Written by Chen Kai Xian, pharmacist.
What is haemorrhagic stroke?
Brain Haemorrhage is a broad term used to describe the incidence of bleeding in the brain. Neurologists and neurosurgeons detect the location where the brain bleeds to differentiate the different types of brain haemorrhage between patients. In this article, we would talk more about intracerebral haemorrhage or more commonly known as haemorrhagic stroke.
The Causes
- Uncontrolled high blood pressure
- Heavy alcohol consumption
- Drug Abuse
- Head trauma & brain tumour
- Untreated ischaemic stroke or transient ischaemic stroke
- Medical conditions during pregnancy / childbirth : eclampsia, postpartum vasculopathy, neonatal intraventricular haemorrhage
People of all ages could be the victim of intracerebral haemorrhage upon ruptured of weakened blood vessels in the brain. For example, cerebral aneurysm and arteriovenous malformation (AVMs).
The Symptoms
People suffering from intracerebral haemorrhage require prompt treatment to prevent unreversed brain damage due to the lack of oxygen supply to the brain tissues and high pressure building in the brain.
The signs of haemorrhagic stroke are as follow:
- Sudden weakness
- Paralysis to part of the body
- Inability to speak
- Inability to control fine motor movement
- Severe and sudden headache and often being describe as “thunderclap”
- Nausea and vomiting
- Sensitivity towards light
- Confusion
- Dizziness
- Loss of consciousness
Community could follow these four simple steps in assessing an haemorrhagic stroke and get medical attention immediately.
- Face drooping / uneven face
- Inability to lift one side of the arm up
- Slurred speech
- Dial and call 999
The Diagnosis
If any case of brain haemorrhage is suspected, immediate examinations would be carry out:
- Physical examination
- Brain imaging including computed tomography (CT) scan or magnetic resonance imaging (MRI) scan for the location, extent and the cause of bleeding.
- Spinal tap or a lumbar puncture to examine cerebrospinal fluid for suspected subarachnoid haemorrhage.
Other test may include:
- Full blood test and urinalysis
- Electrocardiogram (ECG) and chest X-ray
The Treatment
- The immediate solution that medical officer would offer is to lower the intracranial pressure with mannitol or hyperventilation via intubation.
- Severe cases might involve surgery to remove large portion of blood clot in severe cases.
- Medications to relieve blood pressures, headaches, seizures. Patients may also be put on blood thinning medications.
- Early physiotherapy, speech therapy and/or occupational therapy might be very useful in supporting patients back to their basic care in daily life.
- In severe cases, patients might be bedridden and require hospitalization or carer to take care of their daily needs.
The Prevention
Intracerebral haemorrhage may be prevented with……
- Well-regulated blood pressure
- Seek advice from medical professionals to avoid contraindication with daily foods and OTC medicines or supplements. This is crucial if patient is on warfarin
- Lifestyle changes like smoking cessation, reduce alcohol consumption or avoid binge drinking
- Stay away from drug abuse like codeine, ice and methamphetamine.
References
- National Cancer Institute. Meninges. https://training.seer.cancer.gov/brain/tumors/anatomy/meninges.html
- Seattle Cancer Care Alliance. Anatomy of the Brain and Spinal Cord. https://www.seattlecca.org/diseases/brain-spinal-cord-cancers/brain-spinal-cord-cancers-facts/anatomy-brain-and-spinal-cord
- Harvard Health Publishing Harvard Medical School; 2019 Feb. Hemorrhagic Stroke. https://www.health.harvard.edu/a_to_z/hemorrhagic-stroke-a-to-z
- Cleveland Clinic. Brain Bleed/Hemorrhage (Intracranial Hemorrhage). https://my.clevelandclinic.org/health/diseases/14480-intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke
- Aurora Health Care. Brain Hemorrhage. https://www.aurorahealthcare.org/services/neuroscience/brain-skull-base-care/brain-hemorrhage#Diagnosis
- American Stroke Association. Stroke sypmtoms. https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds
- Programs for Stroke Identifications. http://exams.browardhealth.org/Stroke_Awareness/stroke_id_programs_fast.html