Definition

In medical terms, hemorrhagic means bleeding. A hemorrhagic stroke refers to a brain disorder that occurs when a blood vessel in the brain leaks due to high blood pressure or abnormal blood vessels, causing bleeding inside or around the brain. The leaked blood can compress brain tissue and cause the brain to swell. Additionally, the body parts controlled by the injured brain area may not function properly.

Stroke is classified based on the type and location of the bleeding. It is a leading cause of prolonged injury and disability. Brain damage from a stroke can be reduced if the patient receives proper treatment promptly. The more bleeding occurs, the worse the patient's condition can become, potentially leading to decreased consciousness and neurological disorders.

The incidence rate of stroke is 12-15% per 100,000 cases annually, with higher rates in Asian countries. Stroke is more common with increasing age and in men.

Causes

Hemorrhagic stroke is caused by sudden bleeding from blood vessels inside or around the brain. The most common cause of stroke is hypertension (high blood pressure), which causes blood vessels to degenerate. The longer a person has high blood pressure, the more damage occurs not only to blood vessels but also to the smooth muscles of the arteries.

This bleeding compresses brain tissue and increases pressure in the head. The bleeding within brain tissue can enlarge over 3-12 hours, disrupting brain function, cell stability, and causing cell dysfunction and swelling. This eventually leads to inflammation and brain swelling.

Another condition that can cause brain bleeding in the elderly is cerebral amyloid angiopathy. This disease affects the capillaries, arterioles, and small to medium-sized arteries in the brain and cerebellum. The incidence of this disease increases with age, causing spontaneous and recurrent brain bleeding.

Risk factor

The following are risk factors for hemorrhagic stroke:

• Age >55 years and Asian race (non-modifiable)
• Head injuries causing bleeding
• Eclampsia (high blood pressure and seizures during pregnancy or childbirth)
• Brain tumors such as:
• Glioblastoma
• Meningioma
• Pituitary gland tumor
• Metastatic cancer to the brain
• Increased blood clotting disorders and reduced platelets due to chronic liver disease
• Conditions like uncontrolled hypertension or diabetes mellitus
• Chronic kidney disease
• Chronic and excessive use of alcohol or illicit drugs (cocaine, amphetamines, heroin)
• Smoking habits
• Studies show that sleeping more than 8 hours and long working hours can increase the risk of brain bleeding.

Symptoms

In hemorrhagic stroke, there are early symptoms preceding the disease manifestation, known as prodromal symptoms. Increased pressure in the head can cause severe headaches, projectile vomiting, and decreased consciousness. Neurological deficits depend on which part of the brain is compressed by the bleeding. Symptoms can include crooked mouth, slurred speech, vision problems, limb weakness or paralysis, seizures, and decreased consciousness.

Symptoms of hemorrhagic stroke usually occur quickly and progress rapidly. If symptoms worsen, it indicates that the bleeding is expanding, or the brain swelling is increasing. Therefore, patients with stroke symptoms should be immediately taken to the emergency room for prompt treatment to prevent further brain cell damage.

Diagnosis

Doctors diagnose hemorrhagic stroke based on clinical symptoms, physical examination, patient history, and radiological examinations. Radiological exams are performed if a doctor suspects bleeding in the head area. These exams can show blood clots or bleeding in and around the brain. Imaging techniques like head CT scans or brain MRIs are used. The extent of the bleeding and blood clot volume can also be estimated through these results. Usually, a bleeding volume of more than 60 cc is associated with high mortality rates. MRIs can differentiate primary bleeding from changes caused by infarcts and detect other conditions causing bleeding, like cerebral venous thrombosis or tumors.

In addition to radiological examinations, blood tests can help identify patient disorders. Blood tests usually related to blood clotting disorders include bleeding time, clotting time, platelet count, peripheral blood examination, and PT/aPTT tests. Blood sugar, lipid profile, kidney function, and liver function tests are also conducted to rule out other disorders causing brain bleeding.

Management

Patients showing symptoms of bleeding in the brain and surrounding areas require immediate medical attention. Prompt therapy is necessary to prevent further damage and life-threatening complications. Treatment depends on the cause of the bleeding, location, and volume.

Patients are given fluid infusions and blood pressure-lowering medications (if high blood pressure is present) to stabilize the circulatory system. Blood pressure is gradually lowered to 150/90 and checked every 10-15 minutes. Patients also receive medications to stop bleeding, prevent blood clots, and protect against oxidative stress and inflammation in brain tissue.

Surgical procedures may also be performed within 48-72 hours after bleeding or delayed until one to two weeks after the patient's condition stabilizes. The type of surgery depends on the cause of the bleeding.

Patients are closely monitored in intensive care units. Therapy aims to prevent life-threatening complications, prevent stroke recurrence, and help patients regain normal function through rehabilitation.

Complications

Nearly half of stroke-related deaths result from medical complications. Hemorrhagic stroke can cause complications such as hydrocephalus, cerebral edema, blood clots, and organ system issues, including lung and heart complications. Possible complications include:

• Blood clots (deep vein thrombosis, pulmonary embolism)
• Seizures
• Difficulty eating and drinking, leading to malnutrition
• Urinary tract infections
• Heart problems (arrhythmias, heart attacks)
• Bedsores (pressure ulcers)
• Respiratory distress

Prevention

Hemorrhagic stroke can be prevented by avoiding the risk factors mentioned above. Control blood pressure, avoid alcohol and illicit drugs, and reduce or stop smoking. If you have high blood pressure, consult a doctor for necessary medication.

When to see a doctor?

Seek immediate medical attention at the nearest health facility if you or a close family member experience sudden neurological deficits such as slurred speech, limb weakness or paralysis, seizures, or decreased consciousness.

Looking for more information about other neurological diseases? Click here ya!