Hemorrhagic Stroke

What is Hemorrhagic Stroke?

A hemorrhagic stroke is caused by a breakage of a blood vessel in the brain and results in blood leaking into the brain. When this happens the brain cannot get the oxygen it needs to function properly and the brain cells in the area die. Though brain cells usually die within the first hour of a stroke, these cells can survive for a few hours and can fully recover depending on what happens in the time after the hemorrhagic stroke begins. Prompt medical treatment increases the chances of saving these brain cells.

Causes of Hemorrhagic Stroke

There are several disorders that affect the blood vessels and cause hemorrhaging including:

  • Long-standing high blood pressure
  • Cerebral aneurysms

There are two types of hemorrhagic stroke – subarachnoid and intracerebral.

Intracerbral Hemmorrhage Stroke

Occurs when there is bleeding from the blood vessels within the brain itself. Hypertension, or high blood pressure, is the primary cause of this type of hemorrhage.

Subarachnoid Hemorrhage Stroke

Occurs when an aneurysm bursts in a large artery on or near the thin, delicate membrane that surrounds the brain. This area of the brain is filled with a protective fluid, which is contaminated when blood spills in.

Did You Know…

Only 3% of strokes are Subarachnoid Hemorrhage. 30% of the people who experience a subarachnoid hemorrhage stroke die immediately. Another 30% die within 30 days. Of those who survive, very few can live independently again.

Subarachnoid Hemorrhage Symptoms (SHS)

The symptom of a Subarachnoid hemorrhage is a headache so bad it feels like you’re being constantly kicked in the head. The headache pulsates and your consciousness decreases. A hemorrhagic stroke is caused by a sudden bleeding, or hemorrhage, into or next to the brain. This problem accounts for about 20 percent of all people admitted to hospitals for strokes. Most hemorrhagic strokes occur in the brain itself called intracerebral hemorrhages. Smaller groups of people suffer bleeding into the fluid filled spaces located deep in the brain (intraventricular hemorrhage) or into the small space between the brain and the membranes that cover it (subarachnoid hemorrhage).

The source of subarachnoid hemorrhage is commonly located on the surface of the brain. In 80 percent of cases, the problem starts with a congenital weak spot on the wall of a major brain artery, most often where the large arteries divide at the base of the brain.Subarachnoid Hemorrhage Symptoms This defect grows into a thin-walled pouch bulging out of the artery’s side, shaped something like a berry. Such a condition is called an aneurysm. When the walls of the pouch grow too weak to hold the blood inside, it ruptures. The leaking blood may drain not only into the small space surrounding the brain but occasionally directly into brain tissue. The mass of the growing hematoma may also displace or compress vital brain structures.

Hemorrhagic strokes tend to be more deadly than ischemic strokes. Subarachnoid hemorrhage is the most life-threatening, with an average mortality of 40 percent within the first month after the bleeding. Overall, a person’s prognosis tends to be worse if there is more blood around the brain. But an individual’s chances also depend on the exact location of the hematoma and on how severely he or she has been affected.

Arteriovenous Malformation (AVM)

Arteriovenous Malformation is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location.

The genetic transmission patterns of AVM, if any, are unknown. AVM is not generally thought to be an inherited disorder, unless in the context of a specific hereditary syndrome.

Such possible symptoms of AVM include:

  • Difficulties with movement or coordination, including muscle weakness and possibly paralysis.
  • Vertigo (or dizziness)
  • Difficulties of speech (dysarthria) and communication, such as aphasia;
  • Difficulties with everyday activities, such as apraxia;
  • Abnormal sensations (numbness, tingling, or spontaneous pain);
  • Memory and thought-related problems, such as confusion, dementia or hallucinations.
  • In 85% of cases of spontaneous SAH, the cause is rupture of a cerebral aneurysm—a weakness in the wall of one of the arteries in the brain that becomes enlarged.
  • While most cases of SAH are due to bleeding from small aneurysms, larger aneurysms (which are less common) are more likely to rupture.

Brain Aneurysm Statistics and Facts

  • An estimated 6 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people.
  • The annual rate of rupture is approximately 8 – 10 per 100,000 people or about 25,000 – 27,000 people in the United States suffer a brain aneurysm rupture. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% suffer some permanent neurological deficit.
  • Approximately 15% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital. Most of the deaths from subarachnoid hemorrhage are due to rapid and massive brain injury from the initial bleeding which is not correctable by medical and surgical interventions.
  • 4 out of 7 people who recover from a ruptured brain aneurysm will have disabilities.
  • Brain aneurysms are most prevalent in people ages 35 – 60, but can occur in children as well. The median age when aneurysmal hemorrhagic stroke occurs is 50 years old and there are typically no warning signs. Most aneurysms develop after the age of 40.
  • Most aneurysms are small, about 1/8 inch to nearly one inch, and an estimated 50 to 80 percent of all aneurysms do not rupture during the course of a person’s lifetime. Aneurysms larger than one inch are referred to as “giant” aneurysms and can pose a particularly high risk and can be difficult to treat.
  • Women, more than men, suffer from brain aneurysms at a ratio of 3:2.
  • Ruptured brain aneurysms account for 3 – 5% of all new strokes.
  • Subarachnoid hemorrhage (SAH) is one of the most feared causes of acute headache upon presentation to the emergency department. Headache accounts for 1 – 2% of the emergency room visits and up to 4% of visits to the primary care offices. Among all the patients who present to the emergency room with headaches, approximately 1% has subarachnoid hemorrhage. One study put the figure at 4%.
  • Accurate early diagnosis is critical, as the initial hemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms. Despite widespread neuro-imaging availability, misdiagnosis or delays in diagnosis occurs in up to 25% of patients with subarachnoid hemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73% of these misdiagnoses. This makes SAH a low-frequency, high-risk disease.
  • There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50.
  • Based on a 2004 study, the combined lost wages of survivors of brain aneurysm rupture and their caretaker for a year were $138,000,000
  • The cost of a brain aneurysm treated by clipping via open brain surgery more than doubles in cost after the aneurysm has ruptured. The cost of a brain aneurysm treated by coiling, which is less invasive and is done through a catheter, increases by about 70% after the aneurysm has ruptured.
  • 10 – 15% of patients diagnosed with a brain aneurysm will harbor more than one aneurysm.

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