Hemorrhagic Stroke

This type of stroke is also called " intracerebral hemorrhage". The common history is that of long standing high blood pressure, that is poorly controlled. This leads to accelerated arteriosclerotic changes of the brain vessels and wherever the weakest spot is, that' s where suddenly an arterial blood vessel blows a hole and it bleeds to that part of the brain. The result is a devastating sudden stroke, which tends to very quickly lead to a coma and often to death. This is the type of stroke that Ariel Sharon, the Israeli Minister President suffered.

Other causes are: chronic illicit drug use, underlying collagen vascular disease or congenital vascular malformations.

Symptoms:

There is an abrupt beginning with an acute headache followed by increasing neurological signs. If the bleed is located in one of the brain hemispheres, paralysis of the opposed side of the body develops.

With a bleed into the brain stem, which is also common, eye symptoms with blindness and double vision followed by excessively deep breathing and coma will follow.

The brain stem harbors vital centers such as the breathing center and nerves that control eye movement and hemorrhage into these vital areas are usually very lethal. Unfortunately, if patients with brain stem strokes survive, they can be "locked into the brain stem". They understand, hear, see, can think, but cannot express what they feel and think. If the breathing center is permanently damaged they depend on a respirator from then on and after weeks and months they often succumb to secondary infections.

Diagnosis:

Emergency CT scan will show the cerebral hemorrhage as a hyperdense area. The MRI scan can also be done, but it is more difficult to perform and the radiologist needs to have more experience to interpret the difference between hemorrhagic and ischemic strokes. Also, CT scans are more available throughout the country. Here is an image of a CT scan from a patient with a hemorrhagic stroke of the left middle cerebral artery (arrow points to it).

Treatment:

Neurosurgical evacuation of the clot, if it is bigger than 3 cm (=1 1/4 inches) in diameter, often is life saving. However, in elderly patients bleeding often reoccurs as the blood vessels are very brittle and such surgery may have a high mortality rate.

The neurosurgeon consulting regarding a patient would be able to make specific recommendations after examining this patient and evaluating the CT scan images. If surgery is not necessary, treatment would be similar as for the ischemic stroke, except that thrombolytic therapy, of course, would not be done. Also antiplatelet drugs like ASA would not be given. Headaches would be relieved with narcotic medication; nausea and vomiting would be controlled with prochlorperazine (brand name: Stemetil).

Extensive rehabilitation is needed to help minimize the long-term effect of the hemorrhagic stroke.

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Cardiovascular Disease

Strokes

Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

1. KH Lee et al. Arch Neurol 2000 Jul 57(7): 1000-1008.

2. S Schmulling et al. Stroke 2000 Jul 31(7): 1552-1554.

3. D Jackson et al. Clin Rehabil 2000 Oct 14(5): 538-547.

4. ML Hackett et al. Neurology 2000 Sep 12; 55 (5): 658-662.

5. K Tsutsumi et al. J Neurosurg 2000 Oct 93( 4): 550-553.

6. IS Spetzler Surg Neurol 2000 Jun 53(6): 530-540.

7. G Lot et al. Acta Neurochir (Wien) 1999; 141(6): 557-562.

8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 174.

9. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby Inc.

12. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: Jan. 13, 2012