Who is at risk for brain hemorrhage?

What is an intracranial hemorrhage?

Intracranial hemorrhage (ICH) refers to acute bleeding inside your skull or brain. It’s a life-threatening emergency. You should go to the emergency room right away or call 911 if you think you or someone you know is experiencing ICH.

There are four types of ICH:

• epidural hematoma
• subdural hematoma
• subarachnoid hemorrhage
• intracerebral hemorrhage

Epidural hematoma

A hematoma is a collection of blood, in a clot or ball, outside of a blood vessel. An epidural hematoma occurs when blood accumulates between your skull and the outermost covering of your brain.

It typically follows a head injury, and usually with a skull fracture. High-pressure bleeding is a prominent feature. If you have an epidural hematoma, you may briefly lose consciousness and then regain consciousness.

Subdural hematoma

A subdural hematoma is a collection of blood on the surface of your brain.

It’s typically the result of your head moving rapidly forward and stopping, such as in a car accident. However, it could also suggest abuse in children. This is the same type of movement a child experiences when being shaken.

A subdural hematoma is more common than other ICHs in older people and people with history of heavy alcohol use.

Subarachnoid hemorrhage

A subarachnoid hemorrhage is when there’s bleeding between the brain and the thin tissues that cover the brain. These tissues are called meninges. The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm.

A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting.

Intracerebral hemorrhage

Intracerebral hemorrhage is when there’s bleeding inside of your brain. This is the most common type of ICH that occurs with a stroke. It’s not usually the result of injury.

A prominent warning sign is the sudden onset of neurological deficit. This is a problem with your brain’s functioning. The symptoms progress over minutes to hours. They include:

• headache
• difficulty speaking
• nausea
• vomiting
• decreased consciousness
• weakness in one part of the body
• elevated blood pressure

Most ICHs are due to a head injury. Any activities or lifestyle choices that put you at risk for a head injury can lead to ICH.

Factors that increase your risk include:

The signs and symptoms of ICH vary depending on the type, but they usually include:

• a sudden and severe headache
• a headache associated with a recent blow to your head
• a mild and long-lasting headache
• a headache accompanied by neck stiffness
• confusion
• drowsiness
• vomiting more than twice in 24 hours
• seizure
• coma

ICH in children

ICH in a child can indicate child abuse. The damage may be the result of a blow to the head or by shaking the child. This can lead to shaken baby syndrome. This is a condition that occurs when violent shaking leads to serious brain damage in a child.

Other signs of child abuse are:

• swollen head
• retinal hemorrhages
• vomiting
• seizure
• unconsciousness
• fractures of arms and legs of different ages

Babies less than 12 months old may develop a swollen fontanel, or soft spot.

Report suspected child abuse right away by calling 911 or 1-800-4-A-CHILD (1-800-422-4453).

The first step your doctor will take to diagnose ICH is a CT scan of your head. A CT scan can show abnormalities in your brain like swelling or clots.

The CT scan may not show any sign of ICH. If you’re still having symptoms, your doctor may choose to perform a lumbar puncture, or spinal tap, to test the fluid that cushions your spine and brain.

ICH is a medical emergency. Survival depends on getting treatment right away.

It may be necessary to operate to relieve the pressure on the skull. Drilling a small hole in the skull releases blood. Drilling a larger hole or removing a piece of the skull may be necessary to remove a blood clot.

Medications

The following drugs may be necessary:

An ICH can lead to any of the following complications:

• seizures
• paralysis
• headaches
• brain development problems in children
• memory loss
• dizziness
• difficulty concentrating

Basic preventive measures that can help avoid head injuries include the following:

• Always wear a helmet when riding a bike, motorcycle, skateboard, or scooter.
• Always wear your seatbelt.
• If you’re of older age, try to avoid falls.
• Call 911 or 1-800-4-A-CHILD (1-800-422-4453) to report suspected child abuse.

The outlook depends on the severity of the hemorrhage and how quickly you get medical care. Remember, ICH is a life-threatening condition.

Depending on the severity of the hemorrhage, draining a hematoma can lead to recovery. Physical or occupational therapy is sometimes needed to help you return to normal activities.

A stroke, or brain attack, happens when blood flow to your brain is stopped. It is an emergency situation.

The brain needs a constant supply of oxygen and nutrients in order to work well. If blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen.

When brain cells die, brain function is lost. You may not be able to do things that are controlled by that part of the brain. For example, a stroke may affect your ability to:

• Move

• Speak

• Eat

• Think and remember

• Control your bowel and bladder

• Control your emotions

• Control other vital body functions

A stroke can happen to anyone at any time.

A stroke is caused when blood flow to your brain is stopped or disrupted.

There are 2 kinds of stroke: ischemic and hemorrhagic.

• Ischemic stroke. This is the most common type of stroke. It happens when a major blood vessel in the brain is blocked. It may be blocked by a blood clot. Or it may be blocked by a buildup of fatty deposit and cholesterol. This buildup is called plaque.

• Hemorrhagic stroke. This occurs when a blood vessel in your brain bursts, spilling blood into nearby tissues. With a hemorrhagic stroke, pressure builds up in the nearby brain tissue. This causes even more damage and irritation.

At just 47 years old, Amy wasn't expecting a stroke would leave her unable to identify or communicate with her own family members. See how the expertise of Dr. Rafael Llinas helped her get the diagnosis and treatment she needed.

Anyone can have a stroke at any age. But your chance of having a stroke increases if you have certain risk factors. Some risk factors for stroke can be changed or managed, while others can’t.

Risk factors for stroke that can be changed, treated, or medically managed:

• High blood pressure. Blood pressure of 140/90 or higher can damage blood vessels (arteries) that supply blood to the brain.

• Heart disease. Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors.

• Diabetes. People with diabetes are at greater risk for a stroke than someone without diabetes.

• Smoking. Smoking almost doubles your risk for an ischemic stroke.

• Birth control pills (oral contraceptives)

• History of TIAs (transient ischemic attacks). TIAs are often called mini-strokes. They have the same symptoms as stroke, but the symptoms don’t last. If you have had one or more TIAs, you are almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.

• High red blood cell count. A significant increase in the number of red blood cells thickens the blood and makes clots more likely. This raises the risk for stroke.

• High blood cholesterol and lipids. High cholesterol levels can contribute to thickening or hardening of the arteries (atherosclerosis) caused by a buildup of plaque. Plaque is deposits of fatty substances, cholesterol, and calcium. Plaque buildup on the inside of the artery walls can decrease the amount of blood flow to the brain. A stroke occurs if the blood supply is cut off to the brain.

• Lack of exercise

• Obesity

• Excessive alcohol use. More than 2 drinks per day raises your blood pressure. Binge drinking can lead to stroke.

• Illegal drugs. IV (intravenous) drug abuse carries a high risk of stroke from blood clots (cerebral embolisms). Cocaine and other drugs have been closely linked to strokes, heart attacks, and many other cardiovascular problems.

• Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke. Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.

• Cardiac structural abnormalities. Damaged heart valves (valvular heart disease) can cause long-term (chronic) heart damage. Over time, this can raise your risk for stroke.

Risk factors for stroke that can’t be changed:

• Older age. For each decade of life after age 55, your chance of having a stroke more than doubles.

• Race. African Americans have a much higher risk for death and disability from a stroke than whites. This is partly because the African-American population has a greater incidence of high blood pressure.

• Gender. Stroke occurs more often in men, but more women than men die from stroke.

• History of prior stroke. You are at higher risk for having a second stroke after you have already had a stroke.

• Heredity or genetics. The chance of stroke is greater in people with a family history of stroke.

Other risk factors include:

• Where you live. Strokes are more common among people living in the southeastern U.S. than in other areas. This may be because of regional differences in lifestyle, race, smoking habits, and diet.

• Temperature, season, and climate. Stroke deaths occur more often during extreme temperatures.

• Social and economic factors. There is some evidence that strokes are more common among low-income people.

A stroke is an emergency situation. It’s important to know the signs of a stroke and get help quickly. Call 911 or your local emergency number right away. Treatment is most effective when started right away.

Stroke symptoms may happen suddenly. Each person’s symptoms may vary. Symptoms may include:

• Weakness or numbness of the face, arm, or leg, usually on one side of the body

• Having trouble speaking or understanding

• Problems with vision, such as dimness or loss of vision in one or both eyes

• Dizziness or problems with balance or coordination

• Problems with movement or walking

• Fainting (loss of consciousness) or seizure

• Severe headaches with no known cause, especially if they happen suddenly

Other less common symptoms of stroke may include:

• Sudden nausea or vomiting not caused by a viral illness

• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma

• TIA, called a mini-stroke

A TIA can cause many of the same symptoms as a stroke. But TIA symptoms are passing. They can last for a few minutes or up to 24 hours. Call for medical help right away if you think someone is having a TIA. It may be a warning sign that a stroke is about to occur. But not all TIAs are followed by a stroke.

FAST is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to call 911 fast. FAST stands for:

F - Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

A - Arm weakness. One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.

S - Speech difficulty. You may see slurred speech or difficulty speaking. The person can't repeat a simple sentence correctly when asked.

T - Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make note of the time the symptoms first appeared.

How is a stroke diagnosed?

Your healthcare provider will take a complete health history and do a physical exam. You will need tests for stroke such as brain imaging and measuring the blood flow in the brain. Tests may include:

• CT scan of the brain. An imaging test that uses X-rays to take clear, detailed images of the brain. A brain CT scan can show bleeding in the brain or damage to brain cells caused by a stroke. It is used to find abnormalities and help find the location or type of stroke.

• MRI . This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body. An MRI uses magnetic fields to find small changes in brain tissue that help to find and diagnose stroke.

• CTA (computed tomographic angiography). An X-ray image of the blood vessels. A CT angiogram uses CT technology to get images of blood vessels.

• MRA (magnetic resonance angiography). This test uses MRI technology to check blood flow through the arteries.

• Doppler sonography (carotid ultrasound). A test that uses sound waves to create pictures of the inside of your carotid arteries. This test can show if plaque has narrowed or blocked your carotid arteries.

The following heart tests may also be used to help diagnose heart problems that may have led to a stroke:

• Electrocardiogram (ECG). This test records your heart’s electrical activity. It shows any irregular heart rhythms that may have caused a stroke.

• Echocardiography. This test uses sound waves to create a picture of your heart. This test shows the size and shape of your heart. It can check if the heart valves are working properly. It can also see if there are blood clots inside your heart.

How is a stroke treated?

Your healthcare provider will create a care plan for you based on:

• Your age, overall health, and past health

• The type of stroke you had

• How severe your stroke was

• Where in your brain the stroke happened

• What caused your stroke

• How well you handle certain medicines, treatments, or therapies

• Your opinion or preference

There is no cure for stroke once it has occurred. But advanced medical and surgical treatments are available. These can help reduce your risk for another stroke.

Treatment is most effective when started right away. Emergency treatment after a stroke may include:

• Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the blood clots that cause an ischemic stroke. They can help reduce the damage to brain cells caused by the stroke. To be most effective, they must be given within 3 hours of a stroke occurring.

• Medicines and therapy to reduce or control brain swelling. Special types of IV (intravenous) fluids are often used to help reduce or control brain swelling. They are used especially after a hemorrhagic stroke.

• Neuroprotective medicines. These medicines help protect the brain from damage and lack of oxygen (ischemia).

• Life support measures. These treatments include using a machine to help you breathe (a ventilator), having IV fluids, getting proper nutrition, and controlling your blood pressure.

• Craniotomy. This is a type of brain surgery that is done to remove blood clots, relieve pressure, or repair bleeding in the brain.

What are the complications of having a stroke?

Recovery from stroke and the specific ability affected depends on the size and location of the stroke.

A small stroke may cause problems such as weakness in your arm or leg.

Larger strokes may cause parts of your body to not be able to move (be paralyzed). Larger strokes can also cause loss of speech or even death.

What can I do to prevent a stroke?

Know your risk for stroke. Many stroke risk factors can be changed, treated, or medically modified. Some things you can do to control your risk factors are listed below.

Lifestyle changes

A healthy lifestyle can help reduce your risk for stroke. That includes the following:

• Stop smoking, if you smoke.

• Make healthy food choices. Be sure to get the recommended amounts of fruits, vegetables, and whole grains. Choose foods that are low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.

• Stay at a healthy weight.

• Be physically active.

• Limit alcohol use.

Medicines

Take your medicines as instructed by your healthcare provider. The following medicines can help prevent stroke:

• Blood-thinning medicines (anticoagulants) help prevent blood clots from forming. If you take a blood thinner, you may need regular blood tests.

• Antiplatelets, such as aspirin, are prescribed for many stroke patients. They make blood clots less likely to form. Aspirin is available over the counter.

• Blood-pressure medicines help lower high blood pressure. You may need to take more than one blood-pressure medicine.

• Cholesterol-lowering drugs make plaque less likely to build up in your artery walls, which can reduce the risk for stroke.

• Heart medicines can treat certain heart problems that increase your risk of stroke.

• Diabetes medicines adjust blood sugar levels. This can prevent problems that lead to stroke.

Surgery

Several types of surgery may be done to help treat a stroke, or help to prevent one. These include:

• Carotid endarterectomy. Carotid endarterectomy is surgery to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help stop a stroke from occurring

• Carotid stenting. A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery.

• Surgery to repair aneurysms and AVMs (arteriovenous malformations). An aneurysm is a weakened, ballooned area on an artery wall. It is at risk for bursting (rupturing) and bleeding into the brain. An AVM is a tangle of arteries and veins. It interferes with blood circulation and puts you at risk for bleeding.

• PFO (patent foramen ovale) closure. The foramen ovale is an opening that occurs in the wall between the 2 upper chambers of the heart. This opening usually closes right after birth. If the flap does not close, any clots or air bubbles can pass into the brain circulation. This can cause a stroke or TIA (transient ischemic attack). However, experts are still debating whether the PFO should be closed.

Living with a stroke

How a stroke affects you depends on where the stroke occurs in your brain. It also depends on how much your brain is damaged.

Many people who have a stroke are left with paralysis of one of their arms.

Other problems can include having trouble with:

• Thinking

• Speaking

• Swallowing

• Doing simple math such as adding, subtracting, or balancing a checkbook

• Dressing

• Showering

• Going to the bathroom

Some people may need long-term physical rehabilitation. They may not be able to live in their home without help.

Support services are available to help with physical and emotional needs after a stroke.

When should I call my healthcare provider?

Strokes can happen again. Call your healthcare provider if you have symptoms that seem like a stroke, even if they don’t last long.

If you have repeated damage to your brain tissue, you may be at risk for life-long (permanent) disabilities.

Stroke: Key points

• A stroke happens when blood flow to your brain is stopped. It is an emergency situation.

• It can be caused by a narrowed blood vessel, bleeding, or a clot that blocks blood flow.

• Symptoms can happen suddenly. If someone is showing any sign of a stroke, call 911 immediately.

• You have a better chance of recovering from a stroke if emergency treatment is started right away.

• How a stroke affects you depends on where the stroke occurs in your brain, and on how much your brain is damaged.