Brain hemorrhage, or hemorrhagic stroke (from lat. insultus - blow) - the most severe type of cerebrovascular accident resulting from the rupture of pathologically altered vessels under the influence of high blood pressure.

Hemorrhagic stroke begins suddenly, sometimes headache, dizziness, flushing of the face, vision of objects in red light can be the harbingers of impending cerebral hemorrhage. More often during the day, at the peak of physical or emotional activity, during anxiety, when overworked. Hemorrhagic stroke usually affects people 45-60 years of age with a history of causative factors.

Cerebral hemorrhage carries a high risk of death and severe irreversible consequences, up to and including disability.

Thinned vessel walls easily rupture with massive breakthrough of blood. Blood pushes the brain tissue apart and fills the resulting cavity, forming an intracerebral hematoma (blood tumor), which puts pressure on the surrounding tissues, causes compression of the brain stem and damage to vital centers.

There are frequent cerebral hemorrhages in newborns, which occur during difficult and traumatic childbirth. The most common localization of such hemorrhages is the cerebral hemispheres and the posterior cranial fossa.. With a history of cerebral hemorrhage in newborns, the following facts are usually noted:.

first birth with a total duration of the period of contractions and expulsion of 2-3 hours or less;

difficult labor that requires high forceps;

large fetus with relatively small and rigid birth canals.

Hemorrhagic strokes account for 15-20% in the structure of diseases associated with cerebrovascular accidents. They occur with a frequency of 15-35 cases per 100,000 population, and this figure is constantly growing.

Causes of cerebral hemorrhages and risk factors The causes of cerebral hemorrhages can be factors that change the thickness and permeability of the vascular walls, as well as the rheological properties of blood..

The most common ones are:.

hypertension in combination with atherosclerotic lesions of the cerebral arteries;

arterial hypertension;

congenital vascular malformations of the brain (angiomas, cerebral aneurysms);

cerebral atherosclerosis;

blood diseases (polycythemia, leukemia, etc.).

intoxication accompanied by hemorrhagic diathesis (uremia, sepsis);

blood clotting disorders (hemophilia, overdose of thrombolytics).

Transportation of patients with suspected cerebral hemorrhage is carried out with an elevated head end of the trunk.

Risk factors include:.

family history of hemorrhagic strokes;

hypertension, angina pectoris, dyscirculatory encephalopathy in anamnesis;

diabetes;

abdominal obesity;

tendency to microthrombosis;

smoking, alcohol abuse;

sedentary lifestyle;

stress instability.

Forms Depending on the localization, intracerebral hemorrhages are divided into the following types:.

parenchymal (intracerebral) - hemorrhages in the cerebral hemispheres or in the structures of the posterior cranial fossa (cerebellum and brain stem);

ventricular - hemorrhages in the ventricles of the brain;

meninges - hemorrhages in the intershell spaces of the brain;

combined - simultaneously affecting the parenchyma of the brain, membranes and / or ventricles.

Membrane hemorrhages, in turn, are divided into:.

subarachnoid;

epidural;

subdural.

Combined hemorrhages are divided into:.

subarachnoid-parenchymal;

parenchymal-subarachnoid;

parenchymal ventricular.

Stages During the course of the disease, the following stages are distinguished:.

The most acute period - the first 5 days.

II. Acute period - 6-14 days.

III. Early recovery period - 3 weeks to 6 months.

IV. Late recovery period - 6 months to 2 years.

Period of persistent residual effects - over 2 years.

Symptoms of cerebral hemorrhage The clinical picture of cerebral hemorrhage consists of cerebral and focal symptoms.

Cerebral symptoms of cerebral hemorrhage:.

intense headache;

nausea, vomiting, which can be reusable;

high blood pressure;

rapid, short, hoarse breathing;

slow, tense pulse;

profuse sweating (hyperhidrosis);

violation of coordination of movements, orientation in time and space;

hyperthermia up to 41 ° С;

vascular pulsation in the neck;

acrocyanosis (purplish-bluish skin color);

retention of urine or involuntary urination;

paralysis (hemiplegia) or weakening of the muscles in one side of the body in one half of the body (hemiparesis);

articulation disorders;

cognitive impairment;

disorders of consciousness (from stunning to deep atonic coma).

Patients with suspected hemorrhagic stroke are subject to emergency hospitalization.

In the initial phase of a stroke, a coma may develop, which is characterized by a severe disorder of consciousness and impaired cardiac activity and breathing, loss of all reflexes. The patient lies on his back, the angle of the mouth is lowered, the cheek is puffed out on the side of the paralysis (sail symptom), all muscles are relaxed. In this case, hemiplegia is observed on the side opposite to the lesion focus. Usually, the problems are more pronounced in the hands than in the legs..

Focal symptoms are usually combined with cerebral. The severity and nature of the manifestation of focal symptoms depends on the localization of hemorrhage, the size of the hemorrhagic focus, the type of vascular pathology. Symptoms include:.

loss of pupil response to light;

a sharp drop in visual acuity, circles and \;

fading deep reflexes;

increasing respiratory depression and hemodynamics;

seizures;

pathological foot symptoms;

anosognosia;

violation of body schema and right-left orientation;

ataxia;

miosis.

The first two to three weeks after a cerebral hemorrhage are most severe. The severity of the condition in this period is due to the formation of a hematoma and progressive cerebral edema.. By the end of the first month, the cerebral symptoms regress, the more pronounced become due to focal lesions, on which the further course of the disease depends, the complications and consequences of cerebral hemorrhage.

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