Stroke hemorrhagic left side does not move. Hemorrhagic stroke on the right side of the consequences of how long they live. There are three types of stroke depending on the nature of circulatory disorders

26.04.2019

Right side: consequences" data-essbishovercontainer="">

Stroke is one of the most serious neurological diseases that poses a direct threat to the health and life of the patient. A common cause is hemorrhage, followed by tissue compression by spilled blood, cerebral edema, and increased intracranial pressure. In total, there are several clinical forms of stroke, each of which has its own characteristics, and below we will talk about right-sided hemorrhagic stroke.

What is a hemorrhagic stroke?

Hemorrhagic stroke is an acute violation cerebral circulation, in which blood from bursting vessels enters the cranial cavity. It is considered one of the most dangerous forms of the disease, as it often leads to cerebral edema and death of the patient. According to statistics, hemorrhagic stroke accounts for about 10-15% of stroke cases, and half of the patients die in the first day. The prognosis depends on age and general condition the health of the patient, as well as which hemisphere of the brain was damaged.

Damage to the left and right hemisphere: what's the difference?

The brain is without a doubt the hardest part human body, with each half controlling the sides of the body in a mirror image, and is also responsible for individual functions.

In other words, a hemorrhage in one or another hemisphere of the brain gives different symptoms and leads to different consequences. It is believed that a hemorrhagic stroke on the right side leaves a person more likely to recover, but its signs are usually not so pronounced, so patients seek medical help quite late.

Symptoms of a right-sided stroke

Right-sided hemorrhagic stroke can be manifested by the following symptoms:

paralysis and decreased sensitivity of the left side of the face, limbs;
violations of the perception of one's own body: it may seem to a person that the arms and legs are alien or, conversely, that there are too many of them;
memory loss;
disturbances in the perception of the surrounding space: often it is difficult for patients to orient themselves in the room, assess the distance or put on clothes and shoes correctly;
depression, psychological passivity, inadequacy of behavioral responses;
in some cases, hearing impairment.

It is important to note that speech disorders, which are the most striking sign of the disease, are not observed in right-sided hemorrhagic stroke (the exception is left-handed people, in whom left hemisphere brain).

First aid to the patient

The first thing to do to help a person with signs of a stroke is to call an ambulance team, and you should explain in detail to the dispatcher what happened to the victim. Pending medical care you can take the following steps:

raise the patient's head by 30%, placing a blanket or clothes under the back of the head;
provide fresh air and remove or loosen tight clothing;
when vomiting occurs, you need to lay the person on his side, and after the end of the attack, help him clear his mouth of vomit;
measure blood pressure and record indicators.

Diagnosis of hemorrhagic stroke on the right side

The main diagnostic methods for determining hemorrhagic stroke on the right side are magnetic resonance imaging, spiral or conventional computed tomography of the brain. They allow you to determine the location and volume of the internal hematoma, the presence and extent of hemorrhage, the area of edema. These indicators are the most informative in dynamics, so CT studies will need to be repeated after a while.

In addition, it is very important to conduct a differential diagnosis of hemorrhagic stroke with ischemic stroke, as well as with other diseases accompanied by intracerebral hematomas. This requires a number of studies that can be carried out exclusively in a hospital setting. Among the signs characteristic of hemorrhagic stroke, meningeal symptoms and a slow increase in cerebral disorders can be distinguished. In addition, in ischemic stroke, the CSF taken for analysis usually has a normal composition, and in the hemorrhagic form of the disease, blood impurities are observed in it.

The tactics of treating hemorrhagic stroke depends on the degree of brain damage, as well as the characteristics of the body and the general condition of the patient. To combat the manifestations of the disease and normalize the functions of the body's vital functions, drug therapy, surgery, physiotherapy, folk remedies.

Medical treatment

The primary task of conservative treatment is to eliminate cerebral edema, stop bleeding, as well as the speedy rehabilitation of the patient. To stop bleeding, it is necessary to normalize the pressure, for which Gemiton and Dibazol are used.

With absence positive effect the patient can be prescribed "Novocain" and "Aminazin".

To increase blood clotting and reduce permeability vascular walls a solution of vikasol, calcium preparations, rutin, as well as a solution of ascorbic acid are used. In order to eliminate cerebral edema and reduce intracranial pressure in hemorrhagic stroke, Lasix and Mannitol are prescribed.

In addition, cardiotonic drugs can be used to normalize vital functions, Amidopyrine or Analgin solution to eliminate hyperthermia, and in case of pulmonary edema, oxygen inhalation with alcohol vapor.

Surgery

Surgery for hemorrhagic stroke is performed according to the following indications:

the presence of extensive hematomas in the right hemisphere;
the presence of blood in the cerebral ventricles;
rupture of the aneurysm, accompanied by high intracranial pressure.

The operation should be carried out by a qualified neurosurgeon within the first three days from the onset of the disease. During it, the doctor removes accumulated blood from hematomas, due to which the pressure in the tissues of the brain and cranium is significantly reduced. Usually, the prognosis for the patient's life after the intervention improves, but in some cases, recurrent bleeding and other complications are possible.

Physiotherapy

Physiotherapeutic measures are related to rehabilitation methods, and, as practice shows, they have positive impact on the body of stroke survivors. These include:

darsonvalization (impact on tissues with pulsed high-frequency currents);
balneotherapy (mud therapy) and hydrotherapy;
faradization (use of low-frequency alternating current);
acupuncture;
phototherapy.

Folk remedies

Traditional medicine recipes for the treatment of hemorrhagic stroke can only be used as adjuvant therapy after consulting a specialist. The most popular and effective are the following tools.

Peony infusion. One tsp steam dried and crushed plant roots with boiling water, leave for an hour and filter well. Drink four times a day, one tablespoon.
Oil tincture of bay leaf. Take 30 g of bay leaf, pour a glass of vegetable oil, insist for two months. Then strain the tincture, boil and rub into the paralyzed areas.
Remedy from bay leaves and spruce needles. To prepare the product, you will need spruce needles (1 hour), butter (12 hours), bay leaves (6 hours). Mix everything well and rub into the paralyzed areas.
Alcohol tincture pine cones . Rinse a liter jar of opened pine cones (you need to take only whole cones that are not affected by rot or insects), pour vodka to the top and insist in the dark with room temperature over the course of two to three weeks. After this period, strain the remedy (you should get a rich dark red tincture) and consume 1 tsp. two or three times a day.
White step tincture. White stepping stone (also called paralytic grass) is considered one of the most effective medicinal plants for the treatment of hemorrhagic stroke. To prepare the tincture, you need to take a tablespoon of well-chopped roots, pour 300 ml of vodka, leave for a week in a dark place. Strain and take morning and evening, 25 drops dissolved in water.

Despite the fact that hemorrhagic stroke is considered a very serious and dangerous neurological disease, with timely access to a doctor and competent treatment tactics, the patient has every chance of survival and rehabilitation. To prevent its development, it is necessary to get rid of bad habits, lead healthy lifestyle life, as well as regularly monitor arterial pressure.

med-explorer.com

Causes of a stroke

A stroke occurs when blood flow to a part of the brain is interrupted. The functioning of the bled area stops 10 seconds after the blood flow is disturbed, after 5 minutes the cells in the lesion begin to die and the consequences become irreversible. Therefore, if a stroke is suspected, the count goes to minutes and seconds.

Statistics show that stroke is more common in men. This is partly due to the greater prevalence of bad habits and increased injuries among men.

The prevalence of strokes among the elderly is associated with the accumulation of pathophysiological and age-related changes in the body, atherosclerotic vascular changes and arterial hypertension. In young adults, adolescents, and children, stroke can occur when there are congenital vascular defects.

Depending on the causes of occurrence, a stroke is hemorrhagic, ischemic or mixed. Hemorrhagic stroke develops when one or more vessels rupture and local hemorrhage in the tissue. Oxygen starvation of tissues is aggravated by their mechanical compression. Damage to the vascular walls occurs against the background of an abrupt increase in blood pressure. Due to the cessation of blood flow, nerve cells do not receive required amount oxygen and glucose and begin to rapidly die off. Another reason for necrotic changes is swelling in the lesion caused by the resulting blood clots. Hemorrhagic right-sided stroke is a more dangerous condition, since lesions in case of hemorrhage affect a large area.

According to statistical data, the distribution of causes of right-sided stroke looks like this:

Atherosclerotic lesions of the arteries of the brain (about 40% of cases);
Hypertensive crises (30%);
Thrombotic complications of cardiac diseases (25%);
Diseases associated with disorders of blood clotting and capillary circulation.

Sometimes circulatory disorders in the right hemisphere are caused by lesions of the main veins of the right side: vertebral or carotid.

According to the mechanism of development, strokes are divided into:

Lacunar, arising from lesions of small arteries;
Hemodynamic, developing against the background of blood pressure disorders;
Thromboembolic associated with blockage of the vessel by a blood clot and / or foreign body carried with the blood stream.
Hemorheological, in which blood clots form directly in the vessels of the brain.

Most often, pathological changes have signs of more than one type.

Features of the stroke of the right hemisphere

The right hemisphere is responsible for orientation in space, perception of the surrounding world, analysis of information coming from the senses. In lefties, the right hemisphere controls speech functions.

Symptoms of an acute period of a stroke:

Complete or partial paralysis (paresis) of the left side of the body;
Changes in facial expressions (omission of the corner of the lips, characteristic movement of the lips, the so-called "sailing", smoothing of the nasolabial fold);
Attention disorders;
Short-term memory disorders;
Disorders of orientation in space;
Left-handed speech disorders.

During the recovery period after a stroke, psycho-emotional disorders manifest themselves: causeless sudden mood swings, loss of a sense of tact and measure, etc.

With extensive lesions, the symptoms increase rapidly. Patients experience:

dizziness;
Severe headaches;
Movement disorders;
Nausea, vomiting;
Loss of consciousness.

In some cases, swallowing and speech may be difficult.

Against the background of diabetes mellitus or arterial hypertension, a lacunar stroke may develop. Lacunar strokes long time are asymptomatic. Cerebral symptoms are mild. In about half of patients with lacunar stroke, the left half of the face loses sensation, and there is weakness in the left arm and leg. Slightly more than a third of patients experience a loss of tactile and pain sensitivity. In 10% of cases, lacunar stroke leads to loss of the ability to move independently and is accompanied by severe dizziness.

Stroke Symptoms

A stroke often develops suddenly. Among the first acute symptoms of a stroke:

sudden severe headache;
An abrupt increase in blood pressure;
Feeling of numbness all over the body;
Sudden deterioration of vision;
Partial or complete loss of sensation on the left side of the body;
Slow breathing;
Speech disorder;
Nausea, possible vomiting;
Loss of consciousness;
Convulsions.

To confirm the assumption about possible stroke You need to do a few simple tests:

Ask to smile or stick out your tongue. With a stroke, the smile will be asymmetrical, the tongue is skewed.
Talk to the victim, ask any question. If a person has a stroke, he or she will not be able to answer, or the speech will be slurred.
Ask to raise your arms, if possible - and legs. If problems with lifting one of the limbs are noticeable, this indicates a high likelihood of a stroke.
Ask for the date, name, place where you are. With a stroke on the right side, the ability to navigate is lost.

If one or more signs are found, you must immediately call an ambulance, informing the operator of a suspected stroke. The sooner the doctors arrive, the more chances to save the patient's life.

First aid

Before the arrival of doctors, it is necessary to provide the victim with an influx of fresh air, lay him down, raising his head by about 30 degrees. If the urge to vomit begins, it is necessary to turn the victim on his side. If possible, measure the pressure.

A stroke requires emergency hospitalization. If within 10 minutes from the onset of the attack the patient is not provided with appropriate assistance, the risk of death or complete paralysis increases significantly.

The more time has passed since the onset of symptoms of a stroke, the higher the likelihood of the patient falling into a coma. How long this state will last is impossible to predict. In 85% of cases, patients die without regaining consciousness. If the patient managed to be brought out of a coma within 48 hours, he still has a chance to survive.

Diagnostics

To determine the location, type and size of the lesion, brain tomography, ultrasound of the heart, ECG, X-ray are performed. chest. Additionally - general urine and blood tests, measurement of blood pressure. Based on the data obtained, a treatment strategy is developed.

Treatment

Treatment of right-sided stroke includes basic and specific courses.

Under the basic treatment means:

Support for the functioning of vital organs and systems;
Stabilization of blood pressure at a safe level. It is carried out gradually, since sharp fluctuations in blood pressure will only aggravate the patient's condition;
Prevention and elimination of cerebral edema;
Temperature normalization;
Elimination of convulsions, disorders heart rate and other symptoms
Prevention of thrombotic and other possible complications.

Specific therapy includes the following activities:

Thrombolysis. If no more than 6 hours have passed since the first manifestations of a stroke, the patient is injected into a vein with a drug that dissolves blood clots. The earlier the procedure is performed, the more effectively it is possible to reduce the affected area, which increases the patient's chances of survival and recovery after a stroke.
Improvement of blood flow, necessary for the prevention of recurrent thrombosis. For this purpose, antiplatelet agents and anticoagulants are administered.
Neuroprotection. Protection of viable nerve cells.

Consequences of a stroke

Even under ideal circumstances, a stroke does not go unnoticed. After an ischemic stroke are possible:

Partial or complete paralysis of the left side of the body;
Amnesia varying degrees gravity;
Violations of the perception of space;
Distortion of the oval of the face due to paralysis of facial muscles;
Depression;
Left-handers have speech disorders.

After a hemorrhagic stroke, loss of vision occurs, persistent disorders of the vestibular apparatus, swallowing disorders, epilepsy, sleep disorders, and mental disorders develop.

Damage to the right hemisphere leads to loss of the ability to figurative thinking, a holistic perception of the surrounding world, a person cannot perceive other people's emotions, music, artistic figures of speech.

Forecast

In addition to the consequences for the relatives of the patient, it is important to know how long they live after a stroke on the right side. Unfortunately, the prognosis in most cases is unfavorable, since fatal relapses of the disease are not excluded. According to statistics, after an ischemic stroke, about 5% of patients die within a month, the same number of deaths is recorded within 2 weeks after a hemorrhagic form of pathology. The development of a coma leaves almost no chance of survival.

Another 10% of patients die within the first year after a stroke, by 5 years the mortality rate exceeds 50%. Statistics show that about 20% of survivors cross the seven-year milestone and only 10% of stroke survivors live 10 years or more.

80% of patients of any age lose their ability to work and about 20% need constant care.

Rehabilitation

In the acute period of a stroke, the patient is in the intensive care unit, after which he is transferred to the general ward. The patient is prescribed treatment aimed at normalizing blood circulation, preventing thrombosis, normalizing functions of cardio-vascular system and brain. Approximately three weeks after the acute period of the disease, the patient's rehabilitation begins, which continues after discharge and can last from several months to several years. The degree and quality of recovery of the patient's physical and mental activity after a stroke depends on this stage.

The rehabilitation program is compiled individually and usually includes the following activities:

Speech recovery. Full restoration of speech function is very difficult, in most cases speech returns only partially. Carried out with the help of a speech pathologist.
Psychological rehabilitation. The patient is referred for a consultation with a psychotherapist or psychiatrist, in addition to the help of specialists, he needs the support of relatives and friends.
exercise therapy. To restore motor activity, the patient is assigned a set of exercises of therapeutic gymnastics. The complex is developed by the instructor, based on the physical condition of the patient. While the patient is in a hospital or other medical institution, the instructor conducts classes, later gymnastics must be done independently, under the supervision of relatives or friends.
Massage. It is carried out to restore fine motor skills and body sensitivity. Sessions therapeutic massage is conducted by a specialist, but it is quite possible to master the basics of massage and the person who will care for the patient after returning home.
Diet. Spicy, fried, fatty foods, canned food should be excluded from the diet. Specific Recommendations according to the characteristics of nutrition is given by the attending physician.

cardiogid.ru

Characteristic

It's called a stroke most dangerous disease caused by impaired cerebral blood supply, which in turn leads to vascular damage and destabilization of the state of the central nervous system. Translation from Latin (insulto - to jump, jump, attack, blow) fully reflects the moment of occurrence and character pain person. There are ischemic, hemorrhagic, mixed types of stroke. Ischemic stroke of the right hemisphere occurs as a result of impaired blood flow from blockage of cerebral vessels with cholesterol and fatty plaques.

Hemorrhagic - characterized by a sharp, "explosive" nature of the pain blow due to a rupture of a vessel in the brain. An accurate diagnosis of "hemorrhagic stroke on the right side of the brain" can only be established by a doctor after a comprehensive examination. Stroke is right-sided and left-sided, and the defeat of the right side is considered the worst option compared to the left-sided "brother". The secret of the "inequality" of strokes is simple - the cells of the left half of the brain are more tenacious, better restored.

signs

With a heart attack in the right hemisphere of the brain, there are:

complete loss of control over their actions (possible loss of consciousness);
nausea, bouts of dizziness, severe right-sided headache;
breathing problems - the appearance of shortness of breath, a violation of the respiratory rhythm;
external signs: change in facial expression, immobility of the left side of the body. The hemorrhagic form of stroke has similar symptoms, but in a more pronounced form. Understand what happened ischemic stroke right side, it is possible according to some specific features of the patient's condition. If partial immobilization or paralysis of the left side of the body is observed, it means that the central part of the brain is affected on the right side. When the area of the parietal part of the right side of the brain is affected, there are many problems with touch, there is a violation of sensitive factors: there is no sensation of temperature environment, a person ceases to respond to pain, loses the ability to navigate in space and time. The right-sided stroke of the left-hander is especially difficult to tolerate - they have a speech center on their right side.

Distinctive features

With a right-sided stroke, it forms the loss of functional manifestations by the organs of the left side of the body: there may be a lack of response to external stimuli in the left arm or leg, there may be no hearing in the left ear. The most important thing that characterizes a right-sided ischemic stroke is a distortion of the patient's psychophysical state, in which anoagosia occurs (lack of reaction to what is happening around).

The lesion of the right part of the brain has features in the elderly: against the background of atherosclerotic encephalopathy, violations of cognitive processes appear - thinking slows down, memory and attention decrease, volitional apathy, a decrease in intellectual and emotional manifestations are observed. An elderly person needs time to feel the impending disaster and call for help. The destruction of the volitional sphere is especially dangerous, since the recovery period requires willpower efforts in exercise therapy classes.

Risk factors

The following have an increased risk of formation:

Rheumatism of the heart;
Atherosclerotic lesion of cerebral vessels;
High blood pressure;
Vascular tumors;
Depressed psycho-emotional state;
Aneurysm of cerebral vessels;
Taking narcotic drugs;
Alcoholism;
tobacco smoking;
Postponed myocardial infarction.

If one or more of these factors are present, you need to be alert in order to respond to a deterioration in time and urgently call an ambulance. Timely treatment will help to avoid fatal consequences.

Children's cerebral infarction: features and prospects

Over the past few years, stroke has become much “younger” - more and more often the disease is formed in young people. A teenager, and even a child, can get a brain infarction, the reason lies in the individual characteristics of health. The risk of stroke increases in the presence of congenital heart defects, inherited blood diseases, problems with the endocrine system. Symptoms have a clear localization:

Loss of sensation on the left side of the face;
Trembling of hands, legs, convulsions;
Problems with colloquial speech- Difficulties in pronunciation of certain sounds;
Impaired coordination.

If a cerebral stroke is timely and accurately diagnosed, treatment and subsequent rehabilitation lead to a full recovery and restoration of brain activity in full.

Paralysis: symptoms and types

A characteristic complication of a stroke is paralysis - complete or partial. Paralysis of the right side is observed with damage to the left hemisphere, while a noticeable loss of strength and a decrease in muscle tone are clearly expressed.

Distinctive external signs of a stroke - on the face, the right corner of the lips is lowered than usual, the hand is pressed to the body, the fist is strongly clenched, the foot is turned inward.

Paralysis of the right side has good prospects for the future, but there are a number of significant problems:

Loss of control over one's own body, hence - complete helplessness, a sense of dependence, deepening stress.
Hardening of muscle mass, aggravation of immobility of the joints;
Prolonged immobility. The result is the formation of bedsores, the formation of blood clots, the development of pneumonia. Preventive measures - you need to turn the patient over after 3-4 hours, monitor the condition skin, ventilate the room more often. Restriction of motor activity after a stroke with complete paralysis of only the right side has serious consequences for the patient and requires a long-term persistent recovery. Here, the help of others will be required so that rehabilitation measures are carried out systematically. It is important to remember the special danger of paralysis in this area: if the right side is paralyzed, the parts of the brain responsible for the functioning of the heart and lungs are damaged, therefore, paralysis can lead to the death of the patient at any time.

Treatment

Ischemic and hemorrhagic strokes, due to their different nature, have radically different therapeutic methods.

For ischemic stroke, treatment is chosen that involves the elimination of the causes of blockage of blood vessels. Ischemic stroke is treated with neuroprotective therapy drugs, thrombolytic agents, as well as drugs that can counteract the formation of blood clots in the bloodstream. All foci of ischemia formation are exposed to therapeutic effects.

In hemorrhagic stroke under the influence high pressure a hemorrhage occurs in the brain - the walls of the vessels do not withstand the pressure of the blood flow, burst, impregnating the brain tissue. The deep nature of the lesion requires rapid intensive care. However, the catastrophic consequences of vascular rupture are growing rapidly, and death cannot be avoided.

Recovery period

After passing the treatment course of a stroke patient, a recovery period awaits. Recovery after a stroke is a long and complex process, depending on the depth of brain damage, the general condition of the patient at the time of the onset of the disease. The process of rehabilitation after an ischemic stroke on the right side, if the consequences allow for restorative procedures and there are no contraindications, can be started in a week.

The basis of the process is the correction of violations of the motor system.

Treatment includes several stages:

exercise therapy (a set of exercises physiotherapy exercises) - the patient is engaged in special gymnastics.
Visiting procedures for manual therapy, massage to restore the motor apparatus, the use of kinesitherapy.
Conducting sessions of acupuncture, reflexology.
The impact of various physiotherapy procedures.
For problems of an orthopedic nature, drug treatment or surgical intervention is used (to eliminate the consequences of immobilization).

Besides, rehabilitation period after a stroke includes classes with a speech therapist (to restore speech), psychological assistance (to assess the degree of destruction of brain activity, as well as the speedy socialization of the patient).

Therapeutic procedures for hemorrhagic hemorrhage include the appointment of drugs for the speedy recovery of the ruptured vessel membrane and with the ability to thicken the blood. In emergency cases, neurosurgery is required. The recovery period excludes even minimal physical activity. You can start rehabilitation only after the completion of the main treatment course. If, after a stroke, the entire right side turned out to be paralyzed, the procedures should be started very carefully, carefully monitoring the patient's condition, but not earlier than 3 weeks. The best restorative effect has treatment in a specialized type of sanatorium, where the patient is in a correct rehabilitation course around the clock.

Forecast and prevention

A stroke gives rise to many questions of the patient's relatives: what is the difference between cerebral hemorrhages, what is the more favorable stroke on the right side, what are its consequences, how many years do people who have had a cerebral infarction live? A more favorable prognosis awaits patients with small stroke "areas", an extensive stroke causes a complete loss of working capacity, disability.

When asked about life expectancy after a stroke, doctors do not give an unequivocal answer: it all depends on the age of the person, the state of his body before the stroke, the presence of concomitant diseases, quality of life. If you care about your health, be attentive to the occurrence of warning symptoms, avoid bad habits- you can live many full years and not "get acquainted" with a stroke.

IN modern world a person is constantly overcome by problems, stresses, various difficulties. Hence the acquisition of diseases, many of which pose a direct threat not only to health, but also to life. A stroke, even with a favorable outcome, can in most cases be a death sentence for a person long treatment and rehabilitation will not lead to success. To maintain health, you need to protect it, protect it, take care of it - then life will be long and happy.

krov.expert

Causes of hemorrhagic stroke of the brain

The officially proven causes contributing to the development of the disease are considered to be the following factors: diabetes, arterial hypertension, obesity, smoking, sedentary lifestyle, atrial fibrillation, carotid artery stenosis, dyslipidemia, sickle cell anemia, various diseases of the cardiovascular system. The above problems provoke hemorrhagic stroke in ¾ of cases.

The remaining 25 percent of cases have an unrecognized or unclear etiology. Any person who independently and timely corrected own image life, can reduce the risk of stroke by 25 to 30 percent.

Symptoms of a hemorrhagic stroke

The harbingers of a possible hemorrhagic stroke are usually considered a partial loss of vision, severe pain in the eyes, a sharp loss of balance with tingling and numbness of the limbs / body parts, as well as difficulty understanding and reproducing speech. However, as practice shows, the above conditions may not manifest themselves in at least half of the patients, or be mild.

The disease itself manifests itself suddenly and most often its catalyst is severe stress or an over-emotional load. If a person remains conscious, he may feel a strong heartbeat, rapidly increasing headache, vomiting with nausea, intolerance to light, paresis or paralysis of the limbs with difficulty in speech reproduction / understanding.

After some time (from one or two minutes to half an hour), a regression of consciousness begins, accompanied by an epileptiform seizure (up to a quarter of all cases), a person gradually passes into the stage of first stunning, then doubtfulness, then stupor with a weak reaction of the pupils and preservation of the swallowing reflex. The last stage may be coma. The sooner the emergency qualified medical care is provided to the patient, the higher the chances of avoiding a fatal outcome!

Treatment of hemorrhagic stroke

A high risk of death predetermines the complex treatment of a stroke of the above type, which is carried out as soon as possible.

Conservative treatments

The use of drugs is strictly regulated by the attending physician and cannot be carried out outside the hospital at home!

The use of hypotension - selective, mixed and non-selective blockers, such as Atenolol, Acebutolol, Pindolol, Anaprilin, Carvedilol.
The use of calcium antagonists of the second and third generation - Nicardipine, Falipamil, Klentiazem.
Loading doses of antispasmodics of direct and / or indirect action - Drotaverine, Nitroglycerin, Difacil, Aprofen.
Use of ACE inhibitors:

carboxyl - Quinapril, Trandolapril
sulfihydryls - Captopril, Zofenopril
hemostatic - Kontrykal
phosphils - Fosinopril
sedatives - Elenium or Diazepam
Nootropics - Cortexig
antiprotease agents - Gordox
laxatives - Glaxena
antifibrinolytics - Reopoliglyukin
multivitamins - Calcium gluconate / pantothenate.

The fight against cerebral edema and the regulation of the VChP:

corticosteroids - Dexamethasone.
diuretics - Lasix or Mannitol.
plasma substitutes - Reogluman.

Surgical intervention (operation)

Surgical operation is usually prescribed in case of hematomas of the trunk or cerebellum of the organ, which cause severe neurological symptoms, with lateral / global hemorrhages of a large volume, as well as in case of a significant deterioration in the patient's condition during dynamic diagnosis using MRI / CT.

At the same time, medial hematomas and deep coma with irreversible stem dysfunctions can be direct contraindications to surgery - in this case, success surgical intervention estimated at 5-10 percent. If the patient is stable, he does not have a neurological deficit, and there are only supratentorial cerebral hematomas, doctors focus on exclusively conservative treatment.

The above indications can be revised towards the appointment of an operation after neuroimaging diagnostics (CT / MRI, vascular angiography) and the detection of dislocations of the cerebral cistern, worsening of the clinical and neurological status, as well as an increase in HMG over 30 milliliters.

At the moment, the endoscopic microneurosurgery technique with a patient-friendly technique is considered to be the preferred surgical method. Classic method It is recommended only for difficulties in the homeostasis of brain tissues.

Recovery after a hemorrhagic stroke

The process of recovery and rehabilitation of a person who has had a hemorrhagic stroke is quite complex and requires integrated approaches to future activities. In some cases, it can last up to two years and includes a number of restorative procedures such as kinesiotherapy, therapeutic gymnastics, basic self-service recovery, speech therapy, the use of reflex-loading systems, balneotherapy, etc. At the same time, the rehabilitation time depends on the patient's objective condition, the success of the treatment and the person's personal aspirations.

Predictions and consequences of hemorrhagic stroke

Domestic figures and statistics on hemorrhagic stroke are very disappointing - up to 50 percent of patients die. Of the survivors, about eighty percent of the people become disabled of one group or another. Even if you received qualified treatment on time and in full, and the form of the disease itself was not considered severe, the rehabilitation period can take up to one to two years, while only one in five will be able to fully restore all the basic functions of the body.

Possible and very likely consequences of a stroke include partial / complete loss of speech, motor activity due to paralysis. Often, a person acquires a neurological deficit or goes into a vegetative state, in which he cannot take care of himself.

Stroke prevention

Hemorrhagic stroke prevention or prevention re-manifestation consists of a number of complex measures, including:

Regular long term use medicines. In particular, the doctor usually prescribes anticoagulants (Warfarin, Heparin) and antiplatelet agents (Aspirin with Dipyridamole, Clopidogrel, Ticlopidine).
Control of hypertension with immediate reduction of blood pressure if necessary. In this case, it is necessary to add potassium to the diet, limit the intake of alcohol and salt, sometimes it will be rational to take diuretics, ACE inhibitors, angiotensin receptor blockers. All drugs are prescribed exclusively by your doctor.
Adjusting the diet to lower blood cholesterol levels.
To give up smoking.
Reducing excess eyelids with a diet rich in vegetables and fruits.

left-hand side

Stroke ischemic right side

Hemorrhagic stroke is the most severe brain injury. Mortality after a stroke ranges from 50 to 90% of victims, depending on the damaged area. Thus, a stroke of the brain stem leads to almost instant death, a hemorrhage in the periphery provides more chances to survive.

The disease develops rapidly and its consequences are unusually severe.

What is a stroke

Under this name unite all cases of acute circulatory disorders. The disease is accompanied by the formation of certain neurological signs that persist or develop within 24 hours. The highest mortality is observed in the first day of the disease.

The so-called small stroke is different in that the neurological deficit regresses in 3 weeks, not a day. Mortality during this period is 35%.

There are three types of stroke depending on the nature of circulatory disorders

Ischemic - the most frequent and not so categorically leading to death, accounts for 70-80% of cases. Ischemic stroke of the brain is, in fact, a heart attack, tissue necrosis due to blockage or narrowing of the supplying artery and death of brain tissue cells.
- vessel rupture resulting from a cranial injury, aneurysm rupture, vascular disease, tumors, and so on.
Hemorrhagic stroke of the brain is accompanied by bleeding. Vessel rupture occurs by two main mechanisms.

In a hypertensive crisis, the self-regulation of the arteries is disrupted: they lose their ability to narrow and only passively expand under pressure. Not only arteries are filled with blood, but also veins and capillaries, as an attempt to compensate for pressure. But if the cerebral blood flow continues to increase, the walls of the vessels simply can not stand it.

The second mechanism is associated with the opposite phenomenon - spasm or paralysis of the arterial vessels of the brain. An ischemic focus is formed, metabolic processes are disturbed in the area and in the vessels.

As a result, the walls of arterioles are permeable to plasma and red blood cells. Blood seeps through the walls and soaks the surrounding brain tissue.

Depending on the nature and distribution of spasms, the formation of one extensive or multiple foci of hemorrhagic lesions is possible.

The picture is complicated by the occurrence of an intracerebral hematoma: the blood from the vessel forms a cavity, which itself fills it. Subsequently, such a cavity forms a scar or transforms into a cyst. The consequences are severe in both cases. How long they live after such a disease depends largely on how quickly the patient receives emergency care.

It is usually diagnosed in patients over 60 years of age against the background of rheumatic heart disease, heart attack, and hemodynamic disorders. Hemorrhagic stroke occurs in age group from 45 to 65 years old. Its usual "accompaniment" is hypertension and atherosclerosis.

According to statistics, ischemic stroke is the second most common cause of death and the first cause of disability. After the disease, 70-80% become disabled, of which 20-30% require constant care.

Types of stroke

Like ischemic, hemorrhagic stroke is classified according to several signs that indicate the affected area.

Damage to the periphery or in the thickness of the brain tissue. Refers to the most "safe" damage. Rarely causes edema. The consequences here are far from easy, but it is peripheral hemorrhage that most often becomes a stroke suffered “on the legs”, and such cases also occur.
Venticular - an outpouring of blood in the lateral ventricles.
Subarachnoid - the ingress of blood between the membranes of the brain. After damage to the trunk, this form has the most serious consequences.
Combined - observed with an extensive lesion.

Distinguish between primary and secondary stroke

Primary - a consequence or damage to the walls of blood vessels caused by constant excessive pressure. It provokes his strong emotional or physical stress with high blood pressure.
secondary - here the real reason there is a rupture of the aneurysm, an anomaly or acquired deformation of the vessel, which led to its damage, or a violation in the permeability of the walls.

The severity of the disease does not depend on the secondary or primary hemorrhage. The consequences are equally terrible, and the prognosis is disappointing.

Symptoms of the disease

Hemorrhage occurs suddenly, is characterized by cerebral and local neurological signs. Often so unexpressed that the patient does not pay attention to the deterioration.

Threat symptoms are:

nausea and vomiting for no apparent reason, vomiting does not bring relief;
severe dizziness, headache;
uneven intermittent pulse, weakness;
the skin loses sensitivity, there is numbness of the hands and feet.

Usually hemorrhagic stroke manifests itself in the form of a sharp headache and a short-term loss of consciousness. After that, drowsiness or agitation, a state of stupor, nausea can be observed. Often the patient falls into a coma, which is one of the most terrible consequences.

The prognosis for recovery from coma is extremely unfavorable. In 16% of cases, the symptoms are similar to an epileptic seizure, which is an excellent reason to call an ambulance as soon as possible.

If the patient remains conscious and does not feel anything special, except for dizziness, weakness and some disorientation in space, there is Great chance that help will not be provided in time.

Major risk factors for stroke.

Fortunately, a hemorrhagic stroke is distinguished by several other symptoms associated with the site of damage.

A stroke patient is unable to smile. If the right hemisphere is damaged, then the left side of the face remains motionless. If hurt left side, the right side of the face is almost not felt.
The victim cannot stick out his tongue - he is in an unnatural position, sinking to one side.
When trying to repeat even a simple phrase, diction is often violated. This is an optional sign, since the hemorrhage does not always affect the speech centers.
When trying to raise both hands, as a rule, the patient cannot keep them at the same height. Another way: you need to ask the patient to stretch his arms with his palms down and cover his eyes. If one arm begins to move sideways and down, then a hemorrhage has occurred.

If you observe at least one of the listed signs in conjunction with a headache or a short-term loss of consciousness, you should immediately contact an ambulance. His life and health literally depends on how quickly measures are taken.

Critical in hemorrhagic stroke are the first 3 hours, less often 6. If during this time the patient is assisted, the threat to life is significantly reduced - up to 20%. Moreover, with timely assistance received, the threat of disability is also noticeably reduced, the consequences are mitigated, perhaps even full recovery brain functions.

Of course, the prognosis of recovery in this case also depends on many factors: how much time has passed, which part of the brain is affected, what other diseases are in the anamnesis, but, nevertheless, it is the actions in the first 3 hours that can save a person's life.

First aid

It is useless to take the victim to the hospital on your own, since not all clinics can provide the required assistance. Treatment of hemorrhagic stroke is carried out in specialized institutions. That's why right action there will be an emergency call with a description of the symptoms and an indication of how much time has passed since the loss of consciousness.

The victim must be laid in such a way that the head and neck are in line and placed at an angle of 30 degrees. Use for this pillows, folded clothes and so on.
If the victim is vomiting, turn his head to the side.
It is necessary to unfasten clothes, loosen the tie, and prevent the patient from making sudden movements.
If rhythmic breathing is not observed during loss of consciousness, it is necessary to begin cardiopulmonary resuscitation. You should not pay attention to the state of the pulse.
Do not give the patient a drink, as it is possible that as a result of a stroke, the swallowing organs are paralyzed.

Therapeutic measures

Even the most urgent care is impossible without a diagnosis. In this case, it is important to localize the affected area. The main treatment for hemorrhagic stroke starts with research.

In the first few hours, the most informative method is computed tomography. In this way, a complete picture of the blood clot can be obtained. After the start of resorption - about a day, the accuracy of tomography decreases.

At the stage of cyst formation, magnetic resonance imaging is used.

After the diagnosis is established, treatment is prescribed. Its purpose is to do the following:

normalization of pressure - reducing the load on the vessels contributes to their speedy recovery. Adrenoblockers, ACE inhibitors are used;
prevention or reduction of edema - taking diuretics;
regulation of blood viscosity. The use of anticoagulants is contraindicated. correct by the introduction of platelet mass, fresh frozen plasma;
pain relief - non-narcotic analgesics;
neuroprotection.

The first task in a stroke is the withdrawal of blood, getting rid of the hematoma. If the size of the latter exceeds 3 cm in diameter, surgical intervention is prescribed.

Rehabilitation of patients

Consequences stroke include whole list the heaviest damage. Measures taken in time exclude some of them, and some can be dealt with with the help of the right 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 reassuring: hemorrhagic stroke causes 70-80 cases of disability out of 100.

The most commonly observed effects are:

violation of motor functions - lameness, paralysis of the legs or arms. No matter how scary it may sound, but these consequences are among the most acceptable, since they do not entail personality changes or impaired brain functions;
imbalance of urination and defecation;
change in perception, development of dementia;
violation in speech, counting, writing;
memory impairment, loss of orientation in space and time;
change in behavioral complexes - suspiciousness, aggression, delayed reaction;
epilepsy;
vegetative coma.

This condition is the least treatable. Although medical statistics recorded cases of unexpected exit of patients from this kind of coma and the restoration of most functions. However, this is really rare.

Rehabilitation of patients after a stroke should by no means be considered as a desirable but optional event. No matter how long the recovery takes, even a partial restoration of functions is impossible without appropriate procedures and treatment.

Physiotherapy is a complex of various measures aimed at restoring motor abilities and sensitivity. Various forms of paralysis - frequent consequences stroke.
Swallowing correction- After a stroke, such a disorder is often observed. Patients are fed small portions and control the process of chewing and swallowing.
Speech correction - classes in reading and counting skills.
Ergotherapy - a set of measures for the rehabilitation of the hand.
Psychological help - the specialist does not just provide emotional support, but helps to restore lost personality structures, helps the patient to adapt after a severe shock.

Hemorrhagic stroke is one of the most severe brain lesions, it is a real brain catastrophe that requires immediate measures to save a person's life. Despite its severe consequences, practitioners are confident that with a timely operation, support from relatives and efforts from the patient himself, it is possible to restore all functions within 1-2 years.

Hemorrhagic stroke, acute cerebrovascular accident (ACV) according to the hemorrhagic type - acute clinical syndrome, which is a consequence of damage to the cerebral vessels and hemorrhage in the brain. The root cause may be damage to both the artery and the vein. The larger the damaged vessel, the more abundant bleeding, in severe cases, up to 100 ml of blood is poured into the tissue. The resulting hematoma mechanically compresses and displaces the nervous tissue, and edema quickly develops in the affected area.

If medical assistance is not provided to the victim within three hours, the chances of survival are rapidly decreasing and tend to zero. According to statistics, hemorrhagic strokes account for just over 20% of stroke cases.

What it is?

Hemorrhagic stroke is an acute hemorrhage in the brain due to rupture or increased permeability of blood vessels. This cerebrovascular accident differs from the classic (ischemic) stroke, which is more common (70% of patients).

The nature of changes in blood vessels in ischemic stroke is the blockage of their lumen by blood clots, as a result of which gradual necrosis of brain cells occurs, and in hemorrhagic stroke, a violation of the integrity of the vascular wall, as a result of which the brain tissue is impregnated and squeezed by the outflowing blood.

Hemorrhagic type cerebral stroke is a dangerous and insidious disease. It is characterized by:

High mortality (60-70% of patients die within the first week after the onset of the disease).
Suddenness (in 60-65% of patients, hemorrhage occurs without any previous symptoms).
Profound disability of surviving patients - 70–80% of people are bedridden and cannot serve themselves, the remaining 20–30% have a less pronounced neurological deficit (impaired limb function, walking, speech, vision, intelligence, etc.)

More than 80% of cerebral hemorrhages are associated with high blood pressure (hypertension). Taking antihypertensive drugs (normalizing blood pressure) can reduce the risk of stroke, the amount of hemorrhage and the severity of brain damage. If patients are hospitalized in a medical facility in the first 3 hours, this increases the chances of survival. Specialized rehabilitation centers help restore the lost brain functions as much as possible after a stroke. Complete recovery is rare, but possible.

Classification

It should be noted that stroke of the brain stem leads to almost instantaneous death. Only in rare cases can a patient's life be saved with such a diagnosis. At the same time, there is no chance of returning to a full life.

The brain stem is the center of all body systems, and is directly connected with spinal cord. He serves link between the commands of the brain centers and the nerves of the body: it is thanks to him that we are able to move, breathe, swallow, see, hear, and so on. The brain stem also regulates the circulatory system, thermoregulation, and heartbeat. That is why its damage during a stroke is most often fatal.

By origin, primary and secondary hemorrhagic stroke are distinguished:

Depending on the localization zone, I distinguish the following types of hemorrhagic stroke:

Subarachnoid - hemorrhage in the space between the hard, soft and arachnoid membranes of the brain;
Hemorrhage on the periphery of the brain or in the thickness of its tissue;
Venticular hemorrhage - localized in the lateral ventricles;
Combined type: occurs with extensive hemorrhage affecting several areas of the brain.

Peripheral hemorrhage is much less dangerous than intracerebral, which in without fail provokes the formation of hematomas, edema and subsequent death of brain tissue. Hematomas are also distinguished by localization:

Lobar - hematoma is localized within one lobe of the brain, without going beyond the cerebral cortex.
Medial - hemorrhage damages the thalamus.
Lateral - damage to the subcortical nuclei localized in the white matter of the hemispheres (fence, almond-shaped, caudate, lenticular nuclei).
Mixed - hematomas affecting several areas of the brain at once are most common.

Clinical manifestations

Symptoms of hemorrhagic stroke are varied and are divided into two large groups: cerebral and focal. Also, the symptomatology strongly depends on the localization of the focus of hemorrhage, its size, the somatic condition of the patient and many other factors.

The general cerebral symptoms of hemorrhagic stroke include the following signs:

Disturbances of consciousness (stunning, stupor, coma). The larger the hearth, the lower the level of consciousness. However, when the brain stem is damaged, even a small focus of hemorrhage leads to a pronounced depression of consciousness.
Dizziness.
Nausea, vomiting.
Headaches.
General weakness.
Respiratory disorders.
Hemodynamic disorders.

Predominantly focal symptoms include signs:

Paresis or plegia in the extremities, hemiparesis is more common.
Paresis of mimic muscles.
Speech disorders develop mainly with damage to the left temporal lobe.
Visual impairment (including the development of anisocoria).
Hearing disorders.

A stroke should be suspected for any type of speech disorder in a patient, weakness in the arm and leg on one side, the development of epileptic seizures without provoking factors (for example, alcohol use is one of these factors), impaired consciousness up to coma. In any suspicious cases, it is better to play it safe and call an ambulance. Behavior and assessment of the situation in case of suspected stroke should be considered in a separate article.

Coma in hemorrhagic stroke

Approximately 90% of patients with GI in a state of stupor or coma die within the first five days, despite intensive care. Disorders of consciousness are characteristic of many pathologies, manifested by inhibition of the functions of the reticular formation of the brain.

Brain dysfunction develops under the influence of:

Endo- and exotoxins - derivatives of the end products of metabolism;
Oxygen and energy starvation of the brain;
Metabolic disorders in brain structures;
Expansion of the volume of the substance of the brain.

Acidosis, cerebral edema, increased intracranial pressure, impaired microcirculation of brain fluids and blood are of the greatest importance in the development of coma.

The state of coma affects the functioning of the respiratory system, excretion (kidneys) and digestion (liver, intestines). Getting out of a coma at home is impossible, and very difficult even in intensive care.

The clinical definition of coma is carried out according to the GCS (Glasgow Coma Scale), some other methods that are important for clinicians are used. Allocate precoma and four stages of coma. The easiest is the first, and the hopeless state of the patient corresponds to the fourth stage of coma.

Treatment

Treatment for acute stroke may include:

Relief of pain, correction of body temperature (paracetamol, efferalgan, naproxen, diclofenac, often opiates, propafol). Aspisol, dantrolene, drip - magnesium sulfate are put intravenously.
Lowering blood pressure, which helps stop bleeding in the brain. For this purpose, drugs are administered intravenously: labetalol, nicardipine, esmolol, hydralazine. However, a sharp decrease in pressure in the early days is not allowed. Next, tablet preparations are prescribed - captopril, enalapril, capoten (as basic therapy orally or through a probe).
Diuretics with a persistent increase in pressure (chlorothiazide, andapamide, lasix), calcium antagonists (nimotop, nifedipine).
In case of severe hypotension, vasopressors are prescribed drip (norepinephrine, mezaton, dopamine).
To reduce cerebral edema, dexamethasone is recommended for 3 days (intravenously). If the edema progresses, glycerin, beckons, albumin, refortan are dripped.
Often, a continuous intravenous infusion is used to administer the above drugs with pressure control every 15 minutes.
Preparations for the correction of neurological symptoms (sedatives - diazepam, muscle relaxants - vecuronium).
Local therapy is aimed at eliminating bedsores and includes treating the skin with camphor alcohol, sprinkling with talc.
Symptomatic therapy - anticonvulsants (lorazepam, thiopental or anesthesia for 1-2 hours), drugs for vomiting and nausea (metoclopramide, torecan), against psychomotor agitation (haloperidol). With pneumonia and urological infections, a course of antibacterial treatment is carried out.

In the presence of large hematomas (more than 50 ml.), Surgical intervention is performed. Excision of the site of hemorrhage can be performed if it is localized in the accessible part of the brain, and also if the patient is not in a coma. Most often, clipping of the aneurysm neck, puncture-aspiration removal of the hematoma, its direct removal, as well as ventricular drainage are used.

Consequences

If patients can be saved, they face neurological deficits - symptoms caused by damage to the area of \u200b\u200bthe brain in which the hemorrhage occurred.

These may be the consequences of a hemorrhagic stroke:

paresis and paralysis - a violation of the movements of the limbs on one half of the body, since they are constantly in a bent position and it is impossible to unbend them;
violation of speech and its complete absence;
mental disorders and irritability;
persistent headaches;
disorders of coordination of movements;
inability to walk and even sit on their own;
visual impairment up to complete blindness;
face distortion;
vegetative state - the absence of any signs of brain activity (consciousness, memory, speech, movements) with preserved breathing and heartbeat.

Symptoms of the disease and their duration depend on the location of the hemorrhage and its volume. The first 3 days are the most dangerous, since at this time severe disorders occur in the brain. Most deaths (80-90%) occur during this period. The remaining 10–20% of patients die within one to two weeks. Surviving patients gradually recover from several weeks to 9–10 months.

Left-hand side

If the left side is affected, the consequences are characterized by a violation of the work of the right side of the body. The patient has complete or partial paralysis, and not only the leg and arm suffer, but also half of the tongue and larynx. These patients develop gait disturbances, a characteristic posture right hand(folded in a boat).

The victim has a deterioration in memory and speech, the ability to clearly express thoughts is impaired. Damage to the left hemisphere of the brain is characterized by problems with recognition of the time sequence, it cannot decompose complex elements into components. There are violations of written and oral speech.

Right side

If the right side is affected, dangerous consequence is damage to the brain stem, in which the chances of a person to survive approach zero. This department is responsible for the functioning of the heart and respiratory system.

It is quite difficult to diagnose a hemorrhagic stroke on the right, since in this part there are centers of orientation in space and sensitivity. This lesion is determined by speech impairment in right-handed people (in left-handed people, the speech center is located in the left hemisphere). In addition, there is a clear relationship: so if the functionality of the right half of the brain is impaired, the left side suffers and vice versa.

How long do people live after a hemorrhagic stroke?

The prognosis of hemorrhagic stroke is unfavorable. It depends on the location and degree of damage. A hemorrhage in the brain stem is dangerous, which is accompanied by respiratory failure and a sharp, poorly corrected drugs, decrease in blood pressure to critical numbers. Severe and often fatal hemorrhage into the ventricles with their breakthrough.

How long do people live with a hemorrhagic stroke? This pathology ends lethally in 50-90% of cases. Perhaps the onset of death on the very first day - against the background of generalized convulsions, when there is a violation of breathing. More often, death occurs later, by 2 weeks. This is due to a cascade of biochemical reactions triggered by the outflow of blood into the cranial cavity and leading to the death of brain cells. If there was neither displacement of the brain, nor its wedging (getting into the bone hole), nor a breakthrough of blood into the ventricles, and the compensatory capabilities of the brain are large enough (this is more typical for children and young people), then the person has a great chance to survive.

At 1-2 weeks, in addition to neurological disorders, complications associated with immobility of the patient, exacerbation of his chronic diseases or his connection to an artificial respiration apparatus (pneumonia, bedsores, hepatic, renal, cardiovascular insufficiency) join. And if they do not lead to death, then by the end of 2-3 weeks the cerebral edema stops. By week 3, it becomes clear what are the consequences of a hemorrhagic stroke in this case.

Recovery after a stroke

The rehabilitation period after a hemorrhagic stroke is long, especially in old age. It depends on the lost functions and does not guarantee their full rehabilitation. Lost abilities are most quickly restored in the first year after a stroke, then this process is slower. The neurological deficit that remains after three years is likely to remain for life.

Neurologists and rehabilitation specialists are ready to help restore lost functions as much as possible. For this:

classes are held with a psychologist or psychotherapist;
in case of loss of reading / writing skills, classes are held to restore them;
hydrotherapy is carried out (massage in the pool, light exercises in the water);
classes on special simulators;
in case of violations of speech reproduction, a person will have to deal with a speech therapist; in case of paresis or paralysis, physiotherapy is performed (for example, on the Myoton apparatus), massage and exercise therapy are performed with an instructor;
drugs are prescribed that will help restore lost neural connections (Ceraxon, Somazina), which reduce high blood pressure (Enalapril, Nifedipine), antidepressants and sedatives;
color therapy - treatment with visual images.

The prognosis of recovery depends on how large the area was covered by the hemorrhage, as well as on how qualified the actions of doctors and rehabilitators were. Hemorrhagic stroke is a very complex pathology, the consequences of which are unlikely to be completely eliminated. Supportive treatment and rehabilitation last a very long time.

Hemorrhagic stroke

Hemorrhagic stroke - rupture of blood vessels, with hemorrhage in the brain tissue. People who suffer from high blood pressure. The disease can be of arterial and venous origin. The amount of blood that enters the brain depends on the size of the vessel that burst - more than 100 milliliters can spread, causing damage to brain cells with a rapid flow, with tissue displacement. A hematoma forms, the brain swells.

How long people who have suffered paralysis live depends on timely support - first aid, if it is not provided on time, as a result, brain necrosis occurs, followed by death. Providing medical assistance within 3-6 hours gives a chance to save the injured person, otherwise, first clinical and then biological death occurs. If, in rare situations, the patient survives, then he remains in a vegetative state until the end of his life.

Recently, medical specialists have noted an increase in cases of stroke. This serious problem, requiring close attention, before and after the progression of the disease.

Varieties of the disease and clinical course

How long people who have had the disease live also depends on the clinical picture. Hemorrhagic stroke of the brain stem - with this pathology, almost instantaneous death occurs. There are isolated cases of saving the patient and his recovery with such a diagnosis, but a full life is no longer possible.

The center of the entire body system is the brain stem, in conjunction with the spinal cord. It connects the commands of the brain center, the nerves of the body - thanks to this, people move, breathe, swallow, see, hear. It also regulates the circulatory system, thermoregulation, and heart function, so a brain stem stroke is the cause of human death.

From the location of the focus of brain damage

There are several types of hemorrhagic stroke, depending on the location of the focus of brain damage:

Peripheral or deep tissues.
Venticular - localization on the lateral ventricles.
Subarachnoid - in the space between the hard, soft and arachnoid layers.
Combined - with extensive hemorrhage, affecting several areas.

Peripheral hemorrhage is not as dangerous as inside the brain, provoking hematomas, edema and necrosis of the brain tissue.

Localization of hematomas has differences:

Medial - damage to the thalamus.
Lateral - affect the subcortical nuclei, the white matter of the hemispheres.
Lobar - a hematoma within the boundaries of one lobe, not extending beyond the cerebral cortex.
Mixed - hematomas, in several areas of the brain, the most common.

Primary and secondary strokes

Stroke can be primary or secondary:

Primary - due to a hypertensive crisis or due to heavy loads on the arteries and veins and their thinning.
Secondary - a consequence of aneurysm rupture, hemangiomas and other malformations, congenital or formed during life.

Signs of a stroke

A symptom of a stroke is a sharp headache

A hemorrhagic stroke on the left side can provoke an increasing headache with bouts of nausea-vomiting, which worsens in the evening. The increase in symptoms occurs very quickly:

Violated speech, sensitivity, motor function.
Blood rushes to the face, throws into sweat.
Rare pulse.

In this condition, you should immediately contact a medical facility. A hemorrhagic stroke of the left side occurs when one or more central arteries of the left-sided brain are ruptured - there is a threat to life, and even if the patient survives, he often becomes disabled.

With a left-sided stroke, the blood flow in the cranium decreases, and part of the brain cells die. This affliction causes the association of an explosion within the head.

An extensive left-sided stroke is recorded already with a fifty-gram amount of blood spreading inside the brain, sometimes the amount of blood reaches half a liter! The situation is complicated by the closedness of the cranium.

Causes of a stroke on the left side

Hemorrhagic stroke of the left side - symptoms

Hemorrhagic stroke of the left side owes its origin to two main reasons:

The hereditary-genetic factor - a left-sided stroke causes lesions not in both hemispheres, but in one.
Overloads of a physical, psychological nature.

During an attack, there are: clouding of consciousness, speech disorders, a person is not aware of the events. In the future, memory recovery may occur - the patient recalls the moments experienced before the fall - blurred visual focus, vagueness before the eyes, movement of objects in space.

Consequences of hemorrhagic stroke

Hemorrhagic stroke of the left side causes hemorrhage of only one - the left side of the brain. For this reason, the right side of the body is paralyzed. Paralysis causes not only limbs, but also parts of the tongue and throat. After a part of the body is paralyzed - the patient's movement is difficult due to the abandoned leg, the injured arm folds into a boat, as if in a pleading gesture.

A person who has a stroke of the left hemisphere during movement often deviates to the side, although, according to his own reference point, he moves straight.

A hemorrhagic stroke on the left side also causes problems in speech and written recognition, knowledge of letters and numbers, dates, events from past days is erased from memory, the coherence and logic of speech are lost.

The above violations are associated with the activity of the left hemisphere. It is responsible for the following functions:

Written, oral speech.
Logic.
The ability to divide complex objects into elementary parts and further study element by element.
Ability to determine time sequences.
chronological memory.

Treatment of left-sided hemorrhagic stroke

The quality of treatment, recovery, further consequences depend on the speed of first aid, every hour and even a minute after a stroke is important. Qualified therapy is desirable to carry out the first three hours, delivering the patient to a medical facility.

If a person is struck by a left-sided stroke, first aid must be provided:

Put the patient with his head raised above the body, approximately at an angle of 30 degrees.
Provide access to fresh air by ventilating the room.
Turn the patient's head on its side, making sure that the vomit does not enter the respiratory tract.

With further treatment in a hospital, and then carrying out recovery at home, funds are prescribed to increase the conductivity of nerve impulses in the brain. The drugs are taken in a course, according to the recommendation medical specialist. Therapy should be consistent and systematic, you can not interrupt and stop treatment.

The patient is also being rehabilitated, he is re-learned to move around, to talk - already on the third day after the person comes to his senses. To restore motor function apply massage and passive movements of paralyzed limbs. These measures are aimed at increasing blood flow, preventing muscle atrophy, and neutralizing pressure sores that can form if there is paralysis.

Recovery exercises memory is carried out using children's cards, with the image of numbers, letters, various things Everyday life. The patient may not understand the pictures he sees, but gradually the memory should be restored. Special technical means developed by medical engineering have also proven themselves.

The use of a special device allows you to restore control of your center of gravity - the action is carried out in the form of a game that, by consistently training the brain, teaches you again to redistribute your body weight from one lower limb to another, being on the platform, trying to hit the target on the monitor with the cursor.

It is very important for a patient who has survived a stroke of the left hemisphere to feel the support of close relatives and friends, but overprotection should be excluded. It is necessary to create a positive atmosphere of communication, since it is noticed that the patient often closes after he has suffered a hemorrhagic stroke on the left side of the brain.

Stroke recurrence prevention

In order to avoid a primary or secondary stroke of the left hemisphere, the following measures must be observed:

Monitor the level of sugar in the blood - when it rises, the blood thickens, the flow rate through the vessels drops and there is a risk of blockage.
Control cholesterol, as it is able to form plaques, which leads to thrombosis.
Keep track of the food you eat.
Eliminate smoking.
Do not abuse alcohol.
Apply vitamin and mineral complexes, especially vitamins of group B, E to strengthen the walls of blood vessels and general immunity.
Also the inclusion of vitamins C, D providing beneficial effect throughout the brain and body as a whole.

Hemorrhagic stroke of the brain is an acute pathological condition in which the patient has a hemorrhage inside the skull. It appears as a result of spontaneous rupture of a blood vessel. The disease is not diagnosed very often, but it is more severe than ischemic stroke, and can also cause serious (often irreversible) complications.

Despite the fact that the manifestations of the disease are specific, it is not always possible to quickly and accurately determine the hemorrhage. It develops mainly in patients aged 35-50, although even infants are not immune from it. The delay in the provision of medical care often leads to death.

In hemorrhagic stroke, blood is ejected into the brain tissue (sometimes up to 100 ml or more). At the same time, its cells are damaged, a hematoma appears, and the brain swells. If the patient was not assisted within the first 3 hours, then the changes will be irreversible.

Reasons for the development of pathology

Hemorrhagic stroke differs from ischemic stroke in that it is faster, more difficult and more life-threatening. The following factors can provoke a pathological condition:

Stable prolonged increase in pressure, provoked by diseases of the cardiovascular system.
Accumulation of amyloid (abnormal protein) on the walls of veins and arteries.
Vascular aneurysm of the brain.
Congenital malformations of arteries and veins, as well as their damage, provoked by atherosclerosis.

Erythremia.
thrombophilia.
Inflammation of the vascular walls.
Too frequent use of medications that thin the blood.

Significant exercise stress or a stressful situation, a strong emotional experience.
Brain injury.
Avitaminosis.
Severe intoxication of the body.

Violation of blood clotting.
Violation of cardiac functionality.
Cerebral vasculitis.

Pathology of the spinal cord.
Malignant or benign tumor.
Diabetes mellitus (this disease is always accompanied by vascular damage).

The neurosurgeon, professor Sergey Petrikov will tell more about the pathology in the program of Elena Malysheva “Live healthy!”:

An unhealthy diet, excessive body weight, smoking and alcohol and drug abuse can increase the likelihood of developing a hemorrhagic stroke. The age of the patient, the nature of the work is of great importance. Constant stress, prolonged exposure to direct sunlight also do their job. If you accurately determine the causes of hemorrhagic stroke, then a person can be provided with more effective assistance.

Symptoms

Most often, the development of the disease occurs in the daytime, after exposure to a negative factor. The acute form is characterized by such signs of hemorrhagic stroke:

Great pain in the head. As time goes by, it only grows.
Vomiting and nausea.
Sensation of fluid flowing inside the skull.
Discomfort when looking at light.
The appearance of red circles before the eyes.
Gradual depression of consciousness, followed by the patient falling into a coma.

Loss of orientation.
Paralysis or paresis of the arms and legs.
Loss of clarity of speech.
Manifestations of facial asymmetry.
Fever, impaired respiratory function.
The direction of the patient's gaze in the direction of the lesion.
Sharp reddening of the face.
Intermittent pulse, arrhythmia.

A video from emergency doctors will help you deal with the symptoms (theoretical part 00:30, signs of a stroke 03:05):

Since cerebral edema occurs during a hemorrhagic stroke, the victim develops strabismus, different pupil sizes, and a critical decrease in pressure. Depending on which part of the brain is affected, the symptoms may be focal.

If the right side is affected

The difference between this type of disease and damage to the left side of the brain is expressed in the consequences, as well as clinical manifestations. The most dangerous is damage to the brain stem, in which the chances of a person to survive are close to zero. This department is responsible for the functioning of the heart and respiratory system.

If the left side is affected

Such a lesion is characterized by a violation of the work of the right side of the body. The patient has complete or partial paralysis, and not only the leg and arm suffer, but also half of the tongue and larynx. Such patients develop gait disturbances, a characteristic posture of the right hand (folded in a boat).

As can be seen from the figure, the stroke affects the opposite side of the body.

Varieties of hemorrhagic stroke

Depending on the location of the affected area of the brain, hemorrhagic stroke can be of different types:

Stem injury. It leads to the rapid death of the victim, since life-supporting centers (cardiac activity and respiration) are located in it.
Hemorrhage in the thickness of the brain tissue or the periphery of the organ.

Damage to the lateral ventricles (ventricular).
Damage to the space between the arachnoid, hard and soft membranes (subarachnoid).
Extensive hemorrhagic stroke. It spreads to several areas of the brain.

Intracerebral hemorrhage is much more dangerous than peripheral. It provokes the appearance of hematomas, the spread of edema, and subsequent tissue necrosis. By localization, hematomas are as follows:

Medial (if the thalamus is affected).
Lateral (with damage to the subcortical nuclei of the white matter).
Lobar (hemorrhage does not go beyond the cerebral cortex and extends to only one of its lobe).
Mixed.

Hemorrhagic stroke can also be primary or secondary. In the first case, hemorrhage occurs due to a sharp increase in pressure and thinning of the vascular walls. The second is to blame for an aneurysm, hemangioma, or congenital anomaly.

How to recognize the pathology in a timely manner, and what first aid is required for the victim?

If a person has symptoms of a hemorrhagic stroke, it is necessary to call an ambulance as soon as possible. Any delay is fraught with dire consequences. You can determine the primary signs of a stroke yourself. To do this, you need to conduct a small test:

Ask the person to smile. If there is a problem, the patient's lips will be twisted. Also, one half of the face remains motionless.
When you try to show the tongue, its unnatural curvature will be noticeable.

If a person is asked to raise his hands, he will not be able to do it at the same time. Also, the patient will not be able to keep the limbs at the same level.
Hemorrhagic stroke is also indicated by the patient's inability to say at least one simple sentence (ask for his name). Depending on the location of the hemorrhage, a part of the speech apparatus will be paralyzed.

Also, a sick person is unable to walk straight, complains of an intense manifestation of symptoms of pathology (especially severe headache, dizziness). Naturally, such a patient requires immediate qualified assistance from doctors. That is, the first action is to call a team of doctors with clarification of the proposed diagnosis. Urgent care in hemorrhagic stroke, it provides for the following actions:

A person must be laid so that his head is significantly higher than the level of the body.
It is necessary to remove from him all the clothes that hamper his movements, presses, and prevents the normal access of air.
To prevent the patient from choking on vomit, you need to turn his head to one side.
All windows in the room should be open so that the flow of fresh air is constant.
It is strictly forbidden to give the patient any drugs on their own - this will worsen his condition and complicate the diagnosis.

Check out the article that tells what is a subdural hematoma of the brain - what causes it, how it appears and why it is dangerous.

Elena Nechaeva, an ambulance doctor, will tell you about the algorithm of actions in case of a suspected stroke:

With the right and quick action it is possible to restore the functionality of the affected brain regions as much as possible. Emergency help must be provided within the first 3 hours.

Diagnosis and treatment of pathology

In order to start the treatment of the disease as soon as possible, it is necessary to correctly diagnose it. The patient should be examined by a neurologist. For diagnosis, an MRI of the brain with or without a contrast agent is used. You will also need an angiogram. The quantity and quality of diagnostic tools is determined individually for each patient.

If necessary, other specialists are also involved: an endocrinologist, a cardiologist, an ophthalmologist, a rheumatologist. Mandatory laboratory analysis blood. The diagnosis is also made on the basis of the clinical picture.

The focus of hemorrhage in hemorrhagic stroke on MRI

Treatment of hemorrhagic stroke is carried out in a hospital, in which there is an intensive care unit and a neurosurgical department. The fight against pathology is primarily carried out with the help of surgical intervention, since it is necessary to eliminate the hematoma. The patient also requires strict bed rest. He is prescribed glucocorticoids, calcium antagonists. You will also need antiseptics and antibiotics (in the presence of a traumatic brain injury).

Undifferentiated treatment includes:

Respiratory resuscitation in order to normalize the functionality of the system.
Regulation and control of cardiac activity.
pressure stabilization.
To protect the nervous system, Semax, Ceraxon, Cerebrolysin are used (intravenously to start).
To improve the activity of the affected part of the brain, antioxidants are used: Actovegin, Mildronate.
To stabilize blood microcirculation, vasoactive drugs will be needed: Terntal, Sermion.

Proper treatment of pathology will help to avoid irreversible consequences. After a hemorrhage, a person can live long enough. It all depends on which part of the brain is affected, how quickly assistance was provided to the victim.

What is the prognosis and consequences?

Many are interested in the question of how long patients live after a hemorrhagic stroke of the brain. Most of the victims die within the first 1-2 days after the hemorrhage and 1 year after the elimination of the pathology. If a person managed to pass a critical moment, then he manages to survive. Although the quality of his life will be significantly worsened. We can distinguish the following consequences of hemorrhagic stroke:

Hearing loss (partial or complete).
Unilateral paralysis of limbs and face.
Persistent irreversible violation of mental operations, as well as confusion.
Dementia.

Memory impairment.
Loss of the ability to reproduce speech, perceive information.
Coma and vegetative state. This outcome is very common. Most of the victims may experience some emotion, fear. However, over time, in the absence of a positive effect of rehabilitation, the brain will gradually lose all its functions.

Rapid onset of death. Such a prognosis is possible with hemorrhagic stroke, covering the brain stem.
Deep disability. Despite the viability of the organism, its ability to move and communicate is oppressed; mental processes are not functioning normally.
Violation of the swallowing reflex.
Problems with orientation in space.
Behavioral disorders. The patient has unreasonable fear, serious hallucinations appear.
Inability to maintain control over the fulfillment of natural needs.
Epilepsy.

As a result of hemorrhagic coma, a second stroke can occur. Relapse usually happens a few days after the first attack. To avoid this, the patient will have to undergo surgery.

On the video you can see how the neurosurgeons of the Federal State Budgetary Scientific Institution “ Science Center neurology” perform endoscopic removal of hematomas resulting from a cerebral stroke:

With a left-sided violation of cerebral circulation, the patient has the following consequences: problems with the work of the facial muscles, the inability to think logically, paralysis and loss of sensitivity of the right side of the body. There are difficulties with the swallowing reflex. There are severe attacks of headaches, paralysis of mimic and respiratory muscles. The patient manifests prolonged depression, depression, anxiety, problems with sleep.

If the right side of the brain is affected, then the consequences can be as follows: a pronounced disorder in the functionality of the vestibular apparatus, paresis and paralysis of the left side of the body. The patient has visual impairment, up to complete blindness. Neuropsychiatric disorders have also been noted.

Due to prolonged paralysis of the patient, he develops septic processes, arthropathy, hydrocephalic syndrome. Recovery after a hemorrhagic stroke is extremely slow and is not always characterized by positive dynamics.

The rehabilitation process

Timely treatment is just the tip of the iceberg. Most of the time will be spent on restoring the functionality of the damaged areas of the brain. Rehabilitation after a hemorrhagic stroke begins from the end of the acute period. It includes the following actions:

Breathing exercises. It is necessary to prevent the development of pneumonia in bedridden and sedentary patients.
Classes with a speech therapist to improve speech function.
To stabilize the emotional state of a person, consultations with a psychologist and psychotherapist are necessary.
Therapeutic exercise. At first, it provides only passive movements, and then independent exercise. Such treatment contributes to the restoration of neural connections in the nervous system.

We present you a wonderful video by neurologists of the Rehabilitation Center of the Administration of the President of the Russian Federation on an integrated approach to the recovery of patients who have suffered various strokes:

Gym exercises. Physiotherapy suits that help restore motor function can also help.
Electroneurostimulation.
Access to the pool and massage in the water.
Color therapy.
Vibration effect on biological points located on the feet.