Hemorrhagic Stroke: Survival, Recovery, And Rehabilitation

Hemorrhagic strokes are life-threatening and require immediate medical attention. They occur when bleeding interferes with the brain's ability to function. This can happen within the brain or between the brain and the skull. Hemorrhagic strokes account for about 10-20% of all strokes and can be caused by a ruptured aneurysm or arteriovenous malformation (AVM). The survival rate for hemorrhagic strokes is low, with about half of people dying within weeks of the event. However, those who do survive often experience long-term disability and a slow recovery process. The chances of survival depend on the severity of the stroke and how quickly treatment is received.

Hemorrhagic stroke symptoms

Hemorrhagic strokes are medical emergencies that require immediate treatment. Symptoms can vary from person to person but are almost always present immediately after the stroke occurs.

The acronym 'BE FAST' can help you recognise the signs of a stroke:

• Balance: Check if the person feels dizzy or has trouble standing.
• Eyes: Ask if the person has blurred or double vision.
• Face: Ask the person to smile and observe if one side of their face droops.
• Arms: Ask the person to raise both arms and check if one arm drifts downward.
• Speech: Ask the person to repeat a simple phrase and note if their speech is slurred or garbled.
• Time: Call emergency services immediately if you observe any of the above symptoms.

Other common symptoms of a hemorrhagic stroke include:

• A sudden and severe headache, often described as the "worst headache of your life".
• Weakness, paralysis, or numbness in the face, arm, or leg, usually on one side of the body.
• Loss of consciousness or confusion.
• Sensitivity to light.
• Nausea or vomiting.
• Inability to swallow.
• Stiffness or pain in the neck and shoulders.
• Changes in heartbeat and breathing.

Hemorrhagic stroke causes

Hemorrhagic strokes are caused by bleeding in the brain, which can happen when a blood vessel in the brain bursts or when brain tissue starts to bleed. This can be the result of a ruptured aneurysm, which is an abnormal swelling of the blood vessel walls, often caused by high blood pressure or hypertension. In rare cases, it may be due to arteriovenous malformation (AVM), where people are born with abnormally large and weak blood vessels. Aneurysms can also be caused by infections, drugs such as amphetamines and cocaine, or direct brain trauma from an accident.

There are two types of hemorrhagic strokes: intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhage occurs when a blood vessel within the brain breaks and causes internal bleeding. This is the most common type of hemorrhagic stroke and is usually caused by high blood pressure. Subarachnoid hemorrhage causes blood to gather at the surface of the brain and fill the space between the brain and the skull, putting pressure on the brain and causing an immediate headache.

Other common causes of hemorrhagic strokes include brain tumors, tumors that metastasize to the brain, and severe infections in the brain. Risk factors for hemorrhagic strokes include high levels of low-density lipoprotein (LDL) cholesterol, a family history of stroke, heart disease, cardiovascular disease, high levels of stress and anxiety, certain medical conditions such as bleeding disorders or sickle cell disease, use of blood-thinning medication, recreational drug use, lack of dietary variety and nutrition, high alcohol consumption, excess weight, and cerebral amyloid angiopathy.

Hemorrhagic stroke diagnosis

Hemorrhagic strokes are a serious medical emergency and should be treated immediately. They occur when a weakened vessel ruptures and bleeds into the brain or the surrounding area. The bleeding can cause brain cells to die, resulting in loss of function like speech capabilities, muscle movement, or movement of an extremity like an arm or leg.

To diagnose a hemorrhagic stroke, a doctor will consider the patient's symptoms, medical history, and perform a physical examination. They will also carry out imaging tests such as a CT scan or an MRI scan, which can show if there is bleeding inside the brain. An EEG may also be performed to give information about brain function.

If these tests indicate that the patient is having a stroke, further tests will be conducted to determine the exact cause. These may include blood-thinning tests, checking for bacteria in the blood, and an electrocardiogram (EKG).

It is important to seek immediate emergency care if you are experiencing any symptoms of a hemorrhagic stroke, as rapid treatment can significantly improve the chances of survival.

Hemorrhagic stroke treatment

Hemorrhagic strokes are a serious medical emergency and need to be treated immediately. While survival rates are low, there are ways to improve your chances.

• Locate the bleed and surgically 'clip' it: Doctors will locate the source of the bleed and perform surgery to stop the bleeding.
• Drain the skull: Doctors will drain the skull to decrease pressure in the brain.
• Block off any sources of bleeding: Any sources of bleeding will be blocked off to prevent further bleeding.
• Minimally invasive 'burr hole' removal: A 'burr hole' removal is a minimally invasive procedure used to treat intracerebral haemorrhage.
• Medication: After a procedure, medication is typically given to reduce blood pressure, pain, anxiety, headaches, and/or seizures.
• Reduce blood pressure: Doctors may prescribe medication to reduce blood pressure, which lowers pressure in the brain.
• Counteract blood-thinning: If the patient is on blood thinners, medication will be given to counteract their effects.
• Craniotomy: A surgical procedure known as a craniotomy may be necessary if there is brain swelling. A small section of the skull is opened to relieve pressure on the brain.
• Pain relief: Doctors will provide pain relief medication for severe headaches.
• Rehabilitation: Following emergency treatment, the patient will likely have a rehabilitation program to recover as much function as possible and return to independent living.

Hemorrhagic stroke recovery

The first three months after a stroke are the most crucial for recovery, with most patients making the most progress during this period. Patients may experience a phenomenon called spontaneous recovery, where a skill or ability that seemed lost returns suddenly as the brain finds new ways to perform tasks. However, setbacks such as pneumonia, a heart attack, or a second stroke may occur, requiring adjustments to rehabilitation goals.

Rehabilitation typically involves physical, occupational, and speech therapy to help restore function and compensate for any impairments. The goal is to help patients regain as much independence as possible in their daily activities.

The recovery process can be slow and uncertain, and it may be necessary to continue following up with medical specialists even after the initial recovery period. This coordinated effort can facilitate further progress and small advances over time.

While recovery from a hemorrhagic stroke can be challenging, starting rehabilitation as soon as possible and maintaining a consistent treatment plan can improve the chances of a positive outcome.

Frequently asked questions