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What Causes Right-sided Body Weakness, Slurred Speech And Fluctuating BP Post An Injury?
Question: I have a 64 year old male family member who had a hemorrhagic stroke, passed out hit head on steering wheel. no history of blood pressure meds or problems. on IV catapres and IV cardine. he has right side weakness, slurred speech. had several cat scans of heart and brain shows no further bleeding. yet his blood pressure fluctuates a lot , and he is very drowsy, but responds to commands, then drifts back to sleep. his blood pressure keeps him in the ICU unit. what is your opinion?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
There are several types of hemorrhagic stroke, I will assume that it is a hemorrhage in the brain matter due to high blood pressure (as opposed to hemorrhage in the layers of the brain or due to some vessel malformation which would need urgent surgery).
In this case I am afraid that there is not a specific treatment. In some selected cases where the hemorrhage is very close to the surface surgery is at times attempted in the first 48 hours but its benefit is not proven. Otherwise treatment is only supportive waiting for the blood to be absorbed and for the unaffected tissue to slowly compensate the function of the damaged brain. By supportive I mean controlling blood pressure keeping systolic blood around 140 mmHg and avoiding complications which are related to immobilizations such as respiratory infections, bed sores etc which are at times just as life threatening as the hemorrhage itself.
Usually improvement is slow. The hemorrhage itself takes weeks to be absorbed slowly and in the first few weeks there is also swelling around it which increases its mass effect and compression to the unaffected tissue, that is why he is still somnolent. Of course the bigger the size the slower the recovery times. If you can upload some medical or Cat scan reports I would gladly review them.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
There are several types of hemorrhagic stroke, I will assume that it is a hemorrhage in the brain matter due to high blood pressure (as opposed to hemorrhage in the layers of the brain or due to some vessel malformation which would need urgent surgery).
In this case I am afraid that there is not a specific treatment. In some selected cases where the hemorrhage is very close to the surface surgery is at times attempted in the first 48 hours but its benefit is not proven. Otherwise treatment is only supportive waiting for the blood to be absorbed and for the unaffected tissue to slowly compensate the function of the damaged brain. By supportive I mean controlling blood pressure keeping systolic blood around 140 mmHg and avoiding complications which are related to immobilizations such as respiratory infections, bed sores etc which are at times just as life threatening as the hemorrhage itself.
Usually improvement is slow. The hemorrhage itself takes weeks to be absorbed slowly and in the first few weeks there is also swelling around it which increases its mass effect and compression to the unaffected tissue, that is why he is still somnolent. Of course the bigger the size the slower the recovery times. If you can upload some medical or Cat scan reports I would gladly review them.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
so while, the bleeding is being absorbed, does it keep the blood pressure fluctuating? thou he is at rest.
Brief Answer:
Read below.
Detailed Answer:
Blood pressure is usually unstable in the first week after the event even though at rest. It is not merely a question of blood being absorbed, there are several factors at play such as increased activity of the sympathetic nervous system which is activated in situations of stress, damage to brain centers regulating blood pressure, increased intracranial pressure, pre-existing unrecognized high blood pressure etc. As you see there are several hypotheses, it usually is a combination of them all.
The fact is that in the early days after a cerebral hemorrhage blood pressure is difficult to stabilize, usually much higher then values before stroke. This phenomenon is more pronounced in the early days and gradually it starts to settle in most cases.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Blood pressure is usually unstable in the first week after the event even though at rest. It is not merely a question of blood being absorbed, there are several factors at play such as increased activity of the sympathetic nervous system which is activated in situations of stress, damage to brain centers regulating blood pressure, increased intracranial pressure, pre-existing unrecognized high blood pressure etc. As you see there are several hypotheses, it usually is a combination of them all.
The fact is that in the early days after a cerebral hemorrhage blood pressure is difficult to stabilize, usually much higher then values before stroke. This phenomenon is more pronounced in the early days and gradually it starts to settle in most cases.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much that is exactly what I need to know.
Brief Answer:
Thank you!
Detailed Answer:
You're welcome. I hope he gets better soon.
Thank you!
Detailed Answer:
You're welcome. I hope he gets better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Taka, my family found out on yesterday that he is still bleeding on brain. he has become unresponsive. b/p still elevating on and off and found out that he had evident of having a stroke before in past that family was not aware of. we are in the process of having him moved to another facility. what are his chances of recovery. What can be done about stopping bleed.
Brief Answer:
Read below.
Detailed Answer:
When the cause of the bleeding is hypertension I am afraid the only thing which can be done to stop it is blood pressure control. As I said before it should be kept around 140 mmHg (shouldn't be lowered too much either as it may lead to damage to the compressed tissue around the bleed).
There are no other measures apart from that I am afraid, no matter the facility. Only when the cause of the bleed is not simply hypertension but a vessel malformation may surgery be needed to stop it. I am assuming he has had imaging to exclude that. Also I am assuming that his coagulation tests have come back normal, if there are coagulation abnormalities they should of course be corrected. Otherwise it is a matter only of blood pressure control.
As for the chances of recovery, it is hard to say, I do not know the size of the hemorrhage, whether there is blood in the ventricles, the level of conscience in the Glasgow coma scale, other accompanying conditions etc. They are all factors which must be taken into account so it is hard to say without any report.
Read below.
Detailed Answer:
When the cause of the bleeding is hypertension I am afraid the only thing which can be done to stop it is blood pressure control. As I said before it should be kept around 140 mmHg (shouldn't be lowered too much either as it may lead to damage to the compressed tissue around the bleed).
There are no other measures apart from that I am afraid, no matter the facility. Only when the cause of the bleed is not simply hypertension but a vessel malformation may surgery be needed to stop it. I am assuming he has had imaging to exclude that. Also I am assuming that his coagulation tests have come back normal, if there are coagulation abnormalities they should of course be corrected. Otherwise it is a matter only of blood pressure control.
As for the chances of recovery, it is hard to say, I do not know the size of the hemorrhage, whether there is blood in the ventricles, the level of conscience in the Glasgow coma scale, other accompanying conditions etc. They are all factors which must be taken into account so it is hard to say without any report.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. you have been great .your answers helps me to help my family. questions we now know to ask and check on .
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your kind words, I know these are difficult moments for you and I appreciate you taking the time to write them.
Thank you!
Detailed Answer:
Thank you for your kind words, I know these are difficult moments for you and I appreciate you taking the time to write them.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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