Virtual Medical Centre

Haemorrhagic Stroke

• What is Haemorrhagic Stroke?
• Who gets Haemorrhagic Stroke?
• Predisposing Factors
• Probable Outcomes
• How Will Haemorrhagic Stroke Affect Me?
• Clinical Examination
• How is Haemorrhagic Stroke Diagnosed?
• How is Haemorrhagic Stroke treated?
• Haemorrhagic Stroke References
• Drugs/Products Associated with Haemorrhagic Stroke

What is Haemorrhagic Stroke?

Haemorrhagic stroke is characterised by bleeding occuring directly into the brain itself, damaging adjacent brain tissue. This often results from rupture of a vessel due to hypertension or an aneurysm (abnormal dilation or weakness of a vessel).

Who gets Haemorrhagic Stroke?

The majority of strokes occur in patients greater than 55 years of age.

Surveys suggest that stroke of all types, affect 1.2% of Australia's population corresponding to over 200,000 patients affected. At current trends, with growing levels of inactivity and obesity, this number is predicated to skyrocket by the year 2050. Hemorrhagic stroke accounts for 10-15% of stroke cases and these types of stroke tend to produce more severe outcomes.

Men

Men are at greater risk of stroke than women up until the age of 55 years, after which both sexes have similar risks. Stroke is a major cause of morbidity and mortality in the elderly.

Women

Whilst stroke is considered a disease more commonly affecting men, women are actually twice as likely to die from stroke than men. In addition, females have additional risk factors for stroke such as oral contraceptives, that are not present in men. The overall global incidence of stroke is not known but it is considered a leading killer and disabler, being the third most common cause of death and the first leading cause of disability.

Children

Stroke is uncommon in children accounting for only a small percentage of stroke cases each year. Stroke in children is often secondary to congenital heart disease, genetic disorders, abnormalities of vessels within the brain or blood disorders. Half of strokes in children are haemorrhagic and these may be associated with long term disabilities.

Predisposing Factors

On most occasions the leading cause of a haemorrhagic stroke is high blood pressure. The high blood pressure itself stresses the arterial walls within the brain until they break. Another cause of hemorrhagic stroke is an aneurysm. An aneurysm is described as a weak spot that exists within the arterial wall which, when put under high blood pressure, can balloon outward. Eventually this weak spot will burst leading to a stroke and further complications.

Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in elderly patients. This makes the arteries more prone to bleeding and reduces their overall reliability and strength.

General Cardiovascular Disease 10-Year Risk Calculator

This risk assessment tool is based on data from the Framingham Heart Study to estimate 10-year risk for general cardiovascular disease outcomes (coronary death, myocardial infarction, coronary insufficiency, angina, ischaemic stroke, haemorrhagic stroke, transient ischaemic attack, peripheral artery disease, heart failure). This tool is designed to estimate risk in adults aged 30-74 years of age without CVD at baseline examination. Use the calculator below to estimate 10-year risk.

Predictors

Age		years
		Male	Female
Gender
		Yes	No
Have you been diagnosed with Type II diabetes?
Are you a smoker?*
Are you prescribed medication to lower your blood pressure?
If you do not know the following blood pressure and cholesterol parameters ask your General Practitioner on your next visit.
Systolic blood pressure**		mmHg
Total cholesterol***	mmol/L      OR	mg/dl
HDL cholesterol****	mmol/L      OR	mg/dl

Results

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a significant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.

• If diabetic, your sugar levels should be well controlled.
• Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.
• Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
• Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have an elevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.

• If diabetic, you should aim for your sugar levels to be well controlled.
• Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
• Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
• Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a mild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.

• If diabetic, you should aim for your sugar levels to be well controlled.
• Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.
• Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.
• Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.

^*For these purposes "smoker" means any cigarette smoking in the past month.
^**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.
^***Total cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
^****HDL cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.

References:

1. D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.
2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.
3. Stancoven A, McGuire DK. Preventing macrovascular complications in Type 2 Diabetes Mellitus: glucose control and beyond. American Journal of Cardiology 2007; 99: 5H-11H.