Hemorrhagic Stroke: Prognosis & Treatment

Instructor: Adrianne Baron

Adrianne has taught high school and college biology and has a master's degree in cancer biology.

This lesson is going to discuss some of the specifics associated with hemorrhagic strokes. We will detail information on the prognosis and treatment options that can be used.

Hemorrhagic Strokes

Did you know that there are different types of strokes or did you think they were all the same? Not only are there different types of strokes, but there are different severities of strokes. Let's make sure you know what a stroke is. A stroke is a loss of blood supply to the brain that causes brain tissue death and damage.

Bleeding or ruptured blood vessels can cause a hemorrhagic stroke
Diagram showing a hemorrhagic stroke

One type of stroke is a hemorrhagic stroke. In a hemorrhagic stroke, the blood supply to the brain is lost due to the bleeding or rupture of an artery in the brain or an abnormal artery and vein formation in the brain. This causes that artery to not properly deliver oxygenated blood to the brain, which causes brain tissue death. The rupturing of the artery causes the blood to leak onto the brain, which causes damage to the brain tissue.

Prognosis

Hemorrhagic strokes tend to be way more severe than the other main type of stroke. The reason for that is because more damage is done when blood is leaking on the brain and more problems arise due to blood leaking on the brain within the skull. There is only so much space between the brain and the surrounding skull, so blood filling that space creates an increase in pressure, and that can be very deadly.

The above reason makes the prognosis for a hemorrhagic stroke worse than that of the other main type of stroke. The current estimated survival rate for a hemorrhagic stroke is at about 26.7%. Survival rates for most diseases and conditions are looked at based on a 5 year period of time. This means that about 26.7% of people that have had a hemorrhagic stroke live for at least another 5 years.

What is interesting about the low survival rate is that most people that do survive a hemorrhagic stroke recover better than those that have the other main type of stroke caused by a blood clot. These people tend to suffer less disability and may return to a life closer to how it was before the stroke occurred.

Treatments

The first goal of treatment for a hemorrhagic stroke is to stop the bleeding and restore blood flow to the brain. The second goal of treatment is to restore bodily functions that were lost or affected by the stroke. Since most hemorrhagic strokes are caused by high blood pressure or taking blood thinners (drugs that thin the blood and prevent blood clots), then medications may be given to lower the blood pressure and reverse the effects of the blood thinners.

There are also some surgical options that are used if necessary to treat a hemorrhagic stroke. A common surgery is surgical clipping where a clamp is used to clip the artery that is bleeding. This works doubly as a preventative measure to keep the same artery from bleeding again.

If there is pressure between the brain and the skull due to blood filling that area, then a craniotomy may be necessary. A craniotomy is a small incision into the skull that allows the drainage of blood from this area. This will prevent further damage and decrease the likelihood of other hemorrhages in the brain.

Our bodies normally form blood clots in order to stop bleeding. In the case of a hemorrhagic stroke, the blood clot doesn't form, so doctors may go in and cause a blood clot to form in the bleeding artery. This procedure is known as endovascular embolization. It may easy to remember this if you remember that endovascular means within the blood vessel, and embolus, the main part of embolization, means a blood clot in the bloodstream.

A newer surgical method, called stereotactic radiosurgery, uses streams of radiation to repair the artery that is bleeding or correct the abnormality that formed between the artery and vein that caused the stroke. This is an improvement on other procedures because it is not as invasive as other surgeries.

Several surgical procedures can help to treat hemorrhagic strokes
Picture of brain surgery

If the abnormality can't be fixed using the less invasive method, then an AVM removal may be necessary. This is a surgery to remove the portion of the artery and vein that is abnormally joined together. There are many instances when this surgery is not an option. If the abnormality is too big, then this isn't option because it would affect too much of the brain and there would be an increase in loss of function in the body. When the abnormality is deep within the brain, then this is also problematic because so much of the brain would have to be cut in order to get to the abnormality.

You have probably heard of a heart bypass surgery before. Well there is one for the brain too! An intracranial bypass can help to restore blood supply to the brain. The same way that a heart bypass creates a blood vessel bridge to go around the problem area in the heart's blood vessels, an intracranial bypass creates a blood vessel bridge to go around the problem area in the brain's blood vessels.

Lesson Summary

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