Hemorrhagic stroke is bleeding due to rupture of blood vessels in certain areas of the brain. This condition causes blood flow in that part to decrease. Without the supply of oxygen carried by the blood, brain cells can die quickly so that brain function is disrupted.
Hemorrhagic stroke is a critical condition. This means that medical care needs to be given to hemorrhagic stroke sufferers as soon as possible. Early treatment can reduce the chance of permanent brain damage, disability, and even death.
Hemorrhagic stroke is different from ischemic stroke . Ischemic stroke is a stroke caused by a blockage in the blood vessels of the brain.
Hemorrhagic stroke is divided into two types, namely:
- Intracerebral hemorrhage, namely bleeding due to rupture of an artery in the brain, and this bleeding is the most common type of hemorrhagic stroke
- Subarachnoid hemorrhage , namely bleeding in the blood vessels in the space between the brain and the lining covering the brain (subarachnoid space)
Causes of Hemorrhagic Stroke
Hemorrhagic stroke occurs when a blood vessel in or around the brain bursts. This condition causes blood to flow into the cavities inside the skull, rather than into the brain tissue. As a result, the pressure inside the head increases and brain tissue is damaged.
There are several causes of ruptured blood vessels, namely:
- Severe head injury
- High blood pressure (hypertension)
- Brain aneurysm , namely swelling of the walls of the blood vessels of the brain that are weak due to blood pressure or due to abnormalities since birth
- Brain arteriovenous malformation , which is a birth defect in which the arteries and veins in the brain are connected without capillaries
- Blood disorders that increase the risk of bleeding, such as sickle cell disease and hemophilia
- Brain tumors, both malignant and benign, affecting the blood vessels of the brain
Risk factors for hemorrhagic stroke
Hemorrhagic stroke can occur in all age groups, but the risk of this condition increases with age. Hemorrhagic strokes are also more common in men than women.
In addition, there are other risk factors that can trigger a hemorrhagic stroke, such as:
- Smoking habit
- Excessive consumption of alcoholic beverages
- Take anticoagulants or blood thinners, such as warfarin
- Use of illegal drugs or NAPZA
- Unhealthy diet
- Conditions that cause high blood pressure, such as chronic kidney failure and eclampsia
- Excessive sleep time, or sleep disorders such as sleep apnea
- Genetic conditions that cause the walls of blood vessels to weaken and break easily, such as Ehler-Danlos syndrome
Hemorrhagic Stroke Symptoms
Symptoms of hemorrhagic stroke generally occur when the sufferer performs high-intensity physical activity. This is closely related to the most common stroke trigger factor, namely high blood pressure.
Symptoms that arise from a hemorrhagic stroke can vary, depending on how much tissue is disturbed, the location, and the severity of the bleeding. The following is an explanation:
Intracerebral hemorrhagic stroke
Intracerebral hemorrhagic stroke usually occurs suddenly. Symptoms that can occur with intracerebral hemorrhage include:
- Unbearable headache
- Nausea and vomiting
- Loss of consciousness
- Weakness or paralysis on one side of the body
- Numbness on one side of the body
- Difficulty pronouncing words (pelo), words spoken are irrelevant, or unable to speak at all
- Can't understand what other people are saying and looks confused
Subarachnoid hemorrhagic stroke
Subarachnoid hemorrhagic stroke causes initial symptoms in the form of double vision, pain in the eyes, and headaches or dizziness. These early symptoms can occur minutes to weeks before the blood vessel ruptures.
After a blood vessel ruptures, some of the symptoms that can appear are:
- A very severe headache, which could be described as the worst headache I've ever had in my life
- Nausea and vomiting
- Stiffness in the back of the neck
- Blurred vision or feeling glare
- Dizziness spinning or like floating
- Slurred speech and weakness on one side of the body
- Rapid loss of consciousness
When to see a doctor
Bleeding in a hemorrhagic stroke can occur quickly. Within hours or minutes, the damage to brain cells from a hemorrhagic stroke can develop into permanent damage.
Therefore, hemorrhagic stroke must be treated quickly. If you suspect someone is having signs of a stroke, you can do the FAST test as follows:
- F ( facial drooping or drooping face), namely by seeing if the person can smile and see if the mouth or eyes droop
- A ( weak arm or arm), namely by checking whether the person can raise both hands
- S ( speech problems or speech disorders), namely by finding out if the person can speak clearly and understand what you are saying
- T ( time to call 119 or time to call 119), namely by calling an ambulance if the person shows all the signs above
Calling 119 (ambulance) as soon as possible is the most appropriate action to help hemorrhagic stroke sufferers. That way sufferers can immediately get help from medical staff and doctors.
Diagnosis of Hemorrhagic Stroke
Doctors can diagnose someone with a hemorrhagic stroke through symptom analysis, physical examination and neurological examination, as well as supporting examinations. Supporting examinations carried out include:
- CT scan or MRI, to find out the location of the bleeding, how much tissue damage is in the brain, and to see if there are other abnormalities in the brain tissue, such as a tumor
- Brain angiography, which is an examination using X-rays to find broken blood vessels and detect blood vessel abnormalities
- Complete blood count, to check how quickly blood clots can occur
- Lumbar puncture, to determine whether cerebrospinal fluid is mixed with blood (positive sign of subarachnoid hemorrhagic stroke)
Hemorrhagic Stroke Treatment
Patients with hemorrhagic strokes will be treated in the intensive care unit so that their condition can be monitored closely. Treatment will generally focus on controlling bleeding and preventing complications.
In the early stages, the doctor will act quickly to save the patient. Actions that doctors can take include:
- Administering medications to help blood clot, such as administering vitamin K , blood platelet transfusions, or blood clotting factors, if it is known that the patient is taking blood thinners
- Lowering blood pressure slowly with medication
- Reducing pressure in the head, for example by administering diuretic drugs or corticosteroids through an IV
- Give anti-seizure drugs ( anticonvulsants ), to treat or prevent seizures
For cases of hemorrhagic strokes with very large bleeding, surgery is needed to remove the collection of blood that is trapped in the brain and reduce pressure in the head. Surgery also aims to stop bleeding.
Actions that can be taken are:
- Neurosurgical clipping , namely by clamping a ruptured aneurysm to prevent recurrent bleeding.
- Endovascular coiling , namely by blocking blood vessels to block blood flow to the area of the aneurysm and blood clotting to stop bleeding.
Monitoring and recovery period
Patients with hemorrhagic strokes who bleed not too much and patients who have undergone surgery will undergo a period of monitoring and recovery.
The medical officer will closely monitor the patient for at least 1 day. During the recovery period, administration of drugs such as blood pressure lowering, anticonvulsants, or vitamin K, can be continued as needed to keep the patient's condition stable.
Pain relievers can also be given to patients to relieve headaches. However, non -steroidal anti-inflammatory drugs (NSAIDs) are not recommended for hemorrhagic stroke patients, because they can exacerbate bleeding.
Laxatives may also be given to prevent the patient from straining too hard during bowel movements, which can increase pressure in the head.
After the patient's consciousness has returned, rehabilitation therapy can be carried out as soon as possible. Post-stroke therapy that can be done includes physiotherapy , occupational therapy, or talk therapy. These therapies are not only carried out in the hospital, but also need to be continued even if the patient has returned home.
Hemorrhagic Stroke Complications
Patients with hemorrhagic stroke are at risk for serious complications. These complications can occur days or weeks after a stroke occurs. Some of the complications that often occur are:
- Hydrocephalus, which is a buildup of fluid in the brain that can increase pressure in the head and damage brain tissue
- Vasospasm, namely narrowing of blood vessels that can reduce blood flow that carries oxygen to the brain
- Hemorrhagic stroke recurred
Disorders due to brain damage can also be difficult for patients for quite a long time, even for life. Disturbances that can occur include:
- Inability to move a body part (paralysis)
- Numbness or weakness in a part of the body
- Long term headaches
- Impaired vision
- Difficulty speaking or understanding spoken or written words
- Disturbances in thinking and remembering
- Difficulty in swallowing, eating, or drinking
- Personality changes or emotional disturbances
The above disorders can have a major impact on the quality of life of sufferers and their families. In addition, these disorders can also cause other complications, such as:
- Deep vein thrombosis , the result of not being able to move for a long time
- Malnutrition, due to difficulty swallowing food
- Aspiration pneumonia , caused by choking while trying to eat
- Anxiety and depression, which can develop as a result of emotional disturbances
Even so, not all hemorrhagic stroke sufferers experience the above disorders for a lifetime. This condition can improve with control to the doctor and routine post- stroke rehabilitation therapy .
Hemorrhagic Stroke Prevention
Hemorrhagic strokes can be prevented by avoiding the factors that can trigger this condition. Some things that can be done are:
- Controlling high blood pressure (hypertension), using medicines prescribed by doctors and living a healthy lifestyle is recommended.
- Adjust your diet and adopt a healthy diet, by eating foods that contain less bad cholesterol and saturated fat.
- Eat foods rich in fiber, vitamins and minerals, such as fruits and vegetables.
- Maintain ideal body weight .
- Exercise regularly.
- Check regularly to ensure blood pressure remains normal.
- Avoid things that can trigger blood pressure to rise, such as smoking and consuming alcoholic beverages.
Hemorrhagic strokes can also be caused by head injuries. Therefore, be careful when doing activities inside or outside the home. For example, always wear a helmet and obey traffic rules when riding a motorcycle. If you are driving a car, wear a seat belt and be careful while driving.
Regarding the risk of hemorrhagic stroke for warfarin users , always obey the rules and dosages set by the doctor to minimize the risk of bleeding in the blood vessels of the brain.