Hemorrhagic stroke
February 4, 2010 8:46 AM   Subscribe

Hemorrhagic stroke - what next?

A close relative just suffered a hemorrhagic stroke.
He's in his 70s but is extremely fit and active for his age and had never suffered from high blood pressure.
He lost all feeling down his right side and, while he remained conscious, he had difficulty expressing himself and was rather disinhibited - swearing profusely when he was not in the habit of doing so previously.
Within a couple of hours, his feeling had begun to return and his speech started to improve.
He now faces a couple of weeks in hospital, followed by a period of rehab in another hospital.
However, he is not to receive any pharmaceutical or surgical intervention - only various therapies: speech, physio, etc.
My question is: what's his chances of a decent (or even full) recovery and what, if anything, can medicine or we his family do to help him make the best possible progress?
We live in the UK.

Thanks for your help.
posted by Blackwatch to Health & Fitness (6 answers total)
 
Hemorrhagic stroke is a broad class of conditions. Do you know whether the bleeding was in the brain itself or between the skull and the brain? In the latter case, was it an epidural hematoma, subdural hematoma, or subarachnoid hemorrhage?

Frankly I'm quite surprised that the doctors did not recommend either drugs or surgery. Normally a hemorrhagic stroke of any kind is a medical emergency and usually a pretty serious one at that.
posted by jedicus at 9:26 AM on February 4, 2010


My 68yo grandmother had a hemorrhagic stroke a few years ago, complicated by a rollover car accident. She spent October through December in the hospital/rehab center, receiving occupational, physical, and speech therapy. It was almost a month before she started communicating verbally, and the weakness on her right side lasted for a few months after her discharge.

She also didn't have any surgery or other medical intervention. I seem to remember that she was given something, maybe Ritalin or Dexedrine, for a little while to help her focus, but it wasn't long before the drug therapy was discontinued. It really is time, patience, and therapy that makes the biggest difference.

When she came home, my grandfather had installed a few handrails and a taller toilet seat. She used a walker for a few months. She had a bell to ring when she needed help, which would have worked great if my grandfather wasn't hard of hearing. (The bell was thrown and broken after an hour long ringing session one afternoon.) Her memory and conversational skills took a few months to really come back as well.

For awhile, she needed help with her finances, the numbers were just too confusing for her at the time. My mom still goes over her checkbook with her, but that's probably more out of habit now.

She had been a smoker since her teens, had high blood pressure, had high cholesterol, and maybe a touch of Parkinson's (constant hand tremors). Within a year of her stroke, my grandfather was diagnosed with and succumbed to lung cancer. So, it was a pretty stressful year of recovery. But now? Well, you wouldn't know a thing had happened.
posted by wg at 9:30 AM on February 4, 2010


Hemorrhagic stroke is a broad class of conditions. Do you know whether the bleeding was in the brain itself or between the skull and the brain? In the latter case, was it an epidural hematoma, subdural hematoma, or subarachnoid hemorrhage?

Frankly I'm quite surprised that the doctors did not recommend either drugs or surgery. Normally a hemorrhagic stroke of any kind is a medical emergency and usually a pretty serious one at that.


Actually, in my experience, the term "hemorrhagic stroke" tends to either refer to spontaneous intracerebral hemorrhage. I haven't heard that word in clinical practice used to refer to subdural, epidural or subarachnoid hemorrhage, though I could envision scenarios where it might be applied to subarachnoids.

Intracerebral hemorrhage is quite frequently managed without any surgery. In fact, surgical hematoma evacuation is controversial in terms of efficacy, and mostly only considered in cases in which elevations in intracranial pressure can't be controlled with more conservative measures. Current guidelines for craniotomy suggest that only lobar clots within 1 cm of the surface even be considered, and routine evacuation is not recommended.

Medical therapy on the other hand is quite frequently used in the acute setting to control intracranial pressure and blood pressure, prevent and control seizures, and reverse prior anticoagulation. These measures may and probably were entertained in the OP's case. But as for long-term secondary prevention and other medications after the initial hospitalization, blood pressure control is pretty much the only thing that's done. Poorly controlled blood pressure is the major risk factor for recurrence which occurs in about 5% of patients within 2 years of the first hemorrhage. Other non-pharmacological measures include the cessation of smoking, alcohol, and any stimulants.

So in summary, what the OP described isn't particular unusual at all.

To answer the OP's specific question: it's very hard to predict the degree of recovery following a stroke like this, but as wg noted, many patients can make a near-full recovery. Besides controlling blood pressure (which may be a non-issue in this case), making sure he isn't smoking or drinking, and that he is getting and working hard at rehab is the best thing you can do. If speech deficits persist, make sure he's getting speech therapy in addition to physical therapy. Also consider discussing formal neurocognitive testing with his physicians if he continues to act odd -- persistent cognitive deficits can be very difficult to assess without such tests. It can take months before a stroke victim's neurological recovery is complete, so don't lose hope yet, and make sure he keeps at it.
posted by drpynchon at 10:02 AM on February 4, 2010 [1 favorite]


Agree with Dr. Pynchon. Rehab and therapy: super important.
posted by gramcracker at 3:06 PM on February 4, 2010


Therapy is the treatment. There is no pharmaceutical or surgical intervention after the acute phase, other than risk factor management (e.g., blood pressure meds).

No two strokes are alike, and the same applies to the recovery pattern. However, it's encouraging that your relative's symptoms began to improve within a couple of hours.

Best of luck!
posted by onepot at 5:49 PM on February 4, 2010


Hello all.

We now know that he has suffered an intracerebral bleed in the left basal ganglia.

He can walk with the aid of a walking frame and, while he continues to have trouble expressing himself, he is perfectly lucid and understands everything that is said to him.
He now simply wants to get cracking with all the therapies, so let's hope that positive attitude remains.

In my ignorance, I wondered why no intervention was made to correct the weakness which led to the bleed. Perhaps it's simply best to leave it to heal itself, but I assume he's left with a higher risk of it happening again.

He does not have high blood pressure, has never smoked and is not a heavy drinker.

Once again, I have been touched by the time and effort people have taken to respond to my query. All your comments and advice are very much appreciated.
posted by Blackwatch at 1:13 AM on February 5, 2010


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