Hemorrhagic stroke requires prompt medical attention. It can develop quickly into a life-threatening situation. Goals of treatment are to:
- Save the person's life
- Relieve symptoms
- Repair the cause of bleeding
- Prevent complications
- Start rehabilitation therapy as soon as possible
IMMEDIATE TREATMENT IN THE HOSPITAL
Treatment is ideally given in a hospital's intensive care unit (ICU), where complications can immediately be detected. The health care team will pay careful attention to breathing because sometimes bleeding in the brain can cause breathing to stop or become irregular.
A person having a hemorrhagic stroke may be unable to protect their airway when they cough or sneeze because of decreased alertness (impaired consciousness). Saliva or other secretions may go "down the wrong pipe," which may cause potentially serious lung problems such as aspiration pneumonia. A breathing tube may needed to treat or prevent these problems.
Treatment may involve:
- Carefully controlling blood pressure, which can be too high or too low
- Drugs to control brain swelling
- Medications to relief headaches (but should be used with caution because they may reduce alertness and give the wrong impression that the patient is getting worse)
- Seizure medications such as phenytoin
The patient will need to rest in bed and avoid activities that may increase the pressure in the head (increased intracranial pressure), such as:
- Lying flat
- Sudden position changes
- Straining during bowel movement (stool softeners or laxatives may be prescribed)
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein ( intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
Sometimes, surgery is needed to save the patient's life or to improve the chances of recovery. The type of surgery depends upon the specific cause of brain bleeding. For example, a hemorrhage due to an aneurysm or AVM requires special treatment (See: Aneurysm or AVM)
For other types of bleeding, removal of the hematoma may occasionally be needed, especially when bleeding occurs in the back of the brain.
One common problem related to brain bleeding is hydrocephalus, which is the build up of fluid within the brain. A procedure called ventriculostomy may be needed to drain the fluid.
The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:
- Occupational therapy
- Physical therapy
- Speech therapy
Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.
Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases.
Sometimes, urinary catheterization or bladder and bowel control programs may be needed 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 indifference or lack of judgment, which increases the need for safety precautions.
Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.
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 medical needs.
Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).
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. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.