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Hemorrhagic Stroke

Hemorrhagic Stroke is where there is a pooling of blood anywhere within the skull that leads to one type of stroke.

The tissue of the brain is very sensitive to any increase of blood, fluids, pressure, or damage.

Swelling can result when increased damage or other issue occurs. The effect may incorporate the entire Brain or only a specific area where the blood is found.

Hemorrhagic Stroke one of the two main categories of a Stroke.

The other category is Ischemic Stroke. This cause and risk factors for this other category are different. It is important to know which type of stroke is occurring. Treatment, prognosis, and Risk Factors may be different.

20% of all strokes are hemorrhagic in origin.

The other 80% are Ischemic Stroke which consists of a lack of oxygen to certain portions of the brain. Often a thrombus or clot wedges inside the brain in these types of strokes.

Medications used to help treat ischemic strokes can be deadly in hemorrhagic strokes.

Symptoms:

–  Headache
–  Fatigue
–  Nausea
–  Vomiting
–  Weakness
–  Paralysis
–  Numbness
–  Confusion
–  Lethargic
–  Anger
–  Loss or change in sensation
–  Other motor or coordination difficulties
–  Speech changes or inability
–  Loss of consciousness
–  Coma

Potential Causes:

1.)  Tearing or rupture of blood vessel
2.)  Brain Trauma  [Head injury]
3.)  Brain aneurysm
4.)  Certain medications

Types

1.)  Intra-axial hemorrhage  [Blood inside the brain]
2.)  Extra-axial hemorrhage [Blood inside the skull but outside brain]

Intra-Axial Hemorrhage

–  Bleeding into the brain itself
–  Also called cerebral hemorrhage
–  Can see bleeding into ventricles
–  Very dangerous
–  Very difficult to treat

Extra-Axial Hemorrhage

–  Bleeding that occurs within the skull but outside the brain

Three subtypes

1.)  Epidural hemorrhage
2.)  Subdural hemorrhage
3.)  Subarachnoid hemorrhage

Epidural hemorrhage

–  Occurs between the skull and the dura mater [outer most meninx]
–  Result of trauma
–  May result from tear of the “middle meningeal artery”
–  Very dangerous
–  Very uncommon

Subdural hemorrhage

–  Occurs between the dura mater and the inner meningeal layer
–  Different than Epidural hemorrhage which is a tear in the artery
–  Typically is a tear in veins in subdural space
–  Increase in intracranial pressure is common
–  Caused by trauma
–  More common than epidural hemorrhage
–  A classic finding in shaken baby syndrome

Subarachnoid hemorrhage

–  This refers to bleeding into the area around the brain.
–  This area is between the pia mater and the arachnoid membrane.
–  Can be the result of head trauma or other

Diagnosis

1.)  Overall exam for hemorrhagic stroke are essential
2.)  Exam by a provider is essential if any concern
3.)  CT and MRI are useful and quite helpful for evaluation of the brain
4.)  Angiography can be used to find aneurysms

Treatment

Evaluation in the Emergency room is often necessary and essential

Stay at the hospital (ICU department) is often necessary

Ventilation may be required

Medication for Hypertension

Hyper-osmotic agents

  –  Mannitol
  –  Glycerol
  –  Hypertonic saline solutions

Surgery

–  Repair of aneurysm if appropriate
–  Improvement of inter-cranial pressure
–  Removal of blood in brain
–  Removal of excess fluid