Hemorrhages - what is it? Causes and treatment of hemorrhage. Hemorrhagic syndrome - types and causes. Symptoms and consequences of hemorrhagic syndrome in children and adults

Hemorrhagic cerebral stroke: types, symptoms, diagnosis, treatment, risk factors

Hemorrhagic cerebral stroke is a sudden disruption of cerebral circulation with the formation of a hematoma or soaking in blood nerve tissue. Damage to the brain substance leads to significant neurological disorders up to total loss motor and sensory function, as well as disturbances in swallowing, speech, and breathing. Stroke has high probability death, and the majority of surviving patients remain permanently disabled.

Unfortunately, the word “stroke” is familiar, if not to everyone, then to most of us. Increasingly, this diagnosis can be found among people of working age. Similar condition means a violation of blood circulation in the brain due to various reasons, resulting in either necrosis - then they talk about ischemic stroke (cerebral infarction), or bleeding into the brain tissue - then they talk about stroke hemorrhagic type, 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 rates after hemorrhagic stroke are low and significantly lower than for cerebral infarctions. During the first year, 60-80% of patients die, and more than half of those who survive remain permanently disabled.

Causes and risk factors for cerebral hemorrhages

Mechanisms of development and etiology of this insidious disease are well studied and described in textbooks on neurology, but diagnostic difficulties, especially at the prehospital stage, still exist. So what are the main causes of hemorrhagic stroke? Today, the most common of them are:

• Vascular and.
• Among more rare causes can be called:
• Inflammatory and dystrophic changes vascular walls (amyloid angiopathy);
• Diseases accompanied by blood clotting disorders (,);
• Prescription of fibrinolytic agents (aspirin, heparin, warfarin);
• Liver cirrhosis, in which the synthesis of blood coagulation factors in the liver is impaired, the number of platelets decreases, which inevitably leads to the development of bleeding and hemorrhages, including in the brain;
• Hemorrhages in a brain tumor.

It is worth noting that the word stroke is more correctly used in cases when, as causative factor arterial hypertension appears or there are vascular anomalies, while the second group of causes causes secondary hemorrhages and the term “stroke” is not always used in such cases.

In addition to the above factors that create the morphological substrate for the disease (damage vascular wall), exist and predisposing like this:

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

Speaking about 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 blood vessels with the development of necrosis - cerebral infarction, or ischemic stroke. At the same time, damage to the vascular wall with its thinning, atheromatosis, ulcerations in conditions of increased 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 simply do not pay attention to 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 happening in the body irreversible changes, which primarily concern arterial vessels. Brain in in this case is the so-called “target organ” along with the kidneys, retina, heart, adrenal glands.

In arteries and arterioles under the influence high blood pressure thickening of their muscle layer occurs, impregnation with plasma proteins, fibrinoid changes up to necrosis of areas of the vascular wall. Over time, these vessels become fragile, microaneurysms (local dilations) appear, which, with sudden increases in blood pressure () have high probability ruptures with blood penetration 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 comes out through them (diapedetic bleeding) and, as it were, permeates the nervous tissue, penetrating diffusely between cells and fibers.

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

photo: rupture of a saccular aneurysm during a 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 blood vessels with the formation of tangles, weaves, pathological connections between the arterial and venous beds 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 hemorrhage. This is their “cunning”, because patients or their relatives do not even suspect the presence of such a pathology.

serious cerebral vascular malformation that can lead to stroke at

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

In the case of hypertension or vascular abnormalities, it is more important than ever to adhere to healthy image life. Smoking, obesity, and alcohol abuse can create an unfavorable background that will significantly accelerate the progression of the disease itself, as well as increase the likelihood of its severe course and death.

Main types of hemorrhagic strokes and their classification

Depending on the location and characteristics of structural changes in the brain, several types of hemorrhagic strokes are distinguished. Highlight:

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

is an accumulation of blood under the soft tissue meninges, consisting of blood vessels and covering the outside of the brain. Typically, this type of stroke is caused by 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– most common species stroke, in which blood enters directly into the brain. Depending on the nature of the damage, there are two types of parenchymal hemorrhages:

1. Hematoma;
2. Hemorrhagic impregnation.

Hematoma It is a cavity filled with spilled blood. With this type of stroke, the death of cellular elements in the affected area occurs, which causes serious neurological deficit with severe clinical symptoms And high risk lethal outcome. Nervous tissue is highly specialized and very complex functionally and structurally, and neurons are not able to reproduce by fission, so such damage does not have a chance of a favorable outcome.

At hemorrhagic impregnation blood penetrates between the elements of the nervous tissue, but such 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 during arterial hypertension, thrombocytopenia, treatment with anticoagulants.

Intraventricular hemorrhages are possible with ruptures of the vascular plexuses located in them, but more often they are of a secondary nature. In other words, blood penetrates into the ventricular system of the brain in the presence of large hemispheric hematomas. In this case, obstruction (closure) of the cerebrospinal fluid pathways with blood occurs, hydrocephalus develops due to a violation of the outflow of cerebrospinal fluid from the cranial cavity, and cerebral edema rapidly increases. Chances of surviving in such a situation minimal. As a rule, such patients die in the first 1-2 days from the moment blood enters 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 province of neurosurgery.

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

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

When talking about an extensive hemorrhagic stroke, we 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, rapid development of edema and, as a rule, is incompatible with life.

Understand small foci of damage to brain tissue that occur against the background of vasospasm during arterial hypertension, diabetes mellitus. Clinical signs in the form of neurological symptoms most often disappear within 24 hours from the moment of their onset. It is important to start treatment as early as possible, preferably in the first 6 hours. Relatively mild course and the absence of irreversible changes should not ignore this condition, which indicates that changes in the vessels of the brain are already pronounced, and the next stage may be the development of a major stroke.

According to the international classification, acute disorders cerebral circulation belong to the group of cerebrovascular diseases included in class IX (includes all diseases of the circulatory system), and are designated by the letter I (lat.). Hemorrhagic stroke according to ICD-10 is coded in category I61, where an additional number after the dot indicates its location, for example, I 61.3 - brainstem intracerebral hemorrhage.

Despite its widespread use, the word “stroke” cannot be used in diagnosis. Thus, it is necessary to indicate its specific type: hematoma, hemorrhagic impregnation or infarction, as well as the location of the lesion.

Due to high social significance, associated with significant mortality and disability for the majority of surviving patients, the diagnosis of cerebral hemorrhage always sounds under the heading 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 cerebral hemorrhages

The signs of a hemorrhagic stroke are so varied and even complex that sometimes not every doctor can see them, but a neurologist can make this diagnosis without difficulty. Such a dangerous condition can find a 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 nearby who are ready to call a doctor or an ambulance, as well as provide first aid and participate in transporting the patient.

The clinical picture of hemorrhagic stroke is determined, first of all, by the location of the lesion and its size. Depending on which brain structures are damaged, these will appear and specific signs violation of one or another of its functions. As a rule, the motor and sensory spheres and speech are most often affected when the hemispheres are damaged. When hemorrhage is localized in the brain stem, damage to vital respiratory and vasomotor centers is possible with a high risk of rapid death.

infographics: AiF

Depending on the time from the onset of the disease and clinical manifestations, we can distinguish following periods hemorrhagic stroke:

1. Acute period;
2. Recovery period;
3. Period of residual effects.

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 thing in the acute phase is the rapid development of cerebral edema with dislocation of its structures and herniation of the trunk, which will inevitably lead to death.

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

Period of residual effects continues for the rest of your life. With adequate and timely treatment and rehabilitation measures, it is sometimes possible to fairly well restore many body functions, speech and even ability to work, and Patients live for more than one year after a stroke.

The disease often occurs suddenly, during the day, at a time of increased blood pressure (hypertensive crisis), with severe physical activity or emotional stress. A person suddenly loses consciousness, falls, appears vegetative manifestations in the form of sweating, changes in body temperature, redness of the face or, less commonly, pallor. In some patients, breathing is impaired, tachycardia appears, or, possibly, rapid development of coma.

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

Symptoms of hemorrhagic stroke can be divided into two groups.

General cerebral symptoms

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

1. Severe headache;
2. Vomiting;
3. Impaired consciousness;
4. Convulsive syndrome.

Focal neurological manifestations

Focal neurological symptoms associated with damage to a specific department nervous system. Yes, when hemispheric hemorrhages, the most common ones, characteristic symptoms will be:

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

• So, with a hemorrhagic stroke on the left side of the brain, the main symptoms will be expressed on the right, and in right-handed people there will also be a speech disorder. In case of defeat right side– on the contrary, but speech will be impaired in left-handed people, which is due to the peculiar location of the speech center in the brain.
• In case of defeat cerebellum characteristic features will be headache in the back of the head, vomiting, severe dizziness, difficulty walking, inability to stand, change in speech. With large cerebellar hemorrhages, edema quickly develops and herniation into the foramen magnum, which leads to death.
• With massive hemorrhages in the hemispheres, it often occurs breakthrough of blood in ventricles of the brain. This condition is accompanied a sharp violation 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 quite dangerous condition, since vital nerve centers, as well as nuclei, are located in this section cranial nerves. With hemorrhage into 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, impaired respiratory and cardiovascular systems due to damage to the respiratory and vasomotor centers. Such severe cases the probability of death reaches 80-90%.

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

Video: signs of stroke

Diagnostic methods

If a cerebral hemorrhage is suspected, it is necessary to carefully question the patient's complaints if the ability to speak meaningfully is preserved. If possible, even through relatives, find out whether the patient has previous arterial hypertension and the characteristics of the development of the disease. As a rule, the main neurological defects are noticeable even to a layman. So, it is enough to talk to the patient, ask him to smile or stick out his tongue to suspect brain damage. Inability to walk, impaired consciousness, speech, and sudden development similar symptoms point to acute disorder blood circulation in the brain.

IN inpatient conditions Diagnosis of hemorrhagic stroke is carried out through a thorough neurological examination by a medical specialist. Main instrumental method is currently considered to be affordable and very in an informative way diagnostics CT scan can determine the location and size of the lesion.

For small lesions and the presence of vascular malformations, it is possible to use, however, this method is expensive and not always available. In cases of subarachnoid hemorrhages, a study of the cerebrospinal fluid may be informative. lumbar puncture when the detection of red blood cells in the cerebrospinal fluid will be a reliable diagnostic criterion.

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

Differential diagnosis for strokes

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 suffering severe stress. In such cases, in addition to the history, examination and neurological examination, CT and MRI, electroencephalography, and skull radiography come to the rescue.

The question often arises: did an ischemic or hemorrhagic stroke develop in this case? For differential diagnosis you need to know the difference from hemorrhagic. Thus, cerebral hemorrhages are less common, but their mortality rate is much higher; they occur suddenly, during the day, more often in young people, while cerebral infarctions can be accompanied by a period of precursors and occur more often at night or in the morning, in the midst of complete rest. In addition, with hemorrhages in the brain, an accumulation of blood (hematoma) forms, 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;
• Increased cerebral edema;
• Development of occlusive hydrocephalus;
• Impairment of systemic hemodynamics and external respiration function, especially with damage to the brain stem.

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

Another group of complications is associated with dysfunction 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 a risk of developing;
6. Cardiac decompensation.

Currently, the most common causes of death in patients with cerebral hemorrhages are edema, dislocation of structures (displacement relative to each other) and herniation of the brain stem into the foramen magnum. In more late period The most common are infectious and inflammatory complications, in particular pneumonia.

Approaches to the treatment of hemorrhagic stroke

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

infographics: AiF

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

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

• Transporting the patient in a lying position with the head end elevated;
• Normalization of blood pressure by administering antihypertensive drugs(clonidine, dibazole, enalapril);
• Combating cerebral edema with osmotic diuretics (mannitol);
• The use of drugs aimed at stopping bleeding (etamzilate);
• Administration of 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 surgical.

Stroke surgery

Surgical treatment carried out in the neurosurgery department, usually 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. Aneurysm rupture during growth.

Removing blood from the 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 save the patient’s life.

Non-surgical treatment

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

Basic therapy for strokes includes:

• Maintaining 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 heart function for arrhythmias;
• Normalization of water-salt and biochemical balance (infusion therapy, prescription of diuretics - Lasix);
• Prescription 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, and improve repair in nervous tissue. The most commonly prescribed of them:

1. Piracetam, Actovegin, Cerebrolysin - improve trophism of nervous tissue;
2. Vitamin E, mildronate, emoxypine - 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 and irreversible loss of many vital functions require patience and perseverance. As a rule, most patients lose their ability to work. In such a situation, it is important to maintain at least the ability for self-care and independent living.

Involves carrying out:

• Physical therapy;
• Massage;
• Physiotherapeutic procedures.

If necessary, a psychotherapist works with the patient; occupational therapy aimed at restoring ability to work and self-care is also useful.

The consequences of a hemorrhagic stroke usually remain for the rest of your life. Disorders of motor and sensory function, speech, and swallowing require constant attention from relatives caring for the patient. If it is impossible to move and walk, it is necessary to ensure the prevention of bedsores (adequate hygiene, especially in cases of dysfunction of the pelvic organs, treatment of the skin). It is also necessary to take into account the possibility of impairment of cognitive functions - attention, thinking, memory, which can significantly complicate contact with the patient at home.

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

Video: hemorrhagic stroke, cerebral hemorrhage

Hemorrhagic syndrome is a pathological condition characterized by increased bleeding of blood vessels and developing as a consequence of a violation of homeostasis. Signs of pathology are the occurrence of cutaneous and mucous hemorrhages, as well as the development of internal bleeding. The disease can develop at any age - both in newborns and the elderly. There are acute and chronic form this pathological condition. At acute form in children or adults emergency medical care is required, in chronic cases - complex treatment pathology.

Causes

It's hard enough in simple words describe the complex processes of hematopoiesis and their changes, which is why hemorrhagic syndrome develops. If we consider the mechanism of the disorder, it is based on abnormalities in the cellular structure of blood vessels, coagulation disorders, as well as disturbances in the enzyme activity and function of blood elements responsible for coagulation.

Doctors have identified a number of diseases, in the presence of which a person is likely to develop hemorrhagic syndrome. In particular, this pathological disorder develops in some types of oncology, severe viral infections, as well as with a deficiency of prothrombin in the blood, and.

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 hemorrhagic syndrome in a person. Acquired hematopoietic pathologies are characterized by damage to the walls of blood vessels due to an autoimmune process, chemical intoxication, inflammation or mechanical damage.

The main reasons causing this pathological disorder include:

• vasopathy;
• thrombocytopathy and;
• coagulation disorders.

To understand what exactly causes the disease, it is necessary to consider what vasopathy and other pathological changes in the blood system. Vasopathies can cause massive inflammatory processes and genetic defects and they are characterized by increased permeability of the vascular walls. Thrombocytopathy is spoken of when the functions are impaired, despite the fact that there is a sufficient amount of them in the blood. This can occur both due to 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 a consequence autoimmune processes in organism. In addition, the disorder occurs due to severe intoxication, infections, oncological processes in the body, drug abuse and after exposure to radiation.

Very often the disorder occurs with cirrhosis of the liver. This is due to the fact that the disease causes complex damage to blood vessels, accompanied by their dilation. 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 cirrhosis of the liver 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, which 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.

The following types are distinguished:

• hematomatic, which is a consequence of blood diseases caused by genetic mutations. With this type, extensive bleeding occurs due to injuries in soft tissues, forming bruises on the skin, swelling and swelling of the injury site;
• petechial spotted– caused by hereditary and acquired disorders of hemostasis, as a result of which the patient’s blood clotting is impaired. Manifested by the appearance of bruises of various diameters on the body of children or adults;
• purple type of this syndrome, which is usually a consequence of various vasculitis. Its manifestations are erythema on the skin, as well as the development of internal bleeding, in particular from the liver and intestines;
• microcirculatory type of syndrome occurs with von Willebrand disease, disseminated intravascular coagulation syndrome and overdose medicines, causing disturbances 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 vascular pathologies. He is characterized prolonged bleeding, having a certain localization.

Edema-hemorrhagic syndrome is characterized by changes in the lungs, therefore, at birth in such children, it is noted that bloody foam is released from respiratory tract. Such children require emergency medical care because, otherwise, there is a high probability of death. The main reason for the progression of this type of disease is in the mother's womb.

Symptoms

IN clinical picture A special place in the disease is occupied by 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. They usually appear after a certain traumatic impact, even a minor one.

Another symptom is bleeding various localizations. Bleeding may occur:

• from the nasal passages;
• gums;
• esophagus and others internal organs;
• uterus.

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, when blood accumulates in the joints), severe pain is observed.

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

• weakness and;
• vomiting with impurities venous blood;
• dark, loose stools (melena);
• development .

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

Diagnosis and treatment

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

Diagnosis in this case consists of laboratory tests that allow you to see an accurate picture of the blood. Coagulation tests are performed, and sometimes a sternal puncture is prescribed. Treatment of the disease depends on the following factors:

• stages of the disease;
• the reasons that caused it;
• degree of severity of the process.

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

If significant blood loss has occurred, replacement therapy is indicated - patients are given plasma, a concentrate of donor platelets. Treatment also involves the use of heparin, and in some cases the administration of prednisolone is indicated.

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

In the same cases, when it comes to congenital hemophilia, treatment cannot be 100% effective. That's why doctors use hormonal drugs in order 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.

Hemorrhages are hemorrhages in various parts of the body, varying 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

Essentially 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 vascular walls or their disruption. The integrity of the vessel is compromised when a mechanical injury occurs. The reasons for blood leaking through the vessel wall are as follows: dermatological diseases, for example, chronic dermatosis or psoriasis; acquired pathologies of the circulatory system (DIC syndrome, hemorrhagic vasculitis or bleeding disorder, thrombocytopathy); congenital genetic pathology, for example, hemophilia. Hemorrhages of almost all types are closely associated with taking hormonal medications, depression or psychological stress.

Kinds

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

Depending on the location, types of hemorrhage can be:

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

Main symptoms of internal bleeding

How hemorrhages manifest depends on the location and type of bleeding. Although external bleeding is detected quite easily, internal bleeding is very often not felt. Internal bleeding can be detected by several specific symptoms, for example:

• to lower blood pressure;
• tachycardia;
• drowsiness and apathy;
• unnatural pale 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 different types of hemorrhages.

Hemorrhages at the injection site. What is this?

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

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

Causes of skin hemorrhages

Hemorrhages are a pathology that occurs on the skin due to blood leaking into the skin tissue through the walls of blood vessels or hemorrhage. They look like blood spots on the skin. Throughout 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 over time. Especially complications after injections.

Skin hemorrhages also include hematomas.

Subcutaneous hematomas form under 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 arise from any damage to blood vessels. There are three degrees of subcutaneous hematomas.

Signs of hematoma mild degree appear gradually, approximately after a day after receiving the injury, and at the same time it does not in any way affect the functioning of the organ on which it was formed. If there are painful sensations, they are mild. And also, if the resulting hematoma is not complicated, it will go away on its own without treatment. Hematoma formation medium degree occurs after three to four hours, and such a hematoma can partially disrupt the functioning of the organ on which it appeared.

Around such hematomas, soft tissue edema and slight swelling form. Cold should be applied to the hematoma and pressure bandage, and then seek help from a doctor. Serious injury can cause the formation of a severe hematoma, which will disrupt the functioning of organs. The hemorrhage forms quite quickly; within an hour you can already notice a blue spot that has appeared. Basically, this is a subcutaneous hematoma visible to the naked eye. After some time, such a hematoma may 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 to prescribe subsequent 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 ​​damage and how intense the bleeding is. Despite the fact that usually such small injuries resolve on their own, exceptions occur, which 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 severe consequences. In such cases, hemorrhages in the heart, brain and lungs are considered the most dangerous. Eye hemorrhages also occur.

Which specialist should I contact?

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

Carrying out diagnostics

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

First aid for bleeding

Previously, it was found that hemorrhages are bleeding from blood vessels due to their damage. Therefore, the first thing a person can do in case of mild hemorrhage is to apply cold to the injured area, which will reduce the intensity of bleeding. Follow-up care should be tailored to the type of hemorrhage. Venous bleeding is quite easily determined by the color of the blood, which will be burgundy or bright red, and by its continuous but slow flow. With such an injury, to carry out first aid, you need to apply a tourniquet 10-15 cm below the wound and a tight bandage. A mandatory point is the time stamp when the tourniquet was applied. For a small wound, wrap it with a bandage, since venous vessels may self-retract and fall off.

Arterial bleeding

Arterial bleeding differs from venous bleeding in that bright red blood will flow from the wound like a fountain. In this case, you need to immediately apply a tourniquet, because if the bleeding is not stopped, the person may die. In this case, the tourniquet is applied 10-15 cm above the wound, 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 so that blood circulates through the limb, otherwise toxins will accumulate in the stagnant blood, and after removing the tourniquet the 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 does not occur in a person with poor clotting. Then you need to bandage and treat the wound. Such bleeding can be stopped using modern hemostatic agents such as Hemostop and Celox. The powder granules help clot the blood, creating a jelly-like appearance, but this type of wound can be difficult to treat. Internal bleeding is one of the most severe ones, in which case it is necessary to consult a doctor. At the scene of the incident, you can only apply ice to the victim and immediately send him to the hospital or call an ambulance. Until the doctors arrive, the patient should be at rest and practically motionless.

How to get rid of hemorrhages?

Hemorrhages are treated after a thorough examination. When prescribing treatment and making a diagnosis, the doctor needs to take into account that some forms of hemorrhages lead to the development of complications. This is the reason why it is necessary to consult a doctor at every stage of treatment. If complications occur, inflammatory processes may begin, which can sometimes lead to fatal outcome. It is necessary to accurately determine the patient’s condition, the clinical form of hemorrhage and the tendency to complications in order to carry out correct treatment. For example, for minor injuries drug treatment not required. But if skin hemorrhage big size, then treatment is usually used with the application of “Troxevasin” or “Heparin” ointment to the injured area 2 times a day.

We looked at what hemorrhages are. The causes of their occurrence and treatment are also described.

Hemorrhagic syndrome is a violation of the hemostatic system - one of the main biological processes in the body. The main functions of this system are to preserve blood in a liquid state and stop internal bleeding when the vascular walls are damaged. When the integrity of the vessel is compromised, blood penetrates beyond its boundaries, and a specific red and bluish coloration appears on the skin. In the photo below, a patient with hemorrhagic syndrome looks as if part of his body is covered with bruises and red spots. Of particular danger are hemorrhages of the mucous membranes and internal bleeding.

The disease develops at any age. According to statistics, women are more susceptible to it than men. In the pathological course of pregnancy it occurs in newborns.

Treatment of the syndrome involves an integrated approach, which is based on therapeutic methods aimed at improving the blood clotting process. In some cases, when there is a risk of losing a large amount of blood, it is important to get immediate medical attention.

Reasons for the development of pathology

Hemorrhagic syndrome occurs due to disruption of complex hematopoietic processes.

In the presence of certain diseases, there is a high probability of formation of this syndrome. At risk are patients diagnosed with:

• hepatitis - inflammatory processes in the liver;
• cirrhosis of the liver, when the organ is not able to produce substances involved in the process of blood clotting;
• oncological neoplasms;
• infectious and viral diseases;
• hemorrhoidal syndrome;
• hemophilia - a condition of the body associated with a violation of the coagulation process (blood clotting);
• vasculitis – inflammation of blood vessels of an immunopathological nature;
• thrombocytopathy - with a sufficient platelet content, a violation of their functions is observed;
• thrombocytopenia – while platelet functions are preserved, their number decreases.

In medical practice, there have been cases when a change in the process of blood clotting occurs under the influence of certain medicines.

Often, hemorrhagic syndrome develops in newborns. It usually appears a few days after the baby is born. Among the factors influencing its formation are:

• long-term use expectant mother certain medications, the components of which are able to penetrate to the fetus through the placenta (anticonvulsants, antituberculosis drugs, antibiotics, anticoagulants, phenobarbital);
• birth of a child before the due date;
• fetal hypoxia;
• the mother has diseases that are at risk.

The causes of hemorrhagic syndrome are also hereditary and associated with gene mutation.

Classification and main features

In medical science, there are two forms of the syndrome:

• primary (congenital), due to a person’s genetic predisposition;
• secondary (acquired), arising due to damage to blood vessels of various types.

Depending on what part of the body the lesion is located and what caused it, several types of the disease are distinguished. Each of them has characteristic symptoms and features of the therapeutic technique.

Diagnostic tests

The main goal of diagnostics is to establish the cause of the disease, on the basis of which further treatment is prescribed. If a person has an acute form of the syndrome, it is necessary to first stop the bleeding and stabilize the condition.

Main diagnostic method if hemorrhagic bleeding is suspected, lab tests: a detailed blood test and urine test that allows you to see the whole picture. Important has a platelet count in peripheral blood. Additional examination methods include simple coagulation tests and sternal puncture.
When making a diagnosis, the duration of bleeding, as well as the nature of blood clotting, are taken into account.

Therapeutic measures

Treatment of hemorrhagic syndrome in adults depends on several factors:

• causes of the disease;
• stages of development;
• the nature of the course and severity of the disease.

Urgent Care

In the acute form of hemorrhagic syndrome, emergency care may be needed. It is important to stop the source of damage. For this purpose, the following therapeutic methods are used:

• conservative hemostatic therapy;
• cryotherapy;
• laser barotherapy;
• surgical intervention.

Drugs

When first aid is provided and the bleeding is stopped, the patient is prescribed drugs that have a positive effect on the coagulation process. Modern pharmaceuticals have a large number of drugs that improve blood clotting.

In cases of significant blood loss, replacement treatment, involving the administration of plasma, is necessary. The use of heparin and prednisolone is possible.

If hemorrhagic syndrome occurs against the background of any diseases, treatment has characteristics. Therapeutic measures are aimed not only at stopping the pathological focus, but also at eliminating the concomitant illness.
For some diseases, it cannot be guaranteed that treatment will be highly effective. For example, with a congenital type of hemophilia, it is necessary to take hormonal drugs, the action of which is aimed at normalizing the blood circulation process. Patients must be under close medical supervision and follow all his recommendations.

Home Recipes

Facilities traditional medicine can't replace drug therapy. However, their use has a positive effect on the condition of the walls of blood vessels. Only an integrated approach that combines all types of therapy can have the desired effect. Useful for hemorrhagic syndrome are green varieties of apples, cherries, red grapes, raspberries, strawberries, currants, sea buckthorn, red pepper, rowan, rose hips, buckwheat, yarrow.

They have a whole complex of vitamins and nutrients that strengthen blood vessels and increase blood clotting.

Despite all the effectiveness of medicines, as well as mixtures and decoctions prepared according to folk recipes, it is necessary to exclude those components that are allergens. Carefully read the instructions for contraindications and side effects. If the body is individually intolerant to the components of the drug, its use is excluded.

Hemorrhagic vasculitis is considered a disease that is a type of immune vasculitis of small vessels and is characterized by increased formation of immune complexes and increased permeability of vascular walls.

This pathology can develop 2-3 weeks after acute tonsillitis, flu or scarlet fever. Hemorrhagic vasculitis is more common in children than in adults.

Children aged 4 to 12 years are especially susceptible to the disease. Boys get sick 2 times more often than girls.

Causes

Why does hemorrhagic vasculitis occur, and what is it? Hemorrhagic vasculitis is also called Henoch-Schönlein disease or capillary toxicosis. The disease is an aseptic (without infection) inflammation of the capillaries caused by the damaging effects of immune complexes. Capillary toxicosis manifests itself as hemorrhages (hemorrhages), impaired intravascular coagulation and impaired blood circulation in small blood vessels.

The principle of the mechanism of development of hemorrhagic vasculitis is the formation of immune complexes. During circulation through the blood, these complexes can be deposited on the internal surfaces of the walls of small vessels and thereby cause damage with subsequent aseptic inflammation.

When the vascular wall becomes inflamed, its elasticity decreases. As a result, it becomes permeable and forms gaps, which leads to fibrin deposits and blood clots. Based on this, pathological sign vasculitis - microthrombosis and hemorrhagic syndrome (bruising).

Classification

Depending on the clinical variant currents hemorrhagic vasculitis occurs:

• skin;
• articular;
• abdominal (that is, from the stomach);
• renal;
• combined. Any combinations are possible. The most common variant is the skin-articular variant, which is otherwise called simple.

Depending on the flow option the disease may be:

• lightning fast (within several days);
• acute (up to 30-40 days);
• protracted (for 2 months or more);
• recurrent (recurrence of signs of the disease 3-4 times or more over several years);
• chronic (clinical symptoms persist for more than 1.5 years or more) with frequent or rare exacerbations.

Activity level diseases:

• small;
• average;
• high.

Clinical manifestations

Frequency of the main clinical manifestations of hemorrhagic vasculitis in children and adults:

• spotty rashes on the skin (skin hemorrhagic rash) - 100%;
• articular syndrome (pain in ankle joints) - 70%;
• abdominal syndrome (abdominal pain) - 60%;
• kidney damage - 30-35%;

This disease can affect blood vessels in any area, including the kidneys, lungs, eyes, and brain. Hemorrhagic vasculitis without damage to internal organs is the most favorable disease of this entire group.

Symptoms of hemorrhagic vasculitis

In the case of hemorrhagic vasculitis, the symptoms are very varied, but all patients experience skin lesions. It can manifest itself at the very beginning of the disease, or after the appearance of other symptoms. The most typical appearance is purpura - small-spotted (1-3 mm) hemorrhages that are palpable. This rash is symmetrical and is initially located on the feet and legs; later it can spread higher. In addition to purpura, other elements of the rash may also appear (vesicles, petechiae, erythema and even areas of necrosis).

In 70% of patients, symptoms of hemorrhagic vasculitis such as damage to the articular surfaces are detected. This symptom often occurs along with rashes in the first week of the disease. Damage to joints can be minor and cause short-term pain, but it can also be more extensive, when not only large (ankle and knee) but also small articular surfaces are affected. Swelling occurs and the shape of the articular surface changes, and pain can last from 2 hours to 5 days. However, the disease does not cause severe deformation of the articular surfaces.

Damage to the gastrointestinal tract is the most severe. Sometimes abdominal pain appears even before the rash. They occur when hemorrhages appear on the intestinal wall and are cramping in nature. Often such pain occurs in the navel area, in the right iliac, hypochondrium region and resembles the picture acute abdomen caused by appendicitis, intestinal obstruction or perforated ulcer. The pain lasts mostly for three days. But sometimes up to ten days. They are often accompanied by nausea and bloody vomiting, as well as the appearance of blood in the stool. In some cases it develops intestinal bleeding, which is accompanied sharp decline blood pressure and collapse.

More rare signs of vasculitis include kidney damage in the form of glomerulonephritis and pulmonary syndrome, which is manifested by cough and shortness of breath.

Differences in symptoms between children and adults

In adults:

• The onset of the disease is delayed, the symptoms are milder.
• Abdominal syndrome occurs in only 50% of patients and is rarely accompanied by nausea and vomiting.
• Kidney damage leads to the development of chronic diffuse glomerulonephritis, with the formation of chronic renal failure.

In children:

• More than 30% of children develop fever.
• Characteristic is the acute onset and course of the disease.
• Abdominal syndrome is accompanied loose stools streaked with blood.
• Often the kidneys are involved in the process from the very beginning, with hematuria and proteinuria detected in urine tests.

Hemorrhagic vasculitis: photo

What does hemorrhagic vasculitis look like on the legs, we offer you to view detailed photos symptoms.

Complications

TO possible complications hemorrhagic vasculitis includes:

• intestinal obstruction;
• perforation of stomach and intestinal ulcers;
• peritonitis;
• posthemorrhagic anemia;
• DIC syndrome with thrombocytopenia;
• thrombosis and heart attacks in organs;
• cerebral disorders, neuritis.

Complications with hemorrhagic vasculitis occur only in cases of untimely treatment, so it is very important to start treatment as quickly as possible. It is known that any disease is much easier to treat at the beginning of its development. Self-medication, uncontrolled use of medications or traditional medicine will lead to a deterioration in the patient’s condition.

Diagnostics

If hemorrhagic vasculitis is suspected, the doctor examines the patient, collects anamnesis, prescribes laboratory and diagnostic examinations that will help you compose full picture illness and prescribe appropriate treatment.

Main diagnostic methods The following examinations are considered hemorrhagic vasculitis:

1. Coagulogram.
2. Detection of circulating immune complexes (CIC).
3. Determination of immunoglobulins of classes A (increased) and G (decreased), cryoglobulins and components of the complement system.
4. Biochemical analysis ( protein fractions, CRP, antistreptolysin O, seromucoid).
5. General (detailed) blood test with counting absolute values leukocyte formula indicators.

   Treatment of hemorrhagic vasculitis

   Mild manifestations of skin syndrome may require outpatient (but bed!) rest with mandatory adherence to a special diet (exclusion of meat, fish, eggs, obligate allergens, new products) and the prescription of drug treatment. However, the acute period requires hospitalization, constant medical supervision, and in the case of involvement of internal organs in the pathological process, the use of a large number of medications prescribed according to special regimens and in certain dosages.

   The nature of treatment for hemorrhagic vasculitis varies depending on the phase of the disease:

   • debut, relapse, period of remission;
   • clinical form- simple (skin), mixed, with kidney damage;
   • severity of clinical manifestations - mild (satisfactory health, mild rashes, possible joint pain), moderate (multiple rashes, joint pain or arthritis, periodic pain in the abdomen, traces of blood or protein in the urine), severe (drainage rashes, elements of necrosis, recurrent angioedema, persistent abdominal pain, gastrointestinal bleeding, blood in urine, nephrotic syndrome, acute renal failure);
   • nature of the course of the disease - acute (up to 2 months), prolonged (up to 6 months), chronic (recurrent or development of Schönlein-Henoch nephritis).

   The drug treatment regimen includes:

   1. Disaggregants - chimes 2-4 milligrams/kilogram per day, trental intravenous drip.
   2. Heparin at a dosage of 200-700 units per kilogram of body weight per day subcutaneously or intravenously 4 times a day, gradually withdrawn with a decrease in the single dose.
   3. Activators of fibrinolysis - nicotinic acid.
   4. At severe course plasmapheresis or glucocorticosteroid therapy is prescribed.
   5. In exceptional cases, cytostatics such as Azathioprine or Cyclophosphamide are used.

   The duration of treatment for hemorrhagic vasculitis in children and adults depends on the severity of the disease and its clinical form. Usually it takes 2-3 months for mild cases, 4-6 months for moderate cases and up to a year for severe cases Henoch-Schönlein disease, accompanied by relapses and nephritis.

   Therapy of patients hemorrhagic vasculitis complicated by the fact that there are currently no drugs that effectively suppress the underlying pathological process, regardless of its location. It is necessary to exclude exposure to known active antigenic influences, especially those that chronologically coincided with clinical manifestations diseases.

   

   Diet

   It is very important during treatment to prevent additional sensitization of the patient. Therefore, it is necessary to follow a diet that excludes extractives, chocolate, coffee, citrus fruits, strawberries, eggs, industrial canned food, as well as foods that are poorly tolerated by the patient.

   Special diets are additionally prescribed for severe abdominal or renal syndromes. Thus, for severe nephritis, it is recommended to follow diet No. 7 without salt and meat.

   Which doctor should I contact?

   Hemorrhagic vasculitis in children and adults is treated by a rheumatologist. In case of defeat various organs consultation with specialized specialists is necessary: ​​dermatologist (skin), gastroenetrologist (intestines), neurologist (brain), nephrologist (kidneys), cardiologist (heart), pulmonologist (lungs). It is advisable to see an immunologist for timely diagnosis complications after taking medications.

   Forecast

   With hemorrhagic vasculitis, the prognosis is quite favorable. IN in rare cases death can occur in the acute phase of the disease due to complications from the gastrointestinal tract (bleeding, intussusception, intestinal infarction). Fatal outcome may also be a consequence of acute renal failure or damage to the central nervous system.

   Some patients with hemorrhagic vasculitis may develop chronic kidney disease. In approximately 25% of patients with kidney damage in the acute phase of the disease, changes in urine sediment persist for a number of years; the final outcome of the disease in such patients is unknown.