Cerebrovascular disease is one of the first causes of hospital admission. Although it occurs at any age, its incidence increases after 55 years.
The concept of cerebrovascular disease or stroke refers to any disorder in which an area of the brain is affected suddenly, temporarily or permanently, due to a cerebral blood flow disorder that causes ischemia and / or hemorrhage in the central nervous system (CNS).
The stroke can be divided into two groups according to their nature: ischemic stroke or cerebral infarction (80%) and hemorrhagic stroke, or cerebral hemorrhage (20%). Ischemia is generated when there is a total or partial decrease in cerebral blood supply, depending on the duration of the partial ischemic process, it will present as a transient ischemic attack (TIA) if the ischemic deficit reverts in less than 24 hours, otherwise it will be in the presence of a cerebral infarction.
The hemorrhagic stroke, can be a subarachnoid hemorrhage (SAH) (25%) or intraparenchymal or intracerebral hemorrhage (ICH) (cerebral hemorrhage itself) (75%). The brain hemorrhage is a collection of blood within the brain parenchyma (functional tissue of the brain).
Depending on the origin of the bleeding, it is classified as primary or secondary. Primary cerebral hemorrhages are the most frequent and are produced by the rupture of any vessel in the vascular network of the brain, whose wall is weakened by diseases such as high blood pressure or myeloid angiopathy.
The brain hemorrhages secondary generated by abnormal vessel rupture congenitally, or newly formed wall changes by coagulation disorders; they are associated with processes such as tumors, arterial and venous malformations, drug abuse or bleeding in the middle of an ischemia.
Causes of brain hemorrhage
The most common causes of brain hemorrhage are:
· Chronic arterial hypertension is the most important cause for the development of cerebral hemorrhage in all age groups and sex, both systolic and diastolic, being present in 60% of cases of hemorrhagic stroke.
· Disseminated intravascular coagulation.
· Anticoagulants and fibrinolytics.
· Head trauma
· Vascular malformations: aneurysms, venous angiomas and others.
· Primary or metastatic tumors.
· Multiple myeloma.
· Cerebral amyloid angiopathy, is a degenerative process that affects small arteries and arterioles located in the leptomeninges and the cerebral cortex, it is the first cause of lobar hemorrhage in the elderly.
· Venous infarcts and ischemic infarcts with hemorrhagic transformation.
· Other less common causes are CNS infections and vasculitis.
· Drugs like cocaine, amphetamines, and crack; and alcohol.
The clinical manifestations of cerebral hemorrhage can be divided into: general symptoms, focal neurological dysfunction dependent on the location of the hematoma and the effect it induces, and intra- and extra- cerebral symptoms that can be associated with ICH.
The cerebral hemorrhage usually occurs during physical activity, throughout the morning, a fact that is related to the rate of blood pressure.
· Decreased level of consciousness is generated in 42-78% of people who suffer from HCI.
· Headache or headache occurs in 50% of cerebral hemorrhages, is of great intensity and of long duration (with an average of 58h). It starts suddenly and is throbbing, and is more common in women.
· Vomiting is common in all types of strokes.
· Epileptic seizures occur in 5-15%, in some cases the initial manifestation of a cerebral hemorrhage is status epilepticus.
· Myocardial injuries and cardiac arrhythmias.
· Fever, sometimes related to the volume of the hematoma.
· Stiffness in the neck may occur.
The treatment of people with cerebral hemorrhage is fundamentally medical and is based on the maintenance of life support, neurological monitoring, maintenance of homeostasis and prevention of complications, with the fundamental objective of preventing the size of the hemorrhage from increasing. All patients with ICH must be cared for in a health center that has a neurologist, neurosurgeon, computed tomography and an intensive care unit.
· Life support and oxygen saturation: oxygen therapy is administered through a mask to maintain oxygen saturation. Early intubation is recommended in cases of large volume ICH that is accompanied by a low level of consciousness.
· Neurological monitoring: the level of consciousness and neurological deficit should be evaluated periodically.
· Blood pressure: treatment is recommended when systolic blood pressure is greater than 180 mmHg.
· Glycemia: it should be controlled avoiding hyperglycemia and hypoglycemia, in case of presenting, correct hyperglycemia with insulin or with glucose serum in case of hypoglycemia.
· Temperature: fever over 37.5 ° C should be treated with paracetamol.
· Management of hemostasis: people with deficiency of clotting factors or thrombocytopenia should receive platelets or the factors that have decreased. Those receiving anticoagulant treatment should receive vitamin K. In addition, people receiving thrombolytic treatment should undergo transfusions of fresh plasma and platelets.
· Intermittent mechanical pressure should be applied to avoid venous thrombosis and pulmonary embolism.
· In the presence of seizures, antiepileptic drugs should be administered.
· Ventricular drainage is recommended in patients with hydrocephalus.
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