Signs of a stroke harbingers the first manifestations of symptoms and their classes of difference

The nosological form includes two terms: “hemorrhage” is a hemorrhage, and the word “stroke” means a heart attack (ischemic necrosis) of a part of the brain.

Hemorrhagic stroke is a hypertensive hemorrhage in the brain parenchyma, accompanied by acute disturbance of cerebral circulation, loss of function of the affected area, development of pathogenesis in the nucleus and perifocal (around the nucleus) zone. The disease is manifested by general and local neurological symptoms.

More severe pathogenesis compared with ischemic stroke is associated with the cumulative effect of:

Hemorrhages in the brain tissue, compression of the surrounding vessels;

Inflammatory and necrotic processes in the core of a stroke;

Dystrophic and inflammatory processes on the periphery of the nucleus.

There are two main types of hemorrhages in the brain, which have a different origin:

Hemorrhagic stroke (GI) – hemorrhage / saturation of the brain parenchyma;

Subarachnoid hemorrhages (SAH) are hemorrhages in the cerebral cortex of a non-traumatic nature, not connected in any way with vascular malformations.

At the initial observation of a patient, hemorrhage is diagnosed as intracerebral hematoma (VMH). Differentiation is carried out in the clinic based on the results of instrumental (MRI, CT) imaging of the structures of the brain and cranium.

There are several options for the localization of hemorrhages in the brain, namely:

Putuminal lateral (lateral) – on the side of the inner capsule;

Lobar – in the first lobe of the brain;

Talamic (medial) – located to the center of the inner capsule;

Putamenal strokes are widespread – they make up half of all types of hemorrhagic strokes, subcortical and thalamic strokes are less common – about 15% for each type. Hemorrhages in the cerebellum and brain stem are detected much less frequently – up to 8% of all strokes.

The most severe lesions of the body are massive hemorrhages in the hemisphere, trunk or cerebellum of the brain. Hemorrhagic strokes often develop in men who are prone to hypertension and have bad habits. The likelihood of brain hemorrhage increases with age.

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Treatment of hemorrhagic stroke

There is a generally accepted algorithm for choosing a method for the treatment of hemorrhagic stroke.

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Surgical tactics are indicated for:

Lobar and lateral hemorrhages of medium and large volume;

Deterioration of the patient in a dynamic CT / MRI study;

Hematomas of the cerebellum and brain stem, causing neurological symptoms.

Contraindications of surgical tactics:

Deep coma with stem dysfunctions (100% mortality);

Medial hematomas of any size (mortality 90-100%).

Conservative therapy is indicated for:

The stable condition of the patient and the absence of neurological deficit;

Small supratentorial hematomas.

There are two main approaches to performing an operation, namely:

Classical microneurosurgical interventions;

Endoscopic techniques of microneurosurgery.

Visual verification of hematomas before surgery includes CT, MRI, cerebrovascular angiography and other indications.

Surgical intervention is prescribed according to the results of neuroimaging:

The volume of VMG is more than 30 ml;

The location of brain tanks;

Deterioration of the clinical and neurological status.

Given the qualification of the surgical team, the best results are shown by the endoscopic technique (sparing, makes it possible to visualize the cavity of the operation). The classic method of microsurgical intervention is good for the difficulties of controlling homeostasis of the brain tissue.

Here we present drugs of different pharmacological groups used for the treatment of an acute period of hemorrhagic stroke. Regulation of blood pressure and angiospasm is necessary in the acute period of hemorrhagic stroke.

Selective beta-blockers (Atenolol, Metoprolol, Betaxolol, Bisoprolol, Nebivolol, Esmolol, Acebutolol);

Non-selective beta-blockers (Anaprilin, Nadolol, Sotalol, Timolol, Oxprenolol, Pindolol, Penbutolol);

Mixed beta-blockers (Carvedilol, Labetalol).

The first generation (Isoptin, Finoptin, Phenigidin, Adalat, Corinfar, Kordafen, Cordipin, Diazem, Diltiazem);

Second generation (Gallopamil, Anipamil, Falipamil, Isradipine / Lomir, Amlodipine / Norvask, Felodipine / Plendil, Nitrendipine / Octidipine, Nimodipine / Nimotop, Nicardipine, Lacidipine / Lacipil, Riodipine / Foridon);

The third generation (Klentiazem).

Direct action (Papaverine, No-shpa, Drotaverin, Nitroglycerin, Otilonia bromide, Mebeverin, Halidor, Gimekromon);

Indirect action (Aprofen, Ganglefen, Atropine, Difacil, Buscopan).

ACE inhibitors (angiotensin-converting enzyme):

Sulfhydryl group (Benazepril, Captopril, Zofenopril);

Carboxyl group (Cilazapril, Enalapril, Lisinopril, Perindopril, Quinapril, Ramipril, Spirapril, Thrandolapril);

Phosphinyl group (fosinopril).

The following auxiliary medications are used to treat hemorrhagic stroke:

Sedatives (Diazepam, Elenium, Phenobarbital);

Hemostatic (Dicinon / Ethamsylate, Rutin, Vikasol, Ascorbic acid);

Antiprotease (Gordoks, Kontrikal);

Multivitamins with micro and macro elements (Calcium pantothenate, Calcium gluconate);

Antifibrinolytic (Gamma-aminocaproic acid, Reopoliglukin);

Laxatives (Regulax, Glaxena).

Preparations for the regulation of intracranial pressure and cerebral edema:

Diuretics (Mannitol, Lasix);

Thus, hemorrhagic stroke is a severe form of acute cerebrovascular accident, which is characterized by a high level of mortality and disability. The recovery period can last up to two years. Rehabilitation is aimed at teaching the patient how to overcome a neurological deficit. Disability is accompanied by a significant decrease in the quality of life of the patient and his environment.

Article author: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005, an internship was held at the First Sechenov First Moscow State Medical University and a diploma in neurology was obtained. In 2009, graduate school in the specialty “Nervous Diseases” was completed.

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Development mechanism

Stroke is an acute course disorder characterized by a rapid course. The disease occurs due to malfunctioning of blood vessels or their damage. The main difference between hemorrhagic and ischemic stroke is the causes of each of them.

  1. Hemorrhagic – occurs due to a violation of the integrity of the vessels of the brain. Internal hemorrhage develops. Blood stops flowing to certain parts of the body. At the same time, fluid accumulates. As a result of this, intracranial pressure increases, and other parts of the brain are affected.
  2. Ischemic – develops due to worsening patency of a blood vessel, but at the same time its integrity is not violated. Atrophy occurs in the brain tissue, a process accompanied by a lack of oxygen and nutrients. In the future, nerve cells die, which leads to irreversible consequences.

Risk Factors

Vascular disorders creating a deficiency of cerebral blood supply do not occur without cause. A stroke is triggered by a number of factors affecting the condition of the supply arteries; These include:

  • High blood sugar.
  • Bad habits.
  • Abuse of fatty foods.
  • Systematic stresses.
  • Hypertension.
  • Overweight.
  • Endocrine diseases.

Thus, the main difference between ischemic and hemorrhagic stroke is the mechanism of development of pathology.

Symptomatic manifestations in acute violation of the blood supply to brain tissue are very similar. This significantly complicates the diagnosis and early care of the patient. However, some symptoms may vary.

1. The hemorrhagic type is characterized by a rapid onset, rapid development of symptoms. As a rule, it has a paroxysmal course, occurs after exposure to a stress factor, physical exertion, against the background of overwork. Sometimes at an early stage of development the patient has a flush of heat, accompanied by redness of the skin.

  • Headache.
  • Short-term loss of consciousness.
  • Cold sweat.
  • Increased blood pressure.
  • Dilation of pupils.
  • Disorders of motor activity of the limb.
  • Reflex dysfunction of the skin and tendons.

2. The ischemic type is characterized by the gradual development of clinical manifestations. Symptoms are primarily of a neurological origin. The patient often changes in behavior, there are attacks of anxiety, panic, aggression, fear, sudden changes in mood.

The following symptoms are inherent in ischemic stroke:

  • Violation of spatial coordination.
  • The development of speech defects or inability to speak.
  • Swallowing reflex dysfunction.
  • Partial or complete paralysis (sometimes on one side of the body).
  • Urination disorders, urinary incontinence, involuntary bowel movements.
  • Deterioration of memory and vision.
  • Violation of the logic of thinking.
  • Pain in the head is usually pulsating.
  • High pressure.

3 ,. Subarachnoid hemorrhage is a pathological phenomenon that develops against the background of hemorrhagic stroke. Due to damage to blood vessels, blood enters the space between the arachnoid and soft membranes of the brain. This is the most common complication of hemorrhagic stroke. It can also be a consequence of head injuries and can be considered as an independent pathology. The patient’s condition can be extremely difficult.

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Clinical signs of subarachnoid hemorrhage:

  • Intense headache.
  • Loss of consciousness.
  • Impaired orientation in space.
  • Anxiety.
  • Convulsive seizures.
  • Vomiting reflex.
  • Heart rate increase.
  • High body temperature.
  • Deterioration of hearing.
  • Motor impairment.

The likelihood of a fatal outcome with subarachnoid hemorrhage is about 35%. With the repeated development of pathology, the risk increases to 50%.

Men should know

The harbingers of stroke in men are largely similar to female symptoms, but at the same time they have their own characteristics. So, you should be wary if the following signs of an impending stroke are observed:

  • the appearance of muscle weakness in the limbs (“cotton” legs and arms);
  • impaired vision in one of the eyes;
  • shortness of breath of unknown origin appears;
  • any part of the body is numb (upper or lower limb, half of the face or tongue);
  • speech is disturbed;
  • local headaches occur, or the pain spreads throughout the head;
  • dizziness appears;
  • impaired coordination of movements;
  • for no particular reason, nausea and vomiting occur.

Features of manifestations in women

Due to physiological characteristics, the signs of an approaching stroke in men and women are somewhat different, although the overall picture is similar. The harbingers of a possible stroke in a woman:

  • for no apparent reason, severe headaches appear;
  • upper and lower limbs go numb on the right or left;
  • vision is impaired, the appearance of double vision in the eyes is often observed;
  • nausea, vomiting and hiccups periodically occur;
  • facial muscles weaken, signs of numbness are observed;
  • gesticulation and speech are difficult;
  • sensitivity to pain and temperature changes is impaired;
  • the patient loses consciousness for a short time;
  • there are bouts of severe dizziness;
  • convulsions appear (not in each case).

In addition, there are changes in the emotional state of women, a depressed state is replaced by bouts of irritability for no reason.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.