Professional Documents
Culture Documents
Stroke (CVA)
Overview of Stroke
Ischemic Stroke
Transient Ischemic Attacks
Overview of Hemorrhagic Stroke
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Intracerebral hemorrhage accounts for about 10% of all strokes but for a much
higher percentage of deaths due to stroke. Among people older than 60, intracerebral
hemorrhage is more common than subarachnoid hemorrhage (bleeding around,
rather than within, the brainsee Subarachnoid Hemorrhage).
Causes
Intracerebral hemorrhage most often results when chronic high
blood pressure weakens a small artery, causing it to burst.
Using cocaine or amphetamines can cause temporary but very
high blood pressure and hemorrhage. In some older people, an
abnormal protein called amyloid accumulates in arteries of the
brain. This accumulation (called amyloid angiopathy) weakens
the arteries and can cause hemorrhage.
Symptoms
An intracerebral hemorrhage begins abruptly. In about half of
the people, it begins with a severe headache, often during
activity. However, in older people, the headache may be mild or
absent.
Symptoms suggesting brain dysfunction develop and steadily
worsen as the hemorrhage expands. Some symptoms, such as
weakness, paralysis, loss of sensation, and numbness, often
affect only one side of the body. People may be unable to speak
or become confused. Vision may be impaired or lost. One or
both eyes may be unable to move in certain directions. As a
result, the eyes may point in different directions. The pupils
may become abnormally large or small. Nausea, vomiting,
seizures, and loss of consciousness are common and may occur
within seconds to minutes.
Diagnosis
Doctors can usually suspect intracerebral hemorrhage based on
symptoms and results of a physical examination. Computed
tomography (CT) or magnetic resonance imaging (MRI) is done
to confirm the diagnosis. Both tests can help doctors
distinguish a hemorrhagic stroke from an ischemic stroke. The
tests can also show how much brain tissue has been damaged
and whether pressure is increased in other areas of the brain.
Prognosis
Intracerebral hemorrhage is more likely to be fatal than
ischemic stroke. The hemorrhage is often large and
catastrophic, especially in people who have chronic high blood
pressure. About half the people who have a large hemorrhage
die within a few days. Those who survive usually recover
consciousness and some brain function over time. However,
most do not recover all lost brain function.
Treatment
Treatment of intracerebral hemorrhage differs from that of an
ischemic stroke. Anticoagulants (such as heparin andwarfarin),
thrombolytic drugs, and antiplatelet drugs (such as aspirin) are
not given because they make bleeding worse. If people who are
taking an anticoagulant have a hemorrhagic stroke, they may
need a treatment that helps blood clot such as
Transfusions of platelets