Generality
Apoplexy is a pathological condition characterized by a sudden haemorrhage, which occurs at a specific tissue or organ causing serious alterations and causing their destruction.
However, it is good to remember that the stroke - in addition to being hemorrhagic - can also be of ischemic type, ie it can be caused by a drastic reduction or lack of blood flow in the brain.
However, by extension, the term apoplexy is used to indicate also other pathological conditions characterized by a sudden haemorrhage, with consequent loss of functionality of the affected tissue.
Types of Apoplexy
Since the term apoplexy is used to indicate particular pathological conditions, characterized by loss of functionality of the affected area following a sudden haemorrhage, different types of apoplexy can be distinguished according to the body district concerned.
Among the most known types of apoplexy that will be discussed in this article, we recall:
- Cerebral apoplexy (stroke);
- Pituitary apoplexy;
- Utero-placental apoplexy (also known as Couvelaire syndrome, or Couvelaire's uterus).
Causes
As mentioned, apoplexy is characterized by a sudden haemorrhage, which causes damage to the affected tissues and organs.
The causes triggering the aforementioned haemorrhage, usually, are to be found in disorders, alterations and compromises of the cardiovascular system, however, these factors can vary greatly depending on the type of apoplexy discussed.
In the case of cerebral apoplexy, the main causes that cause its onset are: aneurysms, chronic hypertension, congenital arteriovenous malformations and brain traumas.
Pituitary apoplexy, on the other hand, is caused by the presence of a pituitary adenoma; however, the exact mechanism that leads to the onset of bleeding is still not entirely clear. Some believe that the apoplexy in question can be caused by an increase in the size of the adenoma, which compresses the adjacent structures causing different damages.
Utero-placental apoplexy, on the other hand, consists of a serious form of unpleasant placental detachment, a complication of pregnancy in which both the partial or total detachment of the placenta from the uterus occurs before the birth is completed. The cause of this detachment could be of a traumatic nature, or it could be the consequence of other pathologies the pregnant woman suffers.
Diagnosis
Of course, the tools used to diagnose possible apoplexy may vary depending on the type of apoplexy that is to be identified.
However, we can state that the main diagnostic tools used to identify this pathological condition are:
- Blood tests to evaluate a set of factors, such as complete blood count, blood sugar, serum electrolytes, transaminases, bilirubin, prothrombin time, etc .;
- Ultrasound;
- Electrocardiogram (in particular, in case of cerebral apoplexy);
- MRI scan.
Symptoms
Similarly to what happens for the causes that trigger apoplexy, the symptoms can also vary depending on the type of bleeding that occurs.
The characteristic symptoms of cerebral apoplexy consist of:
- Difficulty walking;
- Difficulty of the word;
- Visual disturbances;
- Headache;
- Paralysis and / or numbness of the face and limbs.
The typical symptomatology of pituitary apoplexy, instead, consists in the onset of:
- Headache located behind the eyes and temples;
- Nausea and vomit;
- Visual disturbances.
In association with the aforementioned symptoms, sometimes stiffness of the neck, photophobia, decrease in the state of consciousness may also occur. It should also be remembered that patients affected by pituitary apoplexy often have a deficit of adrenocorticotropic hormone and cortisol secretion (probably caused by the pituitary adenoma), which can lead to circulatory collapse.
Finally, in the case of utero-placental apoplexy, affected patients may present with symptoms, such as:
- Continuous uterine contractions;
- Vaginal discharge of blood that can be of variable intensity;
- Hypotension;
- Tachycardia;
- Shock.
Of course, in this particular form of apoplexy, there is also considerable suffering of the fetus.
Treatment
The therapeutic strategy that one decides to undertake varies according to the form of apoplexy that must be treated.
In the case of cerebral apoplexy, first of all, it is necessary to stop or control the loss of blood by administering specific coagulant drugs. Furthermore, if the bleeding has been conspicuous, it may be necessary to remove the leaked blood, so as to prevent it from generating pressure in the brain. After that, the patient is usually kept under observation.
Furthermore, depending on the cause of cerebral apoplexy, surgery may be necessary.
Finally, in patients suffering from cerebral apoplexy, it is essential to undergo rehabilitation, aimed at recovering all, or at least most, of the impaired and / or lost functions due to the bleeding itself.
More information on the treatment of cerebral hemorrhage
In the case of pituitary apoplexy it is essential to immediately stabilize the circulatory system. Generally, corticosteroids are administered at high doses, to make up for the deficits presented by patients. However, even in this case, it may be necessary to resort to surgery. In particular, emergency surgery is necessary when patients experience sudden visual symptoms associated with oculomotor nerve paralysis.
In the case of uterine-placental apoplexy - which is the most serious form of placental detachment - the doctor can first decide to perform a caesarean section to safeguard the fetus.
To stop the bleeding in women, in these cases the drug therapy may not be sufficient, so surgical treatment is the only alternative available.
Furthermore, in the most severe cases of uterine-placental apoplexy, removal of the uterus (hysterectomy) may be necessary.
