The most feared thing for the elderly is stroke. If you have a stroke, it basically means that you can only stay in bed for the rest of your life. Cerebral hemorrhage is a type of stroke, which is a dangerous condition and has a poor prognosis, which not only causes physical and mental harm to patients and their families, but also brings them a huge financial burden.
Now let's talk about a patient with poor compliance, 67-year-old Uncle Liang, who is a hypertensive patient who usually does not pay attention to blood pressure control. He was presented 2 months ago with sudden slurred speech and weakness in his right limb. Based on his clinical symptoms and examination, he was hospitalized and diagnosed with cerebral infarction, and after active treatment, the patient recovered well and was allowed to be discharged.
Only more than a month later, the patient was sent to the hospital again, his son said that the patient had weakness in the right limb again, and the medicine was useless, the symptoms were getting worse and worse, and there was a headache.
On physical examination, it was found that the patient was not fluent in speech, the muscle strength of the right limb was grade 3, the muscle tone was not high, the pain was reduced, the pathological signs were positive, and the patient was preliminarily judged to have a second stroke.
Clinically, cerebral hemorrhage after cerebral infarction is very dangerous, especially the interval between the two episodes of the patient is only two months, this will happen, mainly related to cerebral thrombosis migration, large-scale cerebral infarction and collateral circulation.
In order to further understand the patient's condition, his blood pressure was measured: 168/90mmHg. The rest of the relevant examinations showed no obvious abnormalities, and the corresponding treatment plan was formulated, mainly to nourish brain cells, dehydration, reduce intracranial pressure, balance of water and electrolytes, control blood pressure, lower lipids, and stabilize spots.
The patient's disease progression has a lot to do with his poor compliance. Hypertension and smoking are independent risk factors for cerebral infarction and cerebral hemorrhage. Before the second onset of the disease, the patient's awareness of blood pressure control was weak, the medication was irregular, and the smoking was not completely stopped, and the superposition of risk factors induced the occurrence of cerebral hemorrhage.
Subsequently, according to the patient's condition, the treatment plan was adjusted accordingly, and the patient was successfully discharged after half a month. His condition was dangerous, and the treatment went relatively smoothly, thanks in large part to his family's keen senses and quick transport to the hospital for treatment.
Cerebral hemorrhage is a serious threat to the lives of patients, and has the characteristics of "three highs" in morbidity, disability and recurrence. Next, we will start from the mechanism of cerebral hemorrhage and discuss how to prevent and detect cerebral hemorrhage early.
1. Why does cerebral hemorrhage occur?
A study in the United States showed that hypertension is a major factor in the development of spontaneous intracerebral hemorrhage. The human brain has a rich blood supply and nerve distribution, and the sufficient supply of blood (oxygen) nourishes the nerves and ensures the normal function of the human brain.
However, if the cerebral arterioles are stimulated by high blood pressure for a long time. is prone to lipid hyal-like denaturation. If this happens, fibroblasts in the lining of the blood vessels proliferate and a large number of macrophages accumulate. These cells, in turn, replace vascular smooth muscle cells, resulting in narrowing and decreased compliance, eventually leading to dilation, necrosis, and the formation of microscopic aneurysms.
Also, some tiny blood vessels emerge suddenly from the large arteries at the base of the skull, and these blood vessels are often difficult to withstand sudden increases in blood pressure and, if they occur, are prone to rupture. These blood vessels are also the ones that are most likely to rupture first when a patient is agitated or traumatic to the brain.
In addition to triggering the disease, high blood pressure can also exacerbate the condition. In the early stage of the disease, hypertension can re-enlarge the hematoma formed in the brain, which further leads to the mass destruction of other brain tissues, and secondary damage, such as cerebral edema, increased intracranial pressure, and abnormalities in the coagulation fibrinolytic system, resulting in degeneration and necrosis of the brain tissue around the hemorrhage.
The inflammatory response is also an important factor in the development of the disease. At present, it is believed that the main pathological changes in the cerebral blood vessels of patients with hypertensive intracerebral hemorrhage are the degeneration of cerebral vascular smooth muscle. In this process, the destruction of astrocytes plays an important role. The inflammatory response can lead to cell destruction and apoptosis.
These cells regulate the integrity of small blood vessels and vascular smooth muscle in the brain, and when they are destroyed, reduce the differentiation of vascular smooth muscle cells. Vascular smooth muscle has a strong ability to contract and relax, and can be adjusted accordingly in the face of large fluctuations in blood pressure, so that the blood vessels cannot withstand large changes in blood pressure and rupture. When vascular smooth muscle cell differentiation is affected, it is naturally easy to induce intracerebral hemorrhage.
The disease is a serious condition and can have more serious sequelae, such as speech and communication disorders, hemiplegia, and cognitive dysfunction. This not only costs a lot of money on diagnosis and treatment, but also severely limits the patient's ability to take care of himself and reduces his or her sense of well-being. Effective disease prevention is important for people who have not yet developed the disease. So how do you do that?
2. How to prevent cerebral hemorrhage in daily life?
To prevent the disease, it is necessary to mitigate the impact of the risk factors associated with the development of the disease.
The most important thing is to control your blood pressure levels. The stimulation of long-term high blood pressure levels, coupled with the inducement of daily strenuous activities, mental stress and overwork, the body's cerebral blood vessels will become extremely fragile. When the pressure in the blood vessels exceeds the volume of the small and medium-sized intracranial blood vessels, it can lead to the rupture of the blood vessels, which can cause morbidity.
To control your blood pressure, you need to reduce sodium intake in your daily life. Eat less salt, which is a routine way for many people to reduce their sodium intake. In addition to reducing salt intake, it is more important to prevent the accidental consumption of sodium-rich foods such as bread, vegetables such as chrysanthemum and fennel, and dipping sauces such as tomato paste.
In addition to diet management, unhealthy lifestyles such as smoking, overwork, emotional agitation, and alcohol consumption can affect blood pressure levels in the body, and these should also be managed. It is worth noting that for patients with high blood pressure, dietary control and correction of unhealthy lifestyle are important auxiliary effects, and they should remember to take medication on time and quantitatively every day.
There is also the need to prevent overdose. In clinical practice, most cardiovascular and cerebrovascular diseases are related to atherosclerosis of arteries and the formation of lipid plaques. To prevent this, the risk of thrombosis is usually reduced by taking some anticoagulants or antiplatelet drugs, such as aspirin tablets.
But studies have found that long-term overdose of these drugs can increase the risk of intracerebral hemorrhage. Because doing so will lead to a decrease in coagulation function, which will increase the permeability of capillaries, which will eventually lead to the development of disease.
It is also necessary to have regular medical check-ups. The disease can also be caused by coagulation abnormalities caused by long-term use of anticoagulant drugs and ruptured aneurysms due to high blood pressure.
Studies have shown that about 3.5-7% of people aged 35-75 have aneurysms in their brains. These two groups are relatively large in number and usually have no symptoms, so they need to be screened through physical examination to predict the risk of disease.
Avoiding risk factors as much as possible is of positive significance in reducing the risk of developing the disease. In addition to disease prevention, early identification of the early occurrence of the disease is also very important for the high-risk groups of the disease. What are the signs of cerebral hemorrhage?
3. Before cerebral hemorrhage occurs, there are these 6 precursors, so you must pay attention!
- The first: headaches
When the blood pressure in the brain increases, it causes the brain tissue to be stretched accordingly, resulting in a painful sensation. This symptom may be a dull ache at the beginning of the episode and not noticeable. However, if you feel that the pain is aggravated, or even evolves into a severe headache, or is accompanied by a crisis such as vomiting and coma, it is more likely to indicate the occurrence of the disease, and it is important to seek medical attention as soon as possible.
- Second: neurological dysfunction
These symptoms can range from facial muscle weakness to speech or numbness on one side of the body. The abundant distribution of nerves ensures that the brain center can send accurate instructions, and the human body can act accordingly.
However, after the rupture and hemorrhage of blood vessels in the brain, the hematoma formed by it and the consequent mass effect will lead to the formation of a "penumbra" in the area around the hematoma, causing ischemic brain injury changes. If there is a lack of blood (oxygen) supply to the surrounding tissues, nerves can be damaged. The symptoms are more severe, and if the disease is not treated in time, it can even lead to sequelae and even hemiplegia.
- The third: impaired consciousness
When a blood vessel ruptures in the brain, it can lead to increased intracranial pressure, which can lead to cerebral edema. Cerebral edema is also one of the important mechanisms leading to structural and functional damage to the human nervous system. The components of the hematoma itself and the active substances it produces, such as thrombin, red blood cells, hemoglobin, etc., have a certain degree of neurotoxicity.
The longer the time drags on, the greater the nerve damage and the more likely it is to develop impaired consciousness, which usually manifests as coma and inability to communicate normally. This condition can also induce signs of shock such as irregular breathing and decreased blood pressure, which poses a great threat to the patient's life. Once the symptoms appear, it is important to seek medical attention in time to avoid delaying the best time for treatment.
- Fourth: vomiting
After the disease occurs, the pressure in the brain also increases, and this increase in pressure also stimulates the vomiting center, leading to the development of this symptom. In addition, rupture of blood vessels can cause damage to the brainstem or traction of brain tissue that irritates the vomiting center, causing symptoms.
- Fifth: darkness in front of the eyes
This sensation is usually transient, such as a sudden feeling of blurring or re-darkening of the eyes. This is mostly due to the lack of blood in the blood vessels after bleeding to meet the blood (oxygen) needs of other tissues.
- Sixth: always yawning, drowsiness
This usually happens due to a mild lack of oxygen to the brain. After the occurrence of the disease, the tissues around the lesion will be relatively hypoxic, which will lead to a decrease in the excitability of brain nerve cells, and it is easy to yawn from time to time or want to sleep.
Uncle Liang in the article received timely treatment for both illnesses, largely because he and his family sensitively sensed the signs that something was wrong with their bodies and went to the hospital for treatment in time. If you really have to wait until a crisis such as impaired consciousness occurs before going to the hospital, your condition will be much more dangerous.
In our daily lives, we should take active measures to reduce our own risk of developing diseases, and we should also identify the precursors of diseases as early as possible and seek medical treatment as soon as possible.
Bibliography:
Stroke and Neurological Diseases,2020,27(1):96-99.
Chinese Journal of Geriatric Cardiovascular and Cerebrovascular Diseases,2015,17(2):214215.
Medical Review,2017,23(12):2380-2384.