HEMMORRHAGIC STROKE

General Information:

What is a hemorrhagic stroke? A hemorrhagic stroke is a condition that happens when a blood vessel in the brain bursts. Blood leaks out and can irritate or injure the brain tissue, or cause damage by pushing into nearby areas. Other blood vessels may get pinched and stop blood flow to areas of the brain. Blood carries oxygen and other nutrients to the brain. When blood does not reach all parts of the brain, brain cells may be damaged or die. A hemorrhagic stroke may begin suddenly, develop quickly, and cause death of brain tissue within minutes or hours. Death of an area of the brain may cause the body functions controlled by that area to be lost. Body functions, such as walking or talking, are controlled by certain areas of your brain. Having a hemorrhagic stroke may cause you to die or lose some body functions forever.

What causes a hemorrhagic stroke? The most common cause of this type of stroke is having long-term high blood pressure (chronic hypertension). The next most common cause is amyloid angiopathy, a condition where proteins build up in the brain blood vessels. Other less common causes include the following:

• Blockage: Blood vessels blocked with fatty plaque (fat build up in the inner wall of the blood vessel). A blood clot that has burst is another cause.
  
• Defects: Problems in the blood vessels, such as aneurysms (sac formed by an area of a blood vessel) and arteriovenous (AV) malformations. These defects may weaken blood vessels and increase the chances of bursting.
  
• Diabetes: Having high blood sugar can lead to problems in your blood vessels.
  
• Injuries: Accidents or trauma to the head can cause bleeding.
  
• Medicine: Blood thinners, such as aspirin or warfarin (Coumadin), that help prevent clots from forming in the blood may cause or worsen bleeding in your brain. Over-the-counter (OTC) medicines, such as for coughing or weight loss, may cause bleeding by increasing blood pressure. Using street drugs, such as cocaine, "meth", or heroin, may also cause bleeding.
  
• Tumors: Brain tumors have blood vessels that easily bleed.

What puts me at a higher risk of having a hemorrhagic stroke? 

• Blood vessel problems: Having weak areas in the blood vessels in your brain increases your risk.
  
• Drug abuse: Cigarette smoking or drinking too much alcohol.
  
• Elderly or ethnicity: Older people have a higher risk for hemorrhagic stroke. African-American, Hispanic, and Japanese people also have a higher risk.
  
• Stroke history: You or a close family member has had a stroke.

What are the signs and symptoms of a hemorrhagic stroke? Your signs and symptoms will depend on which part of your brain is injured and how much damage you have. These signs or symptoms may appear within minutes or hours. You may have one or more of the following:

• Blindness in one eye, or blurred or double vision.
  
• Nausea (upset stomach) and vomiting (throwing up).
  
• Numbness (loss of feeling), tingling, weakness, or paralysis (being unable to move) on one side of your body.
  
• Severe (very bad) headache, dizziness, confusion, or passing out.
  
• Trouble walking, swallowing, talking, thinking, understanding, or remembering things.
  

How is a hemorrhagic stroke diagnosed? Your caregiver will ask about your past medical conditions and drug use. He will ask about the medicines you are presently taking. He will also do a physical exam on you. You may have any of the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
• CT scan:
  • This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
    
  • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
    
• MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. You will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.

How is a hemorrhagic stroke treated? Treatment of a hemorrhagic stroke depends on its cause, and your signs and symptoms. You may be admitted to the Intensive Care Unit (ICU) so that caregivers can watch you closely. You may have any of the following:

• IV lines: An intravenous (IV) line is a tube or catheter placed in your vein for giving medicine or liquids. A central line is a special IV placed further into your body than a regular IV line. It is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. Other central lines, such as a PICC, may be put into your arm. You may need a central line to receive medicines or IV fluids that need to be given through a big vein. You may need a central line if it is hard for caregivers to insert a regular IV. Some central lines may also be used to take blood samples.
  
• IV pressure monitoring: You may have one or more special blood vessel lines that help your caregivers monitor your blood pressure. An arterial line is a tube placed into an artery (blood vessel), usually in the wrist or groin. An arterial line may be used for measuring your blood pressure or for taking blood. A CVP line is a type of central line that is hooked up to a monitor. This is done to take internal blood and heart pressure readings. The CVP line may be used to give medicines or IV fluids, or to take blood samples. This information helps caregivers check your heart.
  
• Fever treatment: You may get a fever and be treated with equipment to cool your body and medicines to bring your temperature down.
  
• ICP monitor: ICP stands for intracranial pressure. An ICP monitor is a small tube that is put through the skull and into the head. The tubing is connected to a TV-type screen. Caregivers use the ICP monitor to keep an ongoing measurement of the pressure inside your skull (the bones of your head).
  
• Medicines: You may get medicines to prevent you from getting infections. You may get medicine to keep you from having seizures, which may result from injury to your brain. You may get medicines to lower your blood pressure. Keeping your blood pressure under control protects your brain from more bleeding and damage. You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow. You may also get medicines to help your blood's ability to clot. This will help prevent more bleeding in your brain.
  
• Surgery: A damaged blood vessel may continue spilling blood until it is repaired. You may need surgery to stop the bleeding, remove leaked blood, and repair damage in your brain.
  
• Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.