Hemorrhage in the brain and cerebral edema
Hemorrhage in the brain (hemorrhagic stroke) -clinical form of acute cerebrovascular accident, characterized by any (non-traumatic) ingress of blood into the cranial cavity, caused by rupture of intracerebral vessels in connection with diseases of the brain vessels. Hemorrhagic stroke is 8-15% of all strokes, and is considered the most severe form of the disease among other ONMI.
The causes of hemorrhage are manifold - can besudden sharp increases in blood pressure, an overdose of anticoagulants, arteritis and other lesions of the cerebral arteries in chronic alcoholism and drug addiction, other diseases:
Primary vascular diseases of the central nervous system:
- Arterial aneurysms of cerebral vessels.
- Vascular malformations (arterio-venous malformations, cavernomas, and arteriovenous fistulas)
- Anomalies of the cerebral vascular system (Nishimoto's disease, exfoliating aneurysms of cerebral vessels)
Secondary vascular diseases of the brain:
- Arterial hypertension
- Diseases of the blood
- Violations of the blood coagulation system
The listed causes lead to a hemorrhage onbackground of previous changes in the arterial system of the brain. In the vast majority of cases, this is the hyalinosis of small arteries and arterioles with persistent arterial hypertension.
Intracerebral hematomas are divided intolocalization and volume. In the overwhelming majority of cases (90%), hematomas are localized in the supratentorial regions of the brain. Lobar, medial, lateral, mixed intracerebral hematomas are distinguished.
- Lobary - hemorrhage in which the blood does not go beyond the cortex and white matter of the corresponding proportion of the brain.
- Hemorrhage in the subcortical nucleus (outside of the inner capsule) is usually referred to as a lateral stroke, and hemolysis into the thalamus is a medial stroke (inside the inner capsule).
- Mixed intracerebral hematomas (found more often), blood is spreading within several anatomical zones.
- Hemorrhage in the posterior cranial fossa (10%) from all intracerebral hematomas.
The development of symptoms of hemorrhagic stroke (hemorrhage) is due to the following main factors:
- Localization of hemorrhage
- Violation of the function of areas of the brain, compressed hematoma
- Increased intracranial pressure and cerebral edema
- Disruption of liquor circulation
- Displacement of brain structures, due to the pressure of the hematoma
- Breakthrough of blood into the ventricles and subarachnoid space
- Development of acute internal hydrocephalus.
Prodromal symptoms are almost absent, occasionally there are nonspecific manifestations - headache, anxiety, dizziness, tinnitus, etc.
Typical for most hemorrhages, isThe sharpest beginning with a very strong headache. After this, depression of consciousness, vomiting, rough symptoms of prolapse develops, meningeal symptoms often join. With a deep coma, meningeal symptoms may be absent. With hemispheric hemorrhages, convulsive seizures may occur.
Hemorrhages in the basal region almost always develops in patients with severearterial hypertension and mainly during the day. Often they occur with a sharp physical strain or stress. Symptoms develop suddenly and reach a maximum within a few seconds. Patients immediately fall and coma comes. Immediately there is paralysis or pronounced paresis on the side opposite to the affected area, pathological stop reflexes are detected. Characteristic deviation of the view towards the lesion, as well as breathing disorders and expressed cerebral symptoms - hyperemia, vomiting, bradycardia. Blood pressure is often increased.
As the volume of the hematoma increases,edema around the lesion, increased intracranial pressure, early symptoms of wedging. In such cases, early surgical intervention can prevent death.
With the breakout of massive deep-seated hematomas into the lateral ventricle suddenly there is an even sharper deteriorationstate. The coma deepens, tendon reflexes fade away, stop reflexes are not caused. The violation of the stem functions is manifested by a sharp violation of breathing, heart rhythm disturbances, hyperthermia, hyperglycemia.
Hemorrhage in the visual crescendo often accompanied by a breakthrough in the third ventricle. The clinical picture is similar.
Low-volume hemorrhage manifest contralateral hemianopsia,contralateral hemiparesis, hemianesthesia and "thalamic arm" - flexion in the wrist and metacarpal joints with simultaneous extension in the interphalangeal joints. Sometimes on the side of defeat there is hyperkinesis.
Massive hemorrhages, localized in the immediate vicinity ofFluid-conducting system, often complicated by acute occlusive hydrocephalus. A sharp disruption of the circulation of the cerebrospinal fluid promotes the displacement of the hemispheric structures and the development of the upper wedge.
With hematomas in the temporal and parietal lobes prevails contralateral hemiparesis (plegygia)with low muscle tone, tendon reflexes are more often oppressed, but can be increased. When the dominant hemisphere is affected, aphasic disturbances are detected.
Total mortality rate forthe hemorrhage to the brain by the end of the first month after the onset of the disease is 35-60%. The lethality with a hemorrhage in the brain stem is -100%, with hemorrhage to the deep parts of the brain - 45-50%, with lobar hematomas 17-28%.
Disability after the transferhemorrhagic stroke is close to 100%, so the earliest neurorehabilitation in a specialized clinic helps restore lost functions and return to active life.