The classification of strokes is based on many factors. First of all, they are based on whether there is a blockage of the vessels or their rupture. In this regard, ischemic and hemorrhagic strokes are distinguished, respectively. Many people suffer from this pathology of the brain. The article will consider stroke: classification, etiology and clinic.
The concept of ischemic pathology
Classification of strokes should begin to be studied from the form that is caused by blockage of cerebral vessels. It is most often diagnosed in elderly patients who have the following comorbidities:
- diabetes mellitus;
- conduction and heart rhythm disorder;
- rheumatic heart disease;
- myocardial infarction;
- ailments of the main arteries;
- hormonal contraception;
- IHD;
- unilateral migraine;
- violations of the rheological properties of blood.
A stroke develops when the arteries that feed the brain tissue become blocked or narrowed. His cells begin to die if they do not get the necessary nutrients and oxygen.
Another name for ischemic stroke is cerebral infarction. Tissues in this pathology are destroyed gradually, the process does not stop even after the restoration of normal blood flow. Therefore, urgent medical care is needed for the patient.
Classification of ischemic stroke by pathogenesis
This pathology may be a consequence of the development of a disease of the cardiovascular system. The classification of ischemic stroke is carried out according to a number of criteria, among which pathogenesis occupies one of the leading positions.
The following types of this factor are distinguished:
- lacunar, which occurs due to occlusion of small arteries;
- atherothrombotic - the cause of which is atherosclerosis of large arteries, resulting in arterio-arterial embolism;
- cardioembolic due to myocardial infarction, valvular heart disease or arrhythmia;
- ischemic disorders associated with rarer causes: non-atherosclerotic vasculopathies, dissection of the arterial walls, blood hypercoagulability;
- pathology of unknown etiology, in which the cause is not established, or there may be several of them.
This TOAST classification of strokes is the most common.
Ischemic stroke symptoms
They are noticed by relatives and relatives by their reaction to irritations and the appearance of the patient:
- vomiting and headache;
- pain sensitivity, voice and motor functions are lost or reduced;
- consciousness is disturbed.
Depending on the severity of the condition and the affected area, the following signs of this pathology are distinguished:
- disorientation in space and stunnedness;
- eye pain, especially when moving the eyeballs;
- loss of consciousness with brief convulsions;
- headaches.
The following picture is typical for right-sided ischemic stroke:
- depression and lethargy;
- paralysis and desensitization of facial muscles on the left side of the face;
- numbness and paralysis of the body on the left;
- memory violation.
The left hemisphere of the brain is responsible for speech, so it can remain normal.
Left-sided stroke is characterized by the following features:
- speech disorder;
- impaired coordination of movements and sense of balance;
- impaired sense of smell, hearing, vision, in severe cases, the disorder extends to both sides;
- suffering sensitivity of the right side of the body with its paralysis of varying degrees.
Thus, there is a classification of strokes according to neurology.
This pathology can be characterized by:
- acute onset, in which there is a rapid increase in neurological symptoms, typical for patients with atrial fibrillation;
- undulating, when symptoms gradually increase;
- tumor-like, in which the increase in ischemia occurs over a long period, which leads to significant damage to brain tissue.
A characteristic sign of the disease is the inability to smile and the fact that the tongue deviates from the center when protruding from the mouth.
Views by defeat
Classification of ischemic stroke according to neurology distinguishes the following types of this pathology:
- transient ischemic attacks, in which neurological disorders are focal in nature, regressing within a day after their occurrence;
- small stroke - restoration of neurological functions is carried out within 2-21 days;
- progressive - focal and cerebral symptoms develop over several hours or days with incomplete recovery of functions afterwards;
- completed stroke - regression may not occur completely or not at all.
Generally recognized species in the world
Classification of strokes is made not only in our country. When recording diagnoses, there is a single system (ICD-10), in which each disease is assigned its own unique code. The WHO classification of strokes is based on the latter. In accordance with it, the following types of diseases are distinguished:
- cerebral infarctionbrain;
- subarachnoid hemorrhage;
- cerebral hemorrhage;
- not defined.
The second and third types refer to hemorrhagic stroke.
Types of ischemic pathology by periods
Depending on the course of the pathology and the period after its passage, the following classification by periods of stroke is used:
- Sharpest - the first three days. At the same time, three hours after the onset of the progression of the disease is called the "therapeutic window", in which thrombolytic drugs can be administered systemically. Regression may occur within the first day.
- Acute period up to 4 weeks.
- Early recovery period - up to 6 months.
- Similar late - up to 2 years.
- The period of residual effects is after this period.
Thus, the classification of ischemic strokes is carried out according to a fairly wide range of factors.
Causes of cerebral hemorrhage
As mentioned earlier, the pathology in question can occur not only due to blockage, but also due to vascular ruptures. Thus, in accordance with the classification of cerebral strokes, not only its ischemic variety is distinguished, but also hemorrhagic.
The causes of this form of illness are as follows:
- bleeding into a brain tumor;
- cirrhosis of the liver, leading to a violation of blood clotting and a decrease in platelets, provoking hemorrhages;
- appointmentfibrinolytic drugs, antiplatelet agents, anticoagulants;
- pathologies with bleeding disorders: hemophilia, thrombocytopenia;
- dystrophic and inflammatory dynamics of vessel walls: amyloid angiopathy, vasculitis;
- arterio-venous malformations;
- vascular aneurysms;
- arterial hypertension.
The last three reasons are the most common.
According to the classification of strokes, which provides for their division into hemorrhagic and ischemic, only 15% of the total number of pathologies are classified as the first.
Clinic of cerebral hemorrhage
It is determined by the size and location of the lesion. Signs of impaired brain function depend on which structure of the brain is damaged. Speech, sensory and motor areas are most often affected. If the hemorrhage is localized in the brain stem, then the vasomotor and respiratory centers may be damaged, which can lead to a rapid death.
Signs of cerebral hemorrhage
For hemorrhagic stroke, the same symptoms are characteristic as for ischemic stroke, in particular, a person cannot raise two hands at the same time, smile, stick out his tongue in a straight position, disturbances in the area of the body opposite to the affected hemisphere. In addition, with this type of pathology, the eyeballs turn towards the hemorrhage.
If the cerebellum is affected, then speech dynamics appears, the inability to stand in a standing position, a violationwalking, dizziness, vomiting, occipital headache. If hemorrhages in this part of the brain are large, then edema quickly occurs, which wedges into the occipital foramen, which leads to death.
When hemorrhages in the hemispheres, the blood enters the ventricles of the brain. In this case, a person either falls into a coma, or his consciousness is disturbed, which is a threat to life.
Subarachnoid hemorrhage may be accompanied by severe headache and other symptoms of a stroke with coma.
With a hemorrhage in the brain stem, bilateral paralysis develops, the cardiovascular and respiratory systems are disturbed, there is a sharp loss of consciousness, rapid development of coma, swallowing and sensitivity are disturbed. The probability of death reaches 90%.
Types of hemorrhagic strokes
They are distinguished depending on the structural dynamics and localization in the brain. In accordance with this, the following types of hemorrhages are distinguished in the classification of hemorrhagic stroke:
- sub- and epidural;
- intraventricular;
- parenchymal;
- subarachnoid.
The first ones are mostly traumatic and are treated by neurosurgeons.
Intraventricular hemorrhages can occur due to rupture of the choroid plexuses, but more often blood enters there as a result of the presence of large hemispheric hematomas. At the same time, the liquor paths are closedblood, the outflow of cerebrospinal fluid from the skull is disturbed, due to which hydrocephalus develops, cerebral edema increases. The survival rate in this case is very low. As a rule, patients die within the first two days after blood enters the ventricles.
Parenchymal hemorrhage is the most common type of hemorrhagic stroke. In this case, the blood enters the very substance of the brain. Parenchymal hemorrhages, in turn, are divided into two varieties:
- hematoma;
- hemorrhagic impregnation.
The first is a cavity filled with blood. In this case, the cells in the affected area die, which causes a neurological deficit and poses a threat to the life of patients. The chances of a favorable outcome are negligible.
In the second case, blood penetrates between the elements of the nervous tissue, while large-scale neuronal death does not occur, as in the first case, so the prognosis is more favorable. This type of stroke can be caused by treatment with anticoagulants, thrombocytopenia, hypertension.
In a subarachnoid hemorrhage, blood accumulates under the pia mater, which consists of vessels and covers the outside of the brain. This type is called vascular malformations and aneurysms. When a vessel ruptures, blood spreads over the surface of the brain. Sometimes there is involvement in the pathological process of the brain tissue, in this case they speak of subarachnoid-parenchymal hemorrhage.
Complications
In ischemic stroke, the following are possibleconsequences:
- epilepsy (it develops in every fifth case);
- depression, irritability, mood swings;
- appearance of various pain syndromes;
- paralysis, weakness;
- motor disorders;
- disorders of urination and defecation;
- cerebral edema;
- cognitive impairment;
- pulmonary thromboembolism;
- deep vein thrombosis of the lower leg;
- urinary tract infections, bedsores, pneumonia and other pathologies.
With left-sided ischemia, a person ceases to navigate in time and space, positions himself as a he althy individual, does not recognize relatives and friends.
In the first week, death may occur due to secondary ischemia of the brain stem, in which foci of infarction are formed. In addition, an ischemic disease can turn into a hemorrhagic one with the formation of a secondary hemorrhage. Cerebral edema may also occur.
With the hemorrhagic variety, myocardial infarction, arrhythmia, cardiac decompensation, development of blood clots with the possibility of developing pulmonary thromboembolism, pressure sores, sepsis, congestive pneumonia, urinary tract infections can occur.
The most dangerous complications in this case are:
- impaired function of external respiration and systemic hemodynamics;
- development of hydrocephalus;
- cerebral edema;
- blood entering the ventricles.
Moreover, these complications can appear both in the acute period of the development of the disease and later.
In closing
There are multiple classifications of strokes according to various criteria. By type, it is divided into ischemic and hemorrhagic. In relation to the first, the classification is more extensive. There are varieties according to pathogenesis, according to ICD-10, which is supported by WHO, according to neurology, according to periods. Different species are characterized by similar symptoms, especially in terms of paralysis of the side of the body opposite to the affected hemisphere, the impossibility of protruding the tongue, raising the arms. The lethal outcome in ischemic stroke is 15-20%, while in hemorrhagic stroke it reaches 80-90%.
