DIFFERENTIATED THERAPY OF PATIENTS WITH INTRACEREBRAL COMPLICATED HEMISPHERIC ISCHEMIC CEREBRAL STROKE WITH SECONDARY BRAINSTEM HEMORRHAGES AGAINST THE BACKGROUND OF HYPERTENSIVE ENCEPHALOPATHY.

The purpose of the study is to assessment of the risk of secondary brainstem hemorrhages against the background of hypertensive encephalopathy in patients with intracerebral complicated hemispheric ischemic cerebral stroke using anticoagulant therapy. Was conducted a clinical and pathological study of 97 patients with intracerebral complicated hemispheric ischemic cerebral stroke aged 41 to 87 years. Of these, 55 were men (56,7%), average age 72,5±2,4; women 42 (43,3%), average age 76,5±2,1. Data on survival time and complications in the form of secondary brainstem hemorrhages directly correlated with the results of pathological changes in the brainstem. During autopsy of deceased patients with hemispheric ischemic cerebral stroke complicated by secondary hemorrhages of the brainstem who received anticoagulant therapy, in 12 cases (70,6%) out of 17, secondary massive hemorrhages in the brainstem were found, consisting of multiple hemorrhagic foci merging with each other. In individuals with hemispheric ischemic cerebral stroke who did not receive anticoagulant therapy, pathomorphologically, secondary massive hemorrhages in the brainstem were noted in only 12 (25,5%) of 47 deceased, while in 35 observations (74,5%), hemorrhages were determined in the form of individual hemorrhagic foci of small size or individual small-point hemorrhages, sometimes detected during macroscopic examination. Data on the presence of hypertensive encephalopathy in the pre-stroke anamnesis directly correlated with the results of secondary pathological changes in the brainstem. At autopsy, hypertensive encephalopathy was detected in 92,2% of deceased patients with secondary hemorrhages in the brainstem, while with ischemic nature of brainstem changes only in 42,4%. The above proves the need to take into account differentiated therapy depending not only on the nature of the damage to the hemispheric structures, but also on the pathomorphological type of secondary changes in the brainstem. In patients with hemispheric ischemic infarction who are predisposed to complicated hemorrhagic secondary brainstem syndrome, especially those with a history of hypertensive encephalopathy, the use of anticoagulant, thrombolytic, and dual antiplatelet therapy is not recommended due to the risk of developing secondary hemorrhagic stem syndrome as a consequence of secondary changes in microvessels, which always change under the influence of high blood pressure.