WHAT IS BRAIN STROKE?
‘Stroke’ or ‘brain attack’ are lay terms used to describe the disruption of blood flow to the brain. This may be caused by cerebral haemorrhage (haemorrhagic stroke) or by blockage of an artery (ischaemic stroke). Approximately one in 10 strokes is caused by cerebral haemorrhage. This type of stroke (haemorrhagic stroke) is usually much more severe than ischaemic stroke. A cerebral haemorrhage is bleeding from a ruptured blood vessel in the brain that can be fatal without prompt medical treatment. A person who survives may be left with permanent disabilities, depending on the location and severity of the brain damage. Cerebral haemorrhage is commonly referred to as a type of stroke.
The brain is wrapped in three membranes, each serving a different function. The innermost membrane contains the blood vessels. The brain is nourished and cushioned by cerebrospinal fluid, which is contained between this first membrane and the second membrane. The third and last membrane (dura) lines the inside of the skull and is comparatively thick and tough.
A cerebral haemorrhage is any bleeding that occurs inside the brain tissue. A subarachnoid haemorrhage is one that occurs in the space that lies between the first and second membranes around the brain.
WHAT ARE THE CAUSES OF BRAIN HAEMORRHAGE?
A major risk factor for haemorrhagic stroke is long-standing high blood pressure (hypertension) that weakens the walls of blood vessels, which then may split under the pressure. Other risk factors for stroke (ischaemic or haemorrhagic) include:
- Cigarette smoking
- Uncontrolled diabetes
- A high fat, high cholesterol, high salt diet
- Family history
- Excessive alcohol consumption
- Advancing age
- Atrial fibrillation (irregular heart beat)
- Intra cranial aneurism
- Craniocerebtral Trauma
- Intra cranial Arteriovenous malformations
- Cerebral amyloid Angiopathy
For poorly understood reasons, pregnancy increases hemorrhagic stroke risk, and women who have just given birth are more than 28 times more likely to suffer hemorrhagic
Head trauma / Head injury may cause a subdural haematoma, which is sometimes included under the loose term of a stroke. This is a clot of blood that occurs under the dura (the outer membrane of the brain), which lines the skull bone. Concussion is a temporary bout of unconsciousness following a blow to the head. A severe blow to the head can break blood vessels and cause bleeding into the brain. Over time, repeated small haemorrhages can cause brain damage with similar symptoms to neurological disorders like Alzheimer’s disease and Parkinson’s disease.
Cerebral Haemorrhage in children
Cerebral haemorrhage is relatively rare amongst children, with only 2.5 children out of 100,000 affected every year in Australia. Most cases occur in children under the age of two years. Sometimes, cerebral haemorrhages are caused by congenital weaknesses in the walls of the blood vessels. In approximately one third of cases, the cause is unknown.
WHAT IS CEREBRAL HAEMORRHAGE?
Cerebral haemorrhage results in a collection of blood, which clots, putting pressure on nearby brain tissue and restricting the delivery of oxygen and nutrients. Without reversal, this may cause permanent brain damage. The symptoms of a cerebral haemorrhage vary according to the location and severity of the bleeding, but may include:
- Sudden onset of symptoms
- Severe headache
- Numbness or pins and needles of the face, arm or leg, usually on one side of the body
- Paralysis on one side of the body
- Slurring speech or difficulty finding words
- Severe headache
- Partial or total unconsciousness
- Difficulty walking or loss of balance
HOW IS BRAIN STROKE DIAGNOSED?
Due to their life-threatening nature, cerebral hemorrhages require immediate neurosurgical evaluation and intervention. Neurosurgeons use specialized examinations for cerebral hemorrhage patients that can help determine the appropriate treatment. Cerebral haemorrhage is diagnosed by different tests, including:
- Physical examination
- Computerised axial tomographic (CAT) scan
- Magnetic resonance imaging (MRI).
Cerebral arteriography may be used to determine the cause for bleeding, since some causes may be surgically corrected to reduce the risk of future bleeding. Selected patients with subarachnoid hemorrhage due to a ruptured aneurism require emergency surgery to “clip” the aneurysm off from the normal brain blood circulation, and they receive specific drugs shown to reduce incidence of complications of this type of stroke.
WHAT TREATMENT OPTIONS ARE AVAILABLE FOR BRAIN STROKE?
Treatment depends on the location and severity of the haemorrhage, but may include hospitalization and certain surgical procedures.
Any suspected signs and symptoms of cerebral haemorrhage require urgent medical attention and the patient should be transported by ambulance to the nearest hospital emergency department.
Strategies to protect the brain during this type of stroke include:
- Blood sugar control
- Blood pressure control,
- Adequate oxygen
- Intravenous fluids
- Detection and treatment of the cause of bleeding
- Constant monitoring
- Immediate treatment for complications from bleeding into or around the brain.
WHAT IS THE LONG-TERM OUTLOOK FOR A STROKE PATIENT?
A cerebral haemorrhage is a life-threatening emergency. Without prompt medical treatment, death may result. A person who survives may be left with permanent disabilities since the brain tissue near to the ruptured vessel will be damaged or destroyed. The disabilities depend on the location and severity of the hemorrhage. Children seem to recover better than adults, probably because of the relative immaturity of their developing brains. If you suspect a cerebral hemorrhage, seek urgent medical attention. The faster you can get treatment, the better the outlook for recovery. Some people make an excellent recovery following a hemorrhagic stroke.
Like ischemic stroke, a haemorhaegic stroke may lead to inflammation of the heart, hypertension arthritis. It may also result in heart disease and be bursting of the delicate blood vessels in the brain.
Unfortunately, some treatments for ischemic stroke aimed at dissolving the occluding blood clot can increase the likelihood of cerebral hemorrhage. Hemorrhagic transformation is the phenomenon in which blood vessels weakened by ischemic stroke rupture to cause hemorrhage in addition (Hemorrhagic transformation can occur without antithrombotics, but they increase the risk
IMPORTANT POINTS TO REMEMBER
- A cerebral haemorrhage is bleeding from a ruptured blood vessel in the brain.
- Causes include weakened blood vessel walls, head trauma or congenital conditions.
A CEREBRAL HAEMORRHAGE IS A LIFE THREATENING EMERGENCY
WHAT IS AN ANEURISM?
Generally speaking an aneurism is a bulge in a weakened portion of a blood vessel wall much like the bulge that results from over-inflating an inner tube. If left untreated aneurisms may burst – or rupture – causing minimal or massive internal bleeding.
Depending on where the aneurism is, rupture can cause a number of serious conditions. For example, rupture of an aneurism in the brain – brain aneurism – may cause a stroke. If an aneurism ruptures in the abdomen – abdominal aortic aneurism – it may cause shock due to massive blood loss. Such events are extremely painful and deadly.
If an aneurism bursts in the chest there is only about a 20% chance of survival even if emergency medical treatment is administered immediately.
Because of this, aneurisms are to be treated with the utmost seriousness. Medical neglect of an aneurism is not an option.
Prevention is the first step. But once an aneurism is detected place yourself obediently under a doctor’s care.
Though there are a number of different types of aneurisms, they can basically be divided into two categories:
- Brain aneurisms and
- Aortic aneurisms. Aortic aneurisms can further be subdivided into
- Thoracic aortic aneurisms and
- Abdominal aortic aneurisms.
All aneurisms share some things in common. However, each type also has its own distinctive characteristics.
WHAT IS A BRAIN ANEURISM?
A brain aneurism – cerebral aneurism – is a bulge in an artery located in or near the brain. Though there are a number of likely causes, the cause is not always known. However, generally speaking, a brain aneurism is often the result of damage done to an artery. This damage may result from…
- Genetic factors
- Bad lifestyle habits
It is also a fact that brain aneurisms often develop without any recognizable symptoms. It is therefore difficult most of the times to diagnose a brain aneurism.
For example, headaches may accompany an aneurism. But this is not always the case. And, of course, many other conditions can cause chronic headaches. Because of this, many people have developing aneurisms and don’t even know it. Aneurism rupture can cause a number of serious results.
In minor cases a leaking brain aneurism might actually heal itself. That is, the bleeding stops without any medical intervention. The aneurism does not go away, however.
In more serious cases it may lead to a stroke and death.
A common occurrence lies between these two extremes. Often a ruptured cerebral aneurism floods one or more parts of the brain with blood. This in turn causes increased pressure on brain tissues resulting in tissue deterioration.
It is true that aneurisms can develop without symptoms. However, as an aneurism grows it is more likely to produce warning signs. Some of the signs might indicate that the aneurism has grown to a dangerous size. Other symptoms might indicate that the aneurism has already ruptured.
HOW IS A BRAIN ANEURISM DIAGNOSED?
Unfortunately the only reliable way to diagnose a brain aneurism is to see your doctor and undergo one or more tests. There are several diagnostic tests available. Depending on your situation your doctor might order one or more of these.
Some of these tests are…
- X-ray angiography
- Computed axial tomography
- Lumbar puncture
HOW CAN A BRAIN ANEURISM BE PREVENTED?
Aneurisms can develop because of certain lifestyle choices we make. Therefore there are some things we can do to lower our risk. The 4 important steps for this are…
- Regularly monitor and keep blood pressure low
- Maintain a balanced lipid (cholesterol) profile
- Don’t smoke
- Reduce Atherosclerosis build up
Even if an aneurism already exists these four measures can help restrict the rate of aneurism growth and reduce the risk of rupture. If a brain aneurism already exists and is of a sufficient size to warrant concern then you must immediately seek Neuro -Surgical advice.
WHAT TREATMENT OPTIONS ARE AVAILABLE FOR AN ANEURISM?
Unfortunately surgery is the only viable option for an aneurism that poses a serious health risk. To date there is no drug that can cure an aneurism. Essentially there are a couple of surgical options. These are…
- Surgical clipping
- Endovascular coiling
The first of these two methods is very invasive requiring accessing the aneurism through an opening in the skull. Endovascular coiling is not nearly as invasive but cannot be performed on all types of aneurisms.
WHAT IS A THORACIC AORTIC ANEURISM?
An aortic aneurism is a swelling that occurs on a weakened portion of the aorta. The aorta is the largest artery in the human body. It originates at the left ventricle of the heart from which point it ascends for a short distance before descending through the chest and abdomen. It ends in the abdomen by dividing into two arteries called the common iliac arteries that go to the legs.
An aneurism which occurs on any portion of the aorta except that which passes through the abdomen is called a thoracic aortic aneurism.
The part of the aorta which passes through the chest is divided into three parts and Aneurisms occurring on any of these three sections have corresponding names such as:
- Ascending aorta – Ascending aortic aneurism.
- Aortic arch – Aortic arch aneurism.
- Descending thoracic aorta – Descending arch aneurism.
Like brain aneurisms, thoracic aortic aneurisms can develop to a dangerous size without producing any symptoms. However in the case of rupture the symptoms can be quite intense.
Unfortunately, by the time a thoracic aortic aneurism ruptures the patient is often in grave danger from massive blood loss. Approximately half of the patients experiencing a rupture or dissection die before reaching the hospital. This is especially true for aneurisms located near the heart.
Patients who have aneurisms treated surgically prior to rupture have a very high survival rate. The key, then, is to diagnose the existence and condition of an aneurism before it ruptures. First it is well for us to consider some of the things that can lead to the development and rupture of a thoracic aortic aneurism.
There are a number of causes which can be said to influence the development and rupture of a thoracic aortic aneurism. Some of them can be classified as diseases or genetic conditions. A few examples would include:
- Idiopathic Cystic Medial Degeneration
- Marfan Syndrome
- Bicuspid Aortic Valve
Unfortunately these conditions are not greatly influenced by life-style choices. The silver lining is that these conditions are relatively rare.
Other unknown genetic conditions can also influence the development of aneurisms. If you have a close relative who has been inflicted with an aneurism you are at higher risk for developing one yourself. Make sure your doctor knows of this situation.
There are a number of more common factors that can promote aneurism development. Of course the good news here is that we can make choices to lessen our risk of having an aneurism. Three prominent aneurism causes are:
- High blood pressure
- Advanced coronary heart disease.
- High cholesterol
Smoking could be considered a fourth factor since it promotes these other three.
HOW IS AN ANEURISM DIAGNOSED?
Though symptoms sometimes are present they are not reliable as a diagnostic tool. If you suspect that you might have an aneurism your doctor will have to run some tests. Among the possible tests you might undergo are:
- plain radiography
- CT scans
ANEURISMS CAN NOT BE SELF DIAGNOSED. Neither can your doctor make a sound diagnosis without applying at least one of these tests.
Once an aneurism is detected your doctor will take steps to control the causes listed above. You will be asked to stop smoking, control blood pressure and cholesterol levels.
Currently there is no non-surgical cure for thoracic aortic aneurisms. That is one reason it is so important to do everything we can to reduce the likelihood of promoting aneurism growth and rupture.
WHAT IS AN ABDOMINAL AORTIC ANEURISM?
An aneurism located on the part of the aorta that passes through the abdomen is an abdominal aortic aneurism (AAA). It is the most common type of aneurism.
Though some abdominal aortic aneurisms do produce symptoms, many do not. As with other types of aneurisms, by the time symptoms are present the patient is often in a critical situation.
The cause of an abdominal aortic aneurism is not always known. Three categories of aneurism causes are:
- Genetically inherited diseases
- Enzyme destruction
- Lifestyle influenced conditions
The first two types are difficult to control. They might include:
- Marfan Syndrome
- Ehlers-Danlos Syndrome
- Congenital Defects
The third category – lifestyle influenced conditions – are perhaps more common and are more directly within our control. These include:
- High blood pressure
- High cholesterol
It is a frightening fact that a high percentage of people who experience a ruptured abdominal aortic aneurism do so without even knowing they had an aneurism. It is obvious from this fact that professional diagnosis is of the utmost importance.
As is the case with thoracic aortic aneurisms, AAA can be diagnosed using one or more of the following tests:
- Plain radiography
- CT scans
Once discovered an AAA can be treated in much the same way as a thoracic aneurism. The critical size of the aneurism varies but the treatments are similar.
As with other aneurisms, an AAA can only be cured surgically. There is no drug that will do the trick.
Any aneurism is serious business. It is therefore important for us to do our part in minimizing the risks. Some of the most common aneurism influences are affected by what we do.
WHAT CAN I DO TO PREVENT ANEURISM DEVELOPMENT?
There are certain lifestyle influences that can lead to the development, growth or rupture of an aneurism no matter what the type. These are:
- High blood pressure
- High cholesterol
- Atherosclerosis buildup.
Apparently it is in our hands to control aneurisms from developing