Stroke Research & Therapy

Description

Hemorrhagic strokes account for around 13% of all stroke cases. A weakened vessel ruptures and bleeds into the surrounding brain, causing strokes. Blood builds up in the surrounding brain tissue and compresses it.

Intracerebral (brain) hemorrhage and subarachnoid hemorrhage are the two forms of hemorrhagic strokes. Aneurysms and arteriovenous malformations are two forms of compromised blood vessels that can cause hemorrhagic stroke.

Aneurysms aren't frequently present at birth. The majority of them appear after the age of 40. Aneurysms are formed by persistent pressure from blood flow and commonly occur at branching sites of arteries. They frequently develop slowly and weaken as they expand, similar to how a balloon weakens, as it extends. Other blood vessel abnormalities, such as fibromuscular dysplasia, cerebral arteritis, or arterial dissection, may be related to aneurysms, but these are uncommon. Infections, medications like amphetamines and cocaine or direct brain damage from an accident can all cause aneurysms.

Diagnosis

A brain aneurysm can be diagnosed with specialized imaging studies. Patients are placed on a table that slides onto a CT scanner for CTA (Computed Tomographic Angiography). An injection of a contrast chemical (dye) is given into a vein, and pictures of the blood arteries are obtained to search for abnormalities like an aneurysm. Patients are placed on a table that slides into a magnetic resonance scanner, and the blood arteries are examined to detect a brain aneurysm in the second test, known as MRA (Magnetic Resonance Angiography).

Diagnostic cerebral angiography is the most reliable test. Cerebral angiography examines blood vessels in the brain for anomalies such as aneurysms and illness such as atherosclerosis using a catheter, x-ray imaging guidance, and the injection of contrast material (plaque). The images of all the blood arteries in the brain are obtained. This test is a little more invasive and uncomfortable than the last one.

Causes for an aneurysm to bleed

The most common cause of subarachnoid hemorrhage is high blood pressure. Heavy lifting or straining might produce an increase in brain pressure, which could lead to an aneurysm rupture. Strong emotions, such as being sad or furious, can cause aneurysms to burst by raising blood pressure. Blood thinners (such as warfarin), various medications and prescription drugs (including stimulants like ephedrine and amphetamines in diet pills) and toxic drugs like cocaine can induce aneurysms to burst and bleed.

Treatments

Medical treatment: Small, unruptured aneurysms that don't cause symptoms might not require treatment unless they enlarge, cause symptoms, or rupture. Annual check-ups are critical for monitoring blood pressure, cholesterol and other medical issues.

Neurosurgery: Open surgery may be recommended depending on a person's risk factors. The neurosurgeon places a surgical clip around the base of the aneurysm while the patient is under general anaesthesia.

Neurointerventionalist/neuroradiologist: It may be possible to treat an aneurysm from within the blood artery, depending on its size, location and form. Cerebral angiography is comparable to this minimally invasive treatment. In addition to capturing photographs, a catheter is inserted into the aneurysm itself through the blood arteries. The endovascular surgeon next delicately implants soft platinum micro-coils into the aneurysm and detaches them using X-ray guidance. The coils remain inside the aneurysm, serving as a mechanical barrier to blood flow, thereby closing it off.

Conclusion

Hematoma expansion, perihematomal edema with increased intracranial pressure and intraventricular extension of hemorrhage with hydrocephalus, seizures, venous thrombotic events, hyperglycemia, high blood pressure, fever, etc. are all complications of ICH. As there are limited number of therapeutic options available for patients with ICH, better surveillance is required for the prevention of these complications or if prevention is not possible, early detection and optimal management, which could be effective in reducing adverse effects early in the course of stroke and improving prognosis. More information is needed to improve the evidence-based management recommendations for this significant clinical condition.