Hemorrhagic stroke of the brain: types, symptoms, diagnosis, treatment, risk factors. Approaches to the treatment of hemorrhagic stroke

The consequences of hemorrhage depend on its severity. Sometimes this does not lead to serious consequence, and sometimes can cause anemia and even lead to death. If blood accumulates inside the tissues of the body, this leads to squeezing of the internal organs, which impairs their functionality. Since bleeding itself is a consequence of the disease, the cause itself must be treated. Accordingly, for such a phenomenon as hemorrhage, treatment will have to be prescribed by a specialist after a thorough examination.

Hemorrhages at the injection site

Hemorrhages at the injection site appear after individual drugs or due to hemorrhagic diseases. There is a method by which the permeability of the vascular wall can be established: 1-2 ml of saline is injected into the skin, after which the manifestation of hemorrhages is observed. This method is called the symptom of Hess (British scientist, 19th century).

Hemorrhages on the skin

Hemorrhages on the skin appear due to hemorrhages when blood enters the tissues of the dermis. Such hemorrhages can be of the following types:

Subcutaneous hematomas: Bleeding into the tissue under the top layer of the dermis. The resulting voids under the skin are filled with clotted blood. At the site of the hematoma, a swelling is formed that changes color over time from bright red-blue to yellow-green;

Ecchymosis (bruising): have different sizes and appear due to subcutaneous hemorrhages;

Petechiae: capillary hemorrhages on the skin. These pinpoint hemorrhages range in size from a dot left by a gel pen to a bean.

Hemorrhages in the stomach

Bleeding in the stomach may be the result of hemorrhagic erosive gastritis. However, hemorrhages in the stomach are not the only symptom of the disease. The patient may experience erosive and inflammatory changes in the mucosa and high secretion of the stomach. Sometimes bleeding can be due to the high permeability of the walls of the vessels of the stomach, as well as a high degree of susceptibility to damage.

Hemorrhage expulsive

Expulsive hemorrhage is a severe postoperative complication on eyeball is bleeding from the ciliary arteries. Bleeding may start during surgery. However, most often the rupture of the ciliary arteries occurs after the operation due to the strong expansion of the vessels in the form of reactive hypertension. It is observed in patients suffering from atherosclerosis, hypertension, hypertension of the eyes. Before surgery, these factors must be taken into account by doctors. Sometimes such bleeding can lead to the fact that through surgical wound choroid and retina are pushed outward, leading to loss of vision. Therefore, expulsive hemorrhage requires urgent surgical intervention: posterior trepanation of the sclera, scleral sutures.

Intramucosal hemorrhages

Intramucosal hemorrhages - a tendency to bleeding of the vessels of the mucous membrane due to injury or in connection with the disease. Such a syndrome may be acquired and may be congenital. In addition, such a tendency can be inherited. Their main cause is considered to be a violation of one or more links of hemostasis.

Among the hereditary causes of hemorrhage, it is worth highlighting the most common diseases: hemophilia types A, B, von Willebrand disease, thrombocytopathy. The reasons for the acquired hemorrhagic syndrome mucosa can become: DIC, hemorrhagic vasculitis, thrombocytopenia, thrombocytopathy and deficiency of prothrombin complex factors.

Hemorrhages - what is it? Types, causes and treatment. Subcutaneous hemorrhages. Bruise after injection

Hemorrhages are hemorrhages in different parts of the body, differing in severity. The causes of their occurrence include internal and external pathologies of the body. Often, hemorrhages are manifested by the accumulation of blood in the tissues, but sometimes the blood comes out.

Causes of hemorrhages

In fact, these are complications after injections, but this is not always the case.

Very often, the cause of bleeding lies in the high permeability of the walls of blood vessels or their violation. The integrity of the vessel is broken when a mechanical injury occurs. And the reasons for seepage of blood through the wall of the vessel are as follows: dermatological diseases eg chronic dermatosis or psoriasis; acquired pathologies of the circulatory system (DIC, hemorrhagic vasculitis or bleeding disorders, thrombocytopathy); congenital genetic pathology, for example, hemophilia. Hemorrhages of almost all types are closely related to the use of hormonal drugs, depression or psychological stress.

Hemorrhages are hemorrhages, which are divided into the following types depending on the causes of their occurrence:

• bleeding caused by violations of the integrity of the walls blood vessel due to exposure to an infection or chemical;
• bleeding due to the fact that there was a decrease in the thickness of the walls of blood vessels;
• bleeding resulting from mechanical damage to blood vessels. This is how a bruise appears after an injection.

Depending on the location, types of hemorrhage can be:

• capillary (bleeding from small vessels);
• internal (hemorrhages in tissues and organs);
• venous (bleeding from damaged veins);
• external;
• arterial (intense bleeding from the arteries);
• parenchymal (bleeding of tissues that form organs).

The main symptoms of internal bleeding

How hemorrhages manifest themselves depends on the location and type of bleeding. Although external bleeding is easy to detect, internal bleeding is often not felt. You can identify internal bleeding by several specific symptoms, for example:

• to lower blood pressure;
• tachycardia;
• drowsiness and apathy;
• unnatural pallor of the skin;
• fainting and dizziness;
• general malaise.

This is how damage to large vessels manifests itself.

These symptoms are common for internal bleeding, but there is also a list of signs that are characteristic of various kinds hemorrhages.

Hemorrhages at the injection site. What is it?

Often, complications can occur during therapy after an injection. Hemorrhages that occur after intramuscular injection are called local bleeding, which appear due to tissue damage.

Usually, over time, the blood spot goes away on its own, but sometimes a specialist may prescribe water-soluble drugs. Intravenous injections can cause bleeding when the vessel is pierced through and be not as pronounced as with intramuscular injections.

Causes of skin hemorrhages

Hemorrhage is a pathology that occurs on the skin due to blood seepage into the skin tissues through the walls of blood vessels or hemorrhage. They look like blood spots on the skin. During the whole time, hemorrhages tend to change color, starting from bright red and ending with greenish-yellow. There is no special treatment in such cases, these spots resolve on their own with time. Especially complications after injections.

Skin hemorrhages also include hematomas.

Subcutaneous hematomas form under the skin layer and look more like bruises. They can be formed as a result of various diseases (lupus erythematosus, scarlet fever, syphilis, tuberculosis) or injuries. Patients with hemophilia often suffer from such hematomas. Spots on the skin of such people occur with any damage to blood vessels. There are three degrees of subcutaneous hematomas.

Signs of a mild hematoma appear gradually, about a day after the injury, and with all this, it does not affect the functioning of the organ on which it was formed. If there is pain, then it is mild. And also if the resulting hematoma is not complicated, then it will pass by itself without treatment. Hematoma formation medium degree occurs after three to four hours, and such a hematoma can partially disrupt the work of the organ on which it appeared.

Around such hematomas, soft tissue edema and slight swelling are formed. It is necessary to apply cold and a pressure bandage to the hematoma, and then seek help from a doctor. A serious injury can cause the formation of a severe hematoma, which will disrupt the functioning of the organs. The hemorrhage is formed quickly enough, within an hour it will already be possible to notice the blue spot that has appeared. Mostly visible to the naked eye subcutaneous hematoma. After some time, such a hematoma can intensify and develop into an intramuscular one, and then the patient will experience pain in the muscles and numbness. With this type of hematoma, you should definitely consult a doctor for the appointment of further treatment. If left untreated, a severe hematoma can seriously harm the human body. And just a bruise after an injection is quite unpleasant.

What is the danger of hemorrhage?

The severity of such an insidious phenomenon as hemorrhage depends directly on the area of ​​\u200b\u200bdamage and how intense the bleeding is. Despite the fact that usually such small injuries resolve on their own, there are exceptions that are characterized by suppuration of the hemorrhage site and the need for surgical intervention. In some cases, hemorrhages lead to tissue destruction, which also leads to serious consequences. In such cases, hemorrhages in the heart, brain and lungs are considered the most dangerous. There are also hemorrhages of the eye.

Which specialist to contact?

No matter how complex the nature of hemorrhage may be, it is very important to determine the cause of its occurrence as soon as possible. A district therapist and highly specialized doctors, such as an infectious disease specialist, hematologist, dermatologist or endocrinologist, will help to resolve such a problem.

Carrying out diagnostics

After the examination, the specialist can make a primary diagnosis, but it will still be necessary to pass a coagulogram (a general blood test to study it for coagulation) for an accurate diagnosis. In some cases, it is possible to prescribe a bacteriological blood test, on the basis of which the issue of therapy will be decided.

First aid for bleeding

Previously, it was found that hemorrhages are hemorrhages from blood vessels due to their damage. Therefore, the first thing a person can do with a slight hemorrhage is to apply cold to the injured area, which will reduce the intensity of bleeding. Follow-up care should be carried out, taking into account the type of hemorrhage. Quite easily, venous bleeding is determined by the color of the blood, which will have a burgundy or bright red color, and by a continuous but slow flow. With such an injury, in order to carry out first aid, you need to apply a tourniquet below the wound and a tight bandage. A mandatory point is the time stamp when the tourniquet was applied. With a small wound, it is wrapped with a bandage, since the venous vessels can self-tighten and subside.

arterial bleeding

Arterial bleeding differs from venous bleeding in that bright red blood will spurt out of the wound in a fountain. In this case, a tourniquet should be applied immediately, because if the bleeding is not stopped, the person may die. In this case, the tourniquet is applied above the wound to us, and a bandage is applied to it. The tourniquet is left for one to two hours, and after this time it needs to be slightly lowered for about 5 minutes in order for blood to circulate through the limb, otherwise toxins will accumulate in the stagnant blood, and after removing the tourniquet, a person may die from shock.

If we talk about such a phenomenon as subcutaneous hemorrhages, then they do not pose a serious danger if such bleeding is not in a person with poor clotting. Then you need to bandage and treat the wound. Such bleeding can be stopped with modern hemostatic agents such as Hemostop and Celox. Powdered pellets help clot the blood, making it look like a jelly, but it can be difficult to treat such a wound. Internal bleeding is one of the most severe cases in which it is necessary to consult a doctor. At the scene of the accident, the victim can only apply cold and immediately send him to the hospital or call an ambulance. Until the doctors arrive, the patient should be at rest and practically without movement.

How to get rid of hemorrhages?

Hemorrhages are treated after a thorough examination. When prescribing treatment and establishing a diagnosis, the doctor must take into account that some of the forms of hemorrhages lead to the development of complications. This is the reason why it is necessary to consult a doctor at each stage of treatment. If complications occur, inflammatory processes can begin, which can sometimes lead to death. It is necessary to accurately determine the patient's condition, the clinical form of hemorrhage and the tendency to complications in order to proper treatment. For example, for minor injuries, medical treatment is not required. But if the skin hemorrhage is large, then treatment is usually used with the application of "Troxevasin" or "Heparin" ointment to the injured area 2 times a day.

We examined what hemorrhages are. Their causes and treatment are also described.

Hemorrhage: causes, symptoms, treatment

Hemorrhagic syndrome is a temporary or chronic damage to the vascular tissues, which results in arbitrary bleeding that can appear in a variety of areas throughout the body. As a rule, the chronic forms of this disease appear only after years, since with age the vessels become weaker. What causes this disease and how it manifests itself, we will consider in this article.

Causes

Hemorrhage is a pathological exit of blood from the lumen of blood vessels or through their tissues into the space around them (skin, mucous tissues, internal organs). There are several types of hemorrhage, which are directly related to the reasons for their formation:

1. Skin hemorrhage. The disease appears when blood begins to penetrate the tissues of the epidermis. There are two types of such hemorrhage:
   • subcutaneous;
   • hemorrhage in the lower layers of the epidermis, forming hematomas and bruises.

Damage to the capillaries leads to the formation of visible blood-colored foci. This hemorrhage is the result of mechanical damage to tissues (contusion, fracture, rupture of ligaments or muscles).

Among the many reasons that can cause various types of hemorrhage can be identified:

• high blood pressure;
• leukemia or leukemia;
• aneurysm;
• Nishimoto's disease;
• vasculitis;
• hypertension;
• hypertensive crisis;
• serious disorders of the nervous system.

Hemorrhage manifests itself very quickly, one might even say - rapidly, so it is inappropriate to talk about the prevention or early treatment of this pathology.

Symptoms

Symptoms of hemorrhage are very clearly visible in outward signs. Since the blood enters the subcutaneous space, one can observe reddening of certain parts of the body, which are the most different forms and sizes. With more serious injuries, painful hematomas are formed, for which a characteristic bluish color is formed.

With expulsive hemorrhage, redness of the sclera of the eyes occurs. In the case of gastric hemorrhage appears:

• nausea;
• feces come out with blood;
• possible presence of blood in the urine.

Hemorrhage is characterized by a general breakdown, pain on palpation of the damaged areas, dizziness, nausea and vomiting. With damage to the sclera of the eyes, vision deteriorates.

Diagnostics

There is absolutely no difficulty in recognizing this disease for a doctor, but identifying the reason for which it arose is already a little more difficult. At similar diseases doctors prescribe:

1. A general blood test for the number of leukocytes to determine the presence of an inflammatory process of damaged tissues.
2. MRI - magnetic resonance imaging. It will help to establish the place of rupture of blood vessels in any type of hemorrhage.
3. X-ray study. With it, you can see the possible accumulation of blood in the tissues and during internal organs.

In general, all these methods are absolutely sufficient to establish an accurate diagnosis, detect the damaged area and find out the cause.

Treatment

At prescribed by the doctor diagnosis, first of all, it is necessary to eliminate the first symptoms and prevent further damage to the vascular tissues. This can only be done with the help of medicines. In such cases, doctors prescribe:

1. Drugs that normalize blood pressure to reduce the intensity of blood flow and its leakage into the internal organs. It can be Captopril, Andipal, Enap.
2. Drugs that increase blood clotting to maximize fast healing damaged vessels - Vikasol, Piracetam, Detralex.
3. Anti-inflammatory painkillers - Nimesil, Ortofen, Movalis.
4. With severe inflammation of the tissues of the epidermis, the presence of bruises and bumps, ointments and other means are often used that accelerate the process of resorption of accumulated blood - Indovazin, Liniment, Bodyaga, Troxevasin.

Based on the foregoing, we can conclude that hemorrhage is not a disease, but just a symptom characteristic of many diseases. But this symptom also has its primary sources and can cause complications, so you should not wait for everything to heal by itself, you must definitely consult a doctor.

Hemorrhagic syndrome - types and causes. Symptoms and consequences of hemorrhagic syndrome in children and adults

Hemorrhagic diathesis appears with changes in the links of hemostasis (such as damage to the vascular wall) and occurs in a state of increased bleeding of both an adult organism and a child. hemorrhagic disease- This is bleeding of the mucous membranes. You can find it by passing a detailed blood test.

What is hemorrhage

In medicine, the spontaneous outflow of blood from the vessels in any part of the body is called hemorrhage. This pathological syndrome manifests itself in patients in response to external influences or in the presence of internal diseases. Hemorrhagic disease occurs due to damage to the integrity of the walls of blood vessels, a decrease in the number of platelets, and a violation of coagulation hemostasis. In this case, the blood flows out of the borders of the blood vessel through the damaged area. Types of anomalies depend on in which part of the body they appear.

Hemorrhagic syndrome is typical for what diseases

Among the forms of hemorrhagic diseases, hereditary and acquired disorders of hemostasis are distinguished. The latter are associated with multifactorial disorders of the blood coagulation system (for example, acute DIC syndrome), damage to blood vessels of dysmetabolic, immune, toxic-infectious, immunocomplex origin, abnormalities in blood plasma adhesive proteins, damage to platelets and megakaryocytes. Hereditary hemorrhagic diseases are caused by:

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• pathologies plasma factors blood coagulation system;
• hereditary disorder of hemostasis;
• genetic structural changes in the vascular wall.

Hemorrhagic diathesis in children

Due to a lack of vitamin K, hemorrhagic syndrome of newborns can develop, among the signs of which there are: hemorrhagic skin rashes, umbilical bleeding. Intestinal bleeding or intracerebral hemorrhage may occur. Doctors call the following causes of hemorrhages in newborns: during pregnancy, the mother took phenobarbitals, salicylates or antibiotics. Hemorrhagic disease in children occurs when:

• neoplastic lesion connective tissue;
• thrombocytopenia;
• coagulopathy;
• vasopathy;
• hemophilia.

The pathogenesis of hemorrhagic syndrome

As a mechanism for the development of the disease with hemorrhagic syndrome and its manifestations, doctors describe the following picture of pathogenesis:

1. coagulation disorders (DIC) and platelet production;
2. changes in the structure of collagen, the properties of fibrinogen, the walls of blood vessels:
   • with circular disorders;
   • decrease in neurotrophic function of the central nervous system;
   • violation of the angiotrophic function of platelets.

Hemorrhagic diseases - classification

In medicine, the following types of hemorrhagic syndromes are described: hematoma, petechial-spotted, mixed bruising-hematoma, vasculitic-purple, angiomatous. The listed types differ in the nature of manifestation, causes. In each individual case, it is necessary to follow the individual treatment tactics chosen by the attending physician. Description of hemorrhagic diathesis according to the type of disease:

1. The hematoma type is due to chronic genetic bleeding. This severe disease on the basis of reduced coagulability manifests itself in the patient in the form of painful sensations with hemorrhages in the joints (hemarthrosis), dysfunctions of the musculoskeletal system. With an injury, internal hematomas form extensive edema in the soft tissues, which causes pain.
2. The petechial-spotted type is also called bruising because of external manifestations on the body in the form of bruises, which can be seen in the photo. It appears with blood clotting disorders (lack of coagulation factors, hypo- and dysfibrinogenemia), thrombocytopathy and thrombocytopenia (thrombocytopenic purpura).
3. Microcirculatory-hematoma, or mixed bruising-hematoma bleeding develops in the presence of immune inhibitors of factors IX and VIII in the blood, an overdose of thrombolytics and anticoagulants, DIC, von Willebrand disease, a severe lack of prothrombin complex factors and factor XIII. Externally, this type of disease manifests itself through petechial-spotted skin hemorrhages, large hematomas in the retroperitoneal region and the intestinal wall, and a petechial skin rash.
4. Symptoms of the vasculitic-purpura type are skin rash red (erythema). With the disease, there is a tendency to bleeding in the intestines and inflammation of the kidneys (nephritis), immune and infectious vasculitis, DIC.
5. The angiomatous type develops in the area of ​​arteriovenous shunts, angiomas, telangiectasias. This type of disease is characterized by hemorrhages in the area of ​​vascular anomalies and persistent bleeding of permanent localization.

Hemorrhagic symptoms may develop with vascular anomalies, disorders of coagulation hemostasis, enzyme activity, blood coagulation system, when taking drugs that disrupt platelet aggregation. Experts were able to establish a variety of diseases in which the risk of hemorrhages is high:

• hepatitis;
• oncology;
• severe viral infections;
• cirrhosis of the liver;
• lack of prothrombin in the blood;
• hemophilia;
• leukemia;
• vasculitis.

The causes of hemorrhages depend on the primary or secondary form of the disease. The first is characterized by the presence of genetic determination: there is a defective gene in the body that can cause a hemorrhagic disease at any time. The secondary form arises from damage to the walls of blood vessels (with an autoimmune process, mechanical damage, inflammation and chemical intoxication), with secondary thrombocytopenia, DIC, hemorrhagic vasculitis and a deficiency of prothrombin complex factors.

Symptoms of hemorrhagic syndrome

There is a connection between the areas of localization of hemorrhagic diathesis and the clinical picture, the intensity of manifestation, the specificity of the symptoms of the disease. Signs of hemorrhage in the nasal cavity are manifested by recurrent bleeding from telangiectasias (dilations of small vessels). This manifestation of symptoms is also characteristic of hemorrhages in the lips, mouth, pharynx and stomach. Before the age of 30 years and during puberty, the frequency of bleeding from telangiectasias increases. Other signs include:

• exfoliating hematomas;
• skin manifestations;
• delayed bleeding;
• reduced number of platelets;
• ecchymosis superficial;
• petechiae;
• hemarthroses.

Treatment of hemorrhagic syndrome

The treatment of hemorrhage depends on the symptoms and cause of the disease in patients. AT complex therapy involved: immunoglobulin, plasmapheresis, glucocorticosteroids. With inflammation of the blood vessels (vasculitis), non-hormonal immunosuppressants, non-steroidal anti-inflammatory drugs (NSAIDs), GCS (glucocorticoid) therapy are taken, and they try to reduce the symptoms of inflammation. For hemophilia A, the missing factor VIII is administered, and for hemophilia B, the missing factor XI. After a detailed blood test, the doctor helps the patient choose the treatment tactics.

Among the fundamental principles of therapy are:

• symptomatic treatment;
• intravenous injection of a synthetic analogue of vitamin K - vikasol, calcium chloride and ascorbic acid;
• if necessary, transfusion of blood, its components (platelet, erythrocyte mass) and plasma is carried out;
• taking medications that help strengthen the walls of blood vessels (etamsylate);
• in the local treatment of hemorrhages are shown: dry thrombin, homeostatic sponge, aminocaproic acid.

Consequences of hemorrhagic disease

When detecting hemorrhages, you should not panic, but you should immediately consult a doctor. With a mild degree of the disease and timely treatment, the prognosis of the disease is favorable. However, there are cases when, with late detection of the disease, there are severe complications hemorrhagic syndrome, which can lead to death.

Among these consequences are: massive internal bleeding, cerebral hemorrhage, cardiac dysfunction, adrenal insufficiency. The child may experience hypovolemic shock, which manifests itself through a decrease in blood pressure and body temperature, weakness, pallor. In order to prevent the described consequences, it is necessary immediately, as soon as the symptoms are noticed, to take the child for a consultation with a pediatrician.

Prevention of hemorrhagic syndrome

Compliance with uncomplicated preventive measures can protect against the development of pathologies. A blood test will help identify hemorrhagic bleeding, and you can reduce the risk of its occurrence if:

• within half an hour after birth, attach the baby to the breast;
• administer vitamin K by injection to children at risk;
• carry out injections of vitamin K with parenteral (intravenous) nutrition;
• perform intramuscular injection of vitamin K during or before childbirth if the mother is taking anticonvulsants.

Hemorrhagic syndrome: symptoms and treatment

Hemorrhagic syndrome - the main symptoms:

• Weakness
• Joint pain
• Vomiting blood
• Bleeding gums
• Nosebleeds
• loose stool
• Uterine bleeding
• Apathy
• Jaundice
• Limitation of joint mobility
• petechial hemorrhage
• joint swelling
• Hematomas
• Intra-articular bleeding
• internal bleeding
• Darkening of feces
• Hemorrhages in the muscles

Hemorrhagic syndrome is a pathological condition characterized by increased bleeding of blood vessels and developing as a result of a violation of homeostasis. Signs of pathology are the occurrence of skin and mucous hemorrhages, as well as the development of internal bleeding. The disease can develop at any age - both in newborns and in the elderly. Distinguish between acute and chronic forms pathological condition. In the acute form in children or adults, urgent health care, in chronic complex treatment pathology.

Causes

It's hard enough to describe in simple terms. complex processes hematopoiesis and their changes, which is why hemorrhagic syndrome develops. If we consider the mechanism of violation, then it is based on anomalies cell structure blood vessels, coagulation disorders, as well as a violation of the enzymatic activity and function of the blood elements responsible for coagulation.

Doctors have established a number of diseases, in the presence of which a person is likely to develop a hemorrhagic syndrome. In particular, this pathological disorder develops with hepatitis, certain types of oncology, severe viral infections, cirrhosis of the liver, as well as with a deficiency of prothrombin in the blood, hemophilia, leukemia and vasculitis.

There are two forms of the disease:

• congenital or primary;
• secondary (acquired).

For hereditary (congenital) pathologies, the general criterion is the presence of genetic determination. That is, the human body already has a defective gene, which at any age (from childhood to adult) can cause a hemorrhagic syndrome in a person. Acquired pathologies of hematopoiesis are characterized by damage to the walls of blood vessels due to an autoimmune process, chemical intoxication, inflammation or mechanical damage.

The main reasons for such a pathological disorder include:

To understand what exactly are the causes of the disease, it is necessary to consider what vasopathies and others are. pathological changes in the blood system. Vasopathies can cause massive inflammatory processes and genetic defects and are characterized by increased permeability of the vascular walls. They speak of thrombocytopathy when the functions of platelets are impaired, despite the fact that there are a sufficient number of them in the blood. This can occur both with genetic mutations and as a result of mechanical, biological or chemical effects on the body of adults and children. Thrombocytopenia is characterized by a decrease in the number of platelets in the blood, while maintaining their functions. This condition may be the result of autoimmune processes in the body. In addition, the violation occurs due to severe intoxication, infections, oncological processes in the body, with the abuse of drugs and after exposure to radiation.

Very often, the violation occurs with cirrhosis of the liver. This is due to the fact that during the disease there is a complex lesion of the vessels, accompanied by their expansion. As a result, symptoms such as bruising on the skin, bleeding from the esophagus, uterus, gums and nose appear. The development of such a pathological condition as hemorrhagic syndrome in liver cirrhosis is also due to a violation of its performance, as a result of which the organ cannot participate in the process of producing substances that affect blood clotting.

Varieties

In modern medical practice There are five main forms of the disease that can occur in both children and adults. At the same time, hemorrhagic syndrome in newborns is represented by an edematous-hemorrhagic variety of this pathology - the sixth form, which stands apart.

There are the following types:

• hematoma, which is a consequence of blood diseases caused by genetic mutations. With this variety, extensive bleeding occurs due to injuries in the soft tissues, forming bruises on the skin, swelling and swelling of the injury site;
• petechial-spotted - due to hereditary and acquired disorders of hemostasis, as a result of which the patient's blood clotting is impaired. It is manifested by the appearance of bruises of various diameters on the body of children or adults;
• the purple appearance of this syndrome, which is usually the result of various vasculitis. Its manifestations are erythema on the skin, as well as the development of nephritis and internal bleeding, in particular from the liver, intestines;
• the microcirculatory type of the syndrome occurs with von Willebrand disease, DIC, and with an overdose of drugs that cause a violation in the hematopoietic system. With this type of pathology, the following symptoms are noted: hemorrhagic hemorrhages on the skin of a petechial nature and the occurrence of large hematomas in the retroperitoneal space;
• angiomatous type of syndrome occurs in areas of vascular pathologies. It is characterized by prolonged bleeding that has a certain localization.

The edematous-hemorrhagic syndrome is characterized by changes in the lungs, therefore, at birth, such children have respiratory failure, with the release of bloody foam from the respiratory tract. These children require urgent medical attention, because, otherwise, there is a high probability lethal outcome. The main reason for the progression of this type of disease is fetal hypoxia in the mother's womb.

Symptoms

In the clinical picture of the disease, a special place is occupied by a skin syndrome, manifested by petechial hemorrhages on the skin and mucous membranes, as well as the occurrence of hematomas of various diameters throughout the body. Usually they appear after a certain traumatic impact, even a minor one.

Another symptom is bleeding of various localization. Bleeding may occur:

In addition, hemorrhages occur in the joints and muscles, which causes impaired mobility and swelling, with the subsequent development of the inflammatory process. In some cases (for example, with the accumulation of blood in the joints), there is a pronounced pain syndrome.

With the development of hemorrhagic syndrome with cirrhosis of the liver, the following symptoms are noted:

Very often, with cirrhosis of the liver, complicated by hemorrhagic syndrome, patients die from gastrointestinal bleeding. Therefore, the earlier the pathology is diagnosed, the higher the chance of a person recovering.

Diagnosis and treatment

Diagnosis is aimed at establishing the cause of the development of pathology and further effective elimination of this very cause. But in the acute form, emergency care is often required, aimed at stopping bleeding and normalizing hemostasis. Therefore, if a person is in a critical condition, he is provided with emergency care, and diagnostics are carried out after his condition has stabilized.

Diagnosis in this case consists in the delivery of laboratory tests that allow you to see an accurate picture of the blood. Coagulation tests are carried out, and sometimes sternal puncture. Treatment of the disease depends on such factors:

• stage of the disease;
• the reason that caused it;
• severity of the process.

As mentioned above, in most cases, acute forms of a pathology such as hemorrhagic syndrome require that the patient receive emergency care. To this end, doctors stop the focus of hemorrhage - cryotherapy or hemostatic therapy is used, as well as surgical intervention or laser barotherapy. After stopping the focus of hemorrhage or in cases where emergency care is not required, patients with this disorder are prescribed drugs that increase clotting.

If there is a large blood loss, substitution therapy is indicated - patients are given plasma, a concentrate of donor platelets. Also, treatment involves the use of heparin, and in some cases, the introduction of prednisolone is indicated.

Treatment of hemorrhagic syndrome in patients with liver cirrhosis has its own characteristics - in addition, the treatment in this case will be aimed at stopping the focus of bleeding, and will also include restorative and replacement therapy. It is also required for cirrhosis of the liver to carry out simultaneous treatment of the underlying disease.

In the same cases, when it comes to congenital hemophilia, treatment cannot be 100% effective. Therefore, doctors use hormonal drugs to normalize blood formation, and such patients need to constantly undergo therapy in order to avoid complications, and are under the supervision of a doctor.

If you think that you have Hemorrhagic Syndrome and the symptoms characteristic of this disease, then a hematologist can help you.

We also suggest using our online disease diagnostic service, which, based on the symptoms entered, selects probable diseases.

Hemorrhagic syndrome, treatment

Hemorrhagic syndrome (HS) is a condition characterized by temporary or permanent bleeding, which is expressed by the spontaneous release of blood from intact vessels.

With the normal functioning of hemostatic mechanisms, hemorrhages do not develop spontaneously, and injuries to most vessels (with the exception of injuries large arteries, main veins and the vasculature of parenchymal organs) do not threaten the patient's life due to the local formation of a fibrin clot at the site of damage to the vascular bed. Numerous coagulation defects prevent the physiological implementation of hemostatic reactions, therefore, with gross violations of the hemostasis system, even small vascular damage can be the cause of the patient's death. It should also be taken into account that in a considerable number of patients, hemorrhagic syndrome is caused not by vascular injury, but by other causes ( inflammatory process, separation of the placenta, destruction of the mucous membrane or hormone-induced rejection of the endothelium during menstruation, etc.).

It is very important to detect a hemostatic defect as early as possible, since patients with even moderate bleeding during and / or after surgical intervention, childbirth, can lose a fairly large amount of blood. In such situations, the attending physician will no longer be able to clarify the diagnosis, since life-threatening hemorrhages often induce consumption coagulopathy, which will result in depression of most components of the hemostasis system (platelets, fibrinogen, and many others), which will not allow identifying the hemostatic defect underlying uncontrolled bleeding.

Causes of hemorrhagic syndrome

HS due to a blood clotting disorder (coagulopathy):

• Hemophilia.
• lack of prothrombin.
• Overdose of anticoagulants.

HS due to impaired platelet formation:

• Werlhof disease.
• Symptomatic thrombocytopenia.
• Thrombocytopathies.

3. HS due to vascular lesions (vasopathy):

• hemorrhagic vasculitis.
• Hemorrhagic telangiectasias.

There are 5 types of bleeding

1. hematoma type. It is characterized by massive painful hemorrhages in the muscles, as well as in large joints. This type is characteristic of hemophilia.
2. Petechial-spotted type (bluish). It is characterized by painful superficial hemorrhages in the skin, bruising. Hemorrhages occur with negligible trauma (for example, when measuring blood pressure). This type is characteristic of thrombocytopathy, may be with a lack of fibrin, some coagulation factors (X, V, II).
3. Mixed bruising-hematoma type. It is characterized by a combination of petechial-spotted bleeding with large hematomas in the absence of hemorrhages in the joints (in contrast to the hematoma type). This type is observed with a deficiency of factor XIII, an overdose of anticoagulants, with constitutional thrombocytopathies.
4. Vasculitic-purple type. It is characterized by skin hemorrhages in the form of purpura. This type is typical for hemorrhagic vasculitis and thrombocytopathy.
5. angiomatous type. It is characterized by recurrent bleeding of a certain localization. This type is observed in telangiectasias, angiomas.

Petechia - a spot of a small size (1-3 mm) of a certain shape of a purple-red color. Does not disappear when pressed.

Purpura is the subcutaneous tissue layer, changed due to hemorrhage, purple or red-brown in color, easily visible through the epidermis.

Echkimosis is a hemorrhagic spot (larger than a petechiae) that is blue or purple.

Symptoms and signs of hemorrhagic syndrome

The clinical picture consists of symptoms of bleeding of various localization and skin hemorrhagic rashes.

Bleeding can occur spontaneously or under the influence of external factors: hypothermia, physical tension, minor injuries. Skin manifestations of hemorrhagic diathesis are diverse - from small petechial rashes and bruises to confluent hemorrhages with an ulcerative necrotic surface. The variety of clinical manifestations of the syndrome corresponds to five types of bleeding.

Hemorrhagic manifestations can be combined with articular syndrome (arthralgia, hemarthrosis), abdominal syndrome, there may be an increase in temperature.

Hemorrhagic syndrome can be observed in diseases such as malignant neoplasms, hepatitis and cirrhosis of the liver, leukemia, sepsis, systemic connective tissue diseases, severe infections, etc. In such cases, the clinical picture will consist of symptoms of the underlying disease and symptoms of hemorrhagic diathesis.

Laboratory and instrumental research

1. Detailed clinical blood test with platelet count.
2. clotting time.
3. duration of bleeding.
4. The time of retraction of the blood clot.
5. Blood for prothrombin and fibrinogen.
6. Plasma tolerance to heparin.
7. General urine analysis.
8. Sternal puncture according to indications.

If necessary, the volume of laboratory studies can be expanded (thrombin and prothrombin time, determination of the activity of coagulation factors, determination of antihemophilic globulin, examination of the adhesive-aggregative function of platelets, recalcification time).

Stages of diagnostic search

1. The basis of the diagnostic algorithm is the presence of hemorrhagic syndrome. To this end, when collecting complaints, it is necessary to clarify the location and nature of bleeding, the frequency of bleeding, to find out whether bleeding is associated with any provoking factor or occurs spontaneously, etc.
2. The second step is the history and physical examination. If the disease manifests itself from early childhood, the assumption of a hereditary or congenital nature of the disease is natural (in this case, it is important to collect information about the presence of similar symptoms in the next of kin).

Since most acquired hemorrhagic diatheses are symptomatic, it is necessary to clarify the presence of the underlying pathology. It can be liver disease, leukemia, radiation sickness, aplastic anemia, systemic connective tissue diseases. Bleeding may be due to drugs that affect platelet function (aspirin) or blood clotting (anticoagulants).

An objective examination involves a thorough examination of the skin, which will determine the nature and type of hemorrhagic manifestations. It is mandatory to examine the mucous membranes, since hemorrhages can be located not only in the skin, but also in the mucous membranes. In some cases, angioectasias can be found in the form of vascular spiders or bright red nodules protruding above the surface of the skin. They are characteristic of hereditary vascular dysplasia (Randu-Osler disease) or may be acquired (for example, with cirrhosis of the liver).

Joint enlargement with limitation of their mobility occurs in hemophilia. These disorders are the result of hemorrhage into the joints (hemarthrosis).

With hemorrhagic vasculitis, there may be a slight increase lymph nodes. Autoimmune thrombocytopenia is accompanied by an enlarged spleen.

Tests for resistance (fragility) of capillaries can have diagnostic value:

1. Symptom Rumpel - Leede - Konchalovsky.
2. Pinch symptom - if you pinch the skin under the collarbone, you will see petechial hemorrhages. When a suction can is applied to the skin, petechial hemorrhages appear. These tests are positive for thrombocytopenia, hemorrhagic vasculitis, and taking anticoagulants.
3. Additional research methods will help establish the final diagnosis.

Differential diagnosis of hemorrhagic syndrome

Bleeding can be detected in diseases in the pathogenesis of which there is no defect in the hemostasis system, so the greatest difficulty in examining such patients is to determine the etiology of the hemorrhagic syndrome. With defects in the hemostasis system, hemorrhages of different localization and other clinical manifestations of hemostatic dysfunction, as a rule, are combined with each other (for example, epistaxis and uterine bleeding), forming an idea of ​​the systemic manifestations that are very characteristic of most hemorrhagic diseases. In addition, in hemorrhagic diseases and syndromes, recurrent hemorrhages are often combined with chronic posthemorrhagic anemia. However, in a number of clinical cases, there are also local hemorrhagic manifestations without other symptoms of bleeding and iron deficiency. In the presence of local hemorrhages or oligosymptomatic bleeding, only hemorrhagic disease can be excluded laboratory research hemostasis systems. If one or two clinical manifestations of bleeding are found, it is useful to consider their relationship with hemorrhagic disease.

When conducting a differential diagnosis of various types of hemorrhagic diathesis, the following considerations should be followed.

1. Identification of coagulopathy from the group of hemorrhagic diathesis is based on the clinical features of bleeding (hematoma type, often hemarthrosis, delayed bleeding), laboratory coagulation studies (prolongation of clotting time, thrombin, prothrombin and thromboplastin time), as well as negative test results for capillary fragility.
2. Hemorrhagic diathesis due to impaired platelet formation is characterized by a petechial-spotted type of bleeding and bleeding from the mucous membranes, positive tests for capillary fragility (a symptom of a tourniquet, pinch), a decrease in the number of platelets or their functional failure.
3. Vasopathies are diagnosed by vasculitis-purple or angiomatous type of bleeding and unchanged laboratory data.
4. The diagnosis of hereditary forms is based on the study of family history and laboratory data.
5. The diagnosis of symptomatic forms is based on the identification of clinical signs of a particular (main) disease, taking into account the characteristics of the manifestation of the hemorrhagic syndrome. Other acquired hemorrhagic diathesis can be diagnosed only after the exclusion of symptomatic variants.

Paramedic tactics for hemorrhagic syndrome

1. In case of bleeding, provide emergency assistance in the necessary and possible volume.
2. If a patient with hemorrhagic syndrome is identified, give a referral for a consultation with a doctor.
3. After establishing the diagnosis, the paramedic monitors patients who are subject to medical examination, working in contact with the doctor.
4. The paramedic should know all patients with hemophilia in his area and have an idea about modern ways its treatment (coagulation factor VIII concentrate - in mild cases 10-15 units / kg, in more severe cases 25-40 units / kg per course of treatment; with hemorrhages in the cavity of the skull, chest, abdomen, the initial dose is 40-50 units. /kg).

Hemorrhage

Hemorrhage is a pathological hemorrhage of varying severity in certain parts of the body, which occurs when external influences or when internal pathologies organism. Patients prone to the development of hemorrhages note the spontaneous appearance of these visual signs of increased bleeding, which are not so much a cosmetic defect as they can be a symptom of a more severe pathology of the blood and blood vessels. Sometimes the appearance of hemorrhage is accompanied by the release of blood into external environment, however, in most cases interstitial accumulation of blood is noted.

Causes of hemorrhage

The development of hemorrhage can be caused both by a traumatic effect on an unchanged vascular wall, and without the presence of an injury, provided that the vessels are pathologically altered. The cause of impaired vascular wall permeability can be congenital genetic anomalies (hemophilia, von Willebrand syndrome), however, pathological bleeding is most often observed among patients suffering from acquired pathology of blood and vessels in the form of thrombocytopathy, disorders of the coagulation system, hemorrhagic vasculitis and DIC.

The formation of hemorrhages on the skin and in the subungual bed is facilitated by various background diseases of the dermatological profile (chronic dermatosis, psoriasis). Most dermatologists do consider the development of subungual hemorrhage in a patient against the background of complete well-being as the first clinical sign of the onset of psoriasis.

For all hemorrhages of different localization, the connection of their occurrence in the presence of predisposing factors, which include depression and psycho-emotional tension, prolonged use of drugs of the hormonal profile group, as well as traumatic effects, is characteristic.

Symptoms of hemorrhage

Clinical manifestations, their intensity and specificity directly depend on the location of hemorrhages. So, the most common clinical form of this pathology is subcutaneous hemorrhages resulting from medical manipulations, in particular, intramuscular and subcutaneous injections. Intravenous administration of the drug can also be accompanied by the development of hemorrhages due to the existing through damage to the venous vessel, which is extremely rare. The degree of hemorrhagic manifestations in this situation directly depends on the thickness of the injection needle and the properties of the injected drug.

The duration of the course of subcutaneous hemorrhages can vary significantly, which is explained by the individual regenerative abilities of each organism. However, all subcutaneous hemorrhages arising from intramuscular injections characterized by a longer course compared to subcutaneous, since muscle contains a larger number of vessels, the diameter of which exceeds the diameter of the subcutaneous vessels. In most situations, subcutaneous hemorrhages do not require the use of specific drug treatment and level out on their own within a short time.

When a certain amount of erythrocyte blood cells enters the thickness of the skin, which occurs with pathological permeability of the vascular wall of the capillaries, signs of hemorrhage form on the skin. Visually, these pathological changes appear as intensely hyperemic spots, merging in places, or as a single punctate rash. For hemorrhages localized on the skin, pathomorphological changes are characteristic in the form of a modification of the color of the hemorrhage from intense red to brown-yellow, which is explained by hemoglobin transformations.

As a rule, the presence of hemorrhages on the skin does not require application medical measures and they disappear on their own within a short period of time. A variety of skin hemorrhages are subungual hemorrhages, which look like dotted spots or linear areas of various colors and shapes, localized under the nail bed. In addition to the presence of hemorrhages, the nail plate itself changes, which becomes dull yellow, uneven and is characterized by increased fragility. Very often, subungual hemorrhages are accompanied by a fungal infection that needs immediate medical treatment.

In a situation where the patient has signs of inflammatory changes in the gastric mucosa, which is observed with erosive gastritis, gastric hemorrhages develop. With damage to the organs of the gastrointestinal tract, so-called submucosal hemorrhages develop, which for a long time can be completely asymptomatic. The first symptoms indicating the development of gastric hemorrhages are unmotivated weakness, dizziness, nausea, which is not related to food intake. In the expanded stage clinical symptoms the patient has frequent episodes of vomiting, and the vomit has a characteristic dark color, which is a pathognomonic symptom gastro- intestinal bleeding. This pathological condition requires the attention of the attending physician and is the basis for the hospitalization of the patient in order to apply specific drug treatment.

Internal hemorrhages also include hemorrhages in liver cirrhosis, observed with severe portalization of blood flow. The most pathognomonic sign of hemorrhage in liver cirrhosis is esophageal bleeding, which can have varying degrees of intensity. Subsequently, in addition to vomiting, the patient develops a stool with an admixture of dark blood.

Hemorrhages on the face are most often localized in the projection of the eyeballs and in the paraorbital region, and are small spots of dark or bright red color, depending on the duration of their course. Pinpoint hemorrhages in the white of the eye are not accompanied by the development of pain syndrome or visual disturbances, however, some patients note the appearance of a sensation of flickering flies before the eyes and a bifurcation of objects. In a situation where the patient has signs of expulsive hemorrhage, as a complication of surgical intervention on the organs of vision or a traumatic effect on the paraorbital region, it is necessary to urgently hospitalize him in an ophthalmological hospital. Signs indicating the development of this complication are a strong pulsating headache, nausea and vomiting, dizziness, a feeling of "bursting" in the eyeball.

The most severe clinical form of hemorrhage is subarachnoid, in which a large volume of fresh blood accumulates in the subarachnoid space. This pathological condition belongs to the category of acute emergency conditions and is accompanied by the development of severe clinical symptoms in the form of an intense pain syndrome in the head of a pulsating nature, varying degrees of impaired consciousness from short-term fainting to deep coma, and the appearance of positive meningeal signs. Visually, subarachnoid hemorrhage cannot be established, however, special methods such as CT scan and analysis of cerebrospinal fluid allow to verify the diagnosis correctly in a short time.

Treatment of hemorrhage

When establishing a diagnosis and determining the tactics of managing a patient who has signs of hemorrhage, it should be taken into account that some forms of this pathological condition are prone to the development of complications, and therefore, all patients of this profile need dynamic observation. Complications of hemorrhage are inflammatory transformation of hemorrhage, as well as the development of post-hemorrhagic anemic syndrome, which in severe cases can cause death.

The expediency of the use of medical measures is established, taking into account the severity of the patient's condition, the clinical form of hemorrhage, its intensity and ability to provoke complications. So, for example, with intradermal and subcutaneous non-extensive hemorrhages, it is possible not to apply therapeutic measures at all, and for large hemorrhages, it is enough to use local treatment(applying Heparin or Troxevasin ointment twice a day to the affected area).

With hemorrhages in the eyeball, ophthalmologists, as a rule, use a combined treatment (local in the form of eye drops "Emoxipin" 1 drop twice a day, and medication). In a situation where drug treatment ineffective, ophthalmologists recommend surgical removal blood clot by vitrectomy.

Hemorrhages in the stomach, found in endoscopy need treatment only for the underlying underlying disease (erosive gastritis), however, at the first signs of gastrointestinal bleeding, even of low intensity, hospitalization of the patient in a surgical hospital is indicated. The fundamental stage of treatment in this situation is replacement therapy using intravenous infusion of fresh frozen plasma and parenteral administration of Vikasol in daily dose 30 mg.

Hemorrhage - which doctor will help? If there is or suspected the development of hemorrhage, you should immediately seek advice from doctors such as a hematologist or dermatologist.

Hemorrhagic stroke of the brain: types, symptoms, diagnosis, treatment, risk factors

Hemorrhagic stroke of the brain is a sudden violation of cerebral circulation with the formation of a hematoma or blood soaking nervous tissue. Damage to the substance of the brain entails significant neurological disorders up to the complete loss of motor and sensory functions, as well as impaired swallowing, speech, and breathing. Stroke has a high probability of death, and most of the surviving patients remain permanently disabled.

Unfortunately, the word "stroke" is familiar, if not to everyone, then to most of us. Increasingly, such a diagnosis can be found among people of working age. Such a condition means a violation of blood circulation in the brain due to various reasons, as a result of which either necrosis occurs - then they talk about ischemic stroke (brain infarction), or outflow of blood into the brain tissue - then they talk about a hemorrhagic type of stroke, which will be discussed in this article.

According to statistics, mortality in the first month from the onset of the disease reaches 80% even in countries with a high level of medical development. Survival after hemorrhagic stroke is low and significantly lower than in cerebral infarction. During the first year, 60-80% of patients die, and more than half of the survivors remain permanently disabled.

Causes and risk factors for cerebral hemorrhage

The mechanisms of development and etiology of this insidious disease are well studied and described in textbooks on neurology, however, diagnostic difficulties, especially at the prehospital stage, still exist. So what are the main causes of hemorrhagic stroke? To date, the most common of these are:

• Vascular and.
• Rarer causes include:
• Inflammatory and dystrophic changes in the vascular walls (, amyloid angiopathy);
• Diseases accompanied by a violation of blood clotting (,);
• Appointment, and fibrinolytic agents (aspirin, heparin, warfarin);
• Cirrhosis of the liver, in which there is a violation of the synthesis of blood coagulation factors in the liver, the number of platelets decreases, which inevitably leads to the development of bleeding and hemorrhage, including in the brain;
• Hemorrhages in a brain tumor.

It should be noted that the word stroke is more correctly used in cases where arterial hypertension acts as a causative factor or there are vascular anomalies, while the second group of causes causes secondary hemorrhages and the term "stroke" in such cases is not always used.

In addition to the above factors that create a morphological substrate for the disease (damage to the vascular wall), there are also predisposing, like so:

1. Smoking;
2. alcohol abuse;
3. Addiction;
4. Obesity and lipid spectrum disorders;
5. Age over 50;
6. Adverse family history (hereditary factor).

Speaking of hemorrhages in the brain, one cannot fail to mention the vascular wall. As a rule, the presence of lipid plaques leads to the closure of the lumen of the vessels with the development of necrosis - cerebral infarction, or ischemic stroke. At the same time, damage to the vascular wall with its thinning, atheromatosis, ulceration in conditions of high blood pressure creates all the conditions for subsequent rupture and hemorrhage.

Video: non-standard causes of stroke

Mechanisms of development of hemorrhagic stroke

As you know, most of the world's population suffers after 40-50 years. Many people simply do not pay attention to the alarming ones or do not even know that the disease already exists and is progressing without giving any manifestations. In the same time, are already taking place in the body irreversible changes, which primarily relate to arterial vessels. The brain in this case is the so-called "target organ" along with the kidneys, retina, heart, adrenal glands.

In the arteries and arterioles, under the influence of increased pressure, their muscle layer thickens, impregnation with plasma proteins, fibrinoid changes up to necrosis of sections of the vascular wall. Over time, these vessels become brittle, microaneurysms (local expansions) occur, which, with sudden rises in blood pressure (), have more likely ruptures with the penetration of blood into the brain tissue. In addition, damage to the vascular walls is often accompanied by an increase in their permeability, as a result of which blood escapes through them (diapedetic bleeding) and, as it were, saturates the nervous tissue, penetrating diffusely between cells and fibers.

If arterial hypertension leads to acute hemorrhagic stroke, usually in the elderly, then changes such as aneurysms or vascular malformations are the lot of young people and even children and adolescents.

photo: ruptured saccular aneurysm in hemorrhagic stroke

is a local expansion of the lumen of the vessel, usually of a congenital nature, having an irregular wall structure.

- This birth defects in the development of vessels with the formation of tangles, entanglements, pathological connections between the arterial and venous bed without the presence of a capillary network, in which blood is discharged directly from the arteries into the veins, which is accompanied by a disruption in the supply of tissue with oxygen and nutrients.

Vascular aneurysms and malformations often do not give any clinical manifestations until they rupture and bleed. This is their "deceit", because patients or their relatives do not even suspect the presence of such a pathology.

a serious malformation of the vessels of the brain that can lead to a stroke at

This problem is especially acute in children and adolescents, when sudden brain damage can leave indelible consequences for the rest of their lives or even lead to death.

In the case of hypertension or vascular anomalies, maintaining a healthy lifestyle is more important than ever. Smoking, obesity, alcohol abuse can create that unfavorable background that will significantly accelerate the progression of the disease itself, as well as increase the likelihood of its severe course and death.

The main types of hemorrhagic strokes and their classification

Depending on location and features structural changes in the brain, there are several types of strokes according to the hemorrhagic type. Allocate:

• Subarachnoid hemorrhage;
• Parenchymal hemorrhage;
• Intraventricular hemorrhage;
• Sub- and epidural hemorrhage (non-traumatic).

is an accumulation of blood under the soft meninges, consisting of vessels and covering the outside of the brain. As a rule, the cause of this type of stroke are aneurysms and vascular malformations. When a vessel ruptures, blood spreads over the surface of the brain, and sometimes involves its tissue in the pathological process - then they talk about subarachnoid-parenchymal hemorrhage.

Parenchymal hemorrhage- the most common type of stroke, in which blood enters directly into the substance of the brain. Depending on the nature of the damage, there are two types of parenchymal hemorrhages:

1. Hematoma;
2. Hemorrhagic impregnation.

Hematoma is a cavity filled with blood. With this type of stroke, the death of cellular elements in the affected area occurs, which causes a serious neurological deficit with severe clinical symptoms and a high risk of death. Nervous tissue is highly specialized and very complex in functional and structural terms, and neurons are not able to multiply by division, so such damage does not give a chance for a favorable outcome.

At hemorrhagic impregnation there is a penetration of blood between the elements of the nervous tissue, however, such a massive destruction and death of neurons, as with a hematoma, does not occur, therefore, the prognosis is much more favorable. As a rule, the main cause of this type of stroke is an increase in vascular permeability with erythrocyte diapedesis in arterial hypertension, thrombocytopenia, and anticoagulant treatment.

Intraventricular hemorrhages possible with breaks choroid plexus located in them, but more often they are of a secondary nature. In other words, blood enters the ventricular system of the brain in the presence of large hemispheric hematomas. In this case, obstruction (closing) of the liquor pathways with blood occurs, hydrocephalus develops due to a violation of the outflow of cerebrospinal fluid from the cranial cavity, cerebral edema rapidly increases. The chances of surviving in such a situation minimal. As a rule, such patients die in the first 1-2 days after the penetration of blood into the ventricles of the brain.

Sub- and epidural hemorrhages, although they relate to strokes, as a rule, they are traumatic in nature and are the lot of neurosurgery.

In addition to the listed types of strokes, there are also their various options depending on the localization the focus of the lesion. So, they distinguish:

• Lobar hemorrhages, located within one lobe of the brain;
• Deep strokes affecting the subcortical nuclei, deep parts of the brain, the internal capsule;
• Hemorrhagic stroke of the cerebellum;
• Stem hemorrhagic stroke.

Speaking of extensive hemorrhagic stroke, they usually mean damage to several parts of the brain or several of its lobes at the same time. This condition is accompanied by damage to a significant part of the parenchyma, the rapid development of edema and, as a rule, is incompatible with life.

It is understood as small foci of damage to the brain tissue that occur against the background of vasospasm in arterial hypertension, diabetes mellitus. Clinical signs in the form of neurological symptoms most often resolve within 24 hours of their onset. It is important to start treatment as early as possible, preferably within the first 6 hours. Relatively mild course and no irreversible changes this condition should not be ignored, which indicates that changes in the vessels of the brain are already pronounced, and the development of an extensive stroke may become the next stage.

In accordance with the international classification, acute violations cerebral circulation belong to the group of cerebrovascular diseases included in class IX (includes all diseases of the circulatory system), and are denoted by the letter I (lat.). According to ICD-10, hemorrhagic stroke is coded under heading I61, where an additional number after the dot indicates its localization, for example, I 61.3 - stem intracerebral hemorrhage.

Despite its wide prevalence, the word "stroke" cannot be used in the diagnosis. So, it is necessary to indicate its specific type: hematoma, hemorrhagic impregnation or heart attack, as well as the localization of the lesion.

Due to the high social significance associated with significant mortality and disability of most of the surviving patients, the diagnosis of cerebral hemorrhage is always heard under the rubric of the underlying disease, although in fact it is a complication, in particular, of arterial hypertension.

Video: causes and types of strokes

Clinical manifestations of hemorrhages in the brain

The signs of hemorrhagic stroke are so diverse and even complex that sometimes not every doctor can see them, but a neurologist can easily make this diagnosis. Such a dangerous condition can catch the patient anywhere: on the street, in public transport, and even on vacation at sea. It is important that at this moment there are, if not specialists, then at least people who are ready to call a doctor or an ambulance, as well as provide first aid and participate in transporting the patient.

The clinic of hemorrhagic stroke is primarily due to the localization of the lesion and its size. Depending on which structures of the brain are damaged, specific signs of a violation of one or another of its functions will appear. As a rule, most often the motor and sensitive spheres suffer, speech with damage to the hemispheres. With the localization of hemorrhage in the brain stem, damage to the vital respiratory and vasomotor centers is possible with a high risk of rapid death.

infographic: AiF

Depending on the time since the onset of the disease and clinical manifestations, the following periods of hemorrhagic stroke can be distinguished:

1. Acute period;
2. recovery period;
3. Residual period.

In the acute period cerebral symptoms associated with increased pressure in the cranial cavity due to hemorrhage predominate. It lasts up to a week and is accompanied by the accumulation of blood with damage to the nervous tissue up to necrosis. The most dangerous in the acute phase is the rapid development of cerebral edema with the dislocation of its structures and the wedging of the trunk, which will inevitably lead to death.

Recovery period begins from 2-4 weeks, when reparative processes are already beginning in the brain, aimed at removing blood and restoring the structure of the parenchyma due to the multiplication of neuroglial cells. This period can last several months.

Residual period continues for the rest of your life. With adequate and timely medical and rehabilitation measures, it is sometimes possible to restore quite well many functions of the body, speech, and even working capacity, and patients live more than one year after a stroke.

The disease occurs more often suddenly, during the day, at the time of an increase in blood pressure (hypertensive crisis), with strong physical exertion or emotional overstrain. The person suddenly loses consciousness, falls, vegetative manifestations appear in the form of sweating, changes in body temperature, reddening of the face or, less often, pallor. In some patients, breathing is disturbed, tachy-or appears, or the rapid development of coma is also possible.

Superficial epidural and subdural hematomas (pictured) may be accompanied mainly by the first group of symptoms

Symptoms of hemorrhagic stroke can be divided into two groups.

Cerebral symptoms

Cerebral symptoms due to increased intracranial pressure due to the accumulation of blood in the brain. The greater the volume of hemorrhage and the rate of its development, the more pronounced they will be. General cerebral manifestations of hemorrhagic strokes include:

1. severe headache;
2. vomiting;
3. Violation of consciousness;
4. Convulsive syndrome.

Focal neurological manifestations

Focal neurological symptoms associated with damage to a specific part of the nervous system. Yes, at hemispheric hemorrhages, the most common, the typical symptoms are:

1. Hemiparesis or hemiplegia on the opposite side of the lesion (complete or partial movement disorder in the arm and leg), decreased muscle tone and tendon reflexes;
2. Hemihypesthesia (impaired sensitivity on the opposite side);
3. Gaze paresis (eyeballs will be turned towards the hemorrhage), mydriasis (pupil dilation) on the side of the lesion, drooping of the corner of the mouth and smoothness of the nasolabial triangle;
4. Speech impairment with damage to the dominant hemisphere (left in right-handers);
5. The appearance of pathological reflexes.

• So, with a hemorrhagic stroke of the left side of the brain, the main symptoms will be expressed on the right, and in right-handed people there will also be speech impairment. With the defeat of the right side - on the contrary, but speech will be impaired in left-handed people, which is associated with the peculiar location of the speech center in the brain.
• When defeated cerebellum characteristic signs are headache in the back of the head, vomiting, severe dizziness, impaired walking, inability to stand, change in speech. With large cerebellar hemorrhages, edema quickly develops and wedging it into the large occipital foramen, which leads to death.
• With massive hemorrhages in the hemispheres often occurs breakthrough in blood ventricles of the brain. This condition is accompanied by a sharp disturbance of consciousness, the development of coma and poses an immediate threat to life.
• subarachnoid hemorrhage accompanied by severe headache and other cerebral symptoms, as well as the development of coma.
• brain stem stroke is a very dangerous condition, since vital nerve centers are located in this department, as well as nuclei cranial nerves. With hemorrhage in the trunk, in addition to the development of bilateral paralysis, impaired sensitivity and swallowing, a sharp loss of consciousness is possible with the rapid development of coma, dysfunction of the respiratory and cardiovascular systems due to damage to the respiratory and vasomotor centers. In such severe cases, the probability of death reaches 80-90%.

Unfortunately, the prognosis in the case of coma after a hemorrhagic stroke is disappointing. Especially often coma occurs with stem, massive hemispheric and cerebellar hemorrhage. Despite intensive therapy, such patients die, as a rule, in the acute period of the disease.

Video: signs of a stroke

Diagnostic methods

If a cerebral hemorrhage is suspected, it is necessary to carefully question the patient's complaints if the ability to meaningful speech is preserved. If possible, even through relatives, to find out if the patient had previous arterial hypertension, the features of the development of the disease. As a rule, the main neurological defects are noticeable even to a non-professional. So, it is enough to talk to the patient, ask him to smile or show his tongue in order to suspect a brain lesion. The impossibility of walking, impaired consciousness, speech, as well as the sudden development of such symptoms indicate an acute circulatory disorder in the brain.

AT stationary conditions Diagnosis of hemorrhagic stroke is carried out with the help of a thorough neurological examination by a specialist doctor. The main instrumental method is currently considered to be an affordable and very informative diagnostic method. With CT, you can determine the localization, size of the lesion.

With small sizes of foci, the presence of vascular malformations, it is possible to use it, however, this method is expensive and not always available. In cases of subarachnoid hemorrhage, it may be informative to study the cerebrospinal fluid during lumbar puncture when the detection of erythrocytes in the CSF will be a reliable diagnostic criterion.

For the diagnosis of subarachnoid hemorrhages and, especially, vascular aneurysms and malformations, a highly informative diagnostic method can be angiography. With this research method, it is possible to determine the nature of blood flow in the affected sections of the vascular bed, the presence of anomalies in the development of blood vessels by introducing radiopaque substances. In addition, angiography data will be very useful for the subsequent surgical treatment of aneurysms.

Differential diagnosis for stroke

In the differential diagnosis of hemorrhagic stroke, it is necessary to distinguish it from brain tumors with secondary hemorrhage, abscesses, cerebral infarctions, epilepsy, traumatic injuries and even hysteria, especially in young women after severe stress. In such cases, in addition to the data of the anamnesis, examination and neurological examination, CT and MRI, electroencephalography, and radiography of the skull come to the rescue.

Often the question arises as to whether an ischemic or hemorrhagic stroke developed in this case? For differential diagnosis, it is necessary to know the difference from hemorrhagic. So, hemorrhages in the brain are less common, but the mortality from them is much higher; they occur suddenly, during the day, more often in young people, while cerebral infarctions may be accompanied by a period of precursors and occur more often at night or in the morning, among complete rest. In addition, with hemorrhages in the brain, an accumulation of blood (hematoma) is formed, and with heart attacks, ischemia and necrosis will be observed, that is, bleeding and, as a result, cell death.

Complications and consequences of cerebral hemorrhages

Complications of hemorrhagic stroke can occur both in the acute period and for a long time after the onset of hemorrhage. Among the most dangerous are:

• Breakthrough of blood into the ventricular system;
• Increasing cerebral edema;
• Development of occlusive hydrocephalus;
• Violation of systemic hemodynamics and function of external respiration, especially with damage to the brain stem.

These complications appear more often in the acute period and lead to the death of patients.

Another group of complications is associated with dysfunction of the pelvic organs, heart, prolonged lying position and weakening of the body's defense reactions. Among them, the most characteristic are:

1. congestive pneumonia;
2. Urinary tract infections;
3. Sepsis;
4. bedsores;
5. in the veins of the leg with the risk of development;
6. Decompensation of cardiac activity,.

At present, the most common causes death of patients with cerebral hemorrhages are its edema, dislocation of structures (displacement relative to each other) and wedging of the brain stem into the foramen magnum. In a later period, infectious and inflammatory complications, in particular, pneumonia, are most common.

Approaches to the treatment of hemorrhagic stroke

If you suspect a cerebral hemorrhage, you should call a doctor or an ambulance as soon as possible. In no case should the patient get up, walk, or move with the help of relatives. Treatment of hemorrhagic stroke should be started as soon as possible. When carrying out the necessary activities in the first 6 hours after the onset of the attack significantly increases the likelihood of a favorable outcome.

infographic: AiF

Treatment of cerebral hemorrhages should be carried out only in specialized clinics, and in the first week it is desirable to place the patient in the intensive care unit under constant medical supervision. Subsequently, with a favorable course, the patient is transferred to a specialized neurological or department for patients with vascular pathology brain. It is important that the hospital has the possibility of round-the-clock diagnostic measures such as CT and MRI, as well as the possibility of emergency neurosurgical intervention.

First aid for hemorrhagic stroke will be provided by an ambulance team at the pre-hospital stage and on the way to the hospital. It includes:

• Transportation of the patient in a prone position with a raised head end;
• Normalization of blood pressure by introducing antihypertensive drugs(clofelin, dibazol, enalapril);
• The fight against cerebral edema with the help of osmotic diuretics (mannitol);
• The use of drugs aimed at stopping bleeding (etamsylate);
• Introduction anticonvulsants if indicated, sedative therapy (relanium);
• Maintaining, if necessary, the function of external respiration and cardiac activity.

Further treatment of hemorrhagic stroke, in a hospital setting, can be conservative and operative.

Surgery for a stroke

Surgical treatment is carried out in the Department of Neurosurgery, as a rule, in the first three days from the onset of the disease. Indications for surgery for hemorrhagic stroke are:

1. Large hemispheric hematomas;
2. Breakthrough of blood into the ventricles of the brain;
3. Rupture of the aneurysm during growth.

Removal of blood from a hematoma is aimed at decompression, that is, reducing pressure in the cranial cavity and on the surrounding brain tissue, which significantly improves the prognosis and also helps to save the patient's life.

Non-surgical treatment

Conservative treatment cerebral hemorrhage involves basic and specific neuroprotective and reparative therapy with the prescription of drugs from various pharmacological groups.

Basic stroke therapy includes:

• Maintain adequate lung function, if necessary - tracheal intubation and artificial ventilation;
• Normalization of blood pressure (labetalol, enalapril for hypertensive patients, infusion therapy, dopamine for hypotension), correction of the heart in arrhythmias;
• Normalization of water-salt and biochemical balance (infusion therapy, the appointment of diuretics - lasix);
• Appointment of antipyretic drugs for hyperthermia (paracetamol, magnesium sulfate);
• Reduction and prevention of cerebral edema (mannitol, albumin solution, sedatives, drainage of cerebrospinal fluid);
• Symptomatic therapy - for convulsive syndrome (diazepam, thiopental), cerucal for vomiting, fentanyl, haloperidol - for psychomotor agitation;
• Prevention of infectious and inflammatory complications (antibiotic therapy, uroseptics).

Specific drugs for the treatment of hemorrhagic stroke should have a neuroprotective, antioxidant effect, improve repair in the nervous tissue. The most frequently prescribed ones are:

1. Piracetam, actovegin, cerebrolysin - improve the trophism of the nervous tissue;
2. Vitamin E, mildronate, emoxipin - have an antioxidant effect.

Consequences and prognosis

Life after a hemorrhagic stroke can create many difficulties not only for the patient himself, but also for his relatives. Long-term rehabilitation, the irretrievable loss of many vital functions require patience and perseverance. As a rule, the majority of patients lose their ability to work. In such a situation, it is important to maintain at least the ability to self-service and independent living.

It implies carrying out:

• Therapeutic physical education;
• massage;
• Physiotherapy procedures.

If necessary, a psychotherapist works with the patient, and occupational therapy is also useful, aimed at restoring working capacity and self-service.

The consequences of a hemorrhagic stroke, as a rule, remain for the rest of your life. Violations of motor and sensory function, speech, swallowing require constant attention from relatives caring for the patient. In case of impossibility of movement and walking, it is necessary to ensure the prevention of bedsores (adequate hygiene, especially in violation of the function of the pelvic organs, treatment of the skin). It is also necessary to take into account the possibility of impaired cognitive functions - attention, thinking, memory, which can significantly complicate contact with the patient at home.

First of all, it consists of a healthy lifestyle, elimination of bad habits, normalization of blood pressure levels. In the presence of unfavorable hereditary factors, it is important to explain that timely warning will help to avoid the development of the disease and its dangerous complications.

Video: hemorrhagic stroke, cerebral hemorrhage

Increased bleeding of the skin and mucous membranes resulting from violations of hemostasis, i.e. biological system organism responsible for maintaining normal state blood is called hemorrhagic syndrome.

As a result of failures in the chain of hemostasis, its functions are disturbed, which leads to hemorrhagic syndromes.

Causes

The causes of hemorrhagic syndrome can be damage to the walls of the vessel, a violation of their structure, a change in the properties and number of platelets in the blood, a violation of blood clotting.

When identifying the causes of hemorrhagic syndrome, it is necessary to take into account that the pathologies leading to its development are quite different and can occur with different frequencies.

Hereditary disorders of hemostasis often lead to thrombocytopathy, von Willebrand disease, vascular diseases- telangiectasia.

The causes of hemorrhagic syndrome of acquired forms can be thrombocytopathy, secondary thrombocytopenia and DIC, and deficiency of prothrombin complex factors.

AT last years there is an increase in the occurrence of hemorrhagic syndrome in connection with the use of drugs that change blood clotting and platelet aggregation. Recently, cases of exposure to psychogenic factors leading to neurotic bleeding and Munchausen's syndrome are also frequent.

Types of hemorrhagic syndrome and signs

Five types of hemorrhagic syndrome are defined:

1. Petechial-spotted or bluish, occurs with thrombocytopathy, thrombocytopenia, congenital deficiency of coagulation factors, hypofibrinogenemia and dysfibrinogenemia. In this case, there is a deficiency of II, V and X coagulation factors. The features of this type of syndrome are spontaneous onset or with minor injuries, skin bleeding, as well as nasal, uterine or renal bleeding. Hematomas are rare, there are no cases of violations in the activity of the musculoskeletal system. But dangerous hemorrhages in the brain are not uncommon. There were no cases of bleeding after operations, with the exception of tonsillectomy.
2. Hematoma type - develops against the background of hemophilia A and B, is characterized by a deficiency of VIII, IX and XI coagulation factors. The patient has a violation of the musculoskeletal system, painful hemorrhages in the joints and soft tissues. Usually the syndrome with this type appears a few hours after the injury. Spontaneous bleeding is rare. Hemorrhages in this type of syndrome provoke fractures, muscle spasms and deforming arthrosis. There is frequent bleeding after the operation.
3. Mixed hemorrhagic syndrome or microcirculatory hematoma is common in DIC and von Willebrand disease. It often appears with an overdose of anticoagulants and thrombolytics, as well as an acute deficiency of prothrombin complex factors and with the appearance of immune inhibitors of factors VIII and IX in the blood. With a mixed form, separate large hematomas appear in the intestinal wall and retroperitoneal space along with petechial-spotted skin hemorrhages. With this type of syndrome, bleeding into the joints is very rare, usually in the subcutaneous tissue.
4. Against the background of immune and infectious vasculitis, hemorrhagic vasculitic-purple syndrome occurs. In this case, a rash or erythema occurs in the area of ​​​​inflammation. All this is accompanied by the addition of intestinal bleeding and nephritis. This form of the syndrome freely passes into DIC.
5. Local bleeding is formed with an angiomatous type of syndrome that develops in the area of ​​arteriovenous shunts, angiomas and telangiectasias. This type of bleeding is characteristic of Osler-Rendu syndrome. The main signs of the syndrome are bleeding (hemorrhagic diathesis), fainting, bleeding of various types and severity.

Edema-hemorrhagic syndrome

Due to the increased permeability of the vessels of the pulmonary system and the occurrence of hemorrhage, an accumulation of protein-enriched fluid occurs in it, and part of the alveoli is filled with blood. As a result, there is a change in the lungs called edematous-hemorrhagic syndrome. This type of syndrome is detected in the first days of a newborn's life, most often along with other pathologies of the pulmonary system.

The main cause of edematous-hemorrhagic syndrome is intrauterine fetal hypoxia. But it often occurs with hyperfusion of the pulmonary circulation, edema and hemorrhages in the ventricles of the brain.

Symptoms of edematous syndrome are expressed respiratory failure immediately after birth. At the same time, the child has bloody foam and moist rales on the lips.

There are frequent cases of acute course of the syndrome. Usually acute hemorrhagic syndrome is manifested by arterial or venous bleeding. Symptoms of the syndrome with arterial bleeding are expressed by the scarlet color of the blood and a fast pulsating jet. Most often ends in shock. With venous bleeding, the blood has a dark red color, flows out evenly. Embolism may be a complication of acute hemorrhagic syndrome in this case.

Diagnosis of hemorrhagic syndrome

Hemorrhagic syndromes are diagnosed based on the timing of occurrence and developmental features.

The causes and nature of the syndrome are determined, background diseases are clarified, the possibility of development under drug exposure and other factors.

In hemorrhagic syndrome, a blood test is of paramount importance. Coagulation tests are carried out, the number of peripheral blood platelets is calculated. In special cases, a sternal puncture is performed.

A blood test for hemorrhagic syndrome is also carried out to determine its coagulation.

A clinical blood test for hemorrhagic syndrome indicates a decrease in hemoglobin, erythrocyte count and color index, poikilocytosis, anisocytosis, leukocytosis, accelerated ESR and neutrophilia with a shift to the left.

Treatment of hemorrhagic syndrome

The treatment of the syndrome is based on an accurate diagnosis and the severity of the process.

The treatment of acute hemorrhagic syndrome, in which there is a possibility of death of the patient from blood loss, is started immediately with the relief of the hemorrhagic focus.

For this, hemostatic or cryotherapy is used.

Surgery or laser barotherapy is often performed.

For the treatment of hemorrhagic syndrome of any kind, agents are used to enhance blood clotting.

With extensive bleeding, replacement therapy is used - blood plasma, cryoprecipitate or donor platelet concentrate.

Regardless of the type and severity of the process, heparin is used in the treatment of hemorrhagic syndrome. In moderate and severe cases, the use of prednisolone is indicated.

In the treatment of chronic forms, drugs of the aminoquinoline series are often used.

Hemorrhage- this is a pathological hemorrhage of varying severity in certain parts of the body, which occurs under external influences or with internal pathologies of the body. Patients prone to the development of hemorrhages note the spontaneous appearance of these visual signs of increased bleeding, which are not so much a cosmetic defect as they can be a symptom of a more severe pathology of the blood and blood vessels. Sometimes the appearance of hemorrhage is accompanied by the release of blood into the external environment, but in most cases there is an interstitial accumulation of blood.

Causes of hemorrhage

The development of hemorrhage can be caused both by a traumatic effect on an unchanged vascular wall, and without the presence of an injury, provided that the vessels are pathologically altered. The cause of a violation of the permeability of the vascular wall can be congenital genetic anomalies (,), however, pathological bleeding is most often observed among patients suffering from an acquired pathology of the blood and vessels in the form of, a violation of the coagulation system, and.

The formation of hemorrhages on the skin and in the subungual bed is facilitated by various background diseases of the dermatological profile (chronic,). Most dermatologists do consider the development of subungual hemorrhage in a patient against the background of complete well-being as the first clinical sign of the onset of psoriasis.

For all hemorrhages of various localization, the connection of their appearance in the presence of predisposing factors, which include psycho-emotional tension, prolonged use of drugs of the hormonal profile group, as well as traumatic effects, is characteristic.

Symptoms of hemorrhage

Clinical manifestations, their intensity and specificity directly depend on the location of hemorrhages. So, the most common clinical form of this pathology is subcutaneous hemorrhages resulting from medical manipulations, in particular, intramuscular and subcutaneous injections. Intravenous administration of the drug can also be accompanied by the development of hemorrhages due to the existing through damage to the venous vessel, which is extremely rare. The degree of hemorrhagic manifestations in this situation directly depends on the thickness of the injection needle and the properties of the injected drug.

The duration of the course of subcutaneous hemorrhages can vary significantly, which is explained by the individual regenerative abilities of each organism. However, all subcutaneous hemorrhages that occur with intramuscular injections are characterized by a longer course compared to subcutaneous ones, since the muscle tissue contains a larger number of vessels, the diameter of which exceeds the diameter of the subcutaneous vessels. In most situations, subcutaneous hemorrhages do not require the use of specific drug treatment and level out on their own within a short time.

When a certain amount of erythrocyte blood cells enters the thickness of the skin, which occurs with pathological permeability of the vascular wall of the capillaries, signs of hemorrhage form on the skin. Visually, these pathological changes appear as intensely hyperemic spots, merging in places, or as a single punctate rash. For hemorrhages localized on the skin, pathomorphological changes are characteristic in the form of a modification of the color of the hemorrhage from intense red to brown-yellow, which is explained by hemoglobin transformations.

As a rule, the presence of hemorrhages on the skin does not require the use of therapeutic measures and they disappear on their own within a short period of time. A variety of skin hemorrhages are subungual hemorrhages, which look like dotted spots or linear areas of various colors and shapes, localized under the nail bed. In addition to the presence of hemorrhages, the nail plate itself changes, which becomes dull yellow, uneven and is characterized by increased fragility. Very often, subungual hemorrhages are accompanied by a fungal infection that needs immediate medical treatment.

In a situation where the patient has signs of inflammatory changes in the gastric mucosa, which is observed in the erosive type, hemorrhages of the stomach develop. With damage to the organs of the gastrointestinal tract, so-called submucosal hemorrhages develop, which for a long time can be completely asymptomatic. The first symptoms indicating the development of gastric hemorrhages are unmotivated weakness, nausea, which is not related to food intake. In the stage of advanced clinical symptoms, the patient has frequent episodes of vomiting, and the vomit has a characteristic dark color, which is a pathognomonic symptom of gastrointestinal bleeding. This pathological condition requires the attention of the attending physician and is the basis for the hospitalization of the patient in order to apply specific drug treatment.

Internal hemorrhages also include hemorrhages in liver cirrhosis, observed with severe portalization of blood flow. The most pathognomonic sign of hemorrhage in liver cirrhosis is esophageal bleeding, which can have varying degrees of intensity. Subsequently, in addition to vomiting, the patient develops a stool with an admixture of dark blood.

Hemorrhages on the face are most often localized in the projection of the eyeballs and in the paraorbital region, and are small spots of dark or bright red color, depending on the duration of their course. Pinpoint hemorrhages in the white of the eye are not accompanied by the development of pain or visual disturbances, however, some patients note the appearance of a sensation of flashing flies before the eyes and bifurcation of objects. In a situation where the patient has signs of expulsive hemorrhage, as a complication of surgical intervention on the organs of vision or a traumatic effect on the paraorbital region, it is necessary to urgently hospitalize him in an ophthalmological hospital. Signs indicating the development of this complication are severe throbbing, nausea and vomiting, dizziness, a feeling of "bursting" in the eyeball.

The most severe clinical form of hemorrhage is subarachnoid, in which a large volume of fresh blood accumulates in the subarachnoid space. This pathological condition belongs to the category of acute emergency conditions and is accompanied by the development of severe clinical symptoms in the form of an intense pain syndrome in the head of a pulsating nature, varying degrees of impaired consciousness from short-term fainting to deep coma, and the appearance of positive meningeal signs. It is impossible to establish subarachnoid hemorrhage visually, however, such special methods as computed tomography and analysis of cerebrospinal fluid make it possible to correctly verify the diagnosis in a short time.

Treatment of hemorrhage

When establishing a diagnosis and determining the tactics of managing a patient who has signs of hemorrhage, it should be taken into account that some forms of this pathological condition are prone to the development of complications, and therefore, all patients of this profile need dynamic observation. Complications of hemorrhage are inflammatory transformation of hemorrhage, as well as the development of post-hemorrhagic anemic syndrome, which in severe cases can cause death.

The expediency of the use of medical measures is established, taking into account the severity of the patient's condition, the clinical form of hemorrhage, its intensity and ability to provoke complications. So, for example, with intradermal and subcutaneous non-extensive hemorrhages, you can not use therapeutic measures at all, and for large hemorrhages, it is enough to use local treatment (applying Heparin or Troxevasin ointment twice a day to the affected area).

With hemorrhages in the eyeball, ophthalmologists, as a rule, use a combined treatment (local in the form of eye drops "Emoxipin" 1 drop twice a day, and medication). In a situation where drug treatment is ineffective, ophthalmologists recommend surgical removal of the blood clot by vitrectomy.

Hemorrhages in the stomach, detected during endoscopic examination, require treatment only of the underlying background disease (erosive gastritis), however, at the first signs of gastrointestinal bleeding, even of low intensity, hospitalization of the patient in a surgical hospital is indicated. The fundamental stage of treatment in this situation is replacement therapy using intravenous infusion of fresh frozen plasma and parenteral administration of Vikasol at a daily dose of 30 mg.

Hemorrhage - which doctor will help? If there is or suspected the development of hemorrhage, you should immediately seek advice from doctors such as a hematologist or dermatologist.

Hemorrhages are blood loss of varying severity that can occur in any part of the human body. The reason for this phenomenon can be various diseases. Most often, hemorrhages are characterized by the accumulation of blood inside the tissues, although there are also external blood loss (when the blood comes out).

Definition of hemorrhage and the process of its development

Depending on the area in which the damage occurred, hemorrhages are conventionally divided into:

• external (bleeding that goes outside the skin of a person);
• internal (blood loss formed in internal organs and tissues);
• venous (moderate bleeding from a hole in the vessel wall, resulting from a violation of its integrity);
• arterial (characterized by profuse blood loss, the cause of which is damage to the artery);
• capillary (leakage of blood from small vessels);
• parenchymal (blood loss from tissues that form organs).

Hemorrhagic syndrome can be both temporary and chronic. Chronic hemorrhages usually occur after the age of 50, as the vessels become weaker during the aging of the body.

Causes

There are three types of this pathological phenomenon, which are distinguished by the causes of education:

• hemorrhage caused by a violation of the integrity of the blood vessel by mechanical damage;
• hemorrhage, the cause of which is a decrease in the thickness of the walls of the vessel;
• hemorrhage caused by a breakdown in the vessel wall, caused by the negative effects of certain chemicals or infections.

• bruises, fractures, torn ligaments;
• surgical interventions;
• high blood pressure;
• aneurysms;
• hypertensive crisis;
• vasculitis;
• leukemia.

The danger of pathology

The danger of hemorrhage is that blood loss can destroy tissue. This can cause more serious consequences, for example, hemorrhage in the brain, lungs and heart.

Symptoms of various types of hemorrhages

For internal bleeding

• lethargy or drowsiness;
• the color of the skin of an unnatural color (pallor appears);
• (intense heartbeat - more than 90 beats per minute);
• darkening in the eyes;
• loss of orientation in space, dizziness;
• fainting state;
• low blood pressure;
• general malaise;
• dehydration, thirst;
• a sharp decrease in hemoglobin and erythrocytes in the blood (determined clinically).

With parenchymal hemorrhage

• feeling weak, tired;
• dry mouth, thirst;
• chills, blanching of the skin;
• manifestation of a threadlike pulse, lowering blood pressure;
• feeling unwell, .

External symptoms of hemorrhage

With hemorrhage in the eye area, redness of the sclera is observed. In addition, in this case, visual acuity is reduced.

If the patient has gastric hemorrhage, then such manifestations as the presence of blood in feces and urine, nausea.

Diagnosis of pathology

• Blood sampling for general analysis. This procedure will help determine the number of leukocytes in the blood, which in turn will make it possible to check damaged tissues for the presence of inflammatory processes.
• MRI. Manipulation will allow you to determine the location of damage to the vessel in any type of hemorrhage.
• X-ray examination. This type diagnostics visualizes the possible accumulation of blood in the internal organs and tissues.

First aid for hemorrhage

Bleeding from a vein It is easy to determine by the color of the blood coming out: it has a dark red color. The intensity of bleeding will be slow but continuous. The first thing to do in this case is to apply a tourniquet below the wound (10-15 cm) and a tight bandage. It is important to record the time the tourniquet was applied. For small wounds, a bandage can be dispensed with, since the veins have the ability to subside on their own.

When arterial bleeding the blood is bright red and spurts or spurts. With this type of bleeding, a tourniquet should be applied immediately. If the blood is not stopped within a minute, the likelihood of death due to heavy blood loss increases. In case of arterial bleeding, a tourniquet should be applied 10-15 cm above the affected area. A bandage must be applied to the wound. After 1-2 hours, the tourniquet is loosened for 3-5 minutes so that the blood restores circulation in the limbs, as stagnant blood can accumulate toxic substances. In this case, the likelihood of developing shock is high, which causes the death of the victim.

Capillary bleeding are not dangerous (with the exception of injuries in people with poor blood clotting). In such cases, the affected area is treated and bandaged. When stopping this type of bleeding, you can also use hemostatic drugs (Hemostop or Celox). These powdered products promote blood clotting.

Internal bleeding are among the most severe, so if they are found, you should immediately go to the hospital or call emergency care. Before the arrival of doctors, the patient should move as little as possible, be in a calm position.

Treatment of hemorrhage

Based on the patient's well-being, clinical form hemorrhage and the level of threat of complications, the doctor determines whether medications are appropriate in this or that case for the treatment of pathology. For example, with weak subcutaneous bleeding drug treatment is practically not used. With the formation of hemorrhage of the skin with a large area of ​​​​damage, the use of various ointments(troxevasin, heparin). They should be applied to the affected areas.

In addition, the following drugs are used for hemorrhages:

• normalizing blood pressure (Enap, Captopril);
• increase blood clotting (Piracetam);
• anti-inflammatory with analgesic effect (Ortofen);
• local action for resorption of accumulated blood (Indovazin, bodyagi ointment).