Treating hemorrhagic strokes a different ballgame than ischemic strokes
Cerebrovascular neurosurgeon Lincoln Jimenez, MD, an assistant professor of neurosurgery, is one of just a few doctors in the region who can treat aneurysms both with endovascular techniques and through open surgery, depending on what is best for the patient. View Larger Image
You may know the signs of an ischemic stroke and the need to hurry to the hospital in time to get the “clot busting” drug, but the signs and recommended treatment for a hemorrhagic stroke are different.
While both types of strokes involve rapidly-spreading damage to the brain, a hemorrhagic stroke is the result of a burst blood vessel in the brain, while an ischemic stroke results from a clot. So while the clot-dissolving intravenous tPA, short for tissue plasminogen activator, is the ideal drug to eliminate clots in ischemic patients, it’s not recommended at all for patients who suffer hemorrhagic strokes.
About 15 percent of strokes are hemorrhagic. Commonly caused by aneurysms, which are weakened blood vessels that can rupture and bleed, hemorrhagic strokes can lead to the same symptoms as an ischemic stroke: weakness in one arm, slurred speech and drooping on one side of the face. But they can also come with additional symptoms, including a sudden severe headache, neck stiffness and lethargy or even loss in consciousness. A hemorrhagic stroke victim may also be nauseated or have difficulty swallowing.
Although there aren’t specific time windows for treatment methods with hemorrhagic strokes the way there is with ischemic strokes, time is just as urgent. During a hemorrhagic stroke, a blood vessel within the brain leaks or ruptures. It bleeds into the brain tissue (intra-cerebral hemorrhage) or into the surrounding space (subarachnoid hemorrhage). The brain is extremely sensitive to bleeding, and it can incur damage very quickly as the blood irritates tissue and causes swelling.
Some patients can be treated on-the-spot with a minimally invasive procedure, but others will need open surgery on their brain. University of Florida College of Medicine – Jacksonville cerebrovascular neurosurgeon Lincoln Jimenez, MD, an assistant professor of neurosurgery, is one of just a few doctors in the region who can treat aneurysms both with endovascular techniques and through open surgery, depending on what is best for the patient.
The endovascular method involves a wire that is inserted through the groin area and placed wherever the aneurysm is. A tiny, curly material called a coil is then released from the wire, filling the aneurism with what looks like an ever-growing ball of string. Once the aneurysm is securely filled with coils, the coils prevent blood from filling the space, so the blood can instead travel through vessels the way it is meant to.
If a patient requires open surgery, a part of the skull must be removed in order to access the brain. Jimenez locates the aneurysm and pinches it closed with a tiny clip that will remain in the brain to prevent blood from going into the aneurysm.
“Some facilities don’t offer endovascular surgery, and some don’t offer open surgery. It’s good to have a person who will be able to do both,” Jimenez said, explaining that patients will fare better with one option or the other depending on specific factors like age and whether there are blockages in blood vessels leading to the brain.
Jimenez said the most important thing a patient can do is get to the hospital as quickly as possible so the Comprehensive Stroke team can begin its work to determine the best course of treatment.
“The sooner the better because it can always rebleed or rerupture,” Jimenez said. “Mortality is over 80 percent, so we want to be able to treat it as soon as possible.”
Learn more about the Comprehensive Stroke Program at ufhealthjax.org/stroke.
This article is the third in our five-part Striking Out Strokes series. Click on the links below to read the rest of the series:
Striking out strokes with an all-star stroke team
Stroke patient grateful for receiving the “clot buster,” IV-tPA
Neuroradiology is a key component in a stroke emergency
Care after a stroke just as critical as the initial treatment
Cerebrovascular neurosurgeon Lincoln Jimenez, MD, an assistant professor of neurosurgery, is one of just a few doctors in the region who can treat aneurysms both with endovascular techniques and through open surgery, depending on what is best for the patient.