Hemorrhagic stroke (intracerebral haemorrhage) – symptoms and treatment

Proven content

Haemorrhagic stroke (intracerebral haemorrhage) is generally more severe and more rapid than ischemic stroke. It is a cerebral hemorrhage due to a rupture of a cerebral vessel, the first symptom of which is often a sudden loss of consciousness, while conscious patients usually experience severe headache, nausea and vomiting.

Hemorrhagic stroke – definition

A hemorrhagic stroke is a condition characterized by a stroke in the brain. As a rule, it has a more severe and more violent course than ischemic stroke, but like it, it is one of the most common causes of death and disability in people who have so far remained in good health. In Poland, the incidence among women is 125 cases per one hundred thousand inhabitants, and in men – 177 cases per one hundred thousand inhabitants. A hemorrhagic stroke is a condition that can occur at any age, but the greatest risk is among those between the ages of 50 and 70. The cause of a cerebral hemorrhage is a rupture of a vessel.

What are the causes of a hemorrhagic stroke?

Haemorrhagic stroke occurs mainly in people with arterial hypertension, who may have ruptured small aneurysms. In more than half of patients, haemorrhagic stroke is associated with hypertensive disease, while in people over 70, the most common etiological factor is the accumulation of pathological protein (amyloid) within the vessels.

There are also risk factors that increase a hemorrhagic stroke, including:

1. alcohol abuse, which causes renal hypertension and vascular complications;
2. a family history of hemorrhagic stroke;
3. congenital or acquired hemorrhagic diathesis (excessive thinning of the blood);
4. complications of taking anticoagulants;
5. malignant tumors located in the central nervous system, e.g. glioblastoma multiforme,
6. tumor metastasis to the brain, e.g. melanoma.

Hemorrhagic stroke – symptoms

A ruptured, torn, and bleeding vessel leads to ischemia of the nervous tissue and a growing hematoma. This hematoma grows very quickly and the swelling of the brain spreads. Due to the inability to expand the bones of the skull and accumulating blood, the syndrome develops increased intracranial pressure. It poses a direct threat to the patient’s life, manifested by:

1. vomiting (usually in the morning, even when fasting),
2. headaches (very severe)
3. speech disorders,
4. problems in understanding speech,
5. paresis (facial numbness, curvature of the lips),
6. trouble breathing,
7. seizure
8. as a consequence: cardiac arrest and respiratory arrest.

The acute form of a hemorrhagic stroke causes the patient to suddenly lose consciousness, in addition, there are fluctuations in arterial pressure and pulse, and hemorrhagic paralysis.

Hemorrhagic stroke – diagnosis

The most important thing is to identify a hemorrhagic stroke and its causes as soon as possible! The most important diagnostic test is computed tomography of the head. It is performed on anyone with symptoms that resemble a stroke. Another examination is magnetic resonance imaging, which is equally effective, but is used much less frequently because this type of equipment is not always available (especially in the emergency room). Sometimes an ECG is also performed. The diagnosis of a hemorrhagic stroke is extended when vascular malformations are suspected.

In hospitalized patients, blood tests are additionally ordered, in the form of:

1. creatinine and transaminases,
2. morphologii,
3. electrolyte concentration tests,
4. glycemia,
5. oxygen saturation of the blood.

Treatment of hemorrhagic stroke

It is said that a patient suspected of having a hemorrhagic stroke should be treated in the same way as a patient suspected of having a heart attack. Immediate medical intervention and hospitalization in the intensive care unit or neurosurgery department is necessary (especially when surgery is required).

The patient is treated with preparations to reduce the swelling of the brain, but their effectiveness has not been proven as accurately as in the case of ischemic stroke. The main therapeutic methods of intracranial hypertension include:

1. hyperventilation,
2. osmoterapia,
3. treatment with barbiturates.

The reduction in intracranial pressure should be gradual (not abrupt) and should not exceed 20% of the baseline value. For this purpose, intravenous drugs are used. In turn, in people with a family history of hypertensive diseases and with symptoms of chronic hypertension, they should be reduced. On the other hand, in people with no history of hypertensive disease, the aim is to lower the blood pressure when the systolic value exceeds 160 mm Hg, and the diastolic value exceeds 95 mm Hg.

In the treatment of hemorrhagic stroke, prevention and treatment of complications are of great importance:

1. systemic (pressure ulcers, pulmonary embolism, deep vein thrombosis, infections),
2. neurological disorders (epilepsy, secondary bleeding).

Rehabilitation

It should be implemented as soon as possible, as soon as the general condition of the patient is stabilized. The time needed for the patient to recover is about 3-6 months, so make the best use of this time. Early rehabilitation not only reduces the risk of disability after a stroke, but also reduces the risk of complications, e.g. thromboembolic changes. Speech and movement rehabilitation as well as occupational therapies evoke a positive mood in the patient and inspire him with greater hope and a desire to recover. It should be carried out under the watchful eye of a physiotherapist, speech therapist, neuropsychologist, occupational therapist – cooperating with the attending physician. Rehabilitation methods should be selected to be as useful as possible for the patient.

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What’s the prognosis?

The prognosis for a hemorrhagic stroke is mainly influenced by the extent of the stroke, age, time when the patient was treated and the presence of additional diseases. Mortality in this ailment is about 40-60% within a month after a stroke. The prognosis improves if the patient survives the first month after the episode.

Among the most serious complications of a hemorrhagic stroke are:

1. swelling of the brain (usually starts in the first days of bleeding and can increase up to two weeks after stroke)
2. intraventricular hemorrhage,
3. recurrent bleeding (occurs several hours after the stroke).

Hemorrhagic stroke – prophylaxis

In hemorrhagic strokes, it is important to reduce blood pressure to a value that is normal for a given age, gender, and health condition. Only proper treatment of high blood pressure can reduce the risk of a stroke by up to half. Blood pressure is also influenced by a proper diet aimed at maintaining a proper body weight; physical activity; quitting smoking; restriction in the diet of table salt.

WARNING! It is not possible to locate the vessel in the brain early.