Hemorrhagic Stroke

ExitCare ImageA 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

A hemorrhagic stroke is caused by a decrease of oxygen supply to an area of your brain. It is the result of a blood vessel that leaks or ruptures. The leaking or rupturing blood vessel occurs due to one of the following conditions:

  • A ballooning of a weak section in a blood vessel (aneurysm).

  • Hardened, thin blood vessels. Blood vessel walls lined with plaque becoming thin and hardened. These hardened, thin artery walls can crack open and allow blood to flow out of the blood vessel.

  • An abnormal formation of a blood vessel (arteriovenous malformation). This condition results in an abnormal tangle of thin-walled blood vessels.

Once the blood vessel ruptures, bleeding occurs. The blood from the ruptured blood vessel accumulates and compresses the surrounding brain tissue. Hemorrhagic strokes are classified as to the location of the bleed. If the bleeding occurs within the brain tissue, the condition is called an intracerebral hemorrhage. If the bleeding occurs in the area between the brain and the thin tissues that cover the brain, the condition is called a subarachnoid hemorrhage.

RISK FACTORS

  • High blood pressure (hypertension).

  • Abnormal blood vessels present since birth.

  • Bleeding disorders, such as hemophilia, sickle cell disease, or liver disease.

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

  • Smoking.

  • Excessive alcohol use.

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

SYMPTOMS

  • Sudden, severe headache with no known cause. The headache is often described as the worst headache ever experienced.

  • Nausea or vomiting, especially when combined with other symptoms such as a headache.

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

  • Sudden trouble walking or difficulty moving arms or legs.

  • Sudden confusion.

  • Sudden personality changes.

  • Trouble speaking (aphasia) or understanding.

  • Difficulty swallowing.

  • Sudden trouble seeing in one or both eyes.

  • Double vision.

  • Dizziness.

  • Loss of balance or coordination.

  • Intolerance to light.

  • Stiff neck.

DIAGNOSIS

Your caregiver will often suspect a hemorrhagic stroke based on your symptoms, history, and exam. A 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:

  • An MRI.

  • Angiography.

  • Blood tests.

TREATMENT

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

  • Medicines may be given to:

  • Lower blood pressure (antihypertensives).

  • Relieve pain (analgesics).

  • Relieve nausea or vomiting.

  • Stop or prevent seizures.

  • Prevent the blood vessels in the brain from going into spasm in response to the presence of bleeding.

  • Other medicines, blood products, or vitamin K may also be given to control the bleeding.

  • 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 blood vessels of the brain that put you at an elevated risk for another bleeding event in the future.

Further treatment depends on the duration, severity, and cause of your symptoms. Physical, speech, and occupational therapists will assess you and work to improve any functions impaired by the stroke. Measures will be taken to prevent short-term and long-term complications, including infection from breathing foreign material into the lungs (aspiration pneumonia), blood clots in the legs, bedsores, and falls.

HOME CARE INSTRUCTIONS

  • 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.

  • If swallow studies have determined that your swallowing reflex is present, you should eat healthy foods. A diet that includes 5 or more servings of fruits and vegetables each 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 each day for men.

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

  • Stop drug abuse.

  • 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 follow up can prevent another stroke from occurring.

SEEK MEDICAL CARE IF:

  • You have personality changes.

  • You have difficulty swallowing.

  • You are seeing double.

  • You have dizziness.

  • You have a fever.

  • You have skin breakdown.

SEEK IMMEDIATE MEDICAL CARE IF:

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

  • You have sudden nausea or vomiting with a severe headache.

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

  • You have sudden trouble walking or difficulty moving arms or legs.

  • You have sudden confusion.

  • You have trouble speaking (aphasia) or understanding.

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

  • You have a sudden loss of balance or coordination.

  • You have a stiff neck.

  • You have difficulty breathing.

  • You have a partial or total loss of consciousness.

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.