Therapy of onmk according to the ischemic type. Acute cerebrovascular accidents (ACI). The main causes of occurrence

Passport data:

FULL NAME. Kriksina Alexandra Dmitrievna

Female gender

Age: 60 years old (21.02.41)

Permanent residence: Moscow, st. Leskova, 9-179

Profession: Pensioner

Date of receipt: 29.10.01

Curation date: 22.11.01

Complaints of sudden speech disorders, weakness in the right leg and right arm.

History of the present disease. (Anamnesis morbi.)

According to the son-in-law: she fell ill acutely on November 29, 2001, when the patient suddenly lost her speech, weakness appeared in her right limbs, the patient fell to the floor, did not lose consciousness. sick long time suffers from hypertension (Stage III). In September 2001, the patient suffered an acute cerebrovascular accident with speech disorders without paresis. However, within a month, speech was almost completely restored.

Life story. (Anamnesis vitae).

Born in 1941 on February 21 in Moscow. Childbirth was normal, without pathology. The patient is the second child in the family, mentally and physical development did not lag behind peers. Secondary education.

Family and sexual history:

Married, 2 children.

Nutrition: Excessive, varied, high-calorie.

Past illnesses:

childhood infections (whooping cough, chickenpox, scarlet fever). The patient has tuberculosis. The patient denies the transfer of jaundice, sexually transmitted diseases

Allergic history:

Allergic reactions to food, serum drugs and vaccines are absent.

Heredity:

Not weighed down.

The present state of the patient. (status praesents).

General inspection.

On general examination, the patient's condition is satisfactory, the position is active. The physique is correct, the constitutional type is normosthenic. The posture is stooped. Body temperature 36.4 degrees Celsius.

The skin is pale in color, the face is hyperemic, dry on the entire surface of the body, without age spots. Visible mucous membranes are pale Pink colour without any pigment spots.

Subcutaneous fatty tissue is moderately developed, there is no pain and crepitus on palpation. Edema is absent.

Lymph nodes: inguinal, axillary, cervical are non-palpable and painless. Zev: the root of the tongue and the soft palate are not hyperemic, there is no plaque and swelling. The tonsils are enlarged, not hyperemic, without plaque.

On palpation of the skeletal system, there is no pain, deformation is not noted.

Respiratory system.

On examination of the respiratory organs, no cough is observed. Shortness of breath in the active and passive position is not observed. There are no pains in the chest.

Auscultation of breathing in symmetrical areas of both lungs is vesicular. Bronchophony in symmetrical areas of the chest is the same.

The cardiovascular system.

At the time of curation of complaints, there were pains in the region of the heart, shortness of breath, suffocation, palpitations, and no edema. Arteries and veins are not enlarged, there is no visible pulsation (positive venous pulse is absent). The area of the heart without visible changes.

There is an expansion of the left border of the heart to the left.

On auscultation of the heart, the tones are muffled. The rhythm is right.

Pulsation of the aorta in the jugular fossa is absent.

The arterial pulse is the same on both arms, 92 beats per minute, of medium magnitude, tension and filling. Blood pressure 180/100 mm Hg.

During examination and palpation of the veins of the neck, swelling, pulsation was not detected. Expansion of the veins of the chest, abdominal wall, no limbs.

Digestive system.

Gastrointestinal tract.

Vomiting, dyspepsia, flatulence, stool disorders are absent. When examining the oral cavity, the tongue is moist, pink, without plaque, cracks, ulcers. Gums, hard and soft palate of pink color, without visible damage. Appetite is reduced.

On examination, the abdomen is of the correct shape, symmetrically participates in the act of breathing, there is no bulging and retraction of the abdominal wall, there is no visible peristalsis.

With percussion of the abdomen, there is no free and encapsulated fluid. Mendel's sign is negative.

With superficial palpation, there is no pain and tension in the abdominal muscles.

Auscultation: peristalsis of normal strength, duration, periodic. The noise of friction of the peritoneum and vascular noises are not auscultated.

Liver and gallbladder.

At the time of curation, there were no complaints of pain in the right hypochondrium and dyspeptic symptoms.

On examination, there are no protrusions and retractions in the area of the right hypochondrium.

The gallbladder is not palpable.

Spleen.

At the time of curation, there were no complaints of pain in the left hypochondrium.

When examining a limited protrusion in the area of the left hypochondrium and respiratory restriction in this area was not revealed.

The spleen is not palpable.

The noise of friction of the peritoneum is not auscultated.

Pancreas.

Pain in the upper abdomen, dyspeptic symptoms are absent.

On palpation, enlargement and induration of the pancreas were not detected.

Urinary system.

When examining the genitourinary system, there is no pain in the lumbar region. There is no pain in the bladder area, urination is not disturbed and painless. Urine: straw-yellow color, transparent, no blood impurities.

Examination of the lumbar and suprapubic region revealed no pathological changes.

The kidneys in the horizontal and vertical position are not palpable, bladder not palpable. Soreness at the costovertebral point and along the ureters is not determined.

Endocrine system.

Violations of growth and physique were not revealed, the physique is proportional. Obesity is absent. The skin is dry, thinned, without roughness. An increase in the size of the nose, jaws, auricles, hands, feet is absent.

The thyroid gland is not enlarged, painless.

neurological status.

In the mind, contact is difficult due to speech disorders. Cerebral and meningeal symptoms are absent.

cranial nerves.

I. Olfactory nerve. The sense of smell is preserved. Perversions of smell, olfactory hallucinations are not present.

II. The optic nerve. Vision is reduced. Loss of the right visual fields of both eyes. The color perception is preserved.

III Oculomotor, IV trochlear, VI abducens nerves. The right palpebral fissure is dilated D>S. The volume of eye movements in all directions is fully preserved. There are no floating eye movements. Paresis of gaze to the right. Set gaze to the left. Pupils of medium size, D=S. Photoreaction (direct and friendly) is saved. There is no strabismus, diplopia, exophthalmos.

V. Trigeminal nerve. Pain in the exit area of the nerve branches is absent. There are no paresthesias. Violation of sensitivity in the peripheral and segmental tip was not detected. The sensitivity of the mucous membranes of the mouth, the tongue of the nose of the eyes is intact. When opening the mouth, the lower jaw does not deviate to the side. The trophic muscles are not broken. Corneal and conjunctival reflexes (V-VII) are positive.

VII. Facial nerve. There is no immobility, maskedness of the face. The right nasolabial fold is smoothed out. The right palpebral fissure is dilated. Asymmetry is observed when the forehead is wrinkled, the eyebrows are furrowed, and the teeth are bared. Positive "sail" symptom.

VIII. Auditory nerve. Hearing preserved on both sides. There is no ringing and noise in the ears. Nystagmus, no systemic dizziness.

IX. Glossopharyngeal, X vagus nerves. Mild dysphagia, pharyngeal reflexes high D=S. The sensitivity of the upper part of the pharynx is preserved. The voice is quiet, hoarse.

XI. Accessory nerve. Raising the shoulder girdle and turning the head, raising the left arm above the horizontal, convergence of the shoulder blades are preserved. On the right side, these arbitrary movements are limited. Head position without tilting to the side. The trophism of the sternocleidomastoid muscles is not disturbed.

XII. Hypoglossal nerve. When protruding, the tongue deviates into right side without atrophy and fibrillar twitching. Dysarthria.

Propulsion system.

On examination and palpation of the muscular system, atrophy, pseudohypertrophy, fibrillar and fascicular twitches are absent. Passive movements of the upper and lower extremities are preserved in full. Lack of active movements in the right limbs. There is a weakening of muscle strength, detected in the Barre test, up to 2-3 points in the right limbs with an increase in muscle tone (in the upper limbs, the flexor tone is increased, in the lower limbs, the extensor tone is increased) according to the spastic type. Akinesis, bradykinesia, hyperkinesis (tremor, chorea, athetosis, choreoathetosis, hemiballismus, myoclonus, torsion dystonia, tics) are absent. Automated gesticulation syndrome was not identified.

Seizures and convulsive twitches are absent.

Movement coordination.

The finger-nose test is carried out confidently. There is no intentional tremor, adiadochokinesis, hypermetry, or chanted speech.

Reflexes.

Tendon and periosteal reflexes are brisk: from the upper limbs D>S, from the lower limbs: knee (L2-L4, femoral nerve), Achilles (S 1

S2, tibial nerve) - D>S.

Skin reflexes: upper (Th7-Th8), middle (Th9-Th10), lower (Th11-Th12) abdominal, plantar (tibial nerve, L5-S2) decreased D>S.

Articular reflexes Mayer (ulnar and median nerves, C7-Th1) and Lehry (ulnar and median nerves, C6-Th1) are reduced.

Pathological reflexes:

pyramidal: Babinski's reflex is detected on the right, Oppenheim's, Gordon's, Schaeffer's reflexes are negative;

the reflections of the Rossolimo group (Bekhterev 1, 2, Zhukovsky) are negative.

Protective reflexes:

positive on the right.

Reimist's synkinesis is revealed.

Pseudobulbar reflexes:

positive reflexes of oral automatism were revealed: naso-labial, labial, proboscis, palmar-chin.

Sensitivity.

Superficial sensitivity (pain, temperature, tactile, hair) is absent on the right, preserved on the left. Deep sensitivity (muscle-articular feeling, vibration, feeling of pressure and weight) is absent on the right, preserved on the left. Complex sensitivity (kinesthetic, discriminatory, two-dimensional, stereognosis) is absent on the right, it is determined on the left. Pain points along the peripheral nerves and roots are not determined.

autonomic nervous system.

Hyperthermia and hyperemia of the face are determined on both sides. Persistent white dermographism. Acrocyanosis is absent. The function of the pelvic organs, as well as the control over them of the patient, is not impaired.

Higher cortical functions.

Results of instrumental methods and laboratory studies.

Complete blood count dated 11/20/01:

Hemoglobin 128g/l

Hematocrit 0.5

Leukocytes 6.5

Band 13

Segmented 61

Eosinophils5

Basophils 0

Lymphocytes 20

Monocytes 4.2

General urine analysis:

Color straw yellow

Transparency is complete

Density 1018

The reaction is sour

Glucose

Leukocytes absent.

Protein absent.

Syndromic diagnosis.

During the examination, the patient reveals:

Movement disorders in the form of:

A) Central right-sided hemiparesis:

hyperreflexia, decreased skin reflexes D>S,

Synkinesia Reinest,

B) Central paresis of 7 and 12 nerves on the right:

smoothness of the right nasolabial fold,

asymmetry when wrinkling the forehead, frowning the eyebrows, baring the teeth,

Positive "sail" symptom,

protrusion deviates to the right side without atrophy and fibrillar twitches,

C) Pseudobulbar palsy:

dysphagia,

dysphonia,

Violation of sensitivity in the form of:

A) Right-sided hemianesthesia: a violation of all types of sensitivity on the right according to the hemitype.

B) Right-sided homonymous hemianopia.

C) Paresis to the right.

Violation of higher cortical functions:

A) Sensorimotor aphasia, agraphia, alexia.

Thus, the patient revealed the syndrome of three "hemi" (hemiparesis, hemianesthesia, hemianopsia).

Topical diagnosis.

1. Motor disorders in the form of a central right-sided hemiparesis indicate a lesion of the pyramidal tract, which begins in the right hemisphere in the neurons of the precentral gyrus, then it goes to the internal capsule (anterior two-thirds of the posterior thigh), then it passes in the middle part of the legs of the brain, descends through the base of the bridge and into the lower part of the medulla oblongata passes to the opposite side and approaches the anterior horns.

Central paresis of the VII and XII nerves indicates a unilateral lesion of the corticonuclear tract, passing in the knee of the internal capsule, in the middle part of the legs of the brain. When approaching the nuclei, this path also crosses. This pathology is due to the fact that only the nucleus XII and the lower pole of the nucleus VII of the cranial nerve have unilateral connections with the cortex.

Pseudobulbar syndrome indicates a bilateral lesion of the corticonuclear pathway (its supranuclear region).

2. Sensory disorders in the form of:

A) right-sided hemianesthesia refers to the defeat of the fibers passing in the posterior third of the posterior thigh of the internal capsule.

Surface sensitivity:

The first neuron is located in the spinal ganglion, the second neuron (spinothalamic) begins at the cells of the posterior horn, its fibers pass through the anterior commissure to the opposite side, entering the white matter. They rise up the brainstem and end in the ventral part of the thalamus. The third neuron starts at the outer part of the optic tubercle, goes through the posterior third of the posterior thigh of the left inner capsule to the superior parietal lobe (thalamo-cortical tract).

Deep Sensitivity:

The central process of the first neuron participates in the formation of the posterior root and, without entering the posterior horn of the segment, goes to the posterior columns. As part of the bundles of Gaulle and Burdakh, the paths rise, without interruption, to the nuclei of the same name in the lower part of the medulla oblongata. They are the beginning of the second neuron (bulbothalamic tract), which immediately passes to the opposite side of the medulla oblongata and, after decussation, forms a medial loop, to which the spinothalamic tract approaches in the area of the bridge. The third neuron is formed from the cells of the outer nucleus of the thalamus and their fibers, which through the posterior part of the posterior femur of the internal capsule to the cortex of the posterior central gyrus and the superior parietal lobe.

B) right-sided homonymous hemianopsia with preservation of the pupil's reaction to light indicates a lesion of Graziola's radiance, because there are non-pupillary fibers in it.

C) gaze paralysis to the right indicates damage to the left frontal oculomotor tract.

Violation of higher cortical functions in the form of sensory-motor aphasia, agraphia, alexia with damage to the posterior part of the lower frontal gyrus - Broca's area (field 44), superior temporal gyrus - Wernicke's area (field 22) of the left hemisphere.

The syndrome of three "hemi" indicates the defeat of the entire posterior posterior femur of the left internal capsule. This area is vascularized by the middle cerebral artery, which is a branch of the left internal carotid artery. Also, this patient was found to have lesions in the radiance of Graziola, 44 and 22 fields of the cortex of the left hemisphere.

Clinical diagnosis.

Primary disease: repeated acute violation of cerebral ischemic type in the system of the left internal carotid artery. Atherosclerosis of cerebral vessels. Dyscirculatory encephalopathy IIIst.

Concomitant diseases: hypertension III stage, circulatory failure 1.

The clinical diagnosis was made on the basis of:

Complaints: according to the words of the son-in-law (due to the speech disorder of the patient), the patient fell due to sudden weakness in the right limbs. However, without loss of consciousness, vomiting. Also complaints about speech impairment. History of the development of the present disease: a patient with a vascular history suffers from hypertension for a long time (20 years), overnutrition. The patient has atherosclerosis of cerebral vessels. Also in September 2001, the patient suffered an ischemic stroke in the basin of the left internal carotid artery. Examination data: absence of cerebral and meningeal symptoms, left hemispheric focal symptoms in the form of right-sided hemiparesis, right-sided hemianopsia and hemianesthesia. The presence of pseudobulbar palsy, as well as sensory-motor aphasia, alexia, agraphia.

Thus, given the patient's age, long-term vascular history, ischemic stroke in the past, we can talk about damage to the left internal capsule (its posterior thigh), as well as damage to the cortex of the cerebral hemispheres due to ischemic stroke of the artery supplying these zones. The proposed mechanism of damage is non-thrombotic, which occurs more often due to occlusion of the vessel by an atherosclerotic plaque, tortuosity of the vessels.

Treatment plan.

Stationary mode. Table 10 Sol.Rheopholyglucini 400 IV drip. Tab.Glicini up to 1 g per day under the tongue. Tab.Aspirini ¼ at night. exercise therapy. Massage. Barotherapy. Expert advice.

22.11.01 Condition is satisfactory. The patient does not present any complaints due to a speech disorder. Right-sided hemiparesis, hemianesthesia persist. Pseudobulbar symptomatology is pronounced. Muscle tone is increased in the right extremities of the postspastic type.

Heart rate 80 beats/min, respiratory rate 18/min. BP 150/100.

26.11.01 Condition is satisfactory. No complaints due to the preservation of speech disorders. Neurological and somatic status unchanged. There is an increase in muscle strength in the right limbs up to 3.5 points.

Physical therapy, massage, barotherapy are carried out.

HR 75 beats/min, RR 19/min, BP 140/100.

The greatest severity of the condition in patients with ischemic stroke is observed in the first 10 days of the disease, then there is a period of improvement, when the patient begins to decrease the severity of symptoms. In this case, the rate of recovery may be different. With a good and rapid development of collateral circulation, it is possible to restore function on the very first day of a stroke, but more often after a few days. Mortality reaches 20-25%. However, in the case of this patient, an unfavorable prognosis is possible due to the fact that she has recently had a stroke and the risk of another stroke increases significantly.

Stage epicrisis.

21st day of stay.

Prevention.

Primary prevention of cerebral stroke consists in the exclusion of possible risk factors (overeating, smoking, stress, etc.), the organization of the patient's work and rest regimen, nutrition, and health improvement. Secondary prevention includes measures aimed at systematic monitoring of the condition of patients with cardiovascular diseases, their treatment, and antiplatelet therapy.

Rationale

In a patient with a burdened vascular history, who suffers for a long time……. Against this background, the extremities suddenly weakened without general cerebral and meningeal symptoms.

Inspection of a speech therapist from 11/22/01.

The patient is generally active, responds adequately to the speech addressed to her, performs simple tasks, with the complication of speech instructions, partial sensory aphasia is detected. Expressive speech is poor, monosyllabic, with large lateral paraphasias, which are noted both in spontaneous and repeated speech. Automated speech sequences are relatively preserved (their detached repetition is possible). Alexia, agraphia.

Stage epicrisis.

21st day of stay.

Dynamics of complaints: no clear complaints in connection with aphasic disorders.

Dynamics of the state: the state is relatively satisfactory, conscious, contact. Against the background of vascular-metabolic therapy, hemodynamic parameters returned to normal - BP 150-180/100. Neurological status without negative dynamics. Sitting, active, trying to restrain himself. Speech disorders persist. Right-sided central hemiparesis with spastic muscle tone.

ECG from 11/16/01 in dynamics from 11/6/01: blood supply to the anterior wall of the left ventricle is improving.

Ds: Recurrent acute ischemic cerebrovascular accident in the system of the left internal carotid artery.

Results of instrumental methods and laboratory studies.

Complete blood count dated 26.02.01:

Hemoglobin 128 g/l

Hematocrit 0.5

Leukocytes 6.5

Band 13

Segmented 61

Eosinophils 5

Basophils 0

Lymphocytes 20

Monocytes 4.2

General urine analysis:

Color straw yellow

Transparency is complete

Density 1018

The reaction is sour

Glucose

Leukocytes absent.

Protein absent.

Treatment plan.

Stationary mode. Table 10 Sol.Rheopholyglucini 400 IV drip. Tab.Glicini up to 1 g per day under the tongue. Tab.Aspirini ¼ at night.

Due to frequent spikes in blood pressure and various work-related problems of cardio-vascular system, including this and a violation of the structure of the walls of large or small blood vessels, a person can experience an acute violation of cerebral circulation of the ischemic type, which is a type of stroke.

This is when a cessation occurs in one of the parts of the brain, a disorder of normal blood circulation, that is, in the area of \u200b\u200bthe pathology, the cells die due to a lack of oxygen. It is impossible to treat them, however, the functions for which they were previously responsible can be revived if more attention is paid daily during the rehabilitation period to the victim of stroke.

Based on this, it is also proved that the number of deaths of stroke victims is constantly increasing every year, as well as the number of people who have received a disability. This may be due not only to concomitant diseases, but also to polluted air, which is especially sinful for cities with a large population. Plus to everything malnutrition and bad habits further exacerbate the condition of many people.

Symptoms of ischemia in stroke

Stroke is one of the diseases that belongs to the type of neuralgia. She never comes alone, but is always accompanied by a number of ailments. Basically, it is important to note that the patient may experience the symptoms of acute ischemic stroke during deep sleep or in the very morning.

As a rule, poor health begins to gradually increase, thereby increasing the person's restless state every hour, so, within a day or several days.

At this very time, patients may experience the following ailments:

Cutting pain in the head.
Lethargy in movement.
Decreased sensation in the body, on any side.
The picture before my eyes becomes less clear.

Distortion of speech functions.
There are periods when, after a cerebral ischemic stroke, patients deny the presence of lethargy and low functionality of the arms and legs.

Together with the listed symptoms, the doctor can also identify the syndrome of lowering pain threshold, unilateral decrease in vision and a severe form of disorders of the speech apparatus.

This includes the distortion of one half of the nasolabial line, the deterioration of reading processes and the functions of swallowing food, and due to poor cerebral circulation, the patient has a violation of the logic of judgment when solving arithmetic problems. Which can sometimes manifest itself as the inability of the victim to adequately assess his condition in the period after the stroke.

What can increase the risk of an acute period?

Ischemic stroke has never been an independent disease, on the basis of which, in a number of situations, stroke by the type of ischemia basically always overtook people at the most unexpected moments as a result of many ailments caused by the following reasons:

Regular pain in the region of the heart.
Disproportionate consumption of sugar, fat and flour products.
A high body mass index is the main reason for the development of diabetes mellitus and blockage of blood vessels.
Ischemic stroke is a common problem among the drinking and smoking population.
As a rule, many young women, fearing their pregnancy, begin to take hormonal drugs on their own, without warning their loved ones about it, including without consulting a doctor.

Hemoglobin in the blood may be high due to insufficient oxygen supply to the brain. In this case, a violation of cerebral circulation can result in a stroke of cerebral ischemia.
The advanced age of a person.
Consequences after head trauma.

Perhaps not all the reasons are listed here, however, even in this case, you should always pay attention to the daily menu, namely, which foods are most often present in the diet, fresh herbs and fruits, or are they sweet rolls with carbonated drinks. This also includes bad habits, when people who choose instead of a healthy active lifestyle can get a lot of problems leading to impaired cerebral circulation.

Necessary restorative actions during stroke

The person himself, who has experienced an acute malaise during an ischemic stroke, cannot determine in advance at what stage he will be able to fully recover. Together with this, he does not have the opportunity to find out what can happen to him in the future after the illness, how he will live on will remain for life in wheelchair or die within the first day.

Therefore, in order to prevent further deterioration of the patient's condition, doctors immediately during hospitalization begin to reduce the influence of the pathology by drug treatment or in an extremely acute period of the ischemic type, they can refer the patient to the department of surgery.

After the treatment of ischemic stroke in the acute period, when the patient improves, stability in terms of pressure and cholesterol, doctors can proceed to the next stage of the patient's recovery, for example, to the use of physiotherapy procedures. In this case, also, depending on certain consequences, rehabilitation courses of exercise therapy, massage and ergotherapy procedures are prescribed to restore mental and motor activity.

Pathological causes of brain stroke

Violation of blood circulation during an ischemic stroke leads to very serious consequences. When practically in the same proportions, patients can die or completely turn into incapacitated people. But, despite the danger of a brain stroke, 5-7% of the victims fully begin to serve themselves and walk without outside help already during the first rehabilitation stage.

But what the patient will eventually expect after a stroke will depend entirely on a number of the following reasons:

Occlusion in the large arteries of the hemispheres and cervical region, accompanied by obstruction of the blood due to a sharp blockage of the lumen due to the high content of platelets in the blood.
The presence in the patient's body of a focus of the inflammatory process.
The postoperative period on the heart, when, due to the formation of a blood clot, there is an immediate acute violation of blood circulation.
Due to dissection of the main artery.
The formation of a transparent dense mass in the internal environment of the connective tissues of the human body.
Violation of blood clotting, this phenomenon occurs mainly with manifestations of infections internal organs protracted nature.

It is also important to note that it will contribute to the development of ischemic brain stroke and various kinds of inflammation of the cervical regions, especially if the carotid arteries were affected in the process, there is such a possibility, but, by the way, it is extremely rare to cause a stroke.

Therefore, great importance should be given to those people who already have a history of osteochondrosis of the upper spine, when there is a possibility that there may be a violation of blood circulation in the area where blood passes from the neck to the brain.

In this connection, in order to improve blood permeability, such people need to constantly massage using an ointment or cream with a warming effect, due to which the blood permeability will be better, by increasing the lumen in the vessels.

Possible consequences after a difficult rehabilitation stage

During the period of a cerebral stroke, patients can get both very serious and quite mild consequences, which after some time can recover and return to their normal environment. If, in the process of recovery, a violation of the blood flow managed to affect larger areas of the medulla, then, most likely, the patient may develop the following ailments as a result:

In certain areas of the body, the patient will have a low threshold of sensitivity.
As a rule, in the post-stroke period, patients cannot fully feel their paralyzed arms and legs.
Violation of the swallowing function, when the patient requires intravenous feeding or by introducing food using a gastric tube.
Patients may not feel the taste of food, as the taste buds on the tongue will also have low sensitivity from the paralyzed part.
Partial or complete loss of hearing and vision after ischemic cerebral stroke.
A frequent sign of poor blood circulation in the brain is a violation of the perception and reproduction of speech.

During the beginning of rehabilitation, the patient can often feel signs of severe dizziness.
The patient's thoughts become less objective and reasonable, so he does not have the opportunity even from the most simple words put together an offer.
Violation of the processes of urination and defecation.
Due to low blood circulation during the period of illness, in most cases, coma for a long time.
Patients lack the ability to control their body position in space.

However, if more time is given to the patient from the beginning of the first and subsequent days, and preferably from the first second when he had a stroke, then there will be much more chances for his rehabilitation. Compared with the moment when help was provided to the patient not immediately, but after a few hours.

What basically happens when the patient himself does not pay more attention to his own health. But, most importantly, everything will depend on the specific area in which circulatory problems in the brain were recorded, and how quickly further complications were eliminated.

Elderly people are familiar with such a disease, the name of which CVA - acute cerebrovascular accident Or just a stroke. Almost every older person has experienced this disease on himself. It is important to understand the causes of stroke and proper treatment diseases.

What it is?

A stroke is a clinical symptom manifested by sharp failures in the normal operation of the existing options of the brain of the head, the duration of which is more than one day.

The main symptoms of CVA are:

The inability of the patient's body to move normally;
Disorders of the organs responsible for sensitivity;
Violations of the proper functioning of the speech apparatus;
The inability of the patient to make swallowing movements;
Frequent headache;
Loss of consciousness.

An unexpectedly appeared violation of the speech apparatus, loss of body sensitivity and problems with coordination of movement pass over the next day. Then they talk about transistor ischemic attack. This is not such a dangerous disease as a stroke, but also applies to stroke.

If the disease refers to disorders in the functioning of the circulatory system, then it is characterized as "stroke by the type of ischemia." In the case when bleeding is confirmed by a specialist, then the disease has the characteristic "CVA by hemorrhagic type".

A stroke that ends in a stroke is the stage when blood flow to some part of the brain stops. This phenomenon is caused by a decrease in the tone of the walls of the arteries of the brain and is accompanied by a disorder of the neurological system, which is a consequence of the destruction of part of the nerve tissue.

ONMK - code according to ICD-10

In the tenth international classification of diseases, stroke has several codes that differ from each other according to the disorders that caused the disease.

Prevention and treatment of this disease are considered at the state level, since stroke ends in death in a third of cases. Sixty percent of patients who have had the disease turn out to be disabled, who cannot do without social assistance.

Causes of stroke

CVA, related to the ischemic type, develops as a result of already existing pathologies in the patient's body.

These diseases include:

ACVE is found not only in the adult category of the population, but also in children. This is due to the fact that the vessels of the child's brain have any anomalies in their development. A high risk of developing stroke is observed in children who have congenital heart disease.

When stroke occurs, only 30% of children recover completely. About fifty percent have incurable disorders in the work of the neurological system. Twenty percent of cases of acute cerebral circulatory disorders in children end in death.

In what cases can CVD be suspected?

The diagnosis of stroke is made if the patient has the following disorders in the body:

A sharp lack of sensitivity in the limbs;
Loss of vision up to blindness;
Inability to recognize the opponent's speech;
loss of balance, problems with coordination;
Very severe headaches;
Clouding of consciousness.

An accurate diagnosis can be established only after the diagnosis.

Stages of cerebral infarction

ONMK has several stages of development. Let's consider each of them in more detail.

Stage number	Stage symptoms
First stage	There is a lack of oxygen, which leads to failures in the permeability of flat cells located on the surface of blood vessels. As a result, fluid and protein from the blood cells enter the brain tissue. Edema develops;
Second stage	At the capillary level, blood pressure continues to fall, which leads to disruption of the cell membrane. Nerve receptors and electrolyte channels also cease to function properly. At this stage, the disease can be prevented;
Third stage	There are disturbances in the work of cell metabolism, lactic acid accumulates in the tissues. Energy synthesis occurs, in which oxygen molecules do not participate. The anaerobic mode does not allow the tissues of neurons and astrocytes to maintain a normal level of vital activity. These cells increase in volume, causing malfunctions in the structure. The clinical picture is focal signs of a neurological nature.

Ischemic stroke

This type of stroke is accompanied by a complete cessation of blood flow delivery to specific areas of the brain tissue, which is accompanied by the destruction of brain cells and the cessation of its main functions.

Causes of ischemic stroke

A stroke of this plan is caused by obstruction of blood flow to any brain cell. As a result, the normal functioning of the brain stops. Plaque, consisting of cholesterol, can also become an obstacle to the normal flow of blood. This causes more than 80% of all diseases.

Risk group

CVA is most often manifested in the category of the population that have the following pathologies:

Vascular disorders that are atherosclerotic in nature;
A sharp increase in blood pressure;
Previous myocardial infarction of an extensive nature;
stretching of the artery;
Heart defects that are acquired or congenital;
Increased blood density caused by diabetes:
Decreased blood flow rate, which is a consequence of cardiac insufficiency;
Excess body weight;
Transistor ischemic attacks previously transferred to the patient;
Excessive consumption of alcohol and tobacco industry products;
Reaching the age of sixty;
The use of oral contraceptives that contribute to the occurrence of blood clots.

Symptoms of the disease

Neurologists distinguish several intervals in the development of ischemic stroke according to the severity of the disease:

The sharpest. Lasts up to five days;
Spicy. The duration is 21 days;
Recovery at an early stage. From the moment the acute symptoms are eliminated, it takes six months;
Late recovery. The rehabilitation period lasts for two years;
Eliminate traces. Over two years.

In addition to general symptoms, ischemic stroke of the brain is characterized by local symptoms. It depends on the area in which the disease occurred.

And so, if struck then the following symptoms appear:

Disorder of the visual system in the direction where the blockage of the vessel occurred;
The sensitivity of the extremities disappears on the opposite side of the focus of the disease;
In the same area, paralysis of muscle tissue occurs;
There are disorders in the work of the speech apparatus;
The inability to recognize your illness;
Problems with body orientation;
Loss of field of view.

With narrowing of the artery of the spine, another symptomatology is noticeable:

Hearing loss;
Twitching of the pupils when moving in the opposite direction;
Objects double in the eyes.

If the defeat happened on junction with an unpaired blood vessel, then the symptoms manifest themselves in a more severe form:

In case of defeat anterior cerebral artery:

Loss of sensation in the opposite side, usually in the leg area;
Slowness in movement;
Increased tone of the musculoskeletal tissue;
Lack of speech;
The patient cannot stand or walk.

If failures interfere with normal patency of the middle artery of the brain:

The result of a complete blockage of the main trunk is a state of severe coma;
In half of the body there is a loss of sensitivity;
Refuses the motor apparatus;
The inability to fix the gaze on the subject;
Fields of vision fall out;
There is a failure of the speech apparatus;
The patient is unable to distinguish the right limb from the opposite.

In case of violation patency of the posterior cerebral artery the following clinical picture is observed:

Obstruction of the optic geniculate artery accompanied by the following symptoms:

Lack of tactile sensations from the opposite side of the face and body;
If you touch the patient's skin, then he experiences severe pain;
Incorrect perception of light and knock;
Forearms and shoulder joints are bent. The fingers are also bent at the base.

Defeat on the site thalamus are characterized by the following symptoms:

The movements of the patient have a wide scope;
There is a strong tremor;
There is a loss of coordination;
Half of the body loses sensation;
Severe sweating is characteristic;
Bedsores occur.

The most severe case of stroke is the process of breakthrough intracerebral hematoma. Hemorrhage occurs in the cerebrospinal fluid, fills the cerebral stomachs with blood. This disease is called "ventricular tamponade."

This case of stroke is the most severe and in almost all cases ends in death. The explanation for this lies in the unhindered flow of blood into the patient's brain.

Treatment of stroke by ischemic type

The above symptoms may appear unexpectedly in native person. It is very important to provide the first first aid sick.

After calling an ambulance, it is necessary to alleviate the patient's condition using the following methods:

Put the patient on the side so that vomiting freely leaves the victim's oral cavity;
The head should be slightly raised;
If there is a tonometer, then it is necessary to measure blood pressure. If a sharp increase in pressure to critical values \u200b\u200bis noticed, then a drug should be placed under the patient's tongue to reduce it;
Provide the patient with the required amount fresh air;
Release the patient's neck from any squeezing things.

Treatment in a hospital

After arriving at the medical facility, the victim is placed in the intensive care unit. Next, the patient is prescribed a special diet, which focuses on the balance of all the necessary trace elements. Nutrition is adjusted so that fatty, spicy, salty foods are not observed in the diet.

Mayonnaise and other seasonings should also be excluded. Vegetables and fruits are limited only during the acute stage of the disease. If the patient's consciousness is absent, then food intake is carried out through a medical probe no earlier than two days later.

After confirmation of stroke, inpatient treatment continues for a month. The consequences after the transfer of this disease are extremely severe.

Severe loss of strength in muscle tissue on the opposite side of the brain, the area of which was damaged. A certain category of patients practically learns to walk again and perform normal movements;

. The decrease in strength occurs only in the area of the mouth, cheeks and lips. The patient is unable to properly eat and drink fluids;

Quite often there is a disrupted work of the speech apparatus. This is caused by damage to the speech center in the human brain. The patient either completely loses speech, or does not perceive the words of another person;

Movement coordination disorder and caused by a lesion in the departments of the central nervous system, which are responsible for the normal functioning of the human motor system. In severe cases, disturbances may persist for several months;

Malfunctions of the visual system are of a different nature and depend on the size and localization of the lesion with a stroke. Usually they are expressed in the loss of visual fields;

Sensory disturbance expressed in the loss pain sensations of heat and cold.

Rehabilitation

Very milestone on the way to recovery after stroke.

Quality therapy includes the following categories of treatment:

Physiotherapy. It is necessary to return the patient to normal movement of the limbs. A set of exercises is selected by the attending physician;
Visiting a speech pathologist. It is prescribed if the patient has speech and swallowing disorders;
Physiotherapy. The most affordable type of therapy, which is in every clinic;
Therapy with medicines. The main stage in the recovery process. Drugs mitigate complications after the disease and prevent the risk of relapse;
Mind training. It is desirable for the patient to read as much literature as possible, memorize poems or excerpts from works.

CVA by hemorrhagic type

Components that have a nutritional effect, which include oxygen, enter the brain through the carotid arteries. Being in the box of the skull, they form a network of vessels, which is the root of the blood supply to the central nervous system. When arterial tissues are destroyed, the blood flow rushes to the brain.

Causes

A stroke of the hemorrhagic type occurs in the event of a hemorrhage into the brain from a vessel whose integrity has been compromised. As a result, a hematoma occurs in the patient's brain, which is limited to the brain tissue. Also, blood from a burst vessel can penetrate into the area surrounding the brain.

Risk group

Particular attention should be paid to the state of their health of the following category of citizens:

Suffering from the expansion of blood vessels of a congenital nature;
Having anomalies in the development of arteries and veins;
Suffering from inflammatory diseases of the walls of blood vessels;
With pathologies of connective tissues of a systemic nature;
Having lesions of blood vessels, accompanied by a violation of protein metabolism;
Abuse of drugs that stimulate the nervous system.

Symptoms

Acute headache;
Constant vomiting;
Frequent loss of consciousness over a long period;
In almost all cases, there is an increase in blood pressure;
Increasing sensations of weakness in the limbs;
A disorder in the functioning of the organs responsible for sensitivity or a complete loss of sensitivity;
Violation of the motor system;
Disorder of the visual system;
Strong nervous excitement;
When analyzed, a small amount of blood is observed in the cerebrospinal fluid;

Treatment of stroke by hemorrhagic type

Drug therapy consists in the use of drugs whose action is aimed at stopping bleeding, reducing the size of cerebral edema, and calming the nervous system. Antibiotics and beta-blockers are used.

Medications can cause stroke recurrence, so it is advisable to eliminate the problem through surgery. First of all, the neurosurgeon removes the lesion, and then eliminates the failure in the vessel.

Reversibility of pathology

During diagnostic tests whether the symptoms of stroke are reversible is essential. When the stage is reversible, the brain cells exist in the paralysis phase, but their integrity and full-fledged work are not disturbed.

If the stage is irreversible, then the brain cells have died and cannot be restored in any way. This area is called the ischemia zone. But therapeutic treatment in this case is possible.

Its meaning is to provide neurons with all the nutrients in the ischemic zone. With proper treatment, cell functions can be partially resuscitated.

It was found that a person does not use all the resources of his body in the course of his life, including not all brain cells are involved. Cells that are not involved in the work can replace the dead cells and ensure their full functioning. The process is rather slow, so full rehabilitation lasts for three years.

Transistor ischemic attack (TIA)

This disease is also a stroke, but unlike ischemic and hemorrhagic stroke is temporary. For a certain period of time, there is a sharp violation of blood flow in the large vessels of the brain, as a result of which its cells suffer from a lack of oxygen and nutrients. The symptoms of TIA - transistor ischemic attack last for days and are similar to the symptoms of a stroke.

If more than 24 hours have passed, but the disease has not receded, then most likely a stroke of an ischemic or hemorrhagic type has occurred.

Symptoms

Consider the symptoms of a transistorized ischemic attack:

There is a decrease in sensitivity in one of the sides of the face, body, lower or upper extremities;
Weakness in the body, which is mild or moderate;
Violations in the work of the speech apparatus up to the complete absence of speech or problems with understanding the words of the opponent;
Dizziness and incoordination;
Sudden noise in the ears and head;
Headache and heaviness.

These symptoms appear abruptly and disappear after 3-4 hours. The deadline that distinguishes a transistor ischemic attack from a stroke is no more than a day.

What diseases can cause TIA?

TIA can be caused by the following conditions:

Persistent increase in blood pressure, which is chronic;
Chronic cerebrovascular disease;
Changes in blood clotting;
sudden drop in blood pressure;
The impossibility of the normal flow of blood through the artery, caused by a mechanical obstruction;
Pathology of the structure of cerebral vessels.

Transistor ischemic attack can and should be treated! Despite the fact that its symptoms pass quite quickly, this ailment already signals a malfunction in the body and, in case of relapse, can turn into a stroke!

Risk group

Transistor ischemic attack is no less dangerous than a stroke. Up to 8% of patients who have had a TIA in the future suffer from a stroke that occurred within a month after the attack. In 12% of patients, a stroke occurs within a year and in 29% within the next five years.

Treatment of transistorized ischemic attack

It is carried out in a hospital.

Diagnostic studies include the following procedures:

Visiting a cardiologist, angiologist and ophthalmologist. The patient is assigned a consultation with a medical psychologist;
To conduct a laboratory analysis, the patient must pass a general blood and urine test, as well as blood for a biochemical analysis;
electrocardiography;
Computed tomography of the brain;
X-rays of light;
Regular blood pressure checks.

The victim is allowed to go home only if the recurrence of TIA is excluded or the patient has the opportunity to be immediately hospitalized in case of a second attack.

The treatment of transistorized ischemic attack is to take the following oral medications:

The action of which is aimed at thinning the blood;
Vasodilating agents;
Lowering cholesterol levels in the blood;
Designed to normalize blood pressure.

It is good to combine drug therapy with balneotherapy and physiotherapy.

Prevention

To avoid the occurrence and recurrence of a transistor ischemic attack, a set of preventive measures should be observed:

Go in for sports, having previously drawn up a lesson plan together with your specialist;
Adjust the diet by reducing the amount of fatty, salty and spicy foods;
Reduce the use of alcohol and tobacco products;
Monitor your body weight.

Survey algorithm

It is possible to diagnose stroke by characteristic symptoms, but in order to determine the degree of the course of the disease, to which type of stroke it applies

It is necessary to undergo a series of diagnostic studies.

Examination by a specialist immediately after the patient enters the medical facility;

Taking blood for laboratory analysis, in order to assess the state of glucose levels, coagulation, enzymes;

CT scan in this case, allows you to get more complete information about the disease. In the first 24 hours after an ischemic disorder, it is not possible to find out the localization of the affected area.

This problem can be solved by conducting magnetic resonance imaging;

Angiography of cerebral vessels helps to determine with reliable accuracy the area where the lesion occurred or the level of narrowness of the artery. With this study, an aneurysm and a pathological connection between the veins and arteries of the brain can be diagnosed.

But the obtained results do not allow to correctly assess the amount of destruction of the nerve tissue. The solution to this problem is to combine vascular angiography with other diagnostic methods;

Collection of cerebrospinal fluid for laboratory research is a threat to the patient's life, but this study allows you to determine what type of stroke belongs to.

This diagnostic method is mainly used in medical institutions, which lack more advanced equipment.

Forecast

A favorable outcome after the disease has a category of citizens who have experienced a small form of stroke. With few restrictions, these patients can normalize their life.

Statistics show that 40% of deaths occur within the first month after illness. 70% show signs of disability in the first month. Over the next 6 months, 40% become disabled. After two years, signs of disability are noticeable in 30% of patients.

Video: ONMK. Signs of a stroke.

In addition, hemorrhage can occur during treatment with fibrinolytic agents and anticoagulants, as well as as a result of the abuse of drugs such as cocaine, amphetamines.

Risk factors for stroke include not only the diseases listed above, but also the following:

violation of fat metabolism;
obesity;
smoking and other bad habits;
lack of physical activity;
elderly age;
genetic predisposition;
significant physical activity;
severe stress.

Not only older people can get sick, but also young people suffering from high blood pressure due to kidney disease. An aneurysm of a cerebral vessel (thinning and saccular expansion of the vessel wall), which can rupture, can also lead to a hemorrhagic stroke. In any case, there is a hemorrhage in the brain, disrupting the activity of this part of the brain. Depending on the site of the hemorrhage, the disease can manifest itself and develop in different ways. If the area of hemorrhage is the cerebellum and the brain stem, death may occur within two days.

Symptoms and course of the disease

Hemorrhagic stroke is sudden and proceeds like a stroke.

The development of a stroke is characterized by an acute course. A person feels a sudden sharp headache, leading to loss of consciousness, the face turns red, there may be vomiting, breathing quickens, tachycardia, hemiparesis or hemiplegia begins. Paralysis quickly develops. In severe cases of stroke, a coma can develop at the first symptoms.

This type of stroke affects people between the ages of 45 and 60 and affects both men and women. A stroke can be caused by overwork, excitement, physical overload or overexertion. A harbinger of a stroke can be a headache, as well as flushing of blood to the face.

So, the general symptoms of the development of a stroke include the following manifestations:

nausea;
disorder of consciousness;
acute headache;
dizziness;
noisy breathing;
cold skin;
tense slow pulse;
dilated pupil on the side of the hemorrhage;
eye divergence;
"swimming" of the eyeballs;
muscle hypotension;
hands fall in the form of whips;
both skin and tendon reflexes are reduced;
outward rotation of the foot occurs;
sudden weakness;
numbness, paralysis of the muscles of the face, limbs (usually on one side of the body);
speech disorder;
a sharp deterioration in vision in one or both eyes;
loss of balance and sudden gait disturbance.

Also, the development of a stroke may be accompanied by meningeal symptoms.

Manifestations of intracranial hemorrhage depend on where the spilled blood gets.

When blood enters the subarachnoid space (between the membranes of the brain, that is, between the substance of the brain itself and the bones of the skull from the inside), the following symptoms develop:

sudden and severe headache;
photophobia ( pain in the eyes when looking at any light source or when in a lit room);
nausea and vomiting that does not bring relief; loss of consciousness.

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With the accumulation of blood in the substance of the brain, a hematoma (local accumulation of blood) is formed. A hematoma, as a volumetric formation, will cause symptoms associated with the pressure of the hematoma on adjacent areas of the brain. Therefore, the manifestations of intracerebral hematoma are determined by its localization in the brain. Hematoma in the frontal lobe can cause the following symptoms:

decrease in intelligence;
the appearance of foolishness (behavior characterized by stupid jokes, talkativeness);
speech disorders: slurred speech of the patient (like "porridge in the mouth"). This is called motor aphasia;
stretching the lips with a tube (as when sucking): spontaneously or when touching an object to the lips;
unsteadiness of gait: often the patient has a tendency to fall on his back when walking.

Hematoma in the temporal lobe can cause the following symptoms:

speech disorders: the patient does not understand the speech addressed to him, although he hears it (his native language sounds like a foreign language to him). This is called sensory aphasia;
loss of visual fields (lack of vision in any part of the visual field);
convulsive seizures that are observed in the limbs or throughout the body.

A hematoma in the parietal lobe can cause a violation of sensitivity in one half of the body (a person does not feel touch, does not feel temperature and pain during painful stimuli).

Hematoma in the occipital lobe can cause visual impairment - blindness or limited visual field in one or both eyes.

With the accumulation of blood in the substance of the cerebellum, the following symptoms are possible:

violation of coordination of movements (movement sweeping, fuzzy);
unsteadiness of gait: the patient deviates to the side when walking, there may even be falls;
large-scale horizontal nystagmus (pendulum eye movements, "eyes run" from side to side);
decreased muscle tone (muscle hypotension);
redness of the face and body;
violation of the rhythm of breathing;
disturbance of consciousness (confusion of consciousness or its complete absence).

In the case when blood enters the ventricular system of the brain, it blocks the lumen of the channel through which the cerebrospinal fluid (cerebrospinal fluid involved in the nutrition and metabolism of the brain) flows from the ventricles of the brain. Acute occlusive hydrocephalus develops (accumulation of cerebrospinal fluid inside the cavities of the brain (ventricles of the brain) with their "stretching" from the inside, compression of the brain substance by increased intracranial pressure). In this case, the following signs are possible:

convulsive seizures (sharp contraction of the muscles of the arms and legs, sometimes with loss of consciousness);
disturbance of consciousness (confusion of consciousness or its complete absence);
violation of muscle tone (paroxysmal increase in tone in the limbs, followed by a lack of tone).

The first 2.5-3 weeks after a 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 manifests itself in the development and increase of dislocation and cerebral symptoms. Moreover, dislocation of the brain and its edema are the main cause of death in the acute period of the disease, when the above symptoms are accompanied or decompensated by previously existing somatic complications (impaired kidney and liver function, pneumonia, diabetes, etc.). By the beginning of the fourth week of the disease in surviving patients, the regression of cerebral symptoms begins and the consequences of focal brain damage come to the forefront of the clinical picture, which will later determine the degree of patient disability.

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Treatment of the disease

With a stroke attack, the patient needs urgent hospitalization. If hospitalization is not possible, then patients are given medications that improve blood circulation.

Treatment for hemorrhagic stroke can be conservative or surgical. The choice in favor of one or another method of treatment should be based on the results of a clinical and instrumental assessment of the patient and a consultation with a neurosurgeon.

Medical therapy is carried out by a neurologist. Basics of conservative treatment of hemorrhagic stroke corresponds to the general principles of treatment of patients with any type of stroke.

If a hemorrhagic stroke is suspected, it is necessary to start therapeutic measures as soon as possible (at the pre-hospital stage). At this time, the main task of the doctor is to assess the adequacy of external respiration and cardiovascular activity. To correct respiratory failure, intubation is performed with the connection of mechanical ventilation.

Disorders of the cardiovascular system are, as a rule, in severe arterial hypertension, so blood pressure must be normalized as soon as possible.

One of the most important activities that should be carried out upon the patient's arrival at the hospital is therapy aimed at reducing cerebral edema. For this, hemostatic drugs and drugs that reduce the permeability of the vascular wall are used.

When adjusting blood pressure in hemorrhagic stroke, it is necessary to avoid a sharp decrease in it, since such significant changes can cause a decrease in perfusion pressure, especially with intracranial hematoma. The recommended level of blood pressure is 130 mm Hg. To reduce intracranial pressure, saluretics are used in combination with osmodiuretics. In this case, it is necessary to control the level of electrolytes in the blood at least twice a day. In addition to the above groups of drugs, intravenous administration of colloidal solutions, barbiturates are used for the same purposes. Carrying out drug therapy for hemorrhagic stroke should be accompanied by monitoring of the main indicators that characterize the state of the cerebrovascular system and other vital functions.

Since a stroke attack occurs on the spot, only the treatment of the consequences of a stroke, as such, is carried out in Israel. Stroke treatment is more of a post-stroke rehabilitation than a general treatment. Patients are prescribed vascular therapy, oxygen therapy, rehabilitation treatment and rehabilitation (physiotherapy, exercise therapy, diet organization). After an attack, the patient is shown bed rest, massage, restorative gymnastics, as well as taking medications.

The most important thing is that in Israel, patients are being treated for the underlying diseases that caused the stroke. Treatment of cardiovascular diseases, hypertension and atherosclerosis stands in the same place with rehabilitation. Patients undergo the following examinations to help identify the disease and begin its treatment in order to avoid new attacks: blood tests, chest X-ray, craniography, etc.

In addition to conservative treatment, surgical treatment is also carried out.

Indications for surgical treatment

hemorrhages in the cerebellum;
hemorrhage with a volume of more than 40 ml;
hydrocephalus (compression of the brain with fluid);
aneurysm rupture.

Surgical removal of the hematoma, if possible (for superficially located hematomas):

carry out either aspiration of blood (through a syringe needle inserted into the hematoma);
or removal of a hematoma and plastic vessel through a burr hole (a hole in the bones of the skull), that is, trepanation of the skull.

Surgical methods of treatment:

suturing a ruptured aneurysm, followed by the application of special clips or wrapping it with muscle tissue to prevent subsequent ruptures;
embolization (blockage) of the aneurysm with a special coil (if it is impossible to remove or sutured it);
radiological technique. As with angiography, a catheter with a balloon is inserted through the femoral artery, the balloon inflates in the right place and stops the bleeding;
stem cell transplant. Gives a good effect by restoring damaged cells or replacing them with new ones;
in some cases of hemorrhagic stroke, in addition to removing the hematoma, it becomes necessary to drain the ventricles (external ventricular drains), for example, in the case of massive ventricular hemorrhage or occlusive dropsy (with cerebellar hematoma).

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Diagnosis of the disease

Analysis of complaints and anamnesis of the disease: how long ago the complaints occurred (weakness in the limbs, swallowing disorder, unsteady gait, etc.); whether the patient has previously noted an increase in arterial (blood) pressure, whether he took drugs that reduce blood pressure (hypotensive); whether the patient abuses alcohol; Has the patient been previously diagnosed? diabetes.
Neurological examination: the presence of impaired consciousness (does the patient answer questions, can he follow the simplest commands, for example, raise his hands); the presence of signs of neurological pathology: weakness in the limbs, impaired sensitivity of the body, impaired swallowing (choking when swallowing), impaired muscle tone (more often increased tone), unsteady gait, etc.
A complete blood count and a coagulogram help differentiate the nature of a stroke and adjust the treatment plan.
Ultrasound (Doppler ultrasound) of the carotid arteries. Sets the topography of the narrowing of the vessel
Computed tomography (CT). Allows you to determine the type of stroke, identify the focus and volume of hemorrhage.
Magnetic resonance imaging (MRI). Solves the same problems as CT, but with a higher resolution.
Angiography of cerebral vessels. The state of the vessels is determined (the presence of aneurysms, narrowings). It is performed using a radiopaque catheter inserted through the femoral artery. After widespread adoption, CT and MRI are used less frequently.
Diffusion-weighted tomography is the latest express modification of MRI, which allows you to determine the area of the brain with impaired blood circulation in a few minutes.
Lumbar puncture. With the help of a special needle, a puncture is made in the subarachnoid space of the spinal cord at the lumbar level (through the skin of the back) and 1-2 ml of cerebrospinal fluid (a fluid that provides nutrition and metabolism in the brain and spinal cord) is taken. Since the subarachnoid space of the spinal cord communicates directly with the subarachnoid space of the brain, if there is a hemorrhage between the membranes of the brain, blood or its remnants can be detected in the cerebrospinal fluid. If the stroke is hemorrhagic, there will be an admixture of blood in the cerebrospinal fluid.