Hemorrhagic
Stroke
I. Definition
Cardiovascular
disease is the nation’s leading killer, among both men and women, in
all racial and ethnic groups.
Cardiovascular
disease includes heart disease, the number one cause of death, and stroke,
the third leading cause of death in the United States. Hemorrhagic stroke
is one particular subgroup of stroke.
A
hemorrhagic stroke, commonly called intracerebral hemorrhage (ICH), is
one in which a defective artery bursts and bleeds out into the surrounding
tissue of the brain.
X-ray
of hemorrhage
An ICH can result in a loss of a constant blood
supply to the brain or in an accumulation of blood that may put pressure
on the surrounding tissues and may even displace brain tissue.This
can affect how the brain functions.
Depending on the location
of the ICH, brain
injury from a stroke can affect the senses, motor activity, speech
and the ability to understand speech, behavioral patterns, thought patterns,
memory and emotions.It is also common
for paralysis on one side of the body to occur as a result from a stroke.
The severity of the hemorrhagic
stroke depends upon the amount of bleeding in the brain.Death
from ICH usually occurs as a result of increased pressure on the brain.Approximately
37.5% of hemorrhagic strokes result in death within the first 30 days.
Those who live, however,
tend to have a better recovery compared to people who have had an ischemic
stroke.An ischemic stroke is
caused by a blocked blood vessel, or clot.The
clot causes part of the brain to die, and it cannot regenerate.On
the other hand, if a person survives after having a vessel in the brain
burst, as in an intracerebral hemorrhage, the pressure from the blood on
the brain gradually goes away.The
brain may regain some or all of its former function.About
20% of all strokes are hemorrhagic strokes.(1,2)
II. Incidence
The
incidence
of hemorrhagic stroke varies somewhat throughout the United States and
the world.
Data from the
First
National Health and Nutrition Examination Survey Epidemiologic Follow-up
Study (NHANES) estimated the annual incidence
in
the United States during a 20-year follow-up period to be 50 per 100,000
among African Americans and 28 per 100,000 among whites.
This
racial disparity could be due to differences in blood pressure, education,
and socioeconomic status.(3)
Other
countries report recent incidence rates to be 11/100,000 inhabitants/year
in Germany, 25/100,000 population in Australia, and 65/100,000 males in
Japan. Higher incidences were reported for males and with increasing age,
except in the Japan study that showed females to have higher rates (106/100,000).(4-6)
III.
Symptoms
Symptoms
of stroke include headache, seizures, dizziness, numbness on one side of
the body, confusion, blurred vision, and trouble understanding or speaking.
If
these symptoms are present, one should seek emergency care immediately.(7)
IV. Prevention
Stroke is a preventable
disease.Most of the evidence of
prevention exists in the pharmacological field, predominantly with blood
pressure and cholesterol lowering medications.Less
evidence is available for life-style modifications such as dietary change
and physical exercise, which would yield a more economical prevention plan.(8)Hypertension
treatment and modification of lifestyle-related risk factors have shown
a reduction in the risk of a first stroke, and, thus, should be targeted
in communities as a major prevention effort.(9)
References
3.Qureshi AI, Giles WH, Croft JB.Racial
differences in the incidence of intracerebral hemorrhage:effects
of blood pressure and education.Neurology.52(8):1617-21,
1999.
4.Schutz H, Bodeker RH, Damian M,
Krack P, Dorndorf W.Age-related
spontaneous intracerebral hematoma in a German community.Stroke.21(10):1412-8,
1990.
5.Anderson CS, Chakera TM, Stewart-Wynne
EG, and Jamrozik KD.Spectrum of
primary intracerebral hemorrhage in Perth, Western Australia, 1989-90:incidence
and outcome.Journal of Neurology,
Neurosurgery & Psychiatry.57(8):936-40,
1994
6. Nakayama T, Date C, Yokoyama T,
Yoshiike N, Yamaguchi M, and Tanaka H.A
15.5-year follow-up study of stroke in a Japanese provincial city.The
Shibata Study.Stroke.28(1):45-52,
1997.
7.Anderson CS, Chakera TM, Stewart-Wynne
EG, and Jamrozik KD.Spectrum of
primary intracerebral hemorrhage in Perth, Western Australia, 1989-90:incidence
and outcome.Journal of Neurology,
Neurosurgery & Psychiatry.57(8):936-40,
1994.
8.Ebrahim S.Cost-effectiveness
of stroke prevention.British
Medical Bulletin.56(2):557-70,
2000.
9.Gorelick PB, Sacco RL, Smith DB,
et al.Prevention of a first stroke:a
review of guidelines and a multidisciplinary consensus statement from the
National Stroke Association. [Review]JAMA.281(12):1112-20,
1999.
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