What Is the Difference Between Ischemic Stroke and Hemorrhagic Stroke?

A stroke is a bleeding or clotting event that interferes with blood flow to the brain. An ischemic stroke is when blood vessels to the brain become clogged. A hemorrhagic stroke is when bleeding interferes with the brain's ability to function.

A stroke is a medical condition where there is an interruption in blood flow to the brain. Without the oxygen and nutrients carried by blood cells, the brain starts dying within a few minutes. That can lead to issues like brain damage, disability, or death.

There are two primary types of strokes: a hemorrhagic stroke and an ischemic stroke. You should contact emergency services right away if you suspect that you or someone else is having a stroke. Early treatment can save a life and raise the chances of recovering successfully from the stroke event. 

What is an ischemic stroke?

Ischemic strokes happen when the blood vessels responsible for carrying blood to the brain become clogged, which leads to the death of brain tissue. There are two different types of ischemic strokes: 

• Thrombotic Strokes — Thrombotic strokes occur when a blood clot forms in blood vessels in the brain. 
• Embolic Strokes — Embolic strokes happen because of built-up plaque debris or blood clots in other parts of the body. They can travel through your bloodstream and make their way into one of the blood vessels feeding your brain. 

What is a hemorrhagic stroke?

A hemorrhagic stroke is caused by bleeding that interferes with the brain’s ability to function. The bleeding can happen within the brain or in the area between the brain and skull. This is the cause of about 20% of all strokes. Hemorrhagic strokes are placed in two categories based on where the bleeding occurs and its cause:

• Intracerebral hemorrhage — Intracerebral hemorrhages are caused by a broken blood vessel located in the brain. 
• Subarachnoid hemorrhage — Subarachnoid hemorrhages occur when a blood vessel gets damaged, leading to blood accumulating on the brain’s surface. 

The symptoms of strokes can vary depending on the type and cause of the stroke. 

Symptoms of an ischemic stroke

Both forms of an ischemic stroke can come on without any warning. You can also experience a brief episode of stroke-like symptoms called a transient ischemic attack (TIA) beforehand. 

The symptoms you might experience from a thrombotic stroke can be different depending on the affected brain area. They include:

• Headache
• Sudden onset of numbness in the body
• Paralysis or weakness on one side of your body
• Loss of vision or other visual disturbances
• Staggering or veering when walking
• Dizziness
• Confusion
• Slurring of speech or not being able to talk
• Problems moving your arms and hands as intended

Signs that you may be having an embolic form of an ischemic stroke include {Tampa General Hospital: “Embolic Stroke Symptoms.”}: 

• Numbness
• Weakness
• Vomiting
• Nausea
• Dizziness
• Confusion
• Paralysis on one side of the body  

Symptoms of a hemorrhagic stroke

An intracerebral hemorrhage usually happens when you are awake. The symptoms typically come on without any warning. They can also develop gradually, getting worse over a period of between 30 and 90 minutes. Signs that you might be having an intracerebral hemorrhage include: 

• Feeling suddenly weak
• Not being able to speak
• Vomiting
• Problems walking
• Irregular breathing
• Losing the ability to control your eye movement
• Paralysis or numbness in your body
• Coma

A subarachnoid hemorrhage can cause symptoms like:

• A sudden, severe headache
• Nausea
• Vomiting
• Loss of consciousness
• Inability to tolerate bright light
• Stiffness in your neck
• Confusion
• Dizziness
• Seizure
• Losing consciousness  

Hemorrhagic strokes occur when the brain loses access to its vital blood supply because of bleeding from a blood vessel. On the other hand, ischemic strokes happen when there is a blockage in one of the blood vessels feeding the brain.

Risk factors that can increase your chances of having a hemorrhagic or ischemic stroke include: 

• High blood pressure
• High cholesterol
• Heart disease
• Diabetes
• Advancing age
• Alcohol and drug abuse
• Poor diet choices

If your doctor suspects that you have had a stroke, they will start by asking about your medical history. They will likely perform a physical exam that includes a neurological check and a heart exam. 

They may also perform a computerized tomography (CT) scan or other brain imaging to help the doctor diagnose and categorize your stroke. With an ischemic stroke, the first thing your doctor will likely do is perform a CT scan to look for any bleeding. 

If they decide that the cause is a hemorrhagic stroke, they will likely assess how well your blood clots and if any blood-thinning medications you take may have contributed. Other tests the physician may perform include: 

• Electrocardiogram (EKG)
• Chest X-ray
• Blood tests to check for bacteria 

If the results show that one of your carotid arteries might be too narrow, they may ask for other tests, like: 

• CT angiogram
• Magnetic resonance angiogram (MRA)
• Carotid angiogram
• Carotid ultrasound

Your treatment plan will depend on whether you had a hemorrhagic stroke vs. ischemic stroke and the extent of any complications. Your doctors’ initial focus will be on triaging the stroke while it’s occurring. 

If you had a hemorrhagic stroke, they would prioritize stopping the bleeding in your brain through surgery. If you had an ischemic stroke, doctors would focus on removing the clot through medication or surgery. 

If you undergo surgery, your doctor may recommend you attend rehabilitation to regain functionality in the parts of your body affected by the stroke.

Lifestyle changes that your doctor might recommend to prevent another stroke from happening can include:

• Switching to a healthier diet
• Losing weight
• Decreasing your high blood pressure
• Managing cholesterol levels and blood glucose
• Stopping smoking
• Becoming more physically active