What is a hemorrhagic stroke?

A hemorrhagic stroke is a serious medical emergency and should be treated immediately. While survival rates are low, there are ways to improve your chances.
A hemorrhagic stroke is a serious medical emergency and should be treated immediately. While survival rates are low, there are ways to improve your chances.

A hemorrhagic stroke is when bleeding unexpectedly and abruptly interferes with the brain’s ability to function. This bleeding can occur within the brain or between the brain and the skull. 

Surviving a hemorrhagic stroke depends on the severity of the stroke and how fast the person is able to get treatment. Unfortunately, the majority of people who have a stroke die within a couple of days. About a quarter of survivors are able to live longer than five years, but the recovery process is long and slow. 

On the other hand, a minority of people who are able to recover can return to complete or near-complete functioning within 30 days of the stroke.

Symptoms of a hemorrhagic stroke

A hemorrhagic stroke that occurs inside your brain is also called an intracerebral hemorrhage. Symptoms of this stroke can vary from person to person. They are almost always present directly after the stroke occurs. The most common immediate symptoms are the person’s face drooping to one side or going numb, an inability to move one or both of their arms, and slurred or unintelligible speech.

Other symptoms may include:

A stroke is a medical emergency. Call an ambulance or have someone drive you to the hospital if you think you’re having a stroke.

SLIDESHOW

What Happens After a Stroke? Signs, Symptoms, Types See Slideshow

Types of hemorrhagic stroke

Hemorrhagic strokes account for about 20% of all strokes and are divided into these two categories: 

Intracerebral hemorrhage 

This type of hemorrhage occurs when a blood vessel within the brain breaks and causes internal bleeding. The most common cause of intracerebral hemorrhage is high blood pressure.

Other types of stroke that don’t initially begin with hemorrhage, like thrombotic and embolic strokes, can lead to intracerebral hemorrhage. A thrombotic stroke is when an artery in the brain is blocked by a blood clot. Embolic strokes are often related to endocarditis, a heart valve infection (endocarditis). In an embolic stroke, an infected clump of bacteria floats from the heart through a process called a pulmonary embolism. It can then travel up to the brain, where it can spread the infection through the artery.
 

Subarachnoid hemorrhage 

This type of hemorrhage causes blood to gather at the surface of the brain. When a vessel breaks, blood fills a portion of the space between the brain and the skull. As the blood flows into the cerebral spinal fluid, it puts pressure on the brain. This produces an immediate headache. After a few days, the clotted blood around the brain can cause brain arteries to spasm. These artery spasms can damage brain tissue.

Causes of hemorrhagic stroke

There are two ways a blood vessel can rupture in the brain. The most common cause is an aneurysm. An aneurysm is an abnormal swelling of the blood vessel walls, often caused by high blood pressure or hypertension. The aneurysm will inflate like a balloon and pop. 

In rare cases, intracerebral hemorrhage may happen due to the abnormally large and weak blood vessels that a person is born with. This is known as arteriovenous malformation (AVM). AVM are larger than capillaries. They allow blood to flow in at a relatively high pressure, which can eventually cause the AVM to stretch or leak.

Diagnosis for hemorrhagic stroke

In order for your doctor to diagnose a hemorrhagic stroke, they will want to know your medical history. They will also need to identify which potential risk factors in your life could potentially cause a stroke. Your doctor will take your blood pressure and perform a physical exam. They will likely call for a neurological exam using a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan and a heart exam.

If these tests show that you are having a stroke, you will undergo further tests in order to distinguish the exact cause. Those tests may include:

QUESTION

What is a stroke? See Answer

Treatments for hemorrhagic stroke

Emergency care treatment

If you are experiencing any hemorrhagic symptoms, seek immediate emergency care. It is crucial to get treated as soon as possible. Rapid treatment can significantly affect the outcome of surviving a stroke.

Medicines can be used to help reduce hypertension and slow the bleeding. If you experience a hemorrhagic stroke while on blood thinners, you’re at particular risk for excessive bleeding. You will likely be given drugs to counteract the effect of the blood thinners while receiving emergency treatment.

Surgical treatment

Once a hemorrhagic stroke is under control, additional medical measures can be taken if needed. If the rupture is small and there’s only limited bleeding and pressure, supportive care may be the only other form of care you need. These include intravenous (IV) fluids and getting rest. If the stroke is more serious or the bleeding doesn’t stop, additional surgery may be needed. Surgery may also be required to relieve the pressure caused by the brain swelling.

Post-emergency treatment

Recovery after a hemorrhagic stroke will depend on the severity of the stroke, the amount of tissue damage, and how soon you are able to get treatment. For those who do survive, the recovery period is long, usually lasting for months or even years. If the stroke is small and there are no major complications during a hospital stay, however, most people are able to resume a normally functioning life within a couple of weeks. 

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Medically Reviewed on 1/20/2021
References
American Stroke Association: “Stroke Symptoms.”

American Stroke Association: “Stroke Treatment.”

American Stroke Association: “Why Getting Quick Stroke Treatment Is Important.”

Harvard Health Publishing: “Hemorrhagic Stroke.”

Medical archives (Sarajevo, Bosnia and Herzegovina): “Risk factors impact on the long-term survival after hemorrhagic stroke.”