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Hemorrhagic stroke

  • Alternative Names

    Brain bleeding; Brain hemorrhage; Stroke - hemorrhagic


    Treatment

    Treatment includes life-saving measures, relieving symptoms, repairing the cause of the bleeding, preventing complications, and starting rehabilitation as soon as possible. Recovery may occur over time as other areas of the brain take over functioning for the damaged areas.

    IMMEDIATE TREATMENT

    Treatment is ideally administered in an intensive care unit, where complications can immediately be detected. Medical personnel pay careful attention to breathing because sometimes persons with brain hemorrhage develop very irregular breathing patterns or even stop breathing entirely.

    A person having a hemorrhagic stroke may be unable to protect the airway during coughing or sneezing because of impaired consciousness. Saliva or other secretions may go "down the wrong pipe," which is potentially serious and may cause lung problems such as aspiration pneumonia. To treat or prevent these breathing problems, a tube may need to be placed through the mouth into the trachea to start mechanical ventilation.

    The blood pressure may be too high or too low in patients with brain hemorrhage. These problems need to be addressed immediately by doctors. In addition, brain bleeding may cause swelling of surrounding brain tissue, and this may require therapy with some drugs called hyperosmotic agents (mannitol, glycerol, and hypertonic saline solutions).

    Bedrest may be advised to avoid increasing the pressure in the head (intracranial pressure). This may include avoiding activities such as bending over, lying flat, sudden position changes or similar activities. Stool softeners or laxatives may prevent straining during bowel movements (straining also causes increased intracranial pressure).

    Medications may relieve headache but should be used with caution because they may reduce consciousness. This may produce the wrong impression that the patient is getting worse. Antihypertensive medications may be prescribed to moderately reduce high blood pressure. Medications such as phenytoin may be needed to prevent or treat seizures.

    Nutrients and fluids may need to be supplemented if swallowing difficulties are present. This can be intravenous or through a feeding tube into the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

    Positioning, range-of-motion exercises, speech therapy, occupational therapy, physical therapy, and other interventions may be advised to prevent complications and promote maximum recovery of function.

    SURGERY

    Sometimes, surgery is needed to save the patient's life or to improve the chances of recovery. The type of surgery depends upon the specific cause of brain bleeding. For example, a hemorrhage due to an aneurysm requires special treatment (see aneurysm).

    For other types of bleeding, removal of the hematoma may occasionally be needed, especially when bleeding occurs in the back of the brain. Some physicians are currently investigating whether the injection of a "clot buster" inside the hematoma can facilitate the removal of brain hemorrhages through needles or catheters, allowing less invasive surgery.

    One common problem related to brain bleeding is hydrocephalus, which is the accumulation of a water-like fluid within the brain cavities called ventricles. To solve this problem, the fluid may need to be drained with a special procedure called ventriculostomy.

    For AVM, different treatments are available, including surgical removal of the AVM network, radiosurgery (using ionizing radiation to reduce the size of the AVM), and intra-arterial embolization (a procedure in which glue is injected into the AVM to close the connection between arteries and veins).

    LONG-TERM TREATMENT

    Recovery time and the need for long-term treatment are highly variable in each case. Physical therapy may benefit some patients. Activity should be encouraged within the person's physical limitations. Alternative forms of communication such as pictures, verbal cues, demonstration or others may be needed depending on the type and extent of language deficit. Speech therapy, occupational therapy, or other interventions may increase the ability to function.

    Urinary catheterization or bladder or bowel control programs may be required to control incontinence.

    A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show a marked indifference or lack of judgment, which increases the need for safety precautions.

    In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs.

    Behavior modification may be helpful for some patients in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

    Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

    Legal advice may also be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with hemorrhagic stroke.


    Support Groups


    Expectations (prognosis)

    Stroke is the third leading cause of death in developed countries. About one-forth of people who have a stroke die as a result of the stroke or its complications, about one-half have long-term disabilities, and about one-forth recover most or all function.

    Hemorrhagic stroke is less common but more frequently fatal than ischemic stroke.


    Complications
    • Pressure sores
    • Permanent loss of movement or sensation of a part of the body
    • Joint contractures
    • Muscle spasticity
    • Permanent loss of cognitive or other brain functions (dementia)
    • Disruption of communication, decreased social interaction
    • Decreased ability to function or care for self
    • Decreased life span
    • Urinary and respiratory tract infections

    Calling your health care provider

    Go to the emergency room or call the local emergency number (such as 911) if symptoms of stroke occur. A stroke is a "brain attack," and minutes can make a huge difference in disability and death rates.

    Emergency symptoms include seizures or breathing difficulties, loss of consciousness, sudden difficulties with movement or sensation, eating or swallowing difficulties, sudden vision change or loss of vision in one or both eyes, rapid onset of speech changes, and sudden (severe) headache.

    Call your health care provider if the condition of a family member with stroke deteriorates to the point that the person cannot be cared for at home.