Hemorrhagic stroke, requires attention to restoring or improving circulation to the brain. Hemorrhagic stroke requires a different approach. The goal in this case is to limit the damage the hemorrhage causes.
One way to treat hemorrhagic stroke to do this is to bring the patients high blood pressure into the normal range. The doctor may also treat any swelling and drain blood from the brain, if necessary.
Control high blood pressure
Most intracerebral hemorrhage in people who don’t have aneurysm or AVMs is due to high blood pressure. So, using drugs that bring down high blood pressure is important in these cases. But it can be a complicated procedure immediately after a stroke, and it must be done very slowly and conservatively.
Moderately elevated blood pressure immediately following a stroke is actually helpful. It keeps blood flowing to the outermost capillaries of the nearby arteries that have not been effected. These caterpillaries normally overlap a bit with those from other arterial system to ensure that all parts of the brain are supplied constantly with blood.
During a stroke, like good neighbours, the intact capillaries continue to provide blood to some of the afected tissue. If the patient’s blood pressure is brought down too quickly, however, blood won’t be able to reach those outermost capillaries, and the brain tissue can die.
Brain swelling can follow a large ischemic stroke or an intracerebral hemorrhage, generally within four days. This serious and fairly common complication doesn’t affect every person who has a stroke. The greater the swelling, or edema, the worse the prognosis.
Symptoms of edema may include a bad headache, difficulty walking, nausea, and vomiting. The person’s consciousness level is also affected and is a sign of the edema’s severity. A person with brain edema may experience drowsiness that comes and goes or lapse into unconsciousness altogether. Because edema can be caused by several different conditions resulting from stroke, treatment varies. A number of drugs can effectively reduce edema.
Hematomas are local pools of blood sometimes found in the brain after hemorrhage. In the skull, where there is little space to spare, a hematoma can dangerously increase pressure on the brain, causing further injury. It is sometimes necessary to drain the hematoma to relieve that pressure.
This is done if the hematoma is life threatening and if it is in a place accessible to surgery. Sometimes hematomas drain spontaneously into the brain’s subarachnoid space or into one of its ventricles, or cavities. From there, the fluids is reabsorbed slowly into the body.
Hematomas can cause periods of unconsciousness. Patients with very large hematomas over their dominant cerebral hemisphere have a smaller chance of recovery. For them, neither surgery nor medication is likely to be of much help.
Most aneurysms are related to artery wall defects that were present at birth. Over a lifetime, these weak spots in the blood vessels tend to become thinner and ballon out. The thinner they get, the more likely they are to leak or rupture. That causes severe, immediate headaches as the escaped blood pools and exerts pressure in the closed quarters of the skull.
Surgery often is called for if an aneurysm or arteriovenous malformation leaks. After an aneurysm leaks once, it is quite likely to leak again, usually within two or three weeks after the first event. Or it may rupture entirely, resulting in a full blow stroke. So far, surgical treatment generally is not recommended for aneurysm that do not already show signs of leakage.