Quick action improves chances after stroke

DEAR DOCTOR K: My grandfather just had a hemorrhagic stroke and is in pretty bad shape. What is it, and how is it treated?

DEAR READER: I’m sorry to hear this, but there’s a chance he’ll make a good recovery. There are two major kinds of strokes. In the most common type, a blockage in one of the brain’s arteries shuts off the blood supply to a part of the brain. That’s called an ischemic stroke.

A hemorrhagic stroke occurs when one of the brain’s arteries bursts and spills blood into the surrounding tissue. This can create pressure inside the skull that damages the brain.

Hemorrhagic strokes, like all strokes, are an emergency. The immediate treatment goal is to prevent a second hemorrhage and to stop any more bleeding from the initial rupture. The options are a procedure called coiling, surgery or medication. The cause and location of the bleeding, either inside the brain (intracerebral) or on its surface (intracranial), helps determine treatment.

Some hemorrhagic strokes are caused by a ruptured aneurysm. An aneurysm is a weak spot in a blood vessel wall. Coiling can prevent an aneurysm from causing a second hemorrhage. In this procedure, the surgeon inserts a catheter into an artery and works it up to the aneurysm in the brain. The doctor releases a tiny coiled ball inside the aneurysm. The coil makes the blood in the aneurysm clot.

Drug therapy for hemorrhagic stroke involves medications to control blood pressure that is too high or too low, or to reduce brain swelling. (High blood pressure is a major cause of hemorrhagic stroke.)

People like your grandfather with hemorrhagic strokes often are severely affected at first. But if they receive medical care quickly and escape the dire consequences of the first hours after the stroke, they can actually recover a lot of brain function.