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Stroke
is acute disorders of cerebral circulation,
rapidly developing clinical signs of focal
(at times global) disturbance of cerebral
function, lasting more than 24 hours or
leading to death with no apparent cause
other then that of vascular origin
Hemorrhagic stroke
Intracerebral (when the hemorrhage is into the
substance or parenchyma of the brain )
Membrane
– subarachnoid (when the bleeding originates in the
subarachnoid spaces surrounding the brain)
– epidural and subdural
Combined
– subarachnoid – parenchymatose
– parenchymatose– subarachnoid
– parenchymatose–ventricular
– ventricular
The most common causes of
hemorrhage are:
Hypertension
Symptomatic arterial hypertension (at
kidney diseases, systemic vessel
processes)
Inborn arterial and arterio – venous
malformations
Blood diseases (leucosis, polycythemia)
Cerebral atherosclerosis
Intoxications, such as uremia, sepsis
Aneurysm
Aneurysm
According to the localization there are :
Lateral hemorrhage (they are located laterally
compared with the internal capsule)
Medial hemorrhage (they are located
medially compared with the internal capsule)
Combined hemorrhages (they take the
whole region of basal nuclei: subcortical nuclei, thalamus,
internal capsule)
Brain stem hemorrhages
Cerebellar hemorrhages
In hemisphere
In ventricules
Pathomorphology
Per rexis
Per diapedesis
The main periods of stroke
Acute (up to 3 – 4 months)
Renewal (up to 1 year)
Residual
Stages of acute period
Precursors
Apoplectic stroke
Focal signs
General cerebral symptoms
severe headache
nausea
vomiting
seizures
consciousness disorders
- sopor
- stupor
- semicoma
- coma
Coma
is characterized by deep
consciousness disorder,
disturbance of breathing
and heart activity. The
patient doesn’t respond to
stimuli.
Coma
response to stimuli is absent
eyes are closed, mouth is opened
face is red, lips are cyanotic, skin is cold,
neck vessels are pulsing
there is breathing disturbance
pulse is strained and slow
blood pressure is increased
temperature increases in 24 hours
patient is lying on his back
all muscles are relaxed
pupils are changed (there can be anizokoria, cross –
eyes, sometimes gaze paresis can be observed)
mouth angle is a little bit lower
On the opposite side
hemiplegia is often observed:
the arm is falling down like bine
there is hypotonia of muscles
reflexes are low
Babinski sign is often observed
too
Large hemisphere hemorrhage
meningeal signs
vomiting and dysphagia
retention of urine or involuntary
urination
in case of cortex irritation epileptic
attacks
Sign of paralysis in right side
Sign of central paralysis
Secondary brain stem syndrome