Brain bleed after a stroke and a stroke from a brain bleed are different things. Brain bleed after a stroke happens in people who have regular strokes and later develop bleeding inside the brain. In some cases, brain bleed after a stroke is a side effect of treatment for a regular stroke.
If you would like to know the difference between a regular stroke (also called an ischemic stroke), and a stroke from a brain bleed (a hemorrhagic stroke), read this article. (link)
This article here will focus on brain bleed after an ischemic stroke. We will explore the following topics:
- How frequently does brain bleed happens after a stroke?
- What causes bleeding after a stroke?
- How the treatment of a stroke may lead to brain bleed
- How the size and location of brain bleed after a stroke makes a difference in the final outcome
- What to expect when your loved one develops brain bleed while being hospitalized for a stroke
How frequently does brain bleed happen after a stroke?
Brain bleed may happen to anywhere from 10% to 40% of patients with an ischemic stroke. Different studies have identified various things that increase or decrease the risk of brain bleed after a stroke.
We will look at a few of those factors here:
- The size of the stroke: The larger the initial stroke, the higher the risk of bleeding afterwards.
- A stroke caused by an abnormal heart rhythm called A fib: A fib, or atrial fibrillation, is a condition in which the upper heart chambers don’t beat regularly. It causes some turbulence in the blood flowing into the heart, increasing the risk of forming small blood clots that may go into the brain and block small blood vessels, causing a stroke. They usually result in multiple small strokes. These small clots can move again, exposing fresh blood into the damaged brain, causing brain bleed after the stroke. According to a study, people who get brain bleed after a stroke are 4 times more likely to have A fib than not.
- Bad symptoms from the initial stroke: If someone had very bad symptoms from the initial stroke, he or she is also at an increased risk of brain bleed after that stroke. Doctors use a scale called the stroke scale or stroke score to keep track of the severity of the stroke. It goes from 0 to 42, where 42 is the most severe form of a stroke. The higher the stroke scale, the higher the chance of brain bleed afterwards.
- High blood sugars: Uncontrolled diabetes with high blood sugars have been found to increase the risk of brain bleed after a stroke.
- Lower cholesterol: In some studies, people with lower cholesterol were found to have a higher rate of brain bleed after a stroke. However, people with lower cholesterol have a lower risk of having a stroke in the first place. That is why it is still recommended to keep your cholesterol low.
- Low platelets: Platelets are the small, disc-like fragments floating in the blood. They help stick to damaged blood vessels and form a clot. With less platelets, you are more likely to have brain bleed after a stroke.
What causes bleeding after a stroke?
A regular stroke is also called an ischemic stroke since it is caused by an interruption of the blood flow to the brain. Ischemic simply means loss of blood supply. When something blocks blood supply to your brain, you have an ischemic stroke. The part of the brain that does not get any blood starts to die off. The walls of the blood vessels inside that part of the brain also get damaged and become leaky. When blood flows again in these parts, it may leak out and cause small bleeding. The damaged blood vessel wall may also burst open and lead to massive bleeding.
How the treatment of an ischemic stroke may lead to brain bleed
When we look at what causes bleeding after a stroke, it is easy to see why the treatment of an ischemic stroke may lead to brain bleed. The goal of treatment of a regular stroke is to get rid of the blockage and get blood flowing again into the part of the brain affected by the stroke. If the blood gets there after the walls of the blood vessels have already been damaged, there is a risk of them bleeding into the brain.
The risk of brain bleed goes up as the time needed to successfully restore the blood flow gets longer. As more time passes, the part of the brain without blood gets more damaged and more likely to have blood vessels with damaged walls. The risk of brain bleed after treatment is one of the reasons why it is important to call 911 as soon as you suspect a stroke. If they are able to get the blood flowing again within 3 hours, the risk of brain bleed after treatment is low.
How the size and location of brain bleed after a stroke makes a difference in the final outcome
Not all brain bleed after strokes cause a worse outcome than the original stroke. In fact, small amounts of blood leaking out after a stroke may be a sign that blood is flowing again in that part of the brain, signaling a better outcome. Many small brain bleeds after strokes may go undetected, because patients may not feel any worse with brain bleed than how they felt with the initial stroke.
In general, if the bleeding occupies 30% or more of the area of the brain affected by the stroke, the outcome will likely be worse. The larger the bleeding, the worse the expected outcome can be.
The location of the brain bleed and whether it is pushing on the surrounding brain tissue also makes a significant difference in the outcome. When the bleeding is in a confined area, it generates higher pressure and pushes on a part of the brain not affected by the initial stroke. That can lead to worsening symptoms, as the previously normal part of the brain begins to deteriorate with pressure.
What to expect when your loved one develops brain bleed while being hospitalized for a stroke
It is important to understand that brain bleed after a stroke is not always a disaster. If your loved one received timely treatment for a stroke and was doing better with improved symptoms, small brain bleed seen on a CT scan may not be significantly worse.
Any new brain bleed after a stroke requires close monitoring in the hospital. If your loved one was being treated on a regular floor of the hospital, you can expect to him or her to be moved to the ICU for closer monitoring. They will watch out for signs of increased pressure inside the brain. Worsening headaches, nausea, or vomiting may signal high pressure inside the brain, and could be cause for concern.
Large brain bleed after a stroke can be very difficult to treat and has a worse outcome. They can sometimes try to treat the bleeding by giving medications to reverse the clot-busting medications used in the treatment of the initial stroke. They can also transfuse platelets to see if that would help prevent any further bleeding. However, large brain bleed has a very poor outcome, and only a small percentage of people with large brain bleed after a stroke survive.
Some patients with brain bleed after a stroke may benefit from surgery. Patients who have moderate-sized bleeding along with increased pressure inside the brain might do better if that pressure can be surgically relieved. Neurosurgeons have several different surgical techniques they can use to try to achieve that goal. It only works in a few patients.
In conclusion, brain bleed after a stroke doesn’t always mean disaster. However, large brain bleed with increased pressure may be life-threatening. People with brain bleed after a stroke need to be monitored very closely in the hospital. A few may benefit from highly-specialized surgery.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200641/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718251/
https://n.neurology.org/content/79/13_Supplement_1/S52.full
https://journals.sagepub.com/doi/full/10.1038/jcbfm.2013.203
https://pubmed.ncbi.nlm.nih.gov/24590407/
https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000152