Hemorrhagic stroke is less common but more frequently fatal than ischemic stroke. Hemorrhagic stroke has two main types. Each is named according to the part of the brain affected by the bleeding:
* subarachnoid hemorrhage refers to bleeding that occurs in the space between the surface of the brain and the skull.
* intracerebral hemorrhage refers to bleeding that occurs within the brain tissue.
In a hemorrhagic stroke, treatment is based on the underlying cause of the hemorrhage and the extent of damage to the brain.
Immediate treatment for hemorrhagic strokes is best administered in an intensive care unit, where medical personnel can immediately detect any complications. Sometimes persons experiencing a hemorrhagic stroke develop irregular breathing patterns or stop breathing. Medical intervention may be needed to protect the airway and avoid choking or inhaling secretions into the lungs if a patient is unconscious or semiconscious.
In addition to basic life support, treatment includes:
If high blood pressure causes a hemorrhagic stroke, antihypertensive drugs are administered to bring blood pressure down. In addition, brain bleeding may cause swelling of surrounding brain tissue, and this may require therapy with drugs called hyperosmotic agents (mannitol, glycerol, and hypertonic saline solutions).
If the hemorrhage resulted from the use of anticoagulants, such as Coumadin or heparin, these medications are discontinued immediately. Medications may be given to reverse the effects of these anticoagulants to reduce bleeding.
In addition, pain relievers and antianxiety medications may relieve the headache that often accompanies hemorrhagic stroke. Medications may be needed to prevent or treat seizures.
Surgery and other procedures
Surgery or another procedure may be needed to save a patient’s life or to improve the chances of meaningful recovery. The type of surgery depends upon the cause of the bleeding, and is usually divided into three categories:
* Aneurysm clipping
Aneurysm clipping involves opening the skull to expose the aneurysm and placing a clip to prevent future leaking of blood from the affected artery.
* Endovascular treatment of aneurysms
In this procedure, a radiologist passes a catheter (thin tube) through the artery to the opening into an aneurysm. Detachable platinum coils are then deposited in the aneurysm to fill it up and prevent blood from entering, eliminating the possibility of hemorrhage.
* Surgical arteriovenous malformation removal
It is not always possible to remove an arteriovenous malformation (AVM) if it is too large or located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain can eliminate the risk of AVM rupture.
* Stereotactic Radiosurgery
Stereotactic radiosurgery may be used to obliterate AVMs. This procedure focuses a beam of radiation on the AVM, causing it to clot and eventually disappear.
* Endovascular treatment (coil embolization) of AVMs
This procedure is similar to the treatment for aneurysms. A catheter is inserted into a leg artery and threaded through the body to the brain arteries. The catheter is positioned in one of the feeding arteries to the AVM, and coils, small particles or a gluelike substance is injected to block the vessel and reduce the blood flow into the AVM.
General Hemorrhage Treatments
* Removal of hematoma
Removal of a hematoma may be needed, especially when bleeding occurs in the back of the brain. Some physicians are investigating whether the injection of a clot busting drug inside the hematoma can help with the removal of brain hemorrhages through needles or catheters, therefore allowing less invasive surgery.
A procedure called ventriculostomy may be performed if fluid accumulates due to bleeding in the brain and needs to be drained
i have an AVM....
i use to type well... not any more!
i use to type my friends and they could understand me... not any more!
Filed under Case 4 |
Friday, March 28, 2008
Wednesday, March 26, 2008
The expression "it's not brain surgery" is synonymous with something not being super difficult. Therefore, "brain surgery" (like, perhaps, "rocket science") is a neat expression for something that is about as challenging as humans can imagine. That is, until you are about to HAVE brain surgery, and then you start to find importance in subtle distinctions -- like "as far as brain surgery goes, it's relatively simple," which i found comforting until the anesthsiologist today suggested that maybe i was being a bit TOO casual about upcoming events, and that I had to cut myself some slack -- that this was "brain surgery, afterall..."
Hell, even the Incas did brain surgery.
Many times when people have big dangerous operations, it's all part of a larger emergency - a stroke or heart attack or accident or whatever; where something happens and you're rushed to the hospital and the next thing you know you've got an IV in your arm and you're in the O.R. You might not even be conscious. By the time you wake up you're just glad the doctors got to you in time. Then there are those other medical moments, when it's an emergency of sorts, but its scheduled. Maybe a tumor or, in my case, an AVM. In these moments you've got LOTS of time to ponder the implications. I imagine it sort of like being on death row. It's not optional. It looms out there in the near future, hard to think about, hard to envision. Best ignored. But it hits you in waves... of panic or fear or loss... sadness often. Then you buck up and it goes away for awhile. It's inevitable. There's a general sense of fear of discomfort or pain. On death row, like in my case, you know there will be pain/discomfort, but regardless, it will be short lived and then, as soon as you're there, you're through it. I felt that way as the nurse outlined the various I.Vs and catheters and stuff that were going into me and when. Some when I was awake, more when i was asleep. I urged her to move as many to the unconscious part of my morning and she agreed.
Anyway, this evening feels full of ritual: the paying of bills, the finding of family documents, the returning of some emails, the packing and the body prep... the shaving of my head, for instance. Less for medical practicality and more for mental preparation and transition. (I thought at first it would keep me from looking lopsided as they shaved whatever they needed to for cutting me - but i have to admit it was ultimately just part of my process - like the face paint of a warrior or the laying out of a uniform.) My uniform and tools (baggy shorts, sweat shirt, some WIRED magazines, a stack of Netflix movies, and a fully charged laptop) is ready to go, although i won't need much until Thursday some time. I'm told Wednesday is going to be an utter haze and as with crossing the International Date Line west to China, you just accept that you're going to lose a day and probably never really get it back.
I'm going to go be somber, find some warm socks, and i'll see ya'll on the other side.
Tuesday, March 25, 2008
this is how I feel....
it is really kinda sad.... but oh well.
my Dad has been goan for less than 48 hours and my wife is a super bitch.
son of a bitch!
here have some amazon...
and have a video...
oh la la!!!!
that reminds me of a friend i have....