Recovery from Hemorrhagic Stroke: What to Expect

Minor stroke with cerebral hemorrhage?

Hello, doctor.
My father was diagnosed with a hemorrhagic stroke due to hypertension on October 9th of this year.
The blood clot is 25cc, and the doctor mentioned waiting for the clot to be reabsorbed, which should take about three months.
Currently, my father is experiencing numbness on the left side of his body and blurred vision, but he is able to take care of himself and his speech is normal.
I would like to know if the symptoms will gradually improve after the blood clot is reabsorbed.
During this waiting period, is it appropriate for him to undergo traditional Chinese medicine rehabilitation? If so, is acupuncture suitable? Thank you.
🥹

Xiao Hao, 20~29 year old female. Ask Date: 2022/10/24

Dr. Jiang Junyi reply Neurology

Dear Mr.
Hsiao,
You mentioned that "currently, the left side is numb, vision is blurred, I can take care of myself, and my speech is normal.
I would like to ask if the symptoms will gradually improve after the blood clot is absorbed?" The possible site of bleeding is in the thalamus, which can easily lead to sensory abnormalities.
As the blood clot is absorbed, the symptoms should gradually improve.
I am not sure if your father has metabolic syndrome (such as abdominal obesity, hypertension, elevated fasting blood glucose, and high lipid levels); if he does, he would be at high risk for another stroke.
It typically takes five years of complete smoking cessation for the stroke risk to return to that of the general population.
In terms of rehabilitation, I often use the following three methods to assist in recovery:
1.
Traditional Chinese Medicine employs "acupuncture" and "herbal medicine" to treat post-stroke sequelae.
Acupuncture stimulates acupuncture points in the body, promoting nerve repair and improving physical function, while herbal medicine is tailored to the individual's constitution.
2.
Hyperbaric oxygen therapy for stroke can effectively increase the partial pressure of oxygen in brain tissue, thereby improving tissue hypoxia and enhancing oxygen levels in the ischemic penumbra, gradually restoring brain function and preventing permanent nerve damage in the ischemic area.
3.
Repetitive Transcranial Magnetic Stimulation (rTMS) involves a treatment regimen that includes inhibitory stimulation of the healthy side of the brain and facilitatory stimulation of the affected side.
After a stroke, cells on one side of the brain die, leading to relative overactivity of the opposite side, which can hinder recovery of the affected side.
Although some nerve cells in the damaged area may have died, surrounding viable tissue may compensate for the lost functions due to neural plasticity.
Magnetic pulses generated by an induction coil penetrate the cerebral cortex, stimulating brain neurons to produce either "facilitation" or "inhibition." Current research indicates that this can improve post-stroke sequelae, with greater efficacy observed the earlier the treatment is initiated due to higher neural plasticity.
Cell death caused by a stroke is irreversible, and active rehabilitation is necessary to connect surviving brain cells.
The rehabilitation effect is most significant in the first month, with limited improvement after three months; this is known as the golden period for rehabilitation.
Family members are typically encouraged to invest more effort during this time.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Chih-Yi Chiang, Taoyuan Medical Center

Reply Date: 2022/10/24

More Info

Understanding recovery from a hemorrhagic stroke, particularly after a diagnosis of hypertension-related intracerebral hemorrhage, involves a multifaceted approach. Your father's situation, with a 25cc blood clot, is not uncommon, and the expectation of the clot's absorption over approximately three months is a standard medical observation. However, the recovery process can vary significantly from person to person, influenced by factors such as the location and size of the hemorrhage, the individual's overall health, and the presence of any pre-existing conditions.

Recovery Expectations
1. Symptoms Improvement: As the blood clot gradually absorbs, many patients experience a reduction in symptoms. The left-sided numbness and blurred vision your father is experiencing may improve as the brain heals. However, it is essential to understand that recovery can be gradual and may not be linear. Some patients notice improvements in their symptoms over weeks or months, while others may experience fluctuations in their condition.

2. Physical and Cognitive Rehabilitation: Engaging in rehabilitation therapies is crucial. Physical therapy can help improve mobility and strength, while occupational therapy can assist in regaining daily living skills. Speech therapy may also be beneficial if there are any communication difficulties. The brain is remarkably adaptable, and rehabilitation can facilitate recovery by encouraging neuroplasticity, where the brain forms new connections.

3. Monitoring and Follow-Up: Regular follow-ups with healthcare providers are essential to monitor recovery progress and adjust treatment plans as necessary. Imaging studies may be repeated to assess the status of the blood clot and any changes in the brain.

Complementary Therapies
Regarding your question about traditional Chinese medicine (TCM) and acupuncture during the recovery phase, many patients explore these options as complementary therapies. Here are some considerations:
1. Acupuncture: Some studies suggest that acupuncture may help alleviate certain symptoms post-stroke, such as pain and spasticity. It may also promote relaxation and improve overall well-being. However, it is crucial to consult with your father's healthcare team before starting any new treatment, including acupuncture, to ensure it is safe and appropriate for his specific condition.

2. Holistic Approach: TCM often emphasizes a holistic approach to health, focusing on balancing the body's energies. If your father is interested in TCM, it may be beneficial to seek practitioners who have experience working with stroke patients and can tailor treatments to his needs.

3. Integration with Conventional Care: It is essential to integrate any complementary therapies with conventional medical care. This means keeping all healthcare providers informed about any treatments being pursued, including acupuncture or herbal remedies, to avoid potential interactions or complications.

Lifestyle Modifications
In addition to rehabilitation and complementary therapies, lifestyle modifications can play a significant role in recovery:
- Diet: A heart-healthy diet low in sodium and rich in fruits, vegetables, whole grains, and lean proteins can help manage blood pressure and support overall health.

- Exercise: As your father's condition improves, incorporating light exercise, as recommended by his healthcare provider, can enhance recovery and prevent further complications.

- Stress Management: Techniques such as mindfulness, meditation, or gentle yoga can help manage stress, which is beneficial for overall recovery.

Conclusion
In summary, while the absorption of the blood clot is a positive step towards recovery, the timeline and extent of symptom improvement can vary. Engaging in rehabilitation, considering complementary therapies like acupuncture with professional guidance, and making healthy lifestyle choices can all contribute to a more favorable recovery outcome. Always maintain open communication with your father's healthcare team to ensure a coordinated approach to his recovery.

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