Cerebral haemorrhage

The haemorrhage insult results from spontaneous break of an intrabrain vessel and is accompanied by formation of a hematoma. Intrabrain haemorrhages are one of the heaviest forms of vascular defeat of a brain, lethality at which reaches 60—80 %. More often haemorrhages in a brain are observed on a background of hypertonic illness (50—60 %), at pathological changes in vessels of a brain which reason most often is the atherosclerosis. In occurrence of a haemorrhage in a brain great value give to aneurysms of brain vessels (arterial, arteriovenous and, the main thing, miliary).
In some cases to reveal the reason haemorrhage an insult it is not obviously possible. As often direct push to development of a haemorrhage the various physiological or pathological factors defining time increase of arterial pressure serve: the physical and intellectual pressure, convulsive attacks, childbearing, emotional stresses, fluctuations of a body temperature, an alcoholic intoxication, etc. The spontaneous haemorrhage in a brain prevails at women.

In most cases haemorrhages are localized close basal kernels and an internal capsule that speaks earlier development of atherosclerotic changes in vessels of the given area. In a clinical practice it is accepted to distinguish lateralis and medial haemorrhages, border is the internal capsule. Lateralis cerebral haemorrhages settle down on the outside from an internal capsule, is closer to a bark of the big brain, medial — on the inside from a capsule. The third variant is the arrangement of haemorrhages simultaneously on both parties of an internal capsule. Medial haemorrhages are quite often accompanied by break of a hematoma in a cavity lateral or III ventricle.

The haemorrhage insult develops mainly sharply, quite often without any harbingers. The clinic is characterized by sudden loss of consciousness and nidal neurologic symptoms. Sometimes in the beginning it is observed one time or repeated vomiting. The person of the patient becomes purple-red, pulse strained, slow, breath noisy, bubbling, the body temperature soon raises. A head and eyes are often turned aside. From nidal symptoms first of all there are impellent infringements in the form of paresis and paralyses of finitenesses on the party opposite to the center of a haemorrhage, resulting a prelum hematoma of fibres of an internal capsule or vessels feeding it. At rather small haemorrhages impellent infringements are poorly expressed, whereas the massive haemorrhages causing prelum an internal capsules, lead to a rough impellent pathology — hemiplegia.

Revealing of some others nidal symptoms at intrabrain haemorrhages, in particular infringements of sensitivity, hemianopsia, speech disturbance, becomes possible after an output of the patient from a coma and restoration of consciousness. During short time from the moment of occurrence of an insult significant fluctuations of symptoms of infringement of vegetative functions are observed: pallor of the person is replaced hyperemia or, to the contrary, hyperemia — pallor, from time to time the person becomes cyanotic, becomes covered then, distal departments of finitenesses cold, cyanochroic, all is frequent these variations prevail on a side of a paralysis.

Right at the beginning of an insult the most typical happens increase of a muscular tone, more often in finitenesses to the broken impellent function. In some cases there is a proof increase of a muscular tone in the form of seizure — hormetonic, usually bilateral, with capture not only muscles of finitenesses, but also a trunk and a neck. Occurrence of hormetonic — the extremely adverse also specifies a symptom dissociation between a trunk and a spinal cord, on the one hand, and a bark of the big brain — with another. Hormetonic syndrome is more often observed at break of blood in ventricula system. Change of the raised muscular tone by a hypotonia and atony is usually observed in a terminal phase of disease on a background of the general fading of reflex activity.

In diagnostics measurement of pressure of a spinal liquid, research of its structure, as well as such methods, as electroencephalography, echoencephalography, angiography and especially computer tomography have great value. If at persons young and middle age pressure of a spinal liquid happens raised at elderly and especially senile age it can be normal and even lowered is more often. Availability of blood in a liquid — frequent and one of the most authentic signs of hemorrhagic insult. In a liquid are quite often marked the raised content of the fiber, moderated pleocytosis.

Research of bioelectric activity of a brain at a haemorrhage in hemispheres of the big brain enables to define the party of defeat and often share localization. The center of pathological activity is usually shown by presence polymorphic, more high-amplitude fluctuations of potentials or sharp decrease in amplitude of fluctuations in the field of defeat.

Echoencephalography at intrabrain haemorrhages with formation of hematomas in hemispheres of the big brain finds out displacement of a signal of M-echo in the opposite party from the center. The important role in diagnostics belongs angiography. At formation of an intrabrain hematoma on angiogram underpressure of vascular figure, displacement of brain vessels with formation a nonvascular zone corresponding localization of process are defined. By means of angiography in some cases it is possible to define not only localization of an intrabrain haemorrhage, but also the reason of its occurrence. The most informative in an establishment of localization and sizes of a hematoma is the computer tomography (the hematoma is defined in the form of the center of the raised density).