Hemorrhagic stroke

In the previous three articles, I mentioned the stroke prevention and first aid of ischemic stroke with cerebrovascular surgery, and this time I want to talk to the reader about the first aid of hemorrhagic stroke.

First review the ischemic stroke, which accountable for 70% of stroke cases, the cause is cerebrovascular embolism, the first aid method is to use drugs or minimally invasive surgery in the blood vessels within the golden hour to save the brain cells that are dying of ischemia. On the other hand, 30% of stroke cases, is caused by hemorrhagic stroke with cerebrovascular rupture, the blood clot overflowing from the cerebral blood vessel will cause sudden increase in intracranial pressure, and the pressure of blood clot directly causing the brain cell necrosis, and the first aid method is to use drugs, minimally invasive drainage or craniotomy to reduce swelling or blood clots in the brain to reduce intracranial pressure to save brain cells that are under pressure.

Hemorrhagic stroke:
The causes of hemorrhagic stroke due to ruptured blood vessels are usually caused by congenital or acquired cerebrovascular disease, due to:

Cerebral ArteriovenousMalformation AVM

Cerebral ArteriovenousMalformation AVM is due to congenital cause, patient age could range from 4 years old to 80 years old.

Cerebral Aneurysm

Cerebral Aneurysm, also known as Subarachnoid Hemorrhage SAH, it is an acquired cause, the patient is between 28 and 100 years old, and is generally not directly related to hypertension.

Brain micro-vessels rupture

The common three highs (hyperlipidemia, hypertension, and hyperglycemia) can also make the micro blood vessel walls of the brain become fragile and rupture, and it is also one of the most common bursting blood vessel strokes. As mentioned earlier, a detailed and objective physical examination includes a three-dimensional contrast MRI of the cervical and cerebral blood vessels, which is the most effective method of screening the human body for potential stroke crisis. Hemorrhagic stroke is belong to emergency and the risk of patients are also the same as ischemic strokes, which must rely on time, place and people. As the patient describes the burst of blood vessel stroke, the symptoms and severity of hemorrhagic stroke are faster and more urgent than ischemic stroke, patients often have symptoms of headache, in addition to the disease may affect speech, face, limb paralysis and weakness, because intracranial pressure will suddenly arise in a short period of time, the patient’s condition may deteriorate very rapid and  lose consciousness or get into deep coma.

Case Study

The following case sharing can give us an insight into the timing, location, people and importance of first aid for bleeding stroke.

Case Study 1:

Miss Yang, 14 years ago Miss Yang, who was 29 years old at the time, lived a normal life in good health and had no symptoms of headache. Three days after the new marriage, the husband came home from work and found his wife unconscious and lying on the ground, so he immediately called an ambulance to rush his wife to a nearby public hospital. A CT scan of the brain showed a subarachnoid hemorrhagic stroke (see figure 1), suspected of being a blast of a cerebrovascular aneurysm, and since there was no cerebrovascular surgery at the public hospital, the patient’s husband asked to transfer his wife to a private hospital.

Three-dimensional cerebral angiodynamic imaging showed that the patient had a burst hemangioma in the posterior artery on the left side of the brain, requiring emergency minimally invasive surgery, and the neurosurgeon used a metal wire to block the location of the cerebral aneurysm to stop the bleeding (see Figure 2), prevent it from rupturing again in a short period of time, and then use drugs to reduce the patient’s intracranial pressure. Fortunately, the damage to the patient’s brain by the hemorrhagic stroke was not serious, and the patient woke up two days after the operation and was discharged after three weeks of recuperation. After three months, the specialist implanted a directed stent for the patient, completely enclosing the remaining space of the aneurysm (see Figure 3), and after successfully removing the remaining bomb in her brain.

Case Study 2:

Three years ago, Mr. Li, who was 39 years old at the time of the stroke, was a construction worker who was married and had a young son, who was the breadwinner of the family. He has always been healthy, exercised regularly and does not smoke or drink. One day, he suddenly had a sharp headache at the construction site and then fainted and fell to the ground. The workers immediately call an ambulance to take him to a nearby public hospital, where Mr. Li was still semi-conscious. A CT scan showed that he had a subarachnoid hemorrhagic stroke in his brain (see Figure 4), and an aneurysm of about one to two millimeters could be seen on the anterior communication artery vessel in Mr. Lee’s brain (see Figure 5). Unfortunately, the morning after observation at the hospital, Mr. Li suddenly fell into a deep coma, and repeat CT scans showed that the aneurysm had rupture for the second time, causing severe blood accumulation in the brain and increase intracranial pressure, and neurosurgeon needed to do emergency craniotomy to remove the blood clot in the brain, and drain the ventricle to reduce hydrocephalus and intracranial pressure (see Figure 6), while using a titanium clip to clamp the blasted aneurysm (see Figure 7) to prevent it from bursting again.

In addition to ischemic and hemorrhagic strokes, transient ischemic attacks (commonly known as “mini-strokes") are precursors to stroke. Patients have stroke symptoms, but the symptoms disappear completely within 24 hours, and stroke images may not be detected on tomography pictures. “Transient ischemic attacks" are mostly caused by thrombosis, but not to the point where blood vessels are completely blocked or brain cells actually necrosis, and clinically 20% to 25% of patients have had a small stroke before stroke, only because the body recovered rapidly at that time and did not seek medical treatment and failed to effectively prevent subsequent strokes.