Brain Bleed And Stroke: Understanding The Link

Hemorrhoids are swollen veins in and around the anal canal. They can be internal, forming inside the anal passage, or external, forming outside the anus. They are usually not dangerous, but they can be very painful and may cause rectal bleeding. They are linked to activities that put more pressure on the anal passage, such as constipation, diarrhea, and heavy lifting. While hemorrhoids themselves do not cause strokes, studies have found an association between hemorrhoids and an increased risk of developing coronary heart disease and peripheral artery occlusive disease, which are leading causes of strokes.

Intracerebral haemorrhage

ICH accounts for 10-15% of all strokes and is the second most common cause of stroke, affecting 15-30% of stroke patients. It is also the most deadly, with a 40% risk of death. ICH has a higher prevalence among men and racial minorities, including African Americans and Asians, possibly due to higher rates of hypertension in these populations. Other risk factors include age, previous history of stroke, alcohol and drug use, liver disease, and the use of blood thinners.

The symptoms of ICH include sudden onset of headache, nausea, vomiting, lethargy or confusion, weakness or numbness in the face, arm or leg, usually on one side, and loss of consciousness. These symptoms are similar to those of an ischemic stroke but can also include a smooth progressive onset over minutes to hours.

Diagnosis of ICH is typically made through a non-contrast computer tomography (CT) scan, which can reveal the extent of the haemorrhage, including the size, surrounding oedema, mass effect, intraventricular clot extension, and raised intracranial pressure. Magnetic resonance imaging (MRI) is also used, particularly T2-weighted and gradient-echo sequences, to identify old clots, although it is less readily available and takes more time.

Treatment of ICH focuses on stopping the bleeding, removing the clot, and relieving intracranial pressure. Non-surgical treatments include clotting factor administration, blood pressure control, and intracranial pressure management. Surgical treatments, such as craniotomy and stereotactic clot aspiration, are considered for patients with favourable locations for surgical evacuation and those who are less than 50 years of age.

The prognosis for ICH is poor, with approximately 70% of patients experiencing long-term deficits. The mortality rate at 30 days can be as high as 50%, with most deaths occurring within the first 24 hours. Early medical attention is crucial to improving outcomes, as the damage caused by increased intracranial pressure over time may be irreversible.

Subarachnoid haemorrhage

The most common cause of subarachnoid haemorrhage is a ruptured aneurysm, which is a weak area in a blood vessel on the brain's surface that bursts and leaks. Aneurysms often develop over a long period, usually after the age of 40, and may not cause any symptoms before rupturing. Other causes include arteriovenous malformations (AVMs), which are abnormal tangles of blood vessels that disrupt normal blood flow and oxygen circulation.

The classic symptom of subarachnoid haemorrhage is a sudden and severe headache, often described as the "worst headache of my life". Other symptoms include nausea, vomiting, sensitivity to light, blurred or double vision, stroke-like symptoms such as slurred speech and weakness on one side of the body, and loss of consciousness or convulsions. These symptoms may occur during physical activities such as coughing, straining, or lifting heavy objects.

If you or someone you know is experiencing these symptoms, immediate medical attention is required. Diagnosis involves a CT scan, MRI scan, angiogram, or spinal tap to confirm the presence of bleeding around the brain. Treatment aims to stop the bleeding and prevent rebleeding, often involving surgery to place a clip or stent on the blood vessel and medication to control blood pressure and prevent vasospasm.

To reduce the risk of subarachnoid haemorrhage, it is important to address risk factors such as smoking, excessive alcohol consumption, high blood pressure, and diabetes. Maintaining a healthy body weight and diet, as well as regular exercise, can also help lower the chances of experiencing this dangerous type of stroke.

High blood pressure as a cause

Haemorrhagic strokes are a form of stroke that occurs when a weakened blood vessel in or on the surface of the brain ruptures and bleeds. They are less common than ischemic strokes, accounting for 10-15% of all strokes. However, they are considered a medical emergency as they can be fatal and often result in long-term disability.

High blood pressure is the most common cause of haemorrhagic strokes. This is because high blood pressure damages arteries throughout the body, creating conditions that make arteries burst or clog more easily. When this happens in the brain, the normal circulation of blood and oxygen is disrupted, and the added pressure can damage or kill brain cells.

High blood pressure can cause small arteries deep inside the brain to rupture, leading to a haemorrhagic stroke. This is especially true if blood pressure is very high or remains high over an extended period. Therefore, maintaining healthy blood pressure levels is crucial for reducing the risk of haemorrhagic strokes. This can be achieved through medication and lifestyle changes, such as a healthy diet, regular physical activity, and managing other health conditions.

In addition to high blood pressure, other factors that can increase the risk of haemorrhagic strokes include smoking, alcohol use, drug use (such as cocaine or amphetamines), high cholesterol, and migraine headaches. Age and gender also play a role, with individuals aged 65 or older and men having a higher risk of haemorrhagic strokes.

Symptoms and diagnosis

A hemorrhagic stroke is a life-threatening medical emergency that requires immediate treatment. It occurs when a blood vessel in the brain breaks and bleeds, disrupting normal blood circulation and oxygen supply to the brain. The bleeding can happen inside the brain (intracerebral hemorrhage) or between the brain and its outer covering (subarachnoid hemorrhage).

Symptoms

The symptoms of a hemorrhagic stroke are often severe and rapid in onset. They can include:

• A sudden, intense headache, often described as the "worst headache of your life"
• Double or blurry vision
• Loss of vision
• Dizziness or loss of balance
• Confusion or lethargy
• Memory problems
• Loss of consciousness
• Weakness, paralysis, or numbness, usually on one side of the body
• Difficulty speaking or understanding speech
• Slurred or garbled speech
• Loss of senses, such as vision, hearing, or touch
• Sensitivity to light
• Stiffness or pain in the neck or shoulders
• Seizures

Diagnosis

If a hemorrhagic stroke is suspected, it is crucial to call emergency services immediately. Doctors will perform a rapid physical examination and take a detailed medical history. They will also use imaging tests to confirm the diagnosis and locate the cause of the stroke. These tests may include:

• Computed Tomography (CT) scan, which is the fastest and most widely available method to rule out a hemorrhagic stroke
• Magnetic Resonance Imaging (MRI) scan, which can show the location of the hemorrhage and any prior strokes
• Electrocardiogram (EKG)
• Blood tests, such as a complete blood count (CBC), blood glucose test, and coagulation studies, to rule out other conditions
• CT angiography to examine blood vessels for aneurysms or arteriovenous malformations (AVMs)
• Lumbar puncture (spinal tap) to test for subarachnoid hemorrhage if a CT scan is inconclusive

Treatment

Hemorrhagic strokes are life-threatening and require immediate medical attention. Treatment for a hemorrhagic stroke depends on what caused it, where it's located, and the size of the hemorrhage. Here is a detailed overview of the treatment options:

Locating the Source of the Bleed

The first step in treating a hemorrhagic stroke is to locate the source of the bleed and stop the bleeding. This may involve performing imaging tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to identify the location and extent of the hemorrhage.

Surgical Procedures

Once the source of the bleed is located, surgical procedures may be performed to stop the bleeding and reduce the pressure in the brain. This can include:

• Surgical clipping: Involves placing a surgical clip around the base of the aneurysm or damaged blood vessel to stop the bleeding.
• Coil embolization: A minimally invasive procedure where a catheter is directed through the blood vessels into the aneurysm, and soft platinum micro-coils are placed and detached to seal off the aneurysm.
• Craniotomy: In cases of severe brain swelling, a craniotomy may be necessary, where a small section of the skull is opened to relieve pressure on the brain.
• Burr hole removal: A minimally invasive procedure to drain the skull and decrease pressure in the brain.
• Endovascular embolization: Blocking off abnormal blood vessels using small tubes (catheters) and materials such as glue or coils.
• Endovascular surgical blocking: Used specifically for treating dural fistulas, by blocking off the abnormal connections causing the fistula.

Medications

Medications may also be given to reduce swelling, prevent seizures, and manage pain. If the patient is taking blood thinners or other anti-clotting drugs, medication may be given to counter their effects and prevent excessive bleeding. Additionally, blood pressure medication may be prescribed to lower pressure in the brain.

Rehabilitation

Following emergency treatment, patients typically undergo a program of rehabilitation to help recover function, return to independent living, and manage any long-term complications. This may include physical therapy, speech therapy, and occupational therapy.

Lifestyle Changes

Lifestyle changes are also important in the long-term treatment and prevention of hemorrhagic strokes. This includes quitting smoking, maintaining a healthy weight, exercising regularly, following a healthy diet, and managing existing medical conditions such as high blood pressure, high cholesterol, and diabetes.

Frequently asked questions