(RxWiki News) Emergency treatment of a hemorrhagic stroke focuses on controlling bleeding, blood pressure, and pressure in the brain.

A hemorrhagic stroke is caused by bleeding in the brain. Emergency treatment of a hemorrhagic stroke focuses on controlling bleeding, blood pressure, and pressure in the brain. Lowering blood pressure lowers the amount of bleeding from the torn or ruptured artery. It is done slowly to prevent additional brain damage.

Drug therapy

Almost all medications for hemorrhagic strokes are used to manage problems such as high blood pressure, brain swelling and blood vessel spasms. Medications commonly given to treat ischemic strokes are dangerous to give to patients with hemorrhagic strokes. These drugs include tPA, heparin, and warfarin. They can make the bleeding worse.

• Brain tissue swelling is a serious and common result of a hemorrhagic stroke. It can be treated with hyperosmotic drugs (such as mannitol, glycerol or saline). These drugs remove extra fluid from the brain.
• Nimodipine, a calcium-channel blocker, may help reduce brain damage from spasms of blood vessels in the brain. These spasms often occur in the first two weeks after a subarachnoid hemorrhage. They can further reduce blood flow to the brain. Worse, they can be fatal.
• Drugs to lower blood pressure may also be used.
• Phenytoin (Dilantin) is a medication that may be given to limit seizure risk.
• Pain relievers can help manage severe headaches.

Surgery

Surgery can be a lifesaving treatment for hemorrhagic stroke. But it does have serious risks. These risks include infections as well as more strokes. For people with a ruptured aneurysm, surgery can be done to stop the bleeding or reinforce the walls of the weakened artery.

• Depending on its location in the brain, an aneurysm that has leaked or ruptured can be clipped across its base. This is called microsurgical clipping. This procedure uses a permanent metal clip to stops blood flow directly into the aneurysm. It prevents the risk of future bleeding.
• Another procedure is called endovascular coiling. In this procedure a platinum coil wire is inserted into the aneurysm. The coil slows blood flow from the aneurysm. This prevents blood from entering it.

Arteriovenous malformation (AVM) is a tangled web of arteries and veins. Bleeding from an AVM is sometimes treated by removing the tangle through an opening in the skull. This procedure is only done if the risk of future bleeding is greater than the risk of complications from the procedure itself.

Sometimes an AVM is located deep within the brain and can’t be reached by surgery. In this case, embolization or radiation therapy may stop the bleeding.

• For embolization, a catheter (thin, flexible tube) is threaded into the center of the AVM and a special glue is slowly injected. When the glue solidifies, it blocks blood flow through the AVM. Embolization often is performed before surgical removal of an AVM.
• Radiation therapy destroys the abnormal blood vessels in the AVM. These blood vessels are then slowly reabsorbed by the body.

People with a hemorrhagic stroke often develop an intracerebral hematoma. This is a blood clot caused by bleeding in the brain.

• The hematoma can increase pressure in the brain to dangerous levels and damage neurons (nerve cells in the brain).
• Large hematomas are usually deadly.
• Emergency drainage by open-brain surgery, known as evacuation, can relieve the pressure.

Ongoing treatment

Once the bleeding is under control, treatment of hemorrhagic stroke focuses on lowering the risk of another stroke. Strategies to reduce risk include:

• Treating hypertension (high blood pressure) with lifestyle measures and medication
• Quitting smoking
• Avoiding heavy alcohol use

Hemorrhagic and ischemic strokes are treated in very different ways. Get immediate medical attention so that a doctor can determine the type of stroke and which treatment to give.