An event called hemorrhagic stroke occurs when a blood vessel breaks in the brain and spills blood into the surrounding tissue. The blood leaks cause compression on the brain, destroying brain cells and undeniably causing grave neurological deficits.
However, treatment of hemorrhagic stroke focuses on stabilising the patient and preventing further damage, and the treatment plan will depend on the exact location and extent of the haemorrhage. This blog discusses various aspects of hemorrhagic stroke treatment and management.
What Is a Hemorrhagic Stroke?
A hemorrhagic stroke happens when a blood vessel breaks in the brain and spills blood into surrounding tissue. The blood leaks cause pressure on the brain, destroying brain cells and possibly leaving serious neurological deficits. Hemorrhagic strokes are mainly of 2 types.
- Intracerebral Hemorrhage (ICH): It is the most common type of hemorrhagic stroke in which bleeding takes place within the brain tissue.
- Subarachnoid Hemorrhage (SAH): This is characterized by bleeding in the space between the brain and the tissues that pickle it (the subarachnoid space).
Directly caused by hypertension, ruptured blood vessels may also be induced by aneurism, trauma to the head, or malformations of blood vessels. Treatment of a different cessation may depend on how the hemorrhagic stroke started, but it generally seeks to treat the bleeding, the pressure in the brain, and the causative agents.
Hemorrhagic Stroke Treatment: Immediate Care
The treatment of hemorrhagic stroke starts in the emergency room, and time is of the essence. The need for timely management cannot be overemphasised because brain damage may proceed and diminish recovery chances. A typical approach to the management of hemorrhagic stroke would be:
- Stabilizing the Patient: This is the first step towards stabilising the patient’s vital signs such as blood pressure, heart rate, and oxygen levels. If there is a reduced level of consciousness, intubation and ventilation may be required.
- Control of Bleeding: If bleeding can be controlled, another possible brain damage may be reduced. If the patient was taking any blood thinners such as warfarin, there are medications to reverse their effects. In some cases, surgery may be needed to remove the blood clot.
- Reducing Brain Pressure: Major bleeding within the brain can cause a rise in intracranial pressure, which is dangerous. Doctors might treat it with drugs to help bring down swelling and pressure, like mannitol or hypertonic saline. In bad cases, a procedure known as a craniectomy may need to be performed to cut away part of the skull, creating space for the brain to swell without too much damage.
- Monitoring and Support: Patients will need to be monitored closely for complications, such as seizures, infection, and further bleeding. That could be routine CT scans or MRIs to monitor the bleeding and how the rest of the brain looks.
Surgical Treatment of Hemorrhagic Stroke
In cases of hemorrhagic strokes, spontaneous surgical intervention may be necessary. Surgery may or may not be warranted depending upon the size, location, and nature of the bleeding. A large or increasing hemorrhagic stroke is opportunistic for surgery that aims to occlude blood flow to the brain. Suggested surgical procedures for hemorrhagic stroke include:
- Craniotomy: The surgeon removes a section of the skull in order to access the area of bleeding within the brain. The surgeon will then do the removal of blood clots, patching any damaged blood vessels, and stopping the bleeding.
- Endovascular Procedures: Endovascular procedures may be used to treat some types of hemorrhagic stroke, especially those associated with an aneurysm or arteriovenous malformation (AVM). The procedure involves the installation of the catheter into the arteries leading to the brain to ensure the sealing the damaged vessel or aneurysm.
- External Ventricular Drain (EVD): If the patient develops excessive accumulation of fluid in the head (hydrocephalus) due to the condition, the doctor implants a catheter into the ventricles through which excess fluid can be discharged to relieve pressure on the grey matter.
Medical Management of Hemorrhagic Stroke
Hemorrhagic stroke is an urgent medical emergency requiring rapid medical intervention.
- Blood Pressure Management: High blood pressure is the single most important risk factor for hemorrhagic stroke, and controlling blood pressure is the first step in the acute treatment of the disease. Blood pressure may be reduced with medications like labetalol or nicardipine to lower the pressure and prevent additional bleeding.
- Reverse Anticoagulation: When the patient is on anticoagulants, such as warfarin, blood-thinning medications need to be reversed in the event of the observed bleeding. Such reversal could be provided by administering vitamin K, fresh frozen plasma, or a specific reversal agent.
- Anticonvulsants: Seizures are a complication that can sometimes occur with bleeding into the brain. If a patient experiences seizures, anticonvulsants such as levetiracetam or phenytoin may be used.
Rehabilitation and Long-Term Management
Post-acute management looks into rehabilitation and the long-term management of the condition. Rehabilitation aims to help the patient get back as much function as possible, work around any disabilities caused by the stroke, and help decrease the risk of another stroke in the future. Components of long-term management may include:
- Physical and Occupational Therapy: Many stroke survivors require therapy to help regain motor skills and independence. Physical therapy works on moving better; occupational therapy helps the patient practice his daily activities, such as dressing, bathing, or eating.
- Speech Therapy: Therapy can indeed help with improving the communication ability and safe swallowing in the patients who have suffered from strokes affecting speech and swallowing.
- Psychological Support: As discussed in the medical management part, emotional and mental disturbances follow strokes. Patients may suffer from depression, anxiety, or post-stroke cognitive problems. Counselling and support groups are invaluable during the recovery phase.
- Stroke Prevention: Medications may be prescribed for the patient to lower blood pressure, cholesterol, and all other risk factors that could lead to a future stroke. Lifestyle changes are equally important for preventing strokes.
Why Choose Olive Elder Care for Geriatric Counselling?
Recovery from a hemorrhagic stroke is a long, complicated task; it is even harder for older adults. Here at Olive Elder Care, we recognise the struggles seniors and their families are facing during these trying times.
Our geriatric counsellors are expertly trained to stay there with you, planning out triggers to what works best and resources for recovery after a stroke. From stroke rehabilitation to medication management and emotional support, we want to make sure that every part is as smooth and effective as possible. Contact Olive Elder Care today for more information about geriatric counselling and support. We want to help you and your loved ones restore health, independence, and peace of mind.
Frequently Asked Questions
What is the management of a hemorrhagic stroke?
Treatment of hemorrhagic stroke centres on stabilising the patient, controlling the bleeding, relieving brain pressure, and treating the underlying cause. That can be medication, surgery, and close monitoring in the ICU.
What is the gold standard treatment for hemorrhagic stroke?
The best treatment for hemorrhagic stroke varies based on the type of bleed, where it occurs, and how large it is; there is no one “gold standard” option. However, prompt blood pressure control, management of bleeding, and sometimes surgery are all key components.
What is the first-line medication for hemorrhagic stroke?
First-line pharmacotherapy for hemorrhagic stroke typically involves blood pressure control (e.g., labetalol) and agents to reverse anticoagulation (e.g., vitamin K or fresh frozen plasma).
What is the management of brain hemorrhage?
The treatment of a brain hemorrhage involves stabilisation of vital signs, hemorrhage control, brain pressure reduction, and complications prevention. Surgery, medications, and close monitoring may be needed as treatment.
