Hemorrhagic stroke
Every year in Ukraine, 100-140 thousand cases of hemorrhagic strokes are registered. The annual incidence of hemorrhagic strokes among the working population is approximately 15-20 per 100 thousand.
Reasons
Intracerebral hemorrhage (ICH) is a local hemorrhage into the brain substance with damage to its structure. Most often, its causes are pathological changes in the cerebral vessels in such pathologies as:
- hypertension,
- atherosclerosis,
- cerebral vascular aneurysms,
- arteriovenous malformations,
- blood clotting disorders,
- brain tumors .
Symptoms
Hemorrhage into the brain is manifested by general cerebral symptoms:
- severe headache,
- dizziness,
- nausea,
- vomiting,
- impaired consciousness.
Focal symptoms
As well as focal symptoms as a result of damage to functionally important areas of the brain:
- speech impairment,
- impaired movement in the limbs,
- visual disorders,
- cramps in certain muscle groups.
Depending on the location and volume of the hematoma, the clinical picture will vary. Sometimes there is a disturbance of the level of consciousness up to coma.
Diagnostics
The method of choice for the initial diagnosis of intracerebral hematomas is computed tomography (CT) without contrast. It is used to determine the localization and volume of the hemorrhage, the presence of displacement of the median structures and mass effect, and the state of the cerebrospinal fluid system.
Contrast-enhanced MSCT angiography, MRI angiography, and contrast-enhanced cerebral angiography (CAG) are used to clarify the cause of hemorrhage. The latter has the highest specificity in detecting arterial aneurysms, arteriovenous malformations , and other vascular anomalies.
Treatment methods
Treatment measures are carried out in accordance with modern protocols and standards of medical care. Their volume and sequence depend on the clinical picture, the severity of the compression-dislocation syndrome, and the characteristics of the hematoma.
In case of disruption of vital functions (such as breathing and blood circulation), the patient is managed according to intensive care algorithms from the moment of admission to the medical facility.
Conservative therapy
Conservative treatment is carried out under the following conditions:
- Compensated compression-dislocation syndrome,
- Controlled intracranial hypertension,
- Preserved CSF dynamics.
It includes correction of blood pressure, blood rheology and water-electrolyte status, blood oxygen saturation, prevention of vasospasm, and use of neuroprotectors.
Surgical treatment
With progressive deterioration of the patient’s condition and the increase in decompensation phenomena, surgical intervention is performed. Its goal is to eliminate the phenomena of compression and dislocation of the brain.
Indications for surgical treatment of intracerebral hemorrhage are determined individually in each case. The clinical condition and data from additional examination methods are taken into account.
Patients undergo osteoplastic trepanation, hematoma removal . The source of hemorrhage is also established and thorough hemostasis is performed.
In case of ventricular hemorrhage with the development of acute occlusive hydrocephalus, the patient undergoes ventriculopuncture and external ventricular drainage is established .
The approximate duration of treatment in the intensive care unit and neurosurgical department is up to 15 days.
Provided the general condition improves, further therapy is carried out in the neurological department, rehabilitation department at the place of residence. In the presence of bone defects of the skull, cranioplasty is performed as planned (after 2-6 months).
