Hemorrhagic Stroke

WHAT YOU NEED TO KNOW

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Hemorrhagic stroke happens when a blood vessel to the brain bursts. Blood from this vessel can leak into the brain and cause damage. There are two types of hemorrhagic strokes:

Inside:

Intracerebral hemorrhage (ICH) means that the bleeding is directly into the brain. Subarachnoid hemorrhage (SAH) means that the bleeding is in between the brain and the skull.

Warning signs of stroke

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Lower your risk

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Other causes of stroke

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Medications



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Tests & treatment

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Recovery

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Healthy lifestyle

9 - 10

Community support

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Follow up

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Departments of Neurology/ Neurosurgery 1 University of New Mexico Albuquerque, NM 87131-0001 (505) 272-3160

Stroke Clinic 2211 Lomas NE Albuquerque, NM 87107 (505) 925-6518

2011, University of New Mexico Hospitals

Warning signs of hemorrhagic stroke Sudden start of: •Dizziness or loss of balance •Severe headache •Nausea and vomiting that comes on very fast •Confusion, hard time speaking or understanding •Weakness or numbness on one side of the body •Trouble seeing in one or both eyes •Trouble walking

If you have any of these signs or if you !

see them in someone else, call 9-1-1 or get to the ER right away!

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How to lower your risk of stroke Don’t take street drugs Taking drugs such as cocaine and methamphetamine increases the risk of hemorrhagic stroke. This is because these drugs increase your heart rate and blood pressure, causing damage to the arteries in the brain. If you take drugs, get help to quit. Call UNM Hospitals Addictions and Substance Abuse Program (ASAP) at (505) 925-2400. Do not smoke! Smoking doubles the risk for stroke. Call the QUIT line at 1-800-QUIT-NOW to receive free coaching, as well as nicotine

! patches, gum or lozenges. Limit alcohol to 2 drinks per day for men and 1 drink per day for women.

Lower your blood pressure High blood pressure is the most common cause of a stroke. It damages the heart, brain and other organs. Normal blood

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pressure is about 120/ 80. If you have high blood pressure, you doctor may ask you to make changes in your diet and to exercise more. You may also need to take medications to lower your blood pressure.

How to take your medications: •Call your doctor or nurse if you have any side effects •Keep taking your medications even after you feel better •Use a pill box to help organize your medications •Tell your doctor if you are taking any herbs or over-the-counter medications •Call for medication refills 2 weeks before you run out

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Other causes of hemorrhagic stroke There are other changes in the brain that can cause a stroke:

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Aneurysm

This is an area where the wall of the artery is weak. The artery gets larger or balloons out to form an aneurysm.

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Arteriovenous malformation (AVM) These blood vessels do not grow normally from birth.

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Cavernomas

This is a cluster of blood vessels within the brain. Cavernomas look like raspberries.

Cavernomas look like raspberries

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Magnetic resonance imaging (MRI) of the brain (above),

Cavernomas look like raspberries. They are made up of abnormal blood showing the typical ‘raspberry’ or ‘popcorn’ appearance of a cavernoma in an area called the ‘midbrain’, vessels through which blood flows slowly – these are the caverns that which is shown by the arrows on the picture. give the condition its name. The cells that line these caverns sometimes ooze small amounts of blood into surrounding brain tissue, which sometimes causes symptoms. developed in the 1980s. Before the MRI test was available, symptoms

Cerebral amyloid angiopathy

of brain cavernomas were sometimes missed, or mistaken for symptoms This is where proteins Cavernomas can get bigger, but this growth is not cancerous - they do of other neurological conditions, such as multiple sclerosis. Even now, not spread to other areas of the body. Most people with the condition some people with a brain cavernoma wonder if they might have been build up on the only have one cavernoma. Some people have more than one cavernoma, diagnosed earlier if they had had an MRI test to investigate neurological and these people sometimes develop new cavernomas over time. symptoms that they had in the past. arteries in the brain. This weakens the How are cavernomas diagnosed? What causes brain cavernomas? Cavernomas have been known about since the middle of theIn19th arteries and can lead most cases, it’s impossible to know what caused a brain cavernoma, century, when they were seen by pathologists examining brains underare two recognised causes. but there the microscope. to a bleed.

treatment Magnetic resonance imaging (MRI) is the most accurate testRadiation and provides Radiation pictures of brain cavernomas. Computed tomography (CT) scans and is used to treat a variety of medical conditions. During treatment, a patient’s brain may be exposed to radiation. angiograms cannot be relied upon to show up cavernomas. radiation Doctors only of these began to see how common cavernomas were when the MRI Some test was first people are later found to have a brain cavernoma. If 4

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Medications after a stroke Medications to lower blood pressure Type of medicine

Name of medicine I am taking

How it helps

Possible side effects

Calcium Channel Blockers

! amplodipine (Norvasc) ! diltiazem (Cardizem, Tiazac) ! felodipine (Plendil)

Helps the heart work better. Can help lower blood pressure and pulse

Headache Flushing of face Dizziness Ankle swelling

ACE Inhibitors

! lisinopril (Prinivil, Zestril) ! benazepril (Lotensin) ! capotril (Capoten) ! enalopril (Vasotec) ! fosinopril (Monopril) ! quinapril (Accupril)

Widens the blood vessels to increase blood flow

Dizziness Weakness Dry cough Decreased taste Metallic taste

ARB (Angiotensin Receptor Blocker)

! candesartan (Atacand) ! irbesartan (Avapro) ! losartan (Cazaar) ! olmesartan (Benicar) ! telmisartan (Micardis) ! valsartan (Diovan)

Widens the blood vessels to increase blood flow

Dizziness Weakness Diarrhea

Beta Blockers

! carvedilol (Coreg) ! metoprolol (Toprol XL)

Helps the heart to relax and work better

Dizziness Slow heart rate Low blood pressure Feeling tired

Diuretics (Water pill)

! furosemide (Lasix)

Helps get rid of extra fluid in your lungs, legs and feet. May also lower blood pressure.

Dizziness Weakness Muscle cramps

* Take Lasix in the morning 30 minutes before you eat ! hydrochlorothiazide (HCTZ) ! bumetanide (Bumex) ! metolazone (Mykrox, Zaroxolyn) ! spirinolactone (Aldactone)

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Tests and treatment after a stroke

Your doctor may order one or more of these tests to find out more about your stroke and how to give you the best treatment:

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Echocardiography This is a type of ultrasound that can show the long term effects of high blood pressure inside the heart.

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CT scan This test takes X-rays from different points around your head.

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CT angiography This test uses a dye to show the areas of a stroke.

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MRI This test uses a powerful magnet to take pictures of the brain and its blood vessels.

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Image: National Institute of General Medical Science

Cerebral angiography This is a procedure where a catheter is inserted into a blood vessel in the groin. The catheter is guided up to the arteries of the brain. A dye is injected that can show the flow of blood through the arteries.

In some cases, a surgical procedure can help to prevent another hemorrhage:

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Surgery to treat an aneurysm: To prevent rupturing:

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Coiling

Clipping

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Recovery after a stroke Different therapists may help you recover after a stroke. Therapists will recommend the type of rehab facility that will be best for your recovery. Physical Therapist (PT) Physical therapy helps with walking, getting in and out of bed, and balance. The PT will help decide if you will need a walker or wheelchair to move around.

Occupational Therapist (OT) Occupational therapy helps with activities such as dressing, bathing and eating. The OT will help you to be as independent as possible.

Speech Therapist Speech therapy helps with making and understanding words, and with swallowing. The speech therapist will also help with memory and thought process.

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Recovery after a stroke Most people need follow up care called rehabilitation (rehab) after a stroke. Rehabilitation helps to build strength, work on balance, improve speech, and meet other goals. Your doctor will work with rehab therapists to decide the type of follow up care that is best for you. A hospital social worker will help with your placement to a rehab facility.

 Rehabilitation hospital This is a hospital for short-term rehab. Usually people get therapy for 3 to 5 hours per day. There are many types of therapy and rehab staff available.

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Skilled Nursing Facility

These are nursing homes with rehab services. They offer short or long-term care. Usually people have about an hour and a half of therapy per day. This is a good choice for people who may not be strong enough for longer therapy.

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Outpatient Rehabilitation

These are places to come during the day for therapy. A person must be able to live at home and travel to the facility. Usually people come several times a week for long therapy sessions.

 Rehabilitation at Home Home health services can provide therapy for short-term care. This is good for people who only need one type of therapy and are not able to travel for outpatient rehab. 8

Healthy lifestyle choices

Control your diabetes High blood sugars cause damage to the blood vessels that can lead

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to blood clots. Take medication for diabetes and follow a healthy eating plan. Watch your weight Being overweight puts stress on the body. Make healthy food choices

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and get regular physical activity.

Did you know? University Hospital has a Diabetes Education Program that can help you to manage this disease. Ask your doctor for a referral or call 272-2340 for more information.

Ask your doctor about an exercise program that is right for you. The goal is to do 30 minutes of activity almost every day. Limit fat, salt and sugar Avoid food with transfat and limit saturated fat in your diet. Saturated fat comes from animal products. Eat less red meat, processed meats, ice cream and cheese. Choose foods with lower sodium to help lower your blood pressure. To limit sugar, avoid soft drinks. Look for products that are high in fiber (more than 3 grams

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of fiber per serving). 9

http://foundation.acponline.org

WHAT YOU CAN DO

The Healthy Plate Think of your plate as 3 different sections: N N N

one section for vegetables one for proteins one for carbohydrates (carbs)

Choose proteins with lower saturated fat. Chicken, turkey, fish, Do not add salt to your

beans, nuts, and low fat

plate. Use Mrs. Dash or

milk are healthy options.

flavor with herbs, spices, onion, garlic, and chile!

Reproduced from: Living with Diabetes: An Everyday Guide for You and Your Family http://foundation.acponline.org/hl/diabguide.htm © 2009 ACP Foundation

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Community support These are things that you can do to reduce your chance of having another stroke:

Some of these things may be hard for you. These changes are very important to your health. Here are some resources where you can get more information and support:

Lower your blood pressure

• American Stroke Association: www.stroke.org 1-888-4-STROKE

Stop smoking Don’t take street drugs

• National Stroke Association: www.strokeassociation.org 1-800-STROKES

Control your diabetes Watch your weight

• New Mexico Agency on Aging www.nmaging.state.nm.us 1-800-432-2080

Limit fat, salt and sugar Talk to your doctor if you use hormone replacement pills

• Albuquerque Stroke Club (505) 268-5685

Questions? Financial Assistance 1131 University Blvd NE, Ste D Albuquerque, NM 87102 (505) 272-2521

Pharmacy 1209 University Blvd NE Albuquerque, NM 87106

Did you know? University Hospital has stroke support group meetings twice every month. Patients, families and caregivers are welcome. Call the stroke program coordinator for more information.

(505) 272-2308

Stroke Program Coordinator

Tobacco Treatment

(505) 272-6105

933 Bradbury SE, Ste 1112 Albuquerque, NM 87016 (505) 272-2340 1-800-QUIT-NOW

Centralized Scheduling (505) 272-1623

Case Management Services (505) 272-2328

Neurology Unit (5 South) (505) 272-9086

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Follow up care Things to know about your follow up appointment • When you call for a follow up visit, tell the clinic that

Your stroke team at the University of New Mexico Hospital

you were just discharged from the hospital • Bring all your medication bottles with you

Your follow up appointment is with:  Neurology Clinic on ________________ (505) 272-3160

• If you are unsure of what

 Neurosurgery Clinic on _____________

your copay is, call financial assistance at (505) 272-2316 • Please keep this

(505) 272-9494



Stroke Clinic on ________________ (505) 925-6518



Your primary care provider on ________

appointment. If you need

Your primary care provider is:

to reschedule, call at least

____________________ and the phone

24 hours before

number is _________________

DIRECTIONS to your follow up appointment at the Hospital (2211 Lomas NE): From Lomas go North onto Yale. Follow signs to patient parking structure. Enter into the Bill and Barbara Richardson Pavillion. Pass the food court and continue up the ramp. Turn left at the information booth. Turn right at the first hallway. The Neurology/ Neurosurgery Clinic is on the right, across from the admissions office.

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