Hemorrhagic Stroke-Treatment, Symptoms, Prognosis, Recovery


Hemorrhagic stroke accounts for about 20% of stroke cases per year. It is a dangerous condition that causes immediate severe damage. But what is hemorrhagic stroke? What causes it? And how could it be prevented?

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Hemorrhagic stroke

The human brain is the center of a human’s nervous system. The brain is responsible for the control of different actions like eating, sleeping, walking, and other activities needed in order to survive. The brain is an important and a very delicate organ and it should be protected all the time. Any severe damage to the brain can cause the death of a person. The brain is also sensitive to any form of bleeding. Once bleeding reaches the brain, it causes irritation to the brain tissues, resulting to swelling and the increased blood pressure in the brain will cause pressure to be exerted against the skulls. Hemorrhage means bleeding and the bleeding in or around the brain area will cause a person to undergo a hemorrhagic stroke.

There are mainly two types of hemorrhagic stroke, the intracerebral hemorrhage and the subarachnoid hemorrhage.

Intracerebral Hemorrhage

Intracerebral hemorrhage is caused by bleeding inside the human brain which is a result from a rupture of a blood vessel.

Causes of Intracerebral Hemorrhage

Intracerebral hemorrhagic stroke can be caused by several reasons:

• A sudden burst of a small artery due to a chronic high blood pressure

• Use of cocaine can cause temporary hemorrhage

• Abnormalities in the blood vessel

• Abnormal protein deposits along the blood vessels

• Traumatic brain injury

• Blood and bleeding disorders like leukemia, hemophilia, low blood platelets, Disseminated intravascular coagulation, and sickle cell anemia

• Brain tumors

• Liver disease associated with increased bleeding

• Using of aspirin or other blood thinners

Symptoms of Intracerebral Hemorrhage

Symptoms vary depending on the location of the bleeding and how damaged the brain tissues are and these symptoms develop without a warning. Symptoms include:

• Abnormal sense of taste

• Difficulty in speaking, swallowing, writing and reading

• Changes in level of consciousness

• Headache

• Loss of coordination and balance

• Difficulty in moving or weakness of a body part

• Nausea and vomiting

• Seizure

• Changes in sensation like facial paralysis, or numbness or tingling

• Changes in vision like uncontrollable eye movements, double vision, or eyelid drooping

Diagnosis of Intracerebral Hemorrhage

Tests may include:

• Bleeding time

• CBC or complete blood count

• Cerebral angiography

• CT head scan

• Magnetic resonance imaging in the head or MRI / MRA

• Kidney and liver function test

• Test for platelet count

• Prothrombin time or PT and partial thromboplastin time or PTT

Treatment for Intracerebral Hemorrhage

A person who suffers an intracerebral hemorrhagic stroke should seek medical help immediately. Treatment varies on the location, amount, and cause of hemorrhage. Surgery is needed when bleeding occurs in the cerebellum. Other medicines include; anticonvulsants (to control seizures), Corticosteroids or diuretics (to reduce the swelling), and painkillers. Some may need blood transfusions or platelet transfusions.

Subarachnoid Hemorrhage

Subarachnoid hemorrhagic stroke is caused by a bleeding in the subarachnoid space. The swelling caused by bleeding from a subarachnoid hemorrhage causes the blockage of blood supply towards a certain area of the brain which causes more severe swelling which may result to unconsciousness or even death.

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Causes of Subarachnoid Hemorrhage

Eighty-five percent of cases with subarachnoid hemorrhagic stroke is caused by bursts of the cerebral aneurysm. While other causes of subarachnoid hemorrhage are as follows:

• Bleeding in the small aneurysm

• Caused by a non-aneurysmal perimesencephalic hemorrhage. In this case the cause of bleeding is still uncertain but the blood usually occupies the subarachnoid spaces.

• Bleeding from neoplasm or hypertension can cause secondary dissection of bleeding in the subarachnoid causing hemorrhagic stroke.

• Infection

• Cortical thrombosis

• Rupture of the saccular aneurysm

• Atherosclerosis

Symptoms of Subarachnoid Hemorrhage

The most common symptom of a person who is diagnosed with subarachnoid hemorrhagic stroke is severe or thunderclap headache. This headache usually thumps at the back of the head. Other symptoms may include:

• Nausea and vomiting

• Changes in the vision or difficulty in seeing

• Snapping sensation in the head

• Muscle aches especially in the neck and shoulder areas

• Paralysis on one side of the body

• Seizure

• Confusion

• Coma

Complications

Subarachnoid hemorrhage can lead to other serious problems. These include:

• Hydrocephalus

Within 24 hours after a hemorrhage blood clotting may occur. The blood clot may prevent from draining as it normally does, resulting to increased pressure in the skull. Hydrocephalus symptoms include sleepiness, headaches, nausea, vomiting, and confusion. It may also increase the risk of coma or death.

• Vasospasm

After 3 to 10 days after a hemorrhage, swollen arteries may contract limiting the blood flow to the brain and when not enough blood flows into the brain, the brain tissues will not get enough oxygen and die. Symptoms include weakness at one side of the body or loss of sensation, difficulty in using and understanding a language, impaired coordination, and vertigo.

• Second Rupture

Sometimes a week after rapture, a possibility of second rupture will likely occur.

Diagnosis of Subarachnoid Hemorrhage

Tests may include:

• Non-Contrast CT Head

• Lumbar Puncture

• MRI / MRA

• Cerebral Angiogram

• ECG

If all the testing done above has subarachnoid hemorrhage negative result, spinal imaging is considered for a dural fistula or spinal AVM.

Treatment for Subarachnoid Hemorrhage

A person suffering from subarachnoid hemorrhagic stroke needs to be hospitalized right away and complete bed rest is advised. Some other methods of treatment include:

• In case of coma: airway protection, positioning, life support, and placement of drain to relieve intracranial pressure in the brain ventricles.

• Removing of the blood surgically may be recommended.

• To prevent seizures, Phenytoin or other medications are used.

• Treatment like craniotomy (opening a hole in the skull) and clipping of aneurysm or endovascular coiling

• Ventriculostomy is done to improve the patient’s grade and for preparation of a major surgery

Prevention for Hemorrhagic Stroke

On most cases, hemorrhagic stroke are specifically associated with risk factors like high blood pressure, cocaine use, and smoking. Preventing and controlling these risk factors is more important than treating a hemorrhagic stroke.

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