Download Hemorrhagic stroke

Hemorrhagic Stroke /
Cerebrovascular Accident
(CVA)
Education
For Our
Community
Definition
Stroke is a brain injury caused by an interruption in
blood flow. Brain tissue that does not get oxygen and
nutrients from blood can die within minutes. The
damage to the brain can cause a sudden loss in
neurologic functions. The types of functions that are
affected will depend on the part of the brain that is
damaged.
There are two blood flow problems that cause a stroke.
Strokes may be ischemic or hemorrhagic.
 A hemorrhagic stroke is caused by a ruptured
blood vessel. It may be:
o Intracerebral hemorrhage – bleeding in the
brain
o Subarachnoid hemorrhage – bleeding in the
tissue around the brain
 An ischemic stroke is caused by a blocked blood
vessel.
Hemorrhagic vs. Ischemic Stroke
Causes
A hemorrhagic stroke can occur because of abnormal
blood vessels in the brain. These vessels are weaker
than normal vessels and break open under pressure.
The blood leaks out of the broken blood vessel and into
the brain. This can lead to brain damage because
blood flow is interrupted and the pooled blood can
cause pressure on the brain.
Blood vessels may be weakened by:
 Abnormality in blood vessel structure
 Arterio-venous (AV) malformation – an abnormal
knot of blood vessels
 Aneurysm – a weakened spot in a blood vessel wall
 Other
illness
or
medical
conditions
like
hypertension
Blood vessel damage can also be caused by trauma
like a blow to the head or a car accident.
Risk Factors
Factors that may increase your risk of stroke include:
 Sex: Men are more likely to have a stroke than
women
 Age: Risk of stroke increase with age particularly
after 55 years of age
 Family history of stroke
Factors that can weaken your blood vessels and
increase your risk of hemorrhagic stroke include:
 Having a vessel abnormality
 High blood pressure
 Smoking
 Cocaine use
 Alcoholism
Blood disorders or mediations that reduce blood
clotting can also increase your risk of a hemorrhagic
stroke.
Symptoms
Rapid treatment is important to decrease the amount
of brain damage. Brain tissue without blood flow dies
quickly. Call for medical help right away if you notice
any of the following symptoms.
Symptoms will depend on the part of the brain
affected. Call for immediate medical help if your have
any of the following:
 Sudden weakness or numbness of face, arm, or
leg, especially on one side of the body
 Sudden confusion
 Sudden trouble speaking or understanding
 Sudden trouble seeing in one or both eyes
 Sudden dizziness, trouble walking, loss of balance,
or coordination
 Loss of consciousness
Other symptoms that may go along with the above
symptoms include:
 Neck stiffness
 Nausea or vomiting
 Sensitivity to light
Family Initiated Rapid Response Call
During your stay, the doctors, nurses and staff of
Morris Hospital will teat you and your family as
partners in your care. If at any time, you or a member
of your family feels that there has been a change in
your status that needs attention, we encourage you to
notify your nurse immediately. If after notifying your
nurse you still feel further assistance may be
necessary, please activate or Family Initiated Rapid
Response Call. The Rapid Response Call will bring
medical professionals to your bedside who will assess
whether additional medical care is needed. To
activate the Family Initiated Rapid Response Call,
dial “0” from the phone in the patient room and
tell the operator the room number and why you
are calling. We want to partner with you to provide
the best possible treatment.
Diagnosis
The doctor will look for muscle weakness, visual and
speech problems, and movement difficulty.
If
possible, you will be asked about your symptoms and
medical history. A CT scan may be done to confirm
the diagnosis.
Detailed images of blood vessels will help identify the
cause of the bleeding. Images may be taken with one
or more of the following tests:
 Magnetic resonance angiography (MRA) – maps
flow of blood
 CT angiogram (CTA) – creates detailed images of
the blood vessels and their blood flow
 Conventional angiogram – a catheter is passed into
the blood vessels in the brain to create detailed
images of the blood vessels
 Doppler ultrasound – to check blood flow in the
head and neck
Blood tests can also help identify clotting problems in
the blood. Your doctor may also examine the fluid that
surrounds your brain and spine.
Treatment
Immediate treatment is needed to stop the bleeding
and relieve pressure on the brain.
Medications
If you were taking medications that reduce your
blood’s ability to clot you will be given medication to
help your brain clot again. This may also include
vitamin K.
You may also be given medication to help:
 Decrease pressure in your brain
 Prevent seizures
 Lower blood pressure
Surgery
Surgery may be done to help stop the bleeding. Some
surgeries can be done by passing catheters from blood
vessels in the groin to the affected vessels in the brain.
Options will depend on the cause and location of the
bleeding:
 For a burst aneurysm – A clip may be placed just
before the damaged vessel to stop bleeding.
 For a leaking or intact aneurysm – A special coil
may be placed in the aneurysm. The coil will help
a clot form in the aneurysm to prevent bleeding. A
clip, as used in burst aneurysms, may be placed
instead of a coil.
 For an abnormal tangle of blood vessels – Surgery
may be done to repair the blood vessels. This may
include removing the tangles or rerouting the
blood around this tangle.
A stroke can cause swelling in the brain. A surgery,
such as craniotomy, may be needed to relieve the
pressure in the brain to prevent further damage.
Rehabilitation
If brain tissue was damaged, rehabilitation can be an
important part of your recovery. Rehabilitation may
include:
 Physical therapy—to regain as much movement as
possible
 Occupational therapy—to assist in everyday tasks
and self care
 Speech therapy—to improve swallowing and
speech challenges
 Psychological therapy—to improve mood and
decrease depression
Prevention
If brain tissue was damaged, rehabilitation can be an
important part of recovery.
Rehabilitation may
include:
Other habits that may reduce your risk of stroke
include:
 Getting regular exercise.
 Eating more fruits, vegetables, and whole grains.
Limiting dietary salt and fat.
 Quitting smoking.
 Drinking alcohol only in moderation (1-2 drink per
day).
 Maintaining a healthy weight.
 Check blood pressure frequently.
Follow your
doctor’s recommendations for keeping it in a safe
rage.
 Stop the use of recreational drugs (such as
cocaine).
Discharge Instructions for Stroke–Hemorrhagic
Home Care
Motivation, patience, and rehabilitation will help you
regain control of your quality of life. You may need
speech, physical, and occupational therapies.
The
earlier rehabilitation is started, and the more you
participate, the better the outcomes may be.
To help with your recovery:
 Arrange for help at home with daily activities, such
as transportation and meals
 Have one-on-one adult conversation
 Speak in a normal, comfortable tone and pace
 Get together in quiet settings without distractions
 Keep in touch with caregivers for updates and care
planning
Diet
If you are having trouble chewing or swallowing, your
doctor will recommend a therapy program. You will
also work with a dietitian, who will help plan your
meals. Begin with small, frequent meals of soft foods.
Remember to drink plenty of fluids throughout the day.
Physical Activity
Stay as active as possible.
prevent your recovery.
Inactivity can slow or
Your doctor or physical therapist will refer you to a
rehabilitation program. These programs will help you
to strengthen your muscles and get back to normal
daily activities.
Physical and occupational therapy will help you learn
how to manage any physical complications form the
stroke. Your therapist will also recommend exercises
to help you increase or maintain your strength.
 Avoid vigorous activity until your doctor days it is
safe to do so.
 Ask your doctor when you will e able to return to
work.
 Ask your doctor when you will be able to resume
sexual activity.
 Do not drive until your doctor says it is okay.
Medications
Your doctor may prescribe medications to help
manager your condition to prevent it from happening
again.
Your doctor may recommend medications to manage
side effects or causes of the stroke. This may include:
 Antiseizure medication
 High blood pressure medication
 Medication to reduce swelling in the brain
Certain medications that decrease the ability for blood
to clot may have been stopped once the hemorrhage
was detected. Your doctor may restart this medication
a few weeks after your stroke. Talk to your doctor
before resuming any medication.
If you are taking medications, follow these general
guidelines:
 Take your medications as directed. Do not change
the amount or the schedule.
 Ask what side effects could occur. Discuss them
with your doctor.
 Talk to your doctor before you stop taking any
prescription medication.
 Plan ahead for refills if you need them.
 Do not share your prescription medication with
anyone.
 Drugs can be dangerous when mixed. Talk to your
doctor if you are taking more than one drug,
including
over-the-counter
products
and
supplements.
Prevention
You and your doctor will plan treatment to prevent
future stroke.
Certain medical conditions such as high blood
pressure, high cholesterol, heart disease, diabetes and
obesity increase your risk of stroke. If you have any of
these conditions, work with your doctor to manage
them and decrease your risk of stroke. Personal habits
such as smoking, frequent alcohol use, and physical
inactivity can also increase your risk of stroke.
Know your personal risk factors for stroke. General
habits that may reduce your risk of stroke include:
 Exercise regularly.
 Eat more fruits, vegetables, and whole grains.
Limit dietary salt and fat.
 Stop smoking.
 Increase your consumption of fish.
 Drink alcohol on in moderation (1-2 drinks per
day).
 Maintain a healthy weight.
 Check blood pressure frequently. Follow your
doctor’s recommendations for keeping it in a safe
range.
 Seek medical care if you have symptoms of a
stroke, even if symptoms stop.
 Stop the use of recreational drugs (eg, cocaine,
heroin, amphetamines).
Follow Up
Your doctor will need to check on your progress. Be
sure to go to all recommended appointments to keep
your recovery on track.
Your doctor may advise
counseling or a support group to help with your
recovery. You and your partner may also be referred
to sexual counseling. It will allow you both to talk
about your concerns and learn how to safely resume
sexual activity.
Call Emergency Services right away if any of the
following happen:
It is important that you and those around you know
the warning signs for stroke. Call for medical help right
away if you have any of the following which may
suggest a new stroke:
 New or worsening symptoms
 Loss of consciousness
 Weakness or numbness on one side of the body,
including the face
 Seizures
 Confusion
 Sudden nausea and vomiting
 Blurry, dimming, double vision, or no vision
 Difficulty swallowing, talking, or comprehending
others
 Dizziness, falling, or loss of balance
If you think you have an emergency,
emergency medical services right away.
call
for
What to do if you think someone is having a
stroke
 Immediately call 9-1-1 or the Emergency Medical
Services (EMS) number so an ambulance can be
sent. Also, check the time so you'll know when the
first symptoms appeared. A clot-busting drug
called tissue plasminogen activator (tPA) may
improve the chances of getting better but only if
you get them help right away.
 A TIA or transient ischemic attack is a "warning
stroke" or "mini-stroke" that produces stroke-like
symptoms. TIA symptoms usually only last a few
minutes but, if left untreated, people who have
TIAs have a high risk of stroke. Recognizing and
treating TIAs can reduce the risk of a major stroke.
PATIENT AND FAMILY RESOURCES:
1. The “Stroke Education for Our Community” booklet that you received at Morris
Hospital can be accessed at:
Morris Hospital
http://www.morrishospital.org/patients-visitors/discharge-education/
2. Try this site to organize your medications at home:
http://www.mymedschedule.com/
3. Free Stroke information at the following websites:
www.stroke.org
www.strokeassociation.org
Stroke Support Group Meeting
Date/Time: Meetings are held from 10:00-11:00 am the 3rd Tuesday of Dec, March, June, and
Sept.
Location: Location is subject to change. When you arrive for the meeting, please stop by the
Morris Hospital lobby desk for the meeting location.
Who should attend?
People who have experienced loss of physical function or communication (such as
aphasia) due to a stroke or other neurological event. Caregivers, spouses, and loved
ones are also encouraged to attend.
What to expect?
We will start by getting together alongside our spouses/caregivers to chat for a bit.
Sometimes spouses/caregivers will gather in a separate room. During this time both
groups can share ideas and offer support to those with whom they are gathered.
Other times we will be joined by a guest speaker.
Why should you come?
Support groups bring together people facing similar issues. People who attend
support groups often share experiences and advice. It can be helpful just getting to
meet and talk or listen to other people who are in the same boat. Participating can
help people cope better and feel less isolated.
Please contact Ali Bute, Speech Pathologist, with any questions at 815-705-7440 or by email at
[email protected]
References
Jones, P. (2014, August). Discharge instructions for strokeintracerebral hemorrhage. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=npr&AN=20
12343412&site=nrc-perc
Jones, P. (2014, May). Hemorrhagic stroke. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=npr&AN=20
12343412&site=nrc-perc
Neff, D. (2014, August). Discharge instructions for strokesubarachnoid hemorrhage. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=npr&AN=20
09869560&site=nrc-perc