A broken blood vessel in the brain is known as a hemorrhagic stroke. Arterial bleeds generally have worse outcomes than vascular bleeds, but either form can be life-threatening. With prompt treatment, it is possible to survive a hemorrhagic stroke and regain near-normal quality of life. But swift medical attention is crucial to survival--and to the quality of life for survivors--because brain functions lost as a result of a stroke are usually never recovered.
Symptoms
A hemorrhagic stroke almost always comes without warning. Patients will usually feel a sudden, intense headache. They may feel weakness or numbness on one side of the face or body, as well as loss of balance, loss of coordination, difficulty walking, trouble speaking or understanding speech, or vision problems. Prompt treatment is crucial. Without a constant blood supply, brain cells begin to die. Even brain cells far from the broken blood vessel may be damaged by swelling. According to the American Heart Association, the brain cannot regrow dead cells, so functions lost in a stroke are often never recovered. The faster a patient receives medical treatment, the more likely he is to survive and retain important brain functions.
Risk Factors
Because hemorrhagic stroke can lead to death or irreversible disability, prevention is vital. Many of the risk factors for hemorrhagic stroke, however, are controllable. The most important risk factor is high blood pressure, or hypertension. According to the National Stroke Association, hypertension contributes to 60 percent of all hemorrhagic strokes. Excessive use of drugs or alcohol also raise stroke risk, as does smoking. According to researchers at the National Institutes of Health, patients can cut their stroke risk significantly by reducing their alcohol intake, quitting smoking and controlling high cholesterol.
Some risk factors are outside the patient's direct control. Certain blood-clotting disorders, like hemophilia and sickle-cell disease, place a patient at increased risk of hemorrhagic stroke. Patients who suffer from these illnesses can still reduce their risk by carefully controlling their blood pressure. Head trauma can also be a cause.
Diagnosis
When a patient enters the hospital with symptoms that suggest a broken blood vessel in the brain, nurses will first perform a neurological assessment. They will have the patient perform simple motor tasks and ask questions to determine whether the patient is aware of her surroundings. If a stroke seems likely, doctors will order images of the brain to confirm the presence of blood. A CT scan, the fastest and least expensive available brain scan, is often used to confirm a stroke.
Treatment
Doctors have several tools at their disposal for treating a ruptured blood vessel. Which tool they choose depends largely on where the bleed is found. Surgeons often will not attempt to operate on a rupture deep within brain tissue, since the surgery itself may cause too much damage to be worthwhile. In such cases, treatment focuses on reducing blood pressure to limit bleeding, and supporting the patient's body as it attempts to repair itself. Surgeons may insert an extra-ventricular drain (EVD), a temporary device that helps drain fluid, to reduce pressure on the brain.
If the site of the bleeding is not deep within the brain, surgeons may choose to operate. They will sometimes insert a clip to close the broken vessel, stopping blood flow to the rupture site. Alternatively, they may insert a tiny coil into the rupture site, which promotes blood clotting, helping to close the torn vessel.
Hemorrhagic stroke often keeps patients hospitalized for weeks. Even after surgery, patients' blood vessels can spasm, re-opening a repaired rupture. To prevent this, nurses may keep patients sedated and under close observation for weeks after surgery.
Prognosis
With prompt medical attention, patients who have suffered a hemorrhagic stroke can recover and return to a life with few limitations. Recovery may require months of rehabilitative therapy and intense effort on the part of the patient. But such cases are rare. Many patients don't receive the quick treatment they need, while others suffer from brain bleeds so severe that some brain loss is unavoidable. The American Heart Association estimates that stroke is the leading cause of long-term serious disability in the United States.
