Recovering From A Hemorrhagic Stroke: Is It Possible?

A hemorrhagic stroke is a life-threatening medical emergency that occurs when a blood vessel in the brain bursts and bleeds, disrupting blood flow to the brain. This can cause permanent brain damage and even death if not treated immediately. The effects of a hemorrhagic stroke depend on the area of the brain affected, the severity of the stroke, and how quickly the person receives treatment. Recovery from a hemorrhagic stroke can be a long process, and it may include physical, mental, and task-based disabilities. However, with prompt treatment and rehabilitation, many people are able to recover and achieve long-term functional independence.

Emergency treatment for a bleeding stroke

A hemorrhagic stroke is a life-threatening medical emergency that requires immediate treatment. Here is an overview of emergency treatments for a bleeding stroke:

Calling Emergency Services

If you suspect that you or someone around you is experiencing a stroke, call 911 or your local emergency number immediately. Do not drive yourself to the hospital. Time is critical in treating strokes, and calling for an ambulance means that medical staff can begin treatment on the way to the hospital. This can make a significant difference in the patient's chances of survival and recovery.

Medical History and Brain Scans

At the hospital, healthcare professionals will ask about your medical history and the time your symptoms started. They will also perform brain scans to determine the type of stroke you had. This information is crucial for guiding further treatment.

Treating Hemorrhagic Stroke

The two main treatments for hemorrhagic strokes are medications and surgery:

• Medications: Providers may administer medications to support clotting and improve your body's ability to stop the bleeding in your brain. This can include vitamin K therapy or prothrombin complex concentrate.
• Blood pressure management: Lowering blood pressure is crucial in treating hemorrhagic strokes as it helps slow down the bleeding and allows for clotting to seal the damaged blood vessel.
• Surgery: Emergency surgery may be necessary to remove accumulated blood and relieve the pressure on the brain. This is especially critical if the stroke is causing increased intracranial pressure.

Stroke Rehabilitation

Rehabilitation is an essential part of treating a hemorrhagic stroke. It helps patients adjust to changes in their brain and body and regain abilities. This may include speech therapy, physical therapy, occupational therapy, and cognitive therapy.

Long-term recovery and rehabilitation

The duration of recovery and rehabilitation after a bleeding stroke depends on the severity of the stroke, the amount of tissue damage, and how soon you were able to get treatment. The recovery period is long for many people, lasting for months or even years. However, most people with small strokes and no additional complications during the hospital stay can function well enough to live at home within weeks.

• Following a heart-healthy diet
• Avoiding or quitting smoking
• Developing a plan for regular exercise, in consultation with a health professional
• Managing body weight, if appropriate
• Developing regular sleeping habits, if possible
• Following the treatment plan, including taking medications and attending follow-up appointments
• Asking about rehabilitation therapy to help with speech, movement, and other challenges
• Seeking support from loved ones and healthcare professionals to manage mental health
• Monitoring for new or worsening symptoms and complications and seeking help if they occur

Types of rehabilitation therapy

Depending on your age, overall health, and the impact of the stroke, a doctor will help determine the best rehabilitation program. Some people may need one or more of the following types of therapy:

• Occupational therapy can help retrain your brain so you can go about your daily activities. This therapy is especially helpful in improving precise hand movements and muscle control.
• Speech therapy can help you regain language and speaking abilities and improve your ability to control muscles that help you breathe, eat, drink, and swallow.
• Physical therapy can help improve or regain the ability to use your hands, arms, feet, and legs. This can also help with balance issues, muscle weakness, and more.
• Cognitive therapy can be helpful if you're having memory problems or difficulty with activities that require focus or concentration.

Risk factors for a bleeding stroke

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 circulation and adding pressure inside the brain, which can damage or kill brain cells. There are several risk factors that increase the likelihood of experiencing a hemorrhagic stroke.

One of the most common causes of hemorrhagic stroke is high blood pressure (hypertension). This is especially true if an individual's blood pressure is very high or remains high for a prolonged period. Unmanaged high blood pressure can lead to a higher risk of experiencing a hemorrhagic stroke.

Additionally, certain medical conditions can increase the risk of a hemorrhagic stroke. These include:

• Alcohol use disorder
• High cholesterol (hyperlipidemia)
• Type 2 diabetes
• History of stroke, heart attack, or irregular heart rhythms such as atrial fibrillation
• Migraine headaches, especially with auras
• Cerebral amyloid angiopathy
• Ischemic strokes that cause bleeding during or after the stroke

Lifestyle choices can also contribute to the risk of a hemorrhagic stroke. These include:

• Smoking or using other forms of tobacco
• Recreational drug use or misuse of prescription drugs
• High levels of stress and anxiety
• Lack of physical activity and unhealthy diet
• Excess weight, particularly around the waist and abdomen
• High alcohol consumption

Furthermore, specific risk factors are associated with two types of hemorrhagic strokes: intracerebral hemorrhage and subarachnoid hemorrhage.

Risk factors for intracerebral hemorrhage include blood vessel malformations such as cerebral cavernous malformation, cerebral aneurysm, and arteriovenous malformation (AVM). Cerebral cavernous malformation occurs when small blood vessels called capillaries collect in the brain, become enlarged, and may affect blood flow. A cerebral aneurysm is a bulge in the wall of a blood vessel in the brain, which can increase in size and lead to uncontrolled bleeding if it bursts. Arteriovenous malformation is a rare genetic condition that affects the blood vessels in the brain and spine.

On the other hand, risk factors specific to subarachnoid hemorrhage include having a bleeding disorder, experiencing a head injury or physical trauma, and using blood-thinning medications.

How to recognise a bleeding stroke

A bleeding stroke, or a hemorrhagic stroke, is a life-threatening medical emergency that requires immediate attention. To recognise the signs of a bleeding stroke, remember the acronym BE FAST:

• Balance: Watch out for a sudden loss of balance.
• Eyes: Look out for sudden vision loss or changes in one or both eyes. Are they experiencing double vision?
• Face: Ask the person to smile. Look for a droop on one or both sides of their face, which is a sign of muscle weakness or paralysis.
• Arms: Ask them to raise both arms. If they are having a stroke, one arm may not move, sag, or be very weak.
• Speech: They might slur their speech or have trouble choosing the right words.
• Time: Time is critical, so don't wait to get help! If possible, note the time that symptoms started, as this can help healthcare providers determine the best course of treatment.

Other possible signs of a bleeding stroke include:

• Thunderclap headaches
• Light sensitivity (photophobia)
• Dizziness or vertigo
• Loss of senses, like vision, hearing, and touch
• Passing out or fainting
• Nausea and vomiting
• Lack of energy and sleepiness
• Difficulty swallowing
• Loss of coordination or clumsiness (ataxia)
• Emotional instability and personality changes
• Confusion or agitation
• Memory loss (amnesia)

Surgical treatment for a bleeding stroke

After a bleeding stroke, surgery through the skull (craniotomy) may be required to remove the blood and relieve pressure on the brain if the area of bleeding is large enough. Surgery may also be used to repair blood vessel problems associated with bleeding strokes.

• Surgical clipping — A surgeon places a tiny clamp at the base of the aneurysm to stop blood flow to it. This clamp can keep the aneurysm from bursting or prevent a recently burst aneurysm from bleeding again.
• Surgical AVM removal — Surgeons may remove a smaller AVM if it is located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of a bleeding stroke. However, it is not always possible to remove an AVM if it is located deep within the brain, is too large, or its removal would impact brain function too much.
• Angioplasty and stents — A surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. Then a stent is inserted to support the opened artery.
• Blood transfusion — Replaces blood lost through surgery or injury.
• Coil embolization — Blocks blood flow to or seals an aneurysm. The surgeon inserts a flexible tube called a catheter into an artery in the upper thigh and threads it to the aneurysm in the brain. The surgeon then pushes a tiny coil through the tube and into the aneurysm, causing a blood clot to form and block blood flow through the aneurysm. This procedure prevents the aneurysm from bursting again.
• Draining excess fluid — Fluid that has built up in the brain after a stroke can push the brain against the skull, causing damage. Draining the fluid relieves this pressure.
• Temporarily removing part of the skull — If you have a lot of swelling, surgery may be performed to temporarily remove part of the skull to allow room for the brain to swell without putting pressure on it.
• Surgery or radiation — May be used to remove or shrink an arteriovenous malformation (AVM), which is a tangle of arteries and veins that can break open in the brain.
• Decompression — A surgeon will drill a hole in the skull to drain blood and relieve pressure.
• Craniectomy — A surgeon will remove a piece of the skull to relieve pressure. Once the skull is open, the surgeon can treat the source of the brain bleed.
• Craniotomy — A surgeon will remove and replace a piece of the skull to relieve pressure and manage the source of bleeding.

Frequently asked questions