Hemorrhagic stroke symptoms first signs

The brain is protected from ischemia: brain nutrition comes from several sources. When the blood supply is blocked in one vessel, the area adjacent to it does not die off, but begins to be fed from a reserve source.

With bleeding, the department is filled with blood and ceases to fulfill its functions. The securing artery continues to nourish it, excluding the death of cells, until the complete utilization of blood clots in a natural way.

The brain substance has good elasticity. With severe bleeding, the sections move away from each other, and the space is filled with blood – a hematoma is formed. But at the same time there is pressure on the areas of the brain, since the movement is limited by the bones of the skull.

With hemorrhage, tissue edema occurs, as around a wound on the skin. Disturbed normal blood circulation, and a high probability of developing coma.

The skull has various openings for blood vessels and nerves. When hematomas or edema appear, the brain shifts, wedges into them, while blood supply is minimized, which leads to the death of cells, and then the person himself.

After damage to the vessel, blood actively flows out of it. The duration of the process is from a minute to several days.

Bleeding stops only after the formation of a blood clot.

The brain is quite well protected from ischemia, that is, from the condition that can occur when more than 70% of the lumen of one of the arteries of medium or small diameter overlaps. This is due to two circles on its basis:

  1. The first circle, called Willisiev, is formed by the branches of the carotid arteries and vertebral arteries that go into the cranial cavity from the chest cavity. So the hemispheres of the brain and their main divisions-lobes are supplied with blood: frontal, temporal, parietal and occipital. From here, the main endocrine organs – the pituitary and hypothalamus – get blood supply.
  2. The brain stem – its department, consisting of several parts that differ in structure and function – is supplied with blood from the vertebral and spinal arteries, which also form a vicious circle. The brain stem is the part that “grows” from the middle of the brain. It consists of several parts, one of which is the medulla oblongata, and, leaving the cranial cavity, without visible anatomical transitions, it becomes the spinal cord. And if there are centers in the hemispheres that are responsible for speech (recognition and reproduction), limb movements, sensitivity of different parts of the body, the brain stem consists of departments that are responsible for vital functions – breathing, heartbeat, and swallowing.

From arteries of medium caliber, forming the two circles described above, smaller branches depart and it turns out that each part of the brain receives nutrition from several sources. This was invented so that if one branch ceases to function, the portion it feeds does not die. But if there is bleeding from a branch, that section (large – if the branch was large or small, if it had a small diameter) is impregnated with blood and “turns off”, ceasing to function.

There are ventricles in the brain. These are cavities lined with special cells from the inside, which can produce cerebrospinal fluid and serve as its conductors inside the brain. For their normal functioning, the ventricles of the brain are richly supplied with blood.

The substance of the brain has a rather elastic consistency. If bleeding occurs, and a lot of blood enters the brain, the sections move away from each other, and in the middle a section filled with blood is formed – a hematoma. It compresses the zones lying around the perimeter, and compresses the vessels supplying them, causing a violation of the blood supply.

Also, if a hemorrhage occurs in the brain, its compressed areas swell, as do the skin cells around the scratch. Such edema further disturbs the blood circulation in the cranial cavity. It is the reason why coma develops with a stroke.

The brain itself is covered on the outside with several shells that protect it from traumatic effects. The upper and middle are fairly closely adjacent to each other, but between them, with the appearance of additional fluid, there are gaps. Between the middle and lower cerebrospinal fluid circulates – cerebrospinal fluid. If the vessel is damaged and blood escapes from it between the membranes, the following will happen:

  • blood mixes with cerebrospinal fluid, due to which the volume of fluid circulating in the cranial cavity increases. This leads to an increase in intracranial pressure;
  • blood in the cerebrospinal fluid coagulates, forming clots. The latter can block those ducts along which cerebrospinal fluid circulates, as a result of the cerebrospinal fluid paths “swell” and swell;
  • blood clots, when dissolved, become inflamed and can cause meningitis (inflammation of the meninges) or even meningoencephalitis (inflammation of both the membranes and brain matter).

In the cranial cavity there are many holes of various diameters through which the vessels, nerves, and parts of the brain pass. The largest of them is the large occipital foramen through which the medulla oblongata emerges. Brain edema or a hematoma arising on it can “shift” the brain towards one of these “wells”, surrounded by a dense (bone or connective tissue) ring.

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The causes of this condition

The causes of hemorrhagic stroke are directly related to high blood pressure. In 85% of cases, patients had thin vessel walls for unknown reasons. With any voltage (stress, cough), the integrity of the vessel is violated. The onset of stroke is contributed by:

  1. arteriovenous malformation is a congenital disorder of the connection between veins and arteries. Blood from the arteries does not enter the capillaries, but enters the vein – intravascular pressure rises. Pathology is common in children and young people;
  2. atherosclerosis – lipids form plaques, which leads to a decrease in the inner diameter of the vessels. Light exercise, overheating, or stress are dangerous. Dyslipidemia can lead to atherosclerosis – a violation of lipid metabolism with a high concentration of cholesterol;
  3. pathology of the walls of the vessel due to:
  • inflammatory reactions that change connective tissue;
  • beriberi;
  • chronic intoxication;

The walls of the vessels become thinner or stretch and aneurysm appears at high pressure. With any stress, malfunctioning of the kidneys, smoking or physical exertion, the saccular expansion breaks:

  • aneurysms of any nature;
  • amyloid angiopathy. Amyloid beta protein accumulates on the walls, which leads to a loss of arterial flexibility and an increase in their fragility. Whenever possible damage to the vessel wall can occur, as a result, blood enters the brain tissue;

They increase blood viscosity and force the heart to work more actively;

  • overdose of anticoagulants;
  • increase in blood viscosity after taking narcotic substances, contraceptives;
    violation of the integrity of blood vessels going to the tumor. They are damaged spontaneously or under the influence of high blood pressure;
  • pregnancy and childbirth. Among female patients, 30% had a stroke after childbirth. This is due to severe blood loss and malfunctions in the functioning of the cardiovascular system.

In the remaining 15% of cases of hemorrhagic stroke, the causes cannot be determined.

However, to start the process, a factor is always required that causes an increase in pressure in the vessels of the brain:

  • overheat;
  • excessive exercise;
  • stressful situation;
  • active smoking;
  • alcohol abuse.

Increase the likelihood of a stroke: constantly high blood pressure (above 160/90), atrial fibrillation, left ventricular hypertrophy, diabetes mellitus, physical vascular pathology.

Unrecoverable risk factors:

  • age from 60 years;
  • male gender;
  • hereditary predisposition.

There are other causes of this serious illness. It:

  • Arteriovenous malformations are incorrectly connected arteries and veins, when blood from an artery, bypassing the capillary system, enters immediately into a vein. The pressure in the vein, not designed for that in the artery, rises. Under its action, the venous wall gradually becomes thinner, and at some unfavorable moment (for example, during stress, sneezing or coughing, when the pressure rises), such a vascular connection ruptures. Arteriovenous malformations are the main cause of hemorrhagic strokes in young people and even children.
  • Atherosclerosis. A dense plaque formed from lipids leads to damage to the arterial wall. As a result of physical activity, smoking, overheating, stress or drinking alcohol at some point, the artery below the plaque is damaged and a hemorrhagic stroke occurs.
  • Changes in the walls of the vessels of the brain with:
    • their inflammation (vasculitis), which most often accompanies systemic diseases of the connective tissue (for example, lupus erythematosus);
    • chronic intoxications (production products, alcohol, nicotine);
    • vitamin deficiency C or mixed.

In this case, a malfunction of the inner layer of the arteries is noted, and with a periodic increase in blood pressure, an aneurysm (saccular expansion) is gradually formed here. At one time, arterial hypertension caused by stress, physical exertion, kidney or adrenal gland disease, heavy libation or smoking leads to a rupture of such an aneurysm, which is why hemorrhagic stroke develops.

  • Congenital aneurysms or those that arise in the process of life due to increased pressure (especially this often happens in places where the vessels of the brain depart from each other at right angles). In these cases, the mechanism of stroke is described above.
  • Amyloid angiopathy. In this case, a special protein, amyloid, is deposited in the arterial wall. Because of it, the artery for some extent becomes “glazed”, does not show the usual “flexibility” with increases and decreases in blood pressure. At a certain moment, which cannot be predicted, when the pressure is once again greatly increased, the wall of the vessel affected by amyloid deposition “breaks”, blood flows into the cranial cavity.
  • Blood diseases: erythremia (increased red blood cell count), thrombophilia (high platelet count). Such pathologies lead to an increase in blood viscosity. As a result, in order for the blood to be delivered to the brain, the heart has to push it under high pressure.
  • Overdose of blood thinners (anticoagulants): Warfarin, low molecular weight heparin and others.
  • Taking drugs that increase blood viscosity: oral contraceptives, drugs (cocaine, amphetamines).
  • Rupture of the vessels that fed the tumor. Arteries leading to the intracranial tumor, convoluted, multiple. They are prone to spontaneous rupture, but are most often damaged due to increased blood pressure.
  • In 15% of cases, the cause cannot be determined.

Whatever the cause of hemorrhagic stroke, a provoking factor is needed for its occurrence. Such a trigger moment are conditions leading to an increase in pressure. It:

  • overheating in the sun or indoors;
  • stress;
  • inadequate physical activity;
  • hypertensive crisis;
  • smoking a large number of cigarettes in a short period of time;
  • intake of a large amount of alcohol.

These factors are especially dangerous if:

  1. often noted and does not decrease pressure above 160/90 mm Hg (the risk is 4 times higher than those whose pressure is lower than 140/89 mm Hg);
  2. a person smokes for a long time and / or smokes a lot of cigarettes per day;
  3. there is atrial fibrillation (the risk of stroke is 3-4 times higher than in the absence of arrhythmias);
  4. a person suffers from coronary heart disease (the risk doubles);
  5. there is left ventricular hypertrophy, determined by ECG or ultrasound of the heart (the risk increases 3 times);
  6. there is heart failure, manifested by swelling on the legs, shortness of breath during exercise or even at rest (the risk increases 3-4 times);
  7. a person suffers from diabetes;
  8. the structure or relative position of the vessels carrying blood to the head is disturbed.

Risk markers also include factors that cannot be corrected. These are: male gender, age over 60 years, heredity in the form of hemorrhagic strokes already encountered in the next of kin.

When rupture of an artery, microaneurysm, or malformation occurs, bleeding begins, which lasts from several minutes to several days, until a blood clot forms in the deformed vessel.

The mechanism of the development of hemorrhagic stroke, as well as the causes of its appearance, are well understood, however, this disease is still difficult to diagnose. To facilitate the task of the doctor, as well as protect yourself from serious consequences, it is worth remembering the factors that can provoke pathology.

Most often, people who have been diagnosed with an ailment are:

  • arterial hypertension and hypertension (they account for up to 85% of all diagnoses);
  • congenital or acquired vascular aneurysm;
  • arteriovenous malformations;
  • vasculitis, inflammatory and dystrophic changes in the walls of blood vessels;
  • blood diseases in which the process of its coagulability is disturbed, for example, hemophilia;
  • cirrhosis of the liver, which entails a decrease in the level of red blood cells;
  • congenital defects of blood vessels of the brain or inflammation of their walls;
  • avitaminosis;
  • diabetes;
  • brain tumors;
  • cardiovascular and spinal cord diseases;
  • amyloid angiopathy, which is manifested by the deposition of protein on the walls of blood vessels;
  • intoxication.
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In addition, at risk are people who:

  • abuse alcohol;
  • smoke
  • use drugs;
  • suffer from obesity or lipid disorders;
  • abuse fatty and meat foods;
  • constantly in a state of nervous strain or subject to frequent stresses;
  • suffered sunstroke or heat stroke;
  • hard work (meaning physical labor);
  • have relatives with such a pathology (in this case we are talking about heredity).

Classification

The division of the stroke into types depends on the location of the bleeding site:

  1. intracerebral – blood enters the brain tissue. Depending on the location of the lesion, there are:
    hemispheric;
  2. subcortical;
  3. stem;
  4. cerebellar.
    subarachnoid hemorrhage – in the space between the membranes. Distinguish:
  • basal;
  • convexital;
  • ventricular – blood enters the ventricle;
  • mixed – occurs simultaneously in several places.

With hemorrhagic stroke, hematomas arise, which also have their own classification:

  • intracerebral – in the lobes of the brain, subcortical nuclei, thalamus;
  • subdural – under the meninges.

Hematomas are distinguished by the size that can be determined by MRI or CT. The volume is affected by vessel diameter, blood coagulation and pressure.

Each pathology provokes the appearance of a hematoma in a certain place. For example, with hypertension, a hematoma forms in the cerebellum, bridge, or nuclei.

According to the time elapsed since the development of pathology, there are:

  1. Acute periodin which, due to hemorrhage, pressure in the cranial cavity rises. At this point, blood continues to accumulate, acting on the nervous tissue and provoking the appearance of cerebral edema. The maximum period that an acute period can last is up to 7 days.
  2. Recovery phase – characterized by the development of reparative processes, blood removal and tissue repair. It can last up to several months, starting from 2 to 4 weeks.
  3. Residual period. It stretches for life. In the case of timely provision of qualified medical assistance, patients not only restore speech and body functions, but also retain their ability to work.

Depending on the location of the lesion, there are:

  • Subaranchoidal hemorrhage – characterized by accumulation of blood under the meninges. It develops due to aneurysm or vascular pathologies.
  • Parenchymal hemorrhage – The most popular species, characterized by the ingress of blood into the substance of the brain. As a result, a person is diagnosed with a hematoma – a cavity with blood, entailing the death of surrounding cells and, thereby, increasing the risk of death, or hemorrhagic impregnation. The latter is characterized by the entry of blood into the nervous tissue and manifests itself with an increase in vascular permeability or with the use of anticoagulants. Due to the smaller effect on the tissue than in the case of a hematoma, the prognosis of its treatment is favorable.
  • Intraventricular hemorrhage – is fixed when the vascular plexus ruptures and often ends with hydrocephalus and cerebral edema. Despite all the efforts of doctors, such patients die already 2 to 3 days after the development of hemorrhagic stroke.
  • Sub- and epidural hemorrhages – they are traumatic in nature.

Note! There are also mixed hemorrhages, in which there are changes characteristic of different types of stroke.

Depending on the location of the hematomas, subdural and intracerebral are distinguished. The first are found under the dura mater.

Intracerebral can be in different areas, because of what this type of stroke is divided into:

  • lateral – localized in the subcortical nuclei;
  • lobar – in the lobes of the brain, capturing white and gray matter;
  • medial – in the thalamus area;
  • mixed – hematomas appear in several places at once.

Intracranial hemorrhages are classified depending on the location of the spilled blood. The following types of hemorrhages are distinguished:

  • intracerebral (parenchymal)
  • subarachnoid
  • ventricular
  • mixed (subarachnoid-parenchymal-ventricular, parenchymal-ventricular, etc.)

Hemorrhagic stroke – symptoms

Symptoms can tell about the approaching hemorrhagic stroke:

  • severe pain in the eyeballs;
  • loss of balance;
  • tingling or numbness of legs, arms, or parts of the body;
  • difficulty understanding speech or slurred speech of the person himself.

Similar symptoms are observed only in half of patients with hemorrhagic stroke; the same manifestations may indicate a developing ischemic stroke or transient ischemic attack (it is popularly called a “microstroke”).

A high probability of a hemorrhagic stroke is indicated by:

  • Dizziness;
  • Change in skin sensitivity;
  • Intermittent pulse;
  • Flushed face;
  • Numbness of one or more limbs;
  • Persistent headache;
  • Attacks of causeless nausea and vomiting, which does not bring relief.

Signs of a hemorrhagic stroke in a conscious person:

  • Rapidly growing headache;
  • Nausea, vomiting;
  • Heart palpitations;
  • Intolerance of bright light, “circles” and “midges” before the eyes;
  • paresis, paralysis of the arms, legs, face muscles;
  • Difficult speech.

There are four distinct stages of regression of consciousness:

  • Stunning – a misunderstood look of the patient, poor response to others;
  • Somnolence – resembles a dream with open eyes, the gaze fixed on space;
  • Sopor – resembles a deep sleep, a weak reaction of the pupils, a light touch on the cornea of ​​the patient’s eye is accompanied by a reaction, the swallowing reflex is preserved;
  • Coma – deep sleep, there are no reactions.

In 65–75% of cases, hemorrhagic stroke occurs in the daytime, when the person is as active as possible. It manifests itself as a sharp loss of consciousness within a few seconds. During this time, patients only manage to make a sudden loud cry, which is caused by a severe headache, drawing the attention of others. After that, a person loses consciousness and falls.

43-73% of hemorrhages result in a breakthrough of blood in the ventricles of the brain. When blood breaks into the ventricles, the patient’s condition becomes sharply heavier – a coma develops, bilateral pathological signs, protective reflexes occur:

  • hemiplegia is combined with motor restlessness of non-paralyzed limbs (violent movements seem conscious (patients pull a blanket over themselves, as if they want to cover themselves with a blanket),
  • hormone deficiency, the symptoms of damage to the autonomic nervous system deepen (chills, cold sweat, a significant increase in temperature). The onset of these symptoms is prognostically unfavorable.

Focal neurological signs are associated with a malfunction of a certain part of the nervous system. Most often, hemispheric hemorrhages develop, for which the following symptoms are characteristic:

  • Hemiplegia or hemiparesis – complete or partial loss of motor activity of the arm and leg, develops on the side opposite to the lesion.
  • Decreased muscle tone and tendon reflexes.
  • Hemigipesthesia – is a violation of sensitivity.
  • Paresis of the gaze – in this case, the eyeballs are directed towards the lesion.
  • Mydriasis – this symptom is the expansion of the pupil on the side of the hemorrhage.
  • Omission of the corner of the mouth.
  • The smoothness of the nasolabial triangle.
  • Speech disorders in lesions of the dominant hemisphere.
  • The development of pathological reflexes.

The progression of the disease and the appearance of cerebral edema are indicated by:

  • strabismus manifested;
  • sluggish reaction of the pupils to the light;
  • facial asymmetry;
  • change in rhythm and depth of breath;
  • violation of cardiac activity;
  • “Floating” eyeball movements;
  • a strong drop in blood pressure.

The first 2,5-3 weeks after hemorrhage is the most difficult period of the disease, since at this stage the severity of the patient’s condition is due to progressive cerebral edema, which is manifested in the development and increase of dislocation and cerebral symptoms.

Moreover, the dislocation of the brain and its edema is the main cause of death in the acute period of the disease, when previously existing somatic complications (impaired renal and liver function, pneumonia, diabetes, etc.) join or decompensate to the above symptoms.

The danger of stroke in the suddenness of the syndrome. The crisis state comes very quickly, not everyone can notice its signs. And the harbingers of a stroke can be confused with signs of another disease. If a hemorrhage has occurred in the brain, symptoms indicate this.

When cerebral hemorrhage occurs, the count goes for minutes. Fatalities can be prevented by responding to harbingers of stroke. If the symptoms of the attack are noticeable to others, then the patient himself must distinguish the premises.

The first signs of a hemorrhagic stroke:

  • nausea and vomiting;
  • confused breathing;
  • Strong headache;
  • noise in ears;
  • increased blood pressure;
  • redness of the face;
  • numbness of limbs;
  • loss of sensation in the muscles, paralysis;
  • weakness;
  • swallowing dysfunction;
  • interruptions in heart rate;
  • violation of urination.

Hemorrhagic stroke, like ischemic stroke, manifests itself differently depending on which part of the brain is affected. As a rule, a vessel is damaged in the area of ​​one of the hemispheres, which is responsible for certain functions in a person. After an attack, completely or partially certain abilities are lost.

A hemorrhagic stroke of the brain on the right side is characterized by the following conditions:

  • paralysis of the left side of the body, in whole or in part (limbs);
  • violation of the muscles of the face – the angle of the mouth and eyes are down;
  • decreased visual acuity or its loss;
  • hearing impairment;
  • inability to swallow on their own;
  • possible dysfunction of the internal organs located on the left (spleen, stomach);
  • serious mental disorders;
  • lack of reaction to what is happening.

A bursting vessel on the left side provokes other lesions that are reflected on the opposite – right – side. These include numbness, paralysis, and other signs of cerebral hemorrhage.

Typical consequences of left-sided localization:

  • loss of logical thinking;
  • lack of voice or speech defects;
  • obstruction of the facial muscles;
  • respiratory muscle paralysis;
  • difficulty swallowing reflex.

Manifestations

  • Balance problems.
  • Eye pain, blurred vision.
  • Numbness of the limbs, part of the head.
  • Inhibition, slurred speech.

However, these symptoms are observed in only half of people.

This manifestation is easily confused with the development of microstroke and ischemic stroke.

Symptoms of a starting hemorrhagic stroke are observed in the daytime after any tension:

  • sensation of a blow to the head and subsequent loss of consciousness;
  • severe throbbing headache;
  • vomiting, nausea;
  • heart palpitations;
  • photophobia;
  • the skin of the face turns red;
  • increased sweating;
  • motor agitation, cramps;
  • meningeal symptoms – a person cannot reach his chest with his chin or straighten a raised leg while lying down;
  • confusion of consciousness.

A person is drawn to sleep, but at the initial stage he can be awakened and adequately talk to him. Further awakening is complicated, and speech becomes incoherent. Gradually, the patient falls into a coma.

Sometimes one of the parties is paralyzed. For example, with damage to the right side of the brain, the left cheek and nasolabial fold sag, the mobility of the left eye is lost, the sensitivity of the left side of the body decreases, and the left limbs lose their mobility.

Symptoms cannot determine the presence of a hematoma. They only indicate the localization of the lesion:

  • the cerebellum is affected: a headache in the neck and neck, decreased muscle tone of the limbs, problems with speech, strabismus;
  • ventricles: a rapid change in state, a decrease in the tone of all muscles, problems with breathing and swallowing, cramps, fever, loss of consciousness;
  • brain stem: respiratory and cardiac disturbances, strabismus, dilated pupils;
  • between the meninges: vomiting, headache, sensitivity to light, cramps, impaired consciousness.

Unnatural eye movement and paralysis appear only after edema. A harbinger may be a sharp pain and loss of consciousness after physical exertion.

Having woken up, patients do not complain about any deviations, but after a few hours or days the condition worsens.

Diagnosis of hemorrhagic stroke

If a hemorrhagic stroke is suspected, magnetic resonance or computed tomography of the brain is performed. This allows you to accurately determine the location of the intracranial hematoma, its size, the presence of edema and brain dislocation. To control the involution of hematoma, an MRI or CT scan is repeated at certain stages of treatment.

In addition, the following diagnostic methods are used:

  • blood coagulation test;
  • determination of the content of narcotic substances in the blood;
  • angiography (performed for patients with normal blood pressure and with localization of the hematoma in an atypical zone);
  • lumbar puncture (performed if it is impossible to conduct computed tomography).

The severity of the condition of the patient after a hemorrhagic stroke, the degree of development of disability and survival largely depend on the location of the intracranial hematoma.

Hemorrhagic stroke is differentiated primarily with ischemic. For ischemic stroke, a gradual onset, an increase in focal symptoms and the preservation of consciousness are characteristic. Hemorrhagic stroke begins acutely, with the development of cerebral symptoms. However, at the prehospital stage, it is impossible to conduct differential diagnosis, relying only on the features of the clinical picture of the disease.

Significantly less often, concussions and bruises of the brain, as well as intracranial hematomas of traumatic origin, become the cause of cerebrovascular accident. In the latter case, the development of hemiparesis is preceded by a bright interval (the time from the moment of injury to the moment of hemiparesis). In addition, an anamnesis – an indication of a traumatic brain injury – allows us to suggest a traumatic etiology of a cerebrovascular accident in this case.

Hemorrhagic stroke must be differentiated from hemorrhage in the tissue of a brain tumor, in particular multiform spongioblastoma. Suspicion of the tumor nature of the disease may occur if there is a history of prolonged headaches, changes in the patient’s personality that preceded the occurrence of hemiparesis.

In relatively rare cases, there is a need for differential diagnosis of hemorrhagic stroke and the condition after partial (Jackson’s) epileptic seizures.

With regular headaches with the same type of localization, you should visit a neurologist. A timely found pathology that can be treated promptly will save you from irreversible consequences and death. The doctor will send a magnetic resonance imaging with a contrast agent to diagnose the state of the vessels.

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Additionally, you may need to be examined by an ophthalmologist, endocrinologist, rheumatologist and cardiologist.

In the laboratory they take blood tests:

An accurate diagnosis will be made only by a neurologist. Neuroimaging is performed using CT, which allows you to identify the initial stage of the disease.

As a rule, people who survive a stroke attack end up in a hospital where doctors diagnose the onset of a serious condition. Specialists study pathology, its localization and severity, find out how extensive cerebral hemorrhage has occurred and how the therapy will go.

To make an accurate diagnosis, the following measures are taken:

  • determination of pressure and measurement of body temperature;
  • consultation and examination by a neurologist;
  • computed tomography to visualize the lesion;
  • magnetic resonance scanning to determine the stage of the process;
  • spinal puncture (exclusion of inflammation).

First aid and treatment

First aid for hemorrhagic stroke primarily consists in calling an ambulance. Then the patient needs to be put to bed, to ensure that its head end is raised 30 degrees. A person must be freed from the squeezing elements of clothing: unfasten the collar, buttons, belt. It is necessary to ensure the flow of fresh air.

You cannot give pills “from pressure” to the arrival of the ambulance: there is a possibility of a sharp decrease in blood pressure, which is dangerous in this case, since otherwise the brain damaged by blood may not receive the oxygen it needs now to continue functioning. Only specially trained medical personnel know the rules by which to lower blood pressure when it rises above 150/100 mm Hg.

With the development of seizures, additional injuries to the patient’s head should be prevented as much as possible. You also need to try to bring out the lower jaw to prevent the tongue from dropping and blocking the airways. To do this, stand facing the legs of a lying person and place your hands on his jaw so that the little fingers, ring and middle fingers are in the area of ​​the temporomandibular joints, and the index and large fingers are where the jaw goes into the chin. With a synchronous movement of both hands, try to push this movable bone so that the lower teeth take a place in front of the upper.

When providing first aid, the following sequence of actions should be observed:

  • Call an ambulance.
  • Lay the patient horizontally, providing a head lift of 30 degrees.
  • Loosen tie, belt, unfasten collar, making it possible to breathe freely.
  • With convulsions, try to maximally prevent injuries and retraction of the tongue.
  • give water and food regardless of the patient’s condition;
  • take pressure-reducing drugs: there is a high probability of developing oxygen starvation of brain cells.

Any medication should be agreed with your doctor, who knows that lower blood pressure only after 150/100.

Aftermath

Symptoms of the debut of a hemorrhagic stroke are the following, and they usually occur during the day, after physical or emotional stress (maybe on the beach or in a hot shop):

  • sensation of a strong blow to the head, after which loss of consciousness usually occurs;
  • if a person remains conscious, he feels a strong and intensifying headache of a pulsating nature, a feeling of a strong heartbeat, nausea, vomiting, pain in his eyes when looking at the light;
  • the face turns red;
  • excessive sweating is noted;
  • after a short time, motor excitement may develop;
  • there may be cramps;
  • in most cases, impaired consciousness gradually increases. At first, a person wants to sleep all the time, but he can be woken up, talk, and he will answer questions. Over time, it is possible to wake a person only for a small amount of time, after which he answers monosyllabic and not always on the topic. Then a coma develops, in which it is impossible to get to the patient.

If during a hemorrhagic stroke the right side has “taken away” and at the same time:

  • you can’t take the left eyeball, puff out the cheeks (the left cheek “sags”), the left nasolabial fold is omitted, the probable diagnosis is hemorrhage into the left brain bridge;
  • movements in the right half of the face are impaired (cheeks cannot be inflated, teeth bared), and pain and temperature sensitivity are reduced on the left, it is soaked in blood or the parietal lobe of the cortex has become a “haven” for hematoma;
  • the upper eyelid is omitted on the left, the pupil in this eye is dilated, there is difficulty in moving the eye to the nose, in addition, it is difficult to bite the teeth or puff out the cheeks on the right, we are talking about left-sided damage to the midbrain.

If the right arm is paralyzed, it is bent in all joints, while the leg, which is in the extension position, is paralyzed on the left, and the lower parts of the medulla oblongata on the right are affected.

When a hemorrhage or hematoma is reflected on the left side of the body:

  • if weakness is noted, pain, tactile and temperature sensations are reduced more in the left leg than in the arm, hemorrhage occurred in the frontotemporal region on the right;
  • if neither the arm nor the leg moves on the left, sensitivity is reduced there, and it is impossible to look away on the right, the right nasolabial fold is smoothed, a stroke occurred in the brain bridge on the right;
  • if the arm, leg and left half of the face do not move on the left, violations of pain and temperature sensitivity are noted in the same place, the parietal lobe of the cortex is saturated with blood or hematoma is compressed by the right;
  • if the arm and leg are paralyzed on the left, deep sensitivity is disturbed in the same place, while the pain and temperature sensations are not affected, and, moreover, there is difficulty in moving the tongue on the right (when opening the mouth, it is turned to the left), the medulla oblongata on the left is affected;
  • if there are no movements of the upper and lower extremities on the left, there is no sensitivity there, and on the right on the face there is a loss of pain and temperature sensitivity with its safety around the mouth, a hemorrhage occurred in the bridge;
  • loss of all kinds of sensation on the left side of the face, left arm and leg indicates right-sided hemorrhage in the thalamus.

The described symptoms allow the doctor only to determine the location of the lesion. It is impossible to distinguish hemorrhage from a hematoma.

If there is hemorrhage in the cerebellum, there is a headache in the back of the head and neck, the person cannot pronounce the words clearly, his tone of arms and legs is reduced (they hang “like a whip”). Strabismus is also noted when one eye looks down and in, the other up and out.

If hemorrhage has occurred in the ventricles, the person’s condition worsens rapidly, and also:

  • muscle tone of all four limbs decreases;
  • difficulty breathing;
  • a person chokes when swallowing;
  • the temperature rises;
  • convulsions may develop;
  • consciousness is disturbed.

Hemorrhagic stroke in the brain stem is manifested by respiratory failure (it becomes irregular, may be superficial), the activity of the heart. Strabismus develops, the pupils become wide, may have a different size. Eyeballs are not fixed, but “float”, tremble when moving. The swallowing process is disrupted.

Subarachnoid hemorrhage has slightly different symptoms. It:

  • severe headache;
  • nausea;
  • vomiting;
  • photophobia;
  • hypersensitivity of the skin of the whole body;
  • there may be cramps;
  • often impaired consciousness, which can be reversible with adequate assistance.

Paralysis, impaired eye movements, changes in the pupils are not characteristic of the initial stages of subarachnoid hemorrhage. They join with the development of cerebral edema.

Subdural hematoma, that is, the accumulation of blood between the membranes of the brain, has its own symptoms:

  • first, against the background of inadequate physical activity, stress or a hypertensive crisis, a sharp headache and loss of consciousness are observed;
  • through time, a person regains consciousness and within a few hours to several days does not bother him;
  • through this “bright period” of time, the state worsens sharply, a person loses consciousness, against the background of which cramps develop, two or one limb stop moving, strabismus, facial asymmetry appear.

The prognosis of hemorrhagic stroke is unfavorable. It depends on the location and extent of the lesion. Hemorrhage into the brain stem is dangerous, which is accompanied by respiratory failure and sharp, poorly adjusted drugs, a decrease in blood pressure to critical numbers. The ventricular hemorrhage with their breakthrough is severely leaking and often ends.

How many live with hemorrhagic stroke? This pathology ends fatally in 50-90% of cases. It is possible death on the first day – against the background of generalized seizures, when respiratory failure occurs. 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.

At 1-2 weeks, in addition to neurological disorders, complications associated with the patient’s immobility, exacerbation of his chronic diseases or connecting him to an artificial respiration apparatus (pneumonia, pressure sores, liver, kidney, cardiovascular failure) join. And if they do not lead to death, then by the end of 2-3 weeks the cerebral edema is stopped. By week 3, it becomes clear what the consequences of a hemorrhagic stroke are in this case.

  1. coma, especially if it developed in less than 3 hours, led to a sharp drop in pressure, respiratory failure;
  2. a combination of paralysis of the arm and leg on the one hand with violent movements (trying to hide behind a blanket, straighten clothes, check the condition of the genitals) of the limbs on the other hand;
  3. chills;
  4. cold sweat;
  5. an increase in temperature, which does not respond to antipyretic drugs;
  6. nasal voice;
  7. irregularity, contraction or rapid (deep and noisy) breathing;
  8. violation of swallowing.
  • constantly monitoring blood pressure;
  • excluding salty foods;
  • removing coffee, black tea, alcoholic drinks from the diet;
  • quit smoking;
  • by making an MRI of the brain and magnetic resonance angiography, which will allow you to see the pathological vessels and treat them promptly in a planned manner;
  • avoiding exposure to the body of harmful substances (varnishes, paints, heavy metals and others);
  • performing small physical activities;
  • excluding physical inactivity;
  • controlling coagulability and lipid saturation of own blood,

you can still live a sufficient amount of time, calculated not in years, but in their tens (if the stroke occurred in youth). Survival will also depend on the health of the heart, liver, kidneys and other internal organs.

As a result of the disease, the following can be noted:

  • paralysis (complete lack of movement) and paresis (partial absence of movement) of the limbs, face or part thereof;
  • impaired reproduction or understanding of speech;
  • inadequate behavior;
  • blindness;
  • loss of sensation on the trunk or limbs;
  • deafness;
  • memory loss;
  • depression;
  • severe pain in the limbs;
  • lack of proper sleep;
  • loss of reading / writing skills;
  • inadequate perception of the surrounding world, in connection with which a person becomes unable to service himself or even can harm himself.

The prognosis for hemorrhagic stroke in most cases is disappointing. The probability of partial recovery determines the location and size of the lesion. For example, hemorrhage in the ventricles or brain stem results in death.

Mortality occurs in 60-95% of cases. On the first day, the probability of death is low, it happens due to respiratory failure. Most cases occur after 2 weeks. This is explained by the development of a number of biological processes that provoke cell death:

  • brain displacement;
  • wedging;
  • blood entering the ventricles (happens in 43-47%).

But the brain has a lot of compensatory possibilities. Moreover, the younger the patient, the recovery is more likely.

In these 2 weeks, exacerbation of chronic diseases and the effects of immobility are added to the main neurological disorders. After this period, the swelling stops, and we can talk about the consequences of hemorrhagic stroke.

Symptoms unfavorable for further prognosis are:

  • fast coma;
  • sharp violation of breathing, its irregularity;
  • chills;
  • not knocked down heat;
  • problems with swallowing;
  • nasal;
  • unilateral paralysis in combination with involuntary movements of the limbs of the other side.

The ability to survive is affected by the condition of internal organs.

Among the common consequences of a hemorrhagic stroke:

  • partial or complete immobilization;
  • problems with speech;
  • loss of sensation in certain parts of the body;
  • loss of hearing, vision;
  • problems with sleep;
  • oppressed state;
  • mental disorders;
  • pain syndrome.

The consequences of a hemorrhagic stroke are very severe. If the victim managed to survive, he will have a long recovery period and severe disability.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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