What is a stroke?

A stroke is damage to part of the brain when its blood supply is suddenly slowed or stopped. A stroke may also be called a cerebral vascular accident or CVA. The part of the brain that does not get enough blood dies and can no longer function.

A hemorrhagic stroke happens when an artery in the brain breaks and bleeds into the brain. They often happen without warning. Any of the following factors can increase the risk of a hemorrhagic stroke:

• High blood pressure
• Cigarette smoking
• Cocaine use
• Bleeding disorders or blood vessel problems
• Use of certain medicines that prevent blood from clotting

Symptoms of a stroke include:

• Sudden numbness or weakness of the face, arm or leg, usually on one side of your body
• Sudden trouble walking or loss of balance
• Sudden trouble speaking or thinking clearly
• Sudden dizziness or severe headache
• Sudden trouble seeing in one or both eyes

What can I expect in the hospital?

All strokes require careful observation, especially in the first 24 hours. You will need to stay in the hospital for testing and treatment after a stroke.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• A heart (cardiac) monitor will be used to check your heartbeat.
• Neurologic examination: Testing to check your strength, sensation, reflexes, mental status, and memory. Your balance and ability to stand or walk may be tested. This will include looking at your eyes with a flashlight to see if your pupils are the same size.
• You may have a small tube (catheter) placed through your skull to monitor the pressure around your brain.
• Your blood oxygen level will be monitored by a sensor that is attached to your finger or earlobe.
• Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
• You may have a small tube (catheter) placed into your bladder through the urethra (the opening from the bladder to the outside of the body) to drain and measure urine from the bladder.

Testing

Testing may include:

• Computed tomography (CT) scan: A series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the brain.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the brain.
• Cerebral arteriogram (also called cerebral angiogram): A series of X-rays taken after your healthcare provider places a long, thin, flexible tube (catheter) into a blood vessel in your groin or neck and injects a special dye into your blood vessels to look for areas where the dye may be leaking out of a blood vessel or blocked blood vessels.
• Blood tests to check for healthy blood cells, anemia, fats in the blood, and the ability of the blood to clot.
• Electrocardiogram (ECG): A test that measures and records the electrical activity of your heart.

Treatment

The treatment for hemorrhagic stroke depends on its cause, your symptoms, how well you respond to treatment, your overall health, and any complications you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs to help you breathe.
• Your provider may stop any medicines that you were taking that may have caused the hemorrhagic stroke.
• You may need surgery to treat hemorrhagic stroke. Surgery may include:
  • Ventriculostomy: Surgery to place a catheter through your skull to drain excess fluid around your brain.
  • Craniotomy: A surgical procedure in which a cut is made in the head and a piece of the skull is removed so the surgeon may treat the cause of the hemorrhagic stroke. Craniotomy may be done to fix abnormal or bulging blood vessels, remove blood or fluid, and reduce swelling in the brain.
  • Endovascular surgery: A long, thin, flexible tube (catheter) is placed into a blood vessel and moved up to the brain arteries to place small coils or other substances in them that will fill in a bulging blood vessel (aneurysm) or block an abnormal group of blood vessels (arteriovenous malformation, or AVM) to stop the bleeding.
• Your provider may prescribe:
  • Blood products to help your blood clot
  • Medicines to:
    • Help your blood clot
    • Treat conditions that may have caused your stroke, such as high blood pressure or high blood sugar
    • Treat pain
    • Reduce swelling in the brain
    • Treat or prevent seizures
• You may start a stroke rehabilitation program while you are in the hospital to help you regain some of the functions you may have lost due to the stroke. Most stroke rehabilitation programs include:
  • Physical therapy to help you regain muscle strength and teaches you ways to move safely
  • Occupational therapy to help you relearn ways to do the tasks that you previously did
  • Speech therapy to help you if you have problems with swallowing, speaking, or understanding words
  • Therapy may include skin care and training to help you control your bladder and bowels.
• You may need help with daily activities.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Weakness, numbness, tingling or pain in your face, arm, or leg, especially on one side of your body
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Trouble speaking or understanding
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Loss of bowel or bladder control
  • Severe headache, dizziness or confusion
  • Seizure or convulsion
  • Personality changes
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on how severely your brain is injured. Some improvement may occur rapidly within the first few days and weeks after the stroke. Other improvement may occur more gradually. The average amount of time to stay in the hospital to treat a stroke is 5 to 7 days.

You may need to go to a rehabilitation facility to continue your stroke rehabilitation program before going home.