Suffering from a stroke can be extremely dangerous and often life threatening. Strokes can be classified into two main kinds: ischemic and hemorrhagic.

Ischemic Strokes
Ischemic strokes are the most common and constitute roughly 90% of all strokes today. Ischemic strokes are usually caused by an occlusion in a blood vessel that supplies nutrients and oxygenated blood to the brain. This is typically aided by the development of atherosclerosis and the subsequent narrowing of the passageways through blood vessels. Ischemic strokes can be further broken down into two types: thrombotic and embolic. Thrombotic strokes result when a blood clot forms directly in an artery in the brain, while embolic strokes result when a blood clot forms elsewhere in the body and travels to the brain. Anyone can suffer from an ischemic stroke, but they are more common among the elderly. Treatment of ischemic strokes can involve mechanical thromboectomy, intra-arterial thrombolysis and intracranial bypass.

Hemorrhagic Strokes

Hemorrhagic strokes are relatively uncommon. They constitute roughly 10 percent of all stroke cases today. Hemorrhagic strokes are known for their chronic bleeding which can be toxic for tissues and cells of the brain. The two different types of hemorrhagic strokes are intracerebral and subarachnoid.

Intracerebral Hemorrhage

Intracerebral hemorrhage refers to bleeding within the brain. This is due to a blood vessel rupture and subsequent bleeding into the tissues in the brain. This can be especially problematic as the leakage of blood can create a surplus of pressure within the skull, which can lead to death. The main risk factor for the development of an intracerebral hemorrhage is hypertension. Thus, hemorrhagic stroke treatment involves lowering blood pressure and take steps to maintain a healthy blood pressure reading. Other risk factors can include trauma and injury. Anyone can suffer from an intracerebral hemorrhage and it is important to take steps in lowering your risk.

Subarachnoid Hemorrhage

Subarachnoid hemorrhages also involve bleeding, but in a different area than an intracerebral hemorrhage. The brain has different levels of meninges, which serve to protect the brain. From outside to inside these include, dura mater, arachnoid mater and pia mater. In between the arachnoid mater and pia mater is the subarachnoid space. In a subarachnoid hemorrhage, this space can fill with blood cause severe pain. Symptoms include a migraine or headache, pain in the neck region and even feeling nauseous. If not treated immediately, a subarachnoid hemorrhage can also result in death. Subarachnoid hemorrhages can occur at any age and their development is related to anomalies in the structure and function of arteries in the brain.

Causes of Hemorrhagic Stroke

The main cause of a hemorrhagic stroke is the rupture and subsequent bleeding of a blood vessel in the brain. This blood begins to pool and put additional pressure on the tissues of the brain and can produce a toxic effect. In particular, there are two main contributors to a hemorrhagic stroke. These are aneurysms and arteriovenous malformation (AVM).

Aneurysm

An aneurysm is defined as a blood vessel that begins to weaken and bulge or balloon. If prolonged, this blood vessel can eventually rupture and blood can spill out into the surrounding regions of the brain.

Arteriovenous Malformation

An arteriovenous malformation is a term used to describe an irregular formation of blood vessels that tend to group together and cause rupture.

Hemorrhagic Stroke Treatment

The first method in hemorrhagic stroke treatment is via use of hemorrhagic stroke medications and lifestyle changes. These work by helping to prevent another stroke from occurring and can also treat the current bleed.

Lifestyle Changes

Lifestyle changes alone are not enough in hemorrhagic stroke treatment. These are meant to help reduce blood pressure and prevent or reverse atherosclerosis development. Exercising and eating a healthy diet are two of the main factors in reducing your risk of a hemorrhagic stroke. Physical exercise can help reduce cholesterol levels and help ensure a healthy heart to reduce blood pressure levels. This in conjunction with eating healthy are imperative not only in hemorrhagic stroke treatment, but living a healthy life.

Hemorrhagic Stroke Medications

There are numerous hemorrhagic stroke medications that can be used in the hemorrhagic stroke treatment process. These include anticonvulsants, beta blockers, vasodilators, calcium channel blockers, diuretics and hemostatics. It is important to discuss these medications with your physician as him or her is the best person to determine what medication is best for you.

Anticonvulsants

Anticonvulsants may be prescribed in those with hemorrhagic stroke as suffering from seizures is a potential side effect. Benzodiazepines are one of the most common classes of anticonvulsants used in the hemorrhagic stroke treatment process. For example, Diazepam works by acting on GABA, an inhibitory neurotransmitter. By doing this, Diazepam can limit the amount of synaptic activity occurring in the brain and thus, work to prevent seizures.

Beta-Blockers

Beta-blockers are another class of common hemorrhagic stroke medications. Beta-blockers are especially important in lowering blood pressure and thus, helping to decrease stroke occurrence and heart related medical complications. For example, Labetalol is a common beta-blocker as it binds on the beta receptors of the heart to help manage heart rate and blood pressure.

Vasodilators

Vasodilators are another medication that is used to treat hypertension. As the name implies, the work by dilating the smooth muscle in the arteries, which helps to limit resistance of blood through the vessels. This can directly reduce blood pressure, which thus, can reduce the risk of suffering from a hemorrhagic
stroke.

Calcium Channel Blockers

Calcium channel blockers are also common in the treatment of hypertension. Calcium channel blockers encourage the relaxation of arteries and veins. This aids with blood flow and works to decrease the pressure in the vessels.

Diuretics

Diuretics are especially important in subarachnoid hemorrhaging. For example, Mannitol, a common osmotic agent, can directly decrease the pressure build up in the subarachnoid space and relive symptoms of migraines, pain and headaches. It achieves this by osmosis and encourages water diffusion out of the subarachnoid space.

Discuss with your doctor on which medication may be right for you.

Hemorrhagic Stroke Treatment: Surgery and Procedures

There are also several other procedures and methods in the hemorrhagic stroke treatment process. These can include brain aneurysm surgery, stent procedures, surgical avm removal, and aneurysm coiling. It is important to discuss with your physician on the side effects of these procedures.

Brain Aneurysm Surgery

Brain aneurysm surgery is a method to help relieve the symptoms of a brain aneurysm. If caught early, surgeons can physically drill into the skull above the aneurysm. Thus, surgeons can clip the aneurysm and prevent its rupture. Another method is an endovascular procedure or aneurysm coiling. This requires a small cut in the pelvis region to allow for access to an artery. A catheter is inserted into the artery and travels to the location of the aneurysm in the brain. Metal wires are placed into the aneurysm and they begin to form a ball structure. This then forms a blood clot and directly prevents the risk of a rupture. Aneurysm coiling is a very effective means of reducing the risk of an hemorrhage stroke. As these are invasive procedures, they are not without risks. These can include additional blood clots, neurological trauma, and infection. If you have any of these symptoms following a brain aneurysm surgery, contact medical assistance immediately. It is important to discuss aneurysm coiling and endovascular embolization procedures with your doctor as they do present side effects.

Stent Procedures

Stent procedures are another means of reducing the risk of a ruptured artery or vein and very useful in the process of hemorrhagic stroke treatment. Stents are usually small tubes that are placed in weakened blood vessels. That also can be inserted in vessels that have atherosclerosis development and need widening. Stents thus, give immediate support to the blood vessel walls and directly increase blood flow through the region. These stents can also be coated in medication that can be released into the blood stream and also work to encourage blood flow and decrease the risk of clot formation. Stents can also be used as “stent retrievers” to locate and remove current blood clots.

Surgical AVM Removal

Surgical arteriovenous malformation removal is very used for the treatment of hemorrhagic strokes due to arteriovenous malformations. These irregular and abnormal blood vessels have a high tendency to rupture and bleed and thus, their removal is critical in preventing hemorrhaging strokes from developing. Arteriovenous malformation is performed by an experienced neurosurgeon who surgically drills into the skull. After the arteriovenous malformation is located, it can be removed with relative ease as the AVM does not house neurons. After removal, the arteriovenous malformation does not return. Thus, if performed correctly, the patient is 100 percent cured and the risk of hemorrhaging stroke is greatly diminished. It is important to note that surgical avm removal cannot be used in all situations. Surgical avm removal depends on the location and size of current arteriovenous malformation and needs to be examined via MRI and CT scans before surgery can begin. It is important to monitor for any difficulties in daily life involving neurological processes and if you notice changes, report them to a doctor immediately.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a relatively newer method and less invasive means of treating arteriovenous malformations. As noted, arteriovenous malformations create a high risk for bleeding occurrences and hemorrhage strokes. Thus, treatment of AVM’s should begin immediately to prevent these occurrences. Stereotactic radiosurgery involves focusing a beam of X-ray onto the arteriovenous malformation in hopes of removing or correcting the malformation. Stereotactic radiosurgery works by using this X-ray beam to induce structural changes inside the walls of the blood vessels. Usually, these vessels thicken which results in their closure. This closure is the goal of stereotactic surgery as it means no blood flow will travel through this AVM and the risk of bleeding is greatly diminished. It is important that the beam of X-ray is in high concentration just in the location of the arteriovenous malformation as the rest of the brain should not be exposed to a high concentration. Stereotactic radiosurgery has relatively high chance of success of closing off the AVM. If the AVM is not removed or closed off, the chance of severe bleeding is still present. It is important to note that this is a non-invasive procedure and requires relatively little time in the hospital. It does require MRI’s to decisively pinpoint the current AVM so the X-ray beam can be position only on the malformation and not other areas of the brain.

It is important to discuss all of these procedures of hemorrhagic stroke treatment with your current physician They do all present side effects so it is important to be informed for both before and after the procedure occurs.