Hemorrhagic stroke is bleeding due to rupture of blood vessels in certain areas of the brain. This condition causes reduced blood flow in that area. Without a supply of oxygen carried by the blood, brain cells can quickly die so that brain function is disrupted.
Hemorrhagic stroke is a critical condition. This means that medical care needs to be given to patients with hemorrhagic stroke as soon as possible. Early treatment can reduce the chances of permanent brain damage, disability, and even death.
Hemorrhagic stroke is divided into two types, namely:
- Intracerebral hemorrhage, ie bleeding due to rupture of an artery in the brain, and this bleeding is the most common type of hemorrhagic stroke.
- Subarachnoid hemorrhage, which is bleeding in the blood vessels in the space between the brain and the membrane covering the brain (the 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 cavities within the skull, not into 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, i.e. bulging of the walls of the blood vessels of the brain that are weak due to blood pressure or due to birth defects
- Arterial venous malformation of the brain, which is a birth disorder 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 anemia 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 any age group, but the risk of developing 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 hemorrhagic stroke, such as:
- Smoking habit
- Excessive consumption of alcoholic beverages
- Taking anticoagulant or blood-thinning medications, such as warfarin
- Use of illegal drugs or drugs
- Unhealthy diet
- Conditions that cause high blood pressure, such as chronic kidney failure and eclampsia
- Excessive sleep time, or sleep disturbances such as sleep apnea
- Genetic conditions that cause blood vessel walls to become weak and break easily, such as Ehler-Danlos syndrome
Symptoms of Hemorrhagic Stroke
Symptoms of hemorrhagic stroke generally occur when the sufferer does physical activity with high intensity. This is closely related to the most common triggering factor for stroke, namely high blood pressure.
Symptoms of a hemorrhagic stroke can vary, depending on how much tissue is affected, the location, and the severity of the bleeding. Here is the explanation:
Intracerebral hemorrhagic stroke
Intracerebral hemorrhagic stroke usually occurs suddenly. Symptoms of 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), the words spoken are irrelevant, or unable to speak at all
- Can't understand other people's words and looks confused
- Seizures
Subarachnoid hemorrhagic stroke
Subarachnoid hemorrhagic stroke causes early symptoms of double vision, pain in the eye, and headaches or dizziness. These early symptoms can occur minutes to weeks before the blood vessel bursts.
After a blood vessel bursts, some of the symptoms that can appear are:
- A very severe headache, which can be described as the worst headache ever experienced in my life
- Nausea and vomiting
- Stiffness in the back of the neck
- Blurred vision or feeling dazzled
- Dizziness spinning or like floating
- Sloppy speech and weakness on one side of the body
- Rapid loss of consciousness
- Seizures
When to go to the doctor
Bleeding in a hemorrhagic stroke can occur quickly. Within hours or minutes, brain cell damage from a hemorrhagic stroke can progress to permanent damage.
Therefore, hemorrhagic stroke must be treated quickly. If you suspect someone is having signs of a stroke, you can perform a FAST test as follows:
- F (facial dripping or drooping face), i.e. by seeing if the person can smile and seeing if his mouth or eyes droop
- A (arm weakness or weak arm), i.e. by checking if the person can raise both hands
- S (speech problems or a speech disorder), that is, by finding out if the person can speak clearly and understands what you are saying
- T (time to call 119 or when to call 119), i.e. by calling an ambulance if the person exhibits all of the above
Calling 119 (ambulance) as soon as possible is the most appropriate action to help people with hemorrhagic stroke. That way the patient can immediately get help from medical personnel and doctors.
Hemorrhagic Stroke Diagnosis
Doctors can diagnose someone suffering from 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 determine 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 ruptured blood vessels and detect blood vessel deformities
- Complete blood count, to check how quickly blood clots can occur
- Lumbar puncture, to determine whether cerebrospinal fluid is mixed with blood (a positive sign of a subarachnoid hemorrhagic stroke)
Hemorrhagic Stroke Treatment
Patients with hemorrhagic stroke 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.
Emergency conditions
In the early stages, doctors will act quickly to save the patient. Actions that doctors can take include:
- Giving medication to help blood clot, such as giving vitamin K, platelet blood transfusions, or blood clotting factors, if it is known that the patient is taking blood thinners
- Lowering blood pressure slowly with medicine
- Reducing pressure in the head, for example by administering diuretics or corticosteroids by infusion
- Give anticonvulsant drugs (anticonvulsants), to treat or prevent seizures
For cases of hemorrhagic stroke with very heavy bleeding, surgery is needed to remove the pool of blood 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 repeated bleeding.
- Endovascular coiling, namely by blocking blood vessels to block blood flow to the area of the aneurysm and clotting blood to stop bleeding.
Monitoring and recovery period
Patients with hemorrhagic stroke whose bleeding is not too much and patients who have undergone surgery will undergo a period of monitoring and recovery.
Medical staff will monitor the patient closely for at least 1 day. During the recovery period, medications 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 in hemorrhagic stroke patients, because they can worsen bleeding.
Laxatives may also be given to prevent the patient from straining too hard during a bowel movement, which can increase the pressure inside 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 after the patient has returned home.
Complications of Hemorrhagic Stroke
Patients with hemorrhagic stroke are at risk for serious complications. These complications can occur within 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 inside the head and damage brain tissue
- Vasospasm, which is a narrowing of blood vessels that can reduce the flow of blood that carries oxygen to the brain
- Hemorrhagic stroke is back
- Seizures
Disorders due to brain damage can also be difficult for patients for a long time, even a lifetime. Disturbances that can occur include:
- Inability to move body parts (paralysis)
- Numbness or weakness in any part of the body
- Long term headache
- Visual disturbance
- Difficulty speaking or understanding spoken or written words
- Disturbances in thinking and remembering
- Difficulty 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, the disorder can also cause other complications, such as:
- Deep vein thrombosis, due to not being able to move for a long time
- Malnutrition, due to difficulty swallowing food
- Aspiration pneumonia, due to choking when 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 life. This condition can improve with regular check-ups with a doctor and undergoing post-stroke rehabilitation therapy.
Prevention of Hemorrhagic Stroke
Hemorrhagic stroke 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 drugs prescribed by a doctor and living a healthy lifestyle that is recommended.
- Regulate your diet and adopt a healthy diet, by eating foods that contain less bad cholesterol and saturated fat.
- Eat foods that are rich in fiber, vitamins, and minerals, such as fruits and vegetables.
- Maintain ideal body weight.
- Exercise regularly.
- Perform regular checks 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 a head injury. Therefore, be careful when doing activities inside or outside the house. 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 when driving.
Regarding the risk of hemorrhagic stroke for warfarin users, always obey the rules and dosages that have been set by the doctor to minimize the risk of bleeding in the blood vessels of the brain.