Hemorrhage or hemorrhagic comes from the Greek word to "to burst forth with blood." A hemorrhagic stroke occurs when there is bleeding in the brain due to a disease of brain blood vessels or a clotting abnormality. Arteries and other small blood vessels create pathways throughout the brain that bring blood from the heart. If these arteries or blood vessels are abnormally formed, they may weaken and burst, and can cause a hemorrhagic stroke. There are several possible causes of hemorrhagic stroke:
The blood carries oxygen and other important nutrients to the brain. The brain needs oxygen to survive. If a part of the brain does not receive oxygen from the blood for a certain period of time, the tissue in that part of the brain will die. Bleeding into the brain from a hemorrhagic stroke interrupts the normal blood flow through the arteries and causes direct damage to tissue in that area of the brain.
Children and teenagers may have one or more symptoms when they are having a hemorrhagic stroke. Typically these symptoms occur suddenly. Initial symptoms may include:
Many children are born with the blood vessel problems that can lead to hemorrhagic stroke. Other children may have other diseases which can contribute to hemorrhagic stroke including blood clotting disorders, Moyamoya disease, trauma or infection.
The Stroke Team will want to find out as much information as possible to diagnose your child's stroke and the reasons why the stroke occurred.
The Stroke Team will perform a thorough physical exam including a neurological exam to gain more information about how your child's brain is currently working.
The Stroke Team will request that blood tests be done to test to see if your child has any underlying blood problems that could cause bleeding. Please see our Glossary for definitions of some of these tests.
The Stroke Team will request that various types of tests be done that will give a better picture or "image" of your child's brain. These tests may include Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiogram (MRA) or Cerebral Angiogram. If the Stroke Team feels more information about your child's heart may be useful, they may order an echocardiogram. Please see our Glossary for definitions of some of these tests.
Depending on your child's symptoms, the Stroke Team may feel a need to order some other tests. These may include a lumbar puncture (LP) also known as a "spinal tap" to look for signs of infection or inflammation that may have caused the stroke. Please see our Glossary for definitions of some of these tests.
Hemorrhagic stroke often requires emergency treatment. Once initial testing is completed, the Stroke Team will consult with the Neurosurgery Team and Interventional Radiology Team to determine if further treatment is needed. In some cases, procedures may be needed to repair the aneurysm or remove the AVM. These procedures may include:
How much the stroke will affect your child's day-to-day life depends on the location and severity of the stroke. Some strokes cause mild problems. Some cause more severe problems. Some children may continue to have seizures. The Stroke Team will consult with the Rehabilitation Team for advice on how best to help your child recover. Rehabilitation is a structured series of exercises to help your child recover from the effects of the stroke. Therapy usually begins within 48 hours of admission, provided your child is medically stable and is able to tolerate these activities. Members of the Rehabilitation Team may include a Physical Therapist (PT), Occupational Therapist (OT), Speech Therapist, Neuropsychologist and Physiatrist ("Rehab" or "PM &R" Physician).
Depending on the results of their assessments, it may be recommended that your child have further rehabilitation. This rehabilitation could range from a stay in the inpatient rehabilitation unit, to Day Hospital rehabilitation, to outpatient rehabilitation appointments. Rehabilitation may last from weeks to months depending on your child's needs. It is important to keep in mind that children recover more quickly from a stroke as compared to adults. Members of the Stroke Team and the Rehabilitation Team will continue to assist you and your child in the recovering process and help your child return to a more normal lifestyle as soon as possible. If your child is school age, we will work with your child's school to recommend any needed changes to your child's curriculum and school day.
Reviewed by: Rebecca N. Ichord, MD
Date: October 2006