A stroke is the death of brain tissue that occurs when the brain does not get enough blood and oxygen. Hemorrhagic stroke is a serious condition that occurs when blood seeps into the brain tissue from a damaged blood vessel.
A hemorrhagic stroke occurs when blood vessels in the brain burst and release blood into the the brain. This prevents normal blood flow to brain cells in the area of the hemorrhage, causing cell death. In addition, the blood can damage nearby brain cells by pushing them out of their normal place.
The products released when cells die cause swelling in the brain. Since the skull has little room for expansion, this swelling can lead to increased pressure within the skull and damage the brain tissue even further, leading to coma or death.
Strokes can cause many different signs and symptoms, depending on the area of the brain that is damaged. Some people have multiple areas of damage. Most strokes begin suddenly, develop rapidly, and cause brain damage within minutes. Signs or symptoms may include: problems with movement, such as weakness, clumsiness, or paralysis. These are often on only one side of the body. In some cases, people may only have weakness or clumsiness in their hand. In other cases, one entire half of the body becomes paralyzed.headachenumbness or a lack of feeling, which is also often on only one side of the bodyspeech impairments, including slurred speech or difficulty finding the correct worddifficulty doing math or writingdifficulty understanding speech or writinginability to recognize family members or common objectsvisual impairment, including blurred vision, double vision, or vision losshearing impairmentpersonality changesdifficulty swallowingbalance problemscomathe inability to breathe on one's own. This may require a person to be put on an artificial breathing machine, or ventilator.
A hemorrhagic stroke may be associated with: high blood pressureheart diseasehigh cholesteroldiabetesprevious history of strokediabetes mellitus abnormal bleeding from blood-thinning medications, such as warfarin or heparinhemophilia A or hemophilia B, which are blood disorders that prevent normal blood clottinglow numbers of platelets, a type of blood cell involved in blood clotting. Low platelet counts are seen in a number of diseases and conditions, including acute infections and a severe allergic reaction known as anaphylactic shock.rupture of a cerebral aneurysm, or weakened blood vessel wall within the brainsickle cell disease, an inherited condition that results in abnormal red blood cellsa group of abnormal blood vessels within the brain known as an arteriovenous malformation or AVMhead injurieseclampsia, a complication of pregnancy that causes high blood pressure in the mothercocaine usephenylpropanolamine, a compound contained in appetite suppressants and cold remedies, significantly increased the risk of hemorrhagic stroke in women 18 to 49 years of age. The Food and Drug Administration (FDA) has since required manufacturers to remove phenylpropanolamine from their product lines.
Some hemorrhagic strokes can be prevented through careful control of the underlying disease or disorder. For individuals with diagnosed cerebral aneurysms, guidelines for monitoring and treatment should be followed. Hemorrhagic stroke from head injuries can be minimized by following sports safety guidelines for children, adolescents, and adults.
The American Heart Association (AHA) guidelines for stroke prevention address both modifiable and less well-documented or potentially modifiable risk factors.
Measures to reduce the modifiable risk of high blood pressure, a leading cause of stroke, include: measurement of blood pressure in adults at least every 2 years to screen for high blood pressureweight controlphysical activitymoderation in alcohol intakemoderate sodium intakefor those who smoke, quitting smokingmedications to treat high blood pressure if the person's blood pressure is over 140/90 after 3 months of these lifestyle modifications, or if the initial blood pressure is over 180/100
Other measures to reduce an individual's modifiable risk factors for stroke may include: smoking cessation using nicotine patches, counseling, and formal smoking programscontrol of blood sugar levels in a person with diabetes through medication, diet, and exercisecareful evaluation of asymptomatic carotid stenosis to determine the need for surgery
Carotid artery surgery, such as an endarterectomy or carotid stenting, may be indicated. An endarterectomy opens the narrow portion of the artery and increases the blood flow to the brain. People with carotid stenosis should also work closely with their healthcare professionals to control other risk factors for stroke. semiannual screening of children with sickle cell anemia, using ultrasound to determine the child's risk of stroketreatment of atrial fibrillation with blood thinners such as aspirin or warfarin, depending on the person's age and other risk factorsmonitoring of high levels of total cholesterol or LDL, as well as low levels of HDL
Depending on the blood levels and the person's other risk factors, medications to lower cholesterol may be given.
Measures to reduce less well-documented or potentially modifiable risks for stroke may include: weight reduction in overweight persons30 or more minutes of moderate exercise a day for most individuals. People with heart disease or disabilities should be in a medically supervised exercise program.a healthy diet for heart disease, containing at least 5 fruits and vegetables a dayfor those who drink alcohol, drinking in moderation. The AHA defines moderate drinking as no more than 2 drinks a day for men and 1 drink a day for women.seeking treatment for drug abuse monitoring of blood levels of homocysteine. For most individuals, a well-balanced diet following the food guide pyramid will provide enough folic acid and B vitamins to maintain a healthy homocysteine level. For people with elevated homocysteine levels, supplements containing folic acid and B vitamins may be recommended.avoiding the use of oral contraceptives in women with other stroke risk factors
Some people have early warning signs that they are at risk for strokes. The most common warning sign is what is known as a transient ischemic attack (TIA). This is a type of reversible stroke that often goes away after a few minutes. These people can often get treatment that will prevent a stroke in the future. For instance, people may be advised to take aspirin or have carotid artery surgery to correct a blockage in a neck artery.
Cranial MRIs and cranial CT scans may be ordered to show the type, size, and location of the stroke.
Blood tests may be done if the person is on blood-thinning medication. Blood flow tests using ultrasound or angiography may be used.
Strokes can cause death or permanent disability. Though many people recover some function in the first several months after a stroke, others show no improvement. Some people have several small strokes over time and slowly get worse with each one.
Strokes are not contagious and pose no risk to others.
If someone has the early warning signs of stroke, the emergency medical system should be contacted immediately. These signs include a sudden onset of: severe headacheweakness or numbness of the face, arm, or leg, especially on one side of the bodydizzinesstrouble walking or loss of balance, known as ataxiaconfusionspeech impairments, including trouble speaking or understanding speechvisual impairments
Supportive therapy may also be needed with some strokes. This may include a ventilator (artificial breathing machine), and an artificial feeding tube if the person cannot swallow. Rehabilitation services can help to improve a person's function after a stroke. Physical therapy and other therapy, such as speech therapy or occupational therapy, may be used to maximize recovery.
Side effects depend on the treatments used. For example, a ventilator may sometimes damage the lungs or cause an infection.
After the person is stable, treatment of the risk factors for stroke, as well as the cause of the stroke, is important to prevent further strokes. For instance, anyone who smokes should stop, and blood pressure, blood sugar, and cholesterol levels must be controlled.
Many people need assistance of one form or another after a stroke. The need may range from a walking cane to 24-hour-a-day skilled nursing care. Ongoing therapy to improve function is usually advised for at least 6 months if the person is able.
People having a stroke are often admitted to the hospital for close monitoring. Once the person is stable, he or she can often be sent home or to a skilled nursing facility or rehabilitation center for further therapy. Any new or worsening symptoms should be reported to the healthcare professional.
