Generality
Hemorrhagic stroke is a type of stroke.
At its origin there is the rupture of one or more blood vessels present in the brain, which results in a leak of blood (hemorrhage).
The main causes of hemorrhagic stroke are: rupture of a cerebral aneurysm, head traumas, chronic hypertension and congenital arteriovenous malformations with encephalic site.
Typical symptoms are paralysis and numbness in the limbs, headaches, confusion, balance problems, difficulty walking, dizziness, nausea, vomiting and vision problems.
The hemorrhagic stroke is a medical emergency, which requires an accurate diagnosis, in order to establish the most suitable treatment.
The therapy consists, first of all, in stopping the bleeding and eliminating the leaked blood and, secondly, in repairing the vessel damage (especially if it is extensive).
Short review of the stroke
The term stroke and its numerous synonyms - including stroke, apoplectic attack, cerebral infarction and stroke - indicate the death, due to insufficient blood supply, of a more or less extensive area of the brain. Following the death, clearly, the affected brain area stops fulfilling its functions.
Stroke, therefore, is a serious pathological condition, characterized by death and the subsequent loss of function of a portion of brain.
What is a hemorrhagic stroke?
Hemorrhagic stroke is the medical term that indicates a specific type of stroke, which occurs after the rupture of one or more blood vessels present in the brain.
From the breaking of the aforesaid blood vessels a blood loss originates, which gradually accumulates in the surrounding brain tissues, compressing them and impairing their function.
SYNONYMS OF ICTUS EMORAGGIC
Hemorrhagic stroke is the clinical condition also known as cerebral hemorrhage .
- Bleeding, because, in the presence of hemorrhagic stroke, there is a loss of blood.
- Cerebral, because the anatomical structure involved is the brain and, more generally, the brain.
ICTUS HEMORRAGIC AND ICTUS ISCHEMIC
Hemorrhagic stroke is one of the two main types of stroke. The other is the so-called ischemic stroke .
With ischemic stroke, doctors mean all those cases of stroke that appear following the narrowing, or closure, of one or more blood vessels in the brain (ischemia).
As a result of this shrinkage or closure, the blood supply to the encephalic portion concerned is lost and this determines the death of the latter.
Epidemiology
Of the two main types of stroke, hemorrhagic stroke is the least common. In fact, it represents only 13-15% of all stroke cases in the general population.
This means that the other main type of stroke - the so-called ischemic stroke - represents 85-87% of all strokes in the general population.
Causes
The main causes of hemorrhagic stroke are:
- The rupture of a brain aneurysm ;
- Head traumas ;
- Chronic hypertension ;
- Congenital arteriovenous malformations with encephalic site.
WHAT IS A CEREBRAL ANEURISM?
A brain aneurysm is a pathological dilation of a blood vessel in the brain, whose appearance is very reminiscent of a berry attached to a branch.
The peculiarity of cerebral aneurysms is that, as long as they maintain their integrity, they are completely asymptomatic; therefore, a person who has an intact brain aneurysm shows no symptoms and feels perfectly healthy.
When a brain aneurysm breaks down, the life of the affected subject is in great danger.
SUBTIPES OF HEMORRAGIC ICTUS
There are two subtypes of hemorrhagic stroke: intracerebral hemorrhagic stroke and subarachnoid hemorrhagic stroke.
- Intracerebral hemorrhagic stroke. It is so called the hemorrhagic stroke due to the rupture of a blood vessel located inside the brain.
The blood that escapes, in addition to no longer replenishing the brain areas to which it was destined, exerts pressure on the surrounding brain tissue, damaging it.
- Subarachnoid hemorrhagic stroke. Hence the hemorrhagic stroke due to the rupture of a blood vessel located in the subarachnoid space . The subarachnoid space is the space filled with cerebrospinal fluid, present between the pia mater (innermost meninge) and the arachnoid (intermediate meninge) of the brain.
As in the case of the intracerebral hemorrhagic stroke, the vasal rupture, consequent to the episodes of hemorrhagic stroke, involves the missed inflow of blood to the interested encephalic area.
Cerebral aneurysms represent the most important cause of subarachnoid hemorrhagic stroke.
Symptoms, signs and complications
Risk factors for hemorrhagic stroke
Tractable:
- Chronic hypertension
- Smoking and passive smoking
- Diabetes
- Overweight and obesity
- Physical inactivity
- Excess alcohol
- Use of drugs
Untreatable:
- Age over 55-60 years
- African, Asian and Caribbean breed
- Family history of stroke
- Male sex
- History of preeclampsia
The symptoms of hemorrhagic stroke (and stroke in general) depend on the area of brain involved in the loss of blood, as - as some readers may know - different regions of the brain control different districts of the human body.
Furthermore, the extent of tissue damage is of fundamental importance: the more extensive and severe the hemorrhagic stroke, the more dramatic and lethal the consequences can be. Therefore, every patient suffering from hemorrhagic stroke represents a case in itself.
TYPICAL SYMPTOMATIC FRAMEWORK
The typical symptoms and signs of hemorrhagic stroke are:
- Paralysis and numbness of the upper and lower limbs;
- Difficulty walking, loss of balance and / or dizziness;
- Difficulty speaking and understanding;
- Visual difficulties;
- Headache, nausea, vomiting and / or stiff neck;
- Confusion and disorientation;
- Loss of knowledge.
WHEN TO REFER TO THE DOCTOR?
COMPLICATIONS
Hemorrhagic stroke can be a cause of temporary or permanent disability. The severity of these complications depends on how long the brain has remained without blood supply, before help, and from the affected brain area.
The typical complications of hemorrhagic stroke are:
- Total or semi-total paralysis of the motor muscles;
- Serious difficulty speaking and swallowing;
- Loss of memory and inability to reason;
- Post-stroke pain;
- Emotional problems and behavioral changes;
- Inability to take care of yourself.
Diagnosis
To an experienced eye, the signs of a stroke, whether hemorrhagic or ischemic, are unmistakable and easy to detect .
However, whoever is the victim of a stroke is subjected to various diagnostic tests, the purpose of which is to identify, first of all, the type of stroke and, secondly, the triggering causes, the precise location of encephalic damage and their severity.
To establish whether a stroke is haemorrhagic or ischemic and to determine all its other characteristics (causes, precise location, etc.), they are fundamental:
- An objective examination and a medical history;
- Blood tests;
- Instrumental examinations, such as the CT scan of the brain, the nuclear magnetic resonance of the brain, magnetic angio-resonance in the encephalic level and cerebral angiography.
Therapy
Hemorrhagic stroke involves a different treatment than ischemic stroke, as they are two conditions that appear with extremely different mechanisms. For this reason, in the diagnosis phase, it is essential to establish the exact type of stroke in progress.
The focal points of hemorrhagic stroke therapy are:
- Stop and control blood loss;
- Reduce the pressure that the bleeding creates on the damage to the encephalic tissues surrounding the rupture area;
- Physical rehabilitation and psychological recovery.
STOP THE HEMORRHAGE AND REDUCE THE PRESSURE AT ENCEPHALIC LEVEL
To stop the bleeding, which characterizes the hemorrhagic stroke, it is necessary to administer coagulant drugs as soon as possible.
If the blood loss has been contained in the quantity, there is a good chance that it will reabsorb spontaneously within a few time. In any case, in these situations, the patient is kept under observation.
If, on the other hand, the blood loss has been significant, the surgically leaked blood must be removed.
TREATMENT IN CASE OF ANEURISMA OR ARTERO-VENOSE MALFORMATIONS
If it depends on a cerebral aneurysm or a congenital arteriovenous malformation, the hemorrhagic stroke requires surgery to repair the artery involved (from the malformation or aneurysm).
The actions that can be implemented in the above circumstances are:
- Classical craniotomy .
It consists in the temporary removal of a part of the skull and in the repair of the vessel or the blood vessels that have suffered the rupture. Clearly, the removal of the skull portion takes place where the hemorrhagic stroke has occurred.
- Aneurysm clipping .
It consists in the temporary removal of a part of the skull and in the application of a sort of clamp (clip) at the base of the aneurysm. The clamp serves to prevent blood from flowing back into the aneurysm, causing it to break again.
- Removal of the arteriovenous malformation .
It consists in eliminating, where possible, the vessel anomaly, in order to reduce the risk of another hemorrhagic stroke.
REHABILITATION PATH
Rehabilitation, for a patient suffering from hemorrhagic stroke (and ischemic stroke), is a fundamental and obligatory step. Without it, in fact, the recovery of some faculties (motor, language, balance etc.) would not be possible. The rehabilitation process restores strength and coordination to the patient and allows him to return, almost always, to an independent life.
Obviously, recovery is not the same for everyone: patients with severe hemorrhagic strokes deserve much more attention and it is not certain that they will recover all their motor or language functions; conversely, patients with less severe hemorrhagic strokes are more likely to recover.
PSYCHOLOGICAL RECOVERY
Many people suffering from hemorrhagic stroke (and stroke in general) develop depression and despondency, as they pass from a normal life (before stroke) to a life dependent on others or otherwise very conditioned (after the stroke). For this reason, it is essential that they undergo treatments aimed at psychological recovery ( psychotherapy ).
Prognosis
The prognosis in case of hemorrhagic stroke depends on several factors:
- Gravity and extent of hemorrhagic stroke. The more the bleeding is extended, the more serious and difficult to recover.
- Timeliness and quality of relief. The sooner action is taken, the less brain damage.
- Age of the patient. An older patient is more difficult to cure, even from the point of view of rehabilitation.
- State of health of the patient. The patient may suffer from other diseases, such as chronic hypertension, which make post-stroke care and recovery more difficult.
- Quality of rehabilitation. The better the rehabilitation process, the greater the benefits.
- Causes of hemorrhagic stroke. There are less treatable and preventable causes than others.
Prevention
Controlling and maintaining blood pressure at normal levels, not smoking, not drinking alcohol beyond the permitted amounts and not using drugs are the main countermeasures, recommended by doctors, to reduce the risk of hemorrhagic stroke.
