Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel in the brain leaks or bursts. Areas of the brain that should receive blood, oxygen, and nutrients from the damaged blood vessel are deprived of blood flow. This causes areas of the brain to become damaged. Damage also occurs to areas of the brain where the leaked blood accumulates and presses on normal tissue. This is a medical emergency. This can cause permanent damage and loss of brain function.

CAUSES

  • High blood pressure (hypertension).

  • Use of cocaine or amphetamines.

  • The accumulation of an abnormal protein (amyloid) within the brain arteries.

  • Abnormal blood vessels present since birth.

  • Bleeding disorders.

  • Disorders that cause blood vessels to become inflamed (vasculitis).

  • The blood becoming too thin while taking blood thinners (anticoagulants).

  • Injuries.

  • Tumors.

RISK FACTORS

Some medical conditions and some behaviors are associated with an increased chance of having a stroke.

  • Hypertension.

  • High cholesterol.

  • Diabetes.

  • Heart disease.

  • The buildup of fatty deposits in the blood vessels (peripheral artery disease or atherosclerosis).

  • An abnormal heart rhythm (atrial fibrillation).

  • Obesity.

  • Smoking.

  • Taking oral contraceptives (especially in combination with smoking).

  • Physical inactivity.

  • A diet high in fats, salt (sodium), and calories.

  • Alcohol use.

  • Use of illegal drugs (especially cocaine and methamphetamine).

  • Being a male.

  • Being an African American.

  • Age over 55.

  • Family history of stroke.

  • Previous history of blood clots, a "warning stroke" (transient ischemic attack, TIA), or heart attack.

  • Sickle cell disease.

SYMPTOMS

These symptoms usually develop suddenly (or may be newly present upon awakening from sleep):

  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • Sudden confusion.

  • Trouble speaking (aphasia) or understanding.

  • Sudden trouble seeing in one or both eyes.

  • Sudden trouble walking.

  • Dizziness.

  • Loss of balance or coordination.

  • Sudden severe headache with no known cause.

DIAGNOSIS

Your caregiver will often suspect a hemorrhagic stroke based on your symptoms, history, and exam. A computerized X-ray scan (CT scan) of the brain is usually performed. This is done to confirm the presence of bleeding in the brain, to look for causes, and to determine severity. Other tests may be done, including:

  • A computerized magnetic scan (MRI).

  • A test to check blood flow (angiography).

  • Blood tests.

TREATMENT

The goals of treatment are to try to stop the bleeding and to control pressure in the brain.

  • Medicines may be given to lower blood pressure, stop or prevent seizures, and prevent the brain's blood vessels from going into spasm in response to the presence of bleeding.

  • Other medicines, blood products, or vitamin K may also help with the bleeding, especially if you have been on anticoagulants in the recent past.

  • If there is a collection of blood putting pressure on your brain, or if the blood vessel continues to bleed, surgery may be required.

  • Surgery may also be needed if tests reveal that there are other problems within the brain's blood vessels that put you at high risk for another bleeding event in the future.

HOME CARE INSTRUCTIONS

  • Medicines. Be sure to take all your medicines exactly as instructed. Do not take any over-the-counter drugs or supplements without talking to your caregiver.

  • Diet: A diet that includes 5 or more servings of fruits and vegetables a day may reduce the risk of stroke. Foods may need to be a special consistency (soft or pureed), or small bites may need to be taken in order to avoid aspirating or choking. Certain diets may be prescribed to address high blood pressure, high cholesterol, diabetes, or obesity.

  • A low salt (sodium), low saturated fat, low trans fat, low cholesterol diet is recommended to manage high blood pressure.

  • A low saturated fat, low trans fat, low cholesterol, and high fiber diet may control cholesterol levels.

  • A controlled carbohydrate, controlled sugar diet is recommended to manage diabetes.

  • A reduced calorie, low sodium, low saturated fat, low trans fat, low cholesterol diet is recommended to manage obesity.

  • Maintain a healthy weight.

  • Stay physically active. It is recommended that you get at least 30 minutes of activity on most or all days.

  • Do not smoke.

  • Limit alcohol use. Moderate alcohol use is considered to be:

  • No more than 2 drinks per day for men.

  • No more than 1 drink per day for nonpregnant women.

  • Stop drug abuse.

  • Home safety: A safe home environment is important to reduce the risk of falls. Your caregiver may arrange for specialists to evaluate your home. Having grab bars in the bedroom and bathroom is often important. Your caregiver may arrange for special equipment to be used at home, such as raised toilets and a seat for the shower.

  • Physical, occupational, and speech therapy: Ongoing therapy may be needed to maximize your recovery after a stroke. If you have been advised to use a walker or a cane, use it at all times. Be sure to keep your therapy appointments.

  • Follow all instructions for follow-up with your caregiver. This is VERY important. This includes any referrals, physical therapy, rehabilitation, and laboratory tests. Proper treatment also prevents another stroke from occurring.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • You have sudden confusion.

  • You have trouble speaking (aphasia) or understanding.

  • You have sudden trouble seeing in one or both eyes.

  • You have sudden trouble walking.

  • You have dizziness.

  • You have a loss of balance or coordination.

  • You have a sudden severe headache with no known cause.

  • You have a fever.

  • You are coughing or have difficulty breathing.

  • You have new chest pain, angina, or an irregular heartbeat.

Any of these symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help at once. Call your local emergency services (911 in U.S.). Do not drive yourself to the hospital.