Insult cerebral - acute disturbance of a cerebral circulation.
Etiology, pathogenesis. In most cases insults are complication of an idiopathic hypertensia and an atherosclerosis, less often they are caused by illnesses of the valval apparatus of heart, a myocardial infarction, congenital anomalies of vessels of a brain, hemorrhagic syndromes and arterites. Approximately in 90 % of patients with an insult find out those or other forms of a lesion of heart with signs of a cardiovascular failure. Exception some variants of hemorrhagic insults, for example at break make only aneurysms at people of young age.
Signs, current. Acute lesions of vessels of a brain section into five groups: transient disturbances of a cerebral circulation, an infarct of a brain, a vascular embolism of a brain, a hematencephalon, a subarachnoidal hemorrhage.
Transient disturbances of a cerebral circulation - it is is acute arising circulatory disturbances at which focal and general cerebral signs keep no more than 24 hours. Their immediate cause is the microembolism clumps of crystals of a cholesterin, fragments of plaques or conglomerates of thrombocytes. The microemboluses brought by a current of a blood in fine vessels of a brain, cause a regional spastic stricture.
The infarct of a brain (a clottage on old classifications) is characterized by presence in the anamnesis of full-transistorized ischemic attacks, gradual (within several hours) formation of focal signs, safety of consciousness, absence or a small expression of the general cerebral signs, absence of a blood in a cerebrospinal liquid.
The vascular embolism of a brain is characterized by development of an insult, quite often loss of consciousness and presence in the majority of patients of the rheumatic mitral illness, less often than recently transferred myocardial infarction. " The paradoxical embolism " - an insult at congenital not the fusion of the interatrial septum causing hit in cerebral vessels of emboluses from thrombosed veins of the bottom extremities. The infarct arising owing to an embolism of a cerebral vessel, can wear both ischemic, and hemorrhagic character and widely varies in sizes.
The hematencephalon in typical cases is characterized by occurrence of focal signs, development of a coma and an impurity of a blood to a cerebrospinal liquid. As a rule, the hematencephalon arises at the patients, suffering an arterial hypertensia; the isolated atherosclerosis without the raised arterial pressure - the rare reason of a hemorrhage. As the indicator of similar complication occurrence in the patient serves in a coma of oculomotor frustration (a strabismus, a ptosis, a mydriasis). The hemorrhage in a cerebellum can cause a prelum of an oblong brain due to shift of tonsils of a cerebellum in the big occipital aperture.
The subarachnoidal hemorrhage is usual (80 % of cases) are caused as break intracranial an aneurysm, as a rule, localized in the field of an arterial circle of the big brain, less often their reason the idiopathic hypertensia, hemorrhagic syndromes serve.