Consequences of hemorrhagic stroke of the left side. Let's list the general manifestations. What is hemorrhagic stroke

Hemorrhagic stroke- the most dangerous vascular disease. The consequences of this type of stroke are always serious, and the prognosis is often unfavorable.

Hemorrhagic stroke and its periods

A hemorrhagic stroke is a sudden bleeding into the cranial cavity. Hemorrhagic strokes account for about 10% acute disorders cerebral circulation , the rest 90% are ischemic strokes. This disease is more common in people 45-70 years old, but can develop even in a child and often ends in death. How many people live after a hemorrhage and the prognosis are determined by the size of the affected area and the speed and quality of the treatment started.

Hemorrhage during a stroke can be both small-focal and extensive, depending on the caliber of the affected vessel. After a rupture of the vessel, a hematoma occurs or hemorrhagic impregnation of the brain tissue occurs. Pathology proceeds according to the following periods:

the most acute - the first day after the development of the disease;
acute - 2 days - 21 days;
subacute - from the beginning of the 4th week to 3 months;
early recovery - 3 months - six months;
late recovery - up to a year after a stroke;
period long-term effects- more than a year from a completed stroke.

Causes and pathogenesis of the disease

Young people have the most common causes stroke associated with rupture or injury vascular malformations - congenital anomalies structures of arteries and veins in the brain. With prolonged existence in aneurysms, dural fistulas and various types vascular deformations, the tone of the walls decreases, they become thinner and can burst under the pressure of blood.

Another common cause of pathology is a chronic increase in blood pressure with hypertension, diseases of the kidneys, heart, and standing pheochromocytomas. More rare causes cerebral hemorrhages are:

deposition of amyloid protein inside the walls of blood vessels;
atherosclerotic lesion of the artery;
inflammation of the wall of the cerebral vessel;
thrombophilia and erythremia;
overdose of blood-thinning drugs.

Pathogenesis can develop in two directions. The altered vessel spontaneously ruptures with massive hemorrhage, or gradually becomes permeable with leakage of blood plasma into the brain tissue.

In the presence of predisposing diseases, stress, alcohol intake, overheating, hard physical work, smoking can provoke a hemorrhagic stroke. a large number cigarettes.

Clinical manifestations of a stroke

Harbingers can tell that a person will soon develop a stroke, but there are similar signs far from always. These include impaired coordination of movements, slurred speech, pain in the eyes, numbness of the extremities, headache on the right, left side. At 50% of patients with hemorrhagic stroke appears suddenly, without foreshadowing symptoms, in a number of patients the same signs turn into a transient ischemic attack, an ischemic stroke.

The pathology clinic is based on spontaneous hemorrhage and, as a rule, includes a feeling of a strong blow to the head or a sudden onset of severe pain. After such a blow, many lose consciousness, a number of patients fall into a coma or die (usually with a massive stroke). Those who are conscious experience the following symptoms of the disease:

throbbing headache;
nausea;
vomit;
strong heartbeat;
redness of the face;
increased sweating;
convulsions;
increasing drowsiness;
inability to answer a simple question;
speech disorder;
decreased tone of the limbs;
strabismus;
paralysis and paresis;
swallowing disorder.

Most of the symptoms on the left side of the body means the development right-sided stroke, and vice versa.

Diagnosis of pathology

The main methods by which the diagnosis of stroke is made are CT, MRI of the brain, as well as radiography. They allow you to determine the location and type of hemorrhage, its size. Also, the patient can be urgently performed angiography, spinal puncture.

Differential diagnosis is made with various diseases accompanied by a similar clinic, according to the following signs:

Pathology	Differences from hemorrhagic stroke
Ischemic stroke	Gradual increase in symptoms, absence of meningeal signs, no blood in the cerebrospinal fluid during lumbar puncture.
Hemorrhage into a brain tumor	Less vivid manifestations, extremely rare development of coma, a person is more often conscious.
brain abscess	An increase in body temperature, often the disease is preceded by epileptiform seizures.
Epilepsy	The presence of seizures in history, the appearance of foam from the mouth, biting the tongue.
Traumatic brain injury	A history of trauma.
uremic coma	Slow increase in symptoms - weakness, insomnia, dyspepsia, edema, pain in the kidney area.
diabetic coma	Availability diabetes, the development of a pre-coma with thirst, abdominal pain, vomiting, the smell of acetone in the mouth.

Complications of a right-sided stroke

If a hemorrhagic stroke occurs on the right side, the consequences, how long they live, are the first questions that interest the patient's relatives. With the right-sided type of pathology, the following signs are noted:

difficulty abducting the left eye;
sagging left cheek;
decreased pain sensitivity on the left;
dilation of the left pupil, etc.

Often, paralysis occurs immediately after the development of the pathology, while the impossibility of movement and flexion of the left leg is more often observed. The most common complications of damage to the right side in left-handed people are speech deviations, which are usually absent in right-handed people. One of the most severe complications are cerebral edema and coma, which can last up to several weeks.

Other possible complications right-sided hemorrhagic stroke are as follows:

paralysis of the left side of the face, glossopharyngeal, ophthalmic nerve;
feeling of alienation of the body;
serious disorders of memory, hearing, perception of the world, orientation in space;
deterioration of brain activity, behavior;
depression, passivity;
psychical deviations.

Complications of a left-sided stroke

When did a hemorrhagic stroke develop on the left side, how long do they live, what are the consequences? The left hemisphere is usually affected more often ( 65% of cases). Since this part of the brain is responsible for speech and logical thinking, these functions suffer the most. Speech disorders include slurring, slurring of pronunciation, incomprehension of someone else's speech, explanation in fragments of phrases. Also, a person cannot think normally, read, his articulation is disturbed.

Paralysis of the right side of the face, right leg and arm is no less common. Characterized by synkinesis- when lifting a healthy arm, the patient involuntarily rises. Failures of acts of defecation, urination are registered.

Often, with this type of hemorrhage, epilepsy subsequently develops, regular severe headaches appear.

Post-stroke treatment and prognosis

First aid to a person should be early - only timely treatment and full recovery will help to recover. First aid includes ensuring the supine position, complete rest and an urgent call for an ambulance. It is strictly forbidden to reduce pressure sharply! The setting of antihypertensive drugs is started only by a doctor, more often in an ambulance, using a special algorithm.

In intracerebral hematoma, surgical intervention with evacuation of blood and stop bleeding. If the operation is impossible, drug therapy is carried out. The following types of medicines are used:

diuretics, calcium channel blockers - to reduce pressure;
neuroprotectors - to protect brain cells;
antibiotics - to prevent infectious complications;
electrolyte solutions - to normalize the water-alkaline balance;
hemostatic agents or drugs for the prevention of thromboembolism (if indicated).

Rehabilitation includes strict regime day and sleep proper nutrition(for violations of swallowing - through the probe). For recovery, you will need breathing exercises, classes with a speech therapist, a psychologist, massage, exercise therapy (including passive gymnastics), physiotherapy, hydrotherapy, treatment in sanatoriums.

The prognosis for a stroke will depend on the quality of the treatment and the size of the hemorrhage. Mortality reaches 40%, of the survivors, approximately 25% die from repeated stroke during a year. 30% of those who survived after the disease become deeply disabled, maximum threshold survival is considered to be 10-15 years, but with timely surgery and proper rehabilitation, it is possible to live a longer full life.

Stroke is a violation of the blood supply to the body, resulting in extensive damage to the vessels of the brain and destabilization of the central nervous system. Hemorrhagic stroke is characterized by a sudden onset. Existing classification diseases are divided into ischemic, hemorrhagic and mixed types. Hemorrhagic is typical for the older generation. However, there is currently a younger age group people who are prone to stroke due to external environmental influences.

Ischemic stroke is a consequence of the blockage of cerebral vessels by cholesterol fatty plaques (thrombus formation).

How does a stroke manifest?

The consequences of hemorrhagic are dangerous for human life. It is preceded by a rupture of a blocked vessel with a hemorrhage in the meninges, accompanied by a sharp pain syndrome like a sharp blow.

How does a hemorrhagic stroke occur?

Depending on the location of the injury, right-sided and left-sided brain damage is distinguished. Severe consequences of right-sided location are due to the lack of regenerative ability of the cells of the right hemisphere of the brain.

According to statistics, one of the fundamental causes of the formation of the disease is arterial hypertension. Slowly flowing under atypical conditions, hypertension provokes a crisis, which in 75% is the starting point for the development of hemorrhagic stroke. not ruled out causality between illness and congenital pathology structure of the vascular branch of the brain, aneurysm, acquired malformation.

Diseases predisposing to the development of hypertension and vascular deformities

Pathology of blood coagulation.
Excessive use of thrombolytics.
Deposition of cholesterol in violation of lipid metabolism in the vessels of the brain (atherosclerosis).
Hidden inflammatory processes in the brain.
Arterial deposition of beta-amyloid protein (amyloid angiopathy).
Modifications of immunopathological vascular inflammation brain (vasculitis, arteritis).
Diseases of the heart, spinal cord.
The presence of tumors.
Diabetes.
Pathological narrowing of the carotid arteries (cerebral stenosis).

Factors contributing to the formation of vascular blockage

Rheumocarditis.
Atherosclerosis of cerebral vessels.
Atypical increase in blood pressure.
Vascular pathologies of the brain.
Arterial protrusion of thinned vascular walls.
Abuse of alcohol, drugs, smoking.
Myocardial infarction.

Conditions contributing to the development and progression of the disease

Severe intoxication.
Long physical surge, psycho-emotional depression.
Constant avitaminosis manifestations.
stressful situations.
Physical trauma.
Obesity 3-4 severity.
Age-related changes in the body.

The presence of one of the following factors - serious occasion think. To avoid adverse consequences, control signs of deterioration, undergo a medical examination in a timely manner, and follow the recommendations of your doctor.

Spontaneous hemorrhage under the cerebral cortex is a point sudden cessation of blood supply to brain cells, swelling of damaged areas of the brain, pathological changes in the subcortical nodes, ventricles, thalamus. These processes are detrimental to the synchronous activity of the organism, therefore, they are irreversible or difficult to recover.

Uncontrolled penetration of the blood flow into the cerebellum or brain stem cells leads to immediate cardiac arrest (clinical death).

People with congenital defect heart, hereditary blood diseases, endocrine system prone to hemorrhagic stroke.

Symptoms of a stroke

Sudden hemorrhagic stroke due to abrupt appearance typical primary symptoms.

Visible sign of pathology

Home reminder to detect the first signs of the disease

Change in skin color to cyanotic, curvature of the face, chin.
Headache of versatile location.
Rapid or weak heartbeat.
Muffled or difficult breathing, turning into hoarse sounds.
Atypical dilation of the pupils of the eyes.
Violation of the swallowing reflex.
Violent pulsation of the cervical arteries.
Fragmentary or complete paralysis of certain parts of the body.
Nausea, vomiting, impaired consciousness.
Fainting, skin cold to the touch, involuntary urination.
A sharp increase in blood pressure.

The increase in the intensity of symptoms is rapid, sometimes a few minutes are enough. At primary signs stroke, it is important to find out in time the causes that prompted the onset of the disease and the tactics of providing urgent medical care.

The first signs of a stroke

The progression of the disease is aggravated by a decrease in the sensitive threshold of one side of the body to complete loss (complicating paralysis), convulsive trembling of the limbs, impaired or loss of spoken language, coordination movements, neurological defects, strabismus, loss of vision and hearing, memory and inadequate behavior. The degree of successive signs of the disease depends on the location of the hemorrhagic zone.

Volumetric hemorrhagic hemorrhage marks the appearance of secondary signals: brain dislocation, continuous convulsions, loss of consciousness, coma. Ventricular, cerebellar extravasation is characterized by a fatal outcome on the first day after the detection of signs of a stroke.

Differential diagnosis of hemorrhagic stroke

The faster the patient is helped, the greater the chance of recovery after a stroke.

Elementary primary diagnostics is carried out using test tasks

Smile. Characteristic drooping of the corner of the lips on one side.
Talk. Pronunciation simple words difficult.
Raising both hands. The simultaneous movement of the limbs visually reveals different lifting heights.

Urgent CT, MRI examination will allow you to quickly find out the cause and degree of brain damage. The contrast will facilitate the establishment of the volume of the lesion, localization, displacement of brain structures and edema, the degree of viability of the cells of the cortical substance.

The presence of blood in the spinal fluid is typical for ventricular or subarachnoid hemorrhage. Lumbar puncture is performed on the basis of CT data. With edema, if the biomaterial is removed, the procedure can cause partial wedging of the medulla into the occipital opening, which will lead to the inevitable death of the patient.

Examination of severe patients in a coma after a stroke is carried out using encephalography. The procedure determines the degree of life support of the cortical substance.

Medical treatment of hemorrhagic stroke

As an emergency treatment for hemorrhagic stroke modern medicine offers intubation, artificial ventilation lungs, cardiac pacing.

Based on the study of the brain, the doctor will prescribe a therapeutic method for the treatment of hemorrhagic stroke. Complex therapy carried out in a hospital setting. Risks of repeated hemorrhagic stroke due to an arterial defect are not excluded.

Treatment of cerebral hematoma is usually carried out with hemostatic agents and osmotic diuretics. The use of ACE inhibitors and beta-blockers affects the maintenance of perfusion pressure, so the drugs should be taken with caution. Antibiotics are used to prevent intracranial infections after a stroke. Additional tool sedatives are added to the set of measures to prevent the consequences of hemorrhagic stroke to relieve arousal.

Surgical treatment disease is carried out only for health reasons with the obligatory determination of the causes of cerebral hemorrhage. Hematoma stereotaxic removal is performed by craniotomy followed by elimination of the defective vessel. The operation lasts 3-5 hours.

Treatment with folk remedies is unacceptable.

trepanation of the skull

Hemorrhagic stroke - prognosis

The severity and nature of the lesion, prognosis and stages of recovery depend on the location and degree of localization of non-traumatic cerebral hemorrhage. Due to diffuse age-related changes in the body and an irreversible slowdown in recovery functions, the prognosis in older people is almost unpredictable, since it depends on the time of assistance, the degree of brain damage at the time of detection, resistance immune system organism.

Immediate medical care will affect the outcome of the disease.

After a time period (up to a week from the moment of detection), the patient develops the consequences of a hemorrhagic stroke - edema with the formation of necrotic brain tissue. The controlled work of such parts of the brain stops, while the disorder of motor functions, coordination movements, paralysis, difficulty in understanding and reproducing spoken language continue.

As a result of damage to the left hemisphere of the brain, the appearance of failures of reflex functions is characteristic - when reading, counting, writing. The disorder of swallowing movements due to illness is caused by the ingress of fluid into the organs of air circulation. Against the background of these features, emotional instability develops, disorganization of the patient, which leads to problems of perception.

Visually, the worsening of the urinary and intestinal functions can be added to the complicating consequences - uncontrolled defecation and urination are possible. The formation of epilepsy is observed in 7-20% of stroke patients. Patients who survive a stroke are given disability status.

Since impaired functions recover for a long time after a stroke, it is almost impossible to do this on your own without therapy and support from loved ones.

Hemorrhagic stroke: consequences

Primary drug therapy It is aimed at stabilizing the patient, stopping intensive progression, removing the cause of the disease.

The second stage of treatment for hemorrhagic stroke involves recovery period requiring a lot of effort. It is carried out against the background of taking drugs that reduce the permeability of the vascular walls and control measures to adjust blood pressure. Includes restoration of damaged organic functions through gymnastics and sports, a balanced diet, rehabilitation activities with the inclusion of electrostimulating agents, magnetotherapy, reflexology.

Restorative gymnastics after a stroke

The fundamental preventive methods of fighting the disease are the constant monitoring of hypertension, the correction of blood pressure, the evolutionary atherosclerotic process.

Categorical cessation of smoking, excessive drinking, calorie management and an active lifestyle are the basic principles of restorative and preventive measures.

Prevention during the period complex rehabilitation increases the chances of a full recovery after a hemorrhagic stroke.

Checking motor functions after stroke

A positive prognosis largely depends on the desire of the patient and the support of people close to him.

Stroke hemorrhagic right side: how long do surviving patients live

An ideal set of circumstances does not guarantee the absence of a trace of an ischemic stroke. The formation of persistent complications: paralysis, amnesia, spatial dislocation, failures of the visual and vestibular nature, lack of figurative thinking in most cases leads to an unfavorable outcome. Patients in a coma are practically hopeless.

Statistical data confirm the development of fatal recurrences of hemorrhagic stroke in 5% of patients during the first six months after the disease, 10% within a year. The mortality rate of the five-year period after the disease is more than 50%.

Stroke hemorrhagic left side: how long do surviving patients live

The probability of a full recovery is minimal, however, using the regenerative feature of the cells of the left hemisphere, it is possible to compensate for the lost abilities. The functions of the dead areas of the brain are taken over by neighboring ones. The process of interchangeability is completely dependent on the time interval between the detection of a hemorrhagic stroke and the start of intensive brain rehabilitation therapy. An important aspect here is the active desire of the patient himself - to re-learn to speak, develop thinking, write and read.

The life expectancy of a person who has had a hemorrhagic stroke does not depend on the place of the disease. Important role play age factors, the timeliness of first aid, appointment proper treatment and powerful restorative procedure after illness.

Given the annual increase in cases of stroke at a younger age, the problem is relevant. Doctors did not come to an unambiguous decision which specialist should solve this problem. This is due to the fact that the disease affects the leading systems human body: cardiovascular and nervous.

Therefore, treatment is carried out by several specialists at the same time (vascular surgeons, neurosurgeons, cardiologists, neuropathologists).

Stroke is one of the most common diseases in the world and is one of the leading pathologies leading to disability.

What is a stroke, types

A stroke is a sudden or acute disruption of the blood supply to the brain. The state cannot be called a complete cessation, because with some types of blood supply in a small amount, but remains.

The classification is based on the mechanism of problem formation:

Without the release of blood from the bloodstream into the tissue and cavity of the brain;
Rupture of the vessel wall and hemorrhage in the intrathecal region or in the brain tissue.

There are 2 types of disease based on the mechanism of formation:

Ischemic stroke (due to blockage or stenosis);
Hemorrhagic (due to the release of blood from the vessel).

According to the international classification of diseases used by doctors, there is the following classification:

Transient disorders of cerebral circulation:
- transient ischemic attacks;
- cerebral hypertensive crises.
Acute hypertensive encephalopathy.
Shell hemorrhage:
- subarachnoid (subarachnoid);
- epi- and subdural
Hemorrhage in the brain:
- parenchymal;
- parenchymal-subarachnoid;
- parenchymal-ventricular;
Cerebral infarction (non-embolic):
- due to the pathology of the main arteries of the head;
- in case of pathology of intracerebral vessels;
- another genesis.
Embolic cerebral infarction:
- cardiogenic;
- another genesis.

According to the localization of the lesion:

Hemispheres of the brain.
The brain stem.
The ventricles of the brain.
Subarachnoid.
Multiple focus (several zones).

Causes of a stroke

In the development of a stroke, reliable and probable causes can be identified.

The probable ones include:

Smoking and alcohol abuse;
Improper nutrition;
stress;
Obesity;
Sedentary work;
oral contraceptives;
metabolic disorder;
Hormonal disorders;
Diets.

Reliable ones include:

Hereditary predisposition (not only strokes in relatives, but also the following pathological conditions and disease);
Myocardial infarction in the past;
Hypertension (2 and 3 degrees);
Cardiac ischemia;
Violations of the rhythm and conduction of the CCC (blockade and arrhythmias);
Elevated blood cholesterol;
Vasculitis (inflammation of the walls of blood vessels);
Aneurysms and anomalies of cerebral vessels;
Blood diseases;
Varicose veins;
Rheumatism.

Signs of a stroke

The prognosis depends on the type of stroke and the severity of the lesion. The main jump in recovery is the first 3-6 months. Further, the critical moment is a year after the attack. The more time has passed, the less chance to restore function.

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 profuse 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 within three hours the victim is not provided health care, 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 vascular changes in ischemic stroke- blockage of their lumen with blood clots, as a result of which gradual necrosis of brain cells occurs, and in case of hemorrhagic - 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, the probability of returning to full life absent.

The brain stem is the center of all body systems, and is directly connected to the spinal cord. It serves as a 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 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.
Headache.
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 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 therapy. 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, violation of microcirculation of fluids of the brain and blood.

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, lures, 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. 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 - no symptoms 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 struck left-hand side, 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 struck Right side The most dangerous consequence 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.

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-handers (in left-handers speech center 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 connecting him 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 increased arterial pressure("Enalapril", "Nifedipin"), 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 is one of the most common causes of human death. This serious brain damage after 3 hours can put the patient in a coma or lead to death.

After a stroke, people subsequently practically do not restore their usual and everyday functions. In most cases, the patient remains in a vegetative state or dies after a long stay in a coma.

Hemorrhagic stroke - what is it?

Stroke of the brain is divided into two types: ischemic And hemorrhagic.

Stages of recovery after hemorrhagic stroke, video:

Prognosis after hemorrhagic stroke

Talk about accurate forecasts after a hemorrhagic stroke is not necessary. Even the most experienced specialists do not resort to this, since there are practically no statistics as such.

If a person has retained all the basic reflexes and functions after a stroke, then he has a much better chance of recovery. Although everything can turn into an extremely opposite situation, but only with improper treatment and repeated hemorrhage.
When a person is unconscious and his muscles contract, he also has a chance to recover.
The chances of recovery and survival rates are significantly reduced if a person has fallen into a coma after a hemorrhage. There are many cases when the patient, without regaining consciousness, dies. This is preceded by the circumstances of the incident, including timely medical assistance. We should not forget about the qualifications of specialists who provided first aid to the victim.

Be that as it may, the life expectancy of a person who has suffered a brain stroke is significantly reduced. On average, a patient after brain damage lives no more than 10 years.

A hemorrhagic stroke is much more dangerous than an ischemic one, but its consequences can be the most unexpected: as a full recovery only with partial loss motor functions, and human death.

Everyone should heed the advice of experts and undergo regular comprehensive examination to prevent the occurrence of the causes of the presented phenomenon.

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