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Hemorrhagic Stroke
Hemorrhagic Stroke Treatment
A hemorrhagic stroke occurs when a blood vessel in the brain breaks, spilling blood into the brain. Hemorrhagic strokes are an emergency and immediate attention is extremely important. Hemorrhagic strokes are not as common as ischemic strokes, accounting for only about 15% of all strokes, but are responsible for more than 30% of all stroke deaths.
There are two types of hemorrhagic strokes:
An intracerebral hemorrhage is caused when a blood vessel within the brain tissue ruptures or breaks, and a subarachnoid hemorrhage is caused when a blood vessel ruptures and blood is spilled around the surface of the brain and under the protective arachnoid layer. While both of these strokes are a result of ruptured blood vessels, they arise from different causes.
Intracerebral hemorrhage (ICH):
This is the most common type of hemorrhagic (bleeding) stroke. This bleeding is the result of a broken blood vessel inside the brain tissue.
Signs and symptoms
Signs and symptoms of a hemorrhagic (bleeding) stroke are not always the same and will depend on where the ruptured vessel is located in the brain and the amount of bleeding. Symptoms of ICH are almost always sudden and may include:
- Sudden, severe headache
- Vomiting or severe nausea
- Sudden numbness or weakness of the face, arm or leg on one side of the body
- Confusion or loss of consciousness
If you experience any of these symptoms, don't wait -- call 911 and get to the nearest hospital that can treat acute strokes.
Causes:
The most common cause of intracerebral hemorrhage is high blood pressure. Another cause is an arteriovenous malformation (AVM), which is a cluster or tangle of blood vessels that are abnormal and weak. These weak blood vessels can break very easily and are usually seen in younger patients (20-40 years old).
Treatment options:
The treatment of ICH will depend on the exact cause and size of the stroke and may include:
- Reducing and controlling blood pressure.
- Surgery to remove blood within the brain tissue or the abnormal vessels (AVM).
- Catheters inserted into the brain to drain the excess fluid.
- Medications and blood products to help the blood clot properly, especially for people who take blood thinning medications.
Subarachnoid hemorrhages (SAH):
This is a result of blood spilling into the protective spaces surrounding the brain.
Causes:
There is no single cause of SAH but the most common is the result of a ruptured or broken aneurysm. An aneurysm is a balloon-like bulge protruding from an artery wall. Blood fills the aneurysm and, like a balloon, the fuller it gets the weaker it becomes until it "pops" or ruptures. More than half of the subarachnoid hemorrhages (SAH) are caused by ruptured aneurysms.
Signs and symptoms:
Many times there is no warning of a SAH. Sometimes the aneurysm will leak before it breaks completely. The most common symptoms of a SAH include:
- Sudden, severe headache usually described as "the worst headache of my life"
- Nausea and vomiting
- Sensitivity to light
- Stiff neck
- Loss of consciousness
Treatment:
Treatment of SAH depends on the cause of the bleeding.
Aneurysms:
Aneurysm ruptures are usually treated by either sealing the aneurysm from the outside or sealing it from the inside. Doctors consider several factors when deciding which treatment option is best:
- Size, location and type of the aneurysm
- Condition of the patient
- Medical history
Surgical clipping:
Clipping is still the most common surgical treatment for brain aneurysms. This treatment seals the aneurysm from the outside and requires general anesthesia. An incision is made into the skull and a section of bone is removed. The surgeon then surgically enters the brain and, using a microscope, carefully separates the aneurysm from the normal blood vessel and clips it with a tiny clip, similar to a clothespin. The clip stops blood from entering the aneurysm.
Endovascular coiling:
This treatment seals the aneurysm from the inside and involves using a tiny catheter that is threaded from the groin artery up into the brain artery and into the aneurysm. Tiny platinum coils are released and packed inside the aneurysm to seal it off. With the advent of this new treatment, some patients who were told their aneurysm was inoperable now have hope for a treatment. For other patients who, because of advanced age, medical condition or other factors could not tolerate open brain surgery, this could be an alternative to their treatment.
