Hemorrhagic stroke
Alternative names:
stroke - hemorrhagic
Treatment:
Treatment includes lifesaving measures, relief of symptoms, repair of the cause of the bleeding, prevention of complications, and maximizing the ability of the person to function.
There is no known cure for stroke. Treatment is essentially based on controlling the symptoms. Recovery may occur as other areas of the brain take over functioning for the damaged areas.
IMMEDIATE TREATMENT
Treatment for coma or decreased mental status may be required, including positioning, airway protection (to prevent aspiration pneumonia), and life support as needed. Strict bedrest may be advised to avoid increasing the pressure in the head (intracranial pressure). This may include avoiding activities such as bending over, straining, lying flat, sudden position changes, or similar activities. Stool softeners or laxatives may prevent straining during bowel excretion (straining also causes increased intracranial pressure).
Analgesics and antianxiety medications may relieve headache and reduce intracranial pressure. Antihypertensive medications may be prescribed to moderately reduce high blood pressure. Phenytoin or other medications may be needed to prevent or treat seizures.
Nutrients and fluids may need to be supplemented if swallowing difficulties are present. This can be intravenous or through a tube in the stomach (feeding tube or gastrostomy tube). Swallowing difficulties may be temporary or permanent.
Positioning, range-of-motion exercises, speech therapy, occupational therapy, physical therapy, and other interventions may be advised to prevent complications and promote maximum recovery of function.
LONG-TERM TREATMENT
Recovery time and the need for long-term treatment are highly variable in each case. Physical therapy may benefit some persons. Activity should be encouraged within the physical limitations. Alternative forms of communication, such as pictures, verbal cues, demonstration, or others, may be needed depending on the type and extent of language deficit. Speech therapy, occupational therapy, or other interventions may increase the ability of some persons to function. Alternative forms of communication, such as pictures, verbal cues, and demonstration, may be needed depending on the type and extent of language deficit.
Urinary catheterization and/or bladder or bowel control programs may be required to control incontinence.
A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show a marked indifference or lack of judgment, which increases the need for safety precautions.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs.
Behavior modification may be helpful for some persons in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with hemorrhagic stroke.
Expectations (prognosis):
Stroke is the third leading cause of death in developed countries. About one-forth of the sufferers die as a result of the stroke or its complications, about one-half have long-term disabilities, and about one-forth recover most or all function. Hemorrhagic stroke is the most frequently fatal form of stroke.
Complications:
Calling your health care provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of hemorrhagic stroke are present. Emergency symptoms include seizures or breathing difficulties, loss of consciousness, difficulties with movement/sensation, eating or swallowing difficulties, sudden vision change or loss of vision in one or both eyes, rapid onset of speech changes, and sudden severe headache.
Call your health care provider if the condition of a family member with stroke deteriorates to the point that the person cannot be cared for at home.
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