o have diabetes and face higher obesity rates. All of these factors increase the risk of stroke.
Nelson, who is African-American, thinks stress may have caused her blood pressure to rise without her realizing it. She didn’t have any other traditional risk factors for stroke.
“About two months before the stroke, I had a new job, a new marriage and my car was broken into,” said Nelson.
Nelson’s blood pressure was dangerously high at the time of her stroke: 240 over 150. A blood pressure of less than 120 over 80 is what’s considered normal, according to blood pressure guidelines. Although blood in the brain can cause blood pressure to rise, Nelson’s blood pressure had likely been elevated for some time prior to her stroke.
“I know I’m very lucky,” she said.
Timing Makes All the Difference
The first few hours after bleeding begins are crucial. Within three hours, about one-third of ICH patients experience significant increased bleeding, which can cause neurological deterioration and even death. Current treatments include blood pressure management, medication and emergency surgery.
Aggressive medical care helps hemorrhagic stroke patients, but there’s less known about early surgical or medical treatments that decrease the rates of death and disability, said Dr. Steven Greenberg, a neurologist and director of the Hemorrhagic Stroke Research Program at Massachusetts General Hospital in Boston and an author of the American Heart Association’s 2015 guidelines for treating ICH.
The role of invasive brain surgery in sensitive ICH patients remains controversial. A 2013 study confirmed earlier findings that ICH patients don’t benefit from surgery to remove hematomas to reduce bleeding and disability. Now, a trial called SWITCH is examining if surgery can reduce intracranial pressure and benefit ICH patients.
Surgery as an Option
Other researchers are studying minimally invasive surgery as an alternative, like in the soon-to-be-completed MISTIE trial that’s examining whether minimally invasive endoscopic surgery plus a clot-dissolving drug called alteplase can safely lessen disability in ICH patients.
“If we can identify those at risk and offer treatment options to reduce that risk, then we can improve outcomes,” Greenberg said.
Sometimes, bleeding in the brain can be caused by blood-thinning medicines and until recently, there were limited options to reverse that excessive bleeding. One of the oldest oral blood-thinners, warfarin, can be reversed with Vitamin K [thus helping treat the stroke].
But newer anticoagulants did not have a reversal agent until 2015. That’s when a drug called idarucizumab was approved in emergency situations to reverse the effects of dabigatran, a blood thinner sold under the name Pradaxa to treat conditions such as atrial fibrillation. Trials for other reversal drugs are ongoing.
“We have some exciting things going on in stroke,” Benson said.
Next Avenue Editors Also Recommend:
- Leg Pain Could Be a Sign of Stroke or Heart Attack Risk
- How Two Strokes Helped Me Become a Better Man
- 7 Surprising Causes of High Blood Pressure
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