Hemorrhagic Stroke

Hemorrhagic Stroke Overview

A hemorrhagic stroke occurs because of a leak or rupture of a blood vessel in the brain. There are two types of stroke, hemorrhagic and ischemic , which occurs when a blood vessel to the brain is blocked by a clot. Hemorrhagic stroke represents about 15% of all strokes, yet is responsible for more than 30% of stroke deaths.

Stroke, which is sometimes called “brain attack,” is the fifth most leading cause of death for Americans and is the leading cause of adult disability. Stroke is more common in women than in men. Each year approximately 800,000 Americans will suffer a stroke and 130,000 will die as a result.

There are two types of hemorrhagic stroke:

Intracerebral hemorrhage (ICH): A blood vessel in the brain bursts, spilling blood into the brain, damaging cells and depriving the region of the brain beyond the rupture of blood. The cause is usually high blood pressure. ICH is the most common type of hemorrhagic stroke.
Subarachnoid hemorrhage (SAH): An artery on or near the surface of the brain spills into the space between the brain and the skull. The typical cause of ICH is the rupture of an aneurysm, which is a weak spot in the artery.

Wellstar physician’s are experts at diagnosing and treating ischemic and hemorrhagic stroke.

Wellstar Kennestone Hospital located in Marietta offers a full service neuroscience program for stroke and other neurological emergencies. Kennestone is one of the few comprehensive cerebrovascular neurosurgery programs in the region, offering state-of-the-art procedures for both open and closed vascular and endovascular procedures for stroke and carotid artery disease. Kennestone is proud to offer the highest level of specialized care in order to meet the needs of our region and beyond. In addition, Wellstar Kennestone offers a CARF certified in-patient Rehabilitation program on campus.

Wellstar participates in clinical trials that let patients participate in the latest stroke research and take advantage of emerging drugs and treatments. As well, we are now part of the Mayo Clinic Care Network. This provides our doctors and other specialists with access to Mayo-reviewed medical information and guidelines.

Symptoms

Call 911 immediately if you believe you or someone else is having a stroke! Think of the acronym FAST to remember symptoms.

F- Facial drop or uneven smile

A- Arm/leg numbness or weakness, loss or coordination or balance

S- Slurred speech, difficulty speaking or understanding simple commands

T- Time to call 911 and get to the hospital immediately; note the time so you'll know when the first symptoms appeared

In addition to the F.A.S.T. symptoms (facial droop, arm/leg weakness/loss of coordination or balance, slurred speech and difficulty speaking or understanding simple commands), other signs of a stroke include:

Partial or total loss of consciousness
Vomiting or severe nausea when combined with other symptoms
Sudden severe headache with no known cause
Dizziness
Paralysis on one side of the body or face (if you try to raise both arms over your head and one begins to fall, it may indicate a stroke)
Vision problems/intolerance to light
Stiff neck
Sudden trouble seeing in one or both eyes

Not all symptoms will be apparent with every stroke. If any of these symptoms appear, get immediate medical help—call 911

Risk Factors

Some risk factors for stroke are the same for men and women:

High blood pressure, which is responsible for about 60% of all cases of ICH
Family history of stroke
Atrial fibrillation (irregular heartbeat) and taking blood thinners
Heart disease
Heart attack
High cholesterol
Cigarette smoking
Diabetes
Being overweight
Physical inactivity
Race. Black people have a higher risk of death from stroke than caucasians
Age. The risk of stroke approximately doubles each decade after age 55
Excessive use of alcohol and drugs
Blood clotting disorders such as hemophilia or sickle cell anemia

Hemorrhagic Stroke Prevention

Primary prevention refers to steps taken to prevent a first stroke. Talk with your doctor about appropriate primary prevention methods like taking blood pressure medication as prescribed, managing Diabetes as well as stress. Other prevention methods include lifestyle changes such as:

Stop or don’t start smoking
Eat a healthy diet rich in fruits in vegetables, high in potassium and low in saturated fats and sodium
Get regular exercise. Talk with your physician before starting an exercise program
Maintain a healthy weight
Limit consumption of alcohol

Medical Treatment

Your Wellstar physician may recommend certain medications and steps to control high blood pressure and/or manage atrial fibrillation in high-risk patients.

Antihypertensives: These medicines treat high blood pressure (hypertension). They lower blood pressure by opening the blood vessels, decreasing the blood volume or decreasing the rate and/or force of heart contractions.
Anticoagulants/antiplatelets: Drugs like aspirin and warfarin interfere with the blood’s ability to clot and can play an important role in preventing stroke. People with atrial fibrillation are generally considered candidates for warfarin therapy.
Control diabetes.
Reduce blood pressure; aim for below 140/90 mm Hg. Some patients, including those with diabetes, chronic kidney disease and atherosclerosis (hardening of the arteries) should aim for a blood pressure below 130/80.
Reduce LDL (“bad”) cholesterol. Ask your doctor about statin drugs to see if these cholesterol-reducing medications may be right for you.

Surgery

Surgical treatment may be used to stop the bleeding in a hemorrhagic stroke. If the bleed is caused by a ruptured aneurysm, a metal clip may be placed surgically at the base of the aneurysm to secure it. Some endovascular (minimally invasive) surgical procedures may be recommended. These involve the use of a catheter introduced through the arm or leg, then guided to the aneurysm or other malformation. The catheter deposits a coil or other mechanism to prevent rupture.

Hemorrhagic Stroke Diagnosis

Immediate medical attention is essential following a stroke. Once a patient arrives at the hospital Wellstar physicians will use a computer-imaging test to determine the type of stroke and the area of the brain affected. If doctors suspect a blood vessel abnormality they may perform an angiogram. This is an X-ray test that provides a picture of the blood vessels in the brain.

Your Wellstar physician will ask about symptoms, their timing, what you were doing when they began and whether you still have them. The doctor will want to know about all medications you take, whether you’ve had a head injury and any family history of stroke or heart disease.

Tools and Tests

Wellstar physicians use various brain imaging techniques to determine if you are having/had a stroke, the type and where it is occurring. Imaging methods include:

Computerized tomographic angiography (CTA) uses a dye injected in the bloodstream and X-rays to create a 3D image of the blood vessels of the neck and brain, revealing bleeding in or around the brain. If none is found, a diagnosis of ischemic (blockage) stroke is made.
Magnetic resonance imaging (MRI) also creates a 3D image of the brain.
Carotid ultrasounduses sound waves to reveal narrowing or clotting in the carotid arteries of the neck.
Arteriography involves injection of a dye into a specific artery through a catheter to provide X-ray images.
Echocardiography is an ultrasound image to determine if a clot from the heart has traveled to the brain, causing a stroke.

Hemorrhagic Stroke Treatment

Treating a hemorrhagic stroke involves controlling bleeding and reducing pressure on the brain. Once bleeding stops treatment includes bed rest while the body reabsorbs the blood, as it would with a large bruise. In some cases surgery may relieve the pressure of blood on the brain or repair the leaking vessel.

Treatment of ICH involves medical and surgical techniques that vary according to the cause and size of the stroke. When ICH is caused by high blood pressure, doctors try to reduce the blood pressure, then address the swelling or pressure that build up inside the head after the blood vessel ruptures. Surgery may be needed to limit the damage to brain cells.

Treatment of SAH targets the cause of bleeding and its complications. Ruptured aneurysms are usually repaired through surgery to clip the aneurysm, or to treat it from inside the vessel. Operating on the aneurysm from the inside (embolization) is done by guiding a small metal coil through the brain artery until it reaches the aneurysm. There, the coil allows for a clot to form and to prevent more blood from entering.

Vasospasm is a condition in which vessels become irritated by blood and begin to spasm. Treatment for this condition includes the use of the oral medication nimodipine, or by closely monitoring the pressure, volume and concentration of blood in the brain.

Treating Risk Factors

After initial treatment your doctor will treat your risk factors, including by recommending lifestyle changes like quitting smoking, following a healthy diet, maintaining a healthy weight and being physically active. If these are not enough, medicines may be prescribed to control the risk factors.

Ongoing Care for Hemorrhagic Stroke

Stroke is a leading cause of disability in adults and places a great burden on patients and their families. However, even if portions of the brain are lost in a stroke, patients can benefit from excellent therapies.br>
After emergency treatment, your Wellstar neurologist will work to develop an individualized rehabilitation program with the specialists at the Wellstar Kennestone Outpatient Neuro-Rehabilitation program. The program serves patients in the acute care hospital setting, inpatient rehab unit and outpatient settings.

There are four locations—Cobb Hospital, Kennestone Hospital, Douglas Hospital (speech only) and Windy Hill Hospital (speech only).

Physical therapists, occupational therapists and speech therapists address issues including:

Regaining independence with daily activities
Regaining functional use of arm and hand
Restoring mobility
Improving balance
Improving cognitive (thinking) skills including memory and attention
Improving language and word-finding skills
Swallowing difficulties
Patient and family education
Brain injury support groups at the Marietta campus (free of charge)
For a support group near you please visit: Brain Injury Association of Georgia

If the stroke has damaged the parts of the brain responsible for speech, it may be necessary to relearn language skills. Fortunately the brain has a great ability to learn and adapt, so other portions of the brain can be trained to take over lost communication function. With time, survivors of strokes that impact speech usually regain some or all previous language ability.

Many stroke patients also require psychiatric or psychological care including counseling and medication to help with depression, frustration and anger resulting from their strokes. Under the care and treatment of our Physiatrists and extended care team, all aspects of the stroke survivor is addressed.

Smoking Cessation

Wellstar offers smoking cessation programs that educate people about smoking risks, encourage behavior modification to help minimize smoking urges and offer numerous coping strategies. Several different methods for changing smoking behavior are explored so that individuals learn approaches that work best for them.