Causes of cerebral hemorrhage in newborns. Consequences of intracerebral hemorrhage in newborns Treatment of extensive cerebral hemorrhage in children

Hemorrhage in the brain general definition all intracranial hemorrhages. Dangerous damage to the tissues and organs of the child, a further violation of their functionality.

information Cerebral hemorrhage is more common if the baby is not full-term and was born weighing less than 1500 g. For example, the probability intracranial hemorrhage in a child born at term, it reaches 0.0001, against 50% in a premature one.

Classification of hemorrhages

According to the World Health Organization (WHO), hemorrhages are divided into four types: intracerebral, subarachnoid, subdural, intraventricular. However, it is also customary to classify them by location:

1. epidural. They are a consequence of fractures and. In infants, it may be a consequence of malformations of the skull. Blood enters between the cranium and the meninges.
2. intracerebral. The effusion of blood into the brain tissue. In this case, the part of the brain damaged by the effusion ceases to function, which is accompanied by the corresponding symptoms.
3. Intraventricular. Blood enters the cavities of the ventricles. The consequences of such a hemorrhage are: inability to suck, swallow, hydrocephalic syndrome, inhibition of tendon reflexes.
4. Subarachnoid. Occur when the vessels or connecting veins in the subarachnoid space, veins in the choroid plexuses of the pia mater are damaged. Blood enters between the inner and middle membranes of the brain.
5. Subdural. Blood is poured between the meninges, namely under the hard shell of the brain. Appear as a result of difficult or first childbirth, the large weight of the baby. The following symptoms are characteristic of subdural hemorrhage: hypertension, retinal hemorrhage and quickly.

The reasons

The most common cause of cerebral hemorrhage in newborns is prematurity. Babies born before 32 weeks of age are most at risk; for them, from the third to the seventh day from birth, an ultrasound examination of the head is done to find symptoms of the disease. With each subsequent week of bearing a child, the risk of hemorrhage decreases. The risk of getting a hemorrhage is high in the first seven days after birth, then the child is almost never in danger.

Often hemorrhages in the brain occur due to toxicosis in the second half of pregnancy, medical errors during childbirth, and infections. It happens that one child has two at once different types hemorrhages in the brain.

Symptoms of a cerebral hemorrhage in a child

For all types of cerebral hemorrhage, the first symptoms are approximately the same:

• convulsions;
• detachment of consciousness (the child is lethargic, inactive);
• vomit;

important All of these symptoms occur suddenly, most often when the child is awake. Each of their manifestations helps doctors judge the location of the hemorrhage, so you should carefully monitor and remember the condition of the child.

Symptoms of hemorrhage in the deep sections:

• respiratory failure;
• lack of pupillary response to light;
• vomit;
• deep coma;
• steady gaze deviation (often towards the damaged part of the head);
• hypothermia;
• sudden hemiplegia (impaired limb function on one side);
• bradycardia.

Symptoms of outflow of blood into the gray and white matter:

• violation of coordination and orientation in space;
• mental disorders (excessive agitation, slowness);
• convulsions;
• hemiplegia, accompanied by muscle weakness;
• foot syndromes in pathology (reflex extension thumb, reflex flexion of the II-V fingers with a light blow to them).

Symptoms of hemorrhage in the cerebellum:

• pain in the occipital region of the head;
• dizziness, persistent or recurring vomiting;
• miosis (narrowing of the pupils);
• disturbance of consciousness;
• a steady tilt of the head back or to the side;
• steady gaze deviation (often away from the injured part of the head);
• ataxia (impaired coordination of movements).

important The consequences of a cerebral hemorrhage can have different manifestations, so it cannot be diagnosed only on a symptom map, the doctor is always obliged to do an x-ray of the head, echoencephaloscopy, MRI (magnetic resonance imaging) or spinal puncture.

Treatment

Cerebral hemorrhage in newborns has certain standards of treatment, but it is complicated by many factors. Such diseases require special management, different from the management of hemorrhages in older children, and even more so in adults.

Most effective method is surgery , which consists in removing the resulting hematoma. Subsequent drug therapy is aimed at treating the symptoms of the disease and reducing the risk of recurrence of vascular ruptures. With a timely start proper treatment there are chances that a cerebral hemorrhage will pass without consequences over time.

Prevention of cerebral hemorrhage in the newborn

It is impossible to name a single remedy for cerebral hemorrhage in newborns. But there are two main methods of prevention:

1. Taking antenatal corticosteroids before preterm birth improves lung development, which helps blood vessels withstand stress in the first years of life.
2. Taking indomethacin newborns, which also helps the vessels at first. Thanks to this drug, they narrow and more easily tolerate pressure drops.

Ischemia-hypoxia, changes in blood pressure and pressure. The presence of the germinal matrix makes bleeding more likely. The risk is also increased in hematological disorders (eg, vitamin K deficiency, hemophilia, DIC).

Subarachnoid hemorrhage is probably the most frequent type intracranial hemorrhage. These newborns are characterized by apnea, seizures, lethargy, or unusual findings neurological examination. Large bleeding associated with meningeal inflammation can lead to hydrocephalus as the infant grows.

Subdural hemorrhage, now less common due to improvements in obstetric techniques, results from bleeding into the falciform space, tentorium, or commissure. Such bleeding tends to occur in newborns of nulliparous mothers, in large newborns, or after a complicated birth, conditions that can produce unusual pressure on the intracranial vessels. Symptoms may present with seizures; rapid head enlargement or abnormal findings on a neurological exam.

Intraventricular and/or intraparenchymal hemorrhages are the most serious type of intracranial bleeding. They are often bilateral and usually develop in the germinal matrix. Hypoxia - ischemia damages the capillary endothelium, reduces cerebral vascular autoregulation, and can increase cerebral blood flow and venous pressure, which make bleeding more likely. In most cases, intraventricular hemorrhages are asymptomatic.

Risk: in premature newborns, the risk of intracerebral hemorrhage and its severity are directly proportional to the degree of immaturity:

• 25 weeks gestation - 50% risk.
• 26 weeks - 38%.
• 28 weeks - 20%.
• Statistics vary, sometimes significantly, between clinics.

manifestation time. In preterm infants, about 50% of hemorrhages appear on the 1st day of life, 25% on the second and 15% on the third.

Sources of bleeding:

Premature babies have a germinal matrix (regresses by 32-36 weeks of gestation) with vulnerable vessels (sensitive to pressure fluctuations, ischemia, hypoxia, acidosis, coagulation disorders). At 28-32 weeks' gestation, most of the terminal matrix is ​​located in the cauudothalamic junction, just posterior to the foramen of Monro. The IV ventricle also contains a vulnerable germinal matrix.

As the newborn matures, the value of the germinal matrix as a source of intracerebral hemorrhage decreases, and that of the choroid plexuses increases.

Classification of intracerebral hemorrhage in newborns

Advice. Instead of the above classifications (there are others), it is better to use a brief, precise description using the terms "germinal matrix", "intraventricular", "parenchymal" and indicating the location.

Papile classification- the most commonly used classification of hemorrhages in HH, based on computed tomography data:

• Hemorrhage II degree: with a breakthrough into the ventricle without its expansion.
• Hemorrhage III degree: with a breakthrough into the ventricle and its expansion.
• IV degree hemorrhage: a combination of I-III degree hemorrhage with hemorrhage in the brain parenchyma.

DEGUM classification(German Society for Medical Ultrasound). Developed by the pediatric department of DEGUM in 1998 and built on the basis of ultrasound data:

• Hemorrhage I degree: subependymal.
• Hemorrhage II degree: intraventricular with filling< 50 % просвета.
• Grade 111 hemorrhage: intraventricular with filling > 50% of the lumen.
• Parenchymal hemorrhages (cerebrum, cerebellum, basal ganglia, brainstem) are described separately (location and size).

Diagnosis of intracerebral hemorrhage in newborns

Intracranial hemorrhage should be suspected in a newborn with apnea, seizures, lethargy, or unusual neurological symptoms; these children should have a CT scan of the head. Although the ultrasound of the skull is not dangerous, CT is more sensitive for thin layers of blood. However, for screening very premature babies (eg,<30 нед гестации) некоторые врачи предпочитают проведение УЗИ. Если диагноз вызывает сомнение, СМЖ может быть проверена на содержание эритроцитов: она обычно содержит много крови. Однако некоторое количество эритроцитов часто присутствует в спинномозговой жидкости доношенных новорожденных.

In addition, blood tests, a complete blood count, and metabolic studies should be performed.

Ultrasound procedure

Premature babies need to perform cranial ultrasound on the first, third and seventh day of life. It also makes sense to perform an ultrasound after the child enters the department (in case of judicial investigations to clarify the time of the first manifestation of the lesion).

If a lesion is detected, a thorough examination of the midbrain and infratentorial structures through additional accesses (anterior and posterior lateral fontanelles) is necessary. Approximately 10% of preterm infants with posthemorrhagic ventricular dilatation have small cerebellar hemorrhages that are poorly visible through the large fontanel (this clinical problem is underestimated).

If a hemorrhage is detected near the arteries, especially in a full-term newborn, a Doppler study of the venous vessels (superior sagittal sinus, internal veins of the skull) is necessary.

In full-term, in addition to ultrasound, you need to perform an MRI and, if it matters for treatment, angiography.

Intraparenchymal areas with echo enhancement (the term periventricular venous soaking or edema is often used) are in most cases the foci of infarction. Sometimes they pass without the formation of cysts and then retrospectively we can only talk about venous congestion. After the onset of cystic transformation (weeks), the areas of echo amplification should be referred to as heart attacks or hemorrhages (important for talking with parents).

Differential Diagnosis

Unlike hemorrhages in premature infants, which are explained by immaturity, hemorrhages in full-term infants require a careful search for the cause: resuscitation, birth trauma, hemorrhagic diathesis (clotting and platelets), thrombophilia, venous and arterial thrombosis, embolism, polyglobulia, hypernatremia, aneurysms, arteriovenous malformations, coarctation of the aorta, tumor, ECMO therapy, etc.

Treatment of intracerebral hemorrhage in newborns

Treatment is predominantly supportive if hematologic abnormalities do not contribute to bleeding. All children should receive vitamin K if they have not received it before. In case of insufficiency of platelets or blood clotting factors, they must be replenished. Subdural hematomas should be treated by a neurosurgeon; it may be necessary to remove the hemorrhage.

Make the most of all the possibilities of conservative treatment:

• Stabilize blood pressure: avoid jumps in blood pressure, use catecholamines carefully, sedation. The principle of correction by minimal means.
• Normalization of oxygenation.
• Avoid hyper- and hypocapnia (decreased brain perfusion).
• Control of coagulogram, correction of deviations.
• Avoid hypoglycemia.
• Widespread use of anticonvulsants.

Attention: it is better to intubate electively than in an apnea emergency.

In full-term - early consultation of a neurosurgeon.

Prognosis of intracerebral hemorrhage in newborns

In preterm infants, grade I-II intracerebral hemorrhage probably does not significantly increase the risk of neurological complications.

The risk of severe neurological complications in premature infants with grade III hemorrhages is approximately 30%, with parenchymal hemorrhages - approximately 70%.

In mature neonates, prognosis depends on site and cause; hemorrhages in the basal ganglia, cerebellum and brain stem are unfavorable prognostically, but the individual course is unpredictable.

The prognosis for subarachnoid hemorrhage is generally good. For a subdural, be careful, but some babies do well. Most infants with small intraventricular hemorrhages survive an episode of acute bleeding and do well. Children with large intraventricular hemorrhage have a poor prognosis, especially if bleeding continues into the parenchyma. Premature infants with a history of severe intraventricular hemorrhage are at risk for developing posthemorrhagic hydrocephalus and should be carefully monitored with repeated cranial ultrasonography and frequent remeasurement of head circumference. Infants with progressive hydrocephalus require neurosurgical intervention for subcutaneous placement of a ventricular reservoir (for CSF aspiration) or a ventriculo-peritoneal shunt. The CSF associated with posthemorrhagic hydrocephalus has a very low glucose concentration, known as hypoglycorachia. Because many children remain neurologically deficient, careful observation and referral for early intervention is important.

The birth of a child is a complex, responsible and often unpredictable process. Sometimes it happens that as a result of childbirth, the baby receives severe damage, in particular, birth injuries of the central nervous system. What are the reasons for such an unpleasant consequence of childbirth in newborns? And will the treatment started in a timely manner give a positive result?

Causes of hemorrhage in infants

A cerebral hemorrhage or intracranial bleeding in a baby is caused by a rupture of blood vessels inside the skull. This could be caused by damage to his skull or lack of oxygen.

Prerequisites for hemorrhage are:

• preterm or premature pregnancy;
• discrepancy between the size of the head of the newborn and the size of the birth canal;
• severe pregnancy (hypoxia, intrauterine infections);
• protracted or, conversely, rapid childbirth;
• improper interventions of obstetricians.

Types of cerebral hemorrhage in an infant

Depending on where in the brain of children the rupture of blood vessels occurred, they are distinguished:

epidural hemorrhages

Such intracranial bleeding occurs in newborns if the vessels between the bones of the skull and the dura mater are damaged. The phenomenon is observed when the bones of the cranial vault are damaged. Its symptoms are:

• pupil dilation is observed on the damaged side;
• slow heartbeat;
• low blood pressure;
• suffocation;
• convulsions.

Epidural intracranial bleeding in newborns is characterized by the presence of a calm interval for 3-6 hours, then a brain compression syndrome occurs, and the baby becomes sharply worse. Literally after a couple of days, the consequences are the worst: he falls into a coma, and even the appropriate treatment does not help.

subdural hemorrhages

Such intracranial bleeding in newborns occurs when the vessels between the soft and hard shells of the brain are damaged. They usually occur as a result of rapid or prolonged delivery of a very large fetus. In this case, damage and displacement of the skull plates is possible. Currently, in newborns, it is quite rare, thanks to the perfect method of childbirth. From how quickly the injury was diagnosed, its causes were established and treatment started, its consequences also depend. This type of pathology can lead to a large load on the surface of the brain, which in turn leads to the development of various neurological disorders or an increased level of bilirubin in the blood to a large extent.

Subarachnoid hemorrhages

The most common type of hemorrhage in newborns. It usually occurs in premature babies with rupture of blood vessels in the space between the arachnoid and the substance of the brain. They can be provoked by prolonged labor with obstetric intervention. With such a pathology, inflammation of the membranes of the brain occurs, which is usually caused by the decay products of the blood that has settled on them.

Signs appear literally immediately or a few days after the birth of premature babies.

Subarachnoid hemorrhage has the following symptoms:

• general excitement of the baby;
• constant crying, sleep disturbance;
• prolonged lying of a newborn with open eyes;
• anxious, wary expression on the face of the baby;
• violent reaction at the slightest irritation;
• an increase in the circumference of the head, caused by the divergence of the bones of the skull;
• neck muscle tension;
• strabismus, convulsions.

With this type of brain damage in premature newborns, the degree of consequences is negligible. Their condition will soon normalize if treatment is started in a timely manner.

Hemorrhages in the substance of the brain and ventricles

Intraventricular hemorrhage in a newborn occurs in the ventricles, i.e. cavities of the brain filled with cerebrospinal fluid. It usually occurs in severely premature newborns who have a slow intrauterine development of the brain. Usually at risk are children born before the 32nd week of pregnancy. Such bleeding inside the skull usually disappears in the first three days of a newborn's life and does not cause much major consequences. If more severe vascular damage occurs, resulting in the ventricles being completely filled with blood, then this is associated with especially dangerous complications, such as behavioral problems or cerebral palsy, even if treatment is started in a timely manner.

Symptoms of a hemorrhage

In premature newborns born with pathology, several types of hemorrhages can often be combined. But depending on the severity of brain damage, among the many symptoms, the symptoms of one of them are most pronounced.

Usually all children who have this or that damage to the blood vessels in the cerebral cortex are very slow, lethargic and apathetic. They have feeding problems.

With the right care, if the right treatment is carried out, cerebral hemorrhages in young children do not cause very big problems. Although, of course, the result of recovery depends on many factors, including:

• degree of brain damage in premature newborns;
• the degree of the disease;
• infections and diseases in babies and the degree of complexity of their course.

In order for a newborn born with such a pathology not to experience any deviations in the future and to be able to develop at the level of his peers, he needs to be provided with proper treatment and a development-stimulating environment already in the first years of life.

Pregnancy and childbirth are not easy for women. But in their hardships, they are not alone: ​​the intrauterine period and the subsequent birth for the baby are considered no less difficult.

Unfortunately, not everything always goes smoothly, and certain dangerous complications are possible. One of these complications of pregnancy and childbirth is cerebral hemorrhage in a newborn. What it is and why it happens, we will tell in this material.

About pathology

Cerebral hemorrhage belongs to the category of the most severe birth injuries, which usually have an unfavorable course and prognosis. It occurs due to a violation of the integrity of the blood vessels, as a result of which blood begins to accumulate under the membranes of the brain, in the interhemispheric space, sometimes the entire brain tissue is saturated with it.

Naturally, brain functions are disturbed, the activity of the central nervous system undergoes changes, often fatal or irreversible. It is cerebral hemorrhage that is considered the most common cause of neonatal death of babies, as well as the development of cerebral palsy in survivors.

Of course, a lot depends on which vessel, in which area of ​​the brain is damaged, how much blood has accumulated, what are the changes in the brain tissue and membranes due to blood mass pressure and leaching, but in general, the forecasts are still, alas, considered unfavorable.

Depending on the exact location of the hemorrhage, several types of pathology are distinguished:

• epidural- accumulation of blood is observed between the cranium and the gray medulla, the brain tissue is not affected;
• subdural- accumulation of blood is present between the pia mater and dura mater;
• subarachnoid- bleeding is localized between the shell and the gray matter;
• interventricular e - blood accumulates in the space between the ventricles of the brain and in them;
• parenchymal (intracerebral)- blood accumulates in the medulla itself, impregnates it.

It should be noted that all these types are considered dangerous, but parenchymal and epidural bleeding is usually called the most severe.

They are quite difficult to establish, and therefore at the time of diagnosis, pathology may already have the scale of a global catastrophe.

• 1st degree corresponds to a hemorrhage affecting only the walls of the ventricles of the brain, not their cavities.
• 2 degrees corresponds to pathology with the penetration of blood into the ventricles of the brain.
• At 3 degrees blood extends outside the ventricles and fills the lateral ventricles
• At 4 degrees there is a massive hemorrhage with damage to the ventricles, lateral ventricles and medulla.

The size of the hemorrhage also matters.

If the area of ​​the lesion is not more than a centimeter, they speak of a mild form of pathology, with an increase in the area of ​​\u200b\u200bhemorrhage to one and a half centimeters, they put a medium-severe form, but if the area of ​​​​the lesion exceeds one and a half centimeters, we will talk about pathology in severe form.

The reasons

Cerebral hemorrhage can develop for a variety of reasons related to the development of the child in the mother's womb, or with the actions of physicians and some complications during childbirth.

Quite often, cerebral hemorrhage occurs in very premature babies who were born before 32 weeks of pregnancy. Their brain is immature, weak, it is not able to withstand the change in pressure during childbirth, the integrity of the vessels is already violated due to the premature birth of the baby.

Neurosurgeons note that the percentage of probability of cerebral hemorrhage in a premature baby weighing more than one and a half kilograms is about 50%. In babies, whose weight at birth is less than a kilogram, a stroke of varying severity is observed in 100% of cases.

Other reasons include the following.

• Acute hypoxia during childbirth. A sharp oxygen starvation can develop during abrupt rapid labor, as well as during prolonged labor with a long stay of the baby in an anhydrous period (after the discharge of the amniotic fluid). The non-traumatic nature of the hemorrhage in this case somewhat increases the chances of a more favorable outcome for life.
• actions of an obstetrician. The imposition of forceps, improper removal of the fetal head can lead to a fracture of the bones of the skull, and then a traumatic hemorrhage develops.
• Postponed pregnancy. If childbirth occurs after 42 weeks, the likelihood of the baby getting a cranial injury during childbirth increases, because the bones of the skull at this time begin to lose the elasticity necessary for unhindered passage through the birth canal. Birth trauma to the skull can be the main cause of subsequent cerebral effusion.
• Unfavorable pregnancy. Hemorrhage of an acute nature in the brain during gestation usually leads to termination of pregnancy, death of the fetus. After birth, pathology may develop due to some malformations of the vessels, heart, and brain. Also, the cause may be intrauterine infection of the fetus with dangerous viruses and bacteria.

If a woman belongs to the risk group (the age of the woman in labor is over 40 years old, pregnancy was accompanied by preeclampsia, severe toxicosis, carries a large fetus with a narrow pelvis, etc.), the woman is usually offered to reduce the risk of hemorrhage in the child by surgical delivery.

After a caesarean section, brain disorders, circulatory disorders in babies develop infrequently.

Symptoms and signs

A child who has a small hemorrhage at birth will not immediately let you know about it. Perhaps at birth he will be more lethargic, perhaps later he will scream, but after a few hours the symptoms will appear, and doctors will be able to diagnose the pathology.

Manifest symptoms of cerebral hemorrhage, acutely, suddenly. The baby's condition is rapidly deteriorating. It is difficult to say what the specific signs will be, it all depends on the size and location of the hematoma inside the skull.

Most often, convulsions appear, vomiting opens, the child loses consciousness. Strabismus may appear sharply (pupils begin to "look" towards the affected hemisphere). Many babies have trouble breathing, it becomes intermittent and then may stop.

Usually, the maternity hospital manages to provide first aid and provide the child with a ventilator.

Constant crying may indicate subarachnoid hemorrhage, low blood pressure and strabismus may indicate epidural bleeding.

Experienced neonatologists have many signs by which they can distinguish not only pathology, but also suggest its size and localization. However, without an accurate diagnosis, the conclusion is not made.

To confirm the hemorrhage, the baby is urgently performed neurosonography and computed tomography of the brain.

Treatment

Treat the child immediately, as soon as the diagnosis is confirmed. If necessary, provide resuscitation assistance. Therapy is aimed primarily at normalizing blood circulation in the brain, at reducing intracranial pressure. If the hematoma is large and the child's condition is severe, he may undergo an emergency neurosurgical operation.

If the life of a child can be saved, parents are warned about a long recovery period without any guarantees, because the consequences of a cerebral hemorrhage can be very diverse.

During the recovery process, which can last for several months, and several years, and sometimes for a lifetime, the child will be shown a dispensary observation by a neurologist, whose recommendations parents will have to strictly follow.

Predictions and consequences

The infant brain is unique in its own way.

He has a high ability to adapt and compensate. And that is why with light hemorrhages in the brain, if they are properly treated, in most cases it is possible to cope. But even with them, the process of rehabilitation of the child will take a long time.

If the degree of hemorrhage was higher than the second, and the course is severe, then the child is likely to become disabled in the future. The degree of damage to the functions of the brain will depend on how destructive the hematoma turned out to be for him. Common lesions in such cases are cerebral palsy, epilepsy, hydrocephalus, dementia.

In the case of severe hemorrhage of the parenchymal type, the survival rate of children is extremely low. Almost one hundred percent lethal outcome is recorded in the case of hemorrhage with a rupture of the sickle or cerebellar tentorium.

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education - Specialist

Additional education:

"Cardiology"

State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia

It is believed that stroke is an “age-related” disease and affects mainly elderly hearts. But the high percentage of deaths and disability after childhood stroke brings the problem to the forefront of medical practice. It is not easy to identify pathology in babies, and they need help literally in the first hours of the development of circulatory disorders in the brain. It is extremely important for parents to know the warning symptoms of a stroke in order to prevent negative consequences.

Brain accident in children

Brain catastrophe can occur at any age, even during fetal development. Children's stroke differs from violations of the blood supply to the brain in adults by a number of signs. In children:

• the condition is more often diagnosed when the blood vessels of the brain rupture;
• local neurological symptoms predominate (in adults - cerebral);
• pathology is characterized by the complexity of diagnosing (patients up to a year have no obvious symptoms);
• often there are microstrokes and lacunar cerebral necrosis with minimal signs of damage;
• recovery of neurological changes is faster.

According to the general symptoms, pathology in adults and infants manifests itself almost the same.

Types of pathology

As in adults, stroke in children is characterized by a sudden disruption of blood circulation. In accordance with the causes of development, several forms of stroke are distinguished:

• hemorrhagic - accumulation of blood poured out of blood vessels in the brain;
• ischemic - thrombotic blockage of the lumen of a cerebral vessel;
• combined - occlusion of cerebral vessels, complicated by hemorrhages. Rare, extremely dangerous.

Violation of blood flow in the vessels of the brain has two periods of development:

• perinatal (from 28 weeks of intrauterine development to 1 month of a newborn's life);
• juvenile (in a child from a month to 18 years).

Perinatal stroke is diagnosed more often.

Age specific

The causes of the development of pathology and its symptoms depend on the age of the child.

Age features of the development of stroke

Hemorrhagic juvenile stroke can be fatal.

Stroke: features of types

Ischemic and hemorrhagic strokes differ in manifestations and causes. The treatment of these types of pathology also has its own subtleties.

Features of ischemic and hemorrhagic types of stroke

In newborns, with proper care, the consequences of cerebral hemorrhages do not lead to significant problems. But recovery is influenced by various factors, including correctly conducted rehabilitation.

General principles of treatment

To provide first aid, a number of actions are carried out:

1. Lay down the child, raising his head;
2. Open windows to provide sufficient airflow;
3. Unbutton or remove tight clothing;
4. In case of vomiting and seizures, turn your head to one side, if necessary, clean the oral cavity;
5. Call the medical team;
6. If breathing stops, perform resuscitation.

All activities should be carried out quickly and clearly, the further recovery of the child depends on this. Basic therapy is carried out in a hospital and eliminates the danger of a child's life:

• normalizes blood pressure, heart rhythm;
• localizes cerebral edema;
• restores metabolic processes;
• relieves cramps and pain.

The main therapy depends on the type of stroke.

Rehabilitation measures

Recovery measures follow after the acute phase of the stroke. They are carried out in two stages:

• the first is based on doctor's prescriptions, proper nutrition, and rest. Showing therapeutic massages, physiotherapy, exercise therapy. Then, the rehabilitation process includes classes with a rehabilitator, speech therapist, psychologist;
• the second is developed individually. Its duration depends on the severity of neurological disorders.

The best option for the second stage is finding the child in a rehabilitation center. Using the necessary medical equipment, medical staff will help restore:

• motor skills (training aids);
• muscle tone, motor coordination (massage, exercise therapy, electrical stimulation, paraffin applications);
• speech (exercises with a neuropsychologist, speech therapist, course hand massage);
• mental activity (taking neurotrophic drugs, nootropics).

Children after a stroke recover faster than adults. The functions of dead neurons are taken over by other brain cells. This is a slow and difficult process, but it is much easier for babies to regain lost functions.