Hemorrhagic stroke

Description:

The hemorrhagic stroke is a hematencephalon as a result of a rupture of vessels under the influence of high arterial pressure. In translation from Latin, the stroke means "blow", the root haemo means blood therefore it is correct to write a hemorrhagic stroke, but not a gemmoragichesky stroke.

At a hemorrhagic stroke under the influence of high arterial pressure there is a rupture of a vessel as the wall of an artery is unevenly thinned (for example, atherosclerosis can be the cause of it). Blood under high pressure moves apart tissues of a brain and fills the formed cavity, so there is a blood tumor, or an intracerebral hematoma. Such hemorrhage arises up to 40 years more often.

Symptoms of the Hemorrhagic stroke:

The hemorrhagic stroke arises, as a rule, suddenly, usually at nervousness, exercise stresses, overfatigue. Sometimes the stroke is preceded by "inflows" of blood to the person, an intensive headache, vision of objects in red light. Development of a stroke usually acute (apoplexy). At the same time the sharp headache, vomiting, breath increase, bradi-or tachycardia, a hemiplegia or a hemiparesis, consciousness disturbance (devocalization, a sopor or a coma) are characteristic. Coma can develop in an initial phase of a stroke, and the patient at once appears in critical condition.

Breath is noisy, stertorozny; skin is cold, pulse intense, slowed down, arterial pressure usually high, the look is often turned towards the pathological center, sometimes on the party of hemorrhage a mydriatic pupil, discrepancy of eyes, the "floating" movements of eyeglobes are possible; on the party opposite to the pathological center an atony of an upper eyelid, the mouth corner is lowered, the cheek at breath "parusit", hemiplegia symptoms often are found: the expressed hypotonia of muscles, the raised hand falls as "lash", decrease in tendon and cutaneous reflexes, rotirovanny stop of a knaruzha. Quite often there are meningeal symptoms.

Extensive hemorrhages in a big parencephalon quite often are complicated by a secondary trunk syndrome. It is shown by the progressing disorders of breath, cordial activity, consciousness, changes of a muscle tone as a gormetoniya (periodic tonic spasms with sharp increase in a tone in extremities) and a cerebrate rigidity, vegetative frustration.

In a brainstem disturbances of vital functions, symptoms of defeat of kernels of cranial nerves and paresis of extremities which are sometimes shown in the form of alternating syndromes are characteristic of hemorrhages. The strabismus (squint), an anisocoria, a mydriasis, the "floating" movements of eyeglobes, a nystagmus, swallowing disturbances, cerebellar symptoms, bilateral pyramidal reflexes are often observed. At hemorrhage to the bridge the miosis, look paresis towards the center are noted (the look is turned towards the paralyzed extremities).

Early increase in a muscle tone (gormetoniya, cerebrate rigidity), look paresis up and lack of pupillary tests (Parino's symptom) arise at hemorrhages in oral departments of a brainstem. The centers in lower parts of a trunk are followed by an early hypomyotonia or an atony, signs of a bulbar syndrome. The expressed dizziness, a miosis, a nystagmus, Gertviga-Marangdi's symptom (the dispersing squint in the vertical plane), repeated vomiting, sharp pain in a nape and a neck, hypotonia or an atony of muscles, bystry increase of intracranial hypertensia, absence of paresis of extremities, an ataxy are characteristic of hemorrhage in a cerebellum.

At a parenchymatous ventrikulyarnoy of a hemorrhage expressiveness of disorders of consciousness quickly increases, the condition of vital functions worsens, there are bilateral pyramidal reflexes, protective reflexes, gormetoniya, vegetative symptoms go deep (there are an oznobopodobny trembling, cold sweat, a hyperthermia).

The heaviest complications of a hemorrhagic stroke are wet brain, break of blood in cerebral cavities, a prelum and shift of a brain trunk. At the extensive polusharny hemorrhages complicated early by the joined break of blood in ventricles the coma masking focal symptoms, and quickly in several hours develops at once, and sometimes at once there comes the lethal outcome. Also quickly death comes at the hemorrhage in a cerebellum and a brain trunk complicated by break of blood in the IV ventricle. The lethality at hematencephalons high also fluctuates within 60-90%.

At limited lateral polusharny hematomas consciousness is usually broken not so deeply. The condition of patients at first is stabilized, and then improves: consciousness becomes m are clear, etat vny frustration decrease вег, signs of the WTO of a river trunk syndrome disappear, focal symptoms gradually decrease. After the period of an early muscular hypertension and hypotonia (is more often from 3rd week of a disease) the late hemiplegic hypertension of spastic type with a characteristic pose of Vernike – Mann (bending of a forearm, pronation and bending of a brush, bending of fingers, extension of a hip and shin) begins to form.

Subarachnoidal hemorrhage. Arises owing to a rupture of aneurism of vessels of the basis of a brain more often, is more rare – at a hypertension, atherosclerosis of vessels of a brain or other vascular diseases. At a part of patients before development of hemorrhage attacks of the associated migraine in the form of acute pains in frontal and orbital area in combination with symptoms of paresis of a third cranial nerve are observed. Occasionally a harbinger of subarachnoidal hemorrhage are dizziness, "flashing" in eyes, noise in the head. Development of subarachnoidal hemorrhage usually happens acute, without harbingers. There is a sharp headache ("blow in a nape", "distribution in the head of hot liquid") which can be local in the beginning (in a forehead, a nape), then becomes diffuse. Quite often pain is noted in a neck, interscapular area. Along with a headache there are nausea, vomiting, short-term or long disorder of consciousness, psychomotor excitement. Epileptic seizures Quickly are possible meningeal symptoms (rigidity of cervical muscles, Kernig's signs, Brudzinsky, etc.), a photophobia develop. The focal brain symptomatology at the initial stage of hemorrhage comes to light not always, however at a rupture of basal arterial aneurisms signs of damage of cranial nerves, especially oculomotor, sometimes an optic nerve or visual decussation are possible. Fervescence is noted. There can be respiratory and cardiovascular frustration.

Reasons of the Hemorrhagic stroke:

The most frequent reasons of a hemorrhagic stroke – a hypertension, symptomatic arterial hypertension and congenital vascular anomalies, first of all aneurisms of vessels of a brain. Development of a hemorrhagic stroke against the background of disturbance of coagulability of blood (hemophilia, overdose of trombolitik) is possible.

Treatment of the Hemorrhagic stroke:

The first and most important rule - to begin treatment of a hemorrhagic stroke with stem cells at once. Recovery therapy after a stroke has to be carried out in the mode of "ambulance" is a guarantee of return of the patient to normal life and "a biological insurance". That is why it is necessary to have the bank of stem cells just in case!

Experience showed that the stem cells entered intravenously can get into a brain, replacing the damaged neurons (a brain cell) in that place where there was a hematoma, and thus to carry out treatment of a hemorrhagic stroke.

Whether the person had a microinsult or an extensive stroke, treatment by stem cells it is capable to return it to normal life!

Besides, stem cells synthesize substances, the activating regeneration processes therefore there are new blood vessels and nervous cells that involves recovery of functions of a brain, and it, in turn, eliminates neurologic symptoms of a disease.

In a word – treatment of a stroke stem cells is one of the most effective methods of rehabilitation. The clinic helped a huge number of people to be recovered. And this main proof that stem cells provide efficient treatment of an ischemic stroke, hemorrhagic stroke and their effects.

But the disease is always more difficult to treat, than to prevent it. If your plans are not a gemmoragichesky stroke, prevention has to be one – lead a healthy lifestyle, and, first of all, avoid stresses.

And if you already have cardiovascular diseases - a hypertension, atherosclerosis - or just increased cholesterol level in blood, you idle time need to complete a course of cellular therapy in time!

Medical actions at ONMK should be begun as soon as possible, it is desirable in an interval of "a therapeutic window" – in the first 3–6 h from the moment of development of a disease. Adequacy to their condition of the patient and intensity substantially define the further course and an outcome of a disease. Hospitalization in a neurologic or neurovascular hospital, in case of development of an extensive stroke – to the intensive care care unit is shown to patients. Considering the high frequency of a combination of vascular damage of a brain and heart, most of patients needs consultation of the cardiologist. Whenever possible in the earliest terms it is necessary to resolve an issue of need and a possibility of neurosurgical treatment. Hospitalization of patients in a condition of a deep coma with disorders of vital functions, heavy organic dementia, nekurabelny oncological diseases is inexpedient.

The bed rest before the end of the acute period and stabilization of a state is necessary for patients with PNMK. Hospitalization is shown in case of acute hypertensive encephalopathy, heavy hypertensive crisis, repeated TIA. The indication for го spitalization serve also lack of effect of the therapy which is carried out in out-patient conditions and an exacerbation of associated diseases, in particular to an ischemic heart disease.

There are two main направ the line of treatment – differentiated, depending on the nature of a stroke (hemorrhagic or ischemic) and undifferentiated (basic), directed to maintenance of vital functions and correction of a homeostasis.

Undifferentiated treatment. Correction of activity of cardiovascular system first of all is directed to control of arterial pressure. Its figures have to on 15 - 25 mm of mercury. to exceed usual for the patient. It is necessary to avoid a rare lowering of arterial pressure in order to avoid development of a syndrome of burglarizing. Hypotensive therapy includes use a beta of adrenoblockers (анаприлин, атенолол), blockers of calcium channels (both short-term action – nifedipine, and prolonged – амлодипин), diuretics (furosemide), if necessary – APF inhibitors (captopril, enalapril). At impossibility or inefficiency of oral administration drugs enter intravenously kapelno under control of arterial pressure. At development of arterial hypotension appoint cardiotonic means (a phenylephine hydrochloride, Cordiaminum), in the absence of effect – intravenous administration of corticosteroids (a hydrocortisone, dexamethasone). In the presence of indications carry out correction of disturbances of coronary circulation, sharply arisen disturbances of a cordial rhythm and conductivity and heart failure

Control of function of a respiratory organs includes ensuring passability of respiratory tracts a toilet of an oral cavity and nose, removal of a secret and emetic masses from upper respiratory tracts by means of a suction. The intubation and transfer of the patient into artificial ventilation of the lungs are possible. At edematization of lungs administration of cardiac glycosides (Korglykonum, strophanthin), diuretics is required. In case of a heavy stroke from first days it is necessary to begin introduction of antibiotics of a broad spectrum of activity (synthetic penicillin, cephalosporins) for prevention of pneumonia. For the purpose of prevention of developments of stagnation in lungs it is necessary to begin in the earliest terms active and passive (including a turning with a side sideways) respiratory gymnastics.

Maintenance of a homeostasis requires introduction of adequate quantity salt a rastvo a ditch (2000–3000 ml a day in 2–3 at an em): Ringera – Locke, isotonic solution of sodium chloride, 5% of solution of glucose, at the same time it is necessary to control a diuresis and expiratory losses of liquid. Considering that at patients with a stroke acidosis quite often develops, use of 4-5% of solution of sodium bicarbonate, 3,6% of solution of Trisaminum is shown (under control of indicators of BRAIDS). If necessary the content in blood of potassium ions and chlorine korrigirutsya. In the acute period of a stroke patients have to receive a diet, vitamin-rich and proteins, with the low content of glucose and animal fats. At swallowing disturbances food is entered via the nazogastralny probe.

Fight against hypostasis of a brain includes use of corticosteroids, first of all Dexasonum (16–24 mg a day, 4 introductions) or Prednisolonum (60–90 mg a day). A contraindication to their use are not stopped arterial hypertension, hemorrhagic complications, severe forms of a diabetes mellitus It is shown глицерол to perosa also intravenous drop administration of osmotic diuretics (15% Mannitolum solution, Rheoglumanum) or saluretics (furosemide).

Control of vegetative functions includes regulation of activity of intestines (a diet rich with cellulose and lactic products, if necessary – use of laxative drugs, cleansing enemas) and urinations. If necessary the bladder zation, purpose of uroseptik for the purpose of prevention of the ascending infection of urinary tract is carried out a catheter. From first days regular processing of integuments by antiseptic drugs for the prevention of decubituses is required, use of functional antidecubital mattresses At a hyperthermia is desirable – use of antipyretics

The differentiated treatment. The main directions of the differentiated therapy of acute disorders of cerebral circulation – recovery of adequate perfusion in a zone of an ischemic half-shade and restriction of the sizes of the center of ischemia, normalization of rheological and coagulant properties of blood, also stimulation of reparative processes in nervous tissue is sewn up neurons from the damaging action of ischemia.

One of the most effective methods of treatment is hemodilution – administration of the drugs reducing hematocrit level (to 30–35%). It is for this purpose used реополиглюкин (реомакродекс) which daily volume and rate of administering are defined by both hematocrit indicators, and level of arterial pressure and existence of symptoms of heart failure. With a low arterial pressure use of Polyglucinum or saline isotonic solutions is possible. Solutions of an Euphyllinum, pentoksifillin (trental), a nitsergolin (sermion) are at the same time intravenously appointed. In the absence of disturbances of a cordial rhythm it is applied винпоцетик (Cavintonum). In process of stabilization of a condition of the patient intravenous administration of drugs is replaced with oral administration. The most effective are acetylsalicylic acid (1–2 mg/kg of body weight), it is desirable to use drug forms. having the minimum negative effect on a mucous membrane of a stomach (тромбоасс): пентоксифиллин, cinnarizine, Prodectinum (ангинин).