Ischemic and haemorrhagic stroke: pathomorphology,diagnosis, treatment and prevention
Purpose of the work - analyze the bases of the pathomorphology of ischemic and haemorrhagic stroke, as well as the principles of diagnosis, prophylaxis and treatment that will prevent the secondary development of the corresponding pathologies. The analysis is done on the basis of articles review and research of 2010-2017, using the databases Pubmed, eLIBRARY.RU, Web of Science. According to the latest data, 16 million people suffer from brain disorders annually, 6 million of them die. Mostly, low- and medium-income countries are vulnerable to strokes. In Ukraine, this problem has been underestimated for a long time in comparison with the developed world's countries, where the prevention and control of the effects of acute cerebrovascular diseases have long been recognized as the most important tasks of modern medicine. A few decades ago, the proportion of patients under 60 among the patients with a diagnosed stroke made up not more than 20%; today, this figure increased to 35%, and in some regions of Ukraine - up to 40. The mortality rate reaches 40 % during a month and 54% during a year, but half of the deaths occur in the first two days. The onset of the ischemic stroke, which may cause thrombosis, thromboembolism or obliteration with an atherosclerotic plaque, is very common. In 60% of cases, a stroke or cerebral infarction is a consequence of atherosclerosis. Mostly, the localization site is the middle cerebral artery circulation. The infarction is characterized, first of all, by ischemic changes of nerve cells and glia, the vessels are most resistant to ischemia. The changes by hyperchromic type, accompanied by pycnosis and destruction of cellular elements, are most typical for neurons. Then the process extends to glia. A haemorrhagic stroke, as opposed to the ischemic one, occurs in the setting of a high blood pressure. Arterial hypertension leads to the change in the permeability of vessel walls, the occurrence of plasmorrhagia, necroses and microaneurysms, which develop, and, as a result, hemorrhage. The localization site is associated with the peculiarities of the angioarchitectonics - basal ganglia and the optic nerve. A cavity, filled with blood, may be formed, or a swelling of the brain matter, which gradually increases up to the formation of a gliomezodermal scar or a cyst, may occur. It is important to timely diagnose this type of pathology. The diagnosis is based on a clinical picture, anamnesis, cerebrospinal fluid analysis and instrumental methods of examination. Urgent hospitalization of patients is necessary. In case of an ischemic stroke, the treatment is aimed at increasing blood flow to the brain, and in case of haemorrhagic stroke - at reducing blood pressure, eliminating cerebral edema and increasing the blood-clotting abilities. In case of prevention of cerebrovascular diseases, the correction of risk factors is of great importance. Thus, the pathologic picture of stroke`s different types is quite diverse. Lesions of nerve cells and glia are presented in ischemia. Damage of the vessels walls, which leads to hemorrhages with necrosis of the tissues, is inherent while hemorrhagic stroke. Using of precisely modern instrumental methods of research is fundamental in the diagnosis of cerebrovascular diseases. Timely prophylaxis of cardiovascular diseases and correction of risk factors prevents the occurrence of stroke.
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