Hemorrhagic stroke (intracerebral hemorrhage) – causes, treatment

Proven content

Intracerebral haemorrhage usually has a more severe and severe course compared to ischemic stroke. Often the first symptom is an unexpected loss of consciousness and, as a rule, severe headache, nausea and vomiting are observed in conscious patients. It is not uncommon to see an increase in blood pressure. Complications may occur, e.g. pulmonary embolism.

Hemorrhagic stroke – characteristics

A haemorrhagic stroke is a medical condition and a life-threatening emergency, often called an intracerebral hemorrhage or cerebral hemorrhage. Blood extravasates as a result of vessel rupture within the brain. Haemorrhagic stroke is one of the most common causes of death and disability in previously healthy people. According to research in Poland, about 177 per 100 inhabitants (men) and 000 per 125 in women suffer from a stroke. Mortality is around 100 deaths per 000 people. The most severe course and the worse prognosis are haemorrhages, in which the hematoma breaks into the ventricular system of the brain, which contains the cerebrospinal fluid. Intracerebral haemorrhage is a disease that can occur in people of all ages, although people aged 65-100 have the greatest predisposition.

The causes of hemorrhagic stroke

The main factor increasing the risk of intracerebral haemorrhage is arterial hypertension, more precisely the lack of its treatment or improper treatment. Hypertension damages the walls of the cerebral vessels, making them more prone to rupture. Much less frequent bleeding is observed where there are abnormally built cerebral vessels, usually in the form of a hemangioma or aneurysm. Thus, more than half of hemorrhagic strokes are associated with arterial hypertension, and in patients over 70 years of age the most common cause is hypertension. cerebral amyloid angiopathy, that is, the accumulation of pathological protein – amyloid in the vicinity of the vessels. High pressure causes the walls of small arterioles to harden, making them less resistant and rupturing. In addition, the following contribute to the formation of intracerebral hemorrhage:

1. vasculitis,
2. infective endocarditis,
3. alcohol abuse causing renal hypertension,
4. family history of hemorrhagic strokes,
5. taking certain medications (e.g. heparin, anticoagulants),
6. neoplasms and their metastases,
7. taking drugs,
8. congenital and acquired hemorrhagic diathesis,
9. coagulation disorders due to e.g. congenital diseases.

Spontaneous subarachnoid haemorrhage usually occurs when the aneurysm ruptures. Most often, aneurysms are located at the site of a branching of the vessels and are usually asymptomatic. People with cystic kidney disease and those who smoke are more likely to develop an aneurysm, and therefore a stroke. One of the risk factors for hemorrhagic stroke is ischemic stroke. Then, in people who had a primary ischemic stroke, a secondary bleeding of the focus supplied by this vessel may occur.

Hemorrhagic stroke – symptoms

The symptoms of intracerebral hemorrhage appear suddenly. The torn and bleeding vessel causes acute ischemia of the nervous tissue, accompanied by an enlarging hematoma and rapidly increasing swelling of the brain. The syndrome of increased intracranial pressure occurs due to the inability to stretch the bones of the skull and the mutual pressure on the structures of the brain and the accumulating blood. Increased pressure is accompanied by:

1. nausea,
2. vomiting (sloshing), usually occurring in the morning, regardless of the food eaten,
3. acute headache (described by patients as the strongest of all experienced so far)
4. loss of consciousness,
5. numbness of the face with a curved mouth
6. paresis and speech disorders.
7. seizures
8. sometimes a stiff neck.

With time, the symptoms of a hemorrhagic stroke begin to appear, which pose a direct threat to the patient’s life. They are clinically manifested by coma and respiratory problems. Sometimes focal symptoms of a stroke are observed, which result from the destruction of specific brain structures, but they are not dominant.

Diagnosis of intracerebral hemorrhage

The diagnosis of hemorrhagic stroke and its origin should be made as soon as possible. Most often for this purpose it is performed computed tomography head in all people with symptoms suggesting intracerebral haemorrhage. Another, also effective method is magnetic resonance imaginghowever, it is used much less frequently due to the lower availability of medical equipment, especially in the emergency room. In any case, it is necessary determination of blood pressure. Diagnostics is extended in patients with suspected vascular malformations. In patients hospitalized due to hemorrhagic stroke, the following are additionally performed: morphology, determination of glycaemia, electrolytes, creatinine, aminotransferases, coagulogram and ECG.

Hemorrhagic stroke – treatment

Any patient suspected of having a hemorrhagic stroke should be taken very seriously and seek immediate medical attention. After a stroke is diagnosed, the patient should be admitted to the stroke unit, intensive care unit, or neurosurgery (especially if he or she requires surgery). Surgical treatment should be considered in cases of large hematomas that cause intracranial constriction. This not only increases the chance of survival, but also improves the prognosis of post-stroke disability. Small hematomas, which have only a small swelling zone in the CT image and do not displace the brain structures, are treated conservatively. Drugs that reduce brain swelling and antihypertensive medications are used. The control of intracranial pressure includes, among others osmoterapia and treatment with barbiturates. A sharp reduction in blood pressure is contraindicated, since the area of ​​intracerebral hemorrhage is surrounded by an ischemic zone, which is formed due to the swelling of adjacent tissues. Lowering blood pressure causes this area to widen, causing increased havoc in the brain. Therefore, lowering the pressure should be gradual, for this purpose intravenous preparations are most often used.

Moreover, in post-stroke patients it is important rehabilitationwhich aims to restore psychomotor performance. It is especially needed after a stroke where various structures are damaged, which in turn leads to some disability. At the beginning, during rehabilitation, passive exercises are performed, the type and duration of which depends on the patient’s condition. In order to prevent the appearance of stiffness, contractures and pressure ulcers, it is recommended to rehabilitate immediately after a hemorrhagic stroke. Then the patient is taught to function independently (as far as possible).

One should also remember about the prevention and treatment of neurological and systemic complications, e.g. pneumonia, infections, thrombosis or bedsores. Treatment of high blood pressure can reduce the risk of a stroke by up to half. Blood pressure assessment is a necessary part of the medical examination, but it should also be examined by the patients themselves. An appropriate diet is also important, thanks to which we will maintain a proper body weight and physical activity. For prophylaxis, it is also recommended to consume less table salt and to quit tobacco addiction.

What’s the prognosis?

The prognosis for hemorrhagic stroke is quite serious and depends on which brain structures have been damaged and to what extent. The age of the patient is also important as well as other additional illnesses from which he or she suffers. The mortality rate in hemorrhagic stroke is about 40-60% within 30 days after the stroke. The prognosis improves for those who survive the first month after this episode. The most serious complications of intracerebral haemorrhage include: cerebral edema (in the first days after a stroke), recurrent bleeding (in the first few hours after a stroke) and intracellular haemorrhage.

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