When To Let Go After A Hemorrhagic Stroke

A hemorrhagic stroke is a life-threatening medical emergency that requires immediate treatment. It occurs when there is uncontrolled bleeding inside the brain or between the brain and its outer covering layer, disrupting normal blood circulation and starving areas of the brain of oxygen. The effects of a hemorrhagic stroke can worsen quickly, and without fast medical attention, it often causes permanent brain damage or death. The majority of people who experience a stroke die within a few days, and about a quarter of survivors live longer than five years. The recovery process is typically long and slow, involving physical, occupational, and speech therapy. The duration of recovery depends on the severity of the stroke, the amount of tissue damage, and how soon the patient receives treatment.

Hemorrhagic stroke survival rates

Hemorrhagic strokes have a low survival rate, and the majority of people who have one die within a few days. However, some sources put the one-year survival rate at 34% or 38%, and it is possible to survive longer than five years.

The survival rate depends on the severity of the stroke, how soon the patient receives treatment, the amount of tissue damage, and the area of the brain affected. The location of the haemorrhage also makes a difference: haemorrhages in the putamen, a common site for hypertensive haemorrhages, have a better prognosis than those in the peripheral brain parenchyma (known as lobar haemorrhages). Cerebellar haemorrhages are the one potential neurosurgical emergency, requiring early craniotomy to prevent brainstem compression.

The first few weeks after a stroke are critical. The typical length of a hospital stay is five to seven days, during which the stroke care team will evaluate the effects of the stroke and determine the rehabilitation plan. The patient will then either be discharged home or moved to an inpatient or subacute rehabilitation facility.

The first three months after a stroke are the most important for recovery, when patients tend to see the most improvement. This is when most patients will enter and complete an inpatient rehabilitation programme or make progress in their outpatient therapy sessions.

After six months, improvements are still possible but will be much slower. Most patients reach a relatively steady state at this point, with some making a full recovery and others experiencing ongoing impairments, or chronic stroke disease.

Factors influencing survival

Hemorrhagic strokes are life-threatening and require immediate medical attention. The outlook for this type of stroke is less favourable than for other kinds, as it is difficult to stop the bleeding, and only a small amount of blood can cause severe symptoms. The survival rate for hemorrhagic strokes is 26.7% within five years.

There are several factors that influence a patient's chances of survival after a hemorrhagic stroke.

Age

Younger patients have a significantly better chance of long-term survival. The lowest number of patients who survived five years after a hemorrhagic stroke were over 70 years old (9%), while the highest number were between 41 and 50 years old (60.5%).

Hypertension

Hypertension, or high blood pressure, is the most common cause of hemorrhagic strokes. It is a significant predictor of five-year mortality for hemorrhagic stroke patients.

Alcohol Intake

Alcohol intake was found to have a significant impact on survival rates.

Diabetes Mellitus

Diabetes mellitus was also found to be a significant factor in survival rates, with patients without diabetes having a better prognosis.

Heart Diseases, Cigarette Smoking, and Transient Ischemic Attack

While not found to be significant in one particular study, heart disease, cigarette smoking, and transient ischemic attack have been found to be predictors of five-year mortality for ischemic stroke patients.

Sex

In one study, being female was found to be a significant prognostic factor among 30-day survivors of hemorrhagic stroke. However, in another study, no statistical significance was found in survival rates between men and women.

Emergency treatment

A hemorrhagic stroke is a life-threatening medical emergency that requires immediate attention. The faster the patient receives treatment, the better their outlook. Here is an emergency treatment plan for a hemorrhagic stroke:

Stabilization and Initial Assessment:

• The first few hours after a stroke are critical and can be overwhelming for both the patient and the medical team.
• The primary goals during this time are to stabilize the patient's vital functions, including breathing, heart function, blood pressure, and bleeding control.
• A neurological assessment is also performed to determine the patient's level of consciousness, motor function, and speech or language abilities.
• The patient's vital signs are closely monitored to ensure stability.

Diagnostic Tests:

• A brain scan, typically a CT (Computed Tomography) scan, is performed as soon as possible to identify the type and location of the stroke.
• Blood tests may also be conducted to check for underlying conditions, clotting ability, blood sugar levels, and kidney and liver function.
• Additional tests may include an electrocardiogram (ECG) to rule out heart-related issues and an MRI scan for further evaluation.

Early Treatment:

• The type of treatment depends on whether the stroke is ischemic (caused by a clot) or hemorrhagic (caused by bleeding).
• For ischemic strokes, doctors may administer clot-busting drugs within a specific time frame to improve the patient's outcome.
• Endovascular thrombectomy (EVT) is a procedure where doctors insert a thin tube through an artery to remove large clots and restore blood flow.
• Hemorrhagic strokes require a different approach since they cannot be treated with clot-busting drugs.

Surgical Intervention:

• A neurosurgeon, in collaboration with the medical team, determines if surgery is necessary to control the bleeding, repair the damaged artery, or reduce intracranial pressure.
• Surgery may involve a craniotomy, where a small section of the skull is opened to relieve pressure caused by brain swelling.
• In some cases, surgery may be required to remove accumulated blood and alleviate pressure on the brain tissue.

Monitoring and Symptom Management:

• The medical team closely monitors the patient's symptoms to ensure they do not deteriorate.
• Vital signs such as blood pressure are regularly checked, and the patient is assessed for alertness, headache, weakness, paralysis, and other stroke-related symptoms.
• Swallowing tests are often performed before administering liquids, food, or medication to prevent complications such as aspiration, malnutrition, or dehydration.
• The patient's risk of falling is assessed, and mobility devices may be introduced as needed.

The emergency treatment phase for a hemorrhagic stroke focuses on stabilizing the patient, identifying the type and location of the stroke, providing early intervention, and controlling bleeding and intracranial pressure. The speed of treatment is crucial to improving the patient's chances of survival and recovery.

Recovery and rehabilitation

The road to recovery after a hemorrhagic stroke is often long and slow, lasting months or even years. The recovery process depends on the severity of the stroke, the amount of tissue damage, and how soon the patient receives treatment. For those who survive, the recovery period can be challenging, but with the right care and support, it is possible to regain independence and improve quality of life.

Initial Treatment and Hospitalization

The first step in treating a hemorrhagic stroke is to stabilize the patient and identify the type of stroke. This typically involves a neurological exam using a CT or MRI scan. Once the cause of the stroke is determined, treatment focuses on reducing hypertension and slowing the bleeding. In some cases, surgery may be required to "clip" the source of the bleed or relieve pressure caused by brain swelling. The typical length of a hospital stay after a stroke is around five to seven days, during which the patient's condition is closely monitored, and a rehabilitation plan is developed.

Rehabilitation

Rehabilitation typically begins as soon as possible after the initial treatment, often within 24 hours. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work together to address the physical, cognitive, and emotional impacts of the stroke. The focus of rehabilitation is on helping the patient regain independence in activities of daily living (ADL), such as bathing or preparing food. It is important to set realistic recovery goals and practice tasks outside of therapy sessions to maximize progress.

Therapy

Physical and occupational therapy play a crucial role in stroke rehabilitation. These therapies help to evaluate the damage caused by the stroke and stimulate the brain to find new ways to perform tasks. Speech-language therapy is also important, especially for patients who have difficulty swallowing due to stroke or aftereffects of a breathing tube. Therapy sessions are typically conducted multiple times per day during the hospital stay and then continue on an outpatient basis as needed.

Long-Term Recovery

The first three months after a stroke are considered the most critical for recovery, with most patients making significant progress during this time. This period often includes an inpatient rehabilitation program or intensive outpatient therapy. After six months, improvements are still possible but tend to be slower. Most stroke patients reach a relatively steady state at this point, with some achieving a full recovery while others experience ongoing impairments, known as chronic stroke disease.

Innovative Treatments

In addition to traditional therapies, researchers are exploring new techniques to enhance stroke rehabilitation. Noninvasive brain stimulation (NIBS), for example, uses weak electrical currents to stimulate specific areas of the brain, boosting the effects of therapy. Technology-assisted rehabilitation is another approach that can extend and enhance the rehabilitation process by targeting specific tasks in engaging ways.

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) is an innovative technique that involves sending electrical pulses to release neuromodulators in the brain. This stimulation can enhance neural connections and improve upper limb function when paired with physical therapy. VNS has been shown to help stroke survivors regain independence and improve their quality of life, even months or years after their stroke.

Outlook and life expectancy

The outlook for a hemorrhagic stroke patient depends on several factors, including the severity of the stroke, the amount of tissue damage, and how soon the patient receives treatment. Other factors that may influence the patient's outlook include high blood sugar levels and chronic kidney disease.

Hemorrhagic strokes are less common than ischemic strokes, but they tend to have less favorable outcomes. They account for about 10% to 20% of all strokes. The majority of people who have a stroke die within a couple of days. About a quarter of survivors are able to live longer than five years, but the recovery process is long and slow.

The duration of recovery and rehabilitation depends on the severity of the stroke and the amount of tissue damage that occurred. Different types of therapy may be involved to restore as much function as possible, including physical therapy, occupational therapy, and speech therapy.

The life expectancy of a hemorrhagic stroke patient depends on several factors and is never the same from person to person. However, statistics show that age is a significant factor in long-term survival. People aged 85 and older have the highest death rate, with a risk of dying that is 13 times higher than that of people aged 65 to 74. The risk of dying is three times higher for people aged 75 to 84 compared to those aged 65 to 74.

In a 2019 Swedish study, 69.3% of people who had an intracerebral hemorrhage (ICH) were still alive after 30 days. The same study found that 37.8% of people with ICH were alive after five years, compared to 64.6% of their peers who did not have a stroke.

A 2018 study indicated that the type of stroke also plays a role in life expectancy. At five years, death or physical dependency occurred for 79% of people who had a hemorrhagic stroke and 70.6% of people who had an ischemic stroke.

The outlook for hemorrhagic stroke is generally less favorable than for other types of stroke because it is difficult to stop the bleeding. Additionally, it takes a relatively small amount of blood to cause severe symptoms.

However, with fast medical care, some people can have a good outcome and recover from a hemorrhagic stroke. The location of the stroke, the severity of the bleeding, and how fast the patient receives care can make a huge difference in their chances for survival and recovery.

Frequently asked questions