brain due to rupture or increased permeability
vessels. Such a violation of cerebral circulation is different from
classic (ischemic) stroke, which occurs more often
(70% of patients).
Hemorrhagic stroke is an extremely serious disease,
often fatal. Due to this feature
cerebral vessels – they subside poorly, and bleeding during their
damage is very difficult to stop. Normal Hemostatic
средства не проникают к сосудам мозга, оперативным же by
only hematomas are removed, and to cross-clamp their bleeding vessel
do not apply.
The triggering mechanism of hemorrhage is a hypertensive crisis,
inadequate exercise, stress, insolation (overheating
in the sun), injury.
Note! The severity of the state is determined by the size
a ruptured vessel, depending on which one can enter the brain
up to 100 ml of blood. Subsequently, it damages cells, displaces tissue,
provokes the development of hematoma and swelling of the brain.
This type of stroke is 8-15%, the remaining 85-92%
have a stroke ischemic nature. It can develop into
any age (even in children under one year old) and in persons of any gender, but more often
in total it is celebrated in men 50-70 years old.
In 75 percent of all cases of hemorrhagic stroke, the cause
The causes leading to the development of hemorrhagic stroke,
- arterial hypertension;
- cerebral aneurysm;
- arteriovenous malformation of the brain;
- amyloid angiopathy;
- hemorrhagic diathesis;
- системные заболевания соединительной fabrics;
- anticoagulant and / or fibrinolytic therapy
- primary and metastatic brain tumors (in the process of
growth, they germinate in the walls of blood vessels, causing
the most damage to them);
- carotid-cavernous fistula (a pathological connection between
cavernous sinus and internal carotid artery);
- hemorrhage in the pituitary gland;
- idiopathic subarachnoid hemorrhages (i.e. those
hemorrhage into the subarachnoid space of the brain, the cause
which can not be installed).
The factors causing the progress of the above diseases and
increasing the likelihood of hemorrhagic stroke:
- Excess weight;
- Unbalanced diet, fatty, meat food;
- Drinking alcohol;
- Age, the aging process;
- Traumatic and vertebral injuries;
- Solar and heat strokes;
- Long stay in a state of stress, nervous
- Hard physical work;
People with an increased tendency to hemorrhagic stroke –
risk group for the occurrence of this disease:
|Risk factors||Increased likelihood of stroke in%|
|Blood pressure increase||20-25|
|Elevated blood cholesterol||13-16|
|Low level of blood neutrophils (leukocytes)||12-13|
|Inadequate nutrition and diet||10-11|
|Alcohol abuse and smoking||3-5|
|Stress, physical and mental fatigue||3-5|
|Diabetes mellitus, chronic heart disease||3-4|
|Brain hemorrhage in close relatives||2-3|
По данным статистики, смертность в первый месяц от начала
diseases reach 80% even in countries with a high level of development
medicine. Survival after hemorrhagic stroke is small and
significantly lower than with brain infarction. During the first year
60-80% of patients die, and more than half of the survivors remain forever
The most dangerous is bleeding in the brainstem.
This structure is directly related to the spinal cord and
controls basic vital functions: breathing, blood circulation,
thermoregulation, palpitations. Brain stem stroke often
turns out to be fatal.
Depending on the localization zone, I distinguish the following types
- Кровоизлияние на периферии мозга или в толще его fabrics;
- Ventilatory hemorrhage – localized in the lateral
- Subarachnoid – hemorrhage into the space between the solid,
soft and arachnoid sheaths of the brain;
- Combined type: occurs with extensive hemorrhage,
affecting several areas of the brain.
Intracerebral may be in different areas, because of what
этот вид инсульта делят on:
- lateral – localized in the subcortical nuclei;
- lobar – in lobes of the brain, capturing white and gray
- medial – in the area of the thalamus;
- mixed – hematomas appear in several places at once.
There are the following stages of the disease:
- Sharper. The first 24 hours from the moment of occurrence
hemorrhage. It is critical that a qualified
medical assistance was provided during this period.
- Spicy It starts a day after a stroke and lasts 3
of the week.
- Subacute. It starts from the 22nd day of illness and continues until
- Early recovery. From three months to six months.
- Late recovery. From six months to a year.
- Stage of remote consequences. Starts one year after
suffered a stroke and lasts until the disappearance of its consequences, in
some cases for life.
Symptoms and characteristic signs
About the approaching hemorrhagic stroke can say such
- strong pain в глазных яблоках;
- loss of balance;
- tingling or numbness of the feet, hands, or parts of the body;
- difficulty understanding speech or slurred speech itself
Similar signs are observed only in half of patients with
hemorrhagic stroke; the same manifestations can talk about
developed ischemic stroke or transient ischemic
атаке (ее в народе называют «микроинсульт»).
On high probability of stroke by hemorrhagic type
- Change in skin sensitivity;
- Intermittent pulse;
- Flushed face;
- Numbness of one or more limbs;
- Constant headache;
- Attacks of causeless nausea and vomiting that does not bring
Признаки геморрагического инсульта у human, находящегося в
- Rapidly growing headache;
- Тошнота, рвота;
- Intolerance bright light, “circles” and “midges” in front
- paresis, paralysis of the arms, legs, facial muscles;
- Difficult speech.
Four distinct stages of regression of consciousness are divided:
- Stunning – uncomprehending gaze of the patient, poor response
- Doubt – like a dream with open eyes, a look
looking into space;
- Sopor – resembles a deep sleep, weak reaction of the pupils, easy
touching the cornea of the patient’s eye is accompanied
response, saved swallowing reflex;
- Coma – deep sleep, there are no reactions.
In 65–75% of cases, hemorrhagic stroke occurs during the day.
time when a person is as active as possible. It manifests itself sharp
loss of consciousness in a few seconds. During this time, the sick
they only have time to make a sudden loud cry, which is due to
severe headache, paying attention to others. Thereafter
a person loses consciousness and falls.
43-73% of hemorrhages end with a breakthrough of blood into the ventricles
the brain. With the breakthrough of blood in the ventricles, the patient’s condition is sharp
becomes heavier – the coma develops, there are bilateral
pathological signs, protective reflexes:
- hemiplegia combined with motor restlessness
paralyzed limbs (violent movements while
seem conscious (patients pull a blanket over themselves, as if
want to take cover with a blanket)
- hormetonium, symptoms of a vegetative nervous lesion deepen
systems (chills appear, cold sweat, a significant increase
temperature). The prognosis of these symptoms
A ruptured blood vessel and cerebral hemorrhage with
Focal neurological signs associated with impaired work
a certain part of the nervous system. Most often develop
hemispheric hemorrhages characterized by such
- Hemiplegia or hemiparesis – complete or partial loss
motion activity of the arms and legs, develops on the side,
противоположной очагу lesions.
- Reduced muscle tone and tendon reflexes.
- Hemihypesthesia – is a violation of sensitivity.
- Paresis of the eye – in this case, the eyeballs are directed towards
- Mydriasis – this symptom consists in dilating the pupil by
- The omission of the corner of the mouth.
- Smooth nasolabial triangle.
- Speech disorders in the defeat of the dominant hemisphere.
- The development of pathological reflexes.
About the progression of the disease and the appearance of cerebral edema
- manifested strabismus;
- sluggish reaction of pupils to light;
- face asymmetry;
- change in rhythm and depth of breathing;
- violation of cardiac activity;
- �”Floating” movement of the eyeballs;
- сильное падение артериального pressure.
The woman had a skewed face with hemorrhagic
The first 2.5-3 weeks after hemorrhage – the most severe
the period of the disease, since at this stage the severity of the condition
patient is due to progressive swelling of the brain, which manifests itself
in the development and growth of dislocation and cerebral
Moreover, the dislocation of the brain and its swelling is the main cause
deaths in the acute period of the disease when to the above
symptoms join or decompensate previously available
somatic complications (impaired renal function and liver,
pneumonia, diabetes, etc.).
Implications for human
Consequences of a hemorrhagic stroke, if a profuse
the output of blood from the vascular network: spatial movement
certain structural units of the brain and its mechanical compression
stem, the frequent consequence of which is death
If such critical events did not occur, after some
time (on average from 1 to 2 weeks) is observed gradual
reduction of swelling and smooth restoration of blood circulation in
brain tissue, but almost always complications after
hemorrhagic stroke persist for life.
The most common effects are:
- violation of motor functions – lameness, paralysis of the legs or arms.
No matter how scary it may sound, but these consequences belong to the most
acceptable because they do not entail a change in personality or
impaired brain function;
- imbalance of urination and defecation;
- a change in perception, the development of dementia;
- speech impairment, by counting, writing;
- memory impairment, loss of orientation in space and
- change in behavioral complexes – suspiciousness, aggression,
- vegetative coma.
After a hemorrhagic stroke of the brain, patients are often
fall into a coma. This means that the person remains alive, however
does not react to external stimuli. Most often, forecasts
doctors at the onset of coma – disappointing.
The probability of death in hemorrhagic stroke in
depending on the patient’s condition:
- Clear consciousness – up to 20%
- Stun – up to 30%;
- Doubt (light confusion) – up to 56%;
- Sopor (sub-com – deep oppression of consciousness) – up to 85%
- Coma – up to 90%.
Геморрагический инсульт и поражение мозга с правой и с
A hemorrhagic stroke can affect both left and
right side of the brain. Let’s look at how
the consequences are faced by people with the defeat of these departments.
|Right side||Left-hand side|
|Information processing using images||
|Fantasies and dreams||
|Susceptibility and art skills||Detailed and phased processing of information logical
|Information processing in general, without analyzing details|
If the right side of the brain is affected
Отличие такого типа заболевания от поражения left side
the brain is expressed in the effects as well as the clinical
manifestations. The most dangerous is damage to the head stem.
мозга, при котором шансы human выжить приближаются к нулю. This
The department is responsible for the functioning of the heart and respiratory system.
To diagnose a hemorrhagic stroke on the right is enough
difficult because in this part there are orientation centers in
space and sensitivity. This lesion is determined by
speech disorders in right-handers (for left-handers, the speech center is in the left
In addition, there is a clear correlation: so in case of violation
the functionality of the right half of the brain suffers the left
side and vice versa.
If the left side of the brain is affected
All the consequences of hemorrhagic stroke depend on the focus
lesions. Here are the main consequences of the left-sided form:
- стресс и подавленность human
- denied limbs, facial and respiratory muscles
- strong pain
- paralysis or cut right side with various disorders
(difficult swallowing, very low overall sensitivity and
low muscle tone)
- impossible to think logically
- limited work of the facial muscles
- difficult to navigate in space.
The main methods for the diagnosis of hemorrhagic stroke:
- spiral CT or conventional CT brain.
They allow you to determine the volume and localization of intracerebral
hematomas, degree of dislocation of the brain and concomitant edema, presence
and the area of hemorrhage.
It is desirable to conduct repeated CT studies to
trace the evolution of hematoma and the state of the brain tissue in
Treatment and recovery
First aid for hemorrhagic stroke is:
- calling an ambulance brigade;
- putting the patient on the bed so that his head
turned out to be 30 degrees higher than the body;
- freeing him from pressure clothing;
- providing him with fresh air.
The patient must be hospitalized immediately.
specialized department with the presence of resuscitation and neurosurgeons.
The main method of treatment – neurosurgical – to remove the poured
blood. The issue of surgical treatment according to computer
томографии и оценке количества излившейся крови и зоны lesions.
The severity of the patient’s general condition is also taken into account. A whole row is being made
tests, the patient is examined by an oculist, therapist,
Hemorrhagic stroke treatment may be conservative or
surgical. The choice in favor of a particular method of treatment should
be based on the results of clinical and instrumental evaluation
patient and neurosurgeon consultation.
All therapeutic measures are aimed at solving the following
- restoration of blood circulation in brain;
- elimination of cerebral edema;
- normalization of blood rheological characteristics;
- stimulation of regenerative processes in disturbed
- stimulation of neurogenesis;
- maintaining the work of organs and systems.
Specific drugs for the treatment of hemorrhagic stroke
must have a neuroprotective, antioxidant effect,
improve repair in the nervous tissue. The most commonly assigned of
- Piracetam, Actovegin, Cerebrolysin – improve the trophism of the nervous
- Vitamin E, mildronate, emoxipin – have antioxidant
With extensive hemorrhages and a number of the above indications
appointed operation to remove hematomas of the brain.
Она должна быть удалена в первые двое суток, поскольку
coagulated blood not only complicates the work and nutrition of the brain, but,
decomposing causes inflammation, swelling and death of others
tissues. The faster the hematoma is eliminated, the higher the chance
survival and recovery.
Indications for surgery for hemorrhagic stroke
- Large hemispheric hematomas;
- Breakthrough blood in the ventricles of the brain;
- Разрыв аневризмы при нарастании внутричерепного
Removal of blood from a hematoma is directed to decompression, that is,
reduction of pressure in the cranial cavity and on the surrounding brain tissue,
which significantly improves the prognosis and also contributes to
In most cases, surgery for hemorrhagic stroke.
pursues several goals and is a combined
surgical intervention. According to the method of the operation can
- Open, with trepanation of the skull;
- Puncture, in which the hematoma is removed through a puncture in the bone
- Puncture, with the installation of drainage.
Through the drainage system in the affected area are introduced
fibrinolytic drugs and the liquefied fraction of the dead is displayed
blood until complete removal of hematoma.
Восстановление после геморрагического инсульта
Recovery is carried out at any stage of treatment, after
eliminated acute signs. The patient is recommended such
- magnetic therapy;
Rehabilitation also includes the following areas:
- Exercise therapy after a stroke. By performing special exercises
a person can improve blood circulation, increase muscle
- Classes with speech therapist.
- Vitamin therapy.
- Self-service training.
During rehabilitation, the prognosis for recovery of functions depends on
the patient himself and his ability to work hard and constantly,
practicing every little thing. There are a lot of stories how heavy
neurological deficiency surrendered to the human thirst for victory.
How long the rehabilitation will last is difficult to calculate, since
regenerative abilities vary.
Prognosis of hemorrhagic stroke is especially unfavorable if
hemorrhage occurred in the brainstem. To negative
predictive circumstances include: advanced age
пациента, большой объем гематомы, пребывание human в состоянии
coma. Most hemorrhage patients doomed
experience neurological defects for life. but
minimizing their harm is much easier than solving problems
arising after brain ischemia.
The threat of recurrent hemorrhage after hemorrhage
fluctuates within 4%, and if there are changes in the structure
vessels the probability of acute conditions increases to 7%.
Relatives, and the patient himself, are interested in how much
recovery. Accurate forecasts are difficult to give, since it depends
not only on the size of an extensive hematoma, presence or absence
complications, the magnitude of the neurological deficit, but also from
effectiveness of rehabilitation activities.
An important question is how long they live after an illness. It depends
от состояния human. Advanced age, severe concomitant
pathology (heart attack, diabetes), large weight, long
preservation of gross neurological deficit – unfavorable
factors reducing this period.
Remember that hemorrhagic stroke is a very dangerous disease,
which requires immediate hospitalization of the patient. During
rendered assistance can save lives and keep healthy
man Take care of yourself and your loved ones!