Hemorrhagic Cerebrovascular Accident
The cerebrovascular accident (CVA) is the second leading cause of death in the world in people over 60 years old and the main cause of disability in Brazil in the adult population. It is worth mentioning that stroke can occur in any age group and, although more frequent, it is not exclusive to the elderly.
In hemorrhagic stroke, through the rupture of the cerebral vessel, blood spreads within the brain tissue (intraparechymal hematoma) or around the brain tissue (subarachnoid hemorrhage – SAH). The hallmark of a hemorrhagic stroke is a sudden onset headache (the pain starts very intense in the first few minutes to seconds).
Hemorrhagic stroke can result from an exaggerated increase in blood pressure, rupture of brain aneurysms, cerebral arteriovenous malformations and other diseases of the brain’s vascularization.
Recognition of stroke symptoms is essential for early institution of treatment to prevent sequelae.
The main signs associated with a hemorrhagic stroke are:
- Sudden severe headache;
- Nausea and vomiting;
- Mental confusion and lowering of the level of consciousness;
- Loss of strength on one side of the body;
- Crooked mouth and/or difficulty speaking;
- incoordination, imbalance
- Convulsion.
When any of these symptoms are identified, medical attention should be sought as soon as possible, especially in a hospital environment where there is a team trained in acute stroke care.
Treatment options vary depending on the cause of the bleeding.
- For hemorrhages resulting from the rupture of a cerebral aneurysm, its treatment should be performed as soon as possible with a cerebral angiography for a better study of the aneurysm and definition of the best form of treatment (embolization or clipping);
- For hemorrhages resulting from an exaggerated increase in intracranial pressure, strict pressure control is necessary to prevent further bleeding;
- Regardless of the cause, treatment should be carried out as soon as possible, in order to avoid permanent sequelae. In cases of massive hemorrhages, neurosurgery may be necessary to drain the brain hematoma.
What are the most common causes of hemorrhagic stroke?
- Untreated high blood pressure, which can lead to a rupture of a brain vessel;
- Brain aneurysm;
- Malformations of blood vessels of the brain;
- Arteriovenous fistulas of the blood vessels of the brain;
- Incorrect use of anticoagulants or antiplatelet agents.
How to confirm the diagnosis?
The diagnosis of a hemorrhagic stroke is made by evaluating the symptoms and performing a CT scan, which allows the visualization of the cerebral hemorrhage.
In addition, a cranial computed tomography angiography is indicated to detect arteriovenous malformations, aneurysms and tumors, which are risk factors for the occurrence of stroke.
What are the differences between ischemic stroke and hemorrhagic stroke?
While hemorrhagic stroke is caused by the rupture of a vessel in the brain, leading to an extravasation of blood within the brain, ischemic stroke arises when a clot clogs a vessel, interrupting blood circulation from that point on.
How to prevent?
Some measures can be taken to prevent the occurrence of stroke, such as controlling blood pressure, in order to avoid spikes, avoid the consumption of alcohol, cigarettes and drugs, and make the rational use of medications, especially anticoagulants that, if taken incorrectly , may increase the risk of developing a hemorrhagic stroke.
