Hemorrhagic Stroke: Recovery And Rehabilitation Possibilities

Hemorrhagic stroke is a medical emergency that requires immediate treatment. It occurs when a ruptured blood vessel disrupts blood flow to the brain, causing brain cells to die and resulting in permanent brain damage. The effects of a hemorrhagic stroke depend on the area of the brain affected and can include difficulty with speech, movement, and thinking, as well as mental health challenges. The recovery process can be lengthy, lasting months or even years, and may involve rehabilitation to help restore function and improve quality of life. While some people may never fully recover, others can achieve long-term functional independence. The outlook for recovery depends on the severity of the stroke, the amount of tissue damage, and how quickly treatment is received.

The two types of hemorrhagic stroke

There are two types of hemorrhagic strokes: intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).

Intracerebral Hemorrhage (ICH)

ICH is the most common type of hemorrhagic stroke, accounting for about two-thirds of all cases. It occurs when blood leaks out of a blood vessel and into the brain tissue, sometimes deep inside the brain. This can cause severe damage to brain cells and affect how the body functions, including changes in thinking, communication, and emotions. ICH is often caused by high blood pressure and can lead to coma or death.

Subarachnoid Hemorrhage (SAH)

SAH is the less common type of hemorrhagic stroke, causing about 5% of all strokes. It occurs when blood leaks out of a blood vessel on the surface of the brain and into the protective layer of fluid surrounding the brain, known as the subarachnoid space. This layer acts as a cushion to protect the brain from injury. SAH is often due to an aneurysm or an arteriovenous malformation (AVM) and can result in a sudden, severe headache, known as a "thunderclap headache". Other symptoms include a stiff neck, nausea, and vomiting.

Risk factors

• High blood pressure
• Old age (over 65)
• Family or personal history of stroke
• Uncontrolled diabetes
• High cholesterol
• Smoking
• Obesity
• Lack of exercise
• Poor diet
• High alcohol consumption
• Cerebral amyloid angiopathy, where proteins collect in the blood vessels in the brain
• Blood vessel malformations, such as cerebral cavernous malformation, cerebral aneurysm, and arteriovenous malformation
• Chronic liver disease
• Low levels of low-density lipoprotein cholesterol and low triglycerides
• Dual antiplatelet therapy
• Use of recreational drugs, such as cocaine
• High levels of stress and anxiety
• Certain medical conditions, such as a bleeding disorder or sickle cell disease
• Use of blood-thinning medication

Symptoms

A hemorrhagic stroke is a medical emergency that requires immediate treatment. It occurs when a blood vessel in the brain ruptures and disrupts blood flow, causing bleeding in or around the brain. This can lead to severe morbidity and high mortality, with worse outcomes the longer it goes untreated.

The symptoms of a hemorrhagic stroke can vary from person to person but are almost always present immediately after the stroke occurs.

Some common symptoms of a hemorrhagic stroke include:

• A sudden, severe headache, often described as a thunderclap headache and sometimes accompanied by sensitivity to light. This is very likely with a subarachnoid hemorrhage (SAH) but can also happen with an intracerebral hemorrhage (ICH).
• Total or limited loss of consciousness.
• Weakness or numbness in the face, leg, or arm on one side of the body.
• Problems with speech or swallowing.
• Confusion or disorientation.
• Vomiting and nausea.
• Stiff neck.
• Inability to move or feel.
• Irritability.
• Muscle pain in the neck and shoulders.
• One eye pupil being larger than the other.
• Seizures.
• Loss of balance or coordination.
• Difficulty seeing in one or both eyes.
• Changes in heartbeat and breathing.

The FAST test is a widely recognised method to help identify a stroke. Some of the signs to look out for include:

• Facial drooping: Does one side of the face droop when the person smiles?
• Arm weakness: When they lift both arms, does one arm drift downwards?
• Speech difficulties: Is the person's speech slurred?

If you observe any of these signs, it is imperative to call the emergency services immediately, as prompt treatment is crucial to improving the outlook for recovery.

Treatment

Medication

Doctors can use medications to reduce blood pressure or slow down the bleeding. If the patient is on blood thinners, doctors will usually give medications to counteract their effects. After the procedure, doctors typically give medication to reduce blood pressure, pain, anxiety, headaches, and/or seizures.

Surgery

For more severe strokes, surgery may be required to repair the ruptured blood vessel and stop the bleeding. If the stroke is due to an arteriovenous malformation (AVM), doctors may surgically remove it. In the case of brain swelling, a surgical procedure known as a craniotomy may be necessary.

Rehabilitation

Following emergency treatment, the patient will likely have a rehabilitation program to recover as much function as possible and return to independent living. The extent of recovery will depend on the area of the brain affected and the amount of tissue damage.

Recovery

Hemorrhagic strokes are caused by bleeding in or around the brain, which can damage brain cells and affect how the body works and how a person thinks, communicates and feels. Recovery from a hemorrhagic stroke depends on the severity of the stroke, the amount of tissue damage, and how soon the patient receives treatment. The recovery period is often long, lasting months or even years. However, most people with small strokes and no additional complications during their hospital stay can function well enough to live at home within weeks.

Treatments

Treatments for hemorrhagic strokes include surgery to repair the ruptured blood vessel and stop the bleeding, and medication to reduce blood pressure or slow down the bleeding. In some cases, doctors may perform a craniotomy, a surgical procedure where a small section of the skull is opened to relieve pressure on the brain caused by bleeding.

Rehabilitation

Rehabilitation is an important part of recovery from a hemorrhagic stroke. This may include occupational therapy, speech therapy, physical therapy, and medication to manage any impact on mental health. The goal of rehabilitation is to help the patient recover as much function as possible and return to independent living.

Prognosis

The prognosis for patients who have suffered a hemorrhagic stroke varies. According to a 2020 study, only about 34% of people who experienced a hemorrhagic stroke survived past the first year. However, researchers estimate that around 12-39% of people are able to achieve long-term functional independence. The impact of a hemorrhagic stroke depends on the location and severity of the damage, as well as how quickly the patient receives treatment.

Frequently asked questions